MicroBirth?

Attractive red-haired scientist looking through a microscope

Homebirth and natural childbirth advocates keep throwing memes against the wall, hoping one will stick.

Obstetricians don’t follow scientific evidence! Except that they do.

The media is to blame for the pain of childbirth! Except that it isn’t.

Homebirth is a human right! Except that it’s not.

A healthy baby isn’t enough! Except that for most women, it is.

My personal favorites, though, are the pitiful attempts by homebirth and natural childbirth advocates to harness to their cause scientific disciplines about which they clearly are ignorant. Their invocation of quantum mechanics and chaos theory aren’t merely pitiful, they are hilarious.

Now they’re about to throw a new meme against the wall: MicroBirth.

That’s the breathless announcement from One World Birth, the same clowns who nominated Lisa Barrett, a one woman birth-crime wave, as a “National Birth Hero.”

What is MicroBirth?

Over the past three years we have been on a journey, trying to connect the pieces of the jigsaw puzzle that is birth…

The more we discovered, the more convinced we were that there was a vital piece missing from the picture.

A piece that connected everything…

The reason it has proved to be so elusive for so long is because it is not visible to the naked eye.

It is microscopic.

What does that mean?

It is supposedly:

… brand new science investigating crucial microscopic events that occur during and immediately after birth.

And, more importantly, what happens when the natural processes of childbirth are interfered with or bypassed completely…

[I]ncreased medicalization of childbirth may be having severe consequences on the life-long health of our children.

What’s more, it could be having a devastating effect on the future of our entire species.

Holy hyperbole, Batman! What could it be?

They don’t say, but I have a guess. I’m going to guess that it’s another pitiful attempt to harness cutting edge scientific disciplines about which they are painfully ignorant, in this case epigenetics and the microbiome.

For those who have no idea about the science of the microbiome and the science of epigenetics, such an effort makes perfect sense:

Natural childbirth and homebirth advocates have a massive problem. The scientific evidence does not support their claims. Natural childbirth isn’t safer and hombirth isn’t safe at all. You might think that would cause them to re-evaluate their core beliefs, but you’d be wrong. Natural childbirth and homebirth are cults, and their core beliefs are non-falsifiable. Therefore, they must abandon their original claims that natural childbirth and homebirth are visibly safer. No problem! Natural childbirth and homebirth are safer on the microscopic scale!

We’ve already seen a preview of this approach. In January 2012, a group of midwives convened a panel on Epigenetic Influence and Impact on Childbirth.

Hannah Dahlen, an Australian midwife, says it could increase respect and demand for vaginal birth. “We’re at the beginning of a very exciting time,” Dahlen says. “I think in 10 years we will potentially look back at what we are doing now and think, ‘What on earth did we do?’” …

They were all frustrated “that despite the research, political activism and efforts they and many others were putting in to increase the rate of normal birth, intervention during childbirth kept rising and arguments about safety and outcomes all had a short term focus,” she wrote in an email.

How frustrating that obstetricians and mothers are focusing on the such short term outcomes as whether the baby lives or dies, is born intact or has suffered a brain injury. Sure, childbirth interventions like C-section make childbirth safer on the macro level (duh!), but at the level of DNA, interventions cause severe consequences on the life-long health of our children (only the ones who survive childbirth, of course) and OUR ENTIRE SPECIES!!!

And not only that, but childbirth interventions might change to microbiome of the gut cause severe consequences on the life-long health of our children (only the ones who survive childbirth, of course) and OUR ENTIRE SPECIES!!!

There’s just one teensy, weensy problem. THERE IS NO EVIDENCE TO SUPPORT THOSE CLAIMS.

Epigenetic changes, the chemical modifications of DNA that are the result of environmental influences, are the results of long term events lasting months or years, like famines. There’s not a shred of evidence that ultrashort term events like childbirth cause ANY changes to DNA, let alone deleterious changes.

Similarly, there is not a shred of evidence that altering the microbiome of the gut of the newborn (if indeed such alterations occur) has any long term impact on health.

But wait! Childbirth interventions and C-section rates have been rising steadily and look at the long term impact on health! Since the advent of modern obstetric interventions …. we live longer and healthier lives than ever. Oops!

I predict that this meme isn’t going to stick, either. First of all, “More babies die at homebirth, but the ones who live have better genes!” and “More babies die at homebirth, but the ones who live have better gut bacteria!” are not like to be an effective rallying cries. Second, the central premise, that obstetric interventions are safer on the macro level but cause long term microscopic health problems is obviously nothing more than nonsense.

Natural childbirth and homebirth advocates are (once again) making themselves look like fools, while failing to advance their cause in any meaningful way. They are simply flailing around trying desperately to justify a failed philosophy that has put, and continues to put, the lives of babies at risk.

  • Guest

    “Similarly, there is not a shred of evidence that altering the microbiome of the gut of the newborn (if indeed such alterations occur) has any long term impact on health.”

    The above statement is simply no longer true.

    http://www.ncbi.nlm.nih.gov/m/pubmed/26994839
    http://www.ncbi.nlm.nih.gov/m/pubmed/27001445
    http://www.ncbi.nlm.nih.gov/m/pubmed/26980815
    http://www.ncbi.nlm.nih.gov/m/pubmed/26839074
    (And many, many more.)

    I would also encourage you to peruse Pubmed for articles discussing the newfound influence of the microbiome on our epigenetics.

    I am certain that most conventional doctors have the patient’s best interest at heart, but I don’t believe they necessarily have the desire, ability, or clinical experience to fully understand the ‘big picture’ of health. If I choose to have a home birth for my next child, it will be based on my own thorough understanding of the potential short and long term risks associated with each scenario.

    • Amy Tuteur, MD

      Please show us what a normal infant gut microbiome looks like.

  • Brittany Alana

    I especially love how you say, “natural childbirth isn’t safer”… I guess we’re the only species with a defective weak uterus, vagina, and so on. I guess they are just there for looks. Guess procreating, laboring, & delivering wasnt at all what my body was designed for… how ever did humans become the dominate species of the world?! Especially, before idiot greedy doctors like you came along?! Yes, because we were all meant to be pumped full of drugs. We’re just meant to be cut open & have major abdominal surgeries!!! …Do yourself a favor, next time you actually want to be taken seriously, don’t say stupid shit like that. -_-

    • Amazed

      Sweetheart, do the world a favour and push your head into your so strong and non-defective vagina. Don’t take it out. You aren’t designed for belonging in the real world but the Yoniland.

    • SporkParade

      You know, there’s a reason that the veterinary memoir “All Creatures Great and Small” starts out with a birth scene. By the way, thanks for proving that natural childbirth is really just eugenics for lazy people. I guess the millions of women and babies who died during childbirth throughout history are just acceptable losses to you.

    • moto_librarian

      Spoken like a true member of the “dominate” species.

    • LibrarianSarah
    • Daleth

      Childbirth without medical interventions (i.e. natural childbirth) isn’t safer than childbirth with medical interventions. That doesn’t mean you are, or women in general are, defective. It just means that you aren’t increasing your and your baby’s safety by having a home birth or refusing all interventions.

    • Azuran

      Because Natural childbirth simply isn’t better. And no, we are not the only specie with a ‘defective weak uterus’
      Birth is a very dangerous moment in the life of every single living animals, wild or domestic. No specie is perfect at birth and no specie has a ‘perfect’ vagina and uterus. Complications of birth in nature in animals are very common, you just don’t see them happening because those animals either die quickly or are killed off before they can recover.
      C-sections are a very common procedure on dogs, cats and cows. I’ve operated on a cat with a uterine rupture, two other with retained dead babies with terrible uterus infection. Multiple cases of eclampsia, puppies stuck in birth canals, uterine inertia, massive blood loss and the likes.
      Birds will often have retained eggs or egg yolk coelimitis.
      Prematurity and dysmaturity are very common problems in horses.

      Thinking that ‘natural’ is safest at pretty much anything shows how little you actually know about nature. There is a very obvious reason animals in zoo will usually live 2-3 times longer than it nature. ‘Natural’ life is extremely hard and dangerous in every single aspect.

    • Sarah

      You’re right, procreating et al aren’t what your body was designed for. Your body wasn’t designed for anything, it evolved. There’s a great big difference between the two.

    • Nick Sanders

      I guess we’re the only species with a defective weak uterus, vagina, and so on.

      More or less:
      http://www.americanscientist.org/issues/pub/why-is-human-childbirth-so-painful

  • Brittany Alana

    Homebirth isn’t a human right?! Why, because it’s less money in your pocket? Sorry but not all of us are brain washed sheep looking to feed your pockets. Long before hospitals became a thing women gave birth at home with midwives. Last I checked, this is supposed to be a free country, and current midwives for through years of training & becoming certified just like doctors do. It is a human very much so a right. My body, my baby, my money, my right!!! Pregnancy isn’t an illness. Not all women need a surgeon (Obgyn) & a sick-infected hospital to give birth in. Especially since a low-risk healthy pregnancy gets ruins by interventions & greed! This entire article altogether made you sound like an ignorant ass. Good job! smh!

    Am I against doctors & cesareans? No. When they are not overused & abused, such things are great for high-risk pregnancies & saving lives. But to say it isn’t a human right to choose how we birth is bullshit!

  • Dorito Reiss

    I would never in a million years let you near my vagina or my babies. You aren’t skeptical, you’re stupid. Doctors like you harm and kill mothers and babies.

    • sabelmouse

      me neither.

    • Daleth

      Dorito, do you have any examples of things Dr. Tuteur has said that led you to that conclusion? Or is it just a scared/defensive reaction to reading things that challenge your beliefs?

    • Nick Sanders

      How so?

    • Amy Tuteur, MD

      What make you think I would take you on as a patient?

      Why would I want to waste my time with an fool who thinks she knows more than I do just because she read some crap on the internet?

      • Proponent

        Don’t forget to add in..

        Cowardly hiding behind an ‘imposter’ user account.

        There seems to be a great disturbance in the troll universe as of late.. they’re coming out of the woodwork. And.. with even more inane and asinine nonsense.. if.. that’s possible.

  • Kim

    When you state that there is no evidence that the event of childbirth has an impact on the Microbiome, you discredit everything else you could possibly say. Apparanyly you haven’t paid attention to two decades of research. And thus, I can only assume you are equally uniformed for other relevant scientific and medical advancements in your field that have occurred in the past two decades. This would concern me if I were your patient.

    • Taysha

      References, please? As you are so well informed, I’m sure you have them handy. Peer review only, please.

  • Iwouldrathereatmyeyeballs

    Amy, are you ACTUALLY a doctor? How terrifying. You do realise that women’s “perceptions” are actually women’s experiences, right? Whether you think it’s right or not…. right? Right? Please tell me this blog is a joke? 1/3 of ACOG guidelines aren’t evidence based. Have you read THAT paper? Congratulations on spouting ignorance, I hope you’re deeply, deeply ashamed.

    • Hold up. One third of the American Congress of Obstetricians and Gynecologists guidelines aren’t evidence based?

      What paper?

      • araikwao

        It’s been written about here before. It’s a bit misleading.

    • birthbuddy

      And MANA doesn’t have any guidelines.
      Your point?

  • Matt

    What do you guys think about this ACOG position paper? It is from 2011, but reaffirmed last year.

    http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Planned-Home-Birth

    • Bombshellrisa

      It says in the first paragraph what has been mentioned in comments to you for the past few days: women have the right to birth at home, should be informed of the risks of setting and birth attendant when OOH and the absolute risk is low for women who are low risk. The numbers talked about reaffirms the statement that the stats your midwife has are terrible.

      • Matt

        I’m confused. Dr. Tuteur said no such right exists.. it’s right there in the beginning of this post:

        “Homebirth is a human right! Except that it’s not.”

        … and from the post that she linked to…

        “…there is no legal or ethical right to have a homebirth”

        http://www.skepticalob.com/2012/09/human-rights-in-childbirth-does-the-baby-have-any.html

        • Amy Tuteur, MD

          You are getting confused between positive rights and negative rights. There is no positive right to have a homebirth. There is a negative right to be left alone. Therefore, no one has to provide you with the means of having a homebirth, but no one can stop you if you choose to give birth at home.

          • Matt

            OK. Now I understand the difference. Thanks for clarifying.

            Well… can you see how it might be less confusing for people coming to your blog if you were a bit more specific with your word choice?

            Speaking for myself… when I read that sentence I interpreted it to mean that you were saying that women do not have the right to choose their venue for birth.

            Do you see? That initiated an emotional reaction within me, which led to an emotional response, which led to all the fallout here over the last few days.

            I’m willing to take responsibility for my unskilled response.

            But are you and your readers willing to take any responsibility for repeatedly making me out to be a “homebirth advocate” and for dogpiling on me before you swoop in for the coup de grace?

            My head on a plate? Really? It this something that brings you satisfaction?

          • Amy Tuteur, MD

            “Let’s leave aside for the moment the fact that there is no legal or ethical right to have a homebirth; the right of autonomy allows for the refusal of hospital care (or any medical care), but it does not mandate an obligation on the part of others to provide a specific form of care.”

            I Was specific. You didn’t bother to read it.

          • Matt

            No I DID read it. I see now what you meant, but it isn’t immediately apparent that when you said NO right.. you meant SOME right. Capisce?

            In addition, I read that after I responded to THIS blog post, in which you wrote, “Homebirth is a human right! Except that it’s not.”

            When I said you should have been more specific, I was referring to THIS post, not the other post. Understand?

            Finally, you have STILL not taken any modicum of responsibility for your mischaracterization and treatment of me here, and you didn’t answer my question…

          • attitude devant

            (Well at least he spelled ‘capisce’ correctly.)

            Matt, you’re BEYOND obnoxious. Maybe YOU should have been more specific yourself. Why anyone should answer ANY of your questions or even respond to you any longer I have no earthly idea.

            And now I’ll go back to my previously scheduled programming of dealing only with people who are actually interested in engaging in dialogue.

            Don’t let the browser close on you on the way out, buddy.

          • mythsayer

            She means that it’s not a protected right such that we are obligated to provide you with a means of having a homebirth. The only people who misread it are the ones who are primed to misread it. You seem to have your heart in the right place in that you want the best for your wife and unborn child, but you also seem as though you are looking for justification that her choice to have a homebirth is safe. The reality is, and you at least should know this so you’ll transfer her ASAP if something seems like it’s going wrong, that even low risk homebirths can go bad. Please, please, please read Hurt by Homebirth just so you can see some of the things that can go wrong. Maybe you’ll learn to recognize shoulder dystocia or something else and you’ll know when she needs to transfer, even if she doesn’t.

          • Bombshellrisa

            That is if the midwife and her assistants don’t block the cars in and take his cell phone away.

          • Who?

            I’ve been an interested viewer here since this particular thing got going. You’re keen to be affirmed in the choice to have a homebirth. This is the wrong crowd for that.

            Sincerely, I hope everything goes really well, and no one gets hurt. If you persist in this choice, I’ll just have to hope three times (or maybe more) harder.

  • moto_librarian

    Matt, I am catching up from the weekend. I now realize that you and your wife are planning a home birth with a CPM. You need to understand the following things about this:
    – CPMs do not carry malpractice insurance. If your wife or child are harmed or killed as a result of negligence, you will get no financial redress from her.
    – CPMs are incapable of self-regulation. If malpractice occurs, there is little reason to believe that your midwife will be punished in any meaningful way.
    – If things go wrong and you have to transfer to the hospital, you will have to pay the midwife AND the hospital. When my son and I had complications, we racked up $50,000 in bills in three days.
    – Unless your wife has a proven pelvis (meaning, a successful previous vaginal delivery), she cannot be considered low-risk. Home births are discouraged for primips in the UK for this very reason.
    – If your wife’s pregnancy goes postdates, know that most OBs would be pushing to deliver her baby between 41 and 42 weeks, and they would suggest BPPs and NSTs to be sure that the placenta and baby are holding up. The doppler alone cannot tell you how well the baby is doing.
    – You should pre-register at the hospital in case you need to transfer. The hospital may be “five minutes away,” but without access to your wife’s records and history, you will face delays. Also know that even if you preregister, you can’t just walk in the door and have a c-section. Your wife will have to be prepped, typed and cross-matched, anesthetized, and taken into the O.R.
    – Be sure that the hospital that you pre-register at has a NICU. If it does not, be prepared for you baby to be transferred to a facility that has one.
    – Be sure that your midwife has your wife tested for GBS. If she is positive, she needs to deliver in the hospital so she can have I.V. antibiotics. This is done to prevent GBS sepsis, which can and does kill babies.
    – If your wife’s water breaks, she needs to transfer to the hospital within 24 hours. If your midiwfe encourages your wife to wait it out, or to lie about when her water broke, you are dealing with an unethical provider.
    – If there is meconium in the amniotic fluid, transfer to the hospital.
    – Make sure that your CPM can carry pitocin, and ask her about active management of the third stage.

    I would write more, but you should get the drift. I am not a medical professional, but everything that I have written above is based on the realities of home birth in the United States. I am also writing this as a mother who delivered both of my children with CNMs in a hospital. Had I not done so, I would not have survived my first birth, a totally natural vaginal delivery that resulted in a cervical laceration, massive pph, and surgical repair in the operating room. Any naivete that I had about child birth was stripped away, and I now know that even a “textbook” labor and delivery can go south in an instant.

    • Matt

      Thanks for the info!

      • mythsayer

        But are you really listening? Are you taking it seriously? I ask because everything she said is true. Home birth is fine, but too many women have lost babies to pneumonia because they were GBS+ and they didn’t know they really needed antibiotics. Or they didn’t realize their midwife didn’t have insurance. I hope your home birth goes well, but please don’t be afraid to transfer if something seems wrong.

        • Matt

          Yes. I am listening! I am taking it seriously.

          I never had the illusion that homebirth is safer… therefore I don’t need to be disillusioned about it.

          I would be interested to get more info on GBS and pneumonia. Isn’t that something that can be treated ahead of time?

          • Bombshellrisa

            Swabbing for GBS is standard during the third trimester. If GBS is found, antibiotics will be given during labor via an IV.

          • Matt

            Why not treat it beforehand, and re-swab?

          • The Bofa, Being of the Sofa

            says the guy who below is bemoaning the overuse of antibiotics…

          • Matt

            LOL- A documented bacterial infection that could threaten the life of the baby is not “overuse” in my opinion. Geez… you’re really gunning for me aren’t you?

          • Dr Kitty

            The point, Matt, is that it isn’t an infection.
            GBS, for most women, is a commensal.
            Swabs, BTW, don’t give instant results- you don’t have time to wait for cultures in labour.

          • Dr Kitty

            Or, in other words, GBS is part of their normal micro biome for many women. Therefore any course of antibiotics will only ever get rid of it temporarily.

            GBS is not a commensal of newborns, it is a pathogen.

            So you need antibiotics IN LABOUR to prevent the transmission of GBS, because it kills the bacteria in the vagina AT THE TIME OF DELIVERY.

            Swabbing and treating before labour is no good, because the GBS can come back.
            Swabbing at the onset of labour and treating based on results is no good, because by the time the results come back it is sometimes too late.
            Swabbing after delivery is also no good for the same reason.
            No one wants to wait for a symptomatic GBS infection to develop in a neonate before they treat.

            Intrapartum antibiotics based on a prior swab is the best we have.

          • Dr Kitty

            So IF your MW doesn’t offer a third trimester swab, or does and suggests ANYTHING other than intrapartum IV antibiotics if the results are positive, you are not getting gold standard care and your baby is being put at risk of GBS sepsis.

          • Matt

            Thanks for the info. If you have any readily available links for stats on that, please share. Otherwise, I will look for myself.

          • Dr Kitty

            http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5111a1.htm
            http://www.perinatology.com/protocols/GBS.htm
            http://fn.bmj.com/content/98/2/F188.extract
            http://www.ncbi.nlm.nih.gov/pubmed/23219695

            This is from the first page of Google.

            From the last study
            “The incidence of invasive early-onset GBS disease decreased by more than 80% from 1.8 cases/1000 live births in the early 1990s to 0.26 cases/1000 live births in 2010; from 1994 to 2010 we estimate that over 70,000 cases of EOGBS invasive disease were prevented in the United States.”

            Do feel free to do your own research.

          • mythsayer

            As I said above… some midwives are so crunchy, they suggest putting garlic in the vagina. I literally just can’t even imagine. If someone told me to do that, I’d be out the door before they even finished talking.

          • The Bofa, Being of the Sofa

            documented bacterial infection that could threaten the life of the baby is not “overuse” in my opinion

            Which is why they treat it. At delivery.

            If they were to treat it when it is detected, when it isn’t affecting anything, there is a chance that it could recolonize and then they’d have to treat it again at birth. So the best approach is to treat it at birth, WHEN IT IS NEEDED.

            It’s not hard to gun at you when you are so readily hanging curve balls.

          • moto_librarian

            You know what, Matt? I am done. You are far more interested in arguing about tangential issues than really learning about how to make the birth of your son safer. By hiring a CPM, you are NOT doing everything possible to make home birth as safe as it can be, and you seem to take a fairly nonchalant view to actually determining if your wife’s provider has any level of competence whatsoever. There is nothing laughable out that.

            If you are so concerned about your baby’s health, use the prompts that I have provided and start doing your due diligence. I think you are behaving like an ass, but
            I do not want to see any harm come to your wife and child.

          • Captain Obvious

            It’s a bacterial colonization in the mother, not an infection. You give antibiotics when the baby is at risk, during the delivery. Not before. There is no LOL about malpractice with GBS.

          • fiftyfifty1

            It’s not an infection. It’s a colonization. Huge difference. You are a walking case of Dunning Kruger.

          • Karen in SC

            Also, Matt, see today’s blog post October 13th. Perfect in your situation, or maybe your wife’s since you keep denying you are a homebirth advocate.

          • Bombshellrisa

            GBS naturally lives in the gut and can come back after antibiotics are given. You can test positive certain times and negative others too, so it’s most effective if antibiotics are given during labor.

          • Captain Obvious

            You obviously don’t understand the idea of colonization and infection. GBBS management has been around for decades, and for you to comment about treating a colonization and reswabbing rather than prophylaxing when the time is important proves you haven’t the faintest idea about medicine or obstretrics. Since you are ignorant about something as simple as GBBS, I worry about your convictions about the safety of your planned Homebirth with a CPM. Maybe you think it’s safe like treating GBS with antibiotics before labor and reswabbing, but in reality your baby and your wife are at risk. Please reconsider.

            A bit about GBS…
            GBS
            Affects 15-40% of pregnant woman.
            Vertical transmission when in labor or ROM, but can occur with intact membranes.
            1996 cultured based approach versus risk-factor based approach.
            However, majority of cases of early onset disease occur with no identifiable risk factors!
            Rectovaginal cultures at 35-37 weeks. Negative predictive value of cultures performed 100.4
            Delivery 18 hours
            GBS bacteriuria
            Previous infant with GBS disease
            Positive culture
            Unknown culture status
            Intrapartum NAAT positive GBS
            No need for Abx:
            Previous pregnancy +GBS
            Planned CS
            Neg culture with 18hrs or fever.
            Antibiotics:
            PCN G 5 million, 2.5 mill q 4
            Amp 2g, 1g q 4
            Allergy: D-zone testing for inducible resistance to clindamycin
            Ancef 2g, 1g q 8
            Clinda 900mg q 8 (20% resistant)
            Vanco 1g q 12 (based on weight)
            (Erythro 30% resistant)
            Why IV?
            Pregnancy has decreased gi transit time and vomiting for oral meds.
            IV meds achieve rapid high concentrations both in maternal serum for placental transfer to fetal systemic circulation and in the amniotic fluid, which is inhaled and swallowed by the fetus. Oral doses needed to accomplish this would be too high of a dose. In non-laboring women, prospective studies found oral therapy did not substantially reduce rectovaginal colonization.
            Outcomes:
            80% reduction in early-onset GBS disease and neonatal death. Late-onset GBS disease has remained stable or decreased.
            Early onset GBS disease, 0-6 days
            Pre 1993: 1.5/1000 live births
            Post 1993: 0.52/1000
            2002: 0.31/1000
            2010: 0.24/1000
            Late onset GBS disease, 7-89 days
            Stable 0.35/1000 live births
            Missed cases: 4% false neg culture.
            60% of early onset GBS occurs in these women.

          • fiftyfifty1

            “Why not treat it beforehand, and re-swab?”

            Seems like a logical strategy, but the science has been done and it doesn’t work. For a real life example of it not working, read the story of baby Wren in Hurt By Homebirth. His mom showed GBS in a urine sample at the beginning of pregnancy. This means you are heavily colonized and even though you treat the UTI with antibiotics, you must consider yourself high risk for carrying GBS at all times in the pregnancy and get abx in labor. His mom decided to follow the advice of “It’s good enough don’t worry” from their homebirth midwife and baby died of GBS sepsis.

          • mythsayer

            I read down farther, but I’ll just say here (I said it above), read Hurt by Homebirth. Those are stories of babies who have been lost or damaged by homebirth. There are a couple of stories about babies who died because of GBS infections. Wren’s mother was told to put garlic in her vagina. Yes… garlic. There’s no evidence that garlic will kill GBS.

            His father talked himself into homebirth by rationalizing that the hospital was 5 minutes away and it was “whole foods”: no better for you than regular food, but no worse, either. And that seems like your opinion. That’s not a bad one. But the reality is that after Wren died, his parents realized that if they had just gotten the antibiotics when she was in labor, that baby would have lived. And not been sick most likely. They didn’t know this until AFTER he died. So you can think you know things and then realize you’re not as educated as you thought. His dad said that it was 6 minutes from the time they saw he wasn’t breathing (and he’d been lying on his father’s chest for an hour before that, so it probably wasn’t too long that he hadn’t been breathing) to the time he was in the NICU, and he still died.

            I don’t think anyone wants to scare you, but there are a lot of things you don’t know… you didn’t know about GBS+ for instance.

            Don’t tell your wife… just read the Hurt by Homebirth blog. Dr. Amy hosts it but she didn’t write the stories… the parents wrote them. No one is saying you’re likely to have those things happen… in fact, even Dr. Amy will say you’re LIKELY to have a healthy baby… but they CAN go wrong. Just know what you’re up against. I think reading other people’s stories are the best way to learn in this case.

  • Karen in SC

    Matt, since you said you were in Michigan, maybe you should be reading and posting on this blog. Here’s a good place to start:

    http://safermidwiferyformichigan.blogspot.com/2014/06/danger-audra-post-cpm.html

    Your CPM isn’t Audra, is it? I hope not. Lots of facts about midwifery and homebirth there (especially in MI), at that blog and the website that was designed to honor Magnus Snyder, a victim of mismanaged treatment by midwives at a birth center.

    You may also like to watch the video Not Buried Twice (on Youtube) explaining what is wrong with the US homebirth industry.

    • Matt

      Thanks for the link and info. Others have also posted that link. I will check out the site. And no… it isn’t Audra.

      Believe it or not, I get what is “wrong” with the homebirth industry. It is the same things that are “wrong” with any kind of “alternative” health field… lack of standards, lack of accountability, misinformation.

      But I also get what is “wrong” with the medical industry… For example did you know that a prominent oncologist around here was recently found to have been willfully misdiagnosing people with cancer and recommending treatments to people that they didn’t need?! Can you imagine that… telling people they have cancer when they don’t?

      http://www.myfoxdetroit.com/story/26548660/cancer-doctor-who-misdiagnosed-patients-pleads-guilty

      Let me tell you… stories like this have a lot more to do with people’s mistrust of medicine than Jenny McCarthy and a few nutjobs in the hills.

      • Young CC Prof

        Yes, I did hear that outrageous story. It took longer than it should have, but he is now being punished harshly.

        Contrast that with stories of alternative health folks who lie about having a cure for cancer, or tell people they have disease they actually don’t, and are NEVER held accountable.

        Also note no one is defending this doctor except his paid lawyer. There are no petitions to free him, no colleagues complaining about his unjust persecution.

        • Matt

          Sure we can contrast them… but I don’t think it is a fair comparison.

          The alternative health folks who say and do those things did not attend medical school. They did not pass board exams. They were not issued medical licenses. They did not build multi-million dollar practices and sit on hospital boards, and earn respect from physicians and the scientific community.

          • Young CC Prof

            Look up Dr. Burzynski, and say that again.

          • Matt

            Wow! OK- so what is going wrong with our “vetting” system when this happens? Why should a health consumer trust anybody about anything health related?

            If we cannot rely on education, licensing, credentials, regulatory bodies, medical boards… why continue to throw those things around as if they carry weight?

          • Young CC Prof

            The only reason he’s still practicing is because his patients actually petitioned Congress. Congress then forced the FDA and other authorities not to move against him. It’s a long and horrible story.

            Dr Robert Biter, California, surrendered his license after multiple complaints including a homebirth death. His patients are now rallying around to help him practice without a license at a new birthing center.

          • Bombshellrisa

            Well, they still want respect. Why else would chiropractors and NDs insist on being called doctors if they didn’t think it meant something to attend school, pass boards and get medical licenses?

          • Matt

            I’m not sure I follow your comment. Are you saying chiropractors and NDs didn’t attend school, pass boards, and get licenses?

          • Bombshellrisa

            No, I am saying they want the respect of everyone for what they are and what they have “achieved”. They often tell people they have cancer when they don’t, and suggest treatments that are not proven to do anything. They use the titles and letters after their names to lend credibility to what they are saying.

          • Matt

            Who is doing this? The licensed DCs and NDs? Or the lay practitioners? Or are you saying they are all the same?

          • Bombshellrisa

            The only practitioners that I have personally witnessed giving diagnoses of cancer are licensed in the state where I live. One ND who is also a CPM who diagnosed a pregnant woman with cancer of the esophagus and a chiropractor who gave a diagnosis of colon cancer.

          • Matt

            Well wherever that occurs, I think that is very concerning. The NDs that I know about that are involved with oncology have additional training, and work in coordination with MDs. But there are licensed MDs that have done similar things, and engage in all manner of questionable practices.

          • Bombshellrisa

            These NDs have training in oncology-the university they attended has an integrative cancer treatment facility as part of its training. They are partnered with Fred Hutchison cancer research center. They prefer their woo.

          • AlisonCummins

            They are much less likely to because MDs are held to a standard of care. They are accountable. (And then you have redress if they still **** you over.)

          • AlisonCummins

            Yes, they did all that. But a professional certification in nonsense is still nonsense. It’s a problem when politicians decide for political reasons that unqualified people who invent impossible treatment modalities should be given professional status and certification because that’s what the public wants to hear. It’s a real problem.

            Sciencebasedmedicine.org is an excellent site for understanding that issue generally.

          • Matt

            Yes.. I’m familiar with that site. I was happy to see a discussion of Dr. Fata to balance out the tirades on alternative practitioners.

            (http://www.sciencebasedmedicine.org/when-conventional-doctors-betray-science-based-medicine-for-money/)

            In this post, he says, “Optimally, this standard of care should be rooted in science- and
            evidence-based medicine and act swiftly when a practitioner practices
            medicine that doesn’t meet even a minimal requirement for scientific
            studies and clinical trials to support it.”

            In my experience, there actually are NDs whose care is rooted in science- and evidence-based medicine, and who base their recommendations on scientific studies and clinical trials.

            They address questions such as:

            “Are there herbs or supplements which might help mitigate the side effects of my cancer treatment?”

            “Is there anything else that my daughter can do to help GERD besides taking the PPIs that her GI doc has her on indefinitely?”

            “Is there anything I can do with diet, lifestyle, or supplements to help get my cholesterol down so I can get off of statins?

            “I’m thinking about taking probiotics… which one should I take?”

            “Is there anything I can do about chronic pain to reduce my dependence on NSAIDS?”

            “Are there nutritional gaps in my diet that can be addressed with food and/or supplements?

            I think those practitioners have their place, and provide helpful services… assuming they practice within the scope of their training.

            Many don’t. But then again, neither do all MDs, or any other type of professional anywhere. Dishonesty and unethical behavior is endemic to humanity, and no profession is immune to it, no matter how “rigorous” the education and regulatory system is.

            The alternative for these people would be heading down to the “health store” and purchasing whatever supplements the clerk recommends for them, or that they read about on some “health guru” blog somewhere.

            But if and when these other groups seek some kind of certification, licensing, or other regulatory process… in order to establish standards and be held accountable to them… those efforts get shot down too.

            Sounds like a mess to me.

          • Young CC Prof

            The ND training does not include the scientific thought process. NDs are taught good information and bad information interchangeably and given no tools to distinguish between them.

          • Matt

            Hmmm… I don’t know if I would say they aren’t given the tools. There’s a lot of NDs that don’t use homeopathy, for example. I get the criticism.

            But at the end of the day, if I am going to try an herb or dietary supplement to help co-manage a disease, or in an attempt to avoid medication if possible, I am certainly going to consult with an ND.

            You -DO- realize that many MDs still say things like “dietary supplements aren’t regulated by the FDA” when what they really should say “dietary supplements aren’t approved by the FDA for treatment of disease.”

            How do you think THAT looks to a patient credibility-wise?

            SOURCE: http://www.fda.gov/Food/Dietarysupplements/default.htm

            “FDA regulates both finished dietary supplement products and dietary
            ingredients. FDA regulates dietary supplements under a different set of
            regulations than those covering “conventional” foods and drug
            products. “

          • Young CC Prof

            Dietary supplements are not USEFULLY regulated by the FDA. In fact, the supplement industry has lobbied vigorously against real safety standards and fought to undermine the tiny inadequate standards that exist.

            The only power the FDA has is to ban given ingredients, and only retroactively, that is, after people are seriously injured or killed. There is no quality testing. Take a look at the FDA’s recall page sometime, screen after screen of dietary supplements recalled because they contained illegal ingredients, in many cases prescription drugs.

            Under the current legal structure, the FDA is unable to provide reasonable assurance that a given supplement is effective, is safe, or even that the label accurately describes the contents of the bottle. I’d call that unregulated, myself.

          • Matt

            What does this mean to you?

            “Under FDA regulations at 21 CFR part 111, all domestic and foreign
            companies that manufacture, package, label or hold dietary supplement,
            including those involved with testing, quality control, and dietary
            supplement distribution in the U.S., must comply with the Dietary
            Supplement Current Good Manufacturing Practices (CGMPs) for quality
            control.”

            No quality testing? Do you mean by the FDA itself? I don’t follow.

          • Young CC Prof

            I don’t care what the laws on the books say. We have this: http://www.biomedcentral.com/1741-7015/11/222/abstract

            as clear-cut proof that the regulatory structure is useless.

          • Matt

            There are other classes of dietary supplements besides herbs. Also- Was this a random sampling? How many of them were from “weight loss,” “body building,” or “sexual enhancement” supplements?

            How many of the products tested were manufactured in a facility that participates in third-party quality testing, or are cGMP certified?

          • Matt

            And what about those FDA-approved drugs? Did they do safety tests to determine if there are any deleterious effects on the gut microbiome before allowing them to go to market?

          • Young CC Prof

            Because obviously “This drug might have subtle uncommon long-term side effects we haven’t found yet” is just the same as “This supplement may cause acute liver failure, and may contain substances known to be poisonous which are not listed on the label.”

          • Matt

            Of course that is not the same thing! But you didn’t answer the question….

            Moreover, is there any evidence to assume that such effects are both “subtle” and “uncommon”? Or is that just your opinion about it?

          • AlisonCummins

            If millions of dollars of premarket research, tight regulation and years of postmarket research haven’t found anything, then yes, it’s subtle and uncommon.

          • Matt

            Huh? What I’m asking is…was any of that research actually assessing impact on the microbiome? Did they look?

          • AlisonCummins

            They looked at whether people who take the drug are healthier than people who do not.

            Looking at the microbiome is irrelevant since we have no idea what to look for. Researchers take a holistic perspective and look at the whole person.

            If (for instance) the diabetes associated with some antipsychotic drugs is mediated by microbiome effects, the concern is the diabetes and whether the tradeoff between control of psychotic symptoms and a risk of diabetes for an individual person.

            Yes, someone may some day decide that we don’t know enough about how risperidal raises the risk of diabetes, have a reason to suspect that it might be partly mediated through effects on dental plaque, and take a look. But that isn’t necessary information when you are conselling

          • AlisonCummins

            … when you are counselling someone about the risks of taking certain drugs and the risks of not taking certain drugs.

          • Matt

            How come millions of dollars of premarket research, tight regulation, and postmarket research didn’t identify the problems with Vioxx, or Bextra, or Rezulin, or Avandia?

            If drug manufacturers have to submit to such “rigorous” proof that their products are not contaminated… then how does contaminated Tylenol end up in the shelves?

          • Dr Kitty

            Matt,
            The problems with Vioxx, Avandia etc were identified, and those drugs are no longer available.

            Sometimes if the adverse outcome is rare it takes more people using the drug than the initial research groups to identify the issue.
            Sometimes, if the outcome is common (for example heart disease in known diabetics who are taking medication for diabetes, as with Avandia) the signal from the drug gets lost in the background noise from the disease.

            And sometimes pharmaceutical companies are bad actors and they suppress research results they don’t like…and then they are fined and sued.

            The system is not perfect, no system is.
            When it fails there is some redress.

          • PrimaryCareDoc

            Because despite what the news would have you believe, side effects from most of those drugs are pretty rare, and it takes millions upon million of doses to get statistically significant information.

          • DiomedesV

            Drug side effects are submitted along with efficacy to the FDA when a drug is up for approval. Are you suggesting that subtle changes in microbiome should now be listed as a side effect and affect the approval of drugs to treat serious problems like schizophrenia, diabetes, thyroid dysfunction, and rheumatoid arthritis? Why? On the grounds of what good quality clinical research that provides a *causal* (NOT associative) link between microbiome diversity and health outcomes. Even if said research does exist, which it generally does not, are you suggesting that the microbiotic diversity of a schizophrenic is more important than dealing with hallucinations and paranoia? That it’s more important than whether or not a woman with rheumatoid arthritis can walk or get dressed in the morning?

            As I stated in an earlier post, there is no good evidence that any one input to microbiota has a disproportionate affect on its diversity OR health outcomes.

          • Matt

            No, I’m not saying that treatment recommendations by physicians should be changed without sufficient evidence to support a change.

            Let’s just look at antibiotics. We know that antibiotics are overused, right? We know that overuse of antibiotics contributes to drug resistance in bacteria, right? (I’m sure you will let me know if I am wrong.)

            And yet… do you know how many stories I hear of people being prescribed antibiotics without any confirmation of a bacterial infection?

            And even if they were bacterial infections… how many of them would have probably cleared up on their own within 7-10 days without any intervention?

            Is that an “evidence-based” practice?

          • AlisonCummins

            My my, you do like your non-sequiturs, don’t you?

            Ok, now you want to talk about whether on-the-ground antibiotic use is science-based. Sigh. (When you change subjects like this why not start a new thread?)

            Answer: sometimes, not always.

            Sometimes a clinician knows it’s bacterial without taking a swab.

            Sometimes the risk of not using antibiotics when they’re needed is higher than the risk of using them when they aren’t.

            How many times have you rushed to the doctor at the first cough or the first throat tickle? If you’re like most people you don’t go unless the cough isn’t going away on its own

          • AlisonCummins

            … unless it’s been a while and the cough isn’t going away on its own or unless the symptoms are distressing or alarming. If you’ve had a cough for two weeks and it’s not getting better, even if it started out viral you probably now have a bacterial infection too. Treating with antibiotics may be evidence-based.

            Sometimes that doctor’s patient base, for cultural reasons, doesn’t think they have received medical care unless they get a prescription. Sometimes a doctor just gets tired of the interminable and fruitless educating and just gives up and writes amtibiotic prescriptions. No of course that’s not evidence-based, nobody says it is.

            If you’re wondering how warranted a given prescription is, why not just ask for the rationale?

          • Matt

            Maybe some patients… for cultural and other reasons, would like to try dietary supplements before getting a prescription from the MD. Is that so wrong? If they want to do this… shouldn’t they have access to whoever has the most training on dietary supplements? Don’t they deserve to know who are the reputable manufacturers of dietary supplements?

            Don’t they deserve something more than… dietary supplements… could be dangerous.. don’t use them.

            If however many MDs aren’t practicing evidence-based medicine, then why not don’t MDs *police their own* before going off on other professions for their lack of evidence-base… or attacking what evidence-base there is even if it isn’t multiple double-blind placebo controlled studies funded by wealthy drug manufacturers?

          • Bombshellrisa

            There are cultures who may wish to avoid seeing a doctor and try to fix whatever is wrong with things accessible to them first. There was a discussion about this on another thread and the reasons behind it are legitimate but have nothing to do with over prescription of medications.

          • AlisonCummins

            Can you be more specific?

            My grandmother takes lutein and zinc prescribed by her MD in the hopes it will slow her macular degeneration. Is that what you mean?

            My doctor prescribes SSRIs instead of Saint-John’s Wort or cannabis because they have a better risk-benefit profile. If you were already taking SJW for depression and cannabis for anxiety when you went to see her, she would probably tell you that the SJW was fine as long as you were ok with the risks but that cannabis for anxiety is both unsafe and counterproductive. She would talk to you about alternatives to the cannabis. Is that what you mean?

            Can you be more specific?

          • Matt

            Sorry… I thought I did start a new thread. I don’t think this comment format is very conducive to discussion.

            This whole side-discussion was originally with DiomedesV. You kind of jumped in the middle of it, so maybe that’s why it’s confusing.

            Thanks for the discussion on diet and nutrition. I’m going to let this thread drop now.

          • Young CC Prof

            Prior to approval, drugs were safety-tested by giving them to people and observing the side effects. If the drug changed the microbiome in ways that were important to health, health effects would be observed. Therefore, logically, either the drug does not change the microbiome, or the change does significantly affect health.

            The exception, of course, is antibiotics, which are known to reduce normal flora. Currently, some real scientists are working on the best way to replace it.

          • AlisonCummins

            Unlike manufacturers of regulated drugs, manufacturers of ‘supplements’ (unregulated drugs) are not required to demonstrate that they contain what they say they do. The FDA can only prosecute if they do their own testing and discover that the manufacturers were making shit up.

            Manufacturers of regulated drugs have to supply their own proof that the drug is what they say it is.

            If I want to make aspirin, I can’t sell it unless I prove rigorously that what I am selling really is aspirin.

            If I want to sell a herbal sassafras supplement, I can make capsules and fill them with litter from my cat’s litter box and Viagra that I ordered from China. I can write a book explaining that sassafras is better than aspirin. I can sell both the book and the capsules. I will get away with this fraud until the FDA decides to analyze my capsules and discovers cat shit. I’m really small potatoes so they probably will never get around to it.

          • AlisonCummins

            So no, practically speaking, unregulated drugs really are not regulated.

          • DiomedesV

            That’s correct. There is no meaningful regulation of supplements. Nor should there be. The FDA has enough to do. They don’t need any more excuses to avoid taking steps that will actually save meaningful numbers of lives– like actually preventing the misuse of antibiotics in animal husbandry.

          • Matt

            Yes- I understand that overuse of antibiotics is a real problem, not only in veterinary medicine, but in human medicine as well.

            Sorry… but when I hear stories (and they are many) of people getting prescribed antibiotics for what very well be a virus (nobody ever checked) and with the thought “oh well it can’t hurt anything”… I have a really hard time finding that to be a credible practice, or one that could be considered “evidence-based.”

          • Matt

            If you believe that they are not USEFULLY regulated… hey that’s fine by me!

            But that is different from saying they are *not* regulated. I get the concept… but I’m not sure if health professionals realize the kind of impact they have on people when they say those sorts of things.

            It’s similar to saying there is “NO” evidence, when what you really mean is there is no good evidence.

            Maybe it’s just an artifact of interacting with other doctors, scientists, professors, all day… but when you are speaking with laypeople… NO means NO. It does not mean SOME, or a LITTLE BIT, or NOT ENOUGH TO MATTER.

            It means NO.. none… nada… zilch. So when a health professional sits there in their office, or worse- on some kind of news broadcast and announces “Dietary supplements are not regulated by the FDA.” and then the health consumer goes to the FDA’s website and finds pages of information on exactly HOW they are regulated… how do you think that looks to the consumer?

            For at least some people… it makes the doctor look like a fool, and it undermines their trust in them.

            Why not just speak correctly? Would would happen if people started writing research papers and using the word “NO” when they mean “SOME” or “INSUFFICIENT”?

            Would that be an acceptable practice?

          • Young CC Prof

            Actually, the problem is that you don’t understand how strongly the word “no” applies in these cases and how deceptive the word “some” would be.

          • Matt

            So we should apply alternative definitions of words because somebody might take something the wrong way? We should lie to people for their own good? No- I don’t understand that. And by no, I mean no.

            Anyway, we can disagree here. I still suggest that such a practice might not actually be having the impact that some health professionals think it is. Maybe somebody should do a study on it, write it up, and subject it to peer review. Otherwise, it’s just an unproven hypothesis with only anecdotal evidence to support it.

          • Young CC Prof

            What practice, and what impact? Telling people that dietary supplements are unregulated is causing people to lose faith in their doctors? That is a hypothesis that would be remarkably difficult to confirm, speaking as someone who has done opinion surveys.

          • AlisonCummins

            What are referred to misleadingly in the US as “dietary supplements” are unregulated drugs. The “regulation” in the US consists of labeling requirements (the pills called “Menopausa” with directions on the side to take one pill twice a day or as needed must not state that the pills will treat menopause symptoms).

            They are supposed to contain what they say they contain but they aren’t required to prove it.

            I would not ask an ND for an unregulated drug in order to avoid taking drugs. That makes no sense at all. If I’m going to take drugs then I want the drugs with the most evidence, the best risk/benefit ratio, the ones best-understood and documented, and the ones most likely to be what they say they are. Which means that I get my drugs prescribed by an MD.

            If you don’t want to take drugs, then don’t take drugs — including the unregulated ones.

          • Matt

            Actually, according to my understanding of the current regulations, something cannot be called a “drug” unless it has been approved for treatment of disease. Kind of a catch-22

          • AlisonCummins

            I’d call it a loophole. If you call your drug a “nutritional supplement” then it doesn’t have to meet any of the standards that protect patients. As long as the label doesn’t claim that “Menopausa” treats menopause symptoms or that “Sleepytime” is a sleep aid, you’re good. Nudge-nudge, wink-wink.

            I don’t have any respect or patience for nudge-nudge, wink-winkers and I would not entrust my health to them. If it does what you say it does, safely, then the evidence exists and my MD will be fine prescribing it. If the evidence does not exist then you have no business marketing it.

            If marketers of “nutritional supplements” were ethical they would be lobbying for improved legislation to protect the public from unethical practices. Similarly, if CNM groups were ethical they would be publishing data whether or not it supported the safet

            Speculation and hypotheses are not evidence.

          • AlisonCummins

            … whether or not it supported the appropriateness of homebirth. They would be publishing and enforcing standards for their members. They would be working actively to phase out untrained midwives.

            I would never entrust my or my child’s life or health to someone who thought nudge-nudge wink-wink was ok. All it means is that they have no concern for safety standards.

            *Speculation and hypotheses are not evidence.

          • DiomedesV

            From my perspective, MDs do not get as much training in the scientific method as I would like. I say that because in my opinion, you don’t really appreciate the requirements and limitations of that thought process until you engage in a problem of your choosing, do your analyses, and then try to convince your colleagues of the soundness of your methods and your conclusions. Most MDs never publish research. Not only that, in my opinion and most of the scientists and statisticians I’ve discussed this with, the MDs that publish are still… deficient (sorry folks). I routinely see basic statistical and logical errors in papers on human medicine that I do not believe would pass muster in a, shall we say, purer science. I think it’s lack of training and the fact that the really good statisticians are working with scientists on improving methodologies, and that stuff trickles down slowly. In that sense, the peer review system is better than nothing, but still flawed.

            BUT, the level of training in the sciences of most MDs is still far superior to that of folks in virtually any other medical profession, including nurses. NDs — not a chance.

          • Matt

            So do you appreciate the perspective from a health consumer when there is a sort of societal imperative that says “you should trust your MD” as if having that credential somehow automatically means that they have the ability to evaluate research, or publish proper studies of their own.

            The level of training in the sciences of most MDs is more than in other professions..particularly if you are including pharmacology and surgery. But that does not automatically mean they are the best expert to consult in all things health. Or do you think it does?

          • DiomedesV

            There’s no question that having an MD does not qualify you to publish studies of your own. In some sense, publishing studies qualifies you to publish studies, and too many studies get published.

            Yes, I think that MDs are the best people to consult because training is everything and they still have the best training. But you’re never–or shouldn’t be, obviously access is an issue for too many people–restricted to just one MDs opinion. And of course, an OB knows more about obstetrics than a psychiatrist, but still probably knows more about psychiatry than a plumber or even many RNs.

          • Matt

            So then are you saying if I want to consult with somebody about diet and nutrition… I should still consult with an MD because they have the “best training”? Can you elaborate on that?

          • Young CC Prof

            An MD could help, but probably wouldn’t have the time. The best option is a registered dietician.

          • DiomedesV

            No, in that case, and if the questions were relatively general, I would consult with a dietician that works with an established practice. If your question is: “how can I find out if I have celiac”? you should see a doctor.

            But nutrition science is…. decidedly subpar.

          • Matt

            I’ve often wondered about nutrition science… I mean… can we really ever hope to produce any kind of “Grade A” research when diet is involved? How can a study be properly controlled?

            And if the is the case… then what? Should people just be told “eat whatever you want” because there is “no evidence” to support eating more healthy foods, or avoiding unhealthy foods?

            What I’m getting at… is it reasonable to hold all health research to the standards required for FDA approval of a drug? And even those standards sometimes fail. :/

          • AlisonCummins

            We have very good evidence about what constitutes a healthy diet.

            People who can’t swallow can live long and healthy lives being tube fed out of a can. Wolves in zoos fed kibble are healthier than wolves in zoos fed carcasses. We clearly have a good handle on nutrition if we can keep animals healthy on these kinds of synthetic foods.

            For,the rest of us, the recommendation is to eat a wide variety of fresh food with an emphasis on fruits and vegetables. This ensures that we get all the nutrients we need plus exposure to a wide variety of what are popularly called “nutraceuticals” without the risk of eating so much of one thing that any problematic components of that particularfood

          • AlisonCummins

            … of that particular food pose a problem.

            Supplementing with individual nutrients is recommended in well-defined cases. For instance, Vitamin D for children in gloomy climates or who are being protected from sun exposure to prevent adult skin cancer.

            When it’s hard to tell whether tweaking food intake improves [a particular aspect of] health, that just means that food just isn’t that big a determinant once certain criteria are met. Not that diet has no effect, but that other things are more important. That shouldn’t be surprising since the human animal has been surviving and thriving in a wide variety of circumstances and climates for hundreds and thousands of years.

            Given that following the recommendation to eat a wide variety of fresh food is already

          • AlisonCummins

            … fresh food with an emphasis on fruits and vegetables is already a high bar for most people, focus on that rather than obsessing over superfoods or toxins or untested pills from the health food store.

            Michael Pollan is hard to beat:
            Eat food.
            Not too much.
            Mostly plants.

            http://michaelpollan.com/articles-archive/unhappy-meals/

          • Matt

            I like Michael Pollan! Personally… I don’t find eating fresh food all that high of a bar.

            I do wonder when people are told by their MDs that diet doesn’t matter… and maybe that’s surprising to you to hear but yes… it does happen.

            One thing I have a hard time contending with is the constant repetition of “you can get everything you need from food.”

            Well, yes, you can. And yes, it’s better to do so. But it is not actually that easy, even for a healthy eater.

            I’ve actually tracked my micronutrient intake using the recommended intakes by the IOM, and let me tell you, there were a few things I wasn’t even coming *close* to. And if I’m not getting close… the vast majority of Americans aren’t even in the ballpark.

            And yet… look in the media and there is always some “expert” ranting on and on about how “useless” multivitamins are, how they might be harmful, and how you can get everything from food.

            But interestingly… they almost never talk about HOW to get everything from food, or recommend that people work with a professional to make sure that they are. I think that’s irresponsible communication.

          • AlisonCummins

            Not fresh food. A wide variety of fresh food with an emphasis on fruits and vegetables.

            That means meat and dairy, a variety of legumes, a variety of nuts and grains both boiled and baked, a variety of brightly-coloured fruit and a variety of brightly-coloured vegetables. If you’relike people have a go-to repertoire of only five basic recipes.

            If you aren’t meeting your recommended intakes, then broaden your variety. Take a multivitamin if you want, but don’t worry about marginal theoretical speculative hypothetical benefits of special alternative pills until you’ve fixed your diet.

            Remember that dietary recommendations are for populations, not individuals. (You can look it up if you don’t understand why it matters.)

          • AlisonCummins

            Your assertion was “science can’t tell us how to eat right.” I explained that it can and does and you’re arguing with me saying 1) that you eat fine but you aren’t getting all your nutrients from your diet and 2) other people don’t eat as well as you do.

            That other people don’t eat as well as you do and that you don’t eat as well as you think you do does not constitute evidence that nutrition cannot be studied scientifically. (You jump around a lot. You’d learn more if you would answer questions.)

            MDs do NOT say that diet is not important. You’re making that up. They do a lot of diet and lifestyle counselling.

            They DO say that diet doesn’t seem to make much difference for various particular things. Eating kale is not going to cure your cancer and eating too much of it will cause thyroid problems. For instance. Doctors hate fad diets.

          • Matt

            Diomedes said that nutrition science is “subpar.” My reply included five questions.

            Anyhow of course kale doesn’t cure cancer. I don’t believe that and never did.

            I am talking about micronutrient and macronutrient intakes from the IOM. And yes, I understand there are differences for individuals.

            Yes, I also understand about variety. Variety is good… but it is not foolproof either. I could eat a lot of variey of fruits and vegetables and still come up short on zinc and vitamin E, for example.

            I’ve actually taken the recommendations from the IOM, and (along with other sources like nutritiondata and whfoods) tried to construct meal plans that meet all of the micronutrient recommendations within the acceptable macronutrient distribution ratios.

            It was not at all easy to do. And I found it impossible to do with less than 2200 calories. I promise you it’s not as simple as “wide variety” it takes a very specific variety. Try it for yourself- you will see what I mean!

            Anyway the point is not that multivitamins (or kale) cure cancer or prevent death… since they don’t. The point is about health professionals poo-pooing multivitamin use in a population that not only doesn’t know how to get all of their nutrition from food (they were never taught) but probably wouldn’t do it even if they know how.

          • AlisonCummins

            Zinc is most available from meat.

            Vitamin E requirements are proportional to PUFA content of the diet, which works because vitamin E is found in polyunsaturated oils.

          • Matt

            Yes… I know where they come from. I looked them all up, remember?

            Assuming I had correct data from nutritiondata.com and whfoods.com…. 4 ounces of red meat has about a third of zinc… other meats are considerably lower. I eat red meat, but not 12 ounces every day.

            The next best sources I found were nuts, seeds, and legumes. About 25% for a quarter cup. I eat those too.. but not every day. And too much nuts/seeds and I go over on the fat.

            All I am saying is that it is definitely possible to get everything from food. But it is also possible to be eating a diet of a wide variety of healthy foods and still miss the mark.

            And if that is the case… why are drugs the first line of treatment for chronic illness? Why not nutrition? And give the state of affairs of people’s diets… even some healthy eaters…. why all the poo-pooing of multivitamins? What’s that about?

          • AlisonCummins

            You’re probably underestimating your zinc intake. You’re probably meeting the RDA without even trying. Apparently the median zinc intake for adult men in the US is 14 mg/day, well above the RDA for adult men of 11 mg. I wouldn’t sweat it. http://download.nap.edu/cart/download.cgi?&record_id=10026&file=442-501

            The reason that supplementation is not routinely advised for most people is that the evidence that it helps anything is not always there. Multivitamins sound sensible but when you look at health outcomes, people who take them are not healthier than people who don’t.

            However, women *are* commonly advised to take iron supplements. Vitamin D supplementation *is* recommended for babies. Fluoride supplementation of low-fluoride water and iodine in salt *are* recommended public-health measures. In these instances the evidence is there that it’s beneficial. Saying that supplementation is never recommended is outright false.

            Drugs are not the first line for all chronic illness. For chronic pain, a combination of moderate exercise and pain medication or spinal blocks. But for moderate hypertension or elevated blood sugar, first line is diet and exercise. If the patient rejects that option, or implements it but it’s not sufficient, then medication

          • AlisonCummins

            … not sufficient, then safe, effective and (sometimes) inexpensive medications exist.

            You keep saying that MDs don’t do lifestyle and nutrition counselling. I don’t know why you say that. The ones I know do. A lot.

          • The Bofa, Being of the Sofa

            I don’t know why you say that.

            I do. Because people think “lifestyle and nutrition counseling” consists of crazy exercise regimens and getting all crazy about testing and supplemental “micronutrients.”

            Instead, MDs say things like, “Exercise, eat lots of fruits and vegetables, and limit your amounts of meat and carbs. Oh, fish is pretty good, too.”

            My doctor says this to me at every physical exam.

          • Bombshellrisa

            Bastyr trains holistic nutritionists : )

          • The Bofa, Being of the Sofa

            Run, Forrest, run!!!!!!

          • Matt

            I dunno… maybe the ones you know have newer/better training? Maybe you live in an area where diet and nutrition are taken more seriously?

            I actually don’t go to the MD that often, because (as far as I know) I am healthy. But I can’t remember a time that the doctor asked me about diet and lifestyle, other than whether or not I smoked.

            I’m just going by stories, and yes I understand that can be skewed. But from what I see around here, there are a lot of very sick people who seem totally oblivious to (or in denial about) the fact that their diet has anything to do with their health.

            They go from one pill to the next, from one surgery to the next, each time convinced that THIS is going to be the solution… and nothing works. They just run up huge medical bills, and then bitch about having to contribute to payment.

            Often times they say they “can’t afford” to eat healthy food… yet they’ve got a new iPhone6 and drive a luxury car….

          • mythsayer

            I just want to say that I am so sick of people telling me I wouldn’t have lupus if I just “ate better”. Do they have any idea how rude that is? They are basically telling me that I caused my body to start attacking itself. That really pisses me off.

          • Young CC Prof

            Your macronutrient levels weren’t coming close? Are you sure you were counting correctly? Because I’ve measured some diets, and unless you literally never eat anything that ever saw a fruit or vegetable, it’s hard not to get there.

          • Matt

            No… macronutrients were fine. Even most of the micronutrients were fine. But a few of them were pretty off as I recall.

            Have you ever tried a tracker for yourself… one that has the micronutrients not just the macronutrients. I found it very instructive!

          • Young CC Prof

            Sorry, that was a typo on my part. I wrote macro when I meant micro. Yes, I did try tracking micronutrients. I stopped after a few days because I always had enough or almost enough of everything. Over a 3-day period, I averaged enough of every nutrient.

          • Matt

            Cool! 🙂 Which tracker did you use? What does your diet look like?

          • Young CC Prof

            I used the one at FitDay. My diet is not extraordinary healthy, although I get some fruits and veggies every day.

          • AlisonCummins

            A registered dietitian belongs to a professional organization which means they are trained to certain standards. This is different from being a “nutritionist” which has no meaning at all. Your cat can be a nutritionist just by saying so.

            Yes, most MDs are pretty good about diet and exercise advice. They will counsel you appropriately. One advantage that an MD has is access to a wide range of tools. If you have hypertension an MD can counsel you on diet and exercise if that’s what you want, prescribe medication if that’s what you want, follow up to see if whatever-it-is is working and suggest changes. If you elected to try diet and exercise first and there’s been no change in six months an MD can continue coaching and encouraging you on diet and exercise and also prescribe ap medication to get your blood pressure down while you get a handle on it.

          • AlisonCummins

            An MD has a good understanding of the limitations of dietary interventions. An oncologist will not try to convince you that kale will cure your cancer, because it won’t. Naturopaths and nutritionists have been known to.

            If you have cancer, an oncologist will want you to bulk up so that you don’t die of starvation and will refer you to a registered dietician who will help you do that while you are sick and undergoing treatment. Naturopaths and nutritionists have been known to put cancer patients on very restrictive, “healthy” vegan diets and starve them to death. This is why cancer patients using alternative diet treatments as an adjunct to medicinal care often do *worse* than cancer patients who stick to just medical care.

            If all you have is a hammer, everything looks like a nail. An MD has a complete toolbox and will be able to choose the right tool for the job.

          • DiomedesV

            Another thing– what motolibrarian said about CPMs being unable to regulate themselves is true. And there was a time when that was true of doctors, too. We no longer rely upon doctors to completely police themselves because the exact same types of abuses occurred that are routinely seen in midwifery, although some would argue they still have too much latitude in that direction.

            CPMs are not automatically worse people ethically, but still, they are not willing to submit to a meaningful regulatory structure where they are held to account and can be disciplined or even disallowed from practicing. And who would, if they could choose not to? It’s not intrinsically evil, but it does mean that as a patient, you are entirely at the mercy of your provider. If you would not be willing to jump into a time machine and see a doctor in 1935 because you have qualms about the ethical standards of that time (I do!), why would you see a provider that is basically following and probably even promoting the same standard — or lack thereof — of patient care and accountability?

          • AlisonCummins

            I’m afraid that you and I have very different understandings of what constitutes science- and evidence-based medicine.

            I’m with Steve Novella.
            http://www.sciencebasedmedicine.org/evidence-thresholds/

            And Tim Minchin.
            “By definition, Alternative Medicine has either not been proved to work, or been proved not to work. Do you know what they call Alternative medicine that’s been proved to work? Medicine.”
            http://www.youtube.com/watch?v=ujUQn0HhGEk

          • Stacy48918

            Why can’t we contrast them? They are willfully misleading people to take their money. Just because they didn’t go to medical school they should get a pass at killing people? Why shouldn’t the quack(s) that advised Steve Jobs face the same penalties as this oncologist?

          • Matt

            Eh? What about the MD quack who was telling people they have cancer when they don’t, who was giving people treatments they didn’t need, and who all the while was a “respected” member of the medical community?

            What I’m saying is… why not fix whatever is allowing THAT to occur, and maybe less people would be herded into the arms of dubious lay practitioners?

          • mythsayer

            Ummm… yeah. They ARE fixing it. They are most likely taking it very seriously. He will lose his license. His insurance will pay out a lot of malpractice claims. In fact, there are probably fraud lawsuits out there, and fraud judgments aren’t dischargeable in bankruptcy. So this will follow that guy for the rest of his life. Contrast that with midwives like Christy Collins who managed to have a bunch of things go wrong in California births, so she just wandered over to Nevada and managed to kill Gavin Michael.

            And yet, the home birth community rallies around midwives who have presided over numerous deaths. They says forcing midwives to carry insurance would ruin their practices. They give midwives who don’t recognize a baby is in danger (look at Aquila, who died because her mom had a placental abruption) a slap on the wrist… a six month suspension, or less.

            How is that fixing the problem? The medical community has ways of monitoring itself. The home birth and alternative communities have none.

          • The Bofa, Being of the Sofa

            Who was the midwife who’s “punishment” was to write a letter of apology to the parents?

            Is there any better indication that they have the perspective of a high schooler/adolescent and not of responsible adults?

          • Bombshellrisa

            That was Faith Beltz. Then you have the serial killers like Brenda Scarpino Newport who make themselves out to be the victims.

          • mythsayer

            So then it would have been Aquila’s midwife again. I believe Liz’s midwife was Faith Beltz… that “hearing” with the other midwives was horrid.

          • mythsayer

            That’s actually worse. The fact that people believe them is scary, to be honest.

  • MaineJen

    *sigh* I see we are still dealing with Mr. “I will make an outrageous statement and then backpedal like the wind when confronted with actual evidence and/or an intelligent argument.” I’m getting tired of reading ‘But I didn’t say that! You misinterpreted me, you silly woman!’ Real tired.

    • guest

      I know. Sigh.. I am starting to feel sorry for the man.. I think he is so defensive about the home birth thing and the choice of a CPM because he knows deep down it’s not a good choice.. he’s come here to argue why we are all “wrong” and in the process he is realizing that maybe those horrible,mean medical people might know a little something about childbirth…

  • AmyH

    As a somewhat long term reader 3+ years), I’m going to suggest that you guys need a “suggested/required reading list” in the sidebar. I came here trying to decide whether it would be safe to have a homebirth with my first child, or whether I should wait till subsequent births, basically. I didn’t like you guys; at the time it seemed that any woman who used the term “high pain tolerance” to explain not getting an epi was viciously attacked in the comments. But I was after facts, and I perused 90%+ of the archives before commenting. And I got facts.

    It is shocking to see someone who believes they are already educated and just want some minor points cleared up citing things like the WHO’s retracted recommendation of a 15% CS rate. I can understand why long-term commenters get snippy. Every two days someone arrives wanting an individual course on home birth with their own set of links to refute the standard set of arguments and a 1:10 student-teacher ratio. I seriously think Dr Amy should open a post where links to previous posts as well as outside info can be submitted, discussed and organized to be placed in the sidebar. Then when someone comes along wanting to discuss the same-old same-old, refer them to this post and say “come back with any specific questions when you’re ready for more.” Would it work? Probably not. But it would be less tiring, and it might actually convince a lot of people who are willing to be convinced.

    • guest

      Great suggestion. It’s emotionally draining trying to reason with them especially when they can’t seem to see the forest for the trees. Focusing on study after study and micro-analyzing every little statistic is just counter-productive and really doesn’t give them real-life information. When they start making claims about so-called “unnecessary interventions” and the rhetoric that goes along with that with nothing to back up their statements, it really is frustrating.

      • Karen in SC

        Many other blogs state clearly in their comments policy that they don’t engage in any Feminist 101 or Racism 101, or whatever and post a link to relevant material.

        If there was such a link posted here, all of us regulars could just post that. Of course, the discourse that follows a parachuter is always interesting.

        • AmyH

          I honestly think an eBook might be an appropriate effort. Personally, I’d like to have something printable and non-inflammatory to share with a few people. It could start by inventorying the “arguments” in BOBB since that’s where a lot of women get their start. Call it something like”Being Born Safely.” Take a page out of the”other side’s” playbook and intersperse the stats and logic with real life stories of the potential consequences of ignoring risks. That’s how parents are being convinced anyway. They don’t care that vaccines are 80% effective in individuals and the protection of the cocoon effect outweighs the small risk of individual bad reactions, because some woman on Baby Bump got the flu shot during pregnancy and her daughter has developmental delays and she thinks it might have something to do with the vaccine. So all that to say, I think an eBook with arguments, testimonies and pics might help some people.

          I have done some freelance proofreading and could probably be convinced to help with that part, as a limited number of hours.

          • Young CC Prof

            That’s a good idea! I’d be willing to help some as well, although time is tight for me at the moment. I can attempt to do things like explain numbers, put risks into context and discuss good evidence vs bad evidence.

          • Matt

            Yes- I think it would be helpful to put risks in context, and to also inform people about relative vs. absolute risk.

            Also I think it would be awesome to discuss good vs bad evidence rather than ranting in all caps about “NO” evidence. It would just be more instructive, and less condescending.

          • Young CC Prof

            Example of context: The .11% increased risk of home birth is similar to the risk of driving your child around without a seatbelt–for his or her entire childhood.

            The 0.5% death rate of a higher-risk home birth is the same as the probability of a child dying between the ages of 1 and 18 from any cause at all.

          • Matt

            Thanks. That is helpful information.

          • The Bofa, Being of the Sofa

            Yes- I think it would be helpful to put risks in context, and to also inform people about relative vs. absolute risk.

            I agree. Let’s put the risks of childbirth in context…

            For example, in the US, the chance of a mother dying in childbirth is 50 times greater than that of a guy who drives home 8 miles from the bar.

            The chance that a low-risk baby born in a hospital will die is the same as the chance of that same drunk driver either getting into an accident or even getting a DUI.

            That’s your context, bud. That’s how risky it is. Compared to childbirth, drunk driving is kittens.

          • Cobalt

            I’d love to be involved in a project like that. Given raw material, I can do a lot of writing and editing, but I need a qualified reviewer and fact checker.

          • AmyH

            Replying to my own post because I don’t know which of you to reply to – I think Dr. Amy’s posts would provide a good starting place for material. They would need some careful reading to make sure they were suitable for a general audience, though…IYKWIM. Doubtless some supplementation also to make them complete in themselves as an information source, instead of the individual blog postings they currently are.

            My thoughts are something like this… It would need to start with a defense of America’s medical system – specifically, an explanation of neonatal mortality vs. perinatal mortality and how the measures directly related to prenatal care and birth show that our system is working pretty well with regard to that. That’s where they scare women, implying they’ll get substandard care in the hospital. This might not need an entire story unto itself, but pertinent personally applicable info could include women who were denied access to an OB in the Netherlands, say. That would shock a lot of US women.

            Next would be “The Myth of the ‘Cascade of Interventions.'” You’d have to deconstruct it completely, from explaining why not augmenting labor in the presence of certain risk factors is…risky (oh the simplicity), to why Pitocin doesn’t cause the bad outcomes “they” say it does. Because average women are swallowing this stuff hook, line and sinker in the absence of accurate information. Lots of stories here, either my own (I was scared to get Itocin but lo and behold, I had a great birth) or a story about what happens when your water breaks and you DON’T do anything.

            Some way to address the idea of “birth trauma” and that the reason your hospital birth was rough isn’t that doctors don’t care about you – it’s that you were looking at potentially a much worse outcome. And on and on.

            I think a lot of the material already exists; it just needs effective editing and compilation. I also think it would be appropriate to have one ebook restricting itself to the average arguments women everywhere are hearing, and (if anyone had the patience) a separate point-by-point rebuttal of the more involved arguments upon arguments.

          • DaisyGrrl

            Doula Dani has written an excellent series of posts on her blog. They cover the BOBB and another one about the MANA study (I think). Her blog is an excellent go-to for newbies to the discussion because she presents everything so clearly.

          • Amy

            Yeah – I don’t think it’s really going to work to tackle an ebook up front. I think a good first step would be to do a post compiling links to existing material that answer a lot of the objections that we see on at least a weekly basis. Once that was done, some people might or might not see their ways clear to making it into a stand-alone work, with the blessing of the various authors, of course, and personal stories voluntarily submitted to drive home the reality of the statistics (like what’s already on Hurt by Homebirth, etc.).

    • Cobalt

      A series of childbirth education type posts would be fantastic. There is really not a good internet resource for childbirth issues for lay people. The resources available are either too dumbed down, too vague, or just a bunch of crap.

      • AmyH

        Check out the author of pregnancy info on about.com, if you haven’t. (That’s not a recommendation.)

        • guest

          Oh my…

        • Cobalt

          Exactly

          • AmyH

            Yeah, in my first pregnancy I was reading those articles and assuming they were objective until I ran across her name here and it sounded familiar.

  • Matt

    Wowee! Now this is pretty interesting and hilarious! After all the resistance I’ve encountered here to the idea that maybe we should be doing less C-sections, and all the tireless defense of the blog author, I thought to myself… Matt, what do you really know about Dr. Amy? I thought a good place to start would be back at the beginning of this blog. Guess what I found as the very first post? You may not have seen it, as I noticed it has exactly -zero- comments.

    How to lower the C-section rate: step 1, look in the mirror

    “Everyone agrees that the cesarean section rate in the US is too high.”

    “a C-section rate of 32% cannot be medically justified if the normal parameters for medical justification are used.”

    “As the C-section rate rises, the percentage of unnecessary C-sections rise and that is a bad thing.”

    But woe be to anybody that raises the hypothesis that passing through a (healthy) birth canal might confer a health benefit to baby. That it might be one additional thing to consider before jumping into an elective C-section.

    No… we can’t consider that. Because “crunchy granola homebirth moms” think that… and if we think that too… that must mean we’re one of them!!!

    You know what? I’ve changed my mind about Dr. Amy. She clearly cares a lot about babies. It’s too bad that she felt the need to make an early departure from obstetrics. It must be really difficult to try to do something you love, and make the right decisions, while constantly under the threat of lawsuits from whackjob parents who refuse to take any responsibility for themselves, and who refuse to accept the sad, sad truth: Some babies die.

    No really, I’m serious.

    I get why Dr. Amy is so concerned about the “homebirth community.” It sounds like there are a lot of hacks and posers who fall prey to the naturalistic fallacy, and who spread misinformation and falsities to justify their position. It must suck for somebody who cares so much about babies to see something like this going on, and seemingly getting out of hand.

    But to Dr. Amy, and her readers here on the “Skeptical OB” I would ask you to consider a new perspective. In her original post here, Dr. Amy laments about the malpractice suits being out of control, and how doctors are merely trying to respond to unreasonable patient expectations.

    Have you considered that at least part of the recent move by some patients away from conventional medicine, and toward more “natural” or “alternative” methods is actually just part of the fallout of this ongoing firestorm of malpractice litigation?

    Think about it. Really consider it for a moment. I know from my own experience that the women I’ve talked who have had homebirths, or are considering homebirths, are driven a lot by fear of the medical system.

    They’re scared shitless to step foot in a hospital… and why? Because they perceive that medical staff are too quick to push interventions like c-section, induction, and episiotomy on them. And they are. Certainly, it seems to me like Dr. Amy would agree:

    “Virtually every American obstetrician is sued. Most are sued several
    times. An obstetrician must assume that she will be sued for every bad
    outcome, and therefore, she must take whatever steps she can to preserve
    a legal defense. Of course, the only acceptable legal defense is a
    C-section.”

    Could it be that interventions are increasingly offered sooner and sooner at the very first sign of something abnormal during the birth process because the medical staff is scared shitless of what might happen if they DIDN’T offer an intervention?

    Could it be that procedures are now being recommended against a physician’s better judgment, not because of what might be best for mother and baby, but because they are working under duress?

    Could it be that maybe… just maybe… there is something driving women to homebirth that isn’t just “pseudoscience” and “woo” but actually based on a very real problem with our healthcare system that continues to go largely unaddressed.

    I can’t speak for women, since I’m not one. But I can say that if I ever had to step foot in a hospital, I sure would hope that the physicians and staff were looking out for ME and placing MY HEALTH AND WELLBEING as a priority over their fear of litigation.

    But it doesn’t seem like that’s the case. It seems like hospitals, and their employees, are too concerned about protecting their own asses. It’s understandable, but it’s not right. It’s a disgrace.

    • MaineJen

      “Could it be that interventions are increasingly offered sooner and sooner at the very first sign of something abnormal during the birth process because the medical staff is scared shitless of what might happen if they DIDN’T offer an intervention?”

      Like…someone might die?

      WHY do people sue doctors? They sue because something happened to their baby, something that could have been prevented. Usually, it is something that could have been prevented by *doing more interventions,* or doing them sooner.

      Shame on you for repeating the trope that “some babies just die.” Yes, that’s true. But in modern times, we have the ability to save a lot of them…with c sections. Would that we all had crystal balls; then we’d be able to tell ahead of time which surgeries were “necessary” and which ones weren’t. Until we have crystal balls, we’ll just have to keep doing the best we can, with the baby’s and mom’s safety put foremost and ahead of their comfort. As a mom, I can live with that.

    • Amazed

      Could it be that women are ready to jump on the intervention train at the very first sign of something abnormal during the birth process because they are scared shitless of what might happen if they DON’T accept the intervention?

      Like, their baby dying or being damaged?

      You’re making it sound as if every second woman is thinking of homebirth. This isn’t so. The overwhelming majority of women – around 99 percent – are very happy to have their babies at hospitals just in case and – gasp! – maternal satisfaction rates are massively positive.

      It’s just this 1 very loud percent that is so, so concerned with interventions. Thank God, most women think along the normal human lines of, “Even if the risk is small, why would I risk my baby?” and happily agree to interventions.

      Of course, Professor Hannah Dahlen (guess what her specialty is?) offers the following pearl of wisdom, “Perinatal mortality is a very limited view of safety, maternal satisfaction should also be considered” and then keeps spinning it as if mothers would be happier with a dead or brain-damaged baby, as long as they felt empowered during their homebirth.

      • Matt

        No… YOU’RE making it sound as if I said something I didn’t. Holy hell… is it even possible to write something on this site without somebody jumping in and making gross mischaracterizations and false assumptions?

        I never said, nor insinuated in any way, that “every second woman is thinking of homebirth.” Who are you arguing against? It’s not me.

        • Amazed

          Then why does it matter that obstetricians are supposedly too quick to intervene? You’re making it sound as if it is being done TO women while in reality, women are perfectly happy to TAKE PART into decision making leading to interventions at the first sign of a problem.

          The only ones who see it as a problem are homebirthers and homebirth advocates.

          I am arguing against you making it sound as if preventative medicine is a problem. And yes, I am most certainly arguing against you since you insinuate that it is.

          • Matt

            I was commenting on the blog author’s ***own post*** about unnecessary c-sections resulting from fear of litigation.

            I was just taking her word for it… so why don’t you go argue against her?

          • Amazed

            Why should I argue with her? I have no problem with doctors acting out of fear of litigation. Their interest coincides with mine – not taking that additional risk that could lead to a worse outcome.

            I don’t understand the reasoning behind, “I want my doctors to act with my best interest in mind, not their own!” My interest and theirs are one and the same. I do not consider myself this special snowflake that stats don’t apply to.

            I do have a best friend, thank you very much. I don’t need a doctor’s love. Just their sound clinical judgment, to protect both our interests.

    • guest

      “Think about it. Really consider it for a moment. I know from my own experience that the women I’ve talked who have had homebirths, or are considering homebirths, are driven a lot by fear of the medical system.
      They’re scared shitless to step foot in a hospital… and why? Because they perceive that medical staff are too quick to push interventions like c-section, induction, and episiotomy on them. And they are.”

      And why do they “perceive” that? My guess would be they’ve been fed a lot of crap by the NCB folks and home birth midwives. I’ve been working in Obstetrics for a long time and I can tell you we don’t “push interventions” at least not in my 10 + years experience. We do, however inform patients what is happening and recommend a course of action based on the clinical picture, our experience and education.

      “But I can say that if I ever had to step foot in a hospital, I sure would hope that the physicians and staff were looking out for ME and placing MY HEALTH AND WELLBEING as a priority over their fear of litigation.

      But it doesn’t seem like that’s the case. It seems like hospitals, and their employees, are too concerned about protecting their own asses. It’s understandable, but it’s not right. It’s a disgrace”.

      Hmmm.. it doesn’t SEEM like that’s the case. Based on what? Your “vast” experience? I hate to break it to you, but we actually DO have YOUR HEALTH and well-being as our top priority! Your perception of “defensive medicine” could be that when distrustful, combative people seek out medical care, we get frustrated. They either refuse every treatment offered and/or recommended or argue about it, taking our precious time away from sick and dying people actually wanting help. It’s really difficult to try to help people who really don’t want it. It never ceases to amaze me. You criticize the healthcare system, yet we are your “back-up” should a disaster occur. And why is that? Because underneath it all you really do trust modern medicine, otherwise you would “handle it yourselves.” My suggestion to all of you who distrust “hospitals and their employees” is to spend about a week with one of us, then tell us what you think.

      • Matt

        Thanks for the response, but have you read the original post that I was referring to? It was written by the author of this site… she was lamenting that fear of litigation is contributing to unnecessary c-sections.

        What do you have to say to that?

        • guest

          Did you not actually read my post? I directly quoted you and responded to your statements.

          • Matt

            “Hmmm.. it doesn’t SEEM like that’s the case. Based on what? Your “vast” experience?”

            Based on the blog author’s ***own post*** to which I referenced. Are you serious?!

          • guest

            “Based on the blog author’s ***own post*** to which I referenced”.

            And to which you stated your opinion, which, again, I quoted your statements and responded to.

          • Matt

            LOL- OK I am seriously lost. Let’s try something simpler.

            Dr. Amy expressed her concern that more unnecessary c-sections are being performed because hospitals and physicians are attempting to avoid lawsuits.

            What is your opinion on that?

        • Amazed

          She was not lamenting it. She was saying it as she sees it.

          Matt, you might be one of the lucky guys who count 5 million dollars as a loose cash. Most of us, though, invest heavily in our education. Do you really think it’s a vile thing that an obstetrician might be unwilling to risk all the years of their training, all the student loans they have yet to pay, potentially their savings, and for sure harm their chance of future employment for the sake of the gamble that the baby MIGHT turn out just fine?

          • Matt

            Hmm. Well thanks for asking me what I think, instead of telling me what I think. That’s helpful. 😉

            No, I don’t think that “it’s a vile thing” for OBs to look out for their own personal, professional, and financial interest.

            I think it’s a vile thing that people are being recommended treatments that they don’t need, and that institutions (and their employees) aren’t standing up to being held hostage to this sort of situation.

            It undermines trust in the system. On all sides. That’s vile. Whatever is the cause of THAT… should be eliminated.

          • Amazed

            See, that’s where we differ. How do you know that patients don’t need the treatment? There is the chance that things could go bad beyond repair without interventions while with interventions, the worse thing that can happen is they might turn out to be useless – but no one knows that before it’s over.

            Until the crystal ball is invented, obstetricians will keep recommending treatments on the basis of problems that are indicated. Because when they know for sure, it might be too late.

            And since you liked me asking you what you think so much, let me ask you another question: Do you really, really think it’s ethical to see something that has the potential to ruin a child’s life – and a mother, by extension – and not recommend a course that would avoid the risk when the risks of the exchange are so small in comparison?

            If you think it’s ethical, do you think it’s ethical of the doctor to withhold the same recommendation from the next woman with the same indication, or would it be ethical for him to go two times a day, every day, to the home of the woman who turned out to have needed the intervention to help her with the wheelchair of her brain-damaged child for the next 30 years?

          • Matt

            I *think* I see what you are saying… there is no way in advance to know if they are truly necessary.

            But where does that lead? I mean… why not just run all sorts of genetic tests while a baby is still in the womb and initiate treatment then?

            What if we have technology that can detect a single cancer cell in the body? What do we do then? Just start treatment.

            And who is going to pay for all of this treatment?

            ” Do you really, really think it’s ethical to see something that has the
            potential to ruin a child’s life – and a mother, by extension – and not
            recommend a course that would avoid the risk when the risks of the
            exchange are so small in comparison?”

            No. But I do think it is equally unethical to overstate and understand risks.

            I do think it is unethical to impose one’s own value equation upon another.

            I do think it is unethical to deride a woman for deciding that something else did in fact outweigh the 0.11% increased risk of neonatal mortality from attempted homebirth.

          • Amazed

            Matt, I suggest that you read a few of the posts here before you rush to conclusions. No one is deriding women who choose homebirth. We’re deriding the current homebirth advocates practice to deceive them into choosing homebirth without knowing that they choose an additional percent of perinatal mortality, no matter how low it is.

            Do you want an example? MANA’s own data showed 3-fold increase in perinatal mortality. What did they say their data was showing? “Homebirth means less interventions and no increase in adverse outcomes!”

            That’s what we are against. You might also want to have a look at Dr Amy’s post about a forced c-section of a woman. Almost everyone here agreed that no matter the reason, the choice is hers. I advocated the opinion that in her circumstances, her choice was reckless and endangering the baby – but it was her informed choice and she should not be deprived of it.

            Again, until crystal ball is invented, obstetricians and mothers will always veer on the side of caution. Totally fine, IMO.

            I really, really doubt that telling a woman, “This might indicate distress, it might be a threat to your baby’s life, your baby’s brain, your baby’s quality of life, that’s why I suggest Intervention A” is imposing one’s values to a helpess patient. First, it’s the truth of the situation. And second, mothers generally prefer not to take the risk.

          • Matt

            That’s fine… I will take your word for it that some of the other posts are different. Again… this post was my first experience of this blog.

            The numbers I had come across (long before I ever came to this site) from published research was 0.09% neonatal mortality rate in the hospital vs 0.20% in the hospital.

            I found that information pretty readily on Pubmed… so I’m not sure why anybody would attempt to obscure or hide it… but it they did then yes, I would agree that is unethical.

            But anyway… I think it is equally unethical to only report on ***relative risk**** while not mentioning absolute risk. It is leaving a very important piece of information out of the equation, and it is misleading and dishonest.

            In fact, the first statistic I ever came across was what you referred to… a 3-fold risk of neonatal mortality for homebirths.

            Yes… but three times the risk of WHAT, exactly..?

            Oh… three times the risk of 0.09%. Well DUH but the biggest contributing factor to the 3X stat is the fact that ****neonatal mortality rates in the hospital are so low***.

            The difference in absolute risk is 0.11%. Why not say the whole truth?

            I have seen other controversial health topics discussed in this way… why people should do such and such because it will “cut their risk in half” or some such thing, but all the while never bothering to mention that the overall risk was **really low to begin with**

            That’s just as dishonest a practice, IMO. If you believe differently, that’s fine. We can agree to disagree here.

          • Bombshellrisa

            Have you looked at the stats regarding long term injuries? So many people who post here have had uncomplicated pregnancies and home births but the ones who have had losses or injuries to themselves it their babies could shed more light on this.

          • Matt

            No, if you have links to that information, please share.

          • Bombshellrisa

            Ok, I am out and about at the moment-but I do want to post some links for you. Meanwhile, there are two links to blogs on the right hand side. The two that can best sum up what I am talking about are Hurt By Homebirth (which also talks about babies who suffered injury or died in hospitals, so it’s not all about home birth) and Better Midwifery Michigan.

          • Bombshellrisa
          • Stacy48918

            You beat me to it. 🙂

            There’s another great article that I had highlighted a bit in the commentary stating that the primary driver of neurologic damage seemed to be the delay in treatment. Not that the cases were more severe initially, but that the delay in treatment caused by transferring from home automatically results in worse outcomes. No matter how close you are to the hospital, you are never close enough in a true emergency. I’m still looking for the actual article.

          • Bombshellrisa

            Yeah, I was trying to find one that got the point across.
            I am still remembering the young woman who attempted a homebirth, she lived in the apartments I could see from the hospital parking lot. The transfer took a long time, she was asystole for 8 minutes before they could get her into the ER. Crash section, her baby boy died a day later, she died two days later. She left behind a husband and little girl. I will never forget the little girl coming in with the husband the morning the woman died. I don’t think I have ever cried so hard on my way home from work.

          • Stacy48918

            I found it – It’s in Grunebaum’s Apgars of 0 at 5 minute paper. Posted above.

          • AlisonCummins
          • Matt

            Did you find the article?

          • Bombshellrisa

            https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585
            This talks about home birth midwifery vs hospital birth in Oregon. There many midwives there who have repeatedly attended births where babies are injured or have died and instead of being held accountable, the community circles the wagons and defends the midwives, shuns and ridicules the parents for speaking out and arranges gofundme sites for the midwives.

          • Stacy48918

            2014-01 – Increased risk of HIE (hypoxic ischemic encephalopathy) necessitating cooling following homebirth: http://www.ajog.org/article/S0002-9378%2813%2901604-9/fulltext
            “Women who delivered at home had 16.9 times the odds of neonatal HIE compared to women who delivered in a hospital.”

          • Stacy48918

            Homebirth carries an increased risk of an Apgar score of 0 (ZERO – no heart beat, not breathing, limp, blue, floppy baby) at 5 MINUTES of life:
            http://www.ajog.org/article/S0002-9378%2813%2900641-8/fulltext

            “We emphasize that the increased risks of poor outcomes from the setting of home birth, regardless of attendant, are virtually impossible to solve by transport. This is because total time for transport from home to hospital cannot realistically be reduced to clinically satisfactory times to optimize outcome when time is of the essence when unexpected deterioration of the condition of either the fetal patient or pregnant
            patient occurs.”

            In other words, it doesn’t matter what “certs” your CPM has, whether she has taken a “neonatal resuscitation” class or if you’re “only 5 minutes” from the hospital. By the time your baby or your wife are in danger, it’s much, much too late.

          • DaisyGrrl

            Dude, I linked to a study showing exactly that two days ago. Are you even reading the links that people are giving you? It’s the same study that Stacy48918 has kindly posted again for you (the 5 minute Apgar score of 0 study).

            Babies who suffer from prolonged loss of oxygen at birth will have permanent brain injuries (there are *very* rare exceptions). Permanent brain injuries to the extent that they may be confined to a wheelchair for life, might require feeding tubes because they can’t take food orally, and will generally require constant care 24/7 for the rest of their natural lives (which will inevitably be shorter and more painful than they otherwise would have been).

            These injuries are very costly on every scale imaginable. I’ve seen families emotionally exhausted and financially ruined because of these injuries. OBs pay high malpractice premiums because lifetime care for birth injuries can easily cost millions of dollars.

            I read elsewhere on this thread that you and your wife are planning a homebirth with a CPM in Michigan. I hope that you read the Safer Midwifery for Michigan website. I hope you look into what kind of liability/malpractice insurance your midwife carries. I hope you look up your midwife’s license and history. And I hope you read From Calling to Courtroom, a guide for midwives who are being sued after a poor outcome (the book is free to read online).

            And while your wife’s planned homebirth is likely to go well, please remember that there are far too many that end in tragedy. Many of us who post here do so out of concern for those women who were inadequately informed and who didn’t realize the additional risks they were taking on.

          • guest

            He’s clutching at straws. I think their OB got his wheels turning when he told them he would have to drop them if they chose home birth. Now he is scared and defensive.

          • Box of Salt

            Matt: “a 3-fold risk of neonatal mortality for homebirths.

            Yes… but three times the risk of WHAT, exactly..?

            Oh… three times the risk of 0.09%.”

            That’s the question, isn’t it? Risk of what, exactly?

            Death.

            “neonatal mortality” means your baby died during birth.

            It’s not a risk of dealing with a rude hospital employee, or the risk of getting a headache from anesthesia. It’s the risk that the baby you’ve (the mother) just spent 9 months gestating won’t get a chance to enjoy life, at all.

            While you spend all this mental energy minimizing the absolute numbers, please recall what that absolute number represents.

            You cannot do a risk assessment without acknowledging the severity of the consequences.

            We are talking about the absolute risk of DEATH – of a newborn.

            Is this a risk you want to decrease, or increase?

          • Matt

            Well that’s a fair question, but not one that I have any faith can be reasonably addressed in this forum. So I will pass. Thanks for the discussion.

          • birthbuddy

            Decrease, Matt, Decrease the risk of death, that is the only logical answer. No thought required.

          • Stacy48918

            This is the primary problem with the NCB/homebirth crowd. A complete unwillingness to address the increased risk of neonatal death. Bury your head in the sand beforehand. Bury the baby (figuratively and literally) afterward.

            You really need to address this before attempting a homebirth. Why don’t you want to consider the increased risk of death?

          • Matt

            The problem with *this* crowd is that people keep engaging me as if I am one of the NCB/home birth crowd. Do you see? People keep acting as if I’m “one of them” when I am not. I am my own party. I am not a “homebirther” in disguise, and yet many people here keep insisting on treating me as if I am. This is kind of rude, don’t you think?

            By your own definition, I do not fit the criteria. You say I am unwilling to address the increased neonatality rate… but if you actually read what I have written… I have brought it up several times. I have never once said homebirth is safer. In fact, I’ve given the exact statistic… a 0.11% increase in absolute risk of neonatal mortality for homebirth vs hospital birth.

            Do you see?

          • Bombshellrisa

            Ok, not a home birther. Having a home birth because the risk is there, but it’s low and you figure most births are uncomplicated and since your wife is low risk, choosing the more cost efficient home birth route makes more sense since you MAY have problems with at home, but paying out of pocket for hospital care is for sure an expense you can’t afford when everything is most likely going to be ok anyway. But still, you are nervous about that small percent of “what if”. Everyone here is supportive of you grappling with that, since your questions and concern indicate that you aren’t just some guy who thinks they know everything about birth and is too cheap to engage proper medical care for his wife and baby cause “women are made to give birth” and actually might believe birth could be orgasmic.

          • guest

            But you are planning a home birth! You’ve hired a CPM! You ARE “one of them”!
            Since you are willing to address the increased neonatal mortality rate in home births, why not just fire the CPM and go with the OB? I read in one of your previous posts you don’t have Maternity Coverage with your insurance. I think another poster had a suggestion regarding Medicaid maternity coverage. It would be worthwhile to check into that. Do you really want to take the risk of the overwhelming cost of an emergency hospital stay if the home birth goes bad? Not to mention the risk of damage to your wife and baby?

          • Guesteleh

            Matt, your insurance should cover pregnancy and birth unless you have an individual policy that was grandfathered in under Obamacare: https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-get-pregnant/

            If you want to know whether you qualify for Medicaid, use this calculator: https://www.healthcare.gov/screener/

            I’d hate to see someone opt for a homebirth because they mistakenly believe they don’t qualify for coverage.

          • Stacy48918

            You came here, vomited a bunch of studies you hadn’t read and knew nothing about by way of saying “Ha! You don’t know anything! Look how harmful C-sections are!”

            And you’re not “one of them”?

            I’m not trying to be completely condescending Matt, but you are so deep into the woo that you can’t see it. There are glimpses of the light making it through in some of your comments, but you are unwilling to question the risk of neonatal death, you write dead babies off as “just happening” and you’re planning a homebirth with a CPM. You ARE a NCB/homebirth advocate, willing to ignore dead babies just to get the “experience” you and your wife are after.

          • guest

            In other words, you can’t come up with a response. You can’t and won’t argue the increased risk of DEATH to your baby and your insistence that home birth is “safer.” Especially now that you have asked and you have the facts. That would make you look like a monster.

          • Matt

            No… I never said home birth is safer. Not once. In fact, I’ve posted the statistics indicating otherwise several times. I already had those facts before I came here.

            The reason I am not continuing to engage is because it is nearly impossible to say something where without somebody jumping in- as you did- and attempting to put words in my mouth and mischaracterize what I am saying.

            I’ve pointed it out several times now, and not once has anybody taken responsibility for it.

          • DiomedesV

            It’s not just an increase in death, it’s an increase in severe birth injury. But I agree with you, the absolute risk is low, and there is a benefit to the mother, who is less likely to get C-section. In fact, I think women who make that choice are explicitly engaging in that tradeoff. I think they might not be aware of the risk in injury, though.

          • Young CC Prof

            Women who make that tradeoff may also drastically overestimate the reduction in c-section risk, and may not realize that they are accepting a much higher risk of the kind of hemorrhage that causes disabling anemia after the birth.

            The MANA study had a 5% c-section rate, but, because they were mostly low-risk, if all those women had gone to the hospital, the c-section rate would probably have been 9-10%. By contrast, 15% suffered postpartum hemorrhage.

          • DiomedesV

            I agree that they may not precisely understand the exact tradeoff they are making, and have underestimated other risks to themselves, but the C-section is currently the most prominent risk that expecting mothers are aware of. I’m not sure I accept your estimate of a 9-10% C-section rate in the hospital, either, especially since many of them were not low risk. They were women with breech babies, with Pre-eclampsia, and women who went postdates.

            I’m not claiming that these women are perfectly or even well-informed. Unlike many commenters here, however, I believe that they know that their baby is more likely to die and they are willing to take the risk.

          • Matt

            I read the other study on APGAR scores and injury… I only saw relative risk reported. Where can I find the data on absolute risk for these in a physician-attended hospital birth?

          • DiomedesV

            I don’t know, but some of the commenters here will probably be able to provide that information.

          • Matt

            OK. Perhaps you might have an explanation for why the authors of a study would choose to report only on relative risk. Why not throw in a table with the absolute risk? Certainly, they require the latter to calculate the former.

            I understand why relative risk is calculated. I’m not as scientifically illiterate as you might think. But no- I’m not a published scientist. I do think that reporting absolute risk along with relative risk gives a more complete picture.

            Why do you think researchers would choose to not report absolute risk?

          • DaisyGrrl

            Absolute risk is listed in Table 2 of the study in the results section. He also provides a link to the CDC data in the materials and methods section so you can play around with it yourself and confirm his findings.

            The absolute risk of a baby having a 5 minute Apgar of zero is 0.16 per 1000 for those delivered by MDs in hospital, and 1.63 per 1000 for babies delivered by “home midwife” (CPM in most cases).

          • DaisyGrrl

            Why don’t you read the studies carefully before running your mouth off?

          • Matt

            Yes. I see that in the link you provided. I may have clicked on a different link to an article that was summarizing the research. In any case, yes the data is there. Thanks.

            I also found a CDC powerpoint presentation in a Goodge search for “hospital birth apgar score distribution” so here is a link to that search if anybody is interested. They’ve got slides on the absolute risk in there.

            http://goo.gl/LKM3xK

          • Young CC Prof

            What study of homebirth death fails to report absolute risk? None I’ve seen.

          • Matt

            Sorry- I think I had clicked a link to an article that summarized the research, and only reported relative risk. Well… I thought it was kind of strange so that’s why I asked about it. But a quick search on my own yielded the info I was looking for anyway.

            You might be surprised… since you have your nose in the research and work with this kind of data all the time… when these things get “reported” say… in the news, they typically only mention relative risk.

            It’s sort of more sensational that way… don’t you think?

          • Young CC Prof

            Oh, definitely. It’s a common reporting error. Which is why, if you want to understand something, the popular-press report is the beginning and not the end of your learning process.

          • Matt

            I would barely even call it a good starting point. 🙁

            Unfortunately… that’s where most people are starting from.

            But you know… it hasn’t been much easier to get good information from this particular source, either.

            I will acknowledge coming in with “fists flying” but they weren’t flying for the reasons most people are trying to make them out to be.

            They were flying because of the derogatory, derisive, and dismissive attitude of this blog post. So… apparently a lot of people here believe that this kind of behavior is actually appropriate for health care professionals.

            That’s pretty problematic when the same people are saying “trust us” we’re healthcare professionals. Don’t you think?

          • DiomedesV

            Were you actually thinking of hiring Dr. Tuteur? No? Then why do you care about her tone?

            What was the tone of the CPM that you hired, I wonder? Trust birth… I’ve attended about 100 births and not lost one yet!*

            *You’ll just have to believe me though. I’m not required to report my statistics to any health authorities or state medical boards, let alone clients.

          • Matt

            I think you’re kind of grasping here. If you really think that a medical doctor on a blog going off with that kind of tone shouldn’t affect her credibility in the eyes of the reader… I don’t know what to say… I’m kind of shocked. But apparently a lot of people here think this kind of behavior is justified and acceptable.

            The CPM we talked to wasn’t derogatory toward hospital birth. She didn’t insinuate it was a risk-free scenario.

            You’re not as bad as some others here… but there seems to be some kind of subtext going on here where people are trying to “guess” my story… tell me about myself and what I believe… or the worst… talk about me as if I’m not here reading the comments. It’s really immature, and unprofessional.

            In the conclusion slides for the CDC presentation I just looked through, they say:

            “Women may opt for homebirth if over-medicalization and unjustified interventions continue.”

            So… at least according to the CDC, over-medicalization and unjustified interventions are real issues. I saw a suggestion above for some permalinks and maybe an intro guide.

            I would suggest: How about a guide as to how to avoid over-medicalization and unjustified interventions in a hospital setting? I think that might be of some real use.

            In addition, they conclude that “Obstetricians should be trained in and consistently demonstrate professional and humanistic skills.”

            Those “professional and humanistic skills” do not shine through in Dr. Amy’s post… and I happen to think that matters too.

          • Amy Tuteur, MD

            Matt, I speak to people like they are adults.

            I assume that they have enough basic intelligence to read scientific papers (not the abstracts, the papers).

            I assume that they know enough basic logic to realize that reading what lay people write about medical literature that they haven’t read makes absolutely no sense.

            I assume they have a maturity to deal with being shown to be wrong.

            I assume that they don’t need to be called “mamas” or “warriors” or constantly praised as if they small children.

            That’s not unprofessional. That’s how science is done. It’s not about making friends and boosting your own self-esteem. It’s about establishing what the scientific evidence is and letting people decide for themselves how they want to incorporate it into their decision making.

          • Matt

            You also assume a lot of other things, which apparently you and some other here believe is part of being a skeptic. If you take a look at the evidence here in this blog, I think it is fairly clear that I am a person that understands, and responds to, logic and reason.

            Making announcements in a public forum about who people are, what they “truly” believe, what their education level and background is, and then persisting in maintaining that image after the person has demonstrated by their words and actions to the contrary… that has nothing to do with skeptic inquiry.

            That is a pathological behavior known as bullying.

            Now that being said- I apologize for flying in here and causing chaos, however I was having an emotional reaction to your emotional post.

            If you will extend me the courtesy to start over…

            I’m still curious about your comments regarding microbiome research. I understand you don’t appreciate the spin that the film producer and their marketing are putting on this documentary.

            But I watched it… and I am really intrigued by some of the comments made by the researchers… particularly Dr. Blaser.

            I have a Bachelor’s Degree in Biology… from 15 years ago. As it turns out, the university I received it from is now doing quite a bit of research on the microbiome.

            I’m very curious about something… I don’t recall learning anything about the microbiome in undergraduate school? Why is that?

            I understand we just didn’t have a lot of the technology we do now to study it…. but when I went back and looked in the literature, I saw that the concept has been around for about 100 years.

            It seems really important. I just think it’s really odd… when I was in school we were talking about all the wonders that will come from mapping the human genome… but I don’t recall the term microbiome being mentioned a single time..

            Why do you think that is?

          • KarenJJ

            “I’m very curious about something… I don’t recall learning anything about the microbiome in undergraduate school? Why is that?

            I understand we just didn’t have a lot of the technology we do now to study it…. but when I went back and looked in the literature, I saw that the concept has been around for about 100 years.

            It seems really important. I just think it’s really odd… when I was in school we were talking about all the wonders that will come from mapping the human genome… but I don’t recall the term microbiome being mentioned a single time..

            Why do you think that is?”

            I’ve no idea, but I’m really interested in why you believe it was left out of your 15yo undergraduate biology degree. So why do you think it was?

          • Matt

            I really don’t have a logical explanation… that’s why I asked.

            Just observing and asking questions. That’s part of scientific inquiry… right?

            There’s a whole ‘nother level of biological organization that exists… and all throughout 16 years of science education… nobody ever mentioned it? It wasn’t in the textbooks? Huh?

            I think that’s pretty bizarre, don’t you?

          • AlisonCummins

            There’s a lot of stuff that isn’t in undergrad textbooks. That doesn’t imply a cover-up of any kind. (In your third- and fourth-year courses you were presumably using journal articles more than textbooks anyway.)

            Thirty years ago I did a BSc in Human Nutrition. Microbiology was part of the course. I wrote papers on gut flora and learned lots of things that weren’t in the texts. I have no idea whether the word “microbiome” was used. If it was, since it wasn’t a trendy, poorly-understood catchphrase being thrown around by people overestimating their own understanding it didn’t have the resonance it would have today. It would be just another word used by microbiologists. ;Actually, most Other people wrote other papers and learned other things that I didn’t learn. That’s okay because we had different goals.

          • AlisonCummins

            [sorry, I’m having trouble editing in Disqus]

            (Actually, most of the gut flora research I found was being published by surgeons who wanted to know the impact of doing various kinds of bowel resections and creating blind pouches.)

            Other people wrote other papers for their microbiology courses and learned different things. Those who went on to do more than the minimum required six credits in microbiology, or who actually majored in it, would have learned more. Maybe the microbiologists talked about the microbiome. Maybe they didn’t have any need for the word because they were able to talk in specifics. I don’t know and I have no reason to conjecture about conspiracies, which is what your “just asking questions” seems to be leading to. (The fact that your undergrad biology course didn’t cover “microbiome” Isa really weird thing to be “just asking questions about.

          • AlisonCummins

            … is a really weird thing to be “just asking questions” about. I’d hazard a guess that 1) it wasn’t a buzzword yet so they didn’t feel the need to examine that concept; 2) you weren’t concentrating in pre-med microbiology. Occam’s razor suggests to me that these are sufficient and obvious answers. Why don’t you think they are?)

          • Matt

            Because I’m wondering about the implications. I’m wondering… when safety tests were done for medications (like antibiotics, PPIs, NSAIDs), novel food additives, agricultural chemicals, etc… did anybody demonstrate that these things do NOT have a negative impact on the microbiome?

            Were these questions asked? Why not? And if not, what does that say about continued reassurances from the scientific community that Agent A is safe, when its impact on the microbiome (positive, negative, or neutral) was never reported?

          • Young CC Prof

            No, we haven’t done most of those studies. Why not? Because we still don’t know what a healthy vs unhealthy microbiome even looks like!

          • Matt

            So… then if we don’t have the studies proving these things are safe, why were they declared safe in the first place?

            I think we do know *something*… or at least have a very plausible hypothesis on the table about healthy vs. unhealthy microbiome, and it has to do with the diversity of the microflora.

            I mean… the assertion that greater diversity is a good thing seems very much in line with a basic axiom of biology. And- I’m sure you’ll correct me if I am wrong- but I believe that there is some decent- if preliminary- evidence to support such an assertion.

          • Matt

            *bump* Any comment here, CC? I’m interested to know your response.

          • Young CC Prof

            They are declared safe on the basis of the empirical evidence that the benefits outweigh the harms, meaning that patients who need the drug and get it do better than those who need it and don’t get it.

            Do antibiotics affect the microbiome? Definitely. Are you suggesting that we should go back to letting children die of strep to avoid microbiome damage? I seriously hope not.

            And can you cool it with the spaghetti flinging? Every time I counter one of your arguments, you bring up another completely unrelated topic.

          • Matt

            Why is it weird? I haven’t launched a conspiracy theory about it… I’m just curious that an entire level of biological organization somehow didn’t make it into the textbooks.

          • AlisonCummins

            Because it’s poorly-understood and effects on function are highly speculative. This means that most of what we think about it now is probably wrong. Most things that are speculative are wrong. Even more thinking about the microbiome was speculative fifteen years ago. Few interesting initial studies turn out to be replicable and when they are the effect is never as large as initially suggested. This is not because of anyone’s incompetence. There are good statistical reasons for it.

            Because there are — say — 50,000 well-understood, highly-probable, clearly-relevant things that should be in introductory textbooks for generalists and room for only for 2,000 of them.

            Given the state of knowledge about the “microbiome” when your introductory generalist texts were being written years ago, and the fact

          • AlisonCummins

            … And the fact that the word “microbiome” wasn’t on the popular radar yet, it would have been weird if it had been in your texts.

            If one of your profs had done their doctoral work on skin flora, they would probably have shared extra insight on microbiomy topics in your courses. Instead, you got extra insight on parasite lifestyles or sleep rhythms or whatever it was that your profs had specific, deep knowledge of. THERE IS NOTHING WEIRD ABOUT THAT.

            If you had done a PhD in microbiology or a medical ID specialization in the past ten years then it would be totally weird if you had not found lots of microbiomy stuff in your reasearch. THERE IS NOTHING WEIRD ABOUT THAT.

            tl;dr:

          • AlisonCummins

            tl;dr: Not ready for prime time fifteen years ago. It’s that easy.

          • Young CC Prof

            Why doesn’t “Star Trek” get credit for inventing cell phones? Just because people were discussing, speculating, or even performing experiments related to symbiotic bacteria 100 years ago, that doesn’t mean they had evidence to confirm what we now know about the microbiome. Some of them had ideas that we now know are true. It doesn’t necessarily make them smarter than the dozens of other scientists from that era who had interesting ideas that were eventually proven wrong. By the same token, when a loony theory is proven true, that doesn’t mean the people who ignored it back when it was a loony theory with little evidence are stupid.

          • Matt

            But I’m not making a commentary on who was smart or stupid.

            I’m making a commentary on a pattern of behavior among the scientific community where individuals are ridiculed, derided, and ostracized for ideas that later turned out to be more correct than incorrect.

          • Amy Tuteur, MD

            You mean “the conceit of the brilliant heretic.” That ploy is common among advocates of alternative health and reflects a profound ignorance of the history of science:

            http://www.skepticalob.com/2009/08/alternative-health-and-conceit-of.html

          • Matt

            No, that’s not what I mean. I didn’t have Galileo and Darwin in mind. I was thinking more of people like Metchnikoff and Dubos. I was thinking more along the lines of how scientific research that is has potential to profit private industry is favored over that which does not. I was thinking about how this might shape the conversation around certain ideas, and how that dovetails into skeptical treatment of new ideas and the notion of “weighing the evidence” when the evidence is heavily biased toward what is profitable.

          • Young CC Prof

            Those two have absolutely nothing to do with the problem of profit bias in today’s medical research arena. You keep throwing ideas at the wall, and right now they’re sitting in the corner in a big pile of spaghetti.

          • Matt

            Alright… so what does have to do with the problem of profit bias? What is being done about it? And how does that impact arguments for or against emerging theories or new hypothesis based on a “preponderance of evidence” if the evidence is biased by profiteering?

          • Young CC Prof

            Let’s assume that there are 1 million people out there with some education and a radical theory about science. (I don’t think this is unreasonable.)

            Most of these ideas are unlikely. Some have already been disproven, thought the idea holder doesn’t know it, others are implausible.

            Now let’s say there are 10,000 with no good evidence for or against, and, within 50 years, one of them will be proven true.

            Should we take the other 9,999 seriously in the meantime? No, that’s absurd. There’s nothing shameful about ignoring wild theories promoted without evidence. The only thing that’s shameful is refusing to consider a new theory AFTER solid evidence has been presented, and within the past few decades, that hasn’t happened much.

          • Matt

            Hmm… but I’m not talking here about “wild theories.”

            I’m talking about Dr. Blaser’s “Disappearing Microbiota Hypothesis.” Do you think that’s a wild theory?

          • The Bofa, Being of the Sofa

            Why doesn’t “Star Trek” get credit for inventing cell phones?

            The Jetsons invented Skype, btw…

            And the Roomba

            (our robotic vacuum cleaner is called Otto, though, not Rosie)

          • Happy Sheep

            Was your CPM honest about having no malpractice insurance? Or her lack of ACTUAL medical training? Or that all she needed to do to get her CPM was have 60 catches and write a multiple choice exam? What about that even if she does know nrp there’s only one of her and she can’t legally carry meds in most states? Did you know that you have to take her word about her experience or her history? Google Brenda Scarpino, or Christy Collins, they are just 2 CPMs who “forgot” to mention their losses or at best dismissed them. Read the posts on here about Abel, who was injured at a HB and really think about how all of these “small” risks add up and what the sad, heartbreaking reality of those absolute risks.
            Then go to CDC wonder and look at the mortality rate for CPMs in Oregon. OR is one of the only states that tracks intended place of birth, which is why I say there. Guess who fought the birth certificate change? CPMs.

          • guest

            If you don’t like Dr. Amy’s style, why are you here?The truth is not always pretty but it must be told. What medical training/education/experience do you have? You’ve come here and made untrue statements about “unnecessary interventions” in childbirth, but you haven’t provided an ounce of evidence to back that up. How do you know an intervention is “unnecessary” ? Unless you have the education, training and experience to make that assessment, you have zero credibility. And until you have worked in the field and experienced what we face on a daily basis, you cannot understand. Or maybe you can’t handle the truth. I don’t know. I do know that we all share Dr. Amy’s passion for justice and that includes promoting competent care from educated providers. Until you have been on the receiving end of a unnecessary medical disaster caused by incompetence and ignorance, you can’t possibly understand. If you are willing to trust your wife and baby’s lives to a CPM with little more than a high school education, there is not much more to say. Hospitals and doctors are not the villains no matter what the home birth crowd tries to tell you. You now have additional education and information from numerous health care professionals on this blog to make a reasonably informed decision and I wish your family the best of luck in whatever you choose.

          • AlisonCummins

            Promoting informed choice, actually. When expectant parents get their information from laypeople or from people who can only make a living if people believe homebirth is safer or better than hospital birth, they typically hold many misconceptions and are unable to make informed choices. If they understand the risks, that’s one thing. They are entitled to make the choices they want. But more typically they do not understand the risks. That’s a problem.

            I think you said something like your wife’s OB recommended your CPM for your homebirth but asked you not to tell anyone, to keep it hush-hush? Also that he would stop caring for your wife if she were choosing homebirth? I’m not sure I understand exactly. I know that some CPMs claim to be working with OBs when they are not. I hope that is not your situation.

          • Matt

            No- he said that he is “supposed” to drop her from care if he knows she is considering a homebirth. Something to do with malpractice insurance. He didn’t ask her to keep it a secret from the world.

            Why would he stop caring for her? Well… he wouldn’t. That’s why she’s still being co-managed. But apparently that isn’t something he is supposed to be doing.

          • AlisonCummins

            I looked up your comments.

            “She is also receiving concurrent care from an OB… he told us that if he knew she were planning a homebirth that he would have to drop her from care, or else he would run the risk of being dropped by his malpractice insurance.”

            “What I can say is that the OB seemed to think she was a good choice.”

            Finally, http://www.skepticalob.com/2014/01/microbirth.html#comment-1619839017
            “She also has done normal vital checks, and has previously comanaged with our OB. She offered the doppler, but we declined since we had just had it done two days prior at the OB’s office. They have a friendly relationship… although that is on the “hush hush” because I guess it is a no-no for an OB to even SEE somebody considering homebirth?!”

            So.
            1) The OB says he will drop your wife as a patient if she’s considering homebirth because he will be responsible for any negative outcome and he can’t take that responsibility.
            2) Somebody says that the CPM and OB secretly comanage homebirths.

            Can you reconcile the two statements? Did the OB or the CPM make Statement 2?

          • Matt

            Sure. The reconciliation is that we are considering homebirth so long as no additional risk factors pop up. Since they could pop up at any time, we have currently opted for comanagement with the OB and the midwife, both of who know each other, and neither of which tried to talk us out of working with the other.

            For some reason I don’t fully understand… an OB can apparently be dropped from malpractice insurance for comanaging? I don’t know if that is really true. It seems odd to me. Maybe I misunderstood the OB.

          • Bombshellrisa

            So you don’t trust the CPM to be able to identify complications?

          • Matt

            Trust is not a black or white thing… it is something that is built over time.

            So far she seems able to identify complications. I’m weighing that against my trust in the OB to make decisions about interventions during delivery that are not clouded by his (or the hospital’s) fear over malpractice lawsuits.

            I haven’t come to any firm conclusions..

          • Bombshellrisa

            What specifically are you afraid will be done that is unnecessary? I can tell you that a small intervention early on can save having to resort to a bigger one later on.

          • guest

            Too risky and huge payout if there is a lawsuit and the MD loses. And we all know insurance companies are all about minimizing risk.

          • AlisonCummins

            That sounds like you are planning a homebirth but will consider a hospital birth if your least-trained, least-experienced provider insists on it.

            By your rationalization of “planning” vs “considering,” you won’t have planned a homebirth until after the baby is born at home because at any time during labour you might decide to transfer to hospital care and your baby might be born there. Does the OB, his insurance company, his hospital and their insurance company all accept this understanding of “planning” vs “considering”?

            If this is not your understanding, at what point before the birth of your child are you going to tell the OB you no longer require his care?

          • AlisonCummins

            Since your CPM is uninsurable (because she is so underqualified that no insurance company would underwrite her, and if they did her fees would be many times the cost of a hospital birth) you will sue the OB and the hospital for damages if your child is one of the 0.21% of babies who die during a planned home birth or the 3.5% of babies who suffer permanent, preventable brain and organ damage during a planned home birth.

            If you don’t have an OB then you cannot sue your OB. You will still sue the hospital if you show up with a dead or compromised baby that they can’t resuscitate or rescue from permanent disability, but you can’t sue a nonexistent OB.

            And you will sue. Not because you are a vengeful person but because if you don’t have the money to pay for a hospital birth then you definitely won’t have the money to care for a disabled child.

          • AlisonCummins

            Can you reconcile your statement that your OB did not ask your wife to be discreet about the fact that he is comanaging a planned/considered homebirth, with your statement that his “friendly” relationship with your CPM is hush-hush?

            Who said “hush-hush”?

          • Matt

            Me, I said that.

          • AlisonCummins

            You made it up?

          • Matt

            It is a figure of speech, not a direct quote. Unfortunately, people use quotation marks when communicating both direct quotes, and figures of speech. Sorry, I know it’s confusing.

            The OB said he is not supposed to know that we are considering homebirth as an option, and that if he did know, he would have to discontinue giving care to my wife in the meantime.

            That sounds totally backasswards to me. No, I don’t remember what exact words were stated. Maybe if you divulged your reason for splitting hairs over that comment, I could give you more pertinent information.

          • AlisonCummins

            Thanks for clarifying. I’m not trying to split hairs, I’m trying to understand. “Hush-hush” is a figure of speech meaning we don’t tell other people. It doesn’t mean we don’t tell eachother. It sounds like you meant “wink-wink”?

            Ok, so your understanding is that your wife’s OB has asked her to lie to him. The CPM doesn’t lie and is completely open about the fact that she is comanaging a homebirth with the OB. The OB, however, will lie in court and deny up and down that it ever occurred to him that you might be planning a homebirth. By doing this he will attempt to keep his insurer and prevent you from getting an insurance payout if you ever need one.

            Have I got this right? It doesn’t seem to me that you are getting optimum coordinated care or any kind of insurance protection in the case that

          • AlisonCummins

            … in the case that your child (or wife) suffers a preventable injury during a homebirth.

            Personally I would refuse to work with anyone who asked me to lie, under any circumstances. I would not hire someone who wanted me to lie and I would not work for an employer who required me to lie. Not just because of my extra-special touchy-freely ethics but because that’s a good sign I’m about to get fucked. And not in a good way.

            I’m trying to pin you down on who said what because it might not be the OB who asked your wife to lie. Is it possible that the OB said, “I can’t care for you if you’re planning a homebirth” and that the CPM said, “ayes, the insurance companies make him say that ,” implying that it’s not a serious requirement when really it is.

            It might make sense to try to get some clarity from the OB and the CPM.

          • Matt

            Yes…l suppose *wink wink* would be a more appropriate term.

            How would you suggest we go about getting optimum coordinated care?

          • AlisonCummins

            If it were me, I’d either drop the CPM (if she were the one insinuating that the OB wasn’t serious when he said he couldn’t care for me if I were planning a home birth) or switch OBs (if he were the one telling me to lie to him for his protection) and then drop the CPM.

            That would be me. It doesn’t sound like that’s an option for your family, so what would work for me isn’t relevant for your circumstances.

            Is in-hospital birth with a CNM an option in your area? Have you asked the OB who can help you determine whether you are eligible for any kind of public insurance?

            However your family decides to proceed, I strongly urge you to find out who it is who thinks the truth is fudgeable.

          • Bombshellrisa

            Drop the CPM, find a hospital based CNM and find out what options you have for insurance assistance and call the billing department of the hospital after the baby is born and talk that bill down. I have seen people without insurance have hospital births and get the bill down to less than $3000. Also take a tour of the hospital and ask to talk to the nurse manager of L&D. Knowing the person you will want to talk to about any concerns with your care can be reassuring.

          • AlisonCummins

            If your wife were asking for my opinion (which she is not) I would urge her to give birth the first time in a hospital and then think about homebirth for a second if the first went well. Second births are typically easier than first births even if the first time was a little tricky, and your wife will know how her body feels when things are going right (or wrong).

            If in-hospital CNM care is an option I would urge her to consider that option for your first child. To me, that would be your best option for coordinated care with a midwife. Then when it’s time for the second you’ll have direct experience of both “the system” and birth and you’ll be better placed to make decisions.

            But it’s not up to me and your wife isn’t asking me. You’ll make your own decisions. Even if you have an unassisted childbirth at home your wife and child will probably both be fine. You only need expert assistance when things aren’t fine, and when things aren’t fine is w

          • AlisonCummins

            When things aren’t fine I don’t want an expert in ‘normal birth’ (things are fine) I want an expert in 1) proactively making sure things will be fine [so, someone who might suggest I reduce my risk of c-section by choosing an elective induction and then supporting my choice either way] and 2) reactively getting the baby out NOWNOWNOW if that turns out to be needed.

            When things aren’t fine I don’t want a CPM and when thing are fine I don’t need a CPM — my cat could attend the birth.

            So, clarity in goals I think is what you want. And being fully prepared for all risks, including low risk of injury but insurance when it happens vs high risk of injury and no insurance to help care for an injured child. As long as you understand your risks, your choices are yours.

          • Bombshellrisa

            Does this sound like a page out of “From Calling to Courtroom”?

          • This is late to the party, but it makes sense to me that an OB could be dropped for comanaging a homebirth. I work in insurance, though not medical insurance, so I understand the basic principles.

            Insurers, like all businesses, want to turn a profit. That means that they want to insure you only for risks that are unlikely to happen or won’t be too costly if they do happen. That serves you too, since it makes your premiums affordable. OBs are already really expensive to insure, because dead or injured babies are very expensive payouts especially if there was any smidgen of a hint of medical malpractice. That’s cold, I know, but that’s how it works. In fact, no insurer would ever take on an OB except that it is in the public interest that OBs have malpractice insurance. So what they do is they form a high-risk pool and divvy up the OBs by company so that everyone has to take on the ‘bad risks’ equally.

            Homebirths are even riskier than hospital births by a lot. The actuaries looked at the numbers from homebirths and said, nuh uh, no way, that will cost us a lot of money. We can’t make premiums on that kind of risk affordable, and we will have to pay out a lot because homebirths are always substandard medical care, so the provider will always be found legally liable for bad outcomes. So they don’t insure homebirths at all. If you have a homebirth, and if something goes wrong, you can sue your OB for millions of dollars if he cleared you to have the homebirth. Insurers do NOT want to pay that out, so anyone who does such a thing will find it impossible to find insurance in the future because they are doing things the insurer explicitly said weren’t allowed.

          • Bombshellrisa

            Matt-why seek care from both a CPM and OB? If you are sure your wife is low risk and the CPM is such a great choice, then why not just continue seeing the CPM? Someone else posted about seeing both a CPM and OB but couldn’t explain the rationale.

          • Matt

            Because if it were totally up to my wife… she would be seeing the CPM only. My influence so far has been to keep the OB in the picture.

            Which also explains why the continued accusations and mischaracterizations of me flying around here (I see you have toned it down) are largely baseless.

            Normally, that would just be rude behavior. But coming from a group of supposed skeptics seems particularly questionable.

          • guest

            Many people on this site have tried to be helpful to you, yet here you are again complaining about “mischaracterizations and accusations” from us. One thing about this site, is your comments, opinions and questions won’t be deleted (unless they are racist, or otherwise outrageous and inappropriate) and you won’t be banned. Try challenging someone on a pro-home birth website and you will be kicked off in a New York minute. If you think we are rude and accusatory, and our behavior is “questionable” why do you continue to engage with us?

          • Matt

            Because *some* people have been helpful. That’s why.

            I’m glad these comments won’t be deleted. They stand for themselves. Go ahead and look and you will find one person after another making sweeping generalizations and assumptions, about who I am and what I believe, and then not even having the decency to apologize when they are shown to be wrong.

            You like evidence right? Go ahead and look for yourself. Or else take my word for it, and stop being such an ass about it. Or if you are going to continue being an ass, at least write your name with your posts. That would be a decent thing to do.

            O

          • guest

            Well, now you’ve resorted to name-calling. I think DiomedesV was right, quoted from the post:

            “I suspect what really gets to you is people who know a hell of a lot more about a subject than you do — and are willing to say so”

          • Matt

            Yup- you are right… I sure did. Writing about somebody in the third person, as if they are not there reading the comments is pretty much being an ass. Sorry, I don’t have any case-control studies to back that up… so it’s just my layperson’s opinion. I hope that’s alright to share here.

            No, actually that is yet another false assumption from DiomedesV.

            I actually like talking to people who know a hell a lot more about a subject than me… so long as they don’t condescend in the process, or become offended if I question them.

          • guest

            So, now I’m saying them directly to you without re-writing them all. I’m with DiomedesV, I’d much rather try to help someone who is interested in availing themselves of the excellent medical care this country offers. It’s too tiring trying to convince people who think otherwise.

          • MaineJen

            No…I think we can say for certain that *none* of your posts will be deleted, Matt. They will be here for everyone to read, for as long as you want. I have spent the past few days reading through them and, indeed, the way this discussion has unfolded has been quite illuminating. Just not in the way you think.

          • Bombshellrisa

            Is she picking the CPM because she wants to try and keep the expenses to a minimum or is she convinced that a natural birth is best? I don’t think anyone is accusing you of anything, although I see why you might think so. When partners don’t agree on the type of healthcare professional and level of care needed, it can be hellish for everyone involved. Personally, I get prickly about guys who insist on natural and home births and who say it’s because of “unnecessary interventions”. I was hired as a doula more than once by couples who read having a doula reduces your chances of interventions. 75% of the time it was pressure from the partner, not the pregnant woman, to avoid these.
            I have also seen laboring women be bullied into “toughing it out” at home when they want to transfer to the hospital for pain relief. It cost too much and insurance won’t pay all of it, their partners reminded them. Not to mention the fact that “they will cut you cause they don’t want to be sued”. You haven’t seen a perfectly low risk woman labor within reasonable limits with no complications only to deliver a stillborn because the midwife couldn’t tell she was listening to the mother’s heart rate, not the baby’s. Just yesterday I had to listen to someone call me and tell me that she transferred to the hospital after 40 hours of labor and 8 hours of pushing and insist she was “threatened with a C-section”. Supposedly all is well so she says that it would have been unnecessary to have a section.

          • Matt

            Look- I appreciate your comments and attempts to be helpful. You are one of the people who have been helpful to me.

            But continuing to deny and/or defend your cohorts’ behaviors here is pointless. Go ahead and look for yourself, and then tell me again that nobody here has been throwing shadows and projections at me.

            I have had to defend myself against varied accusations of being one of the “homebirth crowd.” It was declared several times, by several people, that I claimed homebirth was safer then hospital birth. The claims persisted even after I made *crystal clear* that I did not believe it.

            There is at least one individual- inaptly named “Guest” who has proceeded to talk about me, as if I am not even in the room reading the comments.

            And what is the worst of it all- so far not one person- not a single person here- has stepped up and acknowledged in the *slightest* fashion that anything is amiss with this kind of behavior.

            Anyhow… to clear out hopefully the remainder of your fears… it is not me who is insisting on the homebirth. I am fine with a hospital birth with an OB I can trust. Yes, I am concerned about unnecessary interventions, but I feel confident in my ability to navigate those kinds of conversations.

            I am most definitely concerned about recommendations for a c-section where the OBs concern about being sued seems to be clouding their judgement about what is best for the patient.

            And apparently, Dr. Amy shares these concerns since she wrote about them in her very first post here.

            Yes, cost is a concern. But it is not the only concern. She could get a new plan that covers pregnancy and delivery. But for $2500 more a year, she’d still have a $5000 deductible. I’m just not sure if that makes sense to pay $2500 more every year to avoid paying $10,000 more next year.

            These are numbers we can work with. We can afford to pay cash at a hospital. Unfortunately, trying to find some reliable information on what it really costs is proving exceedingly difficult.

            Yes… adding on procedures that aren’t necessary is not only a health concern, but a money concern. I’m sorry, but I don’t agree that running up hospital bills “just to be safe” makes sense in all cases, at all times. Sorry, I just don’t.

          • Guestll

            Hi Matt, would you please elaborate on what constitutes “unnecessary interventions” ?

          • Matt

            Actually, it might be more instructive if you elaborated.

            Here in slide 30 of this CDC presentation:

            http://www.iom.edu/~/media/Files/Activity%20Files/Women/BirthSettings/6-MAR-2013/Chervenak%20PDF.pdf

            “Obstetricians should learn to avoid unnecessary interventions.”

            What do they mean there by “unnecessary interventions”? And why are there obstetricians out there delivering babies who apparently require more instruction on this?

          • Guestll

            Actually, I am genuinely curious as to what you believe constitutes an unnecessary intervention. I can only speculate as to the authors’ definition since the term doesn’t appear to be defined in your link; since I am not a medical professional, my opinion would not be instructive.

          • Matt

            I am taking the word at face value… if there is some specialized definition that is more applicable, maybe somebody here who is qualified to comment can do so.

          • Guestll

            Okay, but that is at odds with your statement above: “Yes, I am concerned about unnecessary interventions, but I feel confident in my ability to navigate those kinds of conversations.”

            So you have already defined or have an acceptable definition of what constitutes unnecessary interventions, to the point where you feel confident to navigate those kinds of conversations…but you cannot or will not define your parameters here?

          • Matt

            That is because I am trying to better define the parameters in my mind, not because I have already decided what they are, but don’t want to disclose them.

          • Guestll

            How can you be confident in your ability to discuss something you have not yet fully defined?

            Even if you haven’t fully arrived at your parameters, can you share your criteria?

            I will give you an idea as to what I used to believe was an unwarranted intervention — postdates induction. As term pregnancy is generally defined with parameters of 37 to 42 weeks, I held the belief that induction prior to 42 weeks simply because the baby was “overdue” was unnecessary. Additionally, I know many women who’ve gone to 42 weeks and beyond, with good outcomes. I have since revised my opinion on this subject, based on personal experience and the facts on morbidity and mortality.

          • Matt

            What I mean is that I feel confident in navigating through an offer for intervention.

            My understanding is… an intervention will be offered at the moment that an indication arises.

            But that doesn’t necessarily mean that the offered intervention is what that self-same doctor would choose for themselves, in the same circumstances. It just means they are ethically obligated to offer it. The patient can either accept or reject the intervention.

            The doctor may or may not agree with the patient’s decision… but the malpractice risk to the doctor of recommending against an intervention, and have things go poorly is a confounding factor that I am not sure many patients realize.

            The “sweet spot” so to speak is to be able to navigate in that space between when an intervention is offered because it is simply indicated, and when the doctor truly feels it is the best choice.

            Unfortunately, in the context of an impending childbirth, there isn’t much time to hem-and-haw over these things.

            What I am attempting to discern between the strength of an indication for intervention… and how to correct for the C.Y.A. factor.

          • Bombshellrisa

            It would be unethical for a doctor to offer only what course of treatment they would prefer for themselves.

          • Matt

            Yes, I know. But when I get a recommendation, I would much prefer it to be… this is what I really, truly think is the most beneficial course of action. Not… this is what I am going to recommend because I’m scared you will sue me if I don’t recommend it, and something goes wrong. Do you see?

          • DiomedesV

            This is where the relationship you have and build with your care provider comes into play. The problem with OB is that most people go to a practice where they rotate through a few doctors and then are never sure who will be on call for them. In fact, because fatigue and exhaustion can impact decision making, you want the fresh OB to take your case when you go to the hospital. But it does mean that it can be difficult to fashion a relationship with that person.

            That is a limitation and I think that is where the allure of CP-midwifery comes into for a lot of people, but you have to understand that conveying a sense of positive certainty is not the same as being right, or showing good judgment. In that sense, I would rather get a few options, followed by my pointed question of “what would you recommend for your daughter…”, for example, than deal with someone who is positively certain of something that they know less about, and whose training is sufficiently deficient that they don’t know what they don’t know.

          • Matt

            So how does a woman- with no post-secondary education in science- even attempt to engage an OB with the “right questions” and “build a relationship” over a few awkward 7-10 minute visits, many with her legs spread open?

            How exactly is that trust supposed to be built?

            You say: “conveying a sense of positive certainty is not the same as being right, or showing good judgment.”

            I agree. But isn’t that “sense of positive certainly” exactly what is being asked of the public by the medical system? Shouldn’t we all just “trust the good doctor”… look they have a fancy diploma and work in a big hospital! *wink wink*

            Given your previous comments elsewhere, along with the plentiful examples we can think of where MDs acted in poor judgement and/or poor ethics… by what merit does the profession have to command such unquestioning respect from the public?

            Or more specifically, why should an Internet passerby happening upon this here rant by a retired OB think to themselves, “Oh yes, this looks like a highly credible individual whose opinion I should accept without questioning ?”

          • DiomedesV

            First, no one here has said that doctors should command unquestioning respect from the public. And no one has suggested that anyone take Dr. Tuteur position without questioning. You questioned… but ineffectively. You didn’t challenge the content, just her right to an opinion.

            I believe there are resources where patients can learn how to ask their doctors questions and build a relationship. Probably other people who practice can suggest some.

            Second, how let me flip that around: “how does a woman with no post-secondary education in science decide that she can trust the clinical judgment of a practitioner that refuses to get the minimum level training required of midwives in all other developed countries”?

            Finally, yes relationship is important and making your concerns known is important and getting a second opinion, blah blah blah…. but we’re talking about two choices here, and one is associated with starkly worse morbility and mortality outcomes for babies. Not sort of worse… much, much worse. Levels of mortality and morbidity worse than other stats that are sources of concern in other countries. Of course, if neonatal morbidity and mortality are not your only outcomes of interest then I guess you’ll just have to decide where they weigh in the grand scheme of things.

          • DiomedesV

            Honestly the vast majority of women in the US are satisfied with their OB care and their experiences in the hospital. Even Lamaze International has had to admit that. And yet, the vast majority of them also have no post-secondary education in science. How do you think they manage it? Are you implying that a doctor can’t care well for someone who isn’t constantly checking their work?

          • AlisonCummins

            But you think that just anyone is qualified to choose a competent CPM?

            If your doctor does not inspire trust, switch doctors. Anyone knows if they dislike someone. It doesn’t take a post secondary science degree to know that.

            See another doctor. Any doctor. You may not get the very bestest most perfectest doctor this way, but the odds are overwhelming (not certain) that you will get good-enough care.

            If you see a CPM in the US, no matter how nice she is the odds are overwhelming that you will get bad care. You will probably still have a healthy baby, but not because of the CPM. She simply does not have the experience, training or resources to provide good care. She just can’t.

          • Bombshellrisa

            Please explain why you believe that a suggested form of treatment is offered more to avoid being sued then because it IS the best course of treatment. It’s always the choice of the patient to refuse treatment, as long as they understand what can happen if they do. So when a doctor “plays the dead baby card”, it’s to let you know that refusing the treatment might result in the death of your baby. Or injury that will leave them profoundly disabled. It might seem like they are just trying to cover their behinds, but it’s about treating women and their partners like adults who can comprehend the domino effect their choice to refuse can cause.

          • MaineJen

            And if the OB doesn’t recommend it, and something DOES go wrong, and the child dies or is profoundly damaged…isn’t that a worse outcome than, say, having to get an IV? Having to do continuous monitoring? Having the labor augmented? I don’t know what specific recommendations you are scared of, or that you think the docs will recommend for no good reason. But just think about WHY people sue health care providers. It’s because something bad happened, right? So just maybe, what a doctor recommends to you is what he/she feels is likely to lead to the best possible outcome.

          • AlisonCummins

            No, I don’t see.

            If my doctor is trying to keep my baby alive and healthy on the most dangerous day of its life, and is therefore very risk-averse … well yay, because our priorities are aligned.

            If you care more about some other outcome than a living and healthy baby, then you will not be nearly so risk-averse. You need to communicate your priorities clearly.

            “I want to have twenty kids, so it’s more important to me to keep my uterus unscarred for future childbearing than to keep this particular child alive. Do what you need to do, but no c-sections.” The doctor can document the conversation in your file.

          • AlisonCummins

            No, I don’t see. Bombshellrisa points out that the OB has an ethical obligation to offer patients a range of choices so that the patient can make the choices most aligned with her own priorities. Doctors offer pain relief because that’s what they would want for themselves and it’s what most patients want, but if a patient declines it that’s fine too.

            You say you agree, but then you say you believe that doctors secretly know what is best but are refusing to tell you and that you have to guess. So you would be happier if doctors did not offer choices, but required all their patients to have epidurals because that’s what they would want? Or something?

            No, I really don’t see. Are you aware that OBs are the group most likely to deliver their own babies by maternal request c-section? If your own OB delivered her children by c-section at Week 39 because she believed

          • AlisonCummins

            … because based on her knowledge and experience that’s what offers the best outcome for both baby and mother, do you think she should then tell all her patients to do the same? Or do you think she should lay out the risks and benefits of different options and let her patients choose what suits them best?

            Your OB is not going to suggest something bad or dangerous. If it’s offered as an option then it’s perfectly reasonable to accept. If it sounds terrible, say that it sounds terrible and ask why they are offering. They will explain.

            I really don’t see the guessing game you think you are playing.

          • DiomedesV

            You can talk to your doctor about your concerns before hand. Mention your desire to avoid a C-section, if that’s important to you. Mention that no matter what happens, establishing breastfeeding immediately is important to you, if it is (I really have no idea, and I don’t care, remember? 😉 ). It’s always better to be upfront about your concerns and keep engaged in a dialogue than to stew about the lack of communication while not doing something about it…. see what I’m saying?

          • AlisonCummins

            Yes, that’s why people keep pressing you for specifics. Not to accuse you but so that you’ll look more closely.

            Lots of things feel self-evident but when we think about them carefully they aren’t, and then the whole conversation changes.

          • Bombshellrisa

            Sometimes I wish informed consent showed a video of a shoulder dystocia, a true resuscitation and what a PPH looks like.
            Because at this point, we could argue that just seeking care during pregnancy is an unnecessary intervention if everything turns out well in the end. Isn’t that how it’s always diagnosed? Since nothing ended up being wrong, it was unnecessary? I could argue the antibiotics I got during labor were technically not necessary, since my GBS status was not known.

          • AlisonCummins

            What does the CDC mean? Do they define it? If they don’t, is the presentation meaningful?

          • Amy Tuteur, MD

            Matt, I could almost feel sorry for you.

            You came here loaded for bear, prepared to argue with professionals based on what you had learned from the echo chamber that is the world of natural childbirth, which I’ve described elsewhere as an alternative world of internal legitimacy (http://www.skepticalob.com/2012/04/alternate-world-of-internal-legitimacy.html). You came with the intention of schooling us and you came thoroughly close-minded with the intention of proving the correctness of your beliefs.

            You’ve had your head handed to you on a platter. On the one hand, you are to be commended because you’ve have stuck with it. On the other hand, it seems that you have stuck with it because you don’t truly understand what is being said to you.

            As I told you before, you have no idea what you are talking about and no intention of learning about your deficiencies. You are committed to homebirth despite arrangements that ring all sorts of alarm bells.

            If you truly wanted to learn you would have come to one obvious conclusion right away: you’ve been bamboozled by natural childbirth advocates, who make their money by preying on people like you. You would have realized that there are gaps in your knowledge wide enough to drive a tank through and you would have asked yourself why, in all your reading on homebirth, you never came in contact with that information. But instead, you are still desperate to confirm what you already believe about the “safety” of homebirth.

            I wish your wife luck with the homebirth. If anything goes wrong, she’s going to need it since the uneducated clown whom you hired is certainly not going to be able to prevent or treat a real disaster. You are gambling your baby’s life, and fortunately the odds are in your favor. But if everything turns out okay, it doesn’t make you smart; it makes you lucky in the exact same way that someone who drives drunk and doesn’t kill himself or others is lucky.

            Ask yourself, Matt, is there anyone who claims homebirth is safe who doesn’t profit from it in some way, either monetarily or by bragging of their own superiority. If the answer is no, and it is, give serious thought to the idea that you are being bamboozled and your baby may pay the price.

          • Matt

            It is truly astounding to me how many times on your comment above you can continue to tell me:

            1. What I already knew (or thought I knew) coming here.

            2. What my intentions were.

            3. How close-minded I am.

            4. That I now- or ever did- believe that homebirth is safer.

            5. What my desired outcome from this experience is, and my level of “desperation” for it to be a certain way.

            You keep making these claims… and no amount of evidence or experience to the contrary seems to cause you to question your assumptions. Instead, you just keep digging your heels in!

            Apparently, you are unwilling or incapable of seeing how similar this behavior is to those behaviors among the homebirth advocates that you are apparently railing against.

            Do you really think I would continue to persist in denying these kinds of allegations if they were actually true? What would I possibly have to gain from that?

            The reason I persist is because: 1. A small minority of the commenters here have actually been helpful, and 2. The hope that you might actually reflect upon your so-called writing “style” and if it is truly resulting in the outcome you are seeking with this blog.

          • Amy Tuteur, MD

            QED.

          • Matt

            QED indeed. Actually, I already read those posts, but that was after this one. I don’t have any argument against them. But I suspect you will find some way to take whatever I say and twist it to conform with your preconceived notions about me.

            Again… I didn’t know anything about the film before I saw it. I wasn’t fed any propaganda about it. I just watched it.

            I watched it in the same manner that I watch most documentaries… it went something like this…

            blah blah blah… Dr. Blaser… blah blah blah… Dr. Dietart… blah blah blah Dr. Modi.

            I never cared about the “agenda” behind the the film… I knew nothing about the filmmakers when coming to this blog.

            In fact- I came to this blog because I had searched for “microbirth” to learn more about the background to the film, and it came up high in the search results.

            What I *thought* I might encounter in this post was a bona fide skeptical view of the ideas presented by the researchers interviewed in the film.

            What I *found* was a rant against exaggerated claims made by advocates of the film of what those researchers said. But you see… I don’t care what “advocates” have to say about the film… I only care about what the researchers actually said.

            Anyway.. I will try to wrap up my side discussions with the people in this thread who were actually *helpful* to me, and leave you and your followers to attend to your metaphorical beheadings.

          • Amy Tuteur, MD
          • Bombshellrisa

            I am not talking to them, I am talking to YOU. I don’t have to take any notice of or responsibility for anyone else commenting here.
            I read your comment about the child with allergies that you believe had something to do with their c-section birth and the fact that they were not breastfed. I read that you are concerned about tests and procedures being done that are absolutely necessary. It doesn’t make me believe that you don’t understand that there isn’t some risk to the path you and your wife are choosing, it’s that it seems that you are more concerned about interventions and c-sections being done with an absolute, 100% guarantee that it’s necessary.
            As for the money part, I have been dirt poor and on Medicaid and privileged with a great insurance plan. I urge you to see what is available through the state. You can even apply after the baby is born, because if you are approved the start date will be from the time pregnancy was confirmed and everything is covered from that date. It didn’t seem reasonable to shell out $400 (what we were responsible for) for a free fetal cell test to rule out a condition I only had a 1:392 risk of having but when you realize your child’s future (and your own) hinges on knowing so you have a plan in place, it’s a price you will pay.

          • Matt

            Because the CPM cannot order and/or perform the tests to maintain continued assurance she is low risk.

          • Sara

            “I would suggest: How about a guide as to how to avoid over-medicalization and unjustified interventions in a hospital setting?”

            For whom? Providers or consumers? When I had complications in my pregnancy I looked through the recent ACOG guidelines regarding gestational hypertension/pre-eclampsia and to me (as a consumer, not provider) I thought it was very helpful that they laid out the best approaches based on certain criteria, as well as the level of evidence supporting those approaches. To me, that’s exactly what you seem to be asking for, and its accessible to both providers and consumers to see what the decision making basis is for this set of conditions.

            The problem is, when you get into some groups that complain about “medicalized” birth, they do not turn to ACOG & obstetric science as a guide. Just going to a medical authority for advice medicalizes birth in some way. Cynicism about hospitals and the claims that hospitals and docs are doing nothing to reduce unnecessary procedures doesn’t meant that’s actually true.

          • Sara

            “The CPM we talked to wasn’t derogatory toward hospital birth. She didn’t insinuate it was a risk-free scenario.”

            If you make this statement to point out why your CPM’s approach was right, and Dr. Amy’s is wrong, that kind of fallacious tone argument doesn’t really mean anything.

            It doesn’t change the fact that preventable infant and even maternal deaths occur in the unregulated homebirth midwife industries in the US and elsewhere. It doesn’t change the fact that these deaths often occur with no retribution, very little proper investigation and that CPMs and their organizations often rally around the “persecuted” midwives whose clients have died and charges actually have been brought against them.

            Just to add my own anecdote, my HB midwife also never spoke about hospitals in a derogatory way during my prenatal care. No, no, no, she thought hospitals were wonderful. She had given birth in hospitals. She knew ob’s that she loved and all of that.

            But when I actually ended up in the hospital because she didn’t take my labor signs seriously and didn’t show up, she told me over the phone “I thought you wanted a homebirth. Now that you’re at the hospital, they’re going to want to cut you.” Wonderful thing to tell a first time mom who is already terrified of hospitals, right?

            I’m sorry, but a little bit of justified outrage on Dr. Amy’s *blog* is a lot better than a CPM who, in the course of her professional practice, lies about her relationship with doctors and hospitals, shirks her duties and then turns around and attacks her client(s) in their most vulnerable moments.

          • DiomedesV

            Then you must really hate Orac’s blog, huh? I suspect what really gets to you is people who know a hell of a lot more about a subject than you do — and are willing to say so.

            Dr. Tuteur is not a practicing medical professional. And her tone gets results. I’d suggest that it’s one of the reasons you’re still here.

            Finally, you overestimate my interest in your personal life, your reasons for choosing homebirth, or even the outcome. Many of the commenters here care about people like you. I don’t. I don’t waste a lot of time worrying about the tiny percentage of people who are willing to reject excellent medical care on the off-chance that the worst possible outcome won’t happen to them. I’m here because I don’t like to see the creep of this garbage into the level of care that’s offered to the overwhelming majority of women in this country– women who don’t think an otherwise perfect vaginal birth is a reasonable trade-off for a dead baby.

          • Matt

            LOL- Really DiomedesV if you don’t care about me or my personal life, that is totally fine with me. But then why continue to make characterizations about me?

            I notice a few people here claiming that Dr. Tuteur’s tone is successful at achieving her aims. But all I see is a couple of anecdotes. Does anybody have any evidence to suggest that speaking to people in this way is actually more effective than using a more civil tone? Do we really know that the benefit outweighs the risks?

            Or do we keep just rallying around a pathological behavior because we want to reinforce our preconceived notions about how we should be treating people?

            You know… some years ago I was on the other side of this kind of situation. I was one of the ones attacking and justifying my behavior publicly to others. When somebody suggested that I and others were actually just being bullies, I got really pissed and defensive too.

            Do you know why I was so pissed and defensive about it? Because he was right.

            So anyway, thanks for the conversation. You are one of a small handful of people here who have actually been helpful.

            Your calm explanation of facts, willingness to consider my questions, and to behave differently from the rest of the herd is why I’m still here. So just in case you really -do- care just a teensy weensy bit, thank you.

          • Matt

            No… let’s see here are the stats:

            Total Births Attended as Midwife: 419
            1st time mothers: 86 Repeat mothers: 333

            Reasons for Transport of Referred Care (54)
            No progress in labor (25)
            Non-reassuring fetal heart rate in 1st or 2nd stage (11)
            Preterm births (3)
            Requested medication (3)
            Posdates w/ non-reassuring heart tones (2)
            Pre-eclampsia developed at term (2)
            2nd degree tear for suturing (4)
            Placenta covering cervix (2)
            Retained placenta (2)

            Reasons for c-sections (19)
            Mal-presentation with big baby (9)
            Malformed uterus (3)
            Cord issues (4)
            Acute toxemia (1)
            Placenta previa (2)

            Newborn deaths (1)- 3 days of age with congenital heart and lung defects

            Maternal deaths (1)- 33 weeks pregnant with PE

          • Bombshellrisa

            419 births over how many years?

          • Matt

            11. With an additional 102 in 3 years as an apprentice/assistant to another midwife, and 87 in 13 years as a doula (the timeframe overlaps with her midwife experience.)

          • Bombshellrisa

            Ok-so broken down that is about 38 births a year, 3 a month. Remember how you asked why I felt that it’s more likely a CPM would miss signs and symptoms during labor? It’s numbers like that.

          • Matt

            What sort of numbers would you prefer to see? And why?

          • Young CC Prof

            A hospital midwife or obstetrician attends several births a week. And one maternal death out of less than 500 patients is shocking! The national average is one death in 10,000. One death out of 500 babies WITH preemies all risked out is pretty scary, too. The overall neonatal death rate is about 1 in 500, but 2/3 of those are caused by complications of prematurity.

            Like most home birth midwives, she’s attending the healthiest of women and getting terrible outcomes.

          • Bombshellrisa

            An average OB will deliver (on the low end) about 250 babies a year, about 20 a month. This doesn’t include the hospitalist OBs who only deliver babies (they work in L&D exclusively) so their numbers will be different. It’s about keeping up your skill, keeping yourself sharp so you can spot things before they become crisis situations.
            As others have mentioned, the numbers suggest this midwife doesn’t risk out women from her care.

          • Matt

            If I understand the terminology you are using correctly… she “risked out” 53/419, or 12.6% You are saying it should be higher? Such as what number?

          • Bombshellrisa

            Let’s leave the numbers out of it for a minute. She didn’t transfer care for women who needed a higher level of care than what she could give. Heart and lung defects? Something that is looked for at the 20 week ultrasound and if they are found, another more detailed ultrasound is done and then you consult with a mfm and they will usually be consulting along with a high risk OB for the rest of the pregnancy. Not a midwife. Placenta previa is always looked for at the 20 week ultrasound, also something an OB is consulted for. Same with a woman who has a bicornate uterus, even though I know a lot of CPMs will still care these women.

          • AlisonCummins

            40% for first-time mothers. 25% for second or subsequent births if the first birth and pregnancy had no complications.

          • fiftyfifty1

            Wow, substantially worse than average for neonatal death rates, and extremely bad for maternal death rate. Proper prenatal care can identify many women at risk for PE and prevent clots by proper anticoagulation. I also note that she does not mention the outcome of the baby of the woman who died of PE. Likely it was death. Why doesn’t she report that in her stats too?

            These are really bad numbers, and especially sad because her CS rate is not much below what you would expect for a population of mostly multips. A low risk multip has only about a 5% chance of having a CS in subsequent pregnancies. So you put yourself and your baby at very high risk of a bad outcome, and what does it get you in return? Not much.

          • Bombshellrisa

            Omg I just saw the infant death from congenital heart and lung defects-which should have been diagnosed during the anatomy scan, right? Which means a maternal fetal med should have been caring for this woman, not a CPM

          • moto_librarian

            When did she actually refer patients? That is a huge issue, particularly in regards to post dates, placenta previa, and pre-eclampsia. Finding out how quickly she realized there was a problem is key here.

          • Matt

            I don’t know. I’m not sure how to ask without going through every single case and making a distribution graph… LOL Any suggestions?

          • Bombshellrisa

            Pre-eclampsia: “So if my wife’s blood pressure starts to spike, do you want us to see the OB for blood work and a consult?”
            You mentioned she was comfortable with going ten days past the due date, after that, ask her if she transfers care to an OB for a non stress test and consult about inducing. Does she suggest drinking raspberry leaf tea, using evening primrose oil, blue or black cohosh or castor oil to do a “natural induction”? It’s worth asking about

          • AlisonCummins

            Between 5% and 10% of pregnant women in North America and Western Europe develop preeclampsia or eclampsia. Still, women in these countries have access to adequate care so only about 1 in 100,000 of them die of it. Your CPM clearly was either very, very, very unlucky or… offered inadequate care.

            Your wife wants to bet her life that your CPM just had very, very, very bad luck?

          • guest

            Did you expect a warm welcome and a walk on a carpet of roses when you came in with “fists flying”?

          • DiomedesV

            Just looked at the paper…

            Isn’t the absolute risk reported in Table 2? They may not have chosen to report one absolute risk because they look to have had two low-risk hospital birth cohorts, those attended by OBs and those attended by hospital midwives. Looks like the absolute risk in the hospital for a low risk birth attended by an OB (which is a larger population and thus more reflective of care in the US) is 0.16/1000. The absolute risk for a homebirth for all groups attended by CPM is 1.63/1000. (Per 1000 is typical reporting for risk in medical contexts.)

          • DiomedesV

            It’s interesting, too, that the absolute risk for patients treated by OBs doesn’t seem to change by parity or other subgroup, which implies to me that overall, babies delivered in the hospital in the US have access to the best care possible when it comes to resuscitation. For babies born anywhere else, it’s basically a crap shoot.

          • Young CC Prof

            The risk of neonatal death for hospital born babies doesn’t vary by parity. It does vary enormously by gestational age, size of course, and, to a lesser extent, by race, maternal age and maternal marital status.

            With out-of-hospital birth, parity is a HUGE risk factor for neonatal deaths, and if you break it out by cause, most of the excess is labor complications.

          • DiomedesV

            So do the risks reported in this paper lump death and brain injury together? I’ve never been quite certain on that score.

          • Matt

            That’s a good question… and then what about the outcomes? How many of the babies that are resuscitated get discharged with a clean bill of heath? How many of them end up dying in the NICU or within the first year of life?

          • DiomedesV

            I don’t know (and other people here do), but I do know that, per the Grunebaum paper, if a baby is born with an APGAR of 0 far from qualified personnel to resuscitate him/her, their prognosis is as grim as it can possibly be. I guess if a parent doesn’t want to deal with an injured baby at all though, maybe that suits them.

            By contrast, as an example, I heard a few days ago of a term baby born in hospital with APGAR of 1 (VBAC uterine rupture, placental abruption, C-section within 5 minutes, so 5 minutes without oxygen). Worked on by nurses and neonatologist, APGAR increased to 6 after 5 minutes. Placed immediately in cooling treatment, after three days was nursing and in another day was discharged after a “normal” MRI (I say that because it is impossible to rule out long term effects, even if the MRI looks normal). That is the best-case scenario for a situation like that. That will never happen to a homebirth baby. Ever.

          • guest

            You are right. Even if the midwife is NRP certified, she still doesn’t have the additional people, equipment or drugs to effectively perform a complete resuscitation.

          • Young CC Prof

            There are several different papers. Some report on neonatal death, some report on Apgar 0, one studied the incidence of brain injury severe enough to require cooling therapy.

          • Matt

            But what is the difference in risk between babies of normal size and gestational age?

          • DiomedesV

            It is the difference reported in Table 2. From the Materials and Methods: “This study therefore includes only singleton term births (deliveries ≥37 weeks) and infants weighing ≥2500 g.”

          • DiomedesV

            You’ve also made a big deal about risk, relative risk, and absolute risk. But of course, risk and its increase is not the only thing you need to know. You need to know the severity of the outcome that is being risked. These are RR and AR reported for truly terrible outcomes. If this is your first baby, your AR for APGAR of 0 (not death, that’s something different) looks like it is somewhere between 2.40-19.96/1000 (taking the lower and upper bounds of the CI reported for first time moms).

          • DiomedesV

            *Edited to correct AR.

          • Matt

            Yes, of course you are right. I understand that… just trying to construct information piece by piece. Obviously… death or severe disability of the baby weighs differently than the risks of c-section.

            The range you calculated spans nearly an order of magnitude. That causes me to wonder how meaningful that particular result is.

            Also, am I correct in assuming that is among a general population? Are there known subpopulations with lower risk profiles?

          • DiomedesV

            The reason the range is so large is because 1) the numbers of patients are small, and 2) homebirth midwives cannot be relied upon to report their outcomes accurately. In fact, we know from other publications that CPMs routinely inflate their APGAR scores. The fact that they’ve reported an APGAR of 0 at all should actually impress you. And you have no reason not to incorporate the upper range of that estimate in your calculations of whether this is a reasonable risk. In fact, based on their tendency to assign APGARs of 10 when it is clearly unwarranted, the actual risk may even be higher.

          • DiomedesV

            I didn’t assume you were scientifically illiterate. I assumed you were intellectually lazy. More specifically, I assumed you had staked out an opinion on a subject on which you knew little and were desperately trying to justify your position without actually, honestly re-examining it.

            At the time you just looked like another gullible person persuaded by a documentary. But in fact, YOU scheduled a homebirth BEFORE you could even be bothered to look up, for yourself, the absolute risk involved. Then you came charging in here accusing Grunebaum et al. of obscuring the issue by not reporting something which I located in 2 minutes by scanning for the appropriate table.

            I’d say my assumption was correct.

          • Matt

            Well, your assumption was actually not correct.

            I had not staked out an opinion on the impact of mode of delivery on the microbiome and long-term health consequences. That information is not anywhere close to being known yet.

            I was thrown by Dr. Amy’s claim that there is *NO* evidence to support a meaningful connection, when there is in fact evidence. I’m not sure what your standard of intellectual laziness is, but if it means not reading and analyzing every potentially relevant study from cover to cover before I engage in a conversation about it… then I think that is a little over the top! 😉

            Somebody- I think it may have been you- made an argument for why a physician or scientist is within their right to say there is “no” evidence when they actually mean there is no convincing evidence, or some such other thing.

            Personally, I would call THAT intellectually lazy. It is speaking in absolutes, when the reality is not as black or white.

          • DiomedesV

            I have not staked out a final opinion on the impact of mode of delivery on the microbiome, either. When I see convincing evidence for it, I will change my mind.

            On the other hand, I didn’t make a choice about place of delivery without looking up the risk, or almost coming out and accusing researchers (Grunebaum) who know a hell of a lot more about that subject than I do of practically misleading people by hiding a piece of information that was included in Table 2 of their paper.

          • Matt

            The remainder of your assumption is not correct either. Firstly- I did not make a choice about place of delivery. I am a man. Secondly- I did already know about the neonatal mortality risk data long before I ever came here.

            Thirdly… my apologies to Grunebaum but I didn’t see that Table 2. Whatever it was that I looked at had a Table 2… but that wasn’t it. So that is why I asked about it. I would hardly escalate that post to an accusation.

            Grunebaum excluded, I still think it is intellectually dishonest of anybody… media, doctors, family and friends, etc. from spouting off alarming sounding relative risk data…. THREE TIMES! FOUR TIMES! TEN TIMES THE RISK! without concurrently mentioning absolute risk.

            It happens all the time… you might not see it because you are a scientist and presumably mostly conversing with other scientists.

            It’s kind of like… WHAT?! You’re going to jump out of an airplane?! Don’t you know that you are a bagillion times more likely to die from from skydiving, if you actually jump?!

            It’s sort of silly… and personally I don’t find that conversation productive for anybody involved.

          • DiomedesV

            Fair enough, although presumably a man has some influence over place of delivery.

            I agree that the media is egregiously terrible about this and it’s one of my pet peeves. In fact, the world peeve is an underestimate. Fellow scientists specialize more in presenting results to media and often come to me for examples of poor presentation. I never have a shortage.

          • AlisonCummins

            No convincing evidence *is* no evidence.

            As several people have explained, there are hypotheses flying around but there is no evidence they are correct. The hypothesis that c-section will damage humankind (or an individual) forever has exactly as much evidence as the hypotheses that it will improve humankind forever or that it will have no effect. That is, none. If you think there is microbiome-based evidence that a c-section will permanently harm your child, why don’t you think that there is microbiome-based evidence that it will permanently benefit your child? Why isn’t your wife talking to her OB about the possibility of a maternal-request c-section to assure your child the permanent benefits of the superior microbiome associated with c-section?

            Finally,

          • guest

            You’re right, I should have started by saying, “In my opinion”. Gee Matt, your wife is seeing a CPM and you are planning a home birth. It doesn’t take a brain surgeon to conclude you are supportive of home birth. Since you have posted statistics indicating home birth is NOT safer and you stated you already knew this, why are you planning one? If you and your wife are questioning your decision, good for you and I truly hope for her sake and the sake of your baby you decide on a hospital birth.

          • Bombshellrisa

            “But where does that lead? I mean… why not just run all sorts of genetic tests while a baby is still in the womb and initiate treatment then?”
            Genetic screening using free fetal cells can be done, depending on the test, from 8 weeks on. Just draw up a couple tubes of the mother’s blood and It can be screened for things like trisomy 21 and Edwards syndrome. Depending on a family’s medical history, there are lots of other things they can look for. It’s being offered by more and more doctors.

          • Stacy48918

            Matt, any time a patient presents with any problem there is a list of tests and treatments that may be “indicated”. Only once we have a diagnosis or outcome can we truly know which were “necessary”. You want all doctors to be omnipotent and know beforehand precisely which tests and treatments are “necessary” for every single woman and that’s not possible. Yes, unnecessary testing and procedures happen. Every day. But that doesn’t mean they were not indicated.

          • Bombshellrisa

            I agree that it’s unethical to impose ones own value equation upon another. Unfortunately, midwives have no issue with this, and in fact proved it by writing a book entitled “From Calling to Courtroom”. You see, they value above all else their “calling” and should a baby or mother be seriously injured or die in their care, you will see what they value is being able to slither away from taking any responsibility for what they have done. Some of the midwives who are mentioned have had multiple babies die with them as the midwife. All they value is being able to keep catching babies, even if they clearly should not be doing so. http://www.fromcallingtocourtroom.net

    • Young CC Prof

      Keep in mind that in countries with very different healthcare systems, the c-section rate isn’t a whole lot lower. You want a rate below 20%, you’ve got to look at a country where a lot of people don’t have any access to healthcare.

      • Matt

        What about countries that are much higher?

        http://www.npr.org/2013/05/12/182915406/c-sections-deliver-cachet-for-wealthy-brazilian-women

        “Brazil has one of the world’s highest rates of cesarean deliveries: Some
        80 to 90 percent of women in private hospitals in the country give
        birth via cesarean section. In some hospitals that number climbs to 99
        percent.”

        What do you think about that statistic? Is that fine with you? Why or why not?

        And what about this comment from the WHO:

        “he World Health Organization says more than 15 percent of women giving birth by C-section is too many. It cites increased medical costs and neonatal complications as potential problems.”

        Neonatal complications from c-section… but I thought it was totally safe!

        • Young CC Prof

          Most of Brazil’s c-sections are not medically necessary, and no one claims they are. It’s a cultural difference there, that women and doctors prefer cesarean birth.

          And that 15% only applies to countries without the resources we have. In India, for example, when a woman delivers by c-section, she may be forced to deliver her next baby without any real help, which is very dangerous. Here, we can provide a safe repeat c-section or carefully monitored trial of labor the next time.

          • Matt

            What about the neonatal complications from c-section. What are they? What is the incidence of these?

            Isn’t there something wrong with performing- or allowing- unnecessary medical procedures when there is a known risk?

            Why does this happen in Brazil and not here? Why do doctors “prefer” cesarean birth?

          • Young CC Prof

            If a woman is only having 1-2 children, scheduled c-section and planned vaginal birth are approximately equal in risk for both mother and child.

            Scheduled c-section is associated with a much LOWER rate of neonatal complications (and especially serious complications) than is attempted vaginal birth. The only complication that occurs at a higher rate in the c-section babies is something called transient tachypnea of the newborn.

            I would LOVE it if you wanted to learn more about these topics. It’s complicated, and it’s going to take a while, but don’t be afraid to dive in.

          • Matt

            I would be more than happy to learn more, and I’m certainly not afraid to dive in. I do have a college education. (Not that anybody asked.) Please post any resources you might suggest. Even a textbook would be fine with me.

            For some reason- which I can partially understand- people keep attempting to characterize me a certain way, and launch strawman arguments against things I did not, in fact say.

            I actually came to this site hoping to find some useful information… but so far most of what I’ve encountered is derision, ridicule, and fear… and the blog author apparently thinks this is appropriate behavior to model on her site, and condone among her readers.

          • Young CC Prof

            Realize that a huge percentage of the posters here are actual obstetricians, midwives and nurses, and that some of what you are saying comes across in an unfortunately arrogant sort of way.

            Reading some of the posts here, and their sources, is actually a good place to start. Most of the books I can think of either presume a huge level of existing knowledge or don’t go into nearly enough depth. Anyone else want to chime in with some recommended books?

          • Matt

            Thanks for the suggestions.

            But I think you are still *somehow* missing the entire fulcrum of my presence here.

            Let me spell it out for you. I googled “microbirth” and this site came up almost near the top.

            I clicked on it, and was shocked, amazed, and surprised to find a *****medical doctor**** RANTING IN ALL CAPS with a clearly derisive and derogatory tone, and a bunch of followers who seem to think THAT’S AWESOME!!

            I will give you that “some of what [I am] saying comes across in an unfortunately arrogant way.”

            But EVERYTHING that Dr. Amy says in her post comes off in an arrogant and derogatory way.

            Why is that OK with you?

          • Amazed

            That’s Dr Amy’s way of being heard. Because nice bloggers do not get a tenth of the attention she’s getting and their message remains unheard.

            Her tone is totally OK with us because this isn’t a blog devoted to microbiology, it’s a blog about homebirth and it seems that being nice doesn’t help with the nutjobs.

            Why is Dr Amy’s tone not OK with you while Hannah Dahlen’s claim that perinatal mortality is a limited view of safety is totally OK? How can you have any respect for the people who used such a woman to help them with Microbirth?

          • Matt

            But if that is *my* way of being heard… then that’s a problem? *huh*

            Seriously, I hate to break it to you, but I think if you guys (and ladies) believe you have any sort of chance at helping change the minds of nutjobs… and more over you believe in your heart of hearts that fear, ridicule, shame, and derision is ACTUALLY going to accomplish that… then you are the bigger nutjobs.

          • Amazed

            I hate to break it to you but we’ve changed the mind of more than one fence-sitter… it isn’t the nutjobs we’re targeting.

            And since you’re advocating against preventive obstetric interventions, aka you’re advocating the preventable death and injury of children for the sake of minor risks to the mother, yes, it is a problem.

            Why don’t you go and tell this mother how great it was that her hospital was so aiming to save her a procedure that she did not need that it chose inaction at the first sign of something abnormal happening?

            http://www.skepticalob.com/2012/03/cascade-of-non-intervention-emilys.html

          • Matt

            I haven’t “advocated” for anything. Why do you keep putting words in my mouth?

            Seriously… are you people crazy? You’re health professionals?

          • Amazed

            I thought you wanted to be “heard”? Now it looks like you have nothing meaningful to say?

            Yes, we’re crazy. Wanting to prevent unnecessary death and brain damage. Crazy, I’m telling you!

            Lucky us, we have the sane man Matt to keep the situation under control. Hurry, fellow crazies, let’s sing His praises!

          • Matt

            You seriously can’t help but throw projections out, can you? It’s OK. You probably can’t help it.

            Don’t worry. I’ll be gone from here soon, and then you, your web friends, and Dr. Amy can go back to shaming and deriding people into making the “right choice.”

          • Amazed

            Bye, Matt. It was nice chatting with you. We’ve been missing some tone trolls who trot out MANA’s lies about informed choice and how we hate it and throw in some “unneeded interventions!” for good measure. It’s always refreshing to see people caring about the lofty future and taxes of humanity in general since our small brains prefer to minimize the possibility of a current damage.

          • guest

            That’s why I stopped responding to him. He’s looking for a fight and he sounds like he’s trying desperately to justify to himself why his wife should have a home birth.

          • birthbuddy

            Matt, you aren’t fooling anyone. Over the last few days you have managed to raise all the usual NCB myths (and been shot down every time).

          • Stacy48918

            Worked for me.

            I had my first child at home, my second was a homebirth transfer. I was WAY deep in the homebirth woo for a while there.

            After reading this blog and the studies linked here, I will NEVER risk my child’s life at homebirth again. It’s way too risky.

            Dr. Amy is “meen” but so are homebirth/NCB advocates that call all OBs evil, cut-happy doctors.
            http://www.skepticalob.com/2014/02/oooh-dr-amy-is-meen.html

          • Guestll

            Eh, she helped to change the mind of this nutjob.

          • Matt

            “Why is Dr Amy’s tone not OK with you while Hannah Dahlen’s claim that
            perinatal mortality is a limited view of safety is totally OK? How can
            you have any respect for the people who used such a woman to help them
            with Microbirth?”

            I never said I agree with her view. Did I?

          • Stacy48918

            “Isn’t there something wrong with performing- or allowing- unnecessary medical procedures when there is a known risk?”
            Do you have the same level of indignation toward all elective plastic surgery? Or is it a woman’s right to do with her own body as she sees fit?

            If I want a nose job, I should be able to get one. Period. If I want a C-section rather than a vaginal birth, no one (especially someone on the internet with no knowledge of my personal or medical history) should be able to deny me that.

          • Matt

            But if a woman wants a homebirth, rather than a hospital birth… what about that? She should be denied that?

          • Amy Tuteur, MD

            Who’s denying any woman the right to give birth at home attended by whomever she chooses? No one.

          • Matt

            But I thought they didn’t have a right to give birth at home..? Didn’t you say that? Or did I misunderstand you?

            “…there is no legal or ethical right to have a homebirth”

            http://www.skepticalob.com/2012/09/human-rights-in-childbirth-does-the-baby-have-any.html

            Anyway. I’m willing to start over with you, if you are willing to accept that I am not a “homebirth advocate.”

            I am a husband whose wife wants to have a homebirth. I’ve made sure she knows about the risks.. both relative and absolute. She still wants to have a homebirth.

            Let me tell you about our experience thus far.

            First… my wife went looking for a midwife. She wanted to have a midwife with the highest level of training and experience possible… which we understand to be a Certified Nurse Midwife.

            What we learned (and please correct me if it is wrong) is that a CNM is not *allowed* to participate in a homebirth. Therefore, we went for the next best thing… a Certified Professional Midwife.

            My wife searched for all the CPMs in the area. She researched all of them, and selected the one with the most experience. We actually interviewed another one who was very nice, but who hadn’t attended enough homebirths for my wife’s comfort level.

            The CPM we selected fully disclosed all of her statistics, experience, and education. She did not intimate that homebirth was safer than hospital birth.

            My wife wants to have a homebirth, so long as there is no medical reason to have a hospital birth. By medical reason, I mean gestational diabetes, pre-eclampsia, etc. We aren’t considering an “unproven uterus” to be a medical reason, though I understand you might.

            Now since the CPM does not have the equipment to do all the necessary evaluations… blood tests, ultrasound, etc. to establish if there is a “medical reason” we decided that it would be best to be co-managed by our OB.

            We thought it would be a good idea to have him concurrently running the tests, performing the exams, etc., to make sure that everything is looking good.

            Unfortunately- when my wife told the OB that she wanted to attempt a homebirth, he told us that he could be dropped from his malpractice insurance if he knew about it.

            Therefore… he could continue to see her, but only if we “pretended” that we were going to have a hospital birth right up until labor begins.

            So this is the system we are contending with. Maybe it is different in other states… I dunno.

            But that sounds pretty back-asswards to me. Here we have a woman who wants to attempt a homebirth, but get the highest standard of care available within the context of a homebirth.

            Unfortunately, she found out that she does not have access to that care. It is denied to her because… why? I guess I don’t know. Why don’t you tell me?

          • Matt

            Sorry… a correction… apparently it *is* legal for a CNM to practice OOH in Michigan… just very rare to find. I just looked again, and like this blogger here… couldn’t find a CNM who does homebirth anywhere nearby.

            “If I could have hired a certified nurse-midwife (CNM) to
            attend my home birth, I think would have. It is legal in my state for CNMs to
            practice out-of-hospital, it is just very rare. It is also legal in the nearby neighboring
            state for CNMs to practice out-of-hospital. Again, it is very rare. There was
            no CNM practice providing home birth services within a hundred of miles of me.”

            http://safermidwiferyformichigan.blogspot.com/2012/08/home-birth-story-women-deserve-not-to.html

          • The Bofa, Being of the Sofa

            Sorry… a correction… apparently it *is* legal for a CNM to practice OOH in Michigan… just very rare to find.

            And why do you think that is?

            Here is the conundrum that I have never understood:

            Doctors and CNMs, those who are best educated and most experienced in delivering babies, won’t do homebirths because they feel that they are too dangerous, whether it is due to their experience or due to the fact that insurers won’t do cover them.***

            Therefore, the solution is to use the services of someone less qualified?

            That makes no sense.

            It’s like calling a bunch of licensed, bonded and insured electricians to your house to have them do some rewiring for your project. They all tell you, no, I can’t do that, it creates too big of a fire risk. So after all the electricians tell you they won’t do it, you call your neighbor’s brother-in-law, who’s not really an electrician but has installed a couple of ceiling fans in his house. He’ll agree to do it.

            That’s just stupid. But that is exactly what you are doing. Real, qualified professionals are telling you that they won’t do this because it is too dangerous, so your solution is to let someone less qualified do it instead.

            ***Remember that insurance companies don’t give a rat’s ass about the morality of anything, what they worry about is how much it is going to cost them. If the insurance company won’t cover it, it’s because they have determined that the risk of a bad outcome is too high for the level of premium they are getting. Actuarial science is as dispassionate as you can get on these issues.

          • Bombshellrisa

            Because the providers know they can’t provide a level of care that is appropriate in a home setting.
            We have talked a lot about what if about the baby so far, and I realized we have not really addressed your wife. Having an OOH birth puts her in a setting where she is not going to have access to adequate pain relief. Maybe she has done Hypnobabies, prenatal yoga, read every book and has a high tolerance to pain. It can still be a shock how much the pain of a contraction can shake you to the core, making all your breathing and focusing techniques fly out the window. Once your are in that much pain at home, transferring to the hospital is even harder and it still might be quite awhile before an epidural can be placed once she is at the hospital. Homebirth midwives are notorious for not being able to tell how severe tearing is and don’t have to skill to stitch up most tears. There are people who post here who had perfectly low risk pregnancies and textbook labors, who ended up with cervical tears and postpartum hemorrhages. Setting does matter when you are dealing with things like that.

          • Matt

            Well if you think I’m going to have any kind of leverage telling my wife what she is or is not capable of withstanding, I can assure you that you are quite mistaken.

            Actually… she doesn’t do all that well with pain. But that doesn’t seem to deter her from wanting to try.

            I promise you… all the “horror stories” in the world will not change her mind. It will just make me out to be an “unsupportive” husband.

            She has all the facts. She’s made her decision. She’s seen the CPM’s stats and is OK with them.

            She would prefer a CNM, but can’t get one. She would prefer concurrent care with an OB, but that involves playing games to satisfy the underwriters of malpractice insurance policies.

            That is the reality. So now what?

          • Bombshellrisa

            You don’t have to tell her horror stories-it’s best you don’t. I am suggesting that considering how slow a transfer can be and how quickly tears or a PPH need to be treated that she should take it into account before she is in a situation where she is hurting terribly and has no access to pain relief or is in critical need of medical attention and isn’t going to get it at home.
            What influenced her decision to birth at home?

          • Matt

            Well I can’t speak for my wife, but only for my perception of my wife. Here are some of the influences, to my perception:

            1. She feels emotionally, and in some ways physically, safer at home. The tradeoff between the additional physical safety conferred by a hospital setting in the case of an adverse outcome, and the emotional comfort of being in a familiar environment, is sufficient for her.

            2. She does not feel confident that she can be assured sufficient control and influence over the birthing process. Part of this is the uncertainly over the environment. There is also the question about when, and how insistently, interventions would be offered. She is not blindly against interventions, but she doesn’t not want any of them. She is concerned that a nurse or physician might try to talk her into a c-section, induction, and/or episiotomy, and she won’t be in a state where she can advocate for herself.

            3. In addition, the undeniable “C.Y.A.” factor among physicians and hospitals- while perfectly understandable why they exist- for example if I’m not mistaken, Michiganders are particularly litigious when it comes to these things… so that is an impediment to trust in the system.

            4. She has a strong feeling that there is spiritual purpose to the birth process that will be minimized by health care professionals who do not acknowledge or understand those dimensions of health, and how important they are to some women, and even more so during birth. (And no we are not religious nutjobs… we don’t go to church at all.)

            I’m sure there are some others, but why don’t we start with those. I believe they are the largest factors.

          • Matt

            Actually, there are at least three other important factors that I can think of… but those have more to do with personal psychological things… experiences of family members in hospitals not being cared for properly, and family members who ARE health care professionals, each with their own set of views.

            But I won’t even try to touch those here. o.O

          • Matt

            Oh, and there’s the financial and health insurance factor. We have pre-Obamacare policies with HSAs. Currently we have (on each policy, we haven’t combined them) $5000 deductibles, with 100% in-network coverage after that.

            The maximum OOP expense is $15000…. about the amount of a hospital birth… I think… ???

            To get a policy that covers hospital birth would cost an additional $2500 a year… for one with the SAME deductible that we already have on the current plan.

            We’re not poor. But we don’t have fixed incomes either. There’s a real decision to be made about spending $10,000 to mitigate a small absolute risk of something going wrong… and it also being uncorrectable WITH a catastrophic outcome.

          • DaisyGrrl

            Just remember that in countries where midwifery and homebirth are well-integrated into the health care system, the transfer rate for first-time mothers is 40-45%, These are women like your wife – otherwise completely low risk who required transfer during labour because something unexpected happened (often stalled labour or wanting pain relief).

            If your midwife doesn’t transfer first-time mothers at that rate, she is not practicing safely. If she does have such a transfer rate, there are good odds that you’ll end up paying for both a hospital and a home birth.

          • Bombshellrisa

            $15000 sounds excessive for an uncomplicated birth-but again, you can call the hospital and find out what they can do for you if you don’t have maternity coverage.

          • mythsayer

            re: number 2… that’s what you’re there for. You are supposed to be her advocate. Does she really think that if she’d be that weak at the hospital such that she wouldn’t be able to advocate for herself that she’ll be able to think straight enough at home to say that she needs a transfer? It’s not about being pressured to do something… it’s about having the wherewithal to say “yes” or “no”… and that capacity isn’t going to suddenly increase at home. What if your midwife pressure her to stay home when she should transfer? Is she going to be able to make the right choice then? I don’t think #2 is a good reason to stay home. It’s a good reason to make sure you’ve got someone to advocate on your behalf.

            You guys could come up with a safe word. That way if she was screaming “I want pain meds” and you weren’t sure if she meant it, she could say “Grapes, Matt! Grapes! I’m serious this time” and then you’d know she was serious (yes, “grapes” is a weird word… I was eating frozen grapes earlier and it came to mind).

          • Bombshellrisa

            I do understand her apprehension.
            She does sound like she has been handed a lot of misinformation about pregnancy and birth, and it’s clouded her judgement. If you approach something from a place of mistrust and misinformation, even the best doctors and nurses will appear to be pushing courses of treatment that are not needed and potentially more dangerous than they are. It’s much harder to get an elective C-section and epidural than people would have you believe. As someone who was talked OUT OF an epidural even though I very much wanted one, I can say it’s much worse when someone refused to listen to your very real request for an intervention then when they speak to you about an intervention like you are an adult making a decision based on facts.
            Perhaps there is a spiritual element to birth, it is certainly life changing and amazing. It’s also painful, unpredictable and you are more likely to poop during it then have an epiphany.
            As long as she understands the risks to her and the baby, she has the right to choose what course of action she will take.

          • Guest

            Which one of those reasons is about what is best for your child?

            You’ve just said your wife is willing to trade off the physical safety of your baby for her emotional comfort. Maybe she doesn’t see it that way but, I’m sorry, that’s what it boils down to.

            You are still not listening to people. You and your wife are saying that the worst thing that you can imagine – and the one you’ll put your effort into avoiding – is the ‘unnecessary’ intervention. We are trying to say to you that the worst thing that can happen is that your baby dies or is permanently injured. You are telling us that you know that already, but emotional security and location-specific birth mysticism is more important.

            Birth is a powerful experience anywhere, Matt, because your child starts on the inside and comes to the outside. The stars don’t need to line up in some magical way. You just need to be able to hold that precious life in your arms and marvel at the fact that it wasn’t here yesterday. That’s the point.

          • AlisonCummins

            It sounds like the loss of control that being a parent entails is freaking her out. She is a person who needs to feel in control, so she’s concentrating on giving birth as something she wants to keep within her control, something that will prove that she’s still in charge.

            (Am I anywhere close?)

            More realistically, giving birth is something she does not and cannot control. Going through the painful process of learning to accept that is a good spiritual exercise in preparation for the arrival of your child.

            You seem to be working on the assumption that since only 0.21% of babies die at or around a homebirth that it won’t happen to you. You are deliberately ignoring permanent injury, which brings the combined risk of death or permanent injury to something like 3.7%.

            Your CPM has already let one mother die. Presumably you’re confident you are taking care of that by seeing an OB. If you think the OB is better able to keep your wife alive and healthy until labour begins

          • AlisonCummins

            It could actually be a lot higher than 3.7%. The injury:death ratio is much higher in homebirth than hospital birth. http://www.skepticalob.com/2014/01/risk-of-anoxic-brain-injury-is-more-than-18-times-higher-at-homebirth.html

            This isn’t primarily about you or your wife, Matt. It’s about your child. YOUR child. As a father, you can do better by your child than just shrugging your shoulders.

            Again, everything will probably be fine. You probably don’t even need a midwife at all. Given the incompetence and recklessness of your CPM, the marginal benefit to having her around vs going for a UC stunt birth is probably minimal. Yet you hired her. Presumably you recognize thatmyoumwill need help.

          • fiftyfifty1

            Here’s the thing about insurance underwriters: they are the least political people on the planet. They are a business and they don’t give a shit about anything other than making money. They don’t care if something is popular or unpopular. They don’t care about being politically correct or trendy. They look to cold hard numbers about what will lose them $ and what will make them $.

            And that is why you can trust them! If they won’t insure something it’s because they know it is too dangerous and will end in bad outcomes that will lose them $. If it were safe, they would insure it in a heartbeat. What better way to make money than charge people for insurance when you know that you won’t have to be paying out claims!

          • mythsayer

            My friend did hynobabies. She said it was an utter failure. She was dead set on natural birth and was begging for an epi when labor started. She never got one because they wouldn’t give it to her at 3cm and then she progressed to 9cm too quickly. She was traumatized by her birth. She tore, also. So yeah, even people who are convinced they will do it all natural can change their minds.

          • Bombshellrisa

            With my first child, I had concern about having an epidural (would I be able to drive? What if it doesn’t take? Does it slow labor?) and figured I would see how it went but since I had been trained as a doula and midwife that I would be able to relax and use what I had learned. Except I couldn’t. I was triggered terribly, my husband called my family and they showed up at the hospital and bugged the crap out of me during labor and the nurse fed into my fears and told me (among other things) that I wouldn’t be able to drive for six weeks and the epidural would indeed slow down and probably stall my labor. She SHOULD have called the anesthesiologist in and had them address those concerns. I didn’t get that dignity and I ended up howling and screaming through dd’s birth and the repair of the second degree tear I had. To say it was traumatizing doesn’t feel strong enough.

          • onandoff

            Why doesn’t your midwife have a doctor she collaborates with? Why is she practicing when she can’t provide basic prenatal care? That is extremely disturbing to me.

          • fiftyfifty1

            What an impossible position to put your OB in! He doesn’t recommend homebirth because he knows that it is unsafe. But you basically are saying to him “No don’t tell us that it’s generally unsafe, do tests on her and tell us when it’s starting to be EXTRA unsafe, and if you don’t indicate that it is extra unsafe, then we will take that to mean that it’s SAFE”. And the doc (and his insurance plan) are supposed to be all hunky dory with your bullshit and just trust that a straight-up guy like yourself wouldn’t sue if and when the shit hit the fan? Sure buddy, sure.

          • Margo

            Matt look up recent research re the move to Homebirth in America???you might be reassured.

          • Bombshellrisa

            The article on Science and Sensibility by Wendy Gordon and the articles on Improving Birth can hardly be called reassuring.

          • Bombshellrisa

            No.
            What I want is for women who are considering engaging care from a CPM and having a home birth to have is informed consent, meaning that they understand exactly what it means to have care from someone who can’t do anything for them the minute there is any less than a unremarkable and uneventful pregnancy and birth.

          • AlisonCummins

            Nobody here thinks women should be denied the option of choosing homebirth.

            They think that untrained, inexperienced, uninsured, unaccountable people should be denied the option of lying about their qualifications, lying about the realities of birth, calling themselves midwives and charging money for substandard care.

          • Matt

            But no amount of training, experience, disclosure, regulatory framework, licensure, etc. is enough to bring the level of care up to “acceptable” standards? Huh?

          • Bombshellrisa

            OBs and Certified Nurse-Midwives meet all those standards, they are also able to work in settings that allow them to use their knowledge

          • AlisonCummins

            I don’t know why you would say that. Several people here have pointed out that CNMs meet the standard.

          • mythsayer

            That’s the thing… pro home birthers get pissy at anyone who would choose an elective CS, but then claim they are allowed to endanger their babies at home birth. And it IS dangerous. But we acknowledge they have the right to have their children at home. Just like I should have the right to choose an elective CS. And I guarantee an elective CS is far safer than a home birth.

          • Stacy48918

            Where did I say that?

            Have your homebirth. But recognize and admit that in a crisis your baby might day and might not have in a hospital. You don’t want to analyze the risk of death. You cannot truly have informed consent by burying your head in the sand.

          • mythsayer

            Seriously!

        • mythsayer

          I think the WHO finally agreed that the 15% rate was pulled out of someone’s ass…. No one knows what an “optimal” CS rate is.

    • Poogles

      “Could it be that interventions are increasingly offered sooner and sooner at the very first sign of something abnormal during the birth process because the medical staff is scared shitless of what might happen if they DIDN’T offer an intervention?”

      When something seems abnormal in a labor, they are most definitely scared shitless of what might happen if they don’t offer intervention, like injury or death of mother, baby or both. Being scared of a lawsuit is secondary, if you avoid “what might happen” by using interventions when they seem called for, you have no reason to fear a lawsuit – no one can sue if they don’t have a bad outcome to sue for.

    • Poogles

      “Guess what I found as the very first post? You may not have seen it, as I noticed it has exactly -zero- comments.”

      BTW, the reason that post has no comments is because it is from the period of time that Dr. Amy was making the transition from her old blog (“Homebirth Debate” – http://homebirthdebate.blogspot.com/) to this blog; most of the earliest posts on this blog don’t have comments for that reason. That post was located on the old blog, this blog, as well as on Dr. Amy’s Open Salon page: http://open.salon.com/blog/amytuteurmd/2008/08/14/how_to_lower_the_c-section_rate_step_1_look_in_the_mirror

      So, I would venture to guess most of us have seen it, or if not, we are still aware of the opinions and arguments that Dr. Amy made in that piece, because it is not the only time and place she has discussed them.

      • Matt

        Thanks for the additional info. Anyway, I thought it was a good post. It concerns me that fear of litigation is such a prominent factor in the decision-making process. It also concerns me that so many people have unreasonable expectations of our health care system

        • fiftyfifty1

          I’m not so sure fear of litigation regarding birth outcomes really is a bad thing. It’s just responding to what woman want. What the typical woman wants has changed over the years. Fifty years ago the typical woman started having children in her late teens or early 20s. She planned a relatively large family. If a birth “went wrong” it typically ended in the death of the baby because medical technology wasn’t yet advanced enough to save damaged babies. A baby’s death was God’s Will and although it was sad, the woman, being young, could always go on to have more. A woman really did not want a CS because CS at the time was still fairly dangerous.
          The situation is very different now. Woman wait often until their 30s to have babies. They may struggle with subfertility, and if this current pregnancy doesn’t result in a healthy baby, there may be no second chance. C-sections have become very safe, and most women desire 3 or fewer children, so an un-scarred uterus is not a priority. Our society has become more reliant on brain-power jobs rather than manual labor jobs, and so women are very motivated to preserve the brain cells of their babies. Most women, when given a chance, want to ere on the side of caution and are willing to have a CS rather than risk a situation that is borderline and find out in the end that they fell on the wrong side of luck and have a permanenly damaged baby. There is nothing unreasonable about that choice or unreasonable about doctors responding to this preference by being cautious.

    • mythsayer

      So the solution is home birth? How about if the solution is not to be so sue happy? Did you ever consider that maybe physicians are freaked out because we file too many lawsuits? That maybe that woman who screamed she didn’t want to the CS, whose baby ended up brain damaged because she refused the CS, should accept that she was the cause of her baby’s problems and not sue? No? So there are only a couple of solutions: 1) people stop filing so many lawsuits, or 2) doctors protect themselves and make SURE their patients are as safe as possible. You’re blaming the doctors for jumping to CS, when they only did that because everyone is litigation happy. And that’s coming from an attorney.

      • Matt

        “So the solution is home birth?”

        No, that is not a solution.

        “How about if the solution is not to be so sue happy?”

        That would be a good solution, but not one that seems likely.

        “Did you ever consider that maybe physicians are freaked out because we file too many lawsuits?”

        Yes, of course. I understand why. I even said so.

        “…should accept that she was the cause of her baby’s problems..”

        Haha… do you know how much “outrage” such a statement would provoke? Unfortunately, it seems to me that the predominating belief system among Americans is that disease “just happens” to them. You know… like the disease fairy came by in the night and cursed them with illness. It has nothing to do with their crappy diet, lack of exercise, excess stress, attitude, etc. They are just victims of circumstance… they’ve got “bad genes” so… *wink wink*

        “You’re blaming the doctors for jumping to CS, when they only did that because everyone is litigation happy. ”

        No, I’m not *blaming* the doctors… I’m wondering how the hell one is supposed to navigate this insanity.

        “And that’s coming from an attorney.”

        Have you considered that maybe attorneys have played a role in creating this problem?

        • mythsayer

          Ohhhh… you seriously just did one of things that pisses me off royally. Do you have any idea how freaking rude and inconsiderate it is to imply that diet causes disease?

          I have lupus. I’ve been told a bunch of times that it’s because I “eat sugar” or some other such nonsense. That’s right. It’s because I don’t live on a diet of uncooked vegetables that my body decided to start attacking itself. And I’m sure I’d be cured if I just changed how I eat (which isn’t bad, btw… and no, I know you didn’t fully say this… but the implication is partially there… at least to a small extent… I’ve read your other posts).

          It couldn’t have anything to do with the fact that my dad had psoriatic arthritis, his mom had rheumatoid arthritis, and my mom’s dad also had rheumatoid arthritis. No… autoimmune disease running in my family has no relevance.

          Also not relevant is the fact that my disease showed up right after my daughter was born. Pretty sure I had this since I was a teenager, but it never bothered me much until my daughter was born. Pregnancy is a known trigger for autoimmune diseases.

          Let me put it to you this way: did you ever consider that by saying what you basically said (that diet has something to do with disease), you are basically blaming me for my body attacking itself? That is beyond rude. Seriously.

          As for attorneys, I will say this: Of course people wouldn’t sue if attorneys didn’t make it possible, HOWEVER, the only reason there are attorneys willing to bring these suits is because there is a demand for them. Attorneys aren’t forcing people to bring lawsuits.

          Further, I don’t do medical malpractice or any kind of personal injury, so I don’t consider myself part of the problem. I mostly handle real estate fraud, which is a justifiable area of law. So I can bag on attorneys who are ambulance chasers all I like.

          • Dr Kitty

            Diet and lifestyle are implicated in some diseases- smoking related cancers, high fat and sugar diets with diabetes and heart disease, alcohol and liver disease, vitamin D deficiency with rickets, gluten and coeliac, fava beans in G6PD, folic acid and NTD etc.

            However, one CANNOT extrapolate from that the existence of a perfect diet or lifestyle which will prevent all disease, because a) some diseases are not influenced by personally modifiable factors and b) shit happens.

            Matt, you probably don’t have a chronic illness. You’re not being particularly sensitive to those who have, and you know what, sometimes people are indeed the victims of crappy genes and bad circumstances.

            I’ve seen enough smokers living into their eighties and non smokers dying from lung cancer to be under no illusions that some people just have crappy luck.

          • mythsayer

            I don’t disagree with those, for sure. Of course diet is relevant to diabetes, smoking to lung cancer (though as you said, not always… I know a guy whose good friend died of lung cancer at 31… never smoked… they said when you get that type of lung cancer, it’s pretty much a death sentence), etc.

            It’s the implication that sugar or gluten causes inflammation in the body that caused an autoimmune disease that irks me. As you noted 🙂 Crappy genes for sure…

        • mythsayer

          AND FURTHERMORE:

          There is a gigantic difference between someone with cancer or an autoimmune disease and a woman who makes a bad choice and whose baby suffers because of it.

          If a woman at a hospital is told “You need a CS…your baby’s heartrate is dropping and it’s starting to look like you may have an abruption” and she says “screw you, I’m having a vaginal birth!” and the doctors say “fine, just sign here to show you know the risks and consent to them” and she does and the baby dies, then honestly, that is freaking on her 100%.

          Now compare that to someone who has cancer, or, like me, lupus. And you seriously just implied we gave ourselves those diseases. That’s right. I eat basically the same food as everyone else, but I just HAPPENED to get lupus. Do you know how INSANE that sounds?

          Think about it for a second. If diet caused lupus, then in theory everyone who eats a regular American diet should be coming down with an autoimmune disease. Otherwise, OF COURSE there has to be a genetic component. Even if you want to buy into the idea that diet is causing inflammation in the body, why is MY body attacking itself to the point where I have an identifiable disease and all the people over here are just overweight? Just bad luck? Or possibly a genetic component? Probably a combination of both. But I guarantee that people who eat ridiculously healthy food still get sick. So for them it’s just bad luck, but for the rest of us, we were the predominating factor in our sickness manifesting itself?

    • Hi Matt. I know it’s been a while since you wrote this, and you’re probably wondering why nobody responded to this comment. Honestly, you damn near lost me in this post because it’s just so damn long. And, really, you offer nothing new – everything you say here, you said earlier. So, my guess is that none of the regular posters here made it through this super long rant, because, again – it offered nothing new.

      Here’s what I know. I’m a NICU nurse who has never, ever, ever put my fear of litigation over a patient’s well-being. And I’ve never seen it happen amongst my cohorts either.

      I know it’s been a while since this conversation occurred, so I’d love an update on what you and your wife decided to do. I hope you realize that the majority of the people who regularly post on this blog (myself included) have personal ties to homebirths gone wrong…we’ve seen the worst of the worst. and just want women to know – REALLY know – the risks involved with deciding to deliver away from a hospital setting. We’re coming from a genuine place of concern…and sometimes fear….because we’ve seen the negative side of the unpredictability of birth.

      And finally, you claim you want doctors and health care providers to practice without fear of litigation…you want us to focus first and foremost on the health and well-being of our patients. I want you to know….WE do that. Do you know who isn’t focused on outcomes? Midwives. Because…well, they don’t have to. They aren’t subject to the same consequences we are…they can’t lose their licenses because they don’t HAVE licenses. When a baby or mom dies during a homebirth….do you thing that the Midwife in charge faces any legal consequences? Are they held accountable for any deaths or injuries sustained?

      We are.

      First and foremost, we love our patients. Medicine is both an art and a science…we’ve spent years studying the science we need to drive our practice, but at the end of the day, it’s our patient who make us smile and thank the heavens we’re working hard everyday in a profession we love…it’s our passion.

      I hope everything is great with you and your wife and your expected little bundle. And I do hope you’ll pop back in and update us…

  • Matt

    Gosh… I’m really turning out to be an evidence spammer here. I’m sorry folks, but since the author is such a fan of evidence- I went looking for some and keep turning up such interesting information that I can hardly contain myself from excitement in sharing it with you all!!

    Here’s another one of those systematic reviews and meta-analyses.

    Li, Y., Tian, Y., Zhu, W., Gong, J., Gu, L., Zhang, W., … Li, J. (2014). Cesarean delivery and risk of inflammatory bowel disease: a systematic review and meta-analysis. Scandinavian Journal of Gastroenterology, 49(7), 834–844. doi:10.3109/00365521.2014.910834

    CONCLUSION:

    Results of this meta-analysis support the hypothesis that cesarean delivery was associated with the risk of CD but not of UC. The total rate of cesarean delivery of IBD patients was similar with that of control subjects.

    But wait… I thought the blog author very confidently stated to her audience that there was definitively NO evidence in support of the hypothesis that C-section is associated with a higher risk of chronic disease. Hmmm… maybe did she mean there was NO evidence 30 years ago when she graduated from med school??

    • Stacy48918

      Hmmm…chronic disease or dead baby? I’ll take chronic disease for $1 million Alex!

      Thank God for C-sections! Woo!

      • Matt

        LOL- Sure one might still take the C-section after a careful risk-benefit analysis. But I think you missed the point. The point is that the author is claiming there is NO evidence, when there is. Simple as that.

        Alex, the question is: “Who is a fake skeptic?”

        • Young CC Prof

          The evidence of a statistical association between cesarean birth and chronic disease later in life is weak and conflicting. One study finds an association with disease x, but not y or z, another finds one with y but not x. None of these studies are able to fully control for the critically important confounding variable of maternal health, and none of the decent quality ones have demonstrated a large difference in risk.

          So, as a matter of philosophy, I tend to place real and immediate risks, even if small, above future risks that may be statistical artifacts.

          • Roadstergal

            My institution does not have a subscription to that journal, so I can’t read the full text. However, the abstract does note: “Overall, we did not observe a positive relationship between cesarean delivery and IBD (95% CI: 0.99–1.30; p = 0.08).” So it does make me wonder if they were starting to see some statistical oddities of small sample sizes when they broke IBD down into UC and CD.

          • Matt

            Yes, we are starting to see SOME evidence. I’m not so sure why there is so much resistance to that statement- as it is pretty much all I am trying to say.

            The blog author says there is NO evidence. There is SOME evidence. Therefore the author is wrong. That is all.

          • Roadstergal

            I’m saying that I do not find that evidence convincing. I wish I could read the paper and dive deeper and know for sure, but when you take an overall condition with no association with procedure X, and then break that condition down into smaller bits and find a bit that does have an association with procedure X, I want to take a closer look at the numbers to make sure it’s real and not spurious. That is, I am not sure, from just looking at that abstract, that we do indeed have _some_ evidence.

            CD is an interesting and heterogeneous disease (more so than UC) with very poorly understood etiology. Part of my work is with IBD, and with the microbiome, so I know all too well how high the known-to-understood ratio is, and how easy it is to go nuts if you hack off one little portion and think you _have_ it. 🙂

          • Matt

            I would absolutely agree with everything you have said. We certainly do NOT know way more than we DO know. There are many questions to be answered.

            Again, my whole point is that there is indeed SOME evidence. It may indeed be the case that the evidence is not convincing, and considering how new microbiome research is, I would be surprised if any of the research could be considered “convincing” other than to simply say that the microbiome seems to be a really important factor in health and disease.

            Thanks for engaging in a civil dialogue. 🙂

          • Roadstergal

            “the microbiome seems to be a really important factor in health and disease”

            It might be an important factor in some aspects of health and disease. But I believe it to be a highly overstated factor, currently (it was an understated factor, IMO, back when I first got into this field – it’s funny how the pendulum swings). The basic ideas of correlation vs causation and cause vs effect are still barely being scratched at when it comes to the microbiome, e.g.

            Where I disagree with you is in counting things on the level of what you posted as ‘some’ evidence. It’s a hint, a whiff, that might be evidence and might not be. I’ve just seen a lot of ‘evidence’, across various fields, at that level go out with a whimper and not a bang.

          • Matt

            In my opinion, the difference between “some” and “none” makes all the difference between having a healthy dialogue, and no dialogue at all.

            I think that’s important, and is part of what fuels the pendulum swings you referred to.

          • Pillabi

            Matt, in the article Dr. Amy says “THERE IS NO EVIDENCE TO SUPPORT THOSE CLAIMS”: maybe I’m wrong, but to my non-native understanding, this sentence doesn’t necessarily mean “there is no evidence at all”, but rather: any evidence there might be, it is not enough to support claims such as “increased medicalization of childbirth may be having severe consequences on the life-long health of our children…What’s more, it could be having a devastating effect on the future of our entire species”. The video is presented as a revolution in the history of humanity! Don’t you see the disproportion?

          • Matt

            I certainly see the disproportion- which is why it is even more important to use precise language. The sentence means what it means, and Dr. Amy reiterated it in several different ways, and in each instance used words to indicate an absolute.

            Your argument can easily be turned on its head… take a closer look at the stated claim:

            “increased medicalization of childbirth may be having severe
            consequences on the life-long health of our children…What’s more, it
            could be having a devastating effect on the future of our entire species”

            Here you can see that they said “MAY BE” and “COULD BE” which, to my understanding of the English language, implies that they are speaking in conjecture. They are speaking in terms of possibilities… what might or could be true… not what IS true.

            Now I can speak for any of the “buzz” or promotional materials surrounding the film, since I am not privy to it. I wouldn’t be surprised if things have been spun and overstated in that regard.

          • Pillabi

            Fair enough – I see your point and I’ve even voted you up for your neat explanation above here 🙂
            But, since we’ve moved to linguistic, I want to reply to your “defence” of the quoted claims. Register and word choice have enormous importance in communication. A supposedly scientific-based speech cannot use expressions like “life-long health”, “devastating effect” “future of the species” and then hide behind conditional verbs. They are deliberately provoking an emotional response, they are suggesting and evoking, if not stating, something they can’t prove.

          • Matt

            A totally fair argument- I have no counter to it. But the filmmakers are filmmakers and their promotional team are promotional people.

            What is Dr. Amy’s excuse? I did not notice any real logic or reason in her criticism. I did not notice any genuine “skepticism.” Instead all I see were ALL CAPS RANTS, absolute statements, accusations, and an all-around derisive tone.

          • Pillabi

            I won’t provide any excuse for Dr. Amy since she is able to account for herself. If you ask for the reason of such an article, maybe you should know that there are plenty of supposed experts who would use such a film, made by filmmakers and promoted by promotional people, as “scientific evidence” to “educate” pregnant women and couples about the risks of medicalized birth. This is what (many) NCB advocates do. In most case they are not able to recognize real scientific evidence from pseudoscience themselves, despite their scientific degrees. This is at least my personal experience.

          • Matt

            Yes, I would agree with your comments and experience.

            But derision is not going to make the situation any better.

          • Pillabi

            When reading this blog I usually understand derision as a means to draw these people’s attention, to provoke them, to force them to answer and account for their behavior. Does this work? I don’t know.

          • Tenet

            I’m inclined to say no… derision doesn’t work. But that hasn’t stopped medical professionals from continuing to attempt to deride people into doing what they feel to be the right thing.

            Back in the early 19th century, Dr. Semmelweiss was derided by his peers for hypothesizing on why more women were dying in the obstetric clinic than in the one run by midwives. He proposed that some invisible disease agent was being transmitted by the doctors who were performing vaginal exams after working in the cadaver labs and without washing their hands in between.

            He was laughed out of the medical profession, and it wasn’t until a couple decades after his death that we realized… oops he was right! Germs really do exist!

            In the early 20th century, Dr. Metchnikoff hypothesized that consuming fermented foods conferred health benefits, and that many disease processes were a result of toxic byproducts of harmful bacteria gaining access to the bloodstream because of a “leaky gut.”

            “Leaky gut hypothesis” became the laughing stock of the medical world… and a surefire way to identify a quackpot as far as most doctors were concerned. Nowadays you can hardly find a journal article on GI disease without some mention of “impaired intestinal permeability.”

            Dubos was writing about gut microbiota and the gut as an ecosystem back in the 60s. The 60s! Was anybody listening? No no those were “fringe topics” that sounded too much like the “Gaia Hypothesis” to be taken seriously by any “legitimate” researchers.

            What do all these situations have in common? The use of derision and ridicule by the scientific community to edge out highly advanced thinkers who were later proven to be more right than wrong.

            What has science and medicine learned from the last couple centuries of folly? Apparently, not a damn thing.

            Today, doctors and scientists like to blame the likes of Jenny McCarthy for all their woes. Does anybody ever perhaps consider that the reason they have so little trust with the public is that they continue to be proven catastrophically wrong, and yet continue to persist in taking a derisive attitude any time their ideas are challenged?

            Does anybody consider that maybe the reason trust is undermined might have something to do with the number of massive drug recalls that have occurred over the last decades after we found out that highly touted medications were actually killing people?

            Does anybody consider that it might have something to do with recommendations like eating trans fat in order prevent heart disease? Whoops wrong on that one too!

            No no, it couldn’t be any of that… it’s all because of Jenny McCarthy. 😉

            Derision as a motivating factor for positive change. Fail.

          • Young CC Prof

            Um, leaky gut hypothesis has never been accepted. And it’s a bit dishonest to reach back into history, pull up the ONE crackpot theory out of a giant pool of forgotten crackpot theories which happens to have been proven partially correct, and then claim that therefore, all of science is untrustworthy.

            When scientists realize they are wrong, they change their minds. Doctors change and improve their practices all the time. Pseudoscience never sees the need to change, no matter how much evidence piles up against a theory.

          • Matt

            Did I claim that all science is trustworthy? Did I say that? Show me where I said that.

            Or are you ***yet again*** projecting ideas onto me and putting words into my mouth?

            Also, please explain the difference between “leaky gut” and “increased intestinal permeability.”

          • Young CC Prof

            “reason trust is undermined.”

            The difference between the two proposed conditions is only their causes, mechanism of action, treatment options, and in the level of evidence that they really exist.

          • Matt

            “Trust is undermined” does not equate to “all science is untrustworthy” Now does it?

            Please explain the differences in causes and mechanism of action.

          • Roadstergal

            I don’t disagree with that at all – that when we’re in the ‘none’ region, there’s not a lot of meaningful dialog that can occur.

            The pendulum swings because scientists, like everyone else, are excited by new and different data. I remember the first time I heard about hookworms and IBD, I was SO damn excited. Then I looked a little more closely, and turned it down a whole bunch of notches.

          • Matt

            “when we’re in the ‘none’ region, there’s not a lot of meaningful dialog that can occur.”

            Exactly my point. 🙂

            “The pendulum swings because scientists, like everyone else, are excited by new and different data.”

            Yes, though I would also add that scientists, like everybody else, get defensive, and even go into denial, when new and different data contradicts their pet theories or established dogma. 🙁

          • araikwao

            Hey, I heard a lecture from a paediatric gastroenterologist a couple of years back that suggested UC and Crohn’s were probably the same underlying disease with somewhat different manifestations (or at least that was his prediction). Any thoughts?

          • DiomedesV

            The phrase “starting to see some evidence” implies that the truth of the hypothesis is in fact a foregone conclusion, and it’s just a matter of time before we find real evidence that supports its. In fact, most published scientific studies contain at least some errors, and a huge fraction are wrong. This is true for a number of reasons, one of which is the well known publication bias in favor of studies that conclude in favor of a new hypothesis. I have seen manuscripts rejected for failing to find evidence to reject the null because, in the words of the editor “it’s not interesting.” This was not Science or Nature, and it was a hypothesis that is very much still up for debate. The editor didn’t want to waste print on a study that didn’t support the latest most controversial hypothesis.

            Personally, I find it rather ironic that you’re lecturing the blog author on the rigor of language, when, faced with the need to support the claims made by a documentary that has faced absolutely no real standards of intellectual rigor or merit (the kind of evidence you apparently find convincing), you have so far managed to produce a study with a sample size too small to conclude anything, a review paper that basically summarized well known connections between vaginal and amniotic flora and poor outcomes in labor and birth before attempting to rescue what would have been just another OB review article with a few attention grabbing sentences about long term health implications, and a review article published in a trash journal.

            Not all evidence is equal. Scientists are well within their rights to dismiss a publication or an association as “no evidence” because it does not meet their standards of rigor. If this were not true, then the only thing required to establish a hypothesis would be to get it published somehow, somewhere. That is not acceptable, although it is a favored tactic of creationist “scientists” and homeopathic “doctors” everywhere.

          • Matt

            “Starting to see some evidence” does not equate to affirming a hypothesis. Though you are right, not all evidence is equal.

            The greater irony here is you jumping in to defend a poorly written rant loosely disguised as a so-called skeptical blog post against actual articles published in actual scientific journals, however questionable they might be.

            Pseudoskeptics fighting the “good fight” against pseudoscience. It would be funny if it weren’t so pitiful. Clearly, I’ve made an error challenging the unassailable beliefs of the Great and Powerful Dr. Amy. Enjoy your minionhood.

          • araikwao

            Ah, I see what you did there: the irrefutable”minion” gambit, closely related to the”pharma shill” gambit. What a shame, it seemed like there was some useful dialogue beginning there, but you’ve shut it down. At least you can leave with your cognitive biases intact – it’s much more comfortable that way.

          • Matt

            No, actually there was no meaningful dialogue, as the comment began with a false framing of my position:

            “The phrase “starting to see some evidence” implies that the truth of the
            hypothesis is in fact a foregone conclusion, and it’s just a matter of
            time before we find real evidence that supports its.”

            No… it didn’t imply that at all. I understand fully what a hypothesis is. I understand what bias is. I understand that an idea that appeals to one’s intuition- or even sensibilities- could turn out to be false once thoroughly vetted.

            The actual reason there is very little “useful dialogue” going on in this blog is because people appear to be approaching discussion somewhat like a chess game… attempting to anticipate my moves and characterize my “style of play” based on previous experience with others.

            The minion comment isn’t a “gambit” as that would imply I believe that we are playing some kind of game that can be “won” and that I am willing to sacrifice something in order to gain an advantage.

            The minion comment has to do with the bizarre lack of questioning of the blog author’s comment that there is “no” evidence to support a given hypothesis- even though there is clearly demonstrable evidence.

            The quality of that evidence is another question, but based on my experiences here thus far, not one that I feel stands much of a chance of any sort of reasonable treatment.

            To be fair, there are several people in this comment thread which seem to have some sort of normal sensibility, plain respect for others, and a willingness to explore new ideas.

            Unfortunately, there’s too many trolls and minions also present who apparently have no purpose here other than to tirelessly defend Dr. Amy (I mean really, does anybody here thing this blog post is a meritable piece of writing??!) or just simply being sadistic.

          • DiomedesV

            No, the difference between you and I, as a scientist, is that I do NOT place undue confidence in something merely because it has been published in a scientific journal. The concept of critically evaluating published scientific evidence is clearly beyond you.

            Enjoy your naivete.

          • Matt

            Really? Are you a scientist? Then you should know better than to make those kinds of assumptions about what I do and do not understand.

            If you actually read my posts, I didn’t defend any of those studies. I simply pointed out that they exist, and by virtue of their existence that proves the falsity of the assertion that they don’t exist.

            Enjoy your prejudice. And remind me to never take anything you publish seriously.

          • DiomedesV

            You have ignored my point. The existence of a published study =/ evidence.

            You’re caught in a tautological bind, and you don’t even realize it.

          • DiomedesV

            Ah, but if I’ve published something, whatever it is, it must be evidence of something, right? No matter who I am or what I’ve published? By your very own logic? After all, you don’t even have to defend the quality of my work– you don’t even have to read it! It’s been published! Maybe I published an article proving the coexistence of humans with dinosaurs…. and now there’s evidence of that! No one can forthwith declare that no such evidence exists. Doesn’t matter where I published it or whether it’s correct, it’s evidence! (And yes, I have had that conversation with someone.)

            Most papers are probably wrong, and many of them are egregiously wrong. The attitude that the act of their publication constitutes evidence is highly problematic. Because once something has been published, it can become part of a very convincing story that takes on a life of its own. That story enters the collective consciousness of a society and effectively never leaves, even if it is proven wrong, even if that proof comes in the shape of — you guessed it — another published paper! How many people still believe that vaccines cause autism? How many of them will believe it no matter what additional evidence demolishes that erroneous hypothesis? How much more convincing it is if someone made a documentary about it?

            This article in Nature outlines some of these problems:

            http://www.nature.com/news/replication-studies-bad-copy-1.10634

            Dr. Tuteur has the right to declare that there is no evidence for a phenomenon. You have the right to claim that the evidence published is of sufficient quality to be included as evidence. But as you so correctly point out, you haven’t even done that. You’ve simply declared that because someone published something somewhere, the evidence exists.

        • Stacy48918

          The mere existence of a study does not equate with “evidence”. Studies must be correctly designed, sufficiently powered, adequately processed (statistics) and repeatable. THEN we can start to say that there is evidence of one thing or another.

  • Matt

    Since the author claims to know a whole heck of a lot about what kind of EVIDENCE there is out there… I thought it might also be interesting to share this little tidbit. This from the Cochrane Database of Systematic Reviews. If y’all didn’t know… Cochrane reviews are generally considered highly credible.

    Benefits and harms of planned hospital birth compared with planned home birth for low‐risk pregnant women.

    http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0010623/

    Authors’ conclusions: There is no strong evidence from randomised
    trials to favour either planned hospital birth or planned home birth
    for low‐risk pregnant women. However, the trials show that women living
    in areas where they are not well informed about home birth may welcome
    ethically well‐designed trials that would ensure an informed choice. As
    the quality of evidence in favour of home birth from observational
    studies seems to be steadily increasing, it might be as important to
    prepare a regularly updated systematic review including observational
    studies as described in the Cochrane Handbook for Systematic Reviews of Interventions as to attempt to set up new randomised controlled trials.

    Hmm.. wowee now that seems like a little bit more of a balanced and rational conclusion than the author’s rants here in this blog. Don’tcha think?

    • araikwao

      Yeah, wasn’t that the Cochrane review that included 13 patients? And perhaps you could consider the research question and whether it compares to the sample typically discussed on this blog. Never mind, I’ll give you the answer – it doesn’t. Unfortunately, the stories here tend to include high-risk women who were encouraged by (usually) under-qualified midwives to deliver at home. Or low-risk women who developed complications that weren’t recognised, or couldn’t be dealt with out of hospital. They don’t compare to the population of that review at all, so the recommendation does not apply.

      • Box of Salt

        araikwao, you’ve overestimated the number of subjects:

        ” Only one trial (involving 11 women) contributed data to the review.”

        • araikwao

          Oh sorry, I’ve completely blown it out of proportion there 😉

      • Matt

        I’m sure we could debate the value of that particular review all day. But I will still venture to say it presents a more accurate picture than the fear-mongering and rants on this blog.

        If the author of this blog wanted to present an accurate picture of reality, one might think she would include the occasional story of the 9980/10000 babies born at home just fine, with no complications.

        See, the problem here is not that the author’s concerns are invalid, or that her facts are wrong. (Well, some of them are wrong.) The problem here is in railing against midwifery, she employs the very same questionable tactics that she is railing against. That’s very problematic.

        • birthbuddy

          Please list the factual errors for us all to see.

          • Matt

            Factual errors? Did you read my comment? I wasn’t talking about factual errors, I was talking about misrepresentation of facts.

            The data I’ve seen shows a 0.2% neonatal mortality rate for homebirth vs 0.09% for hospital birth.

            Clearly… homebirth is riskier and I don’t see why anybody should be surprised or question that result.

            What I was referring to was the disproportionate amount of “horror stories” posted on this site. If 0.2% of homebirthed babies do not survive the neonatal period, that means 99.8% of them did.

          • MaineJen

            Because the horror stories are real. And they are deleted/banned from certain other sites as “fearmongering.” Any particular reason the horror stories shouldn’t be posted?

          • Amazed

            Because they don’t fit his narrative where big evil doctors are there to get poor little Matt for the sake of not being sued.

            He dislikes the horror stories being posted because that gives, well, face to that 0.2 percent and the fact that it doesn’t equal 0.2 dead babies but hundreds, thousands of dead babies who didn’t have to die.

            I haven’t read all the 500 comments but if he’s indeed preparing for his wife to have a homebirth, I understand his reasoning. If I was making plans to do something that exposes my child to additional risk, you can trust me that I’d stick to the relative risk of 0.02. It’ll make me feel better about myself than the absolute reality of hundreds, thousands of preventable deaths.

          • birthbuddy

            No, Matt, you said some of her facts are wrong. Read your own comment again and list the factual errors.

          • Stacy48918

            Except if it’s your baby, he doesn’t 0.2% die. He’s 100% dead, and most likely preventable.

          • AlisonCummins

            It also means that about 3.2% of them survived with permanent brain damage.

        • Stacy48918

          Matt, you’re the one vomiting studies out to back up your point of view…but you don’t want to actually discuss the merits of the study itself? That’s pretty intellectually dishonest. Yes, you happened to find a piece of paper that says something. Turns out, the Cochrane review is worthless because it references ELEVEN women. You’re really basing your opinion (and your baby’s life) on a “study” of eleven women?? That’s hardly an “accurate” picture.

    • Young CC Prof

      That Cochrane report simply found that there are no controlled trials of ANY usefulness. And those observational studies?

      Basically, the observational studies find that when very low-risk women have home births following thorough prenatal care, attended by skilled practitioners who transfer to hospital promptly when signs of a problem appear, the absolute increase in risk to the child is small, less than 1 per 1000. However, these observational studies of very low risk women with careful and responsible midwives are constantly used to justify home birth by higher-risk women with irresponsible midwives, which result in disaster far more often.

      Here’s where it gets really silly: Those very low-risk women were unlikely to wind up with c-sections in the first place. And since they’re transferred at the drop of a hat, some of them did have c-sections anyway.

      The reduction in c-section rate from introducing safe homebirth practices is trivial. Try encouraging more home births, and the rate of deaths and injuries goes up alarmingly.

      • Matt

        CC- Wow a rational and well-thought out response! Hard to find on fake “skeptic” blogs these days.

        No argument from me here. I basically agree with your response. Just saying if we are going to ride the evidence train, then we must look at all the evidence, not just the evidence that concludes what we want it to conclude.

        The only thing I might challenge in your response is that the very low-risk women were unlikely to wind up with c-sections in the first place. That’s probably true, but depending on the OB, hospital system, I think a lot of low-risk moms are encouraged- or at the very least NOT discouraged- from having a planned C-section when there is no medical reason.

        I can think of one example of somebody I know… she had a planned C-section because she was afraid of the “damage” that natural childbirth might cause to her pelvic region, and didn’t breast feed because, in her opinion, breasts are for sex only.

        Now why didn’t her OB try to talk her out of this nonsense? It’s anybody’s guess. But that’s just one anecdote.

        • Young CC Prof

          One in 8 women who give birth vaginally require major reconstructive surgery later in life due to damage to the pelvic region. It’s not a remote risk at all. Somewhere between 1 and 3% require repair in the OR immediately after birth for 3rd or 4th degree tears.

          I’m not saying every woman should have a c-section to avoid the risk of tearing. I am, however, saying it’s a very real health concern, and not as silly as you seem to think. What if this woman’s mother or sister suffered severe tearing? She’d be at higher risk, then, and have a real and immediate example of how bad it could be.

          • Matt

            Well I don’t know about her family history of tearing. What I do know is that her tiny child already has severe food allergies, and I just can’t help but wonder if C-section (or more likely lack of breastfeeding) had something to do with it.

            I’m curious to know your opinion on birth position though… since you appear more educated than me on this matter. Seems to me that a woman lying on her back on a hospital bed is more likely to suffer tears than one who is allowed to let gravity help with the process. Thoughts?

          • Young CC Prof

            Nowadays, most hospital deliveries are more likely to be in a “reclining” position, sitting partially up on a hospital bed rather than totally flat.

            Totally upright deliveries, such as on a birthing stool, however, are actually associated with an increased risk of severe tearing, possibly because the baby comes out a little faster and the tissues have less time to stretch.

          • Matt

            That is interesting. Can you pass along a reference for that?

          • Bombshellrisa
          • Matt

            A blog post is not evidence. But I was able to extrapolate some real evidence from the information provided in the post. Here is a link to a number of studies done by de Jonge on birth position, for anybody else who might be interested in taking a look at them.

            http://www.ncbi.nlm.nih.gov/pubmed?term=%28de%20jonge%5BAuthor%5D%29%20AND%20birth%20position

            I

          • Matt

            Shoot the link didn’t work. But it was a PubMed search for (de jonge[Author]) AND birth position

          • birthbuddy

            Most people here are familiar with de Jonge, thanks Matt.

          • The Bofa, Being of the Sofa

            Is de Jonge the one that has been desperately trying to spin every result, no matter how damaging, into an argument for homebirth and, more importantly, Dutch midwives? And every time something appears to be positive, upon further investigation, it is not as good as it seems.

          • Matt

            I really don’t know. Could be. That’s just the study that the blog author referred to in the other post.

          • moto_librarian

            Dr. Amy reported on a study that showed that upright positions may actually increase the risk of tearing and blood loss. You might consider using the search bar before you continue to spout off on things that you clearly know nothing about.

            I’ll also share a little anecdata with you: I know three children who were all “naturally birthed.” Two of them have severe ADHD, the other has serious food allergies. Your opinion on your friend’s child is about as relevant as your attitude about her c-section. Neither one is any of your fucking business.

          • Cobalt

            If we’re using personal anecdotes as evidence, let me share some of my personal experiences:

            Babies number 1 through 3: Unmedicated spontaneous full term vaginal delivery in hospital, on my back, no tears or cuts. All started breastfeeding within an hour of birth.

            One had to switch to a special (and ridiculously expensive) formula due to severe food allergies and protein sensitivities that put major limitations on his diet for the next 5 years and had a big impact on his growth pattern.

            Was it because I had an IV? Because that was the only intervention I had.

          • Pillabi

            Did they put a hat on his head?!

          • Matt

            Personal anecdotes aren’t evidence. Was somebody here suggesting they were?

          • Cobalt

            “Well I don’t know about her family history of tearing. What I do know is that her tiny child already has severe food allergies, and I just can’t help but wonder if C-section (or more likely lack of breastfeeding) had something to do with it.”

            Nope.

          • Bombshellrisa

            The current thought about allergies and formula/breast feeding is that solids should start being introduced at about four months, not later as previously thought to be best.

          • Matt

            That’s interesting! What is the rationale?

          • Bombshellrisa

            This is coming from our current pediatrician, I guess the evidence pointed to a higher occurrence of food allergies during the time doctors told parents to introduce solids at a later age. I have two kids who are far apart in age and I was given different instruction on solids with the first one (who was breastfed)

          • Matt

            Hmm… that’s an interesting idea. Thanks for sharing! 🙂

          • Pillabi

            any source at hand?

          • theadequatemother

            there were two studies recently published..RCT of timing of gluten introduction (4 mo vs 6 mo and 4 mo vs 12 mo) in infants with HLA type that put them at risk for celiac and celiac in relatives. There was no difference but the delay in introduction was associated with a delay in diagnosis.

            I think red wine and applesauce or science of mom recently reviewed this topic.

          • araikwao

            There was a study on introduction of egg a few years back too, which favoured egg from ??4 months, I think. With my first baby, it was some convoluted recommendation of yolk at 8 months, white at 12, or something.

        • toni

          Wow, nice quotation marks around “damage”.

          • Cobalt

            Yeah, “damage”. Like “pelvic prolapse” or “incontinence”.

          • Bombshellrisa

            Yeah, how dare anyone want their lady parts to be ok!! Lady parts are for making babies and feeding them, not for ANYTHING else

          • Matt

            Sorry you are right, I didn’t mean to imply damage does not occur. Wrong use of quotation marks.

        • Bombshellrisa

          Why should a doctor discourage a woman from an elective C-section? Why should an OB discourage a woman from choosing to formula feed?

        • Stacy48918

          So you would FORCE her to have a vaginal birth, against her will, risking her perineum, sex life, fecal and urinary continence – among other things – just because YOU think it’s best? And then you would FORCE her to breastfeed because YOU think it’s best? Wow. I can’t believe you so ardently oppose a woman’s right to her own bodily autonomy. Shouldn’t she have the right to direct her own medical care and not have you make value decisions for her? If she’s not planning to have 8 children and can afford formula, what does it matter?

    • Stacy48918

      Ummm…yea. Have you actually READ what the Cochrane report says? Trust me. Many of us here HAVE…and that’s why your rant is ridiculous.

  • Matt

    “Since the advent of modern obstetric interventions …. we live longer and healthier lives than ever.”

    That is actually (yet another) false claim made by the author. Considering the precipitous rise of noninfectious disease in Western nations, I think one would be pretty hard-pressed to say that we are living “healthier” lives than ever. I also recall hearing something about the current generation being the first to have a shorter life expectancy than their parents… but I don’t have a reference for that at the moment so we will leave that one in the realm of conjecture.

    I was further intrigued by some of the author’s comments regarding neonatal mortality rates of hospital vs home births. I cam across this meta-analysis:

    Wax, J. R., Lucas, F. L., Lamont, M., Pinette, M. G., Cartin, A., & Blackstone, J. (2010). Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis. American Journal of Obstetrics and Gynecology, 203(3), 243.e1–243.e8. doi:10.1016/j.ajog.2010.05.028

    OBJECTIVE:

    We sought to systematically review the medical literature on the maternal and newborn safety of planned home vs planned hospital birth.

    STUDY DESIGN:

    We included English-language peer-reviewed publications from developed Western nations reporting maternal and newborn outcomes by planned delivery location. Outcomes’ summary odds ratios with 95% confidence intervals were calculated.

    RESULTS:

    Planned home births were associated with fewer maternal
    interventions including epidural analgesia, electronic fetal heart rate
    monitoring, episiotomy, and operative delivery. These women were less
    likely to experience lacerations, hemorrhage, and infections. Neonatal outcomes of planned home births revealed less frequent prematurity, low birthweight, and assisted newborn ventilation. Although planned home and hospital births exhibited similar perinatal mortality rates, planned home births were associated with significantly elevated neonatal mortality rates.

    CONCLUSION:

    Less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate.

    I was really intrigued by their conclusion- since the title was talking about outcomes and then in the conclusion they seemed to have overlooked many of their own results indicating some better outcomes in a homebirth scenario… hmm.. strange…

    Instead they simply zoomed in on the tripling of the neonatal mortality rate. Certainly, the author of this blog appears very concerned about the mortality rate of homebirthed babies. From her other content- one might surmise that babies are croaking left and right from homebirths. Scary stuff!

    Anyways. One of the things I’ve learned about relative risk studies is that it is important to know what the baseline risk is that we are talking about. Many times reports on studies are quick to point out that a risk was doubled… tripled… quadrupled! from baseline, but fail to mention that the number they are multiplying was very small to begin with.

    Such is the case with neonatal mortality rates. In this case, the baseline neonatal mortality risk I found was 0.09%. That is to say 9 out of 10,000 babies born in a hospital die shortly thereafter.

    The reported neonatal mortality risk for homebirths is 0.2%, or 20 out of 10,000 home births. This is- in fact- about triple the baseline. However in this case we are also tripling a very low number. The absolute increase in risk is 0.11%.

    Given this information, and given a (perhaps misguided?) desire to minimize neonatal mortality at all costs, it makes sense to choose a hospital birth over a home birth.

    But it also might make sense NOT to, when considering the increased risk of other negative outcomes. In the end… the point is that people should act with informed consent, and in many cases (such as this one) reporting only on the relative risk between two options without discussing the absolute risk is, IMO highly irresponsible.

    • DaisyGrrl

      I can count three distinct occasions in my life thus far where I would be dead had I lived before the development of modern medical techniques (or if I lived in a developing country today). One of those occasions was my own birth, which was an instrumental delivery. So I’m a bit prejudiced in thinking that my health and quality of life are currently a bit better than they would have been otherwise. And if you look at cause-of-death data from 100 years ago vs today, why yes, we are dying of non-communicable diseases. That’s because we’ve figured out how to prevent death from infectious diseases with such success, that people get to live longer and die from heart failure. Oh, the horror!

      Now, you may feel that tripling of neonatal mortality is an okay trade-off for the perceived benefits of homebirth. I vehemently disagree with you, but you are free to have that opinion. I’ll give you another study to consider: Amos Grunebaum, a well-respected currently practicing OB-GYN has found that babies born at home are 10x more likely to have a 5-minute Apgar score of 0. That’s a good proxy for finding profound neurological impairment (a less healthy life) and death (shorter life). http://www.ajog.org/article/S0002-9378(13)00641-8/fulltext

      I’d rather have an asthmatic child than a dead one or one that suffered a preventable severe brain injury at birth because I didn’t want a c-section.

      • Matt

        DaisyGrrl- I certainly won’t deny that medicine saves lives… were you thinking I said something like that??

        The question that is raised in the documentary (and of course in the actual literature) is whether or not a general disregard for the impact of modern medical practices on the microbiome is responsible to some degree for the increase in noncommunicable disease. I think it’s a very fair question, and apparently so do many researchers. Do you?

        As for neonatal mortality rates… well everybody is certainly entitled to their own risk/benefit analysis. But if facts are distorted or obscured (on either side of the debate) everybody loses.

        Personally, I think it’s curious how many physicians and mothers-to-be place such a high emphasis on the 0.11% risk reduction of neonatal mortality from hospital births, while thinking nothing of engaging other common practices (i.e. poor dietary habits, overuse of antibiotics, participation in contact sports) that certainly increase their child’s lifetime risk of chronic disease, injury, or even death.

        But anyway- we all do have to make our own choices. Personally, I have nothing against a C-section if there is an actual indication for it. It is the procedures that are done for nothing more than “convenience” that leave me scratching my head.

        • Young CC Prof

          Increase in non-communicable diseases has an awful lot to do with the increase in life expectancy due to reduced death rates from contagious disease. And we don’t have terribly accurate medical data from 150 years ago, so we don’t know precisely what everyone died of, or how common nuisance-level chronic disease was, or how many people were disabled and why.

          • Matt

            You are right- we certainly don’t have that data.

            What we DO know is that changes to the microbiome have been associated with all manner of noncommunicable disease. What we also DO know is that poor dietary practices and overuse of antibiotics result in deleterious changes to the microbiome.

            So I’m not so sure I can agree with your assessment that it is simply due to an increase in life expectancy. Though certainly it is a factor.

            Personally, I’m of the opinion that in our overzealousness to “eradicate” infectious disease from the planet, we have dramatically increased the incidence of other diseases. Oh and the pathogens are stronger now too. 😉

          • Amy Tuteur, MD

            Your opinion? Your opinion based on what precisely?

          • moto_librarian

            Absolutely nothing.

          • Matt

            Based on a mixture of knowledge, belief, and experience. I’m sorry- are we not allowed to state opinions on this blog? Because I was of the understanding that opinions are fine, so long as they are not presented as facts.

          • Amy Tuteur, MD

            You clearly have no idea what you are talking about. You are merely regurgitating what you’ve read on websites written to impress gullible lay people. Unless and until you read actual scientific papers and analyze them, no one is going to take you seriously.

            You don’t seem to have noticed that the people who produced Microbirth are not microbiologists, but rather natural childbirth advocates who seek to increase market share by engendering distrust of obstetrcians. Would you believe Big Coal if it made a film on the dangers of solar power? If not, why would you believe Big Birth when it produces a film on the “dangers” of C-sections?

          • Matt

            You say there is NO evidence, when there is, in fact, SOME evidence. That is all. If you refuse to change your beliefs when presented with facts indicating they are wrong, then you are no better than the people you are railing against.

            I never said I believe everything the movie. What I said is that there is SOME evidence to support the ideas presented in the documentary.

          • Young CC Prof

            So when your partner or housemate claims there’s no food in the pantry, how long do you yell about the fact that there’s one can of beans in there?

          • Matt

            Haha that actually never happens in my house. 🙂 But if it did- yes I would argue about it.

            Again, the difference is between a true statement and a false statement. If one can make a more accurate statement of the facts, why not make it? Why willfully misrepresent the reality of the situation?

            I mean- isn’t that exactly what the blog author is railing against here? How facts are misstated and deliberately obscured in order to support a particular agenda?

          • Matt

            The author could have made several other statements. She could have said:

            “There is no convincing evidence to support these claims.” That would be true.

            “There is scant evidence to support these claims.” That would be true.

            “There is some evidence to support these claims, however the claims are grossly overstated.” That would be true.

            But she didn’t do that, did she? Instead, she went on a rant. Hmmmm….

          • AlisonCummins

            Actually, in this case we aren’t talking bout a can of beans. We’re talking about a box of salt.

            A health professional would not consider something without calories to be food. Someone else might think that anything that someone might ingest is by definition food.

          • The Bofa, Being of the Sofa

            You say there is NO evidence, when there is, in fact, SOME evidence.

            But as far as I can see, that “SOME evidence” that exists is merely evidence that “microbiome affects health.” Even if that is true, that does not mean there is any evidence that the “microbiome changes that are caused by c-sections have a negative impact on health.”

            Maybe the microbiome changes associated with c-sections is overall beneficial? Or maybe it doesn’t mean squat.

            When I hear the claim “there is no evidence” this is what I think about. What is the evidence that the microbiome changes that are associated with c-sections have a negative impact on health?

            Just saying, “We know the microbiome is important, and c-section babies have a different microbiome from non-c-section babies, therefore c-sections are harming people” doesn’t follow.

          • Matt

            No, it doesn’t follow. But that wasn’t the claim. The claim was: “There is not a shred of evidence that altering the microbiome
            of the gut of the newborn (if indeed such alterations occur) has any
            long term impact on health.”

            Yes… there is (at the very least) a shred of evidence, which I have posted elsewhere in the comments. Some posters have argued that it doesn’t yet amount to much. Fair enough.

            The difference is between a true statement and a false statement. Don’t you think that is important?

          • The Bofa, Being of the Sofa

            “There is not a shred of evidence that altering the microbiomeof the gut of the newborn (if indeed such alterations occur) has any
            long term impact on health.”

            The difference is between a true statement and a false statement. Don’t you think that is important?

            No, because the statement is in response to assertion that there is a negative impact.

            You seriously think that the point of the movie Microbiome is that these effects on the gut might be beneficial? No, when they are saying impact, they mean negative impact.

            And that’s what the statement is countering. There is no evidence for long term negative impact. Nor is their evidence for long term positive impact.

            So if there is no evidence for either positive or negative impact, it’s completely fair to say there is no evidence of any impact.

            OK, microbiome can affect health. But how does that lead to the conclusion that the microbiome changes associated with c-section have an impact on long term health?

          • Matt

            I don’t think anybody is saying that they definitively do. I certainly didn’t hear any experts in the film making those claims.

            My takeaway from the film was that there is a legitimate question raised about the POSSIBLE impacts of mode of delivery on microbiome colonization that MAY have long-term effects on health. Therefore- perhaps we should re-evaluate our willingness to recommend/undergo elective c-section when there is no medical indication for it.

          • The Bofa, Being of the Sofa

            My takeaway from the film was that there is a legitimate question raised
            about the POSSIBLE impacts of mode of delivery on microbiome
            colonization that MAY have long-term effects on health.

            But there is no evidence for that, just the supposition that you agree doesn’t follow:
            1) the microbiome has an effect on health
            2) c-sections affect the microbiome
            3) therefore, we need to be concerned about the downsides of c-sections

            It doesn’t work

            Therefore- perhaps we should re-evaluate our willingness to
            recommend/undergo elective c-section when there is no medical indication
            for it.

            But why? Maybe the long term effects of c-sections and the microbiome are BENEFICIAL? In that case, everyone should be doing c-sections even if there is no medical indication.

            There is no evidence that this conclusion is any less likely than the ones drawn in the movie. But they don’t say that. Because it is a propaganda piece not based on rationality. And that’s the problem.

          • Matt

            LOL- OK fair enough. Yes, there is an underlying assumption that evolutionary processes resulted in the ideal mode of childbirth. Since that is non-falsifiable we can’t really argue that on scientific grounds, only philosophical grounds.

          • Diane

            If there are significant long term effects from microbiome differences due to c-sections this would be visible from the significant differences in adults who were born via c-section. No need to know about the microbiome works to find them.

          • Matt

            Cesarean versus Vaginal Delivery: Long term infant outcomes and the Hygiene Hypothesis

            http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110651/

            If you take a look at the section “VAGINAL VS. CESAREAN DELIVERY” there are about 20 other references included there.

          • Matt

            “You are merely regurgitating what you’ve read on websites written to impress gullible lay people.”

            Actually, I haven’t read anything else on websites about this topic. Yours is the first I came across.

            Your derisive tone and gross mischaracterization of me, my educational background, and beliefs, is highly offensive. I’d rather give birth in a cave then have somebody like you anywhere near me.

            Is this how you used to “communicate” with your patients?

          • Young CC Prof

            Poor dietary practices? How many people do you know with rickets? Beriberi? Pellagra? Scurvy? Vitamin-A deficiency blindness?

            Until the mid-20th century, these dietary deficiencies shortened, maimed and blighted countless lives. In some parts of the world, they still do.

            And the pathogens are stronger? Not exactly. Some bacteria have become resistant to antibiotics, but they are not more dangerous in other ways.

            You have a little knowledge and a lot of opinions. Keep your ears open, be prepared to add to the former and discard some the latter.

          • Matt

            It’s a little bit difficult to respond, as you are beginning to make strawman arguments.

            Of course, hardly anybody in Western countries have frank nutritional deficiencies. But the average diet is far from ideal, given what is available to them. Certainly you are not trying to insinuate that there is no connection between diet and chronic disease, are you?

            As for pathogens… yes by “stronger” I meant more resistant to antibiotics.

            This conversation is starting to degrade fairly rapidly from an intelligent discussion to mischaracterizations and faulty assumptions. But that tends to happen on “skeptic” blogs. 🙁

          • Young CC Prof

            My argument is that the average American’s diet today is healthier than that of the average person’s diet years ago. It is not idea, because it contributes to obesity and heart disease, but lousy diets are not something the modern age invented.

          • Matt

            I think it is difficult to draw a firm comparison. Until the modern age, diets were lousy because people generally didn’t have access to enough variety to achieve nutritional completeness, and I would imagine there was also a much higher rate of food-borne illness.

            In the modern age, people have easy access to the cornucopia of the entire planet. Not only that, but they have access to a wealth of information on how to eat well, and the benefits of doing so. Yet they willfully choose not to.

            So- I think those are two entirely different situations really.

          • birthbuddy

            Well said YCCP. I was thinking along the lines of ‘arrogant prick,’ myself.

          • guest

            Sounds like a pretty accurate assessment..

          • MaineJen

            What is the alternative to “eradicating” infectious diseases? (Such as smallpox…surely we wouldn’t want that to come back). Letting them run rampant, and accepting the associated higher mortality rate from preventable illness? How is dying of measles at 12 better than dying of heart failure at 80?

        • Stacy48918

          Which procedures are “done for nothing more than convenience”?

          I’m worried about that 0.11% risk because birth is STILL the MOST dangerous day my child will likely experience in their entire life. More dangerous than driving a car, riding a bike, playing contact sports, etc. You don’t see the tremendous risk that birth still carries BECAUSE of modern obstetrics and how safe it has become. It makes you think “things have always been this way”, when really they haven’t.

          • An Actual Attorney

            And I don’t understand this idea that 0.11% is small. That is more than one out of a thousand.

            Last year there were 82,529 at the Superbowl (per Wikipedia, which isn’t exactly a source but probably pretty close at least). Going to the Superbowl is an amazing experience. If a section of the seats had collapsed and 82 people died and 820-1650 people were permanently disabled from the fall, who would say “eh, that’s a fair chance to take because the Superbowl is so awesome”?

    • birthbuddy

      Ah, those pesky neonatal deaths. Why mention them at all, hey Matt?

      • Matt

        No.. again… dd you read my comment? The question is why mention them exclusively in the results, and not any of the other findings?

        Homebirths: “These women were less likely to experience lacerations, hemorrhage,
        and infections. Neonatal outcomes of planned home births revealed less
        frequent prematurity, low birthweight, and assisted newborn ventilation.”

        Facts are facts… right?

        • Bombshellrisa

          Until they aren’t.
          How much do you know about home birth midwifery in the US? The vast majority of midwives who attend women at home don’t have formal medical training. They can’t prescribe medications, suture, and don’t have privileges at hospitals. The women in their care are supposed to be the lowest of the low risk pregnancies. So of course, it follows that since they didn’t have preeclampsia, gestational diabetes or any pre-existing condition, they will be the women who will most likely deliver without incident and have newborns who are healthy.

          • Matt

            Ahh.. but if they DID have formal training, we would still call them posers, right? If they DID pass licensing laws and regulations, we would lament about the “legitimization of pseudoscience”… right? If they DID have hospital privileges… that would be an outrage… right?

            Actually, I do know a fair amount about various midwifery credentials and training. And actually I do think that homebirthing should only occur in the lowest of low risk pregnancies.

            If my wife had preeclampsia, gestational diabetes, acute or chronic infection, or any other relevant medical condition, rest assured I would tell her she is nuts if she wanted to attempt homebirth.

            But since she is perfectly healthy… so far… all I’ve got to go on is an increased absolute risk of 0.11% neonatal mortality. And that’s a risk she is willing to accept at the current time.

            I can tell you one thing for sure… she would be more open to having a hospital birth if she had any sort of assurance that she wouldn’t be railroaded into interventions by malpractice-fearing hospital staff.

          • Bombshellrisa

            No, we would call them Certified Nurse-Midwives because they already exist, are legal to practice in all 50 states and can prescribe melds, practice as women’s healthcare providers and deliver babies in both centers, homes and hospitals.
            Here is a chart showing the different levels of education and training for US midwives. Keep in mind that most reports that CPM/lay midwives/direct entry midwives use to try and legitimize their practices here are compiled from data that uses numbers from midwives in places like Canada, Australia, the UK and New Zealand, where the standard education and training is university level and the midwives are independent practitioners and able to attend women in hospitals as well as at home. Home birth in these countries had strict guidelines for who qualifies for home birth, there are lists of supplies that must be there and there is a transfer protocol and plan.
            The problem with insisting that a woman is low risk and so being attended during pregnancy and birth by a CPM is that those midwives aren’t trained to spot when there is something amiss. They call things “variations of normal” and treat with herbal remedies and things like the Brewer diet.

          • Bombshellrisa

            http://www.amcbmidwife.org/amcb-certification/why-amcb-certification-
            Here is the chart comparing and contrasting the education and training levels of midwives.

          • Matt

            Thanks for the material! Correct me if I’m wrong.. a Certified Nurse Midwife is prohibited from participating in a homebirth. Right?

          • Stacy48918

            Depends on the state. I have had a homebirth and a homebirth transfer – both with CNMs, 2 different states.

          • Bombshellrisa

            It does depend on the state, some states require OB backup for CNMs, others see them as nurse practitioners. They do have to carry malpractice insurance which is a huge difference right there.

          • Matt

            Well we are in Michigan, and my understanding is that a CNM is prohibited from participating in a homebirth. So if you know of any information suggesting otherwise, please let me know.

            Currently, my wife has selected a CPM who has an excellent reputation and whose certs are all current. She told us she only recommends homebirths for women in a low risk category, and shared a few stories about when she decided to transfer.

            She is also receiving concurrent care from an OB… he told us that if he knew she were planning a homebirth that he would have to drop her from care, or else he would run the risk of being dropped by his malpractice insurance.

            I can tell you that trying to throw “horror stories” at my wife would most definitely be the wrong move.

          • MLE

            What cents does your CPM have?

          • MLE

            *certs

          • Bombshellrisa

            http://m.pediatrics.aappublications.org/content/126/5/e1400.full
            Protocol for NRP-it takes many hands with specific skills. “The hospital is ten minutes away” is too long. You can be certified, but if you don’t have a team, masks and vents and a way to start an IV within minutes of delivery it’s really useless.

          • Matt

            I don’t have her resume in front of me ATM. My understanding is that…. whatever she can have as a CPM, she has it.

          • MLE

            You should take a good look at her resume, and determine if any of those skills will mean anything in an out of hospital setting.

          • Matt

            OK I will. What I can say is that the OB seemed to think she was a good choice.

          • Bombshellrisa

            There is a husband and wife OB/CPM team. He gets all his wife’s transfers. He attended her bathtub HBAC. It doesn’t mean either of them know what they are doing.

          • Bombshellrisa

            Which doesn’t have to be much of anything in Michigan. Oregon is much the same, there are no specific requirements and someone who attends less then 50 births can call themselves a midwife. Heck, 50 is a lot and takes many years for some midwives. Someone who attends only three or four births a month may be warm, friendly and spend lots of time during prenatal visits but they will not be as sharp as someone who attends that many births a week (and I know some OB’s see that in a couple hours being on call). If she is only attending a few births and all low risk births she may be certified in many things but doesn’t get to run drills (hospitals run shoulder dystocia drills) and probably has never used to skills in real life. There are midwives who call 911 in a panic when things go wrong and can’t even communicate what is going on to the dispatcher.
            Something else to think about: even if this midwife brings a birth assistant and student, three people are not enough if a baby is in crisis with a recently delivered woman who needs to be assessed. The midwife may be very good at identifying tears and can repair them or you might end up having to transfer to the hospital for that to be done.

          • Bombshellrisa

            So will the CNM be attending her in a free standing birth center? That is is equivalent of delivering in someone else’s home, just with a nicer bathtub. Hurt by Homebirth’s page features the story of a woman in Michigan attended by CNMs in a birth center and how the transfer process works . Safer midwifery for Michigan is also a good website.
            Also, the way around the “planning a home birth” is to labor at home and have the midwife there as a doula or companion and when the baby is born, have her catch it. It’s not officially planned, so technically if the midwife decided to transfer the patient, she can just say she was there as a friend or doula while the woman attempted a UC. It’s pretty common. I have been on both sides, as a doula and student midwife and now as the nurse who sees the train wreck home birth transfers wheeled into the ER. Women who have been pushing and pushing for hours after days of labor and they are combative with staff and still want to refuse interventions. All there without their midwives, who do not accompany them to the hospital and don’t send their chart along.

          • Matt

            No… there’s no free standing birth center nearby, so currently she wants to have it at home.

            Thanks for the references.

            What do you think contributes to the “train wreck” homebirths? Do you think it is just a totally random thing?

          • Young CC Prof

            Many involve incomplete prenatal care, home birth undertaken despite known risk factors, or refusal to transfer despite clear signs of a problem, including meconium and possible failure to progress.

            The WHO designed charts called “partographs.” A woman laboring out-of-hospital who progresses slower than the partograph recommends needs to be promptly transported to a hospital for evaluation. She might need an intervention, she might not, but it’s definitely time to get her checked.

            Sometimes, however, things go disastrously wrong with no clear warning signs.

          • Matt

            Thanks…. I will check out the partographs.

            In the cases where things go disastrously wrong with no clear warning signs… what it the incidence of this? And in what percentage of those cases did hospital intervention result in a healthy baby?

          • Stacy48918

            Just because the CPM stated after the fact that there were “no clear warning signs” does not mean that they weren’t there. After all, if you aren’t looking, you won’t see them. Allowing a woman to labor alone for a long period of time, intermittent monitoring, no cervical checks, no GBS testing, no GD testing, no US for positioning, no NSTs…these things happen routinely and then the midwife says “there were no warnings”. Well, duh, you weren’t looking. Of course you didn’t know the baby was in distress. Properly monitored, these warning signs and risk factors are much more likely to be caught and attended to.

          • Bombshellrisa

            Train wrecks are usually the result of insisting birth is as safe as life gets, not having access to interventions early on and not having a clear transfer plan in place. Transferring is always time consuming. If your midwife doesn’t have hospital privileges, you can write down in detail what you will be transferring for and how you will get there but ultimately what happens is either midwife calls 911 because something is wrong OR midwife calls local hospitals seeing who has enough staff and beds to take someone. The hospital called has to have the resources needed to deal with the reason for transfer-meaning transfer for pain relief has to go to a hospital where anesthesia is in house 24/7. Non reassuring fetal heart tones will need transfer to a hospital where a C-section can be done. It may not be the hospital where your OB is in the end, and that means before anything can be done, a history and physical had to be taken, labs have to be run and assessments have to be made.

          • Bombshellrisa

            Disqus is acting up so part 2 here: so all these things have to happen in a crisis. Usually a woman who has been laboring for a long time will be tired, frustrated, dehydrated. Most homebirth midwives feel it’s their job to hold the space, just be there to emotionally support the woman and her partner. Labor goes on and on and then pushing goes on and on. So by the time a transfer is initiated, it’s a train wreck simply because a lot of time had passed when something could be done early on in the hospital, but the setting didn’t allow for something like an IV and a tiny bit of pitocon to move things along. Sometimes because a woman had been pushing and pushing but still refuses a c section when she gets to the hospital ends up tearing so badly that she still requires surgical repair. A lot of what I have seen is no change in attitude about interventions once the woman is in the hospital, making everything that much worse for the team who must try and treat the woman and her baby and for the woman herself.

          • Squillo

            In my opinion, one of the biggest problems with home birth midwifery in the U.S. is that the majority of providers are educated and practice in a bubble.

            More than half of CPMs (and who knows how many non-CPM midwives) never attend any accredited midwifery school and are credentialed through a program that allows them to study with a single preceptor, who then signs off on the student’s portfolio. Thus, the student’s practice is enormously influenced by a single practitioner’s knowledge, attitudes and practices.

            They aren’t ever required to practice in a large setting, with exposure to more than a few other practitioners (at best) or with a varied population of clients. Often, the only “professional” witness to a homebirth midwife’s competence in practice is an apprentice midwife. There is, quite literally, no direct oversight.

            All health care settings, including large hospitals, develop their own culture, which can be either a danger or a benefit to patient safety. That effect is magnified in the tiny, insular world that is home birth midwifery in the U.S.

          • Stacy48918

            I think the biggest thing contributing to the high neonatal death rate is the idea of “trust birth”. There is a completely different world view around birth and risk. Viewing everything as a “variation of normal” leads midwives to shrug off very clear indicators of fetal distress or reasons to transfer and so a problem that might otherwise have been manageable becomes a cluster.

          • guest

            And the fact that in many instances they just do not recognize serious, life-threatening complications. Couple that with inadequate education and training and you have a recipe for disaster.

          • Squillo

            CNMs are not prohibited from attending home births in Michigan (the scope of practice regulations in MI are very general), but in practice, few do.

            There is no licensure and no state oversight for non-nurse midwives (i.e., CPMs) in Michigan.

            You might be interested in the Safer Midwifery for Michigan website, which outlines some of the problems with homebirth midwifery in the state.

          • Stacy48918

            “She told us she only recommends homebirths for women in a low risk category,”
            Perhaps this is true for this ONE midwife…but studies show that homebirth midwives routinely take on high risk patients. The MANA study included HBACs, GDs, multiple gestations, breech, etc. There is a great review paper by Amos Grunebaum published earlier this year looking at the risk profiles of homebirths that found that high risk patients are being attended at home by CPMs.

            Have you asked the midwife directly – has she had any neonatal deaths? Have she had any legal action against her?

            Have you looked up her license through the midwifery board?

            Why does your wife not want to go to the hospital? Because of hospital “horror stories”? The NCB/homebirth crowd is very quick to throw out hospital “horror stories” – which always end with a live baby – but don’t want to hear homebirth “horror stories” that nearly always end with a dead baby. I know that was the case for me when I was in the woo. It honestly never crossed my mind that my baby could die at home.

          • Stacy48918

            Also, Dr. Biter has an excellent reputation and I think 3 dead babies under his belt. Oh yea, and he lost his license but women still say “there’s no one I trust more with my body and my babies”.

            Reputation means very little. Look at the facts. Where and how was she trained? How many babies has she delivered? How many transfers? Why? How many deaths? How many NICU admissions? How many maternal admissions? How many brain damaged/injured babies? How many HIE? Any babies that needed cooling?

            Can she even tell you those numbers?

            The NCB crowd decries hospitals that “hide” or don’t report C-section stats, but don’t equally demand transparency for homebirth midwives.

          • birthbuddy

            How about “true stories”?

          • Bombshellrisa

            So why the OB if she is low risk? I ask because this is not the first time this week someone has posted that they are seeing both a CPM and OB during a pregnancy.
            It doesn’t make sense that the doctor will see a patient who is seeking the care of a CPM (who can only attend homebirths) and tell the patient he couldn’t care for her if she was planning a home birth. And it’s especially unfair to the doctor because if the transfer ends up a train wreck, the doctor will be responsible for whatever happens and it’s his malpractice insurance that will have to cover any damages, not the CPM’s.

          • guest

            You know Matt, it sounds like you and your wife haven’t completely researched your decision to home birth your baby. You seem to have a lot of questions and need clarification regarding the qualifications of home birth providers. From my own perspective, I would not consider trusting someone to fix my car who had minimal training or expertise in car repair. I would want a seasoned, educated and experienced mechanic. I can’t even fathom taking the chance of trusting my baby’s life to a practitioner who’s qualifications I had questions about. For your wife and baby’s sake, please stick to your OB and deliver at a hospital. Most L&D units are welcoming, family-centered and do everything they can to accommodate a family’s wishes. The perception that hospitals and doctor’s push interventions on people is outdated and backwards. Go on a few hospital tours and see for yourself. Your wife and baby’s lives are not worth taking the risk of a home birth disaster.

          • AlisonCummins

            Low risk… As in the UK Birthplace study? She’s already had at least one uncomplicated pregnancy? She’s being attended byUk birthplace study
            “Homebirth in the UK for women who have had a previous completely uncomplicated pregnancy, whose current pregnancy has no risk factors of any kind, and who are being cared for by highly educated and highly trained midwives may be safe, so long as those midwives adhere to the very strict criteria in the study. Homebirth in the UK for women *who have never had a baby* but whose current pregnancy has no risk factors of any kind and who are being cared for by highly educated and highly trained midwives increases the risk of perinatal death and brain damage. Everyone else isn’t even a candidate for homebirth.”

            http://www.skepticalob.com/2011/11/real-message-of-birthplace-study-dont.html two nurse-midwives with a transfer rate of 25%?

            Uk birthplace study
            “Homebirth in the UK for women who have had a previous completely uncomplicated pregnancy, whose current pregnancy has no risk factors of any kind, and who are being cared for by highly educated and highly trained midwives may be safe, so long as those midwives adhere to the very strict criteria in the study. Homebirth in the UK for women *who have never had a baby* but whose current pregnancy has no risk factors of any kind and who are being cared for by highly educated and highly trained midwives increases the risk of perinatal death and brain damage. Everyone else isn’t even a candidate for homebirth.”

            http://www.skepticalob.com/2011/11/real-message-of-birthplace-study-dont.html

          • AlisonCummins

            Low risk? Your wife has already had at least one uncomplicated pregnancy and delivery? She’s being attended by two nurse-midwives with a transfer rate of 25%?

            Or maybe you just mean pretty low risk. This is her first pregnancy and you guys accept the 40% likelihood that her two nurse-midwives will transfer her to the hospital they are part of. It’s still measurably higher risk than if it’s her second uncomplicated pregnancy (and personally I’d rather know in advance if I were delivering in the hospital) but it’s not insane.

            (If your CPM has a transfer rate of less than 30% for first-time mothers, dump her. She doesn’t know what she’s doing and presents an unnecessary risk to your wife and your child. With a transfer rate of 30–40% the women she transfers don’t necessarily have any kind of operative delivery but they do get continuous monitoring so that everyone knows that even though the situation looks worrisome the baby is actually doing fine and you can relax. Or that no, the baby is not doing fine at all and you need to do something now. Either way, proper hospital care improves outcomes.)

          • AlisonCummins

            Notice that your CPM doesn’t have to worry about losing her malpractice insurance because she doesn’t have any. That is because she is UNINSURABLE.

            Being uninsurable is a problem. Evaluating risk is an insurance company’s business. That’s what they do. They consider an OB to be high risk because payouts tend to be high, so they charge OBs high premiums. But they consider a CPM so high risk that they won’t insure her at all.

          • Matt

            Also… can you recommend a good resource for learning about warning signs during birth. For example… what sort of things a CPM might miss? Also specifically… good info on “failure to progress”… when it is really a cause for concern and when it is not.

          • Stacy48918

            This website has been my best resource. Seeing real stories of things that are missed. It’s how I knew, even before my CNM told me, that my baby’s heartrate was too low in labor. How did I know? She put the doppler on my belly, then immediately reached up and took my pulse. Through reading stories and information on the SOB I knew that it was possible to pick up and confuse a maternal heartrate for the baby’s…and that that’s likely how many dead babies drop into CPM’s hands without “warning”. Because they were listening to the wrong heartbeat. I knew in that instant that my baby’s heartrate was too low and my midwife was trying to confirm that she was hearing the baby and not me.

            I have learned more about concerns in labor and delivery from this site and the comments than anywhere else.

            And it’s why I’ll never have another homebirth again. Reading this website.

          • Bombshellrisa

            It’s not just missing signs in labor. It’s the combination of attitude about pregnancy (“pregnancy is not a disease, it’s a safe normal process”) that leads to prenatal care that continues the thought that pregnancy is normal, therefore testing is unnecessary if a woman is eating right and exercising right and hasn’t had problems before. So a GBS swab will be done by the woman herself, the GD test will consist of eating 12 jelly beans and then getting her finger poked to test her blood sugar. Women are even given the option of declining these tests. So two things that have nothing to do with labor but determine steps taken in labor if they are found won’t be done and can be deadly. Also things like following up with taking vitals. Elevated blood pressure can be preeclampsia but home birth midwives will treat them with herbs and the Brewer diet. They don’t do any blood work to investigate further. So by the time labor has come, it’s not unusual for women to go two weeks past their due date because “babies aren’t library books”, but placentas do have expiration dates and they do stop functioning. Then labor needs to occur “where women feel safe” without interventions, without cervical checks and without any sense of urgency. Then pushing is something that can last for six hours. This is just average home birth stuff, not even the stuff the more renegade midwives practice.

          • Matt

            Hmm… really? That hasn’t been our experience at all. Our CPM didn’t suggest any of those “alternative” tests. Really? Why not do the regular tests?

            She also has done normal vital checks, and has previously comanaged with our OB. She offered the doppler, but we declined since we had just had it done two days prior at the OB’s office. They have a friendly relationship… although that is on the “hush hush” because I guess it is a no-no for an OB to even SEE somebody considering homebirth?!

            We also specifically talked about going past the due date and potential issues there… she said that the placenta does get “old” and that nutrition transfer can become impaired Luckily, we are pretty confident about the exact date of conception, so there really isn’t much grey area there.

            I mean… I totally get that there’s a lot of incompetence out there in midwifery-land. But I’ve seen a lot of incompetence in physician-land also.

            I still think that trying to fear, shame, and deride women out of homebirth is a really backwards tactic.

            Why not educate women on how to select the highest quality midwife available? Or why not teach them how to navigate the medical system so that they don’t feel so disempowered in the hospital?

          • Bombshellrisa

            I agree that people need to know the difference in midwives, but looking for a CPM that doesn’t practice in a way that raises red flags is pointless. Nurse midwives provide care that is appropriate and more encompassing than just “the child bearing year”. Btw, no midwife should “offer” to check the fetal heart tones. That is a basic standard of care done at every appointment no matter what, it’s not optional. Listening for variability is very important.

          • Bombshellrisa

            So how far past the due date was she willing to transfer care at? What hospital does she prefers to transfer to and how much does she charge if she accompanies the transfer and stays to give report?

          • Matt

            I’m not sure off the top of my head. If I recall I think she said more than 10 days past due..? What do you think about that number.

            We would transfer to the hospital of our choice…? Which would be the same one our OB is affiliated with.

            As far as I am aware, the fee is the fee. She didn’t mention anything about additional fee for transfer.

          • Matt

            Oh… also I should mention another unfortunate reality of the situation… our health insurance policy doesn’t cover maternity care.

            We could get a policy that covers maternity care… but it would cost three times a month and *still* have a huge deductible.

          • guest

            that is very unfortunate. It might be worth your while to pay it anyway, if you can. The cost of emergency and/or continued care (if needed) may very well exceed the cost of paying the extra premium and deductible.

          • Bombshellrisa

            I have been there-with my first child. Is there any way you guys can apply for pregnancy medical insurance through the state? My husband is self employed and we had a policy that didn’t cover maternity care, it’s all we could afford. We were able to get into a spend down program through the state but with the affordable care act, it’s so much easier now to get that help if you don’t have it.
            Choosing a home birth does sound more cost effective, but any transfer to hospital is going to horrendous cost wise. I know most midwives have a care contract they have their clients sign which explains that in case of a transfer, they may or may not be able to accompany the laboring woman. The midwives I trained with never brought up the extra fee until after 911 was called or the woman was finally in the car to transfer.

          • Bombshellrisa

            10 days may be fine for some babies, for others 39 weeks is all they can take. It really depends on the baby and mom, is this your first baby?

          • AlisonCummins

            Why on earth would you want to risk your baby going any days past due at all? After 40 weeks there is no benefit at all and the risk of stillbirth increases every day. http://www.skepticalob.com/2014/09/elective-induction-improves-maternal-and-neonatal-outcomes.html

            Fifty years ago it was normal for pregnancies to go ten days post dates because 1) there was no accurate dating technology and 2) there was no data showing it was a problem. Now we have the data to date a pregnancy accurately and we know how dangerous a post-dates pregnancy is. So today, in order to protect the baby, the standard of care is to offer induction before the pregnancy goes post dates.

            Remember that for every baby who dies, ten to twenty live but have measurable permanent damage. Measures that prevent death also prevent permanent injury.

          • Bombshellrisa

            The CPM explained that an old placenta might not “transfer nutrition”. She didn’t mention what a placenta like that might do during labor.

          • guest

            And with only intermittent fetal monitoring by doppler, subtle signs of placental insufficiency will be missed. Those signs indicate the baby is already in trouble and needs to be delivered. That could explain instances of limp, unresponsive babies in home birth deliveries when the midwife says the heart tones were “fine.”

          • Stacy48918

            And we certainly can’t induce at 39 or 40 weeks, even if it would lower the risk of a C-section because “babies aren’t library books”.

          • Bombshellrisa

            I can’t imagine going through one of those castor oil concoction inductions that midwives use. One of the recipes includes vodka.

          • guest

            It’s troubling that the CPM used the term “transfer nutrition”. It certainly doesn’t sound as dire as “decreased blood flow” or “placental insufficiency.” She also didn’t mention that subtle signs of fetal distress caused by placental insufficiency are extremely difficult if not impossible to pick up by auscultation with a doppler. A CPM may not even know that.

          • Stacy48918

            And as I said, I GUARANTEE, she won’t mention the decrease in C-sections with earlier inductions because it would mean a transfer to OB care and she would LOSE MONEY.

          • guest

            That’s the damn truth, isn’t it? God forbid patient safety should stand in the way of their FEE!

          • araikwao

            To be fair, though, sometimes we use less precise language when talking with patients/families. I hope it was this rather than a lack of knowledge

          • araikwao

            Everyone gets induced at 40weeks exactly?! In Australia, we still use 40+3 unless the situation requires different action. The stillbirth rate doesn’t climb appreciably until a bit later, IIRC, more like 42 weeks?? I’d be interested to know if there’s much difference in outcomes related directly to this..

          • Young CC Prof

            Most doctors currently use 41 and will wait until 42 if the patient really wants to. That might change in a few years, though.

          • araikwao

            Yeah,that sounds a bit more consistent with reports from here, at least

          • Stacy48918

            Nothing good happens after 40 weeks.

            So you’re not happy with your OB to attend your birth from the start…but if everything goes to hell *save me* *save me* *save me*.

            I can’t imagine why he wouldn’t want to keep you as a patient if you’re planning a homebirth. You’re planning to dump a disaster in his lap, rather than allowing him to possibly prevent it in the first place.

            Your midwife still expects you to pay her the complete fee even if she doesn’t actually deliver the baby because you transfer? The Business of Being Born I guess – payment for services not rendered. At least your OB only charges you for the birth if he actually attends it.

          • Bombshellrisa

            The midwife expects you to pay up BEFORE the birth!

          • Stacy48918

            The highest quality midwife available is a CNM. Period.

          • AlisonCummins

            Yes, ‘transfer of nutrition’ to the fetus can be impaired. Ditto transfer of oxygen. Ditto transfer of products of metabolism to the mother.

            Reduced transfer of nutrition sounds like the baby won’t grow as fast. It doesn’t sound like the baby will suffocate or suffer from acidosis. Have you asked the CPM about *all* the problems associated with a deteriorating placenta?

          • theadequatemother

            I can recommend a CNM or an OB. They are adequately trained to look for and pick up warning signs. If you feel like you need to train yourself to be able to pick up the same maybe you should ask yourself how much you are willing to trust a CPM in the first place and if they truly deserve your money.

          • AlisonCummins

            A good resource for learning about the warning signs… obstetrical training.

  • Matt

    Also: “THERE IS NO EVIDENCE TO SUPPORT THOSE CLAIMS.”

    Here is just one journal article I found. Granted- this might not be the highest quality article on the planet, but it does have a list of references. Certainly enough to refute the above ALL CAPS false claim.

    http://esciencecentral.org/journals/natural-childbirth-and-breastfeeding-as-preventive-measures-of-immune-microbiome-dysbiosis-and-misregulated-inflammation-2329-8731.1000103.php?aid=14235

    If the author wants to launch a legitimate scientific- and even “skeptical”- critique, that’s one thing. But this post is hardly that. It is a rant, and nothing more, as evidence by the wildly false claim the author made as to the supposed lack of evidence supporting the claims she is railing against.

    • DaisyGrrl

      True, that is not the highest quality article on the planet. Not by a long shot. It doesn’t contain original research, nor does it purport to conduct an honest review of the existing literature on an existing topic. It is quite clearly an opinion piece.

      This line at the top of the page got me curious: “Review in 3 weeks. Publishing in 72 hours.” I don’t know how science journals work in general, but in my field, papers wait months for review, acceptance, and publication. So this got me curious.

      A little googling shows that this “journal” is part of the OMICS group, a pay-to-publish scam. Low impact factors, and no real evidence that half these journals even conduct peer reviews.

      Given the above, I have difficulty accepting the author’s premise. The articles he cites might have promise, but I’d have to look at each one for what it says and what the conclusions are before I could even begin to decide whether his argument has merit.

      Thus far, the reading that I have done on the microbiome is fascinating and I can’t wait for the field to mature as scientists learn more, but there is insufficient evidence to make large-scale changes to current clinical practices.

      Science requires repeated testing of a hypothesis. Since we’re still learning about the extent of the microbiome, the variability of its contents depending on the individual, their diet, their location, and other factors, and how altering it in one manner may or may not have a predictable impact, it is far too soon to begin to make specific claims concerning the life-long health consequences attached to a particular mode of birth.

      • Matt

        Taking a closer look at the references cited, I think there is plenty of evidence to make the claim that mode of birth is affecting the microbiome. Exactly WHAT kind of effect, and to what extent, clearly remains to be seen.

        But the point of my post is not to argue the details. Rather it is to point out, that in her lambasting of the documentary, the author made a demonstrably false claim.

        She said there is NO evidence to support those claims when there IS evidence. It’s as simple as that.

        When comparing two sources: one a health blogger with a 30 year old medical degree, now retired, ranting on the Internet and making false claims ABOUT false claims, and the other, a researcher with a current university position, with an article published in a questionable journal, but with legitimate references… whom do you feel wins out on credibility?

        • Siri

          It’s ‘who do you feel wins out’, Matt. And your ridiculous article ain’t it.

          • Matt

            LOL- dammit that’s a pet peeve of mine… who vs whom… sorry it was just a typo.

        • Bombshellrisa

          It’s not hard to keep up with obstetrics even if a doctor is no longer practicing.
          You seem quite passionate about this subject. Did you watch the documentary and as a woman, does it make you feel like you much choose a birth with as little intervention as possible because it’s best?

          • Matt

            I am not a woman. My takeaway from the documentary is that the risk/benefit analysis of childbirth procedures, such as elective c-section, are in need of re-evaluation in light of emerging knowledge and evidence about the microbiome. What actually emerges from the research remains to be seen.

          • Bombshellrisa

            Elective c-sections are not easy to come by. You can’t just tell your OB “I want to have a C-section” and boom, done. At least not in the US. There are so many motivators to keep C-section rates down and lots of pressure to attempt a VBAC. Google “reduced c-section rate” and Medicaid and you will find that doctors and hospitals who meet the criteria (low c-section rates are one of the four things) get a certain percentage more $ from Medicaid for doing so. Between this and the baby friendly hospital initiative there is no reason to “re evaluate” elective c-sections when in fact, they are something that have to be fought for already.

          • Box of Salt

            I am curious, Matt, since based on your comments you are interested in the documentary and in debate tactics, what exactly do *you* consider “elective c-section”?

            This is a term that needs a specific definition when you are evaluating its risks and benefits. I need to know how you are defining it, and how that definition compares to my own and to the ones professionals use in order to continue having any discussion of this subject with you.

          • Matt

            Well in the purist sense I would define elective c-section as one that is not medically indicated. But since it appears that SOME kind of justification can almost always be found, I would say that a c-section that a physician recommends largely because they are attempting to protect themselves from possible litigation (as per Dr. Amy’s first post in this blog)… I would also consider those “elective.” . Obviously, that’s a problematic definition. Maybe elective is the wrong word. Unnecessary perhaps? How about: Any c-section that an OB wouldn’t agree to for herself, given the same circumstances.

          • Houston Mom

            If the doctor is afraid of litigation, she is actually afraid that some harm will come to the patient. People sue over injuries. Parents of injured babies needing a lifetime of care need monetary judgments. I think when you say elective c-section, you are thinking of maternal request c-section. I have a friend who has stated she will not get pregnant unless she is guaranteed a c-section. She has a history of sexual abuse and a chaotic, abusive home life as a child. Besides wanting to avoid the exams and exposure of vaginal delivery, she has an extreme need to feel in control. She’s been through so much already in her life. She’s a really tough person but doesn’t want to go through labor. I think her reasons for wanting a c-section are perfectly valid. Do you think her request is unreasonable?

          • Matt

            No, I don’t think it’s unreasonable.

          • Young CC Prof

            Realize that a doctor’s definition of elective is any surgery that is planned in advance rather than an emergency, even if it is absolutely necessary.

      • Matt

        “…it is far too soon to begin to make specific claims concerning the
        life-long health consequences attached to a particular mode of birth.”

        Yes… you are correct. But there are no specific claims being made in the documentary. The only specific claims I see being made are by the author of this article, which are demonstrably false claims.

        The documentary raises a hypothesis… is the rise of noncommunicable disease in “Western” nations connected to the increasing medicalization of birth? A very fair question, I believe. But that’s as far as the documentary goes… it doesn’t purport in the least to have any answers.

        I’m curious- Have you watched the documentary yourself?

        • araikwao

          Part of it is likely due to the increasing survival of very low birth weight infants (& the birth of more big babies, too), who are higher risk for obesity and the NCDs too, according tothe Barker hypothesis.

    • Siri

      Certain distinct advantages that were embedded in ancient cultures and practices? Restoring the human biome super-organism to its historic status? You take this nonsense seriously, Matt?

      • Matt

        Nono… I wasn’t saying that is a great article that I agree with in entirety.

        What I was saying is that there is indeed SOME evidence to support the “Disappearing Microbiota Hypothesis” whereas the author of this blog very definitively states that there is none. That just happened to be the first article I found right off the cuff. But if you look in the reference list, there are some more credible articles in there.

        For example, this from the National Academy of Sciences:

        Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns

        http://www.pnas.org/content/107/26/11971.long

        • Young CC Prof

          That finds differences in babies at one day old. Other studies find that those differences fade as the babies grow older and disappear entirely once they start eating real food.

          The microbiome is important, but it’s a moving target. There’s no evidence or any plausible reason to think that birth alone has a lasting meaningful effect.

          • Matt

            There you go again with that “no evidence” thing. Why do so many people on “skeptic” blogs do this? There is SOME evidence, not NO evidence. Which was the whole point of my original response to this blog.

            Here’s another reference for you:

            The human microbiome and the great obstetrical syndromes: A new frontier in maternal-fetal medicine.

            http://www.ncbi.nlm.nih.gov/pubmed/25242582

            ” The transmission of maternal microbiomes to the neonate, by vaginal delivery or cesarean section, is shown to affect health from birth to adulthood.”

          • Young CC Prof

            I don’t think that article means what you think it means.

          • Matt

            I think it means exactly what it says: “The transmission of maternal microbiomes to the neonate, by vaginal
            delivery or cesarean section, is shown to affect health from birth to
            adulthood.”

            What do you think it means? And why do you keep trying to put words in my mouth?

          • Houston Mom

            Did you hear about the recent study that found the bacteria in infant guts resembles the mother’s oral bacteria much more closely than her vaginal bacteria? Sorry I can’t find a link to the study itself but here is an article about it which names the journal it appeared in.http://www.medicalnewstoday.com/articles/277206.php

          • Matt

            No… I had heard about how there were bacteria found in the placenta, but I didn’t know they were similar to oral bacteria. Interesting…

          • Young CC Prof

            The theory is that oral bacteria go into the bloodstream periodically, and from there reach the placenta.

          • araikwao

            Yes, similar to *either* the mother or her partner’s oral flora. So maybe there should be a bit of dad shaming to balance out all the mother blaming – it’s your fault your baby was born prematurely, Dad! You had the wrong oral microbiota! Should have done some more oil pulling/kale eating/other sanctimony-inducing practice! 😛

          • birthbuddy

            Perhaps women should give birth by mouth?
            There is some evidence to support this (wink wink).

          • araikwao

            It was by Aagaard et al, from Science Translational Medicine, I think. Iread it a couple of weeks ago for an assignment. Very interesting, as they had previously assumed any bugs must have been due to ascending infection.

          • perpetual lurker

            I’m going to have to agree with YCCP on this. The abstract talks a big game, but I just read the article, and as far as I could see, it basically states that some studies show that the intestinal bacteria vary around the time of birth according to mode of birth, and that some other studies correlate microbiome differences with chronic disease later in life, and that the former MAY impact the latter.

            I didn’t see any evidence (1) actually connecting the former to the latter, (2) that the differences at birth are lasting, (3) that the purported diseases associated with the microbiome in adulthood are the same ones associated with c-section (the author cites obesity, but we know that those observational studies re: c-section and obesity are deeply flawed by confounding) (4) that the “microbiotic” benefit of vaginal birth exists regardless of maternal health and matenral microbiome.

            In other words, we really don’t know much.

            That’s my main problem with the “Microbirth” movie. Perhaps the film is more moderate than its publicity campaign, but It’s been billed as ‘OMGZ! We’re going to change the fate of mankind by pushing natural child birth, because the microbiome.” And while I am a BIG fan of this field of study – I really find it fascinating and promising – it is WAY too soon to draw conclusions or promote particular birth practices for the sake of the microbiome.

          • Matt

            I saw the documentary last week and I really didn’t get the feeling that they were pushing homebirth, or that they were claiming any sort of definitive conclusions.

            But I didn’t even KNOW about the documentary until a couple days before I saw it, so there could definitely be a gap between the film itself and the publicity campaign surrounding it.

            I agree with you that it is WAY too soon to draw any firm conclusions. Again, the whole point of my original response to the post was that there is, indeed, SOME evidence, and not NO evidence.

          • perpetual lurker

            Maybe I’ve lost the thread here a bit…

            SOME evidence of what? That the bacterial profile of the microbiome may be correlated with certain illnesses? Okay.

            That the mode of birth has an impact on our lifelong health due to microbiotic differences? No, I don’t think there’s evidence of that. Not at this point, anyway.

          • Matt

            Yes… I think the thread has been lost since people keep putting words in my mouth and responding as if I have a position that I don’t. Let us refocus:

            The OP said:

            “And not only that, but childbirth interventions might change to microbiome of the gut cause severe consequences on the life-long health of our children (only the ones who survive childbirth, of course) and
            OUR ENTIRE SPECIES!!!

            There’s just one teensy, weensy problem. THERE IS NO EVIDENCE TO SUPPORT THOSE CLAIMS.”

            The claim is a conjecture that childbirth interventions MIGHT (please note MIGHT not DOES) change the microbiome of the gut causing health effects.

            The counterclaim is that there is NO evidence to support such an idea. There is, in fact, SOME evidence to support such an idea.

            It may not be MUCH evidence… and it may not be CONVINCING evidence… it may be very PRELIMINARY evidence, but it is evidence nonetheless.

          • Cobalt

            Absolutely. And I was a little bit pregnant. And baby Harlow only had a small clavicle fracture.

          • DiomedesV

            The article doesn’t even really do that. It largely focuses on colonization of the mother’s vaginal tract and amniotic fluid with organisms that may be associated with poor outcomes *in pregnancy*, such as preterm labor.

          • perpetual lurker

            You’re absolutely right, the bulk of the article doesn’t even touch the topic at hand. It’s the last paragraph before the conclusion, I believe, where the oh BTW maybe vaginal vs c-section delivery impacts lifelong health gets kind of sandwiched in there.

  • Matt

    The author of this article has clearly not seen the documentary. Therefore, why should anybody take her comments seriously? Could one even BE any more “unscientific”? Anybody who watched the documentary- even if they disagreed with the conclusions- would know that the vast majority of the time is spent showing interviews with physician researchers from esteemed universities.

    DUH! 😀

  • amy

    You sound very bitter….what happened??

    • birthbuddy

      Formula fed against his will?

  • This is not about homebirth!

    Yet another pitiful attempt to discredit powerful and credible research that threaten your own view of how you believe childbirth should be facilitated.
    You continually bring up homebirth, however as far as I understand it this film is about how we can seed the babies microbiome regardless of how the baby is born, it is not a film advocating homebirth.
    What this film is advocating is that we spread awareness about just how important birth is so that decisions are made with those considerations in mind. It’s so that the next time a woman is offered a c-section because her ignorant obstetrician is going on holidays and needs to get the baby out before he leaves, the woman can be empowered with the knowledge that because it is unnecessary and because vaginal birth will expose her baby to her own flora which is essential for her baby’s health, then this unnecessary c-section is not the best thing for her child.
    The other significant thing this film is doing is to keep healthcare providers thinking about the importance of the microbiome so that if and when a c section is necessary for the baby’s survival, then they will make every effort possible to allow skin to skin contact and breastfeeding as soon as possible after the birth so that the baby is exposed to the mothers skin flora if nothing else. And hopefully hospital policies will begin to change to enable this.

    It is sad and ignorant of you to USE this significant and pivotal film to illustrate your own agenda which we all know is to ultimately slam home birthing.
    I am incredibly glad I have a team of intelligent midwives and a very caring and supportive obstetrician helping me throughout my pregnancy and birth and not someone like you!

    • Belle

      Your commentary perfectly illustrates the total ignorance, arrogance and uninformed mindset of the NCB crowd. Home birthing deserves to be slammed.. it KILLS mothers and babies. Why do you even have an Obstetrician on your “team” (if you really do) since, as you say, they are so “ignorant and schedule unnecessary C/sections before they go on holidays”. If you were informed, you would know that most hospitals have been doing skin-to-skin and immediate breast feeding for quite some time now, including in the OR and RR post C-Section.. but you think the film is going to “enlighten” us lil’ ole’ healthcare providers..give me a break.

    • The Computer Ate My Nym

      What this film is advocating is that we spread awareness about just how
      important birth is so that decisions are made with those considerations
      in mind.

      Cool. So bring on the data! What evidence is there that babies born by vaginal birth are healthier than babies born by c-section?

  • MySpursAreSilver

    Having just watched Microbirth I thought I would point out the much of the film is about microflora in the gut and on the skin and the longterm health outcomes of early immune system damage/lack of development. Yes, there is considerable time spent on talking about how, during birth, skin-to-skin contact and breastfeeding, babies are ‘seeded’ with their mother’s flora. However, the ‘cult of natural birth’ filmmakers were interviewing scientists, perinatologists, nurses, midwives even an OB if I remember correctly about how the foundation of the immune system (the transfer of microbes from mother to baby) might be facilitated through natural birth OR by artificial, mechanical means after a Cesarean birth. Maybe it would be good to see the film before discounting the theories and judging all of the doctors, caregivers, researchers, and filmmakers.

    • Young CC Prof

      Eh, I’ve seen the hatchet editing jobs that pseudoscientists do to actual scientists before.

  • numberonefan

    Another impeccably written, well researched and staggeringly informative piece of wisdom by an “ob” that hasn’t practiced in over 10 years. It is an absolute shame that you left the medical profession. The birthing women of this world have truly lost something wonderful. Thankfully you can still educate everybody using this platform.

    • KarenJJ

      “numberonefan”, have you got some better information for everyone here that hasn’t come from an “ob” that hasn’t practised in over 10 years?

  • Midwife405

    As a midwife, I believe there is a time and place for obstetrical intervention. I am by no means anti-medicine. However, I do believe that if it required a 30% cesarean rate to prevent adverse outcomes then we would never have survived as a species. Humans have pro created for millions of years, and obs have not existed for a fraction of that time. While some cesarean are required to prevent death and injury, the fact of the matter is that you are not needed to run to the rescue of every mom and baby that you encounter.

    • Amy Tuteur, MD

      There’s a 20% miscarriage rate and that hasn’t prevented us from surviving as a species. A massive death rate in childbirth wouldn’t prevent us from surviving as a species, either.

    • An Actual Attorney

      60% of spotted hyena cubs die in birth. We still have spotted hyenas.

    • RebeccainCanada

      Midwife405, Please have the courage to state that opinion to your clients, “Your baby’s safety doesn’t really matter to me as an individual, because if he/she dies in homebirth, the human race will still go on and prosper. You don’t really need to worry about Doctorin’ there’s always next time!”

      Of course you’d probably rather not share that with them because you stake your living on making the client *feel as though* she’s an individual, getting individualized and evidence based care! When it’s all truly about you making your living by making sure they won’t trust doctors, just like you don’t. I’d rather deal will a doctor with a poor bedside manner, at least I know what I’m getting!

    • LibrarianSarah

      However, I do believe that if it required a 30% cesarean rate to prevent adverse outcomes then we would never have survived as a species.

      Then you don’t understand how evolution works. A 70% survival rate is more than enough to continue the species.

      Contrary to what your fellow woo enthusiasts might think, life “in nature” was and is nasty, brutish and short. Humans were under constant pressure from preditors, disease and natural disasters. Women would have several kids in the hope of a few surviving unil adulthood. Through modern medical technology humans have created a world where it is almost garanteed that a child will live until adulthood. But, keep in mind, this is a very recent development.

  • IT

    Dear Amy, could you please post the citations to scientific articles showing that home birth (with normal pregnancies) leads to a larger number of infant deaths?

    • Trixie

      See on the right side, where it says 2013 review? Click on the link that says Homebirth Papers and Statistics.

  • Natalie meade

    Wow, are you seriously an educated person? I am amazed you are not up to date on risk analysis of home birth. I am surprised such an ill informed and backwards “doctor” is critisising a film team (who are not claiming to understand the science – but raising funds to talk to experts in the relevant fields) of being ill informed when you so obviously are the one with your head in the sand.

    • Young CC Prof

      If you want to add to the discussion, why don’t you provide some examples of specific points that you disagree with, along with evidence to support your point of view? “This doctor is wrong” isn’t much of an argument.

      • natalie meade

        not worth my time

        • RebeccainCanada

          Of course not. 😉

        • birth buddy

          And yet, you had the time to pop in and make an inane comment.
          Bye.

  • Judy blue

    Hi all. I had a home birth last year. It was painful but not anything I couldn’t cope with. In fact, I found it exhilarating. The days following the birth of my daughter were euphoric. I know this feeling is down to hormones. I just wondered what you thought about a woman’s right to a positive birth experience, especially when – correct me if I’m wrong – women who have traumatic experiences have higher rates of post natal depression? What about other interventions that potentially ruin women’s lives like episiotomies that kill sex lives. I can see that protecting the life of a baby is the ultimate goal, and I do not argue with that, but can’t that goal be managed better alongside respecting the mother’s outcomes… Surely as screening techniques advance, less UNNECESSARY intervention and more natural births are better for a society as a whole? Surely we have to consider the long term health of the mother too? This concern seems missing from all your comments…

    • Young CC Prof

      Congratulations, I’m glad you had a good birth. About 90% of babies are born OK with or without help. The other 10%, though, would end in disaster without medical intervention, with mother, child or both dying, and that’s NOT a risk most mothers are OK with.

      Yup, a traumatic birth experience can cause postnatal depression. So can a dead baby.

      • Judy blue

        As far as I could tell, the outcomes for the mother are more positive for a home birth. I will fully admit that I did put my needs over and above the needs of my unborn child. Is that really so awful? And if so, why?

        • Trixie

          Okay, well, at least you’re being honest about it. The facts are that home birth in the US is riskier than hospital birth even under the best circumstances. If you close to have a home birth after knowing those facts, that’s your right. Our issue is the lies that MANA and others are telling to women, most of whom would not choose home birth if they knew the facts about the risks.

        • fiftyfifty1

          Nothing is the matter with that. Women should be able to choose homebirth if they want. Women should be able to prioritize themselves over their babies. You are from the UK. In the UK, homebirths to first time mothers have a 40% chance of transferring to the hospital and a 3 times higher risk of baby death. This risk of having to transfer during labor and risk of baby death are much better for multips. Just as long as your midwives shared with you these Birthplace study facts and you went into it with your eyes open, that’s fine. A 3x risk of my baby dying wouldn’t be worth it for me, but I have no underlying fears/issues with hospitals so for me a hospital is the clear choice. But individuals are not all the same so it’s reasonable for us to rank our priorities somewhat differently.

    • The Bofa on the Sofa

      Everyone would gladly aim for less unnecessary intervention. However, most people are perfectly willing to sacrifice the possible unnecessary intervention in exchange for risk to their baby. If you can figure out better ways to improve our assessment of determining when interventions are “necessary” as opposed to not, then that would be great. Make no mistake, OBs are absolutely working on that now.

      Although I do have a question. You commented about the cost of “episiotomies that kill sex lives.” I realize that this is a concern, but the question is, what is the alternatives? Do you think that tears are better? What would be your basis for that?

      I don’t know a lot about it, but I have heard that OBs are not doing routine eplisiotimies these days, and it is because they actually studied the question and determined that routine episitiomies are not beneficial. That does not apply, however, to indicated episiotimies. Therefore, if you have an episiotimy these days, it’s because there was a reason for it, and it was done to prevent additional damage. Why do you think the other damage would be preferable?

      • Judy Blue

        It’s wonderful that medical professionals have reduced the amount of episiotomies and isn’t that because tearing turned out to be a better solution for the majority of women (healing quicker etc)? I read a study when pregnant that showed the long term outcomes for women who had torn naturally vs routine episitiomy was ultimately in favour of the former. Isn’t this an example of when medical interventions have harmed many women for the sake of unnecessary preventative measures? And couldn’t this be the case with c-sections and high levels of induced births now?

        • Young CC Prof

          OBs weren’t sure whether routine episiotomies were a good idea, so they studied the question, and determined that the answer was no, most of the time it doesn’t help, although episiotomy can be helpful in carefully selected cases.

          They have also studied the outcomes for c-sections and inductions, and determined that they are beneficial. Those studies guide the use of interventions today.

          I hear this a lot. “Medicine was wrong in the past, it could be wrong today.”

          True in principle, but many medical treatments in use today have been carefully studied. It’s clear that overall c-sections are doing more good than harm. In the future, I’m sure we’ll have even more information to further refine treatment, but it’s extremely unlikely that future studies will flat-out contradict the ones performed over the last few decades.

          • Judy Blue

            I can’t quote a study, but when I was researching this when I was pregnant I thought that there were concerns arising that the maternal death rate was increasing alongside higher rates of c-section?

          • Young CC Prof

            The maternal death rate in the USA is higher than it used to be. However, most of the rise occurred immediately after the CDC changed the ways that maternal deaths are tracked. What that means is that there may not have been any increase at all!

          • AlisonCummins

            Yes, there were concerns. It’s worth looking into carefully.
            http://www.skepticalob.com/2010/03/hold-handwringing-is-maternal-mortality.html

          • The Bofa on the Sofa

            How do you think we discovered that there concerns about maternal death rate? Hint: it was not because of the NCB/pro-homebirth crowd blustering about the evils of intervention.

          • Trixie

            Geez, who wants to believe in something that corrects itself when it’s wrong?

        • AlisonCummins

          It’s unlikely to be true since the results of close study are not showing it to be true.

          Sometimes we think something is a reasonable course of action, so that’s what we do and we look carefully at outcomes to see if we were right. Then we adjust our course of action as necessary.

          Episiotomy seemed reasonable, obstetricians performed them, looked at the evidence and stopped performing them.

          Both c-section and vaginal delivery seemed reasonable for certain presentations of breech birth, obstetricians looked at the evidence and immediately stopped recommending vaginal delivery.

          C-sections have been both very common and very safe for about twenty years. There as been lots of opportunity to adjust recommendations as the evidence comes in, and it’s happening all the time.

        • fiftyfifty1

          If preserving sexual function is a concern for a woman she would do well to consider an elective c-section before labor starts. Women who have never labored are much less likely to have any pelvic floor damage and are most likely to report that their sex lives are “as good or better” after giving birth. Women who have delivered vaginally are at highest likelihood of reporting that sex for them is “worse or much worse”.

        • The Bofa on the Sofa

          Oh, the “doctors have been wrong before, so maybe they are now?” gambit?

          Unfortunately, you focused on what you wanted in my comment and ignored the important point – the change they made was a result of actually studying the issue.

          And while there are certainly things that have been found to not be working as a result of study, there are an awful lot of things that ARE found to be working.

          Why do you assume that c-sections and inductions are among the stuff that aren’t working as opposed to the ones that do? Moreover, why do you assume that no one is actually studying it?

        • Captain Obvious

          I think “routine” episiotomy has decrease significantly, but “selective use” of episiotomy still has its merits.
          OASIS

          1)The effect of a mediolateral epis during operative vaginal delivery on the risk of developing obstetrical anal sphincter injuries (OASIS), Vogel et al. Am J of Ob & GYN, May 2012, 404.e1-404e5

          Found a 6-fold decrease odds for developing OASIS when mediolateral episiotomy was performed in OVD. In MLE+ group was 3.5%, in MLE- group was 15.6%.

          2)Pelvic Floor Disorders After Vaginal Birth. Effect of episiotomy, perineal laceration, and operative birth. Obstetrics and Gynecology. Vol. 119, No. 2, Part 1, February 2012. Pages 223-238.

          “Forceps deliveries and perineal lacerations, but not episiotomies, we’re associated with pelvic floor disorders 5-10 years after a first delivery.”

          3)Episiotomy Parameters Linked to Risk for Injury During Birth
          Emma Hitt, PhD
          Authors and Disclosures
          March 8, 2012 — Increased depth and length of episiotomy, as well as increased distance from the midline to incision point, are associated with decreased risk for obstetric anal sphincter injuries (OASIS), according to a new study.

          Mona Stedenfeldt, a PhD candidate at the University of Tromsø in Norway, and colleagues reported their findings in an article published online March 6 in the British Journal of Obstetrics and Gynaecology.

          According to the researchers, OASIS are the most common causes of anal incontinence in women. Episiotomy is carried out in roughly 12% to 15% of deliveries and helps minimize the risk for these types of injuries.

          However, the authors note, several episiotomy techniques exist that vary in incision point and in the angle that the incision point makes with the midline, producing variable results. The current study sought to determine the associations among angle, length, depth, and incision point of episiotomy and OASIS.

    • AlisonCummins

      A mother does not have a right to a positive birth experience, just as she does not have the right to happiness. A right is something that the government may not deprive you of without important countervailing reasons. You may never be happy, but the government may not prevent you from pursuing happiness. You may not have a positive birth experience, but the government may not prevent you from going into the difficult, dangerous and unknown with an optimistic frame of mind or from seeking the care you desire.

      Obstetricians provide care for their patients. All aspects of care have risks and benefits. Sometimes benefits clearly outweigh risks, like vitamin K. Sometimes they don’t, like episiotomies, which are now performed much less often now that the evidence (gathered by obstetricians) shows that they are not as beneficial as once thought. Cesarian sections were much less common in the past because they were higher risk. They are much more common now because with modern procedures they are lower risk. Epidurals are common now because they are very effective and low-risk. Because many women prefer them, epidurals that still allow movement and some feeling are often available these days.
      Obstetricians have a deep and broad understanding of the risks and benefits of everything they can offer and they can explain them to you so that you can make the choices that are right for you. If you know that something is likely to have a bad outcome you can be certain that your obstetrician is fully aware! If you don’t understand a recommendation you can ask.
      An american homebirth midwife does not have the training to understand risks and benefits. They may say things that are simply untrue because they lack training or relevant experience and simply don’t know any better. For instance, if your midwife told you that in hospital you were likely to have a routine episiotomy she was mistaken.
      While some women find contact with institutions like hospitals to be inherently traumatic, many more women find the pain of a difficult labour to be even more traumatic. A relative of mine gave birth in a birth centre with a midwife and was unable to bond with her child for a good six afterwards because of the pain of her labour. It’s not either or.

      • Judy Blue

        I live in the UK in an area that is well catered for by the free NHS. I had two midwives attend my birth, one of whom I had gotten to know personally during the course of my pregnancy. We did discuss risks but perhaps due to the fact I probably fit into the category of being someone who finds a hospital experience inherently traumatic, I decided that the risk was worth taking. I knew my labour would stall in a hospital setting. And – shock, horror – call social services, but I wasn’t sure that a healthy, living baby was the be all and end all of my experience. Of course that was important, but in all honesty, equally important to me was being able to maintain my own personal health and well being. And the stats relating to home-births DO show a better outcome for mothers don’t they?

        Is there a gap between what women want and what the medical profession want, or a gap in the understanding of risk? I am not a medical professional, so please correct me if I am wrong, but we do understand how much of an important role that stress hormones play in labour – the way medical professionals do talk about birth in terms of risk without paying attention to emotions (I am getting this from a somewhat flippant comment earlier on this thread where the author says the would like to see 100% c-section rate) does exacerbate the problem.

        I do think there is a gap between a woman aiming to have a completely natural birth and seeing that as a natural physiological process, and treating it like a problem already in progress and preventative measures. I think the key point is what Bofa on the Sofa says below about coming up with better assessments to determine what interventions are necessary. No-one denies that we can aim for better care. Also, we can’t deny the cultural affect that a lack of discussion of birth in (yawn!) the media has on women.

        It just shocked me to hear this kind of statement: ”

        About C-sections…. I have witnessed well over 100. Never saw a baby die yet due to having a section. I have seen babies die or harmed for the lack of a section. If it were up to me, the section rate would be 100% and it would be up to the patient to say, I want a vag birth attempt. The real problem ‘with C-sections ‘ is the media and their
        false portrayal that the ‘rate’ is somehow too high! I do not care! I am more interested in the outcome than the method of delivery. Sadly, many patient aren’t.”

        Am I right in thinking this kind of rhetoric comes from a value system that places the value of positive outcome for the baby over the positive outcome for the mother?

        • AlisonCummins

          “I knew my labour would stall in a hospital setting.”
          No you don’t. What is the evidence for your statement?

          “And the stats relating to home-births DO show a better outcome for mothers don’t they?”
          Not in the US they don’t.

          One problem is how “better outcome” is defined for mothers and babies. Bad outcomes for babies are death and permanent brain damage or other disability such as a brachial plexus injury sustained during a difficult vaginal delivery. Bad outcomes for mothers hardly ever include death and permanent brain damage. Permanent disability interfering with sexuality and activities of daily living is more likely to result from labour or vaginal delivery than from a planned c-section.

          • AlisonCummins

            A mother’s recovery from an uncomplicated vaginal delivery is easier than from a c-section, yes, that is usually true. If you know in advance that your labour is going to be uncomplicated, that makes decision-making very easy.

            In the british Birthplace study that determined that home birth was at least as safe as hospital birth, first-time mothers were excluded as were women who’d had any trouble with previous births. This is as close to being sure that vaginal delivery will be uncomplicated as you can get, and does not mean that home birth is safe for first-time mothers or women who’ve had trouble before. Even then their transfer rate was very high. (25%, I think? 40% is Canada? Someone step in here?)

            (I think we’re all glad that Joe Kano is not king of the world, by the way.)

          • fiftyfifty1

            First time mothers were NOT excluded from the UK Birthplace study, they were just analyzed separately. Transfer rates for first time moms were 40%. Baby death rates for first time mothers were 3 times (!) higher than in the hospital. C-sections were lower.

            In moms who had given birth before, the transfer rate was much lower and the baby death rate was not statistically higher than in the hospital. C-section rates were lower.

            Take home: If you are a 100% low risk mom in the UK who has already had at least 1 prior vaginal birth that went off without any complications, and you get full-spectrum pre-natal care, and you have 2 midwives attend your birth, it is a reasonable option to consider and your chance of a c-section is lower.

        • Young CC Prof

          “And the stats relating to home-births DO show a better outcome for mothers don’t they?”

          The recently released MANA study found a 15% chance of postpartum hemorrhage at home birth, compared to about 5% in the hospital.

          This study did not look at the prevalence of severe tears or psychological health after delivery, which would be other key indicators for maternal outcomes.

          • Judy Blue
          • Young CC Prof

            OK, I looked at the actual study. (Click the link in the first paragraph to read it yourself.)

            I see three concerns:

            1) This is the Netherlands. They have a very thorough risking-out system and good transfer channels. If you are attempting a home birth in the USA, things are going to be very very different.

            2) It’s difficult to be sure that the women who opted for hospital birth really were just as low-risk as the ones who opted for home birth. (I don’t know enough about the Netherlands medical system to say one way or another.) The article did say that the home birth group had fewer immigrants and fewer poor women.

            3) Missing data! The hospital group included 147 cases of severe morbidity out of 54,000 women, and the home group included 141 cases out of 92,000. However, 52 women with severe morbidity who transferred during labor were excluded because their primary care forms were missing, and an additional 46 women with severe morbidity were excluded because their planned place of birth was unknown. Basically, a quarter of the negative outcomes are just missing.

          • Judy Blue

            So it seems that home-births ARE a great and safe option for well educated, healthy, wealthy, mothers who live in affluent societies with good infrastructure. I’m so grateful that I won the lottery of birth and was born into those kind of categories, but just because many women don’t, doesn’t mean that it’s not something that we shouldn’t work towards as a society – even in the US.

          • Young CC Prof

            That’s not exactly what I said. Understand this:

            In the Netherlands or the UK, if you want to have a home birth, you see a midwife for prenatal care. She requests all appropriate prenatal tests, including sonograms. Your records are on file with the hospital system. If any problems crop up during the pregnancy, she just sends you on to the physician who takes over your care.

            When labor begins, the midwife comes to your house and monitors you. If anything begins to look like it’s going wrong, or if labor doesn’t progress, she travels with you to the hospital. You’re already checked in at the hospital, with your test results and allergies already on file, so treatment can begin immediately. The midwife stays with you and updates the doctors and nurses on your labor so far. If you need an emergency c-section, the midwife can call ahead and the hospital will prepare.

            In the USA, if you go for home birth, your prenatal care might be quite patchy. You might be discouraged from seeking tests that could save your baby’s life.

            You go into labor, and the midwife comes to your house. If there are problems, whether or not to transfer you to the hospital is entirely up to the midwife. If you do need to transfer to the hospital, your midwife might not go with you, or she might drop you at the hospital door and run. The hospital has no records on you, so precious minutes will be lost as they examine you and find out your blood type, allergies and history. If the midwife calls ahead and explains the situation, no one will know who she is, and they won’t be able to take her word for it.

            Understand, home birth in the USA is a very different matter.

        • Elizabeth A

          Am I right in thinking this kind of rhetoric comes from a value system
          that places the value of positive outcome for the baby over the positive
          outcome for the mother?

          On the one hand, the person you’re quoting is espousing an unusually strong position in favor of c-section and against trial of labor. However, the statement doesn’t seem to me to value outcome for baby over outcome for mother particularly.

          Not all positive outcomes are equally positive and not all negative outcomes are equally negative. When making choices for my family, I tend to believe that a trauma is something we’ll gladly cope with if it’s what’s necessary for everyone to survive.

          Surgery for me is a bummer. Surgery for me that saves the baby I’ve been working nine months to have is a bummer, but still a positive outcome. I can’t prioritize anyone’s experience over anyone else’s life. I can’t make that choice for anyone else either, but it does raise my hackles when I hear arguments that seem to assume that I think me having a bad time is a worse thing then the child I love and long for dying.

        • AlisonCummins

          Judy Blue,

          I think you will find this article about c-sections and diminishing returns (and the comments, of course) very interesting.
          http://www.skepticalob.com/2009/12/cesarean-mortality-and-law-of.html

        • Amazed

          I am really stunned at how easily you separate the positive outcome for the baby from the positive outcome for the mother. I really cannot fathom how anyone can say with a straight face that not having a c-section or the dreaded episiotomy but ending up with a dead or disabled baby is a more positive outcome than ending up with all the cascade of unnecessary (says who? Mr Google who educated mothers rely on to make them greater expert than them obs) interventions and a healthy baby at the end.

          There are women here who used to be very much like you. They preached the same wisdom once. Visiting their babies’ graves or being subscribed to the local hospitals to treat their babies’ longtime damages sustained at the birth changed their perception pretty fast.

          You are privileged to live in the UK where your risk is considerably smaller. It is much greater in the US, Please stop talking about homebirth in general. There isn’t any such thing. Homebirth is what homebirth does. And that means quite different things in measures of safety and outcomes in different countries. By arguing about homebirth basing your arguments on YOUR homebirth, you’re lending legitimacy to all the clowns who disguise themselves as professionals and destroy lives in another country.

    • KarenJJ

      “I found it exhilarating. The days following the birth of my daughter were euphoric.”

      Me too. My child was born by emergency c-section in hospital.

    • Playing Possum

      ‘Unnecessary’ interventions are only so in retrospect. If you have developed some reliable predictive tool for unmanifested complications that are averted by an intervention, then please share it because the obstetric community would desperately love to use it. That’s the issue. The alternative to intervening is doing nothing and hoping for the best, which is idiotic when you have two lives resting on that hope. Do you want to be the one for whom hope isn’t enough? Truly unnecessary interventions, done out of ignorance, stupidity or cruelty are another matter, and are rare, based on old science that has long since been abandoned (routine episiotomy comes to mind), and I would join you in arms to prevent these. Your use of the word ‘unnecessary’ implies that practitioners are stupid, cruel or uneducated, and that’s unfair, especially since most of the interventions are geared towards either improving the chances of a vaginal birth or safeguarding the lives of the mother and child.

    • Maria

      I had a wonderful birth experience with my first. Shortish labor, glorious epidural, some tearing but nothing horrible, and I was surrounded by a team of doctors and nurses, along with my husband, who cheered me on and made me feel like a rock star. I could say that it was the birth experience that I wanted, except I really didn’t put a whole lot of pressure on myself with a preconceived idea of what type of experience I wanted. I wanted to meet my baby girl!

      Now I am expecting baby #2 and am faced with the possibility of a c-section because she is in breech presentation and doesn’t seem inclined to move. And yet, I expect this birth experience to be just as wonderful. Why? Because I want to meet my baby girl! I could force the issue and refuse a c-section, but why would I put my baby, and my own body, through that kind of stress just to avoid an “intervention” that is more likely to allow me to meet my healthy baby rather than visiting her in the NICU? I imagine the latter option would lead to more PPD than the pain of recover from a scheduled c-section. Process matters, to a point, but to me outcome is much more important.

      • Natalie meade

        Check out spinningbabies.com

        • guesting

          Didn’t work for my breech baby with a nuchal cord.

          • Young CC Prof

            Didn’t work for my breech baby who was wedged into place between my fibroids, either.

        • Maria

          Didn’t work, although i confess I didn’t really try that hard. I did have a smooth, uneventful c-section and pretty easy healing. I am currently holding my one month old and typing with one hand. how she got here matters less and less each day. It is just wonderful to have her here in my arms.

    • fiftyfifty1

      “I found it exhilarating. The days following the birth of my daughter were euphoric.”

      Me too, my daughter was born by elective c-section in the hospital.

      *My first had been delivered vaginally by midwives. It went very poorly. I did not get an episiotomy. Instead my levator ani (pelvic floor) was torn off of my ischial tuberosity (butt bones). The recovery was very difficult and I have permanent urinary and fecal control issues from the muscle and nerve damage I sustained. The midwives were unable to figure out what the problem was (and frankly they didn’t even seem to care). It took an OB to diagnose me correctly. When the time came for my second, The OB and I had long conversations about a repeat vaginal birth vs. elective c-section. I even got a second and a third opinion to be sure I was fully informed. I did opt for the elective c-section and it went very, very well. I was thrilled with the straightforward recovery, but most of all I was thrilled to meet my daughter.

      • Young CC Prof

        And you know, if your local kingdom has trouble with any usurping regicides, it’s only the elective c-section babies who are properly qualified to deal with the problem! (Using appropriate arboreal camouflage, of course.) If we didn’t have any, the usurpers could just sit there on the throne for decades, because no one else would be able to kill them! 😉

        • Siri

          YCCP, I was very remiss not to point this out months ago – you’re not only a dunce, you’re also inane, as your comment above so amply demonstrates…

          • araikwao

            ??

          • Siri

            Lame, I know! Twas meant to be a pun on Dunsinane, as in Birnam forest coming to Dunsinane. Today’s worst pop culture reference….. no offence meant to YCCP!

          • araikwao

            Oh good golly, I was far too much of a dunce to get the reference (it’s Shakespeare, isn’t it??). I just thought it sounded uncharacteristically mean, and wondered if it was actually you, or a parachuter posing as Siri.. o.O

          • Siri

            I just happen to have had an Englishman as my first boyfriend, and he took me to see Macbeth in Stratford after making me read it so I’d stand half a chance of understanding any of it!

    • Amy

      My baby was born vaginally and I suffered a 4th degree tear. I’m now unable to control my bowels and bladder.

      I wish I’d had a c-section to save myself from shitting myself unnecessarily for the rest of my life.

    • RebeccainCanada

      I’ve had three episiotomies. I can’t believe anyone would say it killed their sex life! I have a very healthy, robust sex life! My first two were small and to prevent tearing, they did. My last was an emergency, and it was large and curved into my leg. It was hard to sit for a few weeks but my child’s brain matter is intact. He is bright and mischievous and I am thrilled that my Dr trusted his gut and we didn’t wait through the decels like the crunchy nurse wanted to.

  • KAndrews

    http://midwifethinking.com/ “If the mother has a c-section… and I know it sounds weird but… she may
    want to consider swabbing her vagina and ‘wiping’ the baby with this
    swab. It is even more important to encourage and support breastfeeding
    for mothers who have had a c-section. Again, consider probiotic support.”

    • KAndrews

      Worst baby book moment to capture EVER.

  • Amy Tuteur, MD

    I nailed it! The microbiome and epigenetics:

    http://www.oneworldbirth.net

    • Stacy21629

      Someone posted about it in the homebirth section of MDC as well.

    • Trixie

      I know you’re very busy with the MANA stats at the moment, but when you get a chance, I’m really looking forward to your take on this video and all of the “experts” in it. We will all be ready for a good laugh by then.

    • theNormalDistribution

      I just watched as much of the video as I could before gagging on the bullshit, and then had a look at the “research” they link to that talks about how many trillions we will spend on non-communicable diseases in the next 16 years.

      They’re very very careful not to actually say it outright, but it sounds like their thesis is that the species as a whole would be better off if the people who have “NCD’s” (is that actually a term real scientists use?) didn’t exist. So, yanno. Let those babies die.

      • araikwao

        Yeah, NCDs are all the rage in global&public health

      • KAndrews

        Woman who have a C-section, or really any intervention at all, are not passing down the unspoken knowledge of birth. (That’s kind of like microbirth but smaller). So, it clearly will be the end of humanity. We will not be able to have babies anymore, evolutionar-i-ly, our vaginas will grow back together and our babies will pop out of bellies like on Alien. It’s pretty clear. Obviously, even an idiot could see that. (or only . . .)

    • Sally RNC-NIC

      Reading their “story” to prepare myself for the clip, and this little nugget made me laugh, shrug, and eventually throw-up in my mouth. Here we go again with the fame-obsessed filmmakers moonlighting as birth experts. Money-money-MONEY.

      “We talked a lot about starting a family together, but we feared that if we didn’t get our first feature film out of the way first we may never get to achieve our ambition.”

      Rock on, Hollywood.

  • Joe Kano

    The connection between lay midwives and chiropractors….
    Both have a long history of anti-medications. However, humans being humans, I suspect that IF (and I do not see it happening) the laws changed and both lay midwives and chiropractors could freely prescribe and administer ‘medications’ respective to their areas, then in 10 years, chiropractor colleges would have pharmacology classes and all new grads would be spouting the benefits of medications!
    Lay midwives would be split into the purists movements who disavow anything but ‘pain during birth is a right of passage into full womanhood’, and those others eager to test out what ‘really’ is the max dose of the medication, because you know, you can’t trust what the PDR says….
    And the patients / clients are again, the losers.
    About C-sections…. I have witnessed well over 100. Never saw a baby die yet due to having a section. I have seen babies die or harmed for the lack of a section. If it were up to me, the section rate would be 100% and it would be up to the patient to say, I want a vag birth attempt. The real problem ‘with C-sections ‘ is the media and their false portrayal that the ‘rate’ is somehow too high! I do not care! I am more interested in the outcome than the method of delivery. Sadly, many patient aren’t.
    If you don’t like a C section, then simply do not sign the consent and you won’t have one! It really is that simple. But do not interfere in the decision making of other patients…. They must live with the outcome of their decision same as you must live with the outcome of your decision.

  • Trixie

    Well Dr. Amy, you were exactly right! So much comedy gold here. I’m wondering if someone can find out more on the experts they interview in their indiegogo pitch video. http://www.donotlink.com/dgo

    • Houston Mom

      Here they are. First two have degrees in zoology (Dr. Dietert is listed with the Cornell College of Veterinary Medicine). Then a public health person who advocates for more CPMs, a CNM who attends homebirths, a graduate student, another midwife, & a pediatric nurse. No M.D.s
      1. Sue Carter, Biologist & Behavioral Neurobiologist

      http://academicdepartments.musc.edu/psychiatry/education/continuinged/GrandRounds/Bios_Obj_12-13/Carter.htm

      Dr. Sue Carter is currently Principal Researcher in Behavioral Neuroscience at the Research Triangle Institute International, Research Triangle Park, NC. Dr. Carter was Professor of Psychiatry and Co-Director of the Brain Body Center at the University of Illinois at Chicago from 2001-2012. She formerly held the position of Distinguished University Professor of Biology at the University of Maryland and prior to that was Professor in the Departments of Ecology, Ethology and Evolution and in Psychology at the University of Illinois, Urbana-Champaign. Dr. Carter is past president of the International Behavioral Neuroscience Society, and holds fellow status in that Society and in the American Association for the Advancement of Science. She has authored over 275 publications, including editorship of 5 books. The most recent of these is Attachment and Bonding; A New Synthesis (MIT Press). Research from Dr. Carter’s laboratory documented the role of oxytocin and vasopressin in social bond formation. Her most recent work focuses on the developmental consequences of oxytocin, including perinatal exposure to synthetic oxytocin, and the protective role of this peptide in the regulation of behavioral and autonomic reactivity to stressful experiences.

      Research Triangle Institute International

      http://en.wikipedia.org/wiki/RTI_International

      Her bio from RTI

      Carter is an internationally recognized expert in behavioral neuroendocrinology. She was the first person to identify the physiological mechanisms responsible for social monogamy, and her research interests focus on the neurobiological basis of behavior and the developmental and epigenetic effects of early experience.

      For 11 years, she was a professor of psychiatry and the co-director of the Brain-Body Center at UIC. Prior to those positions, she was Distinguished University Professor in the Department of Biology at the University of Maryland and assistant through full professor at the University of Illinois at Urbana-Champaign. Her research programs have discovered important new developmental functions for oxytocin and vasopressin, and implicated these hormones in the regulation of long-lasting neural effects of early social experiences.

      In 2009, Carter was awarded the Wayner-NNOXe Pharmaceutical Award for Translational Research by the International Behavioral Neuroscience Society and holds fellow status in that organization. She also is a fellow of the American Association for the Advancement of Science.

      Carter holds a doctorate degree in zoology from the University of Arkansas.

      2. Rodney D. Dietert, Professor of Immunotoxicology Cornell University College of Veterinary Medicine

      http://www.vet.cornell.edu/microbiology/faculty/Dietert/

      Dr. Dietert is a Professor in the Department of Microbiology and Immunology. He received the BS degree in Zoology from Duke University in 1974 and his PhD from University of Texas at Austin in 1977. Dr. Dietert has been: Director of Graduate Studies for the Graduate Field of Immunology, Senior Fellow in the Center for the Environment, Director of the Institute for Comparative and Environmental Toxicology, Director of the Program on Breast Cancer and Environmental Risk Factors and President of the Immunotoxicology Specialty Section of the Society of Toxicology. His research on immunotoxicology has been supported by the NSF, the USDA, the NIH and industry.

      Research Interests

      My research and public health interests concern the protection of children from immune dysfunction-based chronic diseases. The initiatives include: 1) study of developmental immunotoxicity of environmental chemicals and drugs and the adverse outcomes that result, 2) identification of patterns of interlinked chronic diseases, 3) improved approaches for immunotoxicity testing to protect against chronic diseases, 4) application of fractal biology to the assessment of immune status and, 5) intervention strategies that can reduce the risk of chronic disease comorbidities during aging

      3. Carol Sakala, Director, Childbirth Connection Programs, National Partnership for Women and Families

      https://www.childbirthconnection.org/pop.asp?ck=10369

      Another bio here from her talk, The Imperative to Train More Midwives, sponsored by

      http://cpmsymposium.com/sponsors/

      Carol Sakala, PhD, MSPH has worked to improve maternity care as a researcher, educator, author, policy analyst, and advocate for over twenty-five years. Since 2000, she has been Director of Programs at Childbirth Connection, working with colleagues and partners to advance Childbirth Connection’s mission of improving the quality and value of maternity care through consumer engagement and health system transformation (transform.childbirthconnection.org, http://www.childbirthconnection.org). Carol is a member of the Expecting More team that is creating state-of-the-science maternity care decision aids; co-author of 2010 direction-setting companion reports: “2020 Vision for a High-Quality, High-Value Maternity Care System” and “Blueprint for Action”; lead author of the Milbank Report Evidence-based Maternity Care: What It Is and What It Can Achieve; a co-investigator of three path-breaking national Listening to Mothers surveys; founding author of a quarterly evidence column (2003-07) that continues to be published in midwifery and nursing journals; author of an annual column in Birth (2006-); and guest editor of special issues on Transforming Maternity Care, The Nature and Management of Labor Pain, and cesarean section overuse. Carol holds voluntary leadership positions with such organizations as National Quality Forum, Guidelines International Network, and Cochrane Collaboration Pregnancy and Childbirth Group. Her current work focuses on implementing priority “Blueprint for Action” recommendations within Childbirth Connection’s ongoing Transforming Maternity Care project to improve the system that provides maternity care to the nation’s women, newborns and families.

      4. Aleeca Bell, Assistant Professor University of Illinois at Chicago College of Nursing

      http://www.nursing.uic.edu/faculty-staff/aleeca-f-bell-phd-rn-cnm

      The long-term goal of Dr. Aleeca Bell’s research program is to promote optimal birth & exemplary birth care by understanding the biological underpinnings linking the birth experience with maternal-child outcomes, such as postpartum mood and mother-infant interaction.

      Dr. Bell’s research is focused on oxytocin, a neurohormone important in birth and lactation, as well as maintaining positive mood, healthy attachment, and reduced stress reactivity. The oxytocin receptor is a plausible gene candidate linking the birth experience with maternal-child outcomes. Genetic/epigenetic knowledge is important for determining whether there are at-risk women for negative postpartum mood or poor mothering behaviors after exposure to certain birth interventions or birth experiences affecting the oxytocin system. This program of research may impact policy decisions in support of physiologic birth – known to dramatically reduce health care costs and improve maternal-infant outcomes.

      Dr. Bell collaborates with experts in the disciplines of nursing, psychology, behavioral neuroscience, genetics, epigenetics, and epidemiology. As a Certified Nurse Midwife, her research questions are informed by her clinical experience. She has attended home births in the Chicago area, and has provided family planning, well-woman annual exams, and prenatal care at two Illinois federally-funded clinics: Alivio Medical Center and Will County Community Health Center.

      5. Siddhartha Sinha, graduate student, Cornell

      6. Soo Downe, OBE, Professor in Midwifery Studies University Central Lancashire & co-founder of EPI-IC International Research Grou

      http://www.uclan.ac.uk/staff_profiles/professor_soo_downe.php

      OBE for services to midwifery 2011

      PhD Midwifery, University of Derby 2000

      MSc Research, University of Derby

      Registered Midwife 1985

      BSc (Hons) Literature and Linguistics, University of York, 1981

      Soo has used a wide range of methods, in her research, including trials, surveys, systematic reviews (metasynthesis and meta-analysis), ethnography, phenomenology, and participatory action research based on appreciative enquiry. She is interested in the utility of complexity theory in understanding dynamic health states. Her specific focus is the normal physiology of childbirth, including the processes which can maximise normal birth, with a focus on the understanding of the nature of positive wellbeing (salutogenesis) as opposed to simply reducing pathology.

      Her other areas of general interest include methodological innovation, particularly in the area of metasynthesis, and the creation of collaborative links with service users at all stages of the research process.

      EPIIC = Epigenetic Impact in Childbirth

      http://www.uclanmidwifery.co.uk/tag/epiic/

      Prof. Soo Downe is an author on a new paper which has been published online in Medical Hypothesis. Dahlen HG et al. The EPIIC hypothesis: Intrapartum effects on the neonatal epigenome and consequent health outcomes. Med Hypotheses (2013) http://dx.doi.org/10.1016/j.mehy.2013.01.017

      7. Jacqueln Taylor, Associate Professor of Nursing, Yale

      http://nursing.yale.edu/taylor

      About

      Jacquelyn Taylor is an Associate Professor in the Pediatric Nurse Practitioner Specialty. Her undergraduate, masters and doctoral degrees in nursing are from Wayne State University College of Nursing in Detroit Michigan. She is prepared as both a pediatric nurse practitioner and a school nurse practitioner. She holds a certificate in molecular genetics from Georgetown University and has completed additional coursework in cardiovascular epidemiology at Washington University in St. Louis, MO. Dr. Taylor also completed a post-doctoral fellowship in Urban Health of Older Populations at the Institute of Gerontology at Wayne State University in Detroit. Prior to coming to Yale, Jacquelyn Taylor served as a faculty member and coordinator of the Pediatric Nurse Practitioner program at the University of Michigan, Ann Arbor.

      Research

      Her career has focused on addressing health disparities in hypertension among African Americans. Her interest developed from research experiences early in her career and clinical practice. As an undergraduate nursing student she spent 5 years working as a research in a physiology laboratory examining the effects of various drugs on vascular smooth muscle cells for the treatment of hypertension. In 2001 she completed the Summer Genetics Institute at NIH/NINR. As she continued her graduate work for the PhD, she practiced as a PNP for the School Mobile Health Center at Children’s Hospital of Michigan. In 2008 she completed an NIH/NHLBI funded course on cardiovascular genetic epidemiology and bioinformatics at Washington University in St. Louis, MO. These research and clinical experiences led her to study both genetic and environmental influences on blood pressure. Her work has been funded by several NIH agencies and her current study, funded by the Robert Wood Johnson Foundation Nurse Faculty Scholars Program, examines the interaction between genome-wide association and social environmental factors related to blood pressure among African American hypertensive parents and early risks for high blood pressure among their untreated children. Her long-term goals are to develop nursing interventions to prevent and reduce gene-environment risks associated with hypertension.

      • Trixie

        So…no offense to Cornell’s Veterinary Medicine program, because it is one of the best in the country…but, why is a professor in the College of Veterinary Medicine any sort of authority on human birth?

        • Houston Mom

          He’s probably one of the few people they could get on camera to spout off about this stuff. This is from Dietert’s personal website, ”
          Rodney Dietert, Ph.D. has devoted his career to better protecting pregnant women and children from the environmental hazards that promote chronic diseases.”
          http://www.rodneydietert.com/

          • Trixie

            So hilarious

        • Stacy21629

          To be fair, he’s not a veterinarian. And there’s a lot of cross-over in the basic sciences between species. I had several non-DVM professors in my lower level veterinary classes (histology, virology, etc). More specific classes (anatomy, medicine, surgery, etc) were all DVMs.

          • Trixie

            I understand he’s not a DVM — again, not slamming Cornell or vets, it just seems like his training is fairly far removed from what he’s claiming as an area of expertise.

    • Houston Mom

      Dr. Amy has written about the two midwives in the video previously…Bell and Doone

      http://www.skepticalob.com/2012/06/is-there-any-limit-to-what-midwives.html

    • Houston Mom

      About Sue Carter:

      http://www.pbs.org/thisemotionallife/node/204/bio/print

      “Her research established how the biological basis of monogamy should be analyzed, and established the prairie vole as the major model for examining the biology of adult social bonds.”

      • AlisonCummins

        The prairie vole work on monogamy is actually very cool.

        • Trixie

          But again…they aren’t people

        • Houston Mom

          I just googled prairie voles. They are so cute!

  • Houston Mom

    Well their video is now up and I feel so awful that my c-section is going to contribute to the decline of our species and global financial crisis.

    • Trixie

      It really is all your fault.

  • thankfulmom

    OT: Can someone give me an easy explanation of why taking a bath in epsom salts is not the same as the IV mag. given in the hospital. I just saw it recommended again and would like to give a clear concise explanation as to why it isn’t the same. Thanks!

    • The Computer Ate My Nym

      I don’t think magnesium is absorbed through the skin. And if it is, taking a bath in epsom salts does not allow accurate or precise dosing the way IV mag in the hospital does. Those would be my first two thoughts.

    • Dr Kitty

      OK…
      If you lie in a bath for an hour, does the water go into your blood stream?
      No.
      It does not, for the same reason that your blood doesn’t leak out through your skin. Skin is waterproof.

      If you lie in a bath with Epsom salts in it, will the Epsom salts go into your blood stream?
      No.

      IV Mag Sulphate is delivered at very specific concentrations and doses directly into the blood stream.

      Epsom salts is delivered into the bathwater, and nowhere else.

      If you drink the Epsoms salts, you’ll get diarrhoea, but still, very little proportionally will get into the blood stream.

      If lying in a bath of Epsom salts delivered medically effective doses of magnesium sulphate into the blood stream, Epsom salts would be sold and regulated and licensed as a medicine, with very specific doses and lots of warnings on the packet about hypermagnesaemia. Last time I checked Epsom Salts are sold as bath salts, without any regulation or dosing instructions.

      • thankfulmom

        Thanks for the good explanation. I suspect the response will be that some things can be absorbed through the skin and will to a degree have some effectiveness. I certainly agree that it can’t get into the bloodstream. Can’t some things be absorbed through the skin to a degree? Like a patch of numbing anesthetic? So it is just that a small amount of epsom salts absorbed into the skin (if it is at all) wouldn’t be in medically effective amounts. Perhaps the point there is no warning on the packet about hypermagnesaemia would be helpful enough (my daughter’s nicu report listed that she had hypermagnesaemia). What other things might be listed in a warning if it was absorbed in large amounts?

        The recommendation was for preventing pre-term labor.

        • Antigonos CNM

          The numbing effect of a local anesthetic rubbed onto the skin only affects the top centimeter or so, which is why novocaine has to be injected for a deeper anesthesia.

          The causes of preterm labor are varied; nowadays mag sulfate isn’t even much used — there are much more effective treatments. The main use for MgSo4 is in pre-eclampsia.

          • thankfulmom

            What is generally used for pre-term labor now? I have some good information now, so I promise no more questions after this. Thanks everyone!

  • Petanque

    Because of course when scientists look through a microscope they’re being all reductionist and patriarchal. Now that women are using our mysterious female powers to gaze into the wondrous intimacy of the microscopic world it’s a whole other paradigm!

  • Val

    Gah, I am so glad that I managed to distance myself from this nonsense! I’ve had 3 c-sections (one emergency, two planned), and have no regrets. What I do have is a family of healthy children (no allergies, no health problems at all) and my and my son’s life. I shudder to think of what could have happened if I’d listened to the people who tried to convince me away from a good OB. I don’t know if I would have survived the severe preeclampsia and HELLP during my first pregnancy! Needless to say, I love interventions and think medical science is pretty darned amazing.

  • Bomb

    Homeopathic birth?

  • Trixie

    I like how they talk about the 35,000 miles they’ve flown. Because being a frequent flier is the same thing as learning science.

    • Young CC Prof

      Sometime when I’m less tired, I’ll figure out how many hours you’d have to log on commercial airlines to add up to the risk of one home birth–to mother or child. I vaguely suspect it’s longer than human life expectancy.

      • Trixie

        Air travel has a death rate of about 30 people per billion hours of flight time. And in recent years, that statistic has been falling rapidly. If you just look at the US, you’re looking at even less. There were no fatalities due to large comercial airline accidents in the US from 2010-2012. One NYT article quotes a professor who has calculated that you could fly every day for 123,000 years straight before being killed in an airline fatality. So, yeah.

  • melindasue22

    Just wow. I have a biology degree and I’m not going to walk around like I know all about epigenetics. Really annoys me when people talk about stuff that folks have dedicated their lives to studying like they’re just all over it after reading one magazine article. Do some darn bench science and then you can talk.

    • Sue

      The problem is that they are talking to each other in an echo-chamber, so there is no-one to tell them how foolish it sounds (except for the MEEEEAAAAANNNN “”Dr”” Amy…

  • Guest

    Two things that massively infuriate me that NCB people say a lot: ‘You
    can’t make a baby you can’t fit out (vaginally)’ – like the baby doesn’t also
    have the father’s genes, and everyone’s body is perfect and every part
    of a person’s body communicates perfectly with every other part, does
    it?? I’d also like a baby that makes it out healthy too, thanks.The other one ‘Your body is perfectly designed for birth’ – how do
    you know? Why is it perfectly designed for birth, but people’s bodies go
    wrong all the time for other things? Ignoring people whose bodies aren’t perfectly designed for birth is completely bonkers. Aargh, exhausting!

    • Dr Kitty

      NCB/AP is beyond ableist.

      Not that I, personally, consider myself to be disabled, but I’m definitely a lemon as far as birthing babies and babywearing goes.

      Vaginal birth, baby wearing and co sleeping are only really good options for the perfectly heathy.

      For the rest of us, the not so subtle subtext is very much “go and raise your untermenschen babies whatever way you want, who cares, we’re talking about the GOOD babies here”.

      • Guest

        I don’t think it’s even considered. They’ve just their hands over their ears and won’t listen to any ‘negative’ stories. It’s so sad that some people are left feeling like less of a person if they can’t get their baby out on their own. I certainly don’t feel like less of a person for needing glasses because my eyes weren’t perfectly designed. I don’t feel bad about the fact that somebody made those glasses for me either.

        • rh1985

          Well I didn’t get her in on my own, my awesome IVF doctor and the lab did, so if she needs to come out “unnaturally” that is fine with me. Interestingly, at my last OB appt, she mentioned she might recommend scheduled c-section over induction if I go overdue with no signs of progress, because they don’t like to let IVF babies go very overdue due to certainty of age and a scheduled CS is easier to recover from than one after a failed induction. Any experience with that? I am 36 weeks so too early to know about progress really. Baby is head down and probably average sized.

          • Houston Mom

            I was in the same situation: IVF pregnancy and induction at 40 weeks to the day of fertilization. My doctor said they see more placental problems in IVF patients and that was reason enough for me. After 26 hours of labor, the OB recommended the c-section. I wish we had just sceduled it. I had a difficult recovery and have heard scheduled c-sections are easier. Also my son’s poor little head was really scraped up .

          • rh1985

            I agree about not going overdue because of that – I guess if I make it to 40 I will see which she suggests based on factors that increase or decrease the odds of a successful induction. I hope she decides to come on her own before then though!

          • klyn

            I have had 5 births 4 vaginal and 1 emergency C-section. Recovery is recovery…… There are good and bad to both. My CSection was my last baby and my recovery was comparably equal to my other births. Different yes but not completely hard. And an alive healthy baby was worth every stitch to recover from.

      • Comrade X

        This….. ^^^ ….so much this….

      • Hannah

        Makes me think of the 50’s and 60’s, where kids born with mental difficulties (Down’s, etc) were sent away to homes to be raised, hidden away from society at large.Hide what’s not ideal and pretty, screw whoever gets hurt from it.

      • realityycheque

        “NCB/AP is beyond ableist.”

        Don’t forget lactivism! (although, I suppose that might fall under the AP umbrella). Women who cease BFing to try and care for their mental health receive bugger all support and acknowledgement from these people. The general attitude seems to be one of, “suck it up, princess”, or a complete state of denial in which PPD isn’t that bad, women who cease BFing because of it just aren’t committed enough, or the insistence that BFing will be best for mother’s depression if she just keeps trying!

        The ableism/sexism/classism/patronising fetishisation of women in third world countries/”tribal women” inherent in so many crunchy practices is beyond wrong.

    • Labor RN

      We used to have a saying you can get anything threw the vagina but can you get it threw High school

    • deafgimp

      I had a boyfriend with an enormous head. He had big thick bones period, but his head was huge. As an adult, he can’t wear regular baseball caps because they don’t make them large enough to fit his noggin, he has to buy them from big hat shops.

      When he was born this caused problems. This was back before ultrasounds were the norm. During birth, his mother tried to push out his big fat head. She actually ended up cracking her pelvis in three places before it dawned on them that a c-section was needed.

      Screw those who say babies are designed for birth and women’s bodies can accomodate them.

  • mydoppleganger

    I just hit the 40 week mark and all the hoopla of natural birth/vbac/ is so done for me. I find myself now just wanting the baby out and healthy, by any means needed. My thoughts wander on how the placenta is holding up, how much fluid I have, etc. It’s not even the extreme tired feeling, just a Mama Bear considering her baby more important than some ideal birth. Although I had strongly hoped for a vbac in this pregnancy, it seems like I’m thinking of a csection more and more. Natural birthers might say it’s quitting, but maybe I’ve made peace with my true priorities and not peer pressure.

    • Dr Kitty

      Or maybe it’s the mama intuition they insist you should pay attention to…

      • mydoppleganger

        Exactly. Just because it’s not someone else’s idea of honoring intuition/birth/God/anything else does not mean I’m falling at it. Baby is not engaged yet and I have zero signs of labor. Could it happen and surprise me? Yes. Yet I feel more peaceful now just coming to terms with what’s best for my child. One cannot make something happen that has a reason not to, no matter how many affirmations are applied. I am comforted that there may just be a very good reason things are shaping up this way.:)

        • mydoppleganger

          Edit: “failing at it.” Darn typos!

    • Lisa from NY

      You can still have a trial of labor, but in a hospital.

      • mydoppleganger

        Yes going to the hospital when it’s time or a planed csection next week if nothing happens.:)

        • mydoppleganger

          *Planned.* Guess I am pretty tired today!

    • Trixie

      Best wishes for a happy and healthy delivery.

      • mydoppleganger

        Thank you! I will take all the support I can get!:)

    • Wishing you a healthy and happy delivery…

    • yentavegan

      when my 5th pregnancy past the 40 week mark I bravely called up my ob and said,”I want to give birth today.” She said,”you want to be induced?” I said.,”no , I want a c/sec. ” My request was honored and dd5 is now a healthy 12 year old.

    • Mishimoo

      Best wishes for a happy and safe delivery.

    • Sue

      Best wishes – hope it goes well for you and babyganger

      • Siri

        Dopplebaby you mean!

  • auntbea

    Let’s say birth could cause immediate and major changes to DNA. Why do we assume that’s a bad thing? Maybe without those changes we would all enter the world still sporting large, hairy brow ridges.

    • Zornorph

      Are you prejudiced against neanderthals?

      • auntbea

        No. Of course not! Some of my best friends are Neanderthals. I mean, it’s not their fault they’re so…unusual-looking. And rather old-fashioned, too. Bless their hearts.

      • Sue

        ”Are you prejudiced against neanderthals?”

        I am. Very backward.

    • Trixie

      I just keep picturing a bunch of c/s babies spontaneously sprouting extra appendages.

      • auntbea

        But see, again, why is this a problem? I feel like additional hands could only improve our efficiency as a species.

        • An Actual Attorney

          I’ve always felt that we should be given an extra arm and hand for each baby we get handed. It would be very useful.

          • Dr Kitty

            I’m remembering a short story about a child getting its arm ripped off by an animal at the zoo, and it turns out at the end that humans have evolved to have four arms, and the kid’s father comforts himself that the kid still has one more than people used to think was sufficient.

            Probably just me though.

          • VeritasLiberat

            That story is from this book:

            https://www.kirkusreviews.com/book-reviews/jane-yolen/zoo-2000/

            The story itself is called Zoo 2000.

          • Antigonos CNM

            The Hindus have this perfectly brilliant idea that the more important the god, the more pairs of arms. IMO, all mothers deserve at least 4 pairs.

    • Sue

      Hey – what if they found that there WERE significant epigenetic changes caused by the physical process of birth, and that C/S babies were smarter and had ”stronger immune systems” – and the effect was greater than 5 years of breast feeding, two years of carrying and even a ton of pureed kale.

      What would the parenting competitors do then?

      Why would we assume that any epigenetic changes – unlikely as they would be, caused by a mechanical process that takes a few hours – would be detrimental?

      Maybe it’s an advantage to have less hypoxia.

  • AllieFoyle

    Man, being a midwife makes you an expert on everything now, doesn’t it? They don’t even know enough to understand how little they know and how ill-qualified they are to even speculate about it. Idiots.

    • Zornorph

      They have different ways of knowing.

      • Mishimoo

        Why is that only if it’s a positive outcome despite complications? It seems to me that if they intuit that there is a problem, then NCBers try to say that the complications are caused by the mere thought of a negative outcome.

  • Jessica S.

    ““I think in 10 years we will potentially look back at what we are doing now and think, ‘What on earth did we do?’” …”

    Yes, I’m hoping we will all be saying “what on earth were you doing?”, but not in the way I assume she means it…

    Also, these people need to pick up a couple hobbies or something. They have way too much time on their hands, focusing on minutia of an event that is (hopefully) but a blip on the screen of a human’s life.

    • Staceyjw

      I am glad I read the comments first, because I was just about to post this exact comment.

  • jenny

    I like that this concept is so ridiculous it hardly needs any snark but a question mark.

    • Trixie

      I’m actually really looking forward to tomorrow when these morons launch their video so we can see if Dr Amy’s prediction is correct.

  • Allie P

    I’m telling you right now, if c-sections give my kid allergies but keep her living, cut me up. I mean, is this seriously their argument? Risk your child’s death and save her from a lifetime of lactose intolerance? Pass.

    • Mel

      The anecdote I always pull out during the “live naturally and no one will get allergies” is my husband. Vaginal birth: Yes. Surrounded by germs due to living by animals: Yes. Breast-fed: Yes. Allergies and asthma: Yes and yes. Lactose-intolerant: Yup (and he enjoys the irony of being a dairy farmer who is lactose-intolerant. Although, he’s a bit jealous of our dairy farmer neighbor who has a true milk allergy. That’s irony…)

      Probabilities aren’t promises.

    • Lori

      I do feel bad that my oldest was a C-section baby because he was breech and ended up with food allergies. Food allergies can be not only scary but life-threatening. That is one reason that I decided to go VBAC, and it did work out, but it wasn’t without complications. Either way, I guess I just couldn’t win. But so far, my younger son has no signs of food allergies or asthma, which I am so grateful for.

      • An Actual Attorney

        How does a c-sec or being breech cause a food allergy? I’m not diminishing the seriousness of food allergies, I have some life threatening ones. But why would you think there is is a link between that and how one is born?

        • Lori

          Some studies have linked C-sections and food allergies. Here’s an abstract for one: http://www.ncbi.nlm.nih.gov/pubmed/19076564 I only know this because I’ve done a lot of research on this because dealing with my first son scratching till he bled from eczema was kind of awful. We knew then that something was wrong and had him tested for allergies. However, my younger son ended up getting a fever and have to be increased for an extra week, so that’s not ideal either. Also, our oldest son stopped breathing two hours after he was born, and breathing difficulties can also be tied to C-sections. Those are the reasons that I was not anxious to have a repeat.

          • Bomb

            Uh no.

            ” however further studies using objectively diagnosed food allergy as the outcome are needed to verify whether this equates to an increase in confirmed food allergy. Future birth cohort studies should control for the effects of mode of delivery when investigating environmental modifiers of food allergy.”

            That in no way concludes a correlation or causation. It concludes more study is needed.

          • Lori

            I’ve looked at other evidence that does suggest there is a link. I just happened to pull up that study right at this second. There does seem to be a link. Also, C-section babies do more frequently have breathing difficulties at first. My son stopped breathing for 4 minutes. That’s a pretty significant amount of time.

          • Lori

            Also, my son has asthma, and research does suggest that there is a link there as well: http://www.medicalnewstoday.com/articles/256915.php

          • thepragmatist

            There is a link between vaginal birth and severe brain injury, really beats the hell out of asthma in terms of devastation. Hypoxia in the infant is pretty damn unlikely during a MRCS. You know, the risks to the baby are SMALLER in a c-section, and we can try to find correlates (and even get right down to quasi quantum physics to do it) but you know, the research is there.

            And I will say this: I’m pissed at my OB/GYN. She was just helping me with a different issue, and I had to tell her, “You bitch! You sewed me up so well that I can’t even SEE my scar anymore.”

          • Pillabi

            So you haven’t had your scar HARMONIZED?!

          • VeritasLiberat

            Now what will you show your kids to make them feel guilty?

          • Bomb

            Correlation == causation

          • Lori

            No, it doesn’t. But what else is or might be responsible for the correlation? It seems that in this case, causation might be the reason for the correlation. C-sections do save lives, but they aren’t without issues. Since my baby was breech and wouldn’t turn, I chose to deliver him by C-section, but, if I could have avoided it, I would have.

          • The Bofa on the Sofa

            Is the other evidence as good as the first one you pulled up?

            I have to admit, from an outside observer, that is pretty funny. You get called out on a claim, provide a reference to support it, and when that gets shown to not support it, you respond with “there is other evidence”

            pretty weak

          • deafgimp

            This talk reminds me of an article I read (not EVEN a study!) that talked about a paper where they found from a questionnaire that people who gave their kids tylenol once a month during the first year of life had kids with more asthma. Everyone started freaking out, oh no, overuse of tylenol means more asthma by the age of 7!

            Except that the tylenol was given in response to fevers from pneumonia and bronchitis, which can lead to asthma. Shocking, isn’t it? Plus, many of these kids had a family history of asthma. So many natural living blogs were going on and on about the evils of using painkillers (both acetaminophen and ibuprofen) until they were schooled by better research.

          • AlisonCummins

            Lori,

            An abstract of one study doesn’t tell us much. Most published studies are wrong.
            http://theness.com/neurologicablog/index.php/are-most-medical-studies-wrong/

            That doesn’t mean that science is worthless, it means that doing good science means looking at the whole of the literature.

          • Lori

            There are a number of studies that find a possible link between food allergies and C-section and/or asthma and C-section: http://scholar.google.com/scholar?hl=en&q=food+allergy+c-section+link&btnG=&as_sdt=1%2C47&as_sdtp=
            Is the link conclusive? No. Is it beyond a shadow of a doubt? No. But if I have the choice, I’m not going to choose to do something that might cause skin cancer, for example, as opposed to something that wouldn’t. In the case of a breech baby, I don’t think the risk of delivering a baby vaginally outweighs the benefits of vaginal birth. However, with my second child, I felt the benefits of vaginal birth including less of a chance of breathing problems, food allergies, and increased risk of asthma outweighed the risk. Of course, every situation is different, and, of course, I know that you need to look at more than one study.

          • Stacy21629

            Here’s what you WON’T find on your study-googling – negative studies. The fact is, studies that have a positive result (Csec = allergies) are far, far more likely to be published than those that have a negative result (Csec = no allergies). It’s called publication bias. So just because you manage to find a couple papers that have CORRELATION does not mean that there aren’t 30 more that weren’t published for negative results.
            Completely ignoring of course the genetics of the whole thing.

      • Young CC Prof

        Keep in mind, if there is a connection (the jury is still out on that one) it’s not terribly strong. What weak correlation means is that, your child probably would have had his food allergies either way.

    • Allie P

      I was joking. Also, I was a c-section baby and have never had any allergies or asthma and my friend’s baby, who has been hospitalized for severe eczema, was a vaginal birth. Correlation does not equal causation. There are all manner of reasons children have asthma and allergies and method of birth is not likely to be one of them.

  • Dr Kitty

    Natural Physiological Childbirth: What doesn’t kill you makes you stronger!

    • Who needs a pelvic floor anyways? And what’s a little incontinence to a real woman?

  • Comrade X

    Is it me, or is the eugenics coming closer and closer to the surface?

    “More babies die at homebirth, but the ones who live have better genes!” might not be a very pithy rallying cry, but it sure has echoes of some extremely unpleasant historical ones that had at least temporary success, with devastating consequences.

    • Mel

      Add Alpha Mother’s smoldering racism and you’ve got lovely example of social darwinism.

    • Are you nuts

      Yes, that baby wasn’t meant to be born. What gross thing to say.

  • It is almost as though there’s a deep seated fear that maybe, just maybe – an approach other than their preferred approach might be valid and as a result everything and anything must be used to discredit the alternatives.

  • AlisonCummins

    “Natural childbirth and homebirth are cults, and their core beliefs are non-falsifiable.”

    Ok, how do you define their core beliefs? That unmedicated vaginal birth is spiritually superior to any other variation? Or superior in an unquantifiable way unrelated to any possible outcome? Yes, those would qualify as unfalsifiable.

    How do you define cult membership? Wanting a home birth? Because many people who want a home birth believe it’s just as safe as hospital birth if they have a midwife and transport to a hospital, and given that belief they’d prefer to manage on their own — just like many people prefer to make their own bread without strictly adhering to a belief that the B-vitamins in home-baked bread are somehow better than the B-vitamins in storebought bread.

    While the preference for DIY is not falsifiable in the sense that it’s a matter of taste and comfort, the premise that DIY birth is just as safe is absolutely falsifiable. As you know, because you do it all the time.

    • Staceyjw

      The NCB/HB hardcore is a cult, and shares almost all of the characteristics used to define cults. There are things that get people confused on this point.

      A big one is that they picture cults as unified groups of people IRL. These days, the Internet allows people to belong, even if they never meet in person. It’s a mindset, more than just a membership.

      Secondly, the NCB/HB cult has some ideas, that others not in the cult also share. Like not wanting pain killers, or hiring a doula. These people may share some, even all, of the core of ideas, but don’t have the cult mentality, and are simply individuals with certain preferences.

      All cults have some general ideas that will appeal to outsiders, and all but the most extreme have others that share beliefs but aren’t among the core group. This is how they spread.

      I will have to dig up the info on cult characteristics, and add a link.

      • Houston Mom

        Here’s a list of cult characteristics. A number of them do seem to fit.

        http://www.prem-rawat-talk.org/forum/uploads/CultCharacteristics.htm

      • AlisonCummins

        Non-falsifiable describes a statement that by definition can’t be challenged. “There is a silver teapot circling the sun in such a way that we can’t detect it” is unfalsifiable because it’s impossible to prove that something undetectable isn’t there. “There is a bat hanging from your nose” is falsifiable: you check your nose, there is no bat. (I hope!) Falsified.

        Resistant to evidence describes a person who can’t change their mind, whether because they are delusional or too committed to a particular belief set and accompanying social structures.

        Because Amy Tuteur, MD didn’t describe the core beliefs of the cult I can’t tell whether she means that the beliefs are unfalsifiable (undetectable goodness of vaginal birth) or whether she means that the cult members are resistant to evidence (home birth is as safe as or even safer than hospital birth) which is NOT what unfalsifiable means.

        And how does one distinguish between a cult member and an outsider who talks like a cult member? What are the markers of an NCB cult member vs someone with a DIY ethic but no medical background who believes and repeats statements like “hospitals can deal with emergencies better but emergencies are less likely to happen at home so the risk evens out”?

        This has been frustrating me since the beginning. The person with the DIY ethic can’t reasonably expect to know they are being lied to or that they are repeating attractive falsehoods but they get called all kinds of names by Amy Tuteur, MD in her posts. As soon as an individual shows up here saying “I was lied to” everyone is sympathetic. When an individual shows up saying their baby died but justify home birth anyway, there’s a mix of sympathy and judgement. When an individual shows up repeating what they’ve been told, they get judgement.

        There are people who should know better. People like Melissa Cheyney. They should know better and yet they resist the evidence. But most people aren’t in that position.

        John Wilkins has a post on “How to argue with silly thing believers.” http://wp.me/p1rYgm-1Q7 It’s the last of a series. Worth reading them all.

  • OT but its a bit of an SOS for a woman in a cesarean by choice group I run – she’s 34 weeks in the Toronto area and her Dr has been leading her on – she wants an elective CS, has from the start and the Dr is basically forcing her into a trial of labor. If any one here could direct me to an ob who could help out, I’d appreciate it….

    • Josephine

      Oh no. I wish I had a name or some information but I really hope she finds a willing OB. How awful that he couldn’t just be honest with her so that she could go elsewhere earlier on.

      • True – the lack of transparency is frustrating and now it just seems like short of a minor miracle she’ll undergo a TOL she really doesn’t want.

    • AllieFoyle

      If she can’t find anyone else and it’s causing her considerable distress she might consider bolstering her case by asking for clear documentation of her request in her chart and maybe getting backing from a mental health professional. She shouldn’t have to, of course, but her doctor may take her request more seriously (and might receive less professional flak for doing a “frivolous” c-section). Does she know why the doctor has suddenly changed his/her mind?

      • I don’t think it’s a case of “suddenly changed her mind” – I think it’s a little more vague than that, more passive aggressive. She seems to think that the doctor has been trying to find medical reason for it – but that ignores what has been requested. I think its a case of not saying no, but not saying yes either – and now absent a real medical reason for the CS she’s running out of time to find someone who respects CS as a valid choice for women to make after knowing the risks and benefits of the options. Her doctor is even claiming that “she’d have to answer to the Ministry of Health” if she granted the request – which is complete BS.

        • AllieFoyle

          That’s ridiculous. Poor woman. I hope she stands her ground and gets the CS. It seems like a public awareness campaign for CS as a legitimate choice is needed. You can have all sorts of strictly unnecessary surgeries, but a woman can’t choose to have her child delivered by CS in this day and age? Outrageous.

          • There’s not a lot of “standing one’s ground” one can do if one does not have a willing surgeon and facility. You can stand ground all you want, but labour doesn’t care and at some point nature will take its course, whether you want it to or not.

          • AllieFoyle

            It’s true, but for her sake, I hope she doesn’t just accept what she doesn’t want because she feels she has no choice.

          • thepragmatist

            If she is very brave, she should go public. With Magnus Murphy. Right now! I’d be willing to liaison and would someone else we know through here (perhaps) to provide back up/positive experiences. As for “your scar might itch, or get numb” I would counter with, “Yeah, and you might tear into your ass and get rectal incontinence.” AND?

          • Staceyjw

            Yep, I can get fake boobs, a new nose or chin, or get implants in my butt put in! I can even have my vagina tightened, and have my labia reduced.

            But a CS? NOOOOOOOOOO. Not wanting to have a baby out your vag must mean you are mentally unhealthy and must me pushed into a VB right away!

        • Staceyjw

          This happened to me with my first. I asked for an MCRS and wasn’t denied outright. I had purposely chose a hospital known for many CS, and mentioned it on the very first appointment, so I figured it would be OK or he would have said something.

          Nope. He was purposely vague, but I still didn’t think I would be refused. It was always “We will talk more about it later”. Had he just said NO, I could have fired him and went elsewhere. The closer I got to the birth, the more I was discouraged and pressured into a VB. By the time I realized I was going to get stuck with a TOL, it was too late to switch OBs.

          By term (or postdates, as my EDD was conflicted), I still didn’t want a TOL, but was not getting an MCRS. I was terrified that I would get stuck in the heavy traffic at the Tijuana/San Diego border, as I lived in Mexico, and drive 1.25 hrs to this hospital. I didn’t want to end up in pain, or w a baby in the car, so I asked for an induction at the very least, and was denied.

          Yes, denied the MCRS and an induction, even when already dilated 2cm. Even though my EDD was in question (OB had one, MFM another, the wheel yet another) and I was either right at term or as much as 2 weeks over. I had been getting NSTs 2x a week, so its not like he didn’t know this. Even though going into labor meant I would need to cross the busiest land border in the world while in labor, possibly being stuck in traffic for hours (on top of the already far drive).

          And after all of this, I made it to the hospital, and ended up with a CS anyway. But after 36 hours of labor and 4 of pushing, it was more painful and difficult than it needed to be. Grr.
          He did apologize and I think he felt bad. No matter, I was hurting and annoyed.

          Had I known what I know now, I would have stayed in Mexico where you can get a MCRS on demand for pennies compared to the US, but with comparable care. They even advertise this on billboards! the CS rate is very high, and it’s commonplace and seen as normal. But I didn’t speak Spanish, and my insurance didnt cover it (US was covered 100%), so I didn’t.

          I just never thought I would be refused in this way. Now I know better. This is a case where knowledge would have been empowering, as I could have made better choices.

          When I compare this experience to my second OB, I am amazed by the difference. My second OB respected me in every way. Of course, her willingness to do an MCRS anytime it’s possible health wise makes her stand out in this town. it will be a sad day when she retires.

    • R T

      She should write a letter and give it to the doctor and hospital administrators ASAP! She needs to start making a stink now!

    • R T

      I ended up having a csection based on medical need, but I asked my doctor if he would perform an elective csection based on patient request alone. He said of course he would it was my body and I had a right to decide those sorts of things for myself. However, he said it had to be 39 weeks or later or he’d get in trouble! I can’t understand an OB saying anything other than “it’s your choice”. It’s really upsetting anyone would be forced to have a TOL against their wishes!

    • Lisa from NY

      Please tell her that a CS will limit how many children she can have, and that ideally she should have a trial of labor.

      I have friends who complain that their scars from a CS itch like crazy.

      • The Bofa on the Sofa

        Maybe she doesn’t care about limiting the number of children she can have? And my wife never complains about her CS scar.

      • Dr Kitty

        Ideally she should have EXACTLY what she wants, if she is aware of the risks involved.

        CS only limits family size if you plan to have more than 5 children, because almost all women can have between 2 and 4 CS without developing dangerous thinning of the lower segment. Since most women in the developed world choose to have fewer than four children, CS or not, I’m not sure that is an argument that is applicable to the vast majority.

        • The Bofa on the Sofa

          And who cares whether it IS applicable to the vast majority? This person is not the vast majority, she is an individual. I don’t care if the vast majority wanted 10 kids, that wouldn’t affect her decision.

      • Ra

        Most people aren’t going for a family the size of an atheltic team these days.

      • She is very aware of the need to be planning a small family as a result and was planning on only 1 or 2 children.

      • Why “ideally she should have a trial of labor” ideal to who?

      • LovleAnjel@hotmail.com

        Damn, if only I’d had a vaginal birth, I wouldn’t be going through this horror of needing to scratch my crotch in public! I really should have thought twice about that CS!

        Or not.

        • Dr Kitty

          I have lots (and lots) of scars.
          None of them give me the slightest bother.

          I’m also the person who will (shock horror) wear a bikini despite the fact that I’m obviously no longer the factory default model. I try very hard to empathise with women who feel sad about their CS scars, but I just don’t get it.

          My scars show that I have lived an interesting life, that I have become more than I was, that stuff went wrong and I survived, and in the case of the CS, that I have an indelible reminder on my body of my daughter’s birth.

          “Scar…oh noes!” is, IMO the single WORST reason not to have a CS.

          • Jessica S.

            Exactly. Hearing stories of what can sometimes happen in the other birthing region, a scar – even an itchy one – might be a fair trade off. The “drawbacks” of vaginal delivery are often left out of the comparison.

          • Houston Mom

            My grandmother who delivered at home (not by choice): uterine prolapse/hysterectomy & incontinent most of her adult life. My mother after delivering two under 7 pounders: uterine prolapse/hysterectomy & vulvodynia. Me with my c-section: teeny little scar.

          • Houston Mom

            My c-section scar was my fifth surgical scar and the least noticeable. It never itches. None of them do. The first three are from life-saving surgeries I had as a small child to correct a congenital defect. The fourth is from the removal of a painful, swollen lymph node following a nasty cat bite. So according to the nature-loving crunchies, neither I or my son was “meant to live.”

          • The Bofa on the Sofa

            I’ve mentioned a few times, I have honestly never actually seen my wife’s c-section scar. I’ve never noticed it, and believe me, it is not for the lack of looking, including close-up views.

            I won’t comment on any extent of itching or anything, but it’s certainly not something visually noticeable.

          • An Actual Attorney

            To quote Pat Benatar:
            “I’ve enjoyed every age I’ve been, and each has had its own individual merit. Every laugh line, every scar, is a badge I wear to show I’ve been present, the inner rings of my personal tree trunk that I display proudly for all to see. Nowadays, I don’t want a “perfect” face and body; I want to wear the life I’ve lived.”

          • Comrade X

            Aren’t these gals all about being Warrior Women (TM)? What kind of Warrior Woman are you without a few scars?

      • yentavegan

        lisa dear My dd2 was c/sec. the next two were not, dd5 was a c/sec. That makes 5 children. c/sec did not limit my family size.

        • Jessica S.

          That’s really interesting! And great to point out!

          • Pillabi

            When I was discussing the pros and cons of a trial of labor for my second baby, my ob/gyn told me: “if you want other children after this one, this could be an extra reason to try a VBAC; however, just yesterday we’ve had a woman having her 5th [5th!!] c/sec and she’s doing fine.”
            Another thing the wise man told me then, during labor: “we must care about the safety of one baby at a time”.

      • Trixie

        I have nerve damage in my thigh that both reduced sensation and left it itchy, from my c/s. But it’s a great place to get injections, I don’t feel a thing! At any rate, a possibility of itchiness is not really a major factor in anyone’s decision to have a c/s.

        • KarenJJ

          This! I’ve really enjoyed having numbness around my c/s incision. It’s a shame the sensation has been slowly coming back.

      • AllieFoyle

        Yeah, I’m sure she’ll completely change her mind once she realizes she’ll have an itchy tummy.

  • I started a project for my ex-home birther and safer midwifery utah blogs where I email midwives asking for evidence of safety. So far I’ve gotten that crap BMJ study and one from the netherlands. No one has been honest yet. I’m emailing people about high risk births too to see who will take them or not, if its easy to find someone, etc. This should be interesting.

  • The Bofa on the Sofa

    Oh no, the TOXINSSSSSSSSSS!!!!!!!!!!!!!!!!!!!!!!!

  • Mel

    I love how the article piles some actual researchers in the same category as some data-hating midwives.

    Followed the links back to PubMed. I don’t have access to the entire article, but I found a very important line in the abstract results.

    “Infants born by CS exhibited higher DNA-methylation in leucocytes compared with that of those born by VD (p < 0.001). After VD, newborn infants exhibited stable levels of DNA-methylation, as evidenced by comparing cord blood values with those 3-5 days after birth (p = 0.55). On postnatal days 3-5, DNA-methylation had decreased in the CS group (p = 0.01) and was no longer significantly different from that of VD (p = 0.10)"

    Also, the study followed a whopping 37 infants – 21 vaginal delivery and 16 CS babies.

    • The Bofa on the Sofa

      3-5 days, huh?

      But I thought the problem is with LONG TERM outcomes?

      • Mel

        Perhaps only the first 5 days of life after birth matter.

    • Julia

      According to their logic one CS could mess up the epigenome of all generations to follow – but then wouldn’t one vaginal delivery just fix everything again?
      As a scientist it drives me crazy when a scientific concept is distorted by people who don’t understand it at all – and they end up getting all this attention for it…

  • Sullivan ThePoop

    All the alternative medicine, antivaxx and natural this or that people swear that we are more unhealthy than ever before even though observation says we are healthier than we have ever been. There are some things that are rising with modern society like type II diabetes and autoimmune disorders, but still. Then there is cancer and alzheimer’s. I mean, don’t people realize that when you cut the greatest cause of death in all well fed societies since records were kept by more than 1/2 we are going to start noticing other things? I mean if you don’t die from cardiovasular diseases you still have to die from something.

    • Mel

      Having read “Little Women” when I was a kid made me realize I’ve never met anyone who died from rheumatic fever like Beth did. Plus, I don’t personally know anyone who died of tuberculosis either.

      • EmbraceYourInnerCrone

        I know one person who had rheumatic fever, when she was 12. One of my mom’s close friends. It was after the advent of penicillin but she lived in a place where antibiotics where not easily available. She ended up with permanent heart damage as a result and eventually needed at least one of her valves replaced.

      • Antigonos CNM

        At the beginning of my career I saw a significant number of women who had had rheumatic fever in childhood, and had to have penicillin prophylaxis in labor, but it must be at least 20 years since the last case I had. Contrariwise, at the beginning of my career, no one knew how vaginal GBS could affect a newborn.

        • Guestll

          My paternal grandmother had rheumatic fever as a child. After my father’s difficult birth, my grandparents were strongly advised not to have any more children. Four years later, she had my aunt. My grandmother suffered a stroke during the birth. at age 24, and was never the same. She died of heart failure, aged 38. My father and aunt were ages 18 and 14.

          • Dr Kitty

            The reason my FIL was an only child and his father was a widower before he was 40…

            Mitral valve prolapse from rheumatic fever, which eventually killed my husband’s grandmother, who got rheumatic fever, less than 10 years before the discovery of penicillin.

    • Trixie

      My grandfather had scarlet fever as a child and almost died. When was the last time you heard of a kid with scarlet fever?

      • Amy M

        I had scarlet fever when I was 10 (I am 36 now)…but I got antibiotics and suffered no long term effects.

      • Dr Kitty

        Scarlet fever is just strep throat with a sand papery red rash.
        I see it a lot. 7-10 days of penicillin or 3 days of azithromycin and it is all good.

        Rheumatic fever…now THAT we don’t see so much.

      • Lionessong

        My toddler got scarlet fever this past summer, but since we live in this modern day and modern medicine, he got antibiotics. So he only ended up being really sick for two day and mildly ill for another 4 days.

    • Hannah

      With immune disorders, it’s also discovering that they even exist. I’ve got lupus, and it’s only really been recognized for about 60 years. Before that, I’d just be dead of kidney failure for no apparent reason. Instead, I survived (and luckily was able to stop kidney problems before permanent damage occurred), and now live with it rather than be dead from it.

      • KarenJJ

        That’s what I was about to say. I have an immune system issue that was only first described in the medical literature in the 1960s. Before that it still existed (a few large family groups) but nobody in the medical field had recognised it or had a name for it.

    • DiomedesV

      They’ve never heard of the Demographic Transition. Either that, or they think *they* could do without it. They’d like a little more culling, please. You can start with the C-section babies.

  • Young CC Prof

    The state of the actual science on gut flora:

    It’s important to have bacteria in your gut, and it seems to be important to have the right ones. Lack of bacteria, or the wrong ones, can cause digestive problems and possibly other health problems. A serious health problem clearly linked to the disruption of gut flora is antibiotic-associated C. Difficile infection.

    We don’t, however, know what an ideal gut flora looks like, and we don’t know what variations from normal mean. Probiotics? Probably a good idea, but we aren’t sure about the right organisms or doses.

    The state of the pseudoscience on gut flora:

    Anything goes!

    • Sullivan ThePoop

      Gut flora changes between households. I am sure it must be very different depending on the environment in which you live. It could change continuously with differing lifestyles and environments. There should be more studies before we go all probiotic crazy.

      • Karen in SC

        Isn’t that part of the reason you get when traveling? You don’t have the same “gut flora” to handle whatever’s in the local water?

    • I’m so excited for updates on this specific topic. Its super interesting.

    • SarahSD

      Right! I find the theory that babies born vaginally will be exposed to different bacteria than those born via c-section to be plausible. Whether it makes a long term difference is another story. But like you say, without knowing how gut flora works, and what ideal gut flora looks like, it’s pretty impossible to say that vaginal birth is a primary or even a contributing factor in developing a healthy microbiome.

      I would be really interested in knowing if and how there is a causal relationship here. Highly doubt that the difference is so black and white, so catastrophic that we are damning the future of our entire species (this is as absurd as that guy, (is it Odent?) who thinks that epidurals suppress the natural love hormone and will therefore cause the collapse of society). I think there is something interesting here beyond mere ignorance. Something strategic. I’m beginning to think that “cutting edge” research is appealing BECAUSE of its newness, its incomplete understanding of the mechanisms in play, its potential to make it say what you want. But what happens if and when the science advances and does understand it better, and shows your theory to be wrong? They’ll probably find a new hot area of science to latch onto.

      If you are really interested in understanding how the microbiome works and how to create a healthy one, pursuing this research would ideally help people figure out how to foster a healthy gut, regardless of the manner in which they were born. In spite of it, if it does turn out that there is any significant causal link there. The advancement of research in this area should only help find new ways to create a healthy gut, and overcome the hypothesized problem of vaginal birth (if it even exists as a problem).

      If you are interested in finding science to support your belief that NCB is better, it’s not really in your interest for the science to advance beyond the exciting “gut flora!!!!!!!!important!!!!!” phase. NCB advocates who throw around the microbiome arguments are just moving the target from the safety of non-interventive birth to the newer, greyer areas of microbiome and epigenetics. The “nature knows best” argument is simply displaced from one narrative (body knows how to give birth) to another (vagina is magic determinant of future health).

      The fact that the research on the microbiome is in its early stages is actually good for their argument because it can support almost whatever they like. The advancement of this research is bad for their argument, because it will either show that there is no link between a healthy gut and vaginal birth, and/or it will ultimately find solutions to the problem other than vaginal childbirth.

      Sorry for the novella. I’m a grad student in Science and Technology studies so I think a lot about this stuff and actually struggle myself with how to be critical of science (part of my work) while taking it seriously. Thinking about how different groups are engaging with the science helps.

      • LynnetteHafkenIBCLC

        I think it’s fascinating too. But it’s interesting how some people assume that an altered biome is going to be inherently bad just because it’s not the normal, natural state. It could be irrelevant, or it could be *better* than the vaginally colonized biome.

        • SarahSD

          Yeah! There is a serious and weird worship of all things “natural”. In my field it is pretty well accepted that the boundaries between natural and artificial are, well, artificial. And drawn strategically.

      • An Actual Attorney

        Warning — about to be very vulgar, but I’m tired, and vulgarity suits me.

        Why not just encourage a lot of eating pussy?

        • The Bofa on the Sofa

          Works for me!

    • Dr Kitty

      The only gut bacterium that it is probably a bad idea to have is Helicobacter Pylori.
      Everything else…work away!

  • PrecipMom

    Oh, so exposure to vaginal flora is totally important, right? So we can expect for them to come out ANY MINUTE in favor of induction of labor at 41 weeks because it decreases the risk of c/s compared to expectant management, rite??

    I’ll be over here in the corner, waiting for that announcement to come out. Don’t worry, I won’t be holding my breath.

    • Young CC Prof

      But you see, if labor is induced, then babies aren’t exposed to the flora in the right way, because… Yeah, I got nothing.

      • Mel

        Induction scares the bacteria so badly the bacteria undergo scary epigenetic changes.

    • SarahSD

      And what about all the garlic cloves they’ve been shoving up there? Isn’t killing your vag critters the same as having a c-section, by this logic?

      • Amy M

        I don’t know, it might just be introducing new ones, whichever ones live on garlic cloves and aren’t naturally found in the vagina in the first place.

        • An Actual Attorney

          And keeps away naturally occurring vampire flora.

    • anne

      They could do what the researchers in the NY Times article did – swab the baby with vaginal flora after the c-section delivery.
      http://www.nytimes.com/2013/05/19/magazine/say-hello-to-the-100-trillion-bacteria-that-make-up-your-microbiome.html?pagewanted=all

  • Guest

    I am so confused. I have three healthy, vibrant kids. There is nothing wrong with them. They were born by section (first emergent, others elective ’cause I wasn’t going through that shit again.) There is nothing wrong with my cousin’s c-section kids or my brother’s. What is the crisis here? What are we trying to fix? I can’t even begin to guess what the “bonding” piece is all about. I didn’t meet my first until many hours after she was born — I was getting put back together after a bad PPH. I can’t figure out what magic was lost, because I absolutely adore her and so far she shows no sign of truancy, vagrancy or any other bad “c” other than the one that saved her little newborn life twelve years ago.

    • Mel

      I was born at 29ish weeks 32 years ago. My mom had severe post-partum pre-ecclampsia and couldn’t come to see me or my twin in NICU for several days. We couldn’t come out of our isolettes for 15 days.

      According to NCB hogwash, my twin and I must be horribly scarred in someway. You know, totally unable to bond to anyone.

      Too bad I didn’t read any of that as an infant. I love my mom and dad. I really like my siblings. I am inordinately fond of my husband and have loved watching my sister and her wife start their lives together.

    • Sullivan ThePoop

      What?!?! I only believe anecdotes that agree with my bias.

    • The Bofa on the Sofa

      What is the crisis here? What are we trying to fix?

      I always tell my students, the most important step in solving a problem is to figure out what is causing it. However, at least in our case, we actually know we have a problem. Your questions are very important.

      Unfortunately, if you ask these questions, the only answers you are going get are going to be non-sequitors (there are too many interventions!) or vague, content free.

      For example, they may claim that there is a bonding problem, and kids who are not sufficiently bonded will not thrive as well. How do you determine there is a bonding problem? Either by anecdote, or by asserting that c-sections harm bonding, and nuff said.

      Where is the data suggesting the long term problems of c-sections that they claim exist that need to be solved? Other than, “There are too many c-sections, m’kay?”

      • Guest

        I remember the pain — the holy-GOD just kill me pain — and the fear, and the blood and how it was the worst day of my life, so much worse than I could have imagined. And then this little sweet face under the hat. The utter astonishment, looking at her, that none of it mattered. I’d do it again for her in a second, anything to keep her safe. I worry about women who deprive themselves of that kind of bonding because they are so focused on the stuff that doesn’t matter.

        • Guest

          I posted before adding: I know so many mothers who didn’t bond or feel that love for the first few months and didn’t really feel connected until the kids were older … and they’re great moms with great kids. They just weren’t in to newborns, or they had PPD or they just took a while to adjust. There are so many ways to parent well.

    • Josephine

      My kid was born by c-section and has lost all chance of being an Indigo child. 🙁 It’s a HUGE problem, in my estimation.

      • Dr Kitty

        I’ll take my super bright, very polite four year old over an “Indigo child” any day.

        I take very little credit, she’s turned out like this despite my parenting and the CS…must be the magic breastmilk…or just that she’s awesome.

        • Josephine

          I’m gonna be honest, the description of indigo children traits just sound like another description for “unruly little shits” to me. Shudder.

          • Guest

            You made me Google this. I will never forgive you. My eyes rolled back in my head so far it actually hurt.

          • araikwao

            Oh no. I was just about to go get a Google U diploma in Indigo Child Studies because I have no idea what it means. Perhaps I shouldn’t.

          • Josephine

            It will involve a lot of groan-chuckling, just to forewarn you.

          • Poogles

            “just sound like another description for “unruly little shits”‘

            1. Born feeling and knowing they are special and should be revered.

            2. Knows they belong here as they are and expect you to realize it as well.

            4. Absolute authority, the kind with no choices,
            negotiation, or input from them does not sit well.

            5. Some of the rules we so carefully followed as children seem silly to them and they fight
            them.

            6. Rigid ritualistic systems are considered archaic to an indigo child. They feel everything should be given creative thought.

            7. They are insightful and often have a better idea of method then what has been in place for years. This makes them seem like “system busters.”

            8. Adults often view an indigo as anti-social
            unless they are with other indigos. Often they feel lost and misunderstood, which causes them to go within.

            9. The old control methods like, “Wait till your father gets home,” have no effect on these children.

            10. The fulfillment of their personal needs is important to them, and they will let you know.

            [Emphasis mine – http://www.2012-spiritual-growth-prophecies.com/indigo-child.html%5D

            Unruly little shits? No way! /sarcasm

          • Poogles

            And of course, we can’t forget the Crystal children and Rainbow children who are successionally more “evolved” and “special” than the Indigo children….

  • Mel

    This is a great example where a smidgen of truth is mangled into a hideous massive idea.

    Yeah, if you don’t intervene at all in births, evolution (changes in relative frequencies of genes) will select for genotypes that don’t die in a non-intervention system.

    Giant problems:
    1. Mothers and infants will die some hideous deaths in the process.
    2. Maternal and infant deaths will never disappear for two reasons. A. Not all pathologies are genetic. B. Traits are rarely simple Mendelian recessives with two alleles. It’s more likely tens or hundreds of genes with many, many alleles and many outcomes.
    3. You wont know if you are the person sacrificed to the gods of childbirth until you give birth. Sounds fun, eh?
    4. Humans have an agonizingly long generational time. Proving any of this will take several generations which is a few hundred years. In that vein, I bet humans will grow wings.

    • Sullivan ThePoop

      Not to mention we traded a lot of traits that would have made birth safer to gain beneficial traits in other areas because it is pretty easy for humans to have a higher birth rate than death rate.

      • An Actual Attorney

        Yeah, I’ll take walking upright, a big brain, and medical intervention. Thank you very much.

    • Staceyjw

      I am pretty sure that if we were going to evolve into a species that births with little loss, we would have already done it by now. I mean, how many hundreds of thousands of years have we had to get this done? To think a few decades of CS saving the ones that would have died, would make any difference is so ignorant.

      WTG, just one more part of science they are clueless about, but claim as experts.

      • The Bofa on the Sofa

        And the loss in births is nothing compared to the loss due to miscarriage. Miscarriage rates are the prime example of how evolution does not give you perfection, it gives you “good enough.”

  • Karen in SC

    How many midwives have PhD.’s in microbiology or genetics? There used to be a saying – “consider the source.”

    • Mel

      Or even an undergraduate concentration in Biology.

      • Trixie

        Or even an AP Biology course in high school.

        • Josephine

          Or even a high school diploma.

    • Young CC Prof

      One of my grandmother’s favorite sayings. Clearly, I came by my skepticism honestly.

  • Zornorph

    More of the same lunacy that brought us the concept of the ‘virgin gut’ to try and guilt parents into making sure that their children never have even a drop of formula rather than despoil their immaculate intestines.

    • Sullivan ThePoop

      So, I have an aquaintance who is crazy about breastfeeding and was saying something about allergies and asthma. I told her I thought I her restrictive diet would prevent the kind of protection that breastfeeding provides against allergies and asthma. She is a vegan and eats gluten free plus is legitimately allergic to a lot of foods. Well, anyway I saw her a couple of days later and she told me she took to heart what I said because she trusts me on these issues and decided she was going to use camel colostrum or something because she read online that it would fix the problem. I had to walk away.

      • Zornorph

        Remind her that camels are the one mammal (besides non-crunchy humans) who don’t eat their own placenta and recommend zebra sperm instead.

      • Trixie

        We have Amish dairy farmers here who are getting into the raw camel milk business. $10 a pint plus shipping!

      • Jennifer2

        Man, this just makes me want to come up with some out-there crazy scam and profit off all these wack-a-doos. I could sell camel colostrum. All my camels would have home births too. I would make them give birth in a kiddie pool in my living room.