Midwifery theory gets ever more goofy

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Midwifery has a serious problem. A lot of its central claims simply aren’t supported by science.

There are two ways that midwifery theorists could address this problem. They could modify the central claims of midwifery theory (unmedicated vaginal childbirth is best, midwives provides evidence based care, obstetricians ignore scientific evidence) or they could dismiss science. They have taken the second approach with truly laughably results. Their pathetic attempts at dismissing scientific evidence extend from improperly invoking scientific theories of quantum mechanics and chaos theory, which they clearly don’t understand and which have zero applicability to midwifery, to attacks on the notion of randomized controlled trials, to rejecting rationality altogether and insisting that Including the Non-Rational Is Sensible Midwifery.

Simply put, while scientific research seeks to learn, specifically to learn how the human body works and how to maximize healthy outcomes, midwifery research seeks to justify, specifically to justify a primary role for midwives in the delivery of obstetric care and to justify the use of methods and claims not supported by scientific evidence.

Now comes the latest bit of midwifery buffoonery produced by Denis Walsh. You may remember Walsh, a professor of midwifery, as yet another in a line of old white men mansplaining the “benefits” of labor pain to women. Walsh has mangled yet another mainstream theory in a desperate effort to justify ignoring scientific evidence. His new paper, Critical realism: An important theoretical perspective for midwifery research, published in this month’s issue of the journal Midwifery, will no doubt impress other midwives (such big, fancy words!), but real scientists and philosophers would just howl.

According to Walsh:

Midwifery research has grown exponentially over the past 20 years and has been widely disseminated in a range of midwifery and obstetric journals. Research methods that are utilised are increasingly eclectic and reflect the variety of research questions addressing different aspects of childbirth. However conspicuously absent in midwifery journals has been in-depth discussion and debate about the philosophical underpinning of different research methods, though these have taken place in midwifery research texts and other health professions’ journals. The debate asks important questions about the nature of reality (ontology) and how we gain knowledge of it (epistemology). Such a focus is fundamental to research endeavour because unless the right questions are asked about the reality we are attempting to describe, explore or explain, then our knowledge of that reality will remain superficial and impoverished and is less likely to make a difference to childbirth practices and women’s experience. In addition, it can result in research that is inadequately justified, lacks internal coherence and therefore lacks wider credibility.

English translation: Midwifery research is, in large part, nothing more than crap and therefore no one takes us seriously. But even though our research looks crappy, it’s only because no one has explored the deeper philosophical underpinnings.

That’s where critical realism comes in.

What is critical realism?

Critical realism is a philosophy of the SOCIAL SCIENCES (not the natural sciences) combines a general philosophy of science (transcendental realism) with a philosophy of social science (critical naturalism) to describe an interface between the natural and social worlds.
It was promulgated by philosopher Roy Bhaskar:

… [W]hen we study the human world we are studying something fundamentally different from the physical world and must therefore adapt our strategy to studying it. Critical naturalism therefore prescribes social scientific method which seeks to identify the mechanisms producing social events, but with a recognition that these are in a much greater state of flux than those of the physical world (as human structures change much more readily than those of, say, a leaf). In particular, we must understand that human agency is made possible by social structures that themselves require the reproduction of certain actions/pre-conditions. Further, the individuals that inhabit these social structures are capable of consciously reflecting upon, and changing, the actions that produce them—a practice that is in part facilitated by social scientific research.

This may make sense in the world of social science research (although there are many other philosophers who would disagree), but midwifery claims are generally natural science claims, so critical realism doesn’t apply.

Walsh doesn’t really care about the validity of invoking critical realism in assessing the validity of midwifery research, he merely intends to use it as an excuse to ignore scientific evidence in favor of midwifery beliefs and intuitions.

Walsh does not like the scientific evidence about dystocia (stalled labor):

An example of this is the current research into dystocia, a complication of labour that is the principal contributor to caesarean section in nulliparous women. Most of the research has explored interventions to speed up labour … The methods utilised in these studies have been randomised controlled trials … [which] promises certainty in addressing the condition, based as they are on a positivist epistemology (knowledge that is always true and generalisable) … However, the incidence of dystocia and its negative consequences for women continues to rise. If researchers had grasped the limitations of their research methods by critiquing their ontological and epistemological underpinning, they might have asked different questions about the aetiology of dystocia, researched different interventions to manage it and ultimately had a greater impact on women’s outcomes and experience.

English to English translations: The large body of scientific literature on dystocia does not support midwives’ intuitions and claims about dystocia.

Never fear! Critical realism supposedly comes to the rescue:

Nine years ago, Anderson  began asking different questions about the aetiology of dystocia, suggesting some new categories – organisational dystocia (lack of continuity of care on labour wards), environmental dystocia (clinical, non-homely décor) and interpersonal dystocia (disagreements between labour ward midwives and obstetricians). Of course what she was hinting at were environmental, social and psychological effects that could impinge upon a woman’s ability to labour normally. Later, Downe and McCourt articulated the limitations of studying labour predominantly by using randomised controlled trials (RCT’s) because the theoretical foundations of trials reside in a positivist epistemology based on simplicity, linearity and certainty. However, labour does not unfold with a singular cause and effect physiology (oxytocin secretion therefore cervical dilatation) which then proceeds with regularity (cervix dilates in a constant trajectory) to end with birth at a relatively predictable point (average of 10 hours). It is a much more complex phenomenon which might more accurately be referred to as ‘orderly chaos’. Clearly, experiences like labour are impacted on by multiple factors in the physiological, psychological and social domains. Simply applying quantitative research methods suited to the controlled confines of a laboratory are not going to capture the intricacies of the uncontrolled milieu of a labour ward.

In other words, midwives don’t like what the scientific evidence shows so it’s okay if we ignore it.

Let’s leave aside for the moment that critical realism has been dismissed on its own terms by philosophers and let’s focus on the relevant facts:

1. The central claims of midwifery theory are not supported by scientific evidence.
2. Midwives have no intention of modifying cherished beliefs just because science shows they are false.
3. There is a desperate, ongoing search among midwifery theorist to justify ignoring scientific evidence.
4. A variety of theories from other disciplines, poorly understood or misunderstood by midwives, are invoke by midwifery theorists to baffle their followers with bullshit.

What should the average pregnant women take away from these bizarre, goofy theoretical justifications? It’s startlingly simple:

If you want science based care in childbirth, stick with obstetricians.

  • itry2brational

    “Midwifery theory”? Hardly, Critical Theory is promulgated by feminists in women’s studies programs.

    “Popular methodologies within the field of women’s studies include standpoint theory, intersectionality,multiculturalism, transnational feminism, autoethnography, and reading practices associated with CRITICAL THEORY, post-structuralism, and queer theory.” -wiki

    Most of the usages of “midwives”/”midwifery” can be replaced with feminists/feminist theory and it works equally well…actually better since most of the NCB movement is buttressed and founded on feminism and its theories.

    “[feminism] has a serious problem. A lot of its central claims simply aren’t supported by science.” -True
    “Let’s leave aside for the moment that critical realism has been dismissed on its own terms by philosophers…”

    But oddly not dismissed by feminist academics and women’s studies programs.

    “1. The central claims of [feminist] theory are not supported by scientific evidence. check
    2. [feminists] have no intention of modifying cherished beliefs just because science shows they are false. check
    3. There is a desperate, ongoing search among [feminist] theorist to justify ignoring scientific evidence. check
    4. A variety of theories from other disciplines, poorly understood or misunderstood by [feminists], are invoke by [feminist] theorists to baffle their followers with bullshit.” check

    http://en.wikipedia.org/wiki/Women's_studies

    Course: Feminist Critical Theory
    http://www.newschool.edu/NSSR/courses.aspx?id=30538

    Feminist Theory and Critical Theory: Unexplored Synergies
    http://csi.gsb.stanford.edu/feminist-theory-critical-theory-unexplored-synergies

    http://www.critical-theory.com/tag/feminism/

    Feminism and Power: The Need for Critical Theory
    “Feminism and Power: the Need for Critical Theory therefore argues that the critical theories of Theodor Adorno and Jacques Derrida have much to offer feminism, and a feminist understanding of female empowerment.”
    Ah, Jacques Dirrada, now there’s a name in feminism from way back.
    http://www.amazon.com/Feminism-Power-Need-Critical-Theory/dp/0739175793

    Feminist Critical Theory
    http://prezi.com/dvaynha9om03/feminist-critical-theory/

    ^^^All of the above links come from just the first page of a google search: “‘Critical theory’ feminism”

    I’ve encountered doctoral papers by feminist philosophy students which promulgate nonrational ways of knowing. The first dealt with “birth rape”. Women are getting their PhDs on this garbage…and we are helping pay to educate them.

    Your biggest problem is not being able to see the nose on your own face: feminism is the problem with the NCB movement. It drives it, guides it, provides the BS theories it uses and is almost entirely, if not entirely, composed of feminists and women can’t resist the empowerment message. Feminists run the show. Many of the most popular, if not all, pro-NCB blogs and sites are adamantly feminist or they even use it in their titles.

    “For educated, independent women, these choices may come from a FEMINIST sensibility that leads them to reject a paternalistic and technological model of birth. For other women, birth choices may be “driven by God.”
    http://humanwithuterus.wordpress.com/2014/03/11/home-birth-and-social-control/

    So regardless of which ideology/religion you choose or adhere to, both will lead you to make poor decisions. The educated(smart), independent, feminist woman still makes the same mistake(s) as a woman who believes in a magic man in the sky.

  • Pillabi

    Dr. Amy, I’d like to know your opinion on English Midwife’s statement below:
    “physiology is affected by environment, emotions, psychology, all robust
    findings that can be supported by a raft of psychological research”.

    In principle I agree with this. Of course the problem begins when emotions and (supposed) psychology turn into the excuse to justify not science-based practice.
    But on the other hand, shouldn’t these aspects be taken into account by scientific research? Does this happen already, or could this become a perspective for further studies on physiology?

    • Amy Tuteur, MD

      I’m not aware of any research, psychological or otherwise, that has have been able to demonstrate any predictable, reproducible effect of environment, emotions, etc. on any aspect of childbirth.

      I realize that it is an article of faith among natural childbirth advocates that emotions affect labor, but they basically made that up.

      • Pillabi

        Ok thanks.
        And now a plea to natural childbirth advocates: if you don’t agree with Dr.Amy, if you are sure that such reproducible effect does exist and has been demonstrated, please QUOTE.

  • English Midwife

    For someone arguing logic and science you are very rude, and irrationally angry. For you to dismiss the idea that physiology is not affected by psychological and emotional factors is to ignore a huge body of research in the field of psychology. As far as your scientific evidence about labour progress, scientific evidence can be distorted to support all sorts of intervention. RCOG guidelines on supposed labour dystocia rate their own evidence level for instrumental delivery due to slow progress as level 2, sounds good until you read the table, cleverly labelling all evidence levels +++1, ++1, +1, 1 +++2, ++2, +2 and 2. The evidence level in for this very oft used intervention of assisted delivery based on a time limit for the second stage is based on retrospective case studies, small sample sizes, described in the guidelines as having a very high likelihood of bias!! In addition, the ‘science’ behind EFM continues to show an increased level of intervention without any reduction in neonatal mortality yet it is still used. Good well trained midwives don’t ignore the evidence base, but they will continue to challenge obstetric practices that are based on poor evidence. I wonder if your irrational and highly unbalanced diatribe has anything to do with the fact that in your country maligning midwives is about protecting your own highly lucrative income

    • Dr Kitty

      Can you link to the relevant RCOG Greentop?
      I’m having difficulty finding it.

      • Dr Kitty

        Oh, got it.
        It is the Operative Vaginal Delivery guidance and the relevant paper is Cheung et al. The evidence is 2- because other studies haven’t been done and the Cheung data is pooled data from a single institution between 1976 to 2001, which makes it less reliable.

        http://www.rcog.org.uk/files/rcog-corp/GTG26.pdf
        http://www.ncbi.nlm.nih.gov/pubmed/15467567

        • Dr Kitty

          And…
          Level 1 evidence requires RCTs.
          Good luck getting an ethics committee to approve a RCT where one arm of the study is randomised to expectant management of a prolonged (>4hr) second stage.

          • Siri

            Exactly what I was thinking! (Yay, I shared a thought with Dr Kitty! She’s a doctor! And really clever!). How the heck are we going to get any better evidence? And how do you explain away the damaged babies doomed … sorry randomised … to open-ended 2nd stage? Or damaged mothers for that matter? Does English Midwife not realise that by this time, most mothers WANT their labour over and done with? And are grateful for the intervention? Sheeshety sheesh-sheesh.

          • English Midwife

            There is a vast difference between an open ended 2nd stage and one strictly controlled by rigid guidelines based on poor evidence. There are also many levels of evidence and +++1 an RCT is a raft away from the -2 evidence used to justify this intervention. Which incidentally is recommended according to those guidelines after 1 hour for a multip, not 4!

          • Siri

            And as you also know, hospital staff work primarily with PEOPLE, not policies/protocols. We midwives advocate for our clients, and most obstetric registrars these days will have a discussion with the labouring woman before making a decision, taking into account each case’s unique set of circumstances, eg mum and baby’s wellbeing, mum’s wishes, presence/availability of regional anaesthesia, exact progress and station, midwife’s opinion etc etc. It’s never, Well it’s been this long, so this has to happen.

          • Young CC Prof

            The obstetrician might well say, “If there’s no progress in an hour, you’re going to need an intervention.”

            A patient who is primed by the NCB movement hears,”I’m going to section you because I’m late for dinner.”

            In fact, the doctor means, “If there’s no progress in an hour, I don’t think there ever will be,” or, “You and your baby can’t endure much more of this without danger.”

            The good thing about electronic fetal monitoring is that it lets doctors say, “Well, sure, your labor is taking longer than average, but you’re making some progress, and the baby is still fine. You can keep going a while longer.”

          • Siri

            Exactly. It’s an holistic assessment, with room for negotiation; mum’s wishes are an important part of that.

          • Siri

            P.s. most primips I’ve cared for in labour have WANTED help getting their baby out, and the very, very few multips I’ve seen get an instrumental have all needed and wanted it. It’s so unusual, there is normally a good reason.

          • Dr Kitty

            You’re seeing rigid guidelines. I’m not.

            From the Greentop:

            “The time constraints listed in Table 2 are therefore for guidance. The question of when to intervene should involve balancing the risks and benefits of continuing pushing versus an operative delivery”

            ALL CLASS 1 EVIDENCE REQUIRES RCTS.

            “1– Meta-analyses, systematic reviews of
            randomised controlled trials or randomised controlled trials with a high risk of bias”

            So the best you can hope for is 2++, which requires case-control and cohort studies with a low chance of bias.

            Any thoughts on how, EXACTLY you would design that study case-control study or cohort study? How you would remove bias and prove causation?

            Because the cases where OBS were happy to allow extended second stage may be different from the ones in which they were keener to intervene, and the women who refused OVD and preferred to keep pushing may be different from women who accepted the offer of intervention.

            The evidence we have may not be fantastic, but realistically it is what we have to work with and I’m not sure how to make it better.

            Would love to know your ideas.

    • The Bofa on the Sofa

      For someone arguing logic and science you are very rude

      For someone complaining about logic and rationality, you are one big non-sequitor

      • Siri

        Sequiteuse, surely, Bofa? And what’s with the fattism (big)? She might well be a slim, ravishing non-sequiteuse. Most UK midwives are stunners (I should know, I used to be one! Har har).

        Sorry Bofa. As you were. Ignore me.

    • Siri

      English Midwife, US obstetricians already care for the vast majority of pregnant women, and most are salaried, meaning that the odd home or birth centre birth makes no dent in their income. It’s like saying that if you’re a salaried staff midwife in the UK, your income will suffer if a woman checks into the Portland for private treatment, so UK midwives have to try their best to persuade women never to go private.

      Doesn’t make sense, does it? If, on the other hand, I tell you that lay midwives in the US are NOT salaried, and depend on every single birth for their income, you have to admit it puts a rather different complexion on it (you’ll have to imagine me saying all this in a very clipped RP accent for added affect). Now who is protecting their financial interests? Those lay midwives/birth junkies, that’s who. And if you think obstetricians rely on poor quality evidence, is it really the answer to use no evidence at all?

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

    Question raised by some of the discussion below – Why do people claim diet and lifestyle changes are “simple?” I’ve made many – they are WAY harder than a simple pill.

    • AlisonCummins

      They are simple. They are not, however, easy!

  • Allie

    I wonder if Louis Pasteur sat around contemplating the ontological and epistemological implications of his work or whether he instead satisfied himself with the millions (perhaps billions now?) of lives his research and discoveries had saved and would continue to save.
    The thing I don’t understand is don’t these people read Dickens or Austen? We can sit around and chat about epistemology all day; it doesn’t change the fact that modern medical practices derived from randomized controlled trials have saved countless lives and rendered the spectre of the mother who died in childbirth, a literary device so common as to be cliché, a thing of the past.

    • Young CC Prof

      I was reading some classic Sherlock Holmes. Holmes looks out the window, sees a young man in dressed in mourning doing some household shopping and buying a baby rattle, and concludes that, since he’s doing his own shopping, it’s his wife who’s dead, and, since he has a little baby, she died in childbirth.

      It’s all over the place in classic literature: Deaths in childbirth were commonplace.

    • MaineJen

      I just watched “Wuthering Heights” on instant video the other day…literally EVERY mother who gave birth in that miniseries, died in childbirth. Every single one. Granted, it’s a literary exaggeration, but I’m betting the Bronte sisters were well acquainted with this phenomenon as well. (And for fans of the Walking Dead…the miniseries is well worth watching, if only to hear the Sheriff speak in his native accent.)

    • Trixie

      I’m reading Bully Pulpit, the new Doris Kearns Goodwin bio of T.R. and Taft. It might as well be called Everyone You Love Will Die of Typhoid or Eclampsia.

      • Young CC Prof

        Heck, you don’t even need history. You just have to listen to your friends’ birth stories with an open mind and some actual knowledge.

        In a one-year period ending just after I got pregnant with Baby CC Prof, four of my friends bore sons. All had a major problem of some kind.

        A few generations ago, two of them would definitely have died, baby and all (HELLP, severe placenta previa). One would have had an uneventful pregnancy and birth, then watched the baby turn blue and die within a few days (congenital heart defect). Friend #4 might or might not have been OK. (Hypertension) That’s 5-7 deaths out of 4 mothers and 4 babies.

        Instead, I have 4 healthy friends who have 3 perfect babies, and one baby who still has problems, but will most likely grow up and lead a relatively normal life.

        • Trixie

          Yeah, I had two friends within a month need c-sections for transverse breech.

        • Fuzzy

          Way back, renal failure as a result of PIH was well-known and probably accounted for not a few of the post-partum wasting deaths. I found an old book written by a physician who started practicing in 1875. Basically, they watched babies and mothers die. There was very little that was actually effective

    • Busbus

      When I prepared for my second home birth, my midwife told my partner a story about an irresponsible lay midwife (despite being a CPM, my midwife was actually relatively non-woo – emphasis on relatively – and relatively well educated as far as I can tell, and I had parallel prenatal care from an OB she had an agreement with). Anyway, she told my partner about that lay midwife who had a woman die in labor in my state a few years prior. I was very pregnant at the time, and very anxious about my own upcoming labor, and I started to cry because I just couldn’t fathom the horror of someone being in so much pain, and then dying in so much pain.

      It is no wonder people used to be scared of child birth. Not just that it was really dangerous; death in child birth is about one of the most horrible ways I can imagine dying. And it used to be so common.

      I am so glad we live in a different era today.

  • drmoss

    Sounds like we have entered the era of post-modernist obstetrics.

  • Amy Tuteur, MD

    OT:

    Does anyone have any experience with the Japanese system of maternity care? Someone write to me privately seeking advice, but I know very little about it.

    • Dr Kitty

      Good outcomes, long hospital stays, paternalistic care is my sum knowledge.
      Hopefully someone else knows more.

      • Dr Kitty

        Oh, and that Japan has the lowest incidence of natural twin conceptions. But I’m sure you knew that.

        • Antigonos CNM

          Identical or fraternal?

          • Dr Kitty

            Fraternal.
            Incidence of natural identical twinning is the same worldwide, fraternal twinning varies greatly between ethnic groups. The highest incidence is in Nigeria.

          • Antigonos CNM

            Thanks. Fascinating, but hardly surprising that it is fraternal, or that it should be highest in a country where people tend to marry within their tribe and so strengthen the genetic component.

    • Anj Fabian

      http://www.amazon.com/Ivan-Ramen-Obsession-Recipes-Unlikely/dp/1607744465

      I was flipping through this book. The author lost his first wife (Japanese, in Japan) because she went to the hospital, miscarried, staff missed signs of an infection while she was in the hospital and she developed sepsis. And died. All of this happened while she was an inpatient, which is shocking to me.

      I don’t know much about the system, but stories imply that Japan has similar problems to other NHS type systems due to low staffing.

    • attitude devant

      We used to have a poster here who delivered there. Her name was Charlotte

    • Burgundy

      I read from another blog (in Chinese) that the Japanese system was expensive but the OB takes good care of you. Each hospital has its own system so they have to do their homework. For some reason, they are very focus on the mother’s weight gain. She got ding because she gained 2 kg more then “she supposed to”.

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

      I found a link about the system of japanese midwifery care while doing research on my Debunking The Business of Being Born series on my ex home birthers blog. http://www.nurse.or.jp/jna/english/midwifery/pdf/mij2011.pdf

    • Haelmoon

      I don’t have any direct experience, but have had the opportunity to care for quite a few women who have had children in Japan – both complicated and uncomplicated pregnancies. Their experiences are very interesting and very paternalistic. The whole expectation around having babies and maternal roles are overwhelming. My husband is part Japanese and as interesting insights into the country.

  • Anne

    I know a HBM who told me that she didn’t believe in evidence based practice. Because, you know the evidence in obstetrics doesn’t exactly support her practice.

  • Elizabeth Neely

    Alice in Blunderland = homebirth

  • hurricanewarningdc

    I have a graduate degree and about 20 years of increasingly responsible work experience. I’ve traveled the world, spoken other languages, lived and studied in many different places. My IQ doesn’t make me a genius but I’m no dummy. Yet even with all of that, I HAVE ABSOLUTELY NO IDEA WHAT THIS MAN IS SAYING. If one has to construct a bunch of blather like this, words so tortured and convoluted in a weary effort to appear “scientific” and “smart,” then surely, the author had nothing of value to say at all. And I’m a lawyer (non-practising, thank you) so I can appreciate the art of saying something simple in 100xs as many words. ;) But even then, we evil attorneys know how to make our verbosity worth your while. This, however, is pure garbage – as is typical of this faux movement. (Brava to Dr. Amy for having the patience to translate.)

    • Lisa from NY

      But you can only figure that out because of your high IQ (probably genius).

    • Antigonos CNM

      The deliberate use of jargon and polysyllabic nonsense words to obfusticate simple meanings is a distinctive feature of the ignorant attempting to sound intelligent. Ever since nursing stopped being a profession based on a training program leading to a diploma and became an “academic” profession, I’ve noticed the explosion of such language, often the higher the degree of the writer, the more obscure the writing.

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

        We utilize overwrought prose to obfuscate statements among of-age persons from the auditory range of precocious offspring who are prematurely able to cogitate words spelled in his vicinity.

        (Spell i-c-e-c-r-e-a-m and he knows. Chilled high fat dairy, on the other hand…)

    • English Midwife

      This man is a trained obstetrician like the charming one who rights this blog. This man is saying quite simply and clearly that physiology is affected by environment, emotions, psychology, all robust findings that can be supported by a raft of psychological research. This man is saying that studying a human being in labour in a RCT measuring the purely physical events and ignoring the context is superficial science and will not examine the confounding variables that affect labour such as the woman’s emotional state and her environment. Would have thought being a lawyer you could have worked that out quite easily, reads very clearly to me

      • Dr Kitty

        He’s not an obstetrician, actually.
        Dr Denis Walsh is a midwife with a PhD in the Birth Centre Model.

        https://www.nottingham.ac.uk/healthsciences/people/denis.walsh

      • Young CC Prof

        But the thing is, you don’t need psychological research and theory. You can directly test the effects of different environments on the progress of labor. Any trials on that? Please do be specific.

  • Mac Sherbert

    I do believe this site has spoiled me for rational discussions. I can no longer take people serious that buy into the NCB philosophy or the whole it’s just natural. Take this comment on one my friends facebook posts about amber necklaces for babies.

    “Even if a bead does come off, and even if baby does swallow it, choking is very, very unlikely because the beads are so small. It’s amber, and non toxic. It will just pass right through the baby.. No biggie. :)”

    Really, It’s not a biggie if you babies swallows beads? There isn’t a possibility they might choke on it? Help me to understand this. Please.

    • Mac Sherbert

      Sorry for the OT post. Maybe this one falls more under the Attachment parenting post?

      • Mac Sherbert

        Thank you the comments. I was starting to think it was just me!

    • Guestll

      Even if your baby does get to your cigarette pack, and even if baby does swallow it, tobacco is natural. It will just pass right through the baby. No biggie.

    • Mishimoo

      And what if it contributes to an intestinal blockage?

      • prolifefeminist

        But it’s AMBER. So is’ok.

    • palma fm

      I have also been spoiled. Now I am struggling to have a logical discussion with my mother who keeps telling me to take our (now) 7month old to the homeopath because he’s gotten 3 infections since starting day care and “wouldn’t I rather he have something natural?”. Because, you know, natural is always better.

      • Ceridwen

        You should remind her that infections are natural.

        • EmbraceYourInnerCrone

          I have this discussion with my daughter on a regular basis. Despite being quite intelligent she has, at 19, bought into the “it’s natural, its organic, its not full of chemicals, ergo it’s better”.

          And while I understand wanting to know where your food comes from and how it was raised/what went into its production, there has to be a balance.

          Natural doesn’t necessarily mean good or better than man made or laboratory produced.

          Or as I tell her: Arsenic is natural, radon is natural, dying from tetanus is natural if you you don’t get immunized. Not to anthropomorphize too much but basically, Mother Nature is often trying her best to kill you.

          • Guest

            That’s all true, but my father in law controls his diabetes with diet and exercise rather than drugs or insulin. And he was literally near death when he was diagnosed.
            Society seems to be addicted to the “quick fix”, forgetting how much of a different simple lifestyle changes can make. We’d much rather take a pill than get some exercise and eat healthy foods.
            This doesn’t fix all health problems obviously, but if you could control a disease that simply, would you? Or would you take the drugs (that can be very expensive) and continue to live a sedentary life, eating unhealthy food? Unfortunately, I think a lot of people would choose the later.

          • Siri

            Why do so many people decry the ‘quick fix’ supposedly supplied by drugs? Are lifestyle changes morally superior to drugs? In many cases yes, I’d rather ‘pop a pill’ than take the long way round, whether my problem is depression or diabetes. So sue me. Lifestyle changes are often far more expensive than drugs, take longer, and may not be feasible at this point in time. By all means eschew drugs, but don’t fool yourself that your choice makes you a better, more moral person. It ain’t so.

          • Young CC Prof

            And of course, lifestyle changes work for some people with Type 2 diabetes, but other folks need pills or insulin also, no matter how careful they are with their lifestyle. It depends how far advanced the disease is.

            And there are many diseases that simply can’t be managed with lifestyle changes. Like cancer.

          • theNormalDistribution

            This whole conversation showed “guest” as Dr Kitty. I thought it was some kind of tongue-in-cheek satire and was very confused by the genuine responses she received.

            It wasn’t until Dr. Kitty posted a question about her seventh pregnancy in the newer thread that I realized something was up.

          • Dr Kitty

            Yeah…Disqus is weird and I only have one child!

            Personall, I think kids should primarily be treated by psychological therapies where feasible, but I firmly believe medication has a role in child and adolescent mental illness.

          • Guesteleh

            To be fair to guest, there’s a pretty big debate going on in the psychiatric community about medication use in children. Check out this report from American Psychological Association on the use of psychtropic drugs in children

            Despite recent advances in treatment research, significant knowledge gaps remain…Most of the evidence for efficacy is limited to acute symptomatic improvement, with only limited attention paid to functional outcomes, long-term durability, and safety of treatments. Few studies have been conducted in practice settings, and little is known about the therapeutic benefits of intervention under usual, or real-life, conditions.

            For most of the disorders reviewed herein, there are psychosocial treatments that are solidly grounded in empirical support as stand-alone treatments. The preponderance of available evidence indicates that psychosocial treatments are safer than psychoactive medications. Thus, the working group recommends that in most cases psychosocial interventions be considered first.

          • The Bofa on the Sofa

            But if that would have been her approach, or if she had specified that medication of kids was “debatable,” it would have been very different.

            However, she came with her claims that it’s not just kids, but that we are an overmedicated society, and the basis for her claim ultimately turned out to be one anecdote.

            None of that is addressed by your comment.

            Moreover, your comment does NOT address the question of overall “over medication.”

            Are there kids being treated with something they probably shouldn’t be? Almost undoubtedly so. Shoot, there are adults who are, as well.

            But that doesn’t mean society is over medicated. As I have noted, it could mean that those people should be on different medications, not necessarily no meds. And it ignores people who aren’t medicated that should be.

            Could our medicines be improved? Sure. Does that mean that we have too many of them? Absolutely not.

          • Guest

            It has nothing to do with morality or anyone being a better person for choosing lifestyle changes over drugs and I never said that it did. We seem to be an over medicated society at this point and not all of the drugs out on the market have been safety tested over the long term to see if they do damage over the years or decades.
            I don’t advocate for quick fixes with natural remedies either. Quite often, the quick fixes are just too good to be true.
            I also said that it doesn’t work for all diseases or all people. But by making healthy lifestyle changes as simple as diet and exercise, you reap so many other benefits that a pill to, say, lower cholesterol, can do, isn’t it worth the effort?

          • The Bofa on the Sofa

            We seem to be an over medicated society at this point. It has nothing to do with morality or anyone being a better person for choosing lifestyle changes over drugs

            but

            We seem to be an over medicated society at this point

            In what way? And if we are an “over medicated society” then why aren’t people who eschew drugs making it better?

          • Guest

            Little kids on anti-depressants and anti-anxiety medication comes to mind…

          • The Bofa on the Sofa

            On what basis do you claim they are over medicated?

            You might claim they are “improperly” medicated, but that does not mean there is not a better medication that they could be taking, or SHOULD be taking.

          • Guest

            I can’t speak to whether a particular child should be medicated or not, but their brains are still developing at young ages.
            Children can suffer from mental illnesses, but they are notoriously difficult to diagnose in small children, hence my belief (notice I said my believe, not my fact) based on articles I’ve read (by psychiatric professionals), is that they seem to over or improperly medicated. Maybe improperly medicated would be more appropriate as that could cover over medicated as well.

          • The Bofa on the Sofa

            I can’t speak to whether a particular child should be medicated or not

            Of course not, because that would mean you couldn’t get away with making up generalizations.

            It’s REAL easy to say, “Oh, we are overmedicated” but as soon as you get called out on it, you can’t actually come up with any real examples of someone being medicated who shouldn’t be.

          • Guest

            Ok, fine. My niece is one. Had horrible experiences with all the medications various psychiatrists had her on. They didn’t help with any of her emotional problems and created new ones now. She had been on them from about age 14-18. She’s now 22 and off all anti-depressants, goes to therapy, exercises and eats healthy. She’s also out of puberty, so was that a misdiagnosis? Over medicated, under medicated or improperly medicated? All we knew was she was worse on the drugs.
            I’ve also heard from parents whose kids were on meds for ADD or ADHD, got worse on the drugs, then got better after a few years. Maybe they grew out of it?
            What I meant by the comment you quoted was that I’m not a psychiatrist, so I can’t speak about any children I might be treating.

          • AlisonCummins

            If your niece was worse on medication than off it, why did she take it?

            Is it possible that her puberty was particularly rough and antidepressants helped keep her alive so that she could sort herself out when she calmed down?

            If your friends could see that their kids were worse on ritalin or adderall, why did they give it to them?

          • Guest

            My niece: The docs kept saying it would get better or this new medication would work, in the meantime she was suicidal, cutting and unable to deal with her younger siblings.
            The parents: They did take them off, but it was going against the advice of their docs, so they hesitated to do it for a long time, hoping that the doc was right and things would improve.

          • Nashira

            You have no way of knowing that the meds didn’t help keep her from getting worse. I spent several years on anti-depressants as an older teenager where I was still depressed as hell, but I know from the times I tried to go off them or ran out of meds, that the meds *were helping*. I was just that sick.

            Also, would it kill you to say “self-harming” instead of baldly describing what she did? This might surprise you, but there’s lots of us out there who used to self-harm, and no matter how long we’ve been in recovery, it can be distinctly upsetting to run into graphic terms in places we don’t expect them.

          • moto_librarian

            If she had suicidal ideation and was cutting, then she almost certainly needed medication and intensive therapy.

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

            You don’t “outgrow” ADHD and ADD. You learn to better manage your life and the problems ADD & ADHD cause. It’s never goes away and you cannot be cured. Medication can help some people. See also: insulin dependent vs lifestyle/diet for diabetes.

          • The Bofa on the Sofa

            But how do you not know that the problem is not that she is medicated, but that she has the wrong medication?

            “over medicated” means there are people that are being medicated that should not be. It does not mean that they should be taking something else.

            That we don’t have the right medication for a given treatment doesn’t mean that medication is improper, but could mean that we need to find the right medication.

          • moto_librarian

            Finding the right “fit” for psychiatric medications is very difficult. It took four to find the right one for me, and by the time I was switched to the fourth, I was ready to throw in the towel on that option. Fortunately, we finally found the right one, and I began to stabilize enough to make good gains in therapy.

            Some people are able to get of anti-depressants, and it is possible that your niece never should have had them prescribed. I used to think that I wouldn’t need to take them eventually. I was weaned down to a very low dose, and slid into the worst depressive episode of my life. I now know that I will always need to take them, and I’m okay with that. I would rather pop a pill every day than get to the point where my husband and children might be in the position of finding my dead body.

          • AlisonCummins

            I was worse on the first medication I tried and I couldn’t engage in therapy any more. My therapist suggested that I go off the meds so that I could engage in therapy again. My psychiatrist (at the time) told me there was no point in switching to a different medication because all meds have side effects and at least I wasn’t suicidal any more so that was good, right? My GP gave me permission to stop therapy if it wasn’t helping, and suggested I switch meds. Which I did and which was one of the best decisions I ever made in my life.

            Of note, my therapist and psychiatrist primarily dealt with pediatrics (long story). They were very firmly anti-med, pro-therapy and so on. This was completely inappropriate for mid-thirties me for various reasons I won’t go into. This suggests to me something about the culture around pediatric psychiatry. If your niece was getting medication it was probably because she needed more than “deal with it.” Maybe the alternatives weren’t great, but it sounds like whoever was treating her was very worrried about her.

          • AlisonCummins

            Do you believe that the prescribers are unaware that the children’s brains are still developing?

          • Amy Tuteur, MD
          • Guest

            Looks interesting. Comments are interesting as well.

          • Mac Sherbert

            That was awesome. Thank you posting that!

          • Mac Sherbert

            Yes. Medicating children is a difficult task. It becomes especially hard as they hit adolescent. That does’t mean that kids should not be treated for their mental illness with medication. It means they should be carefully monitored for side-effects and that responsible adults will way those side-effects against the benefits for the child.

            I’m pretty sure the kid I taught that said he was happy now that the bad voices went away would tell you he was medicated just right.

          • Dr Kitty

            Because deeply emotionally distressed children who are too young to process things through talking therapies should have NO treatment?

            Or do you think children can never suffer from mental illnesses?

          • AlisonCummins

            How do you know they are over-medicated? Have you examined them yourself? What do you know about the alternatives?
            http://psychiatrist-blog.blogspot.ca/2007/09/suicide-rates-shoot-up-in-youths.html

          • Guest

            Again, I thought we could comment on our beliefs here? I’ve stated why I believe them. I’m not trying to convince anyone that they need to believe what I believe, just adding another opinion to the discussion.

          • AlisonCummins

            Sure, but it helps if you can define your beliefs in a way that other people can understand them, and if you have something to support them with.

            Some beliefs are better founded than others. If your belief is well-founded then I’ll be happy to adopt it. If I can’t even figure out what your belief is, it’s hard for me to learn something new.

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

            State your opinion here, sure. But we are NOT a “support only” board.

          • Guest

            “Support only” board? Does that mean if I don’t agree I shouldn’t post?

          • Young CC Prof

            Nope! It means that if other people disagree, they will argue. We try to stay polite, and avoid personal attacks, but we WILL argue with your ideas.

            There’s nothing wrong with disagreement. We like debate, we all learn from it.

          • Guest

            That’s what I’m trying to do, argue and learn. It seems like there are some people who are more polite than others and also some that read the point of my posts a little more clearly than others as well.

          • AlisonCummins

            If we’re asking questions you aren’t sure how to respond to, it’s ok to take a break to mull over your thoughts and feelings.

            Nobody’s being impolite or mean. We’re asking you to clarify your thinking. When we ask how you know something, we really mean it. How do you know?

            Maybe the answer is that you don’t really know but it seems right. That happens a lot to all of us if we’re living life right — that is, exposing ourselves to new things.

            Maybe the answer is that you do know, and then you can share your knowledge and we can learn something, which would be cool.

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

            I’m sorry, but I clearly, and in ALL CAPS, said NOT a support only board.

          • The Bofa on the Sofa

            Does that mean if I don’t agree I shouldn’t post?

            Who has told you not to post?

            You are the one complaining about us posting in response to your comments.

            No one has complained about you posting. They have only questioned the validity of what you have said and the conclusions derived from them. That’s not impolite, that’s discussion.

          • Guest

            Guess I took some of these personally then. It’s really hard to give examples of things I’ve seen myself or heard people say about their own lives to then be told that those experiences aren’t valid.
            I’m new to posting/discussing on blogs and you guys are a tough crowd!

          • The Bofa on the Sofa

            t those experiences aren’t valid.

            I don’t know what that means, “the experiences aren’t valid.”

            No one has questioned your experiences. Your conclusions based on those experience, OTOH, have been called completely into question.

            Yes, we are a tough crowd. You can’t just make shit up and expect us to accept it.

          • The Bofa on the Sofa

            I thought we could comment on our beliefs here?

            So why are you complaining about us doing it?

          • Mac Sherbert

            Yes. Little kids are over medicated because you know only adults have mental health issues.

          • Fuzzy

            You know, I was passively-actively suicidal/self-injurious from first grade til my 40s. It might have been nice to have been medicated as a kid.

          • Siri

            If a physician has prescribed it for them, presumably they thought it was needed/justified/warranted? Do you presume you know each kid’s clinical situation better than them, their doctor, their parents?

          • Guest

            Read the rest of the comments. The parents I was talking about were unhappy with the treatment and knew it wasn’t working, but it took time for them to realize they had to go against their doctors’ orders or get a second opinion.

          • Siri

            The very specific case of your niece is what prompted you to generalise about ‘little kids on anti-depressants and anti-anxiety meds’? Rather a big leap?

          • Siri

            Given the prevalence of so much illness both of body and of mind, isn’t it fairer to say we’re a grossly UNDERmedicated society?!

          • AlisonCummins

            Homeopathy instead of antibiotics to treat ear infections contracted in a daycare has nothing to do with natural or not-natural except in the sense that homeopathy is supernatural and antibiotics are natural. The more relevant point is that antibiotics work and homeopathy does not.

            Diet and exercise are the first-line recommendations for *everyone* with diabetes, hypertension or risk factors for heart disease. A lot of public health goes into trying to figure out why people have bad diets and don’t exercise and what we can do about it. Your father-in-law was presumably counselled on diet and exercise by his doctor. The point is not that it’s “natural,” it’s that it’s effective and low-risk. Something can be “natural” (by some arbitrary definition of the term) and also ineffective and high-risk. Something can also be “unnatural” (by some arbitrary definition of the term) and be effective and low-risk.

            What we are all looking for is effective and low-risk. “Natural” and “unnatural” are esthetic considerations.

          • KarenJJ

            Bring on the over-medicalised society. 9 years ago there was no effective treatment for my rare disease and now they have developed more options and better targeted medication. It’s awesome being able to use technology to help increase my life-span and prevent my daughter suffering the sort of issues that I have.

          • AlisonCummins

            What does science-based treatment of diabetes have to do with homeopathy?

          • The Bofa on the Sofa

            Her father does it “naturally” and that is better than everyone who uses drugs.

            Or something like that.

            I mean, it certainly wouldn’t have anything to do with a strawman about how not everything natural is bad or anything.

          • AlisonCummins

            But homeopathy isn’t natural. It’s supernatural.

          • The Bofa on the Sofa

            Her father isn’t doing homeopathy

          • Guest

            People were talking about using natural remedies. I was speaking to that.

          • AlisonCummins

            She brought up “my father-in-law is successfully managing his type II diabetes with science-based methods” to defend palma fm’s mother. “Now I am struggling to have a logical discussion with my mother who keeps telling me to take our (now) 7month old to the homeopath because he’s gotten 3 infections since starting day care and “wouldn’t I rather he have something natural?”. Because, you know, natural is always better.”

          • Sullivan ThePoop

            Alhough a healthy diet and exercise works for about 25 percent of people who have diabetes I am not sure what you expect the other 75 percent to do.

          • Guest

            Then they use the medication. I’ve used medication for various conditions in the past, I’m obviously not against it. I haven’t found a way to get off my thyroid medication, but if I can, I will. I just prefer not to take anything that I don’t have to. Having said that, I’ll keep taking it if I need to.

          • Dr Kitty

            Cholesterol is largely influenced by genetics. There is a significant proportion of people who can have a BMI of 21, run 50miles a week and eat a low fat diet and will still hate cholesterol which puts their Qrisk above 20%.
            Statins can save lives when prescribed appropriately.

          • auntbea

            Why is it unfortunate if people take the pill instead of exercising? If it solves the problem and they’re happy who gives a poop?

      • Trixie

        Tell her you decided to save time and money by giving him sugar and water at home.

      • Durango

        Nothing natural about homeopathy, anyway.

    • Antigonos CNM

      What about being garotted by the necklace if it should catch on something and tighten around the baby’s neck?

      • Trixie

        The people who have mommy businesses on etsy who make them claim that it’s a “breakaway clasp.” Of course, there’s no testing whatsoever of this. I wish the CPSC would crack down, but they probably don’t have the resources.

      • Irène Delse

        Which is why some pediatricians, from what I’ve heard, tell parents to wrap the amber necklace around their baby’s ankle if they are determined to use one.

    • Guest

      My daughter wore an amber necklace pretty much the whole time she was teething. I have no idea why it works, but while she wore it, no drool and very little pain/fussiness. We lost it for about a month when her back molars came in and she was a different kid. The drool was uncontrollable! When we found it again and put it back on her, no more drool or fussiness. We never had a problem with it coming apart, breaking or her getting it caught on anything.

      • Trixie

        Or maybe the molars are the most painful teeth, and that coincidentally was when you lost the necklace, and by the time you found it again, she was over it.

        • Dr Kitty

          I had one of those kids who never fussed or drooled with her teeth.
          If I’d had an amber necklace or used homeopathic tooth powders I could have attributed that fact to them.
          As it was, she got nothing more exciting than carrot sticks, and it is rather hard to monetise that as a teething remedy!

          • Trixie

            I’m so jealous.

    • araikwao

      Aspirating a foreign body that obstructs a bronchus leading to infection +/- partial collapse? Sounds big enough to want to avoid, to me at least!

  • attitude devant

    Is anyone besides me reminded of Alan Sokal and “The Einsteinian constant is not a constant, is not a center…”? I’d think this was a parody or a hoax if you hadn’t linked to the source…..

    • Sue

      “”Organisational dystocia” – ya gotta love it!

      Reminds me a lot of the non-rational aspects of Chiropractic – adjusting the spinal Subluxation and removing nerve interference to restore the body’s innate ability to heal.

      Then they go looking for evidence to support the philosophical/historical model. So far, none has been found. But don’t let that deter you!

      • attitude devant

        The central premise of NCB (which is demonstrably false) is that childbirth functions smoothly and reliably because womankind has what it takes (the pelvis, the hormones, the reflexes) to do the job. So when it doesn’t work (and it often doesn’t, because human reproduction is remarkably dysfunctional) they are left floundering, looking for what might be needed to restore that ‘primal’ state where birth can occur ‘unhindered’ or something like that.

        PSSSTTTT!! Guys! It’s your model. Go back to your original precepts and examine them carefully. THEY ARE WRONG!!!

        • Sue

          The problem is, like Chiro, there is too much invested in the model to allow evidence to pull it down. They either won’t look, or will shift the goalposts.

          • The Bofa on the Sofa

            As I always say, any profession that regularly defends itself with “not all of us are quacks” is a profession with a serious problem.

            See also: midwifery

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

          They apparently believe that for whom it doesn’t work, their fate was deserved.

          • sarahh.rosanne@gmail.com

            I’ve been rereading some of my NCB books, looking at them through 20/20 hindsight. There is so much language serving to moralize anatomy and bodily functions. I would even say it smacks of eugenics in certain instances.

          • Siri

            That’s interesting. Any particular examples that stand out?

          • sarahh.rosanne@gmail.com

            I am not able to quote specifically now but the notions such as unmedicated vaginal birth is “right”, a personal choice/lifestyle decision, and that it reflects the character of the mother all place a moral imperative on the manner in which birth occurs. By default, a woman who doesn’t meet the expectations defined by the movement would be committing an immoral act. Or her body- “artificially” resolving complications due to her pelvis or the lie of her placenta- would be viewed as a moral defect. That extends to the baby when there is a preventable death and that’s where lends itself to the idea of eugenics. If mother and baby are not ideal physical specimens, the moral tenets of the natural birth movement inherently preclude their survival.There is even more moralization of breastfeeding, I think.
            I’m sorry to present such a vague idea without being able to substantiate it (I’m also covered with little human beings who use me as furniture), it’s just a general thought I’ve been exploring as I’ve reconsidered my past beliefs about childbirth.

          • Dr Kitty

            Please can you quote if possible.
            It would be really interesting. Thanks.

      • Young CC Prof

        Organizational dystocia, yeah, been there done that. I spent, like, a year trying to get some website updates at work processed. Finally gave up. Clearly the large updates cannot fit through the small, oddly shaped IT department.

        • Siri

          Did no one suggest surgical intervention?

          • Young CC Prof

            Actually, there was an attempt at surgical intervention: one person was fired. However, the organizational dystocia ran too deep, and her replacement could make no traction.

          • Siri

            Lol!

  • Hannah

    Critical realism is very much applicable to the natural sciences (or the philosophy of natural sciences), it’s just that I’m not sure it means what he thinks it means. Critical realism is the theory that there is a fundamental reality or truth that science seeks to access, but we’re limited in our ability to access it by the our own fallibility and our perception limited by (for example) language and models based around our day to day experiences that mediate that knowledge. Nevertheless, that doesn’t mean you stop trying. It tries to cut a third way between logical positivism that holds up an absolute authoritative truth accessible through science, and the more radical postmodern theories where there is no ultimate reality beyond what’s constructed by our language and perception. This isn’t so much applicable to medicine but it’s very relevant in, say, theoretical physics, where what you’re studying starts to diverge wildly from what can be conceptualised through our day to day experiences of the world.

    It’s not about handwaving because everything’s so very complicated that you can believe what you want to believe. I’m also not sure what his broad concept of “dystocia” really means or what the use of bringing together all of those issues, (or indeed playing them off against each other), while individually important, under one umbrella, is, or what it has to do with critical realism. To the extent that what he’s saying has any meaning at all (individual and organisational considerations are important in labour as well as physiological factors) I’m sure it could have been said without all of the long words. But of course what he’s really saying is that he doesn’t like the answer so he’s going to rewrite the question.

  • student78

    https://www.facebook.com/heavenlyhandsbirth?hc_location=stream
    Train wrecks waiting to happen, and they are bragging about it. Since when are twins NOT high risk? So sick of this “variation of normal” crap.

    • toni

      I am disturbed by the picture of the baby still in its sac. Placenta is detached. How can it breathe??

      • Mom2Many

        …and the baby that is in his carseat going home….is it just me or are his hands blue?

        • Trixie

          They are. The seat looks too upright and that head thing is pushing his head forward.

      • Antigonos CNM

        It can’t. It is asphyxiating.

    • Dr Kitty

      Goodness, that is a lot of macrosomic looking blue babies.

      Being born “in the caul” is not so good if the placenta detaches before anybody gets you out of it and breathing.
      APGAR schmapgar, let’s get a photo!

      • Siri

        And those membranes can be jolly tough! If they’ve survived the first AND second stage of labour, it’s going to take some effort to remove them.

    • drsquid

      of course they plan on happy and healthy twins.. that is always the plan,., the way you do it is by having them in a location where you can intervene if there are problems to make sure they are healthy.. sigh

    • Guesteleh

      One photo caption:

      Another set of twins coming in the spring! Will be Tina’s 4th set.

      So reassuring to have an attendant with that level of expertise at your high-risk birth. :

      • auntbea

        They don’t even say whether all four of those sets turned out okay.

        • Trixie

          That’s irrelevant. The important thing is, Tina had a great experience.

    • Trixie

      http://www.heavenlyhandsrockwall.com/services.html
      $3,800 paid in full before 36 weeks, no refunds if you transfer care for any reason. And she has 25 credit hours towards a college degree in Psychology!
      On the plus side, that is a beautiful building. Perhaps she should have opened a B&B in it.

      • Dr Kitty

        I’d feel really cheesed off if I was the woman who paid all that money and then had my baby eight minutes after arrival…

        Mostly I feel sorry for the cold, blue babies doing skin to skin in tubs. They don’t look very happy.

      • Young CC Prof

        Yeah, the rooms are gorgeous. I’d love to spend a weekend there, relaxing. Not having a baby, though!

        Looked at the photo page, an awful lot of the immediate postpartum babies don’t look so good. I especially love the bragging on the photo page about the crazy risks they take. VBAC! Another VBAC! Twins! 10-pounder! (and is it just me or does that 10-pounder have the kind of belly that begs for shoulder dystocia?)

        • Dr Kitty

          Did you see the very blue 11lb baby born in the tub to a primip?

          Because there is no way THAT could have ended badly…

      • Meerkat

        Wow, what an ugly looking website!

    • GuestB

      There are way too many exclamation points on that FB page.

  • Trixie

    http://www.scienceandsensibility.org/?p=7791
    The horrifying tale of a woman forced to labor in a room WITH NO WINDOW!

    • rh1985

      I can’t imagine I’ll even notice if there are windows and what is outside once I am in labor.

      • The Bofa on the Sofa

        I don’t remember if there was a window in the L&D room. We have pictures from being in there (she didn’t deliver, but that was home before the c-section) but I don’t remember.

        I know we had windows in post-partum

      • MaineJen

        I had windows in my labor room but I definitely didn’t care. There came a point where I didn’t care about *anything* any more other than when the damn epidural-giver was going to arrive.

      • Mishimoo

        I loved my windows. For the first, there were stars, for the second, fireworks. Last time, I saw the the dawn and heard birdsong for the last 3 hours or so. Just as he was born, the lorikeets flew over screeching and the magpies + butcher birds broke into song again. It was peaceful, happy and on the third floor of a decent hospital only 30 minutes from the state capital.

        • Dr Kitty

          Sounds lovely- if they were Rainbow Lorikeets it must have looked beautiful.

          • Mishimoo

            They were Rainbow Lorikeets, but I was focusing on the bub and missed the show. We have some visit our yard regularly, its so much fun to watch their acrobatics.

          • KarenJJ

            We used to get Rainbow Lorikeets visit our balcony at our flat in Sydney. They were so cheeky and funny (and noisy!).

      • mtbakergirl

        I walked into my L&D room in the middle of a huge contraction, looked out and saw an ocean view through the window and actually thought, “I am really going to appreciate that tomorrow” (L&D and postpartum is done in a single room). Then I got right back to business!

      • Trixie

        I can’t remember if my L&D room had a window. My postpartum room did, looking out over the roof onto a highway.

      • Guestll

        My room had windows. City hospital, curtains open, and they were close-ish to the street. It struck me as odd that here I was, screaming and begging for deliverance, and these people, they just kept on walking by!

    • The Computer Ate My Nym

      I couldn’t even tell you if there was a window in the room where I labored. I know that there was a fetal monitor and an OR down the hall, though, because I used those.

    • OBPI Mama

      The one time I looked out the window during my 30 hour long homebirth was in the diningroom… and what did I think when I looked out…, “When the heck is this gonna end. I’m going to die!” The midwife’s assistant took some picture outside on our farm during my labor because she thought it’d be nice… I really just couldn’t care less… Come to think of it, maybe that’s where she was when the midwife was yelling for her to get oxygen and all that when my son finally got pulled out…

      • Siri

        Thought it would be nice to take some photos did she? Wasn’t she there to aid the midwife and support YOU? Did you think it would be nice for her to get some pics, or were you trying to get through unmedicated labour with your life and sanity intact? Sheesh – I feel really indignant on your behalf. And your baby’s.

    • Dr Kitty

      My bed was next to the window in the postnatal ward (I thought paying £100 a night for a private room was a waste of money, and still do).

      It had a view of the hospital car park, and the bonfires burning in the surrounding neighbourhoods on the 11th of July. I really didn’t care.

    • fiftyfifty1

      Something similar happened to me!!! My hospital room did have a window but it MUST NOT HAVE BEEN WORKING!! Whenever I looked at it, I could see absolutely nothing except a blackish square with some of my own reflection bouncing back at me. Only at the very end of my labor did it seem to start working, first giving a very pale image of the surroundings which grew slightly stronger over the next hour. Then the baby was born and they transferred me to another room which luckily seemed to have a working window. I’m still really pissed at the hospital for ruining my birth experience over this!

      • Antigonos CNM

        This usually happens when the sun comes up. You should have arranged to go into labor at a better hour.

      • Siri

        It’s a little-known fact that this complication can occur at homebirth too; it happened at mine. My windows were still working, albeit not well, when I started contracting at 8pm. Window function was lost soon afterwards despite the arrival of TWO community midwives! I was well miffed. I can’t tell you what a relief it was to arrive on labour ward at 6am and find a functioning window!

  • R T

    Okay, no matter how ridiculous he is, I don’t think his sex should matter or be a basis of jokes. I see the NCB crowd constantly bashing male OBs and even had some of crunchier friends say they were surprised I was so comfortable with a male perinatologist, forget he’s the best in the region! I think people can be equally foolish regardless of sex. It bothers me to see sexism promoted in any form! This post would have been as informative, thought provoking and funny without it! Men have as much business being midwifery “experts” as they do being OBs and that’s completely equal to women. It’s not just women’s work!

    • Trixie

      When it’s mansplaining about how women’s pain or failure to progress in labor is all in their silly little heads, I think it’s relevant.

      • R T

        Women to the same thing to other women. I don’t see the relevance in pointing out its a man this time? Are you saying its okay as long as its another woman?

        • Trixie

          No, it’s not okay then either. I think Dr. Amy is pointing out that this is a historical pattern within the NCB movement going back to Lamaze and Grantley Dick-Read.

  • moto_librarian

    “Nine years ago, Anderson began asking different questions about the aetiology of dystocia, suggesting some new categories – organisational dystocia (lack of continuity of care on labour wards), environmental dystocia (clinical, non-homely décor) and interpersonal dystocia (disagreements between labour ward midwives and obstetricians). Of course what she was hinting at were environmental, social and psychological effects that could impinge upon a woman’s ability to labour normally.”

    Or maybe the baby really is too big to fit through the mother’s pelvic outlet. Seriously, this is all such bullshit! If psychological effects are so damned important, why do so many women have preterm labor and delivery? I can’t think of a situation much more stressful than that, yet the baby comes anyway. And why should I trust this midwife and her talk of “interpersonal dystocia?” We all know that’s code for a midwife bitching about an unnecessary c-section because she was overruled by the OB.

    • MaineJen

      This paragraph made me giggle. “Interpersonal dystocia,” really?

      • The Bofa on the Sofa

        LOL! Actually, I quit reading the quote when I hit the “environmental” part, so thanks for quoting it.

        I am assuming that “interpersonal” refers to the concept that mws and obs disagree on what actually constitutes dystocia, and that something that an OB calls dystocia a MW would not?

        • Sue

          I’m imagining a lecture on dystocia:

          “There are three main types of dystocia: organisational, environmental and interpersonal.”

          “Every clinician should have this question in their dystocia drill: is it organisation, environmental or interpersonal”?

          • Antigonos CNM

            As Gertrude Stein would have said: “Dystocia is dystocia is dystocia.”

        • Antigonos CNM

          Sadly, there are some midwives who feel that no matter how long labor takes, that’s quite all right and there aren’t any sequellae, such as Bandl’s Ring, cardiac exhaustion, etc.

          The whole concept of what constitutes the best kind of labor, both in duration and type, to result in the best outcomes, really only developed fairly recently because there simply weren’t any reliable statistics before the 1920s. It was noticed that there was a higher degree of spastic/CP kids with very prolonged labors, more hemorrhage because of uterine atony, etc. and so someone realized that an “ideal” rate of progression could be theorized, within certain limits. it is actually a fairly broad range. As with so much else in ideological midwifery, ignoring the statistics is a regression.

          Of course, defining the onset of labor is also important. Proper labor often [very often!] begins much later than a woman thinks it does, so she can claim the “centimeter an hour to full dilatation, then 2 hours to birth” is nonsense. “I was in labor for 3 days” is something I’ve often heard, when in fact the contractions were either painful Braxton-Hicks or prodromal labor, not active labor at all.

    • Siri

      Women have given birth in concentration camps, in dugouts too small to move around in, in trees during floods, in rice paddies being worked practically to death. War, famine, terror, panic, loss of home, family, security, sexual slavery; whatever unimaginably awful circumstances women can find themselves in, they can (and have) give birth in.A polish woman, heavily pregnant when murdered by Nazis, her baby was partially born post mother’s mortem and was found between her legs when the corpse was reburied. If a newly dead woman can give birth, so can a privileged Western one give birth in spite of ‘clinical’ or ‘not homely’ surroundings!! Why are these people so STUPID?!!

  • Dr Kitty

    Ladies and gentlemen, I learn a lot from you.
    Thank you.
    Sometimes the slightly OT conversations are the most fun to read, and I learn a lot about things I don’t expect to.

  • moto_librarian

    I am beginning to think that the most galling piece of the midwifery movement is the elevation of complete ignorance over evidence. Women have worked very hard to obtain advanced degrees in all areas of academics, including medicine and the sciences. This valuing of “other ways of knowing” is extremely insulting to every woman who has ever worked to be respected as something beyond her basic biological functions. It is insulting.

    • Trixie

      And the fact that they’re successful speaks to the overall horrible lack of basic scientific literacy in the US.

      • Life Tip

        Absolutely. My experience might be more extreme, because I was raised in a fundamentalist Christian home and went to schools that taught creationist “science”. Their rhetoric is similar to woo advocates. Big words, circular reasoning that “sounds logical” to someone without an adequate science education, serious mental gymnastics in an attempt to make the evidence match their already assumed-conclusion.

        It’s not so much that they’ve never taken an intro university science course. It’s because they’ve missed fundamental scientic principles that they should have learned in middle school.

  • Meerkat

    I couldn’t read this paper’s excerpts at all. Is it my art school education, English being my second language, or the author trying to sound as confusing as he possibly can? I really needed that English to English translation!!!

    • Are you nuts

      It’s like he re-wrote it using a Thesaurus.

    • Ainsley Nicholson

      I couldn’t understand it either, and I’m a native English speaker with a PhD in the biological sciences. What we really need is a pseudo-science to English translation.

      • Meerkat

        Thanks, everyone! It was truly painful to read. I wonder how many people read the entire paper and understood it? (Besides Dr. Amy, of course.)

        • Antigonos CNM

          It was probably painful for Dr. Amy, too.

    • MaineJen

      It’s not English…this is what happens when someone who has no idea what they’re talking about tries to sound like they do.

    • Sue

      Neologisms and malapropisms, and using ten words when three would do, are a sure sign of Dunning-Kruger phenomenon.

  • Mel

    So, if I’m reading the comments correctly, this author has managed to mangle science, philosophy AND most social scientists…..sweet.

    • araikwao

      And he gets the trifecta!

  • The Computer Ate My Nym

    I remember that at one point the NCB movement was claiming it was better because OB was not “evidence based”. I guess they’ve given up on this claim then?

    • Mel

      Nope. You’re assuming that proof matters in making claims. OBs use science that doesn’t support NCB ideas and therefore the methods of study the OBs use must be not ‘evidence-based’ and flawed.

    • Amy Tuteur, MD

      Exactly. The most important point is that midwifery theorists are acknowledging that science supports obstetrics, not midwifery theory. Instead of explicitly acknowledging that obstetrics is evidence based, they have resorted to claiming that scientific evidence is not meaningful.

      • Meerkat

        I am starting to think that this NCB nonsense is all about money. It’s about inventing a problem and coming up with products and services to remedy said problem. It’s amazing how many people created careers and niche “areas of expertise” out of thin air and are making money on it. Midwives, doulas, lactation consultants, NCB experts and theorists, baby wearing consultants, NCB educators and authors—all have financial stakes in this philosophy.

        • Amy Tuteur, MD

          Don’t forget placenta encapsulation specialists!

          • Meerkat

            Oh yes, and baby chiropractors. What are those called?

          • Are you nuts

            I think Quack is the technical term.

          • Melly

            I come here a lot (don’t post much, though) but I just have to say that I took my second child to a chiropractor when he was 3 months old. He was tongue-tied at birth, but it wasn’t revised until 3 months when it was apparent he had a very bad latch and weak suck. The doctor who revised the tie recommended Craniosacral therapy. I thought it was quackery, but my insurance covered it, and the chiro came highly recommended.
            I didn’t think it would do much, but after each session of her massaging his jaw muscles, his mouth could open wider and wider. We only needed 3 sessions over 3 weeks, and he went on to develop a great latch and nursed for 18 months.

          • Trixie

            I’m very glad your baby was safe. And I’m horrified that insurance would pay for that or that a real doctor would recommend it. Although I suppose gently massaging the baby’s jaw is fine, but couldn’t you do that at home? http://www.skepticalob.com/2011/02/infant-dies-after-craniosacral-therapy.html

          • Meerkat

            That post is horrifying. Horrifying. I read it recently and couldn’t sleep at night. That baby was basically tortured and killed. I really hope the quack that did this to the baby is in jail.

          • Melly

            My insurance covers chiropractors, acupuncture, massage therapy, etc. for every member of my family. Not sure why that’s horrific. Yes, there are certainly CST horror stories, but the majority of chiropractors do not fall into that camp.

          • Trixie

            With the price of insurance, you’d think that companies would only pay for treatments that are actually evidence based. Which acupuncture, chiropractic, and CST aren’t.

          • Melly

            I think our definitions of “insurance” are different. I live in Canada. My insurance covers everything universal health care doesn’t. Like prescriptions, everything I listed above, private hospital rooms, etc.

          • Trixie

            In that case, I’d be pissed that my tax dollars were being spent on woo that doesn’t work.

          • AlisonCummins

            I think she means that public insurance (universal health care) pays for her doctor and that her private insurance (no tax dollars) pays for the woo.

            In the province I live in, doctors, nurses, hospitals and medical procedures are all paid for by universal public insurance. We all get the same ones no matter who we are. Nobody is uninsured.

            Medication is paid for by private insurance if you have it and public insurance if you don’t. Everyone’s medication is covered by insurance this way. Nobody is uninsured.

            Radioimaging is covered by public insurance but there are also freestanding private radioimaging clinics that take cash or private insurance. (Healthcare providers in Canada have to choose: either they take public insurance and only public insurance, or they don’t take cash or public insurance at all. Hospital radiology clinics would be the former, freestanding clinics the latter.) Nobody is uninsured but some people have to endure long waiting lists.

            Things not covered by public insurance unless you’re on welfare: dental care, glasses, physiotherapy.

            Things not covered by public insurance at all: massage therapy, chiropracty, acupuncture, aura readings.

            It’s possible that some employers offer a (private) group insurance plan as part of their benefits package that is padded out with a lot of ineffective stuff on the grounds that these additional things are relatively inexpensive.

          • Melly

            This. Thanks for the eloquence. I have a very comprehensive family benefits package through my employer.

          • AlisonCummins

            Craniosacral therapy: imaginary.
            http://www.sciencebasedmedicine.org/cranial-manipulation-and-tooth-fairy-science/

            Acupuncture: imaginary.

            Chiropracty: just as effective as physiotherapy for lower back pain; ineffective for anything else. It’s not about being a bad chiropractor, it’s the whole basis of chiropractic itself that is imaginary.
            http://www.sciencebasedmedicine.org/chiropractic-abuse-an-insiders-lament-2/

          • Bethany Barry

            Tongue tie often resolves on its own, so it could very well be that over the course of the major physical and neurological developmental period between 2-4 months of age, your child outgrew his problem. Because the result was gradual over three weeks and not immediate (and that it sounds like the development of a “great latch” was gradual over a longer period), it’s hard to link the improvement directly to the “massage.” One of the favorite tricks of the chiropractic quack is to perform an inert procedure over an extended and possibly indefinite period, and ascribe unrelated improvement to the procedure. One session, three sessions, six sessions–however many go by until the issue spontaneously resolves.

            Regardless, I am glad the “massage” (which I hope was all she was doing) from an increasingly familiar face was probably very relaxing for your baby. And I’m glad your pedatrician, while I greatly disagree with his/her recommendation of craniosacral therapy, did not jump quickly to surgical division of the frenulum, as any surgery should not be taken lightly. My big problem is with chiropractors doing adjustments on babies. It’s chiropractic adjustment that is extremely dangerous.

          • Melly

            I just clarified above, but yes there was a laser revision, done with local anesthetic. Also, if the tongue is very restricted, it will not resolve on its own. My brother had his tongue tie revised at the age of two (in 1989) due to speech problems. I have a four year old nephew who my sister could not breastfeed, didn’t know why at the time, now he’s got speech issues and has been diagnosed as tongue tied. Ties cause problems.
            As for the CST, the worksheet did on his jaw relaxed his jaw. That’s all I can say. I would not have consented to spine manipulation.

          • Melly

            “Worksheet” should say “work she”. Autocorrect fail.

          • yentavegan

            Melly, when you say that the baby’s tongue tie wasn’t revised until 3 months, do you mean it was clipped or laser treated? Craniosacral therapy usually means light touching of the neck,( which had no scientific basis). Perhaps you were fortunate because the professional you brought your baby to was a physical therapist? I am just guessing but it is so disturbing to learn that a cranio sacrsal quack can get insurance reimbursements.

          • Trixie

            I am guessing this depends on the state. I recently found out someone I knew a long time ago is a Rolfer and gets insurance reimbursement for treatment of people after motor vehicle accidents.

          • Melly

            Sorry for any confusion. He was laser revised at three months but still had a weak suck on both breast and bottle. His weight gain had stopped prior to revision. The doctor who revised recommended the CST, and I was willing to do anything to get milk into my child. His suck was so bad that we were looking at the possibility of a SNS. We tried switching to bottles, but he couldn’t coordinate drinking from those at all.
            The CST was very gentle massage of his jaw muscles. I would not have consented to spine manipulation.

          • Are you nuts

            I’m glad it helped you guys. I think there are limited applications where chiropractic care can help, but when I hear about a chiropractor adjusting an infant’s spine, it makes me cringe.

          • Trixie

            You’re a shill for Big Dehydrator.

        • The Computer Ate My Nym

          Baby wearing consultants? Is that really a thing?

          • Box of Salt

            Baby wearing consultants = moms who sell slings/etc.

          • Mishimoo

            Ooops! I gave a babywearing consult for free the other day, and here I was thinking that I was just helping out a new mum who’d approached me with questions while I was shopping. Hide me from the NCB mafia!

          • The Bofa on the Sofa

            Right up there with “Home Management Engineer”

          • Meerkat

            Yup, there are actual classes in Manhattan. They were a part of the baby carrier store, and the aim was obviously to sell slings or carriers.

      • Young CC Prof

        Well, to those who don’t understand statistics, empirical evidence sounds like just another debate tactic. And to those who don’t have a grounding in basic biology, the “facts” that get in their heads first can be downright immovable.

        Give me a few months to get Baby CC Prof a little bigger. Then I’ll go back to vaccinating the population against all such scams, one student at a time.

        • Amazed

          Just yesterday, I vaccinated a friend and her sister against the idea that autism can be “cured” by putting your child on a restrictive diet. Oh, and the fact that autism seems to have biological foundation does not mean it can be “cured” through bio-medicine and whatever scams the Great Minds of Autism-Related Industries are hatching. And by the way, that it’s a new product of letting your child to have too much screentime and too little attention… or a product of our unhealthy lifestyle. Really, don’t you think all those fairytales of children being “stolen” by the fairies and replaced by changelings sound awfully like someone who’s convinced that the MMR vaccine did it?

          Of course, they are both intelligent women who are not into the woo at all… but what they read in their free time did sound scientific. Once I pointed out a flaw, they started finding logical ones too, The fact that neither of them is a mother of autistic child did help, too. But I suppose that’s also a way to start believing in the Great Conspiracy theory.

          Oh and by the way, they might tell me about all those scientific-y theories but they are pretty terrified by the notion of leaving their children unvaccinated.

          • KarenJJ

            Or now. My local health authority has issued an alert for measles. It’s summer holidays here and someone brought back a case from overseas and visited the cinema near me. Glad we weren’t there that day, but there’s heaps of families that would have been.

          • Amazed

            Lucky you. I hope people take the alert seriously.

            Actually, the friend I vaccinated the other day almost died by this innocent childhood disease – when she was a child.

  • Mel

    ” However, labour does not unfold with a singular cause and effect physiology (oxytocin secretion therefore cervical dilatation) which then proceeds with regularity (cervix dilates in a constant trajectory) to end with birth at a relatively predictable point (average of 10 hours). It is a much more complex phenomenon which might more accurately be referred to as ‘orderly chaos’. Clearly, experiences like labour are impacted on by multiple factors in the physiological, psychological and social domains. Simply applying quantitative research methods suited to the controlled confines of a laboratory are not going to capture the intricacies of the uncontrolled milieu of a labour ward.”

    Ah… the joys of analyzing shoddy rhetoric.
    Labor isn’t due to a single linear physiology: True.
    Labor is complicated from a biological perspective: True.
    Labor is “orderly chaos”: That’s an opinion, so true/false doesn’t apply.
    Labor experience is impacted by multiple factors: True
    Research methods couldn’t possible resolve such a messy morass: False. Just because the author can’t get scientific methods to support his wanted conclusions doesn’t mean science is at fault.

    • Expat

      The development of chaos requires, for example, a nonlinear medium which is traversed over and over in an oscillatory pattern. So is the medium the uterus or the fetus? In what way are these nonlinear? Do they become nonlinear when overstimulated? The contraction pattern or fetal heart rate pattern could be considered to be getting chaotic during a dystocia or distress. But, the macro situation is still predictable, just not the spectrum of the signal. Somehow, I don’t think that is what he meant when he wrote that labor is orderly chaos. He must have meant it in a literary sense then.. Oh god. Don’t google chaos and literary theory, just don’t. It made literal minded me a bit ill. He must have meant it in a religious sense then, but invoking the goddess Eris (ancient Greece, chaos and discord) as a mechanism is a bit archaic for a modern scientific journal.

      • The Bofa on the Sofa

        He should talk to Ian Malcolm from Jurassic Park. He’s a Chaotician.

      • Expat

        I’m deliberately misinterpreting him. He was implying that labor is infinite dimensional, and therefore chaotic and upredictable, but if we did that in every area of science we would never learn anything. Cell biology? Too complicated – chaos! Molecular excitation? Too complicated – chaos. The microstates are unpredictable but we know quite a bit about the macrostates.

        • Amy M

          That’s on par with the “intelligent design” brainiacs who decide that since they can’t figure it out, God must have done it.

      • CognitiveDissonaceHurts

        I feel a little bit smarter from having read your comment and having understood it. :)

    • Young CC Prof

      Basically, “I can’t model it, therefore it can’t be modeled.”

    • Sue

      Are there really physiological processes that are non-linear, biologically complex and impacted on by many factors?

      Wait – what about DIGESTION?

      So, there’s no research possible in gastroenterology or colorectal surgery or endocrinology? Nah – just hundreds of journals full. Sigh.

      • KarenJJ

        The end result of a pregnancy is a lot more fun then the end result of the digestive system.

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

          Provided the only way both get out is all natural pushing? /snark

  • KAndrews

    Keep spinning the web of B.S!
    I will say that ” . . . unless the right questions are asked about the reality we are attempting to describe, explore or explain, then our knowledge of that reality will remain superficial and impoverished . . .” explains exactly what led me to make the catastrophic cascading decision to use midwives.

  • auntbea

    I actually don’t think the English translation of the first paragraph is fair. Though he of course goes on to write a silly essay, that paragraph is a standard philosophy of science intro. The validity of different methodological approaches are entirely appropriate things to discuss in an academic journal: to say that current methodologies are not sufficient is not necessarily a signal that one’s own work is mnethodologically flawed. Replace “midwifery” with “psychology” or “history” or “political science” and you have a perfectly reasonable (if rather vague) introduction.

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

    I’m definitely in the social science realm (economics) and while there is some room for variations in care based on different valuations of risks and benefits (subjective) – that does not change what the actual risks and benefits are. Individual women will make choices based on the set of risks and benefits that best meet their needs – however, depriving women of the information they need to make the “right for them” choice is an immense travesty. That is where midwifery is severely lacking – it’s not that homebirth is “as safe or safer than” hospital birth, it’s that it has wholly different risks and benefits. Most women will trade superficial benefits (your own environment) for significant benefits (decreased risk of death and disability) and choose hospital (some won’t but to each their own)- but failure to be blunt about the trade off that is being made is what I see as being severely detrimental to the health and well being of women.

  • auntbea

    Full time social scientist here: I have never heard of critical realism.

    However, I have seen this type of critique, under other theoretical names, frequently in the social sciences.

    The argument is that since the world can never be fully predicted and issues are complex, we can’t identify patterns or establish relationships, so why even try. Believe it or not, these people usually do not have a good grasp of statistics or statistical methods.

    • Comrade X

      Is this related to that douchenozzle Popper?

      • auntbea

        Yes. Yes it is. Although I wouldn’t call Popper a douchenozzle. His work underpins a lot of modern scientific thinking, in a good way. However,there are people who cite his work as justification for asserting that if I can find one example where your predictions don’t hold, EVERYTHING IS WRONG AND POINTLESS.

        • Expat

          Kuhn is much more fashionable these days.

    • Josephine

      On that note, why study anything at all? I’m just going to start making up facts and yelling them loudly over anyone who tells me I’m wrong. Oh wait…I think I’ve been beaten to the punch.

    • Dr Kitty

      Which sounds like it is veering towards Epistemiological Nihilism, and I’m afraid Walter Sobchak and I share an opinion about Nihilism.

      • MaineJen

        Donny, you are out of your element :)

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

          AM I WRONG???

          • theNormalDistribution

            Haha. NERDS!

  • Comrade X

    2 things:

    #1: Not to blow my own trumpet, but I have an actual degree in Philosophy. From Oxford. Idiots who have zero idea what they’re talking about misusing the language of philosophy (and this includes some so-called “academic philosophers” themselves) in order to get away with talking utter bullshit below the radar PISSES ME OFF BIG-TIME.

    #2: While human beings, and human functions like giving birth, may well be very complex things, the kind of situations, interventions and scenarios that this dude is talking about ARE EMINENTLY AMENABLE to ordinary empirical testing. There is ZERO NEED to rely on intuition, or to try to half-arsedly drag in irrelevant concepts or terminology from other disciplines that you don’t understand (and hope to hell your readers don’t understand either). It would be QUITE SIMPLE in theory to design well-controlled tests as to the effects of things like decor, furnishings, lighting and type-of-care-provider on the progress of human parturition. He is pretending that such a thing is not simple, maybe even impossible, because he strongly suspects that such empirical tests would NOT END UP SUPPORTING HIS PREFERRED HUNCH. In actual fact, back in the real world, there are already many examples of phenomena of this type that are common knowledge and well-understood. Like “white coat hypertension”. Douchebag just doesn’t want to put his money where his mouth is, because he knows he’s talking bollocks, so instead he tries to obfuscate with “complicated-sounding” language. People don’t usually need to do that when they aren’t talking bollocks.

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

      There might be some degree of “white coat hypertension” like things happening – but I imagine that the impact is relatively small. Again do a RCT of homebirth against hospital birth to figure out what it really is.

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

        Further – wouldn’t it be plausible to go the other way as well? I mean I would find it absolutely terrifying to labour at home without access to interventions if I happened to need them. I suspect that me birthing at home would have far worse outcomes than me birthing in a hospital simply because I’d be a complete basket case.

        • Comrade X

          I agree with you that any measurable effects of such things on the physical progress of labour and delivery are probably almost non-existent. I think that’s EXACTLY what he’s afraid of. If he were so sure that these were major factors affecting human parturition, he could design and carry out some rigorous studies to back it up, and be the toast of the scientific community. Why doesn’t he? Because deep down, he knows he’s talking shite.

        • Comrade X

          Also, I’m the same in terms of the psychological side of these things. I would be MUCH CALMER in a hospital surrounded by people with more letters after their names than in them and machines that go ping. “I’m sure you’re alright” just doesn’t cut it for me compared to “I have reams of hard evidence that you’re alright.”

          • The Computer Ate My Nym

            Me too. I also want someone who looks at me and says, “Another person with condition X? Ok, I’ve got it” rather than “Whoa! Condition X is occurring. How unique!” I want the bored expert to attend me, not the passionate non-expert.

    • The Computer Ate My Nym

      So the philosophy the NCBers are claiming to use here is as valid as the physics that they’re claiming to use when they invoke quantum mechanics? Not surprising but good to know.

    • Mel

      Awesome! The NCB-industrial complex has managed to anger philosophers as well as scientists and mathematicians.

      Welcome to the club, Comrade X.

      • Comrade X

        I was already angry with the death and the eugenics and the general bullshit, but thanks! :)

    • tilmorning

      Thanks for this, comrade. I’m having bad flashbacks to my postgrad Philosophy of Social Sciences class. The tone of the article struck me immediately because it was familiar – it’s exactly what my sort of fumbling around, not completely understanding it but trying to sound confident essays from that class sounded like. I passed (barely), but would be mortified if anyone saw them.

      • KarenJJ

        I loved uni, but am so relieved I stuck to the relative safety of a technical degree. So much of this is incomprehensible to me. I can’t imagine attempting a whole class based on this.

  • theadequatemother

    You are right – I am literally howling with laughter, which postpartum, is not an activity without risk.

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

      Note: Go to the washroom before reading SOB and have coffee after reading SOB.

    • Meerkat

      I was wondering where you went! Congratulations!

    • Mishimoo

      Oooh! Congratulations!

    • Bethany Barry

      Congratulations!!!!! Enjoy your baby moon (with all its leakage and uncomfortable farting on both your parts).

    • Sue

      Congrats, morethanadequatemother!

  • Zornorph

    I suspect if you observed a bunch of laboring women, half in ‘clinical’ hospital rooms and the other half in ‘homey’ rooms with candles burning and dim lights, you would find an equal percentage of stalled labors. And they they would have to find a new excuse. But one thing I can predecit based on scientific observation is that they WOULD find a new excuse.

    • me

      An easy, albeit totally unscientific, way to disprove this hypothesis is to answer a simple question: in the last twenty or so years, ever since hospitals made L&D rooms more “homey”, started allowing dads in the room, and rules about eating and drinking, etc have relaxed, are labor complication rates, including stalled labors, any lower than they were before these changes occurred? If no, well, no correlation means no causation. If yes, they might be on to something and, yeah a RCT might help determine what factors (if any) would be helpful. Or it could reveal that observational studies generally suck ;) and no causation exists.

      • The Computer Ate My Nym

        To be fair, there may be reasons that the rate of stalled labor is increasing over time that counter any effect the “homey” rooms have. You’d really have to look at your covariables carefully.

    • KAndrews

      My labor was stalled and the majority of that was spend at home. Then I was off to a birth center. There excuse is that I was resisting the pain (I was NOT, however I was so overwhelmed with pain that I could not speak). I was later asked by one of my midwife’s if I had secretly being thinking thoughts of not wanting to be a mother yet. That was her logical leap as to why my labor was so long.

      • The Computer Ate My Nym

        What does “resisting the pain” mean? And what happened to the claim that labor at home isn’t painful? You must have had bad beliefs or something.

        • Zornorph

          Or bought the wrong brand of essential oils.

        • KAndrews

          It meant clenching, tightening not pushing, not allowing it to happen because your afraid it will hurt. If it does not fit into their belief structure they blame the woman for not doing it “right”. Not sure what you mean at the end. This were never my beliefs. This is what they said to me afterwards.

          • fiftyfifty1

            She was being ironic when she said that about “bad beliefs”. She knows that beliefs don’t really affect labor even if midwives say they do to try to make you think things were your fault not theirs.

      • Zornorph

        In other words, it was all your fault. It’s amazing how often Midwives blame their patients when things go off script.

        • Josephine

          From the stories I’ve read on this site I’d bet a 95%+ rate of blaming it all on the mother for not “taking responsibility” in some way. The other 5% is “some babies (or women?) just aren’t meant to live”.

      • Meerkat

        Someone told me that my emergency C-section was a result of my fear. Idiots.

        • Zornorph

          I was constipated once because I was afraid of how bad my poop would smell.

          • Meerkat

            Did you get interventions? I hope you didn’t and just waited for it to come out naturally. You should have also imagined a field of roses and breathed through your fear.

          • Zornorph

            It certainly went way past its due date. I gave birth to it out in nature, though, and there were birds singing in the trees. Of course, they all died when they got a whiff but they were not meant to live.

          • Meerkat

            You must be so proud!

          • Zornorph

            I posted the results on Facebook!

          • Meerkat

            I hope you will post a video and a detailed account of the process later.

          • Trixie

            I remember during my labor when someone told me to imagine the contractions like waves in the ocean that I could float on top of. Instead I imagined punching her in the face.

          • OBPI Mama

            All that talk actually did help me get through my back labor. My mom kept telling me to go with the pain and not fight it… I know I was in laborland, but it did help in my mind.

          • Trixie

            I think what I yelled was, “I f*cking hate the ocean! Shut up!”. Lol

          • Young CC Prof

            I’ve never been through labor, but I have experienced severe pain with no options for relief. And yes, there are mental tricks to get through it, breathing, visualization, etc. Through the centuries of natural childbirth whether we wanted it or not, human culture devised any number of tricks to endure.

            Overall, though, I prefer a morphine pump.

        • Trixie

          Well yeah…a result of your fear that your baby would be harmed if you didn’t have a c-section, based on the advice of a doctor. That’s a totally legit fear. That’s not what they meant though.

          • R T

            Amen to that!

        • OBPI Mama

          People are insane. I’ve been told my son’s shoulder dystocia was a result of fear.

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

          I’ve gotten this one too.

      • auntbea

        You can help lead her to enlightment, by encouraging her to embrace the pain of being punched in the nose.

      • Comrade X

        I’m sorry – this should be criminal. A health-care provider trying to imply to a patient, with ZERO evidence, that their physical condition is being caused by “secret thoughts”. Unless we’re talking about psychiatry, or about a condition with well-known and well-documented psychosomatic components, my “secret thoughts” are precisely NONE of my doctor’s or nurse’s business.

        • Dr Kitty

          A GP colleague of mine is reading “Cracked” at the moment, he’s not so sure your secret thoughts should be your psychiatrist’s business either…

          http://www.amazon.co.uk/Cracked-Psychiatry-Doing-More-Harm/dp/1848315562

          I’m wondering whether or not to read it myself.

        • KarenJJ

          It happens a lot :( I am a member of a few groups of people who all have a similar undiagnosed rare disease to what I have. A few have been referred on to psych’s, some have been accused of trying to find something wrong with their kid (one family, their toddler’s headaches were so bad he had papilledema and changes on his MRI when they finally got things checked out properly by a doctor that did believe them when the child was 5yo).

          A lot of us gave up and stopped mentioning things to our doctors for fear of being thought of as a hypochondriac and malingerer. Having a name for the condition and a genetic diagnosis has made a world of difference as to how we get treated by doctors. The fact that it is so rare, difficult to diagnose and that doctors are now so incredibly helpful has helped me forgive them. My doctors even published a paper on my family and how rare and difficult it is to diagnose and have been trying to raise awareness at conferences, training and with surveys etc.

          • Sue

            Karen, I always try to keep your story in mind – good perspective for a clinician to have when approaching a person with a difficult presentation.

      • Amy M

        I had a very long labor, due to irregular contractions, which the OB on call (in the hospital) decided to deal with by giving me pitocin after 12hr. He (and everyone else involved) felt the irregularities were caused by extremely distended uterus thanks to carrying twins. Because the contractions were so weak, the first half of my labor was not comfortable, but it wasn’t super-painful either. I was ready to be done being pregnant, since that was pretty uncomfortable by then, and Baby A’s water had broken anyway….so I wonder what the problem was (by a midwife’s standards?) The lights were dim, the only one around, once the initial exams were done was my husband, the babies even thoughtfully waited until after I’d seen the season premiere of Lost, and gotten a few hours of sleep….maybe the mere fact of being in the hospital was inhibitory. :)

      • R T

        I might have physically attacked her in your shoes, lol!

      • Maria

        What the…? I don’t have much tolerance for that kind of BS under normal circumstances and I am not sure what I would have said or done during labor. I have the unfortunate habit of showing exactly how I feel all over my face before I have a chance to even verbalize it. My MIL says I have an “expressive” nose. I am sorry you had to put up with that during a long and complicated labor!

      • fiftyfifty1

        It wasn’t your fault!!! It was your midwife’s fault for not touching your “button” to help you relax!

    • Young CC Prof

      Assuming the same people were doing the measuring, yes. If you had NCB fanatics only in one group, you might see far fewer diagnoses of stalled labor. “What? You want to drop out of the trial? You don’t trust birth? It’s only been 30 hours!”

  • Josephine

    As someone whose field is arguably a social science (history), I find these people deeply insulting to those disciplines.

    Alternately, I’ve read a lot about Civil War amputation surgeries so I feel confident that I could do one myself. Dirty rags and blood-caked surgical tools keep you closer to nature. Orgasmic amputation!

    • The Bofa on the Sofa

      As a scientist whose field includes a lot of application of quantum mechanics (not just indirectly, but explicitly, as in, I use quantum mechanics in my work), I gave up being insulted by the moronic attempts to apply QM by idiots like Deepak Chopra etc. I just laugh at them.

      • Josephine

        Excellent point! Laughter is better. Eyerolling is also a great option.

      • The Computer Ate My Nym

        When I use my evil genius(TM) to take over the world, my first dictate will be that anyone using the term “quantum” had better be talking about a discrete change from one state to another or I will send my entirely Newtonian robots out to destroy them and all their works! Yes, I’m going to build robots without semiconductors. What’s the point of being an evil genius if you can’t do things the ridiculously hard way?

        • The Bofa on the Sofa

          anyone using the term “quantum” had better be talking about a discrete change from one state to another

          I wouldn’t take it that far. I would, however, insist that they write the Hamiltonian.

          • The Computer Ate My Nym

            Ooh, I like! Subtler and yet probably equivalent in effect. I’ve decided to make you my first lackey in charge of annoying people who misuse the word “quantum” when I take over.

          • Box of Salt

            I’m pretty sure I once asked someone on this forum just to explain what a Hamiltonian is, and why I was asking.

            I didn’t get a reply.

          • auntbea

            I believe I offered you an explanation of the federalist papers.

          • The Bofa on the Sofa

            I offered her a crisp, clean $10 bill to go away….

          • Box of Salt

            Ba-da-bing!

            Sadly, that one is also going to be lost on a lot of people.

          • The Bofa on the Sofa

            I thought auntbea’s response was nice, too.

          • auntbea

            At first I thought he was bribing me to go take my political science talk elsewhere, and my feelings were a little hurt.

          • The Bofa on the Sofa

            The only thing I know about Alexander Hamilton is that he wanted a national debt to justify a federal income tax. At least that’s what I’ve learned from the Tyrannosaurus Debt episode of Schoolhouse Rock.

          • Vyx

            You could call us Aaron Burr with the way we’re dropping Hamiltons.

          • Dr Kitty

            I hope, only the relevant 51…

          • Dr Kitty

            So…not only unaware of what a Hamiltonian is, but unwilling to use Google to find out cut and paste the fruits of their research.

            Not exactly of suggestive of intellectual curiosity. How surprising.

          • The Bofa on the Sofa

            This is the beauty.

            If you don’t understand the question, you certainly don’t know enough about QM to be trying to apply it to anything.

            Now, understanding the question isn’t sufficient for being able to apply QM, but it is certainly necessary.

          • Box of Salt

            Bofa “If you don’t understand the question, you certainly don’t know enough about QM to be trying to apply it to anything”

            Exactly.

      • Trixie

        http://www.shopqht.com/product-p/hgo.htm
        Wait, so you’re saying these quantum orbs are just….marbles?

  • Dr Kitty

    Oh dear lord…

    Obstetricians: your labour stalled, let’s start pit!
    MW: your labour stalled because the room is too clinical, let’s dim the lights!

    He seemingly forgets that you can do RCTs on the midwifery interventions too…

    • auntbea

      Don’t need them. Have other ways of knowing.

      • Mel

        Magical ways that shouldn’t be questioned too deeply. Don’t want to let the magic escape.