Risk of anoxic brain injury is more than 18 times higher at homebirth

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I’ve been struck by the number of stories on this blog of homebirths that ended with the baby receiving cooling therapy. The treatment, known as therapeutic hypothermia, is designed to reduce the brain damage of hypoxic ischemic encephalopathy (HIE) that results when a baby is deprived of oxygen before birth. To my knowledge, no one had looked at the association between homebirth and cooling therapy … until now.

The poster entitled Home birth and risk of neonatal hypoxic ischemic encephalopathy, to be presented at the forthcoming February meeting of the Society of Maternal-Fetal Medicine looks at precisely this issue.

The authors, from Weill Cornell Medical Center, explain:

Since 2007 our institution has been a primary referral center in New York City (NYC) for neonates with suspected HIE that undergo therapeutic hypothermia (cooling). A database of all cooling cases from 2007-2011 at our institution was linked to vital records. Four normal controls per case were then selected from the birth certificate data after matching for year of birth, geographic location (community district), and gestational age in weeks. The odds of HIE for home versus hospital birth was assessed via logistic regression.

What did they find?

Of the 69 infants who received cooling therapy, 5 had been born at homebirth. That represents 7.2% of babies who underwent treatment, an extraordinary number consider that homebirth accounts for only 0.5% of births.

Indeed:

Women who delivered at home had 16.9 times the odds of neonatal HIE compared to women who delivered in a hospital (p <0.01). The odds remained significant after controlling for maternal age, ethnicity, education level, primary payer and prepregnancy weight (aOR 18.7, 95% CI 2.02-172.47). After controlling for mode of delivery the odds of HIE increased for home birth compared to hospital birth (aOR 32.9, 95% CI 3.52-307.45).

In other words, homebirth increased the the odds of a baby needing cooling therapy for brain damage due to lack of oxygen by more than 18 fold!

When compared with babies born vaginally in the hospital, babies born at homebirth had a rate of hypoxic brain damage 32 times higher, suggesting that C-sections dramatically decreased the risk of hypoxic brain injury.

The results are appalling, though hardly surprising. All the existing scientific evidence, as well as state and national statistics shows that American homebirth has an increased risk of death of at least 3-9 times higher than comparable risk hospital birth. Since most of these deaths are due to oxygen deprivation in labor, it is not unexpected that the risk brain damage is also dramatically increased.

This is yet another stunning indictment of American homebirth. Far from being safe, homebirth dramatically increases the risk of brain injury as well as death.

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  • Uncle

    I have a nephew that was just born yesterday – didn’t breathe for 30 minutes. He had to be lifeflighted to a children’s hospital where he is receiving this treatment. They did a brain scan on him today and guess what? No brain activity.

    The risks outlined on this website are real and our family is living through the grief and pain that happens when home birth goes wrong. Home birth should be illegal.

    • Box of Salt

      I am sorry for you family’s loss.

    • yentavegan

      So sorry for the pain you are all going through.

    • Amazed

      I am so sorry for the needless suffering your family is experiencing.

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

      I am so, so sorry.

    • Happy Sheep

      I am so sorry your family is going through such a horrible time. Please keep up updated on the baby’s status if you can.
      I know stories like these being shared will help get the word out, but I wish they never had to happen

    • Meerkat

      I am so sorry.

    • Young CC Prof

      I am so terribly sorry for what your family is going through.

    • Uncle

      Unfortunately the baby’s condition has not improved. The family is waiting till tomorrow to remove the baby from life support. Sadly, his mother’s birthday is today.

      • Amy Tuteur, MD

        I am so very sorry hear that.

      • Daisygrrl

        How devastating. I’m so sorry for your family’s loss.

      • Burgundy

        I am so sorry to hear that. My heartache for your family.

      • KAndrews

        Uncle, I am so sorry to hear that. That is very similar to what happened to our son, although he did recover but has Athetoid Cerebral Palsy from his brain injuries. The layers of trauma run so deep. If I can help or if your sister would like someone to talk to please don’t hesitate, Kristine Andrews on Facebook. Again, I am so sorry for the needless pain your family has to go through.

  • kisarita

    whats the absolute risk?

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

      Does the fact that your question falls right between two tragic stories of home birth – injured babies, one of whom was born *yesterday* have any impact on you at all?

      • Amazed

        I’ll be the bad guy here and suppose that she’ll say, But we don’t know that Uncle’s story is true! It might be something Dr Amy made up! At the same time, the likes of her howl all the way to the moon when Dr Amy “steals” a real story.

        I am sorry, Uncle, I truly didn’t mean any disrespect. That’s just how their mindset works.

    • The Bofa on the Sofa

      What’s the absolute risk of drunk driving? I’m not talking about the annual risk, I’m talking about driving home from the bar drunk. What’s the absolute risk?

      Hint: it’s much, much, much less than the risk of childbirth TO THE MOTHER, much less the baby.

      Are you opposed to drunk driving laws?

  • KAndrews

    Thank you for sharing this. It is very close to home, as this is what happened to our son Abel. He did not receive the cooling treatment but it was discussed. They thought he was doing okay without it . . . we will never know if it would have helped his outcomes a little. If I had read these numbers I would have made different choices about whom to intrust with the birth of our son.

    • moto_librarian

      I am so sorry, KAndrews. I have a friend whose son also would likely have benefited from cooling treatment, but he did not receive it either. I hate to think about the number of babies who now face lifelong disability due to the dishonesty of lay midwives.

    • Amazed

      I am so sorry, Kristine. Stay strong. Your superhero deserved so much better than what he got thanks to these clowns’ irresponsibility.

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

      You are so brave, going public. Best of luck!! I’m also Oregonian, and we need fighters here. I wish there were words that helped. Though if Abel likes superheroes, I know Batman and Superman (well, guys who dress like them) who would probably send autographs or video greetings.

      • KAndrews

        If they would like to do that I am sure Abel would love it!

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

          Drop me an email at my username @gmail .com and we’ll make it happen

  • Guestll

    I have an American friend who has had two CPM homebirths. Her first baby was born in a hospital. The first homebirth involved an almost 10 lbs baby (no GD testing) and a shoulder dystocia. SD resolved, baby born safely. The second homebirth involved a 10.5 lbs baby (no GD testing) and another SD…except this time, it was not resolved very quickly. This child is now 8 and has profound learning disabilities. Is she brain injured? We will never know, nor do we know how many of these children are potentially out there. Scary.

    • Sue

      This is likely a very serious birth injury – probably never to be reported. If the death rate is x3, you have to bet that the rate of anoxic brain injury also has to be multiple times the hospital rate.

  • Leah

    As a NICU RN this research study is confirming everything medical professionals involved with labor and delivery and postpartum care have already known. Homebirth can be a huge risk for your baby’s brain.
    We’ve been getting a lot of head cooling kids lately and 8/10 (this is by no means a scientific number, I am just counting those I can recall in the last year) are home births or clinic births. Many of them had quick transfers to the hospital, but by that time it is too late. The parents are always upset with US as they view it as us intervening and ruining their birth experience (when on head cooling they often can’t hold, breastfeed, and do all the other fun and crunchy things they wanted to do after delivery), instead of seeing it as us trying to save their child from a lifetime of brain damage. Unfortunately, they do often end up with some level of brain damage and sometimes organ damage.
    Its a really sad reality of homebirth. I think people thinking of having homebirth need to hear the horror stories but they excuse themselves from them under the excuse that homebirth is about feeling confident and you should only read positive birth stories. Yah, because somehow reading positive birth stories will help you prevent your trainwreck birth story.

    • KAndrews

      I am sorry on behalf of the parents. It is extremely traumatic to go thru something like this and can leaves you feeling like you don’t know who to trust. Keep up the good fight. I still remember the faces and words of everyone that took care of my son when he was in the NICU. Not everyone was patient and nonjudgmental. The ones that were still shine in my mind. Thank you for all that you do.

      • Susan

        When a baby is critically ill is no time to be having any discussion about judgment. I am so sorry anyone was ever anything but kind and caring to you. So many nurses and doctors don’t understand that most homebirth parents are exposed to the “as safe or safer” crap and nothing else… they really believe they are making the safest choice. It’s really important that the word gets out there that though there are a few homebirth parents that think, it’s riskier but it’s my right to take that risk, the vast majority really believe they are making a choice that is actually safer. That’s why I am so supportive of this site because very few medical professionals actively fight the misinformation that’s out there. I can’t imagine that anything much could be worse than questioning the what if’s when your child might have a preventable and serious deficit. No one should make that pain worse. The complete opposite of being a caring professional. I am so sorry.

    • Sue

      Does the hospital pre-natal education include a tour of the NICU?

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

        Ours didn’t, but I assume the NICU probably doesn’t want germy tour groups stomping through. We did see the infant resuscitation rooms – adjoining every single birthing suite.

  • Young CC Prof

    OT: My son is here and he is perfect! 2250 grams at 37.5 weeks, which is pretty small. 9/9 Apgars, still breathing awesomely, maintaining temperature and blood sugar. He is a treasure beyond all measure.

    They sent the placenta to pathology to find out why he was growing so slowly, but whatever they find, I think delivering now was the right call.

    I may also have set a record for the shortest interval between scheduling and incision for elective c-section on a woman not in labor: two hours! The blizzard was coming, my cervix was ripening, I’d skipped breakfast just in case, and the OB had an opening. Gee, it’s nice to have a scheduled section so you can make sure everything is ready. Two hours! Natural labor is way more warning than that! : – )

    The lactation consultant was a highly amusing parody of herself, but the evening nurse did an awesome job of helping us figure out feeding.

    So here’s to my 37-week elective cesarian birth, the trifecta of unnatural, and the wonderful amazing baby that resulted. Going to get some sleep now!

    • amazonmom

      Congrats! What a neat story!

    • Box of Salt

      Congratulations to your whole family! Welcome the little one!

    • Josephine

      Congratulations!

    • Burgundy

      Congratulation!

    • toni

      Abhinandan! So weird they tell you the weight in grams! I’m so happy for you :) x

      • Antigonos CNM

        Not weird at all It is the Americans with their pounds and ounces that are out of step with the rest of the civilized world!

        • Nashira

          Lord, tell me about it. Stupid growing up thinking in Imperial units is such a hindrance!

        • toni

          Well you were a midwife in Cambridge so you will be aware that we still use imperial measurements for weighing babies in Britain and Ireland. For all people in fact, and for height, distance and beer. If you gave your height in cms people would think you very odd indeed. If you are under a certain age you will probably use it for temperature and for weighing flour, sugar etc but not necessarily. There are a lot countries where they are officially metric by decree but the people choose to use imperial day to day. My mother is from an upper class Anglo-Indian family who never adopted metric and were very ill disposed to the change although India was generally quite receptive.

          • Antigonos CNM

            Actually, the UK was going metric just when I was at Cambridge, so we usually gave both sorts of measurements. “Don’t tell me about this P thing! What’s that in REAL money?”

            But since I’ve now been in Israel for about 35 years, I’m completely converted.

        • KarenJJ

          In Australia you mostly get told both. Metric for us and imperial so the grandparents can compare.

        • MichelleJo

          UK as well. The hospital records in KG, but the parents will always convert it into pounds and ounces before telling anyone the birth weight. Coming from the UK and living in Israel, I find myself doing it all the time, as birth weight is by grams in the medical and lay communities alike, but even after 17 years, it only means anything to me once I’ve worked out the pound weight. Kind of like tourists working out the price of something in their own currency before they buy, Hard rut to get out of.

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

      Congratulations to you and your family as you begin this new adventure!

    • theNormalDistribution

      Whoo!! That’s great to hear. Congrats!

    • rh1985

      Congrats!

      • Siri

        You’ll be next?! Has your final countdown started?

        • rh1985

          Well I still have a ways to go – I am due Feb 27 so just barely not in March. I will be happy if she decides to come a couple of weeks early though! I feel so done so it would be nice to have only six weeks left instead of eight.

          • Siri

            Fingers crossed and best of luck!

    • Siri

      Congratulations and well done!! The best days are when gorgeous new babies arrive… Wishing you every happiness with your treasure.

    • Certified Hamster Midwife

      Welcome, Young CC Prof Jr.! Glad to hear that everything went well.

    • Dr Kitty

      Congratulations! Enjoy what little sleep you can, and the cute baby fingers and toes.

    • Antigonos CNM

      Mazal tov!

    • Trixie

      Surely you’ll get the placenta back from pathology so you can encapsulate it, right? ;-) Congratulations!

      • Siri

        C’mon Trixie, give Young CC Prof some credit – I’m sure she took a good nibble out of that placenta before it was bagged up and sent off. She hasn’t been a regular reader of this blog for nothing…

        • Trixie

          You’re right, of course!

        • Young CC Prof

          Thankfully, the placenta was not seen by me. At all.

    • Mishimoo

      Congratulations! So glad that he’s here safely, hope that he gains well and continues being awesome.

    • araikwao

      Congratulations!! Wonderful news

    • Nashira

      Congratulations!!! Let’s hear it for unnatural births and amazing babies. <3

    • Comrade X

      Congratulations, Mazel Tov and hugs to all the family!! xx

    • The Bofa on the Sofa

      Congrats!

    • attitude devant

      Oh that’s just terrific! So happy for you. I had an IUGR baby too. She’s 18 and also a treasure.

    • fiftyfifty1

      thrilled to hear it!

    • Karen in SC

      Congrats!!

    • moto_librarian

      Congratulations!!! I am so very glad that your little boy arrived safe and healthy!

    • Ainsley Nicholson

      Congrats!!!!

    • Sue

      Wonderful news – welcome to little Baby Prof!

    • Meerkat

      Congrats!!!

  • Guest

    My first baby was a crash section after failure to progress. Baby was huge, but great after brief NICU stay. I recovered nicely. I considered VBAC but the OB explained that between increased risk of shoulder dystocia and uterine rupture, a vaginal birth would carry a higher risk of brain damage to the baby. Easiest equation ever. “Elective” c-section it was for that baby, and the next — who are both also healthy and awesome. Your great post is what I would point to today if I were explaining why I was never going to attempt a vaginal delivery. There is not a doubt in my mind I was not built for childbirth — or Olympic skating, or astrophysics, or football, or a singing career, or … — and I am so grateful to the medical teams that brought my babies into the world. Because I WAS meant for motherhood, and they were meant for life.

    • amazonmom

      My son was an RCS because I just didn’t want to take the risk of a rupture. It turned out to be a good choice, he was 9 pounds 7 ounces at 39 weeks. Head was in the 95th percentile and he had huge shoulders. I didn’t have GD (maybe I developed it after I was tested?). I’m so glad I didn’t try to VBAC now. I love your comment.

      • Mel

        Some families have huge shouldered babies without GD. I’ve had several cousins need CS because our genes seem to create babies with the shoulders of oxen even at normal blood sugar levels.

      • Mac Sherbert

        I also tested negative fo GD, but had a 9 lb plus baby with broad shoulders. In fact, the OB commented on ithe broad shoulders during my RCS. So no doubt for us that RCS was best thing we could have done

    • rh1985

      I’m pretty sure I’m not built to deliver a giant baby either. Mine is measuring average so far and I have had extra ultrasounds for various reasons – not sure if the US estimates tend to be more accurate if multiple US are showing the baby always at the same percentile? I’d ideally choose to have a complication free vaginal birth just because the recovery would be better and it would be very difficult for me to not be able to drive for several weeks, but I’d certainly rather have a c-section over something happening to my baby, or myself ending up with a 3rd/4th degree tear. If not for the recovery issue, I’d actually rather have an elective c-section regardless of baby’s size.

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

        Not driving several weeks is likely a myth for many if not most women. You might be surprised at the cesarean recovery – its not as advertised for many women. I’d take it any day of the week myself.

        • rh1985

          Yeah, I am mainly worried because the only person who could drive me (if I can’t drive for a while) is also the only person who can babysit the baby.

        • Dr Kitty

          Yep- if you’re off the strong painkillers and can safely wear a seatbelt and put your foot to the floor for an emergency stop you can drive. I got signed off as fit to drive at 2 weeks and will sign off most of my patients between two and three weeks.

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

            maan wish I had known that. I was too scared to get any follow up care.

        • Antigonos CNM

          My mother was terminally ill, and 10,000 miles away when I gave birth to my first child — her first grandchild, as I am an only child — by C/S.

          Without feeling that I was doing anything unusual, I flew with Shimshon when he was 10 days old to be with my mother, and I drove, shopped, and cooked for Dad for the three weeks I was in the US, as well, of course, as taking care of my baby. Never felt anything but slightly tender when turning on my side. The “recovery” aspect of C/S vs. vaginal birth is greatly exaggerated, IMO. Home visiting to new mothers after vaginal birth has shown me lots of residual birth trauma that causes significant pain for quite a while.

          In all, I had three C/Ss within the space of 3 1/2 years without complications. My hip replacement a year and a half ago took me much longer to recuperate from.

          • Mel

            My mother and mother-in-laws both had much more problems recovering from extended 2nd stage than they did from CS. Both ladies have stories of needing to stand to urinate for weeks/ being unable to sit without padding etc.

        • Trixie

          Really? I don’t think I drove for a month because it hurt to extend my foot to brake and I was worried I wouldn’t react quickly enough to avoid an accident. I hope it’s different for her, but my cesarean recovery was really rough and it was months until I wasn’t in pain.

          • fiftyfifty1

            Ouch, I’m sorry to hear that! I had a really easy recovery like Mrs W did, but I had a friend with a hard c-section recovery like you. I wish I had the power to grant every woman an easy birth and recovery (however it happens).

          • Trixie

            Hey, it’s what needed to happen to get the baby, and I’m grateful for it…but yeah, it was not the easy recovery I read about other women having. I also lost sensation in my upper left thigh from the surgery. My subsequent vaginal birth was a breeze, I felt great right away. Of course, I realize it could have gone south and ended in a c section anyway, but I was pretty motivated to avoid that recovery again if I safely could.

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

          FWIW, post section recovery was a breeze for me. I went home a day early (for cs, normal for vb) & it mostly felt like I’d done WAY too many sit-ups. I am sure I could have driven within a week, but I didn’t for two, because I barely left the house at all. Newborns keep you home a lot, IMO.

  • amazonmom

    Off topic. I needed a breath of woo free air after seeing that a whole bunch of people on my online pregnancy group got their placentas encapsulated and are claiming it makes them feel sooooo wonderful. Paying hundreds of dollars to consume something with your CHILD’s DNA? Ewwwwwww doesn’t cover it.

    • SkepticalGuest

      The placebo effect is an amazing thing.

    • Trixie

      I wonder how well the doulas actually sanitize their food dehydrators in between clients. I mean, making unsalted jerky is a bad idea, right? I’d love it if someone would take their placenta pills and have them analyzed for bacteria.

      • Are you nuts

        Had ever considered that. Man that’s nasty.

        • Trixie

          Because I am a sadist, I just read the USDA guidelines for home preparation of jerky to several sites that offered online instructions for dehydrating a placenta. Let’s just say they have a pretty loose interpretation of a safe cooking temperature. Some sites recommend drying the placenta at under 120 degrees, to preserve the hormones.

          • The Bofa on the Sofa

            I still want to know how all these people who are having someone else “encapsulate their placenta” know what they are getting is their placenta and not just…beef jerky?

            Once again, too bad I have ethics. Be so easy to take them for a ride…

          • Trixie

            Honestly, that would probably be equally effective, and a whole lot more sanitary.

          • The Bofa on the Sofa

            And easier. You just make up a batch of 500 and sit them in a bottle on the shelf. It would cost about $5 in supplies. When someone gives you their placenta, you throw it away and give them a pill a couple days later, and charge them $50 for the privilege.

            Great scam, no one would know any better. I just don’t have the lack of ethics it would take to do it.

          • Trixie

            More than that — placenta encapsulation costs $250 or so.

          • The Bofa on the Sofa

            So we can run a discount service…:)

          • amazonmom

            Heck yeah, we can take pictures of us in my kitchen with a dehydrator and post them on our website for added effect.

          • Trixie

            I actually own two dehydrators (not for placentas), so that’s a terrific plan!

          • Trixie

            Actually, you can get a jar of dessicated liver capsules on Amazon — $16 for 250. Save yourself the work and just put it in a new jar with some placenta tree artwork on it.

          • EmbraceYourInnerCrone

            Well, except for the fines etc for not disposing of human medical waste/biohazards properly..

          • Sue

            Do they get chromosomal/DNA proof that it is actually THEIR placenta? Like Bofa says, could be anything.

    • Burgundy

      Congratulate them on consuming the oldest form of sex pill?

    • amazonmom

      OH GOD WHY!!!!!! The ringleader of the crunchies that are all eating placentas hasn’t given birth yet. She’s waiting for her second HBAC, she’s term right now. Just got diagnosed with PERTUSSIS!!!!!! We butted heads over the CDC recommendations regarding vaccination in pregnant women a few months ago. I usually don’t read what she posts in the group but oh I hope that Z pack she was given helps prevent that poor baby from getting it.

      • amazonmom

        I wish I was making this up but I am not. So infuriating.

      • Bombshellrisa

        Since she probably claims to have “done her research” why hasn’t she googled “pertussis newborn”? The sounds of gasping and crying from a baby with pertussis reduced me (at 32 weeks pregnant) and my husband to tears. We BOTH had a shot and my mother offered to have another (her last Tdap was when my nephew was born two years ago) as did my whole family.
        I have the typical Seartle friends who are into “natural flu shots” (tea and “shots” of ginger, lemon, pineapple juice over the course of a week) and not vaccinating. I flat out told them all I refused to have anyone unvaccinated at the baby shower and have been labeled “difficult” and “ungrateful”. These are the people who told me it was “unwise” to get a flu shot during pregnancy based on them “doing their research”. Guess they didn’t read about what can happen to a pregnant woman who gets the flu.

        • Certified Hamster Midwife

          That natural flu shot sounds delicious, especially if you add rum. Wouldn’t depend on it to prevent flu though.

          • Antigonos CNM

            Have a few of those “shots” though, and if you add enough rum, you won’t care if you have the flu

        • rh1985

          My aunt, my mother’s younger sister, had pertussis as a baby nearly sixty years ago and my mother still remembers that cough. She recovered but was in the hospital a while. That is one vaccine I just can’t understand people skipping. I feel like in some ways vaccines have worked so well that some people foolishly think there is no reason to fear these diseases because they never saw someone who was sick from them.

        • amazonmom

          She’s whining about being ill. No concern whatsoever that her baby or someone else’s might DIE because of her irrational refusal of vaccination. Having to tell a family that their child needed ECMO for the best chance of surviving pertussis but wouldn’t survive the transport was the most heartbreaking news I helped deliver. The doc wanted a trusted nurse there when he broke the news. The family got fully vaxed while we waited to see if that baby would survive. He did live. They became pro vaccination activists after that.

        • guest

          I’m 35 weeks with my third. I’m also an ob/gyn. This is my first “winter” baby and I find myself justifiably frightened of neonatal flu or pertussis. I’ve been vaccinated and re-boostered, as have my husband and children according to CDC and ACOG guidelines. I just had to tell my mom that I won’t allow any visitors who are not vaccinated. Let’s just say that conversation went poorly. My mom stated “I don’t believe in the flu shot and I had whooping cough as a kid. Whenever I get the flu shot I get the flu”. Of course, I tried to reason with her–unsuccessfully. When I finally ended with “are you really more concerned that you–a fairly healthy 59 year old may have a few days of flu-like illness or that your newborn granddaughter could have influenza or pertussis, go to the NICU, require ventilator support, and ultimately die?” There was silence and then “I’ll think about it but you know I’ll never agree with you”–click. I’m not expecting many visitors. Their loss.

          • The Bofa on the Sofa

            Congrats, and good job sticking to your guns.

            Amazing how selfish your mom is being.

          • Trixie

            I’m really sorry you have to deal with that. Did you explain that pertussis immunity isn’t lifelong?

          • guest

            Yeah. I’ve also explained that in most healthy previously exposed adults pertussis appears to be nothing more than the common cold, thus it would be impossible for her to know if she was spreading something much more dangerous. Ironically, this whole conversation started after she told me how sick my 80 year old grandfather was with the flu. Of course, he doesn’t get vaccinated either. When I tried to compare how sick he is with how sick a newborn could become it was like talking to a brick wall. Oh well. They’ll miss out on visiting for a few months. Luckily, my neighbors will help if needed and my husband is a stay-at-home dad so those first few postpartum weeks are much easier for me than for others.

          • Trixie

            I hope your grandfather comes through okay! I know how even a normal cold can really knock my 80-something grandparents out for a few weeks. You’re doing the right thing, sorry your mom won’t believe you.

          • Bombshellrisa

            We are posting a HUGE sign on the front door. It’s mostly to keep unwanted people away, it will state unless you have a specific appointment DO NOT DISTURB and we will not be accepting visitors who are not current with their flu shot and Tdap.

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

        That’s awful.

      • Trixie

        That’s so awful and stupid.

      • Mishimoo

        Good grief! I hope that all of the babies are okay!

        I was hoping that nothing could top one of the local swim instructors continuing to swim/instruct while contagious with pertussis, but that just did.

        (I found out a few months after she’d recovered, and was rather grateful that our vaccinated munchkins were fine. Mother-in-law couldn’t understand why I was furious – “It’s only hundred days cough, it’s not a big deal.”)

    • Cartwheel

      Someone was going to rent my rental property and was clearly an aggressively attachment-parenting kind of single mom – okay, I found it off-putting but we can’t be discriminatory in housing. But then she told me (as though it were a bonus! with reference to the website!) that the roommate she had in mind had a placenta-encapsulating business that would be carried out on my property.
      No. Way.
      That is a liability risk I was just not comfortable with. Visions of disease outbreaks being traced through the kitchen of my rental house… nope nope nope.

    • rh1985

      which board are you on? I’m on baby center, most people are sensible but some are just insane (as in jumping on a mom who is going to have a scheduled CS between 37-38 weeks because she had uterine surgery less than 3 months before getting pregnant)

      • amazonmom

        It’s a private group that split off of a BabyCenter group. Most of the ladies are sane but a few of em are woo infected.

    • Dr Kitty

      I got out of the whole Due date club nonsense when the judging and glurge started.

      In particular, a woman who posted about her decision to end a wanted pregnancy after a diagnosis of Edward’s Syndrome and who got lots of “We would NEVER do that- how COULD you!”, “Drs can be wrong you know- why don’t you just see how it turns out?”,”I’ll pray for healing for your baby- miracles can happen!”, “maybe God wants to teach you a lesson about trust and endurance- you need to see it through” or “I know lots of people with Down’s and their parents don’t regret having them!” and almost no-one giving genuine support or understanding.

      It was unsympathetic, unhelpful and judgemental.

      No one got called on it by the Moderators, and if any posts warranted a “supportive comments only” notice, I think it is those.

      • rh1985

        That’s T18 right? There was someone on my due date board who terminated due to anencephaly and she also got some cruel comments. The mods ended up locking the thread to stop the comments.

        • Dr Kitty

          Yep T18.
          Not Downs.
          It was not pretty.
          And people think we are mean here, really they haven’t seen anything.

      • The Bofa on the Sofa

        I got out of the whole Due date club nonsense when the judging and glurge started.

        I got kicked out of the “due date” club (big surprise there, huh?), because I didn’t put up with nonsense. And if that meant judging, it didn’t stop me.

        Then again, I didn’t miss it much, because everyone was so “non-judgmental” it was really boring. I’ve described it before as basically everyone sharing their favorite colors or pizza toppings, but even when talking about pizza toppings, you can at least say you don’t like something that someone else does. Every thread turns into basically…

        “Hey everyone, I like red. What’s your favorite color?”
        “Mine’s blue.”
        “Blue is great, but I like green better.”
        “I’m going with red.”
        “I’m not so much into solid colors, but like plaids.”
        “Oh, that’s so interesting that you like plaids. If I had to do that, I’d choose something with peach in it.”
        etc

        barf

        Now replace colors with names, nursery designs, changing tables, diaper pails, and that was about the whole board, until 17 – 22 weeks, where every member had a thread titled

        “IT’S A BOY!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!” (or girl, but don’t forget the exclamations points) with a bunch of responses that just say “Yay”

        Oh, and don’t forget the sig files that fill up have the screen.

      • Bombshellrisa

        I haws hearing what other people think they would do with a situation that they have never faced and never lived through. We had to do a level 2 scan and ended up taking a Harmony test (tests for Edwards along with Downs and something else). Between the level 2 scan and when we got the results of the blood test, we had well meaning but clueless people tell us how Down’s children are full of love, a blessing, ect. They went on about how we would love him no matter what as soon as we held him. Not supportive, not helpful.

        • Carolyn the Red

          I have never had to go through a bad result, but I was kind of terrified until my anatomy scan, since I had a brother with a different chromosomal abnormality (DiGeorge) who died young. My parents strongly suggested any screening tests I could get-they don’t recommend the experience.

          They loved him. It didn’t mean he didn’t have serious health issues that killed him.

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

            Word.

  • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

    I think you should add this to your blog you just posted with all the other home birth studies. And then add that post to the left side of your blog template, right near your post Twelve Things You Shouldn’t Say to Dr Amy. It’s an awesome, informative post and deserves to be highlighted, IMO :)

    P.S. Hi everyone!!

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

      YES PLEASE. This is desperately needed for moms considering NCB who are new to this site. Coming here and seeing whatever happens to be the topic of the day can really give new people the wrong idea. I am also wondering why this site needs to be a one-person effort? I am sure lots of the regulars here would be willing to help with things like that to improve the site. If I had more technical know-how I would pitch in.

      • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

        I assume it’s a one person effort b/c that’s how Dr. Amy wants it :) She does have guest posts from time to time. She does very well on her own, considering she has a new post up 5 days a week and tons of traffic. I have no idea how she manages to so-quickly responds to latest and “greatest” articles and studies that pop up out there about childbirth, breastfeeding, etc.

      • AlisonCummins

        It’s not a one-person effort. Amy Tuteur, MD puts out something scathing with more-or-less of an explanation. Sometimes there’s a very detailed explanation, sometimes there are only a bunch of assertions with absolutely no support and perhaps even one or two that are unsupportable.

        The commenters add the nuance. When there are questions asked/ challenges raised, Amy Tuteur, MD may or may not respond to them and when she does it might be with a helpful answer or it might be with an unsupported accusation. There’s always a commenter to answer helpfully.

        She tried participating in sciencebasedmedicine.org for a short time but without the regular commenters and the context of the site it just didn’t work. That’s why she recognized the commenters — even by name — in the 2013 recap.

        • theNormalDistribution

          Dr. Amy’s blog is well researched and meticulously documented with source material. It is certainly the most transparent source of information relating to obstetrics and homebirth you’ll find on the internet. Her commenters are good because her blog is so good.

          Of course Amy doesn’t respond to every question or challenge in the comments. Firstly, many them have been asked and answered. Over. And over. And over again. I’m surprised by the patience of the commenters who do respond. Secondly, she is actually only one person, she can only reply to so many comments. Do some more reading: you’ll likely find Amy’s response to those unanswered “challenges” in one of the hundreds of other informative posts she has written.

          • AlisonCummins

            “Dr. Amy’s blog is well researched and meticulously documented with source material.”
            Often, yes. Not always.
            “Of course Amy doesn’t respond to every question or challenge in the comments.”
            I didn’t say she should, I said she didn’t and that commenters took on this role.

            “you’ll likely find Amy’s response to those unanswered “challenges” in one of the hundreds of other informative posts she has written.”
            Not necessarily. She invented a psychiatric disorder and has been known to diagnose psychiatric disorders in online commenters. When I said that 1) she was not a psychiatrist and that 2) she was not the psychiatrist of the online commenter in question and 3) offered a plausible alternative narrative to explain the same data she simply reiterated that she was correct even though there was no way she could know it.
            She often pronounces that such-and-such a belief is ridiculous and derides the people who accept it, without explaining how ordinary people could possibly be expected to know that it’s ridiculous.
            Sometimes the explanation is hidden somewhere on the blog — with five or six years of material that’s not surprising — but it’s hard to find. Sometimes there is no explanation beyond the statement that there is “no evidence.” How is an ordinary person supposed to know what “no evidence” means? Does it mean we never looked for any, or that we looked and didn’t find it? Does it mean that the belief is implausible on its face and there is no reason to consider it? Or is it irrelevant, something like saying that there is “no evidence” that Minkee blankets are warm because they haven’t been specifically evaluated in a lab even though lots of other, similar blankets are warm? Commenters will add this essential nuance.
            When she was posting to SBM she recycled old posts that she’d written for an NCB audience, often in very general terms. At the time the only thing I knew about the NCB movement was that two of my less-close friends had had home births and one of them had told me why. Another friend of mine — an ER doc — considered a home birth on the grounds that hospitals are filthy, but when her OB friend changed her mind about attending her she gave birth in the hospital after all and was glad she did.
            When Amy Tuteur, MD started talking about NCB-ers on SBM she spoke in terms that were simply inappropriate to apply to the people I knew. It wasn’t until I’d read this blog for a while that I was able to figure out who she was talking about, and it wasn’t from her posts — it was from the commenter’s personal stories. The context is important. Without the context of this community her SBM posts were very hard to understand.
            She has said more than once once that she knows my agenda but has never deigned to tell me what it is.
            On SBM she posted about the protection circumcision offers against HIV … and then concluded that the APA should change its recommendation that the risk of transmission of HIV should be taken into account when deciding whether or not to circumcise. When I said that didn’t make sense she called me a pro-circumcision troll.
            “Her commenters are good because her blog is so good.”
            Yes, and the whole is greater than the sum of its parts. Is this a problem for you? It’s not a problem for me. Amy Tuteur provides something for her commenters to work with and they work with it. Sometimes it’s data-driven, sometimes it isn’t. I like her data-driven posts because they are the ones I understand; other people relate to the unsupported personal attacks because they know the people being attacked and they make them pull out their hair.

          • Amy Tuteur, MD

            Could you please provide the relevant quotes? For instance, I don’t remember ever calling anyone a pro-circumcision troll.

      • KarenJJ

        Some different perspectives might be nice, I know that one regular commenter was asked if she wanted to do a guest post and she declined, preferring to remain in the comments section. There have been a couple of other guest posts.

        Thing is that those in the know that comment/read here are likely medical practitioners and those of us that aren’t in the know – well – I wouldn’t have much to say about the topics apart from personal experience in moving beyond NCB.

        But I do agree in linking some of the factual posts to the side for easy reference. Or maybe even a “10 posts to read of Dr Amy’s” before starting to troll the comments.

  • attitude devant

    Reading this is an odd mixture of horror and gratification. Gratification because when I started learning about NCB (that unhindered birth was safest) it went against everything I saw every day. I knew birth was tricky, perilous, and untrustworthy and here were all the people saying that my toolkit for preventing harm was itself the problem. So that pleases me at a deep level: that something that seemed so at odds with my perception is shown to be false.

    On the other hand, I am horrified because the injuries wrought by undertrained personnel heedlessly practicing with no guidelines are even greater and more numerous than I realized. So much loss. So much wasted potential. And for what?

    • staceyjw

      For nothing but the chance of an easy, VB, and no hospitAL..
      I am sure that those choosing it simply don’t know, these are the possibilities.They don’t believe anyone but the sources that lie..

      What’s really scary? These were NOT lay MWs or CPMs. NY is a CNM ONLY AREA.

      • Certified Hamster Midwife

        Depends on when they did this study. New York has CMs now. NYC could have patients referred from parts of NJ and various New England states, though.

        • Box of Salt

          Are there similar facilities in Philadelphia or Boston? If so, you’re only likley to be adding in patients from north Jersey and eastern Connecticut.

          • Certified Hamster Midwife

            Must be. Still, NYC is called the Tri-state area for a reason.

          • Box of Salt

            CHM “NYC is called the Tri-state area for a reason.”

            Sure. Try drawing a circle with lower Manhattan as the center. It will include north NJ and eastern CT.

            NJ is weird because it’s between two major metropolitan areas. I used to live there. From central Jersey southwards, medical referrals tend to get sent to Philly, not NYC. It’s closer.

          • sleuther

            I think you mean Western CT, not Eastern CT. Southwestern CT is the area of the state closest to NYC.

          • Box of Salt

            sleuther, D’oh! You are correct. I moved from the East coast to the West coast and had to retrain my brain as to where the ocean is! I forgot to switch back. In CA, inland = east. But of course in CT inland = west.

          • Trixie

            Possibly parts of northeastern PA, like the Poconos area, would go to NYC for stuff like that. But most of eastern PA would go to CHOP, I’d guess.

          • Box of Salt

            Trixie, I agree. I left them out for simplicity.

            I was also trying to guess where the Boston vs NYC line would be in CT, but that gets complicated by Yale in New Haven.

          • Box of Salt

            since sleuther’s correction is far below, I will add a note here that I meant western CT, *not* the area closer to the open Atlantic Ocean. I mixed up my frame of reference.
            .

      • Trixie

        Except, just because CPMs aren’t licensed in a state, doesn’t mean that they don’t operate there. There are CPMs in PA even though only CNMs are licensed. It would be interesting to know what credentials the home birth midwife had in these cases.

  • staceyjw

    Where are the NCB HB trolls now?

    I bet they will ignore these issues.nothing can get in the way of the amazing HB!

    • Burgundy

      They will parachute in 5+ months later as usual.

  • Trixie

    Also OT, but has everyone seen the picture of the baby giving Jenny McCarthy the stink eye? It made my day. http://bzfd.it/1cHmNri

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

      Donnie, noooooooo! Don’t make it even MORE humiliating to be a former NKOTB fan!!

      • Trixie

        I was more of a Marky Mark girl, myself.

        • Lisa

          It’s like you’re blind to the obvious cuteness of Joey McIntyre.

          • Trixie

            Oh, gross, I almost had to downvote that.

          • EastCoaster

            I used to pause the videos (that I obsessively taped from the countdown!) and kiss Joey. He was so my jam in 6th grade. *sigh*

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

            I was all about Joey in the day. Did you have one of those hats with no top?

          • Amy M

            Nah, I was all about the hair bands…BonJovi in particular. He (and his band) was all over my wall.

  • theadequatemother

    I’m glad this type of data is coming out now. I wonder how Henci will spin it on “Science” & Sensibility or if she will just ignore it…?

    • Sue

      It has always seemed bad enough to see the excess mortality at HB, and only wonder at the likely hypoxic injury – now confirmed.

      It’s now more than clear – the HB setting is associated not only with a measurable excess mortality, but a significant risk of brain injury.

      Without explicit acknowledgement of this, there is no informed consent.

      Such an irony considering the lactivism that pushes unmeasurable cognitive benefits, isn’t it.

  • Carolina

    Off-topic, but I thought this might be fodder for a post. It popped up on my facebook feed. We apparently need to further demonize formula….

    http://www.motherchronicle.com/watchyourlanguage

    • Zornorph

      The fact that she uses the term ‘artificial feeding’ shows how high up in the breastapo she is.

      • rh1985

        Indeed. Though I will happily artificially feed my artificially conceived baby. Natural is overrated!!! :-p

        • Siri

          Highly overrated. Your artificially conceived and fed baby will be beautiful, intelligent, amazing and wonderful, the apple of your eye and the joy of all your family. Wield those bottles with pride, and ignore the morons of this world!

    • amazonmom

      I tried to read this link, I really tried. Felt the urge to bang my head on the wall within a few sentences. I don’t know how Dr Amy can stand reading stuff like this closely enough to respond in a coherent manner…

    • Siri

      Truly despicable; talk about a low blow. Passive – aggressive doesn’t begin to cover it. Of my five children, only the 15-yr-old was breastfed for more than a couple of months (refused bottles, self – weaned at 9/12). My 23- and 21-yr-olds both recently graduated (the younger with first class honours, the elder with 2nd class honours and a full-time managerial job in retail throughout his university years), my 19-yr-old is reading Maths and Geography (they teach him how to get from x to y), and my 4-yr-old has just started school.

      My 4 big kids are all taller than me, slim, attractive (well, I think so, lol), popular and very rarely ill. The two eldest are in stable, loving relationships with lovely young people. They are all well-adjusted, despite their parents’ divorce, my remarriage and the arrival of a much younger sibling. We’ve just spent Christmas all together, including my mum, my daughter’s boyfriend and son’s girlfriend, and it was relaxed, fun, and loving.

      At no point could ANYONE have identified the child who breastfed the longest, or even begun to guess whether or for how long each was breastfed. My bond with each child is unique, and not determined by feeding method. Their immune systems are great, aided by the full schedule of vaccination.

      Ok, boast finished!

      • Siri

        But according to this moron, I’ve failed, and might just as well have got my kids hooked on cigarettes when they were toddlers. They are stupid, fat and chronically ill anyway, so what would it have mattered?!

  • araikwao

    So that captures the most severe cases of HIE. I wonder if it would also be a risk for more moderate cases, too, but how would that be measured? Early imaging plus developmental assessment at school age?

    • Lizzie Dee

      As the report refers to those “suspected” of having suffered damage, presumably hospitals, having much to lose, are more likely to refer borderline cases – whereas one gets the impression that many homebirth midwives optimistically opt for “fine” if not actually obviously in deep trouble.

      I do sometimes (rather often) wonder how the uninformed think “brain damage/oxygen deprivation manifests itself. The damage to my daughter’s brain is extensive – I had no idea just how extensive until she had a closely analysed MRI as an adult. Up to 11 months, she was “fine” – though an expert could probably have told us that it was a very provisional “fine”. Once CP was diagnosed, it was a very long waiting game, with some aspects of her development and behaviour leading us to underestimate the problems she would have as an adult..

      It is quite possible, if you are lucky, to go through life unaware that a bad birth may have reduced your IQ by rather more than BF enhanced it.

      Needless to say, I can’t for the life of me understand why anyone would risk it.

      • attitude devant

        Aside: Lizzie, so nice to see you! You’d been missing from the comments for several weeks and I was missing your participation. Happy New Year!

        • Lizzie Dee

          Thanks! Still here, and reading.

          Happy New Year to all.

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

        Many who absolutely would not risk it, by choosing cesarean in the first place, are demonized.

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

          I’ve been told I don’t deserve to have children because I chose cs (during labor) and wish I’d scheduled it in the first place.

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

            The awful things we say to mothers and to women – I can think of little that is more hurtful. Sorry to hear that Kumquat, of all the reasons a woman would not “deserve” children, choosing a cesarean as one of them is absurd.

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

            Funny thing, it was a parachute troll who said it. But plenty has been said IRL too. I have been completely rejected by my former circle of friends because of my non support of ncb. I’ve been told to my face that I did not give birth, and that I only needed a cs because 1)I was induced, 2)I had an epidural, 3)I pushed on my back, 4)I didn’t trust birth, and, most damning, I said I loved my c section and wish I’d scheduled it in advance.

            Since my son’s birth, I’ve been deliberately excluded from all talk of pregnancy/birth, which, when you have young kids, is a LOT of talk. The women I thought were among my best friends stopped talking to me and I stopped being included in things like our weekly brunch dates. At this point I see them a couple times a year at major events. I go to these because I am still friends with most of their husbands and some of their kids. I come home sad every time though.

            This had a devastating effect on my life. Depression, terrible anxiety, anger. ..my marriage was strained, it was incredibly hard to parent without my entire support system, and I really still struggle with self image a lot. I have a hard time getting close to new friends because I don’t want to go through this again.

            So much for supporting mothers, eh?

          • Burgundy

            OMG that is crazy! I am so sorry that your formal friends are so ignorant and mean.

          • Maria

            Thankfully I haven’t experienced this with my friends, but I do have a hard time connecting with new mothers because I live in a very crunchy area and I feel like me loving my epidural and only breastfeeding for 9 months would make me too “conventional” for them. I am sorry you had to experience that! There is nothing worse than feeling abandoned by those you thought were there for you through thick and thin.

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

            Kumquat – that sucks. Truly. I’m sorry. I know too well of what you speak.

          • Amy M

            I’m sorry you live so far away, you could hang out with me. I don’t care about that crap and neither do any of my friends.

          • Siri

            That is beyond horrible. Even I can tell you’re an amazing mum and a lovely, loving, funny person, and I only ‘know’ you from your blog and here! How stupid can you get – fancy sacrificing your friendship for some ridiculous ideas. Harrumph.

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

            Hey, thanks for the support/validation. I feel like I whine about this issue a lot, but it still hurts so damned much and affects me daily. From the heart, yo, thanks.

          • The Bofa on the Sofa

            I can understand why it would hurt. It’s just so …. bizarre. The people who should be sources of support abandon who for, what exactly?

            I would think with everyone having young kids, that they would all be focusing on more important things than how they arrived. It’s just bizarre.

          • Siri

            You never whine. Talking about something painful isn’t whining. You reveal a lot of good things about yourself through your writing; blogging at its best.

          • An Actual Attorney

            Who said that? And did you punch them?

          • amazonmom

            What?!?!?!?!? Really?!?!?!?! People have been rude as hell to me but never dared to say something as awful as that.

          • Box of Salt
      • Certified Hamster Midwife

        I often wonder whether my mother smoking throughout pregnancy and my first few years affected my brain or my health in any way.

        • The Bofa on the Sofa

          To a first approximation, I’d take a Paracelsusian perspective and think about how much she smoked. It’s all about degrees…

          Then again, Paracelsus drank himself to death at the age of 40, so I don’t know if he knew what he was talking about. Or at least he failed to heed his own wisdom. That crazy Bombastus…

          • Siri

            They called him Mistah Boombastus. ..

    • Antigonos CNM

      The cause[s] of conditions like dyslexia and other learning disabilities [often all lumped together, but can be very different] is still unknown, although there are a lot of theories, and my own personal view is that ultimately a number of “triggers” will be found. So to blame learning disabilities exclusively on either genetics or hypoxia at birth would be rather dicey, at this point.

      But, as the mother of two children who have learning disabilities — my son who has a sort of diffuse mild dyslexia coupled with ADHD which made it worse, and a daughter with classical severe dyslexia — it would not surprise me in the least if intrapartum hypoxia is not discovered to be a major component.

      A lot of these kids who seem to “pink up” and do “just fine” after prolonged resuscitation and/or NICU treatment seem to have sequellae that don’t become obvious for literally years. Sally runs around like a maniac but didn’t begin to do so until 2 years of age ["just was a placid child"]. Billy couldn’t construct coherent sentences but could make his needs known with phrases, “he’s just not a highly verbal child”; Johnny doesn’t like to play ball games because he always swings or kicks at the wrong time; finds math more challenging than his younger siblings, gets lost easily and confuses left and right a lot. “He’s just clumsy” and “boys are like that”. People can live perfectly well with these traits; often no one even thinks that they are all that much odd [unless extreme]. But it might just be that a few too many cells died in certain parts of the brain at birth.

  • The Bofa on the Sofa

    IIRC, something like 5% of HBs still turn out being c-sections, right?

    So even if we use a c-section rate of 35%, that means that you are 7 times more likely to have a c-section if you are in a hospital, but you trade that for a 3 times increase in baby death and an 18 times increase in HIE.

    • Amy Tuteur, MD

      The current rate of 32% includes many planned C-sections for done for medical reasons. The likelihood of an individual low risk patient ending up with a C-section is far less, probably in the range of 20%.

      • The Bofa on the Sofa

        Yeah, I thought about that, but left it at 35%, since it certainly accounts for everything and it doesn’t change the conclusion.

        But yeah, if hospital vs homebirth only had a 4 times greater chance of a c-section, traded for a 3 times greater chance of death and 18 times greater chance of HIE, it is even more dramatic.

      • amazonmom

        The last number I heard from the head of OB at work is about 21 percent. Our overall rate is close to 40 percent but that includes all of our high risk and repeats. We have a huge MFM practice influencing our numbers.

      • WhatPaleBlueDot

        I’ve seen several hospitals with very high c-section rates that, when broken down, their rate of a first c-section is only 15% or so. You know, that magical, made up rate that supposedly is acceptable?

  • areawomanpdx

    wow. I have wondered about this statistic for a long time. We hear (relatively) a lot about the death rate from homebirth, but I have always assumed that the rate of brain injury was (relatively) high as well.

  • Susan

    Are major newspapers picking up this one? Powerful and scary.

    • JC

      Unfortunately, I doubt major newspapers will pick this up? Why? Because so few women have homebirths. Newspapers choose stories that may be important to the majority of their readers and the chances of that including homebirthers is pretty slim. I’m sure they’re much more likely to pick up stories about hospital birth because many more women choose this route. HB may be growing in popularity but it’s still pretty much a fringe group.

      • staceyjw

        Then why do they post all those stories showing the increased rate of HB?

        It’s a fringe with fingers into the mainstream.usually those they pick to write about it are fanatics and pushers of lies.

  • PrimaryCareDoc

    Wow.

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

    Now Dr. Amy – we all know that the really important things to avoid in birth are cesarean sections and interventions! I mean these things have been shown to be the root of all real evil, like breastfeeding difficulties and you and I both know that formula feeding is the path to obesity, tooth decay and cancer. And why should women actually be provided informed consent by being informed of these other serious but rare complications? I mean it is just their bodies and their babies at stake. Oh, and did I mention that homebirth and vaginal delivery saves money, and surely nothing can be more important than thrift when it comes to the health of women and children. (Note: this is sarcastic, but sadly accurate of what seems to be current thinking on birth in North America).

  • Dr Kitty

    Big CIs ….

    At best HB only doubles or trebles the risk…at worst it is 200 times worse.

    At face value it looks like a well done observational study with good efforts to match controls.

    Any easy way out for the NCB crowd, of course, would be to say “but no HB babies were sent to the OTHER places that do cooling” (if that is the case)..which makes sense to people who don’t understand statistics (if HB accounts for only 0.5% of births and other cooling centres see only a handful of cases a year, they SHOULDN’T see any HBs. Of course, if all the other cooling centres ALSO got a higher percentage than 0.5% of HB transfers too…well it looks even worse.

    I think it would be an excellent idea to collect this data on a national level.

    • Antigonos CNM

      I would be happy if it could be collected even if restricted to a number of states, since a statewide sample would be better than a city-wide sample.

  • me

    My niece’s child had to have cooling therapy (hospital born). She had refused c-section after a prolonged labor (not sure on all the details, I believe the pushing stage was prolonged – first baby). Thankfully my nephew ended up being okay, and is now a healthy, happy, almost 2 year old, but I remember being flabbergasted by the whole thing. I was pregnant with my third child at the time, and while I understood wanting to avoid c-section, I just can’t wrap my head around listening to a doctor tell you that your baby is in trouble, but still refusing a c-section. Her mom (my sister) had 4 kids (3 vaginally, her youngest by cesarean) and let’s just say she never was wrapped too tight. I could see her filling my nieces head with nonsense about how much “better” vaginal delivery is…. I’m just glad the near miss didn’t result in permanent damage. I guess I’m sharing this to point out that even in the hospital, if the mother is steeped in woo, I wonder how many cases of hypoxia are the result of refusing intervention that could prevent the need for cooling therapy in the first place. All the appropriate intervention in the world won’t prevent these things if mothers are refusing them because they seriously don’t understand the ramifications…

    • AlisonCummins

      My understanding is that for some women, the need to have as many children as god gives them is foremost, and since god giveth and taketh away it’s ok if a baby dies or is injured during birth as long as the mother’s uterus is preserved intact so that she can have sixteen more babies.

      Women from these religious cults are overrepresented in the NCB community and will speak as if it’s obvious that a c-section is unacceptable in any circumstance but don’t say that the unacceptability is purely religious. (Which is odd, because their goal is to produce more children than non-cult members, so you would think that they would want to emphasize to non-cult members that it’s PERFECTLY FINE to have a c-section.)

      Non-cult members hear these assumptions over and over again without deconstruction and just assume that c-sections must indeed be bad.

      • Former NCB Tryue Believer

        This was not true in the NCB subculture that I escaped from, hardly anyone was religious at all, though I do not doubt that people with these belief systems exist. I just haven’t met them.

        It is sad since scripture praises women for their faith, loyalty and willingness to put themselves at risk to do what is right. I don’t see any examples in scripture where a women was singled out as an amazing for having a bunch of babies, though That may have been a cultural expectation. Instead, women that didn’t meet those ideals were blessed and shown to be worthy.

        I think my point is that people try to justify their beliefs and mix them with their religious background as a justification. There really isn’t any basis for this. I’m a conservative Christian and these folks are really missing the point, I guess is what I’m trying to say. Ironically, I was an agnostic when I was a NCB worshiper.

        • AlisonCummins

          Ina May Gaskin is one, isn’t she? Did anything she said/wrote influence any of the discussions you had?
          I’m thinking of quiverfull-type cults, not simply religious conservatism.

          I know of a jewish atheist who started homeschooling her children when she moved to an area where the public schools weren’t great. She explained that she was doing this even though she doesn’t particularly enjoy the company of children “because parents are responsible for educating their children. It’s lazy and irresponsible to let schools do it for them.” Which it turns out is rhetoric from the christian homeschooling movement and a distortion of an old testament quote. She was repeating something that sounded good to her without realizing where it came from or what the rationale was.

          • me

            Honestly, I think my sister’s perceptions of c-section stems more from her own experience than anything else. She’s not religious, nor is she opposed to BC or anything of the sort; she has four kids for the same reason I have three – we’re very fertile; 2/4 of hers were unplanned, 2/3 of mine were unplanned ;). I do sympathize with her, on the one hand; after 3 uneventful vaginal deliveries, few would anticipate the fourth delivery landing you in the OR. And I’m sure her recovery was no picnic (being older, having MS, and three older kids to care for at home).

            I will always wonder why my sister would think it would be okay for her to accept surgical delivery due to prolonged pushing, but then discourage her daughter from accepting the same intervention for the same complication. Then again, I wasn’t there and do not know for certain how much of it was truly my niece’s decision vs how much of it was the message she got from my sister. If the message from my sister was complimented by a healthy dose of NCB rhetoric, well, that’s a really bad combo. And to be fair to my sis, that was likely the case. It’s easy to get sucked into the woo, especially when you are young and having your first child.

          • AlisonCummins

            Yeah, that’s kind of what I was thinking.

            I don’t know personally know very many people who have being a grand multipara as their primary goal for their time on earth, but if I were to get onto some of those NCB boards for some other reason — trying to find out more about what my mother was ranting about, for instance — I imagine I would become exposed (directly or indirectly) to some of their thought processes pretty quickly. Because we both agree about A, when they say B I may assume we both agree on B too, especially if I’m not very critical.

          • Former NCB True Believer

            Surprisingly I have never read anything by Ina May Gaskin, so I’m not sure. She seemed a little nutty to me even then. :)

            There are lots of secular/liberal homeschoolers with views like that! I don’t think it is unique to the Christian homeschool movement, but then again I only really hung out with the Waldorf school types. Maybe because we met at LLL instead of church.

          • Trixie

            Waldorf isn’t secular, though. It’s the educational arm of the anthroposophy movement, which, if not exactly a religion, has many many trappings of one.

          • Dr Kitty

            There is a Steiner school nearby.
            It used to be where the middle class kids with ADHD and ASD went.
            They’d struggle in mainstream school, someone would suggest medications or special education and the parents would throw their heads up, say that everyone was misunderstanding their special snowflake’s unique gifts and enrol them in Steiner, where you basically do whatever you want to. If you can’t read at age 14 because you’d rather line up toys in a row, or run around in circle, or play soccer, or finger paint, well that is FINE.
            The adults I have met who went to it…a nice description would be naive and unworldly, an accurate description would be unable to function as independent adults.

            I have been told that some Waldorf/Steiner schools are excellent. The local one might be an aberration, but colour me unimpressed.

          • Trixie

            At ours nearby, you fill out an enrollment questionnaire including what the child’s birth experience was like, and how long he was breastfed. This is so the teachers can treat your child differently based on how natural of a mother you are. I’m not making this up. Also, you have to go to parent education nights on the benefits of raw milk and selective vaccination. And they think children under 7 should never be told facts about things, but instead you should tell them little gnomes are inside of machines to make them work. Steiner was seriously nuts.

          • The Bofa on the Sofa

            ouch

          • Burgundy

            Wow, do they really think their kids are that stupid? Even my 6-year old daughter knows how a radio or an ipad works.

          • Trixie

            It has something to do with the child’s astral body not being fully descended from the ether yet. Or I might not have the terms exactly right but basically they think you’ll scare off the child’s soul from entering its body if you bombard it with too many facts. Like I said, the whole thing is nuts.

          • Burgundy

            That is crazy!

          • Sue

            How do people STOP bright kids from learning to read? You would need to blindfold them to stop them absorbing the world around them, or refuse to answer their questions. Cruel, in my view.

          • The Bofa on the Sofa

            Wow, do they really think their kids are that stupid? Even my 6-year old daughter knows how a radio or an ipad works.

            Whenever something isn’t working, my three year old says, “We need to change the batteries”

          • Amy Tuteur, MD

            Years ago when I had a strep throat and fever of 102, I told my 3 year old that I was too tired to play with him. He suggested that we change my batteries so I would have enough energy to play.

          • The Bofa on the Sofa

            Batteries and duct tape. Is there nothing they can’t solve?

          • Dr Kitty

            My kiddo suggests we re-charge the cat when it falls asleep during the day!

          • Amy M

            We went to a local science center when the boys were about 2.5. There is a train there, that goes around the grounds. It was broken and one of my children suggested changing the batteries, to the delight of his grandparents who were with us.

          • Box of Salt

            “they think children under 7 should never be told facts about things”

            Wow. I’ve been telling my children facts since they learned how to ask questions (i.e., they could speak).

            Are the goal to teach there, or to indoctrinate future cult members?

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

            They also believe children shouldn’t be taught to read before seven! It’s nuts. We have given factual, accurate answers in age – appropriate terms and depth. I had enough trouble building the Santa mythos, I can’t imagine telling him that gnomes ran his computer! Not to mention that he is a BORN skeptic and hasn’t taken a thing on faith, like, ever. Maybe if I’d trusted birth more he’d be more gullible.

          • Trixie

            I stopped trying to sell Santa by like age 3. He saw right through it, and I was losing credibility. So I just gave up.

          • An Actual Attorney

            A friend was extolling the virtues of Waldorf by telling me if they even found out that your kid watched any TV anywhere, little darling would be expelled. No thanks. My government is enough Big Brother for me.

          • Trixie

            Oh yeah, I forgot about the TV bit.

          • Siri

            My child’s birth experience? Wait, let me ask him. Hmmm, says he can’t remember. That’s bad. Must have suppressed those memories…

          • Mel

            I teach. I would need a survey to tell me about birth experience and breastfeeding for each of my students I’d never know from their classroom behaviors. I might be able to figure out raw milk/selective vaccination but only because of reoccurring gastrointestinal illnesses and being the only HS student born inside the USA whose had chickenpox.

            BTW, it makes me really happy that less than 1% of my students have ever had chickenpox.

          • The Bofa on the Sofa

            BTW, it makes me really happy that less than 1% of my students have ever had chickenpox.

            That’s amazing. I remember growing up how chicken pox would take out basically half the class over the course of a month, with always 4 – 5 students out at once (out of a class of 20)

          • Trixie

            Another foundation of anthroposophic medicine is that the fever from childhood illnesses causes a child to spiritually advance. Thus they encourage you to decline the MMRV.

          • T.

            I went to a Steiner’s school for a couple of years. There were MANY strange kids, but I was strange too.
            Still it wasn’t unplaesant, and I did learn some intersting and useful skill. We learnt how to sew and latin for example.

          • Dr Kitty

            I have a GCSE in Latin from my state school.
            Can’t say I’ve ever actually USED it…

          • The Bofa on the Sofa

            I have a GCSE in Latin from my state
            school.

            Can’t say I’ve ever actually USED it…

            Reminds me of The American President

            “Esther, do you speak French?’ – President
            “Latin.” – Ester
            “I thought you spoke French.” – President
            “No, Latin.” – Ester
            “Great, the next time Julius Caesar comes to town, you’re our gal.” – President</blockquote

          • Dr Kitty

            Oh wait…no, I’ve used the Latin to work out some dreadful puns.

            So slightly more useful than my diploma in European Studies, which consisted of learning the ins and outs of the Schengen Agreement and getting slightly drunk on a school trip to Galway without our teachers noticing (we were 18 and they specifically told us which pub THEY would be in so we could avoid it, so I’m not even sure it counts as teenage rebellion).

            Maybe Waldorf would have been better…

          • Siri

            You went on a trip to … Galway? For European Studies. Still, I guess it meant you got to buy drinks with euros. Wouldn’t you have preferred France or Germany though? I grew up in Norway, and we’d have been miffed if they’d fobbed us off with Denmark or Sweden as school trip destinations.

          • Dr Kitty

            I know!
            It wasn’t even Euros, it was Irish pounds back then.
            We were “twinned” with a school in Mayo so it was because of that.

            We did get proper school trips to France and Italy, this was just a quick visit.

          • T.

            Me being Italian, Latin is actually quite useful. It had been very useful in learning French and Spanish :)

            Also, I don’t think everything needs to have a use. If we would only fund “useful” things, then a good 50% of all science would be completely de-funded.

          • guest

            That’s weird. I find a lot of unschool-minded people who have that idea about Waldorf end up with a pretty sharp shock. Waldorf education is supposed to be in line with development, but it’s not at all child-centric or “inquiry led.”

          • Trixie
        • Trixie

          A lot of it just goes back to Every Sperm is Sacred and Onan spilling his seed on the floor. The sex act without the possibility of procreation is against god’s will. Or so the thinking goes. Although some will accept periodic abstinence, others, like quiverfull, reject even that.

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

            Procreation, not recreation!

      • me

        Well, my family is certainly not religious, lol. I know my sister’s c-section was unexpected (after 3 uneventful vaginal deliveries) and I imagine being older (over 35) and having three little ones to look after at home made the recovery harder than it might have otherwise been. And she’s a total drama queen to begin with, so I’m sure my niece got worst possible picture of c-section possible, while her mother waxed poetic about vaginal deliveries, and my niece was pretty young (20) and impressionable, so I’m sure she took her mom’s word as gospel. It’s too bad she didn’t get a more honest, less c.r.a.z.y. view of her options. I just hope her little one ends up okay later down the line. so far he’s doing well and I take that as a good sign.

      • Trixie

        Since you can only have so many c-sections, this is a big reason why many of these people will try to HBAC if they can’t get a hospital to go along with their VBAC. Or often even if they could try for a hospital VBAC. Because you’re supposed to get right back on that horse and keep trying to push out babies, even if it means risking leaving your existing kids motherless.

        • Mac Sherbert

          That is true, but not in all circles of the “The Lord will give us as he sees fit”. The Duggar mom has had csections. Although, I believe her DIL had home births. I have friend that is religiously against birth control, but when one of hers was breech she didn’t think twice about getting a csection, if the baby didn’t turn.

          I think these religious groups that advocate these large families and NCB are really the fringe of the fringe. Most would describe my church as very conservative, but you will not find these ideas there. The church membership is made up of doctors, nurses, teachers, engineers and quiet a few other science and medical based professionals. If I got a crazy notion for HB2C, there’s a nurse that would be at my door tomorrow!

          • Trixie

            She’s had c sections, but then she’s also had HBACs. I think even after multiple c-secions.

      • choices

        I was strongly suggested to have an HBAC with current pregnancy and it was all a faith based thing. That God would protect my baby and myself, that I was made to labor at home, etc. However, no matter how empowering the faith based talk made part of it a beautiful thought, I couldn’t marry myself to the idea. I think medical care and science should not be frowned upon to go rogue. Thoughts of my baby being delivered with complications would not leave my mind. What will this child think at 27 about Mom trying home birth? My guess is this child would rather insist on having the best opportunity to thrive possible. In the end, although hospital birth is not the cozy homebirth experience the NCB group sings about, I know I can handle it. I have more peace about it. Although it seems in others eyes I will not get the *faith points* I realize doing so would be more of giving into peer pressure rather than my personal faith. And I really can’t get into the whole “trust birth” slogan with a few safety belts to help the journey.

        • amazonmom

          I was told not to tempt the Lord and to choose one of the options that my OB thought was reasonable when I mentioned HBAC in passing. Playing games with the life of my child would probably get me an intervention at church and at work. I am speechless when I see people choosing a reckless path thinking God will swoop in and give them the outcome they want.

          • Siri

            Told not to tempt the Lord, I like that! I’m sure many, if not most of the girls and women dying in labour as I type are praying desperately to their God, any God, for deliverance. Yet privileged crunchies assume that THEIR God will see them right in spite of reckless choices…

    • T.

      I don’t want to throw water over fire, but it is a tad early to say the child escaped completely unscathed… I HOPE so, but he may find out he has problems down the road -probably when he’ll start school-

      Lets hope.

      • me

        Yeah, I am hopeful. He seems on target developmentally so far. But you are right, he’s not entirely out of the woods yet. I hope, for both their sakes, that he really is okay.

  • Gene

    My first thoughts on this involved wondering how they classified homebirth transfers (the ones planned at home, ended up delivering at the hospital). I can’t read the paper I home.

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

    I wish there was this much evidence against out of hospital birth when I got pregnant.

    • SkepticalGuest

      I agree. If someone had said, “Your baby is 18 times more likely to have a brain injury if you try to give birth at home,” I would’ve planned a hospital birth in a heartbeat.

  • madwife

    Being cooled is just a variation of normal.

  • SkepticalGuest

    Hoping Dr. Amy or someone else can clarify this:

    “In other words, homebirth increased the the odds of a baby needing cooling therapy for brain damage due to lack of oxygen by more than 18 fold!

    When compared with babies born vaginally in the hospital, babies born at homebirth had a rate of hypoxic brain damage 32 times higher, suggesting that C-sections dramatically decreased the risk of hypoxic brain injury.”

    It seems to me that if homebirth increases the risk 18 times compared to HOSPITAL birth and 32 times compared to VAGINAL HOSPITAL birth, the difference between HOSPITAL C-SECTION and homebirth would be LESS THAN 18 times.

    In other words, I would not conclude that C-SECTION “dramatically decreases”, because it would seem that MORE babies have brain injuries with c-sections than hospital births.

    Of course, I wouldn’t conclude that c-sections were problematic…since it’s an intervention performed when baby is in distress, it’s no surprise that a larger percentage of c-section babies would have a brain injury.

    I’m just confused about how this data shows that c-section “dramatically decreases” the risk of brain injury.

    Anyone?

    • fiftyfifty1

      “When compared with babies born vaginally in the hospital, babies born at homebirth had a rate of hypoxic brain damage 32 times higher, suggesting that C-sections dramatically decreased the risk of hypoxic brain injury.””

      I took it to mean that the rate of a hospital-born vaginal-born baby needing cooling is really low because all the babies in the hospital who had bad strips (early signs of not getting enough oxygen) were appropriately given c-sections before the lack of oxygen could cause brain injury that needed cooling. So basically the hospital is doing a good job finding the at-risk babies and giving them the intervention (c-section) they need.

      • SkepticalGuest

        Ah, yes, that makes sense! Thanks, fiftyfifty1.