The birth was the most beautiful, intense experience; too bad the baby died

whatever in letterpress type

It’s very early in the year, and I’ve already heard about two homebirth deaths. The latest was revealed on Reddit:

… active labor was the most beautiful intense experience – the baby had perfect heart fetal tones until crowning where hft dropped to 70 -born unresponsive with heart rate of 90 -3 tears, 8 stitches, 1 of them 2nd degree -child died at hospital

It wasn’t a beautiful experience for the baby, who was dying for minutes or perhaps hours before birth. The baby apparently succumbed to that strange homebirth epidemic that never occurs in the hospital: the baby with “perfect heart tones” who unexpectedly falls nearly dead into the clueless midwife’s hands.

I wrote about similar cases on:
December 27, 2013
September 13, 2013
June 21, 2013
April 29, 2013
March 22, 2013
March 7, 2013
September 28, 2012
August 29, 2012
July 9, 2012
May 10, 2012
December 26, 2011
September 21, 2011
August 31, 2011
July 28, 2011
May 20, 2011
March 24, 2011
February 24, 2011

That’s 17 times in the past 3 years alone that a baby unexpectedly dropped into a homebirth midwife’s hands either dead or nearly so. I have never seen this happen in a hospital. I have never even heard of this happening in a hospital.

What is the mother in the latest homebirth horror story upset about in the wake of her baby’s death?

I was also transported to hospital where I receive two unnecessary pelvic exams

The mother had appeared on Reddit several months before to wail about the “culture of pain” surrounding childbirth:

FTM here looking to have a med free home birth, utilizing visualization, deep breathing and meditation techniques.

I understand this experience is going to be intense, I understand that I have no concept of this experience because I have never gone through it. However, I do not understand why people want to push how much pain I’m going to be in. I’m doing my best I be polite. Explain while intensity will be involved prior events in my life have shown me the amount if pain I feel does seem to be connected to my state of mind. Fear–> anxiety–> tension–> pain DO seem to be correlated. Relaxing ones mind has helped “deal” with things.

And:

This may be my only time I experience this. It’s a thing so intense I could die ( not that I plan to) , and I will be a gateway for a tiny human to enter into the physical plane after having grown inside me from a seed, I’m totally looking forward to this!

As she had hoped, she found labor to be a beautiful, intense experience. Too bad the baby died so she could have that experience.

  • wuzzi

    When I was in labor with my son, his heart beat would fall dramatically with EVERY contraction. They had me start pushing early, did an episiotomy and used suction to get him out more quickly. They immediately rushed him away (I hadn’t had his gender shared with me before birth, and can remember asking to at least know if it was a boy or girl, but things were so shaky no one would even tell me that) for oxygen, etc., and returned him almost ten minutes later.

    I can’t imagine what would have happened in a home birth. :(

  • Doctor John Smith

    They can’t just decide that “Oh, I’m going to have a good experience, and be independent and deliver the baby at my home.” You can’t just do that. You need to actually have the right equipment and have the right knowledge so the baby, or you doesn’t get injured or die.

  • LMS1953

    A little OT but pertinent. Dr Amy has often said that the hallmark of midwives reasoning powers is that if they can do it, the intervention is GOOD. If they can’t, then it is BAD. Here is a case in point. As part of our Maintenance of Certification, we are required to read two or three dozen articles each year. This is one of last year’s articles:

    http://www.ncbi.nlm.nih.gov/pubmed/23107610

    Is maternal posturing during labor efficient in preventing persistent occiput posterior position? A randomized controlled trial.

    CONCLUSION:

    Our study failed to demonstrate any maternal or neonatal benefit to a policy of maternal posturing for the management of OP position during labor.

    I have witnessed CNMs put their “clients” (I was admonished for referring to them as “patients”, so I asked, “Does a BP of 160/110 or a post partum hemoglobin of 6.0 make a client a patient? for which I was written up) through the Hokey-Pokey – put your right leg out, put your left leg in, go to knee-chest position and then you turn it all about. It turns out EVIDENCE BASED MEDICINE shows that none of that makes a jack of difference. Do you think they will have the intellectual integrity to cease and desist? Please keep some O2 on standby while I hold my breath.

    • The Bofa on the Sofa

      In lieu of reading the paper, my question is, compared to what? What’s the control here? “Strapped to the bad flat on her back” (ha ha – that’s a joke, son)

      But seriously, what was the control group doing?

    • The Computer Ate My Nym

      “Does a BP of 160/110 or a post partum hemoglobin of 6.0 make a client a patient?

      It depends…was it hemolysis or exsanguination that brought the hgb to 6?

      • LMS1953

        Who the hell knows? The idiot midwives refuse to get admit CBCs because “pregnancy is not a disease” and “it does not give positive affirmations to the birth process”.

      • fiftyfifty1

        Good point. Exsanguination is a variation of normal in my opinion, so the woman should remain a client. Hemolysis, however, is a condition of nasty, unhealthy, lesser creatures who probably deserve what they got because they didn’t eat enough kale. You may refer to these women as patients.

    • Mishimoo

      My CNMs didn’t make me do the hokey-pokey, but then, they didn’t ‘make’ me do anything. They just hung out with us, joked, and made sure that we were safe. That did include some interventions, but I asked for those before they suggested them.

      • expat

        I had cnms who made me do the hokey pokey. It was like: that hurts more? Oh, lets try that again! For 2 hours.

        • Mishimoo

          That’s awful! I wish I could share mine with everyone, they truly were/are awesome. The only time that they shifted my position was to move the head of the bed down for a McRoberts Manoeuvre with the last one, but I didn’t count it because I didn’t have to make the effort to move.

          • sarahh.rosanne@gmail.com

            The CNM suggested we play tug of war with a sheet with my second baby. We did for it for at least an hour. It brought a sense of playfulness to the proceedings but was unsuccessful.

    • Trixie

      I’m not being snarky, I’m actually curious: is there any evidence for any type of position or exercise to rotate an OP baby before labor?

      • LMS1953

        I am sure idiot midwives can give you dozens of Ina Mae articles that say there is. I think one of them is to stand on your head while the midwife burns hogwart over your right lesser toe and your significant other looks up placental encapsulation providers on the Internet

      • LynnetteHafkenIBCLC

        Not what you asked, but Dr Amy posted a study a while back that laboring upright was associated with more pelvic floor damage.

      • toni

        The NGM says on her blog that she thinks sitting in reclining chairs during pregnancy has contributed to more babies being born in bad positions. No idea how true that is or even if more babies *are* OP these days. It was just something she said she noticed when she was practicing. That more and more babies were diagnosed(?) as OP.

        • Trixie

          I’ve read that elsewhere, and wondered if there was any truth to it.

        • Mishimoo

          Anecdotal, but the CNMs at my deliveries all had a minimum of 10+ years experience and all remarked on the rarity of my OP babies.

      • Becky05

        There is no evidence for any prelabor anything. There is some evidence that certain positions may help OP babies turn into an OA position during labor. The effect doesn’t last long enough for positioning to be used prelabor.

        • theadequatemother

          I did pelvic rotations on a Pilates ball during my induction until I felt the head engage because I had some idea in my head that if I put myself does ally recumbent before that he might engage in an unfavourable position. It did not, as an idea serve me well. From head engagement to baby was 27 minutes…3 minute second stage. Should have just gotten the bloody epidural when I had the chance.

      • Ob in OZ

        No evidence before or during labor…at all. As in, everything that has been thought to be helpful and then studied has not been helpful…at all.

        • Trixie

          Thanks. In NCB everyone acts like if the baby is in a bad position it was your fault for not trying hard enough.

    • Allie

      I got my prenatal care through a birth program that was a little bit woo except that all the participants were expected to give birth in hospital (a specialty maternity hospital that is the best in our province) and we all filled out our admission forms in advance as part of the program. The program includes family doctors, midwives (I’m in Canada, where midwives are university trained and deliver babies in hospital) and doulas. At one of the group sessions, they brought in a doula who is also a Tahitian dance instructor. She taught everyone some Tahitian dance moves (they kind of look like the dancing in the commercial for the yogurt that helps you poop) and swore up and down doing Tahitian dancing in your last trimester would ensure proper positioning of the baby. I don’t know if it’s true or not, but it’s certainly a perfectly harmless activity, so falls under the category of can’t hurt. She swore it worked and said as a doula she had never spent more than 8 hours in hospital. She also advised against sitting in reclining chairs.

      • LMS1953

        How do you know that it is a harmless activity with certainty? Have you done a controlled double blind study to see if it is safe and has any effectiveness whatsoever that might outweigh the risk? Only EVIDENCE BASED MEDICINE need apply. We do not allow common sense, cultural heritage, knowledge gleaned through years of experience. No-sir-ree-Bob

        • Allie

          LOL, I suppose I am just ASS-uming it is harmless, and we all know how that goes. In truth, I didn’t do it although I did make a point of sitting up straight for my last trimester. In the end, I was pushing for 5 hours : l Towards the end I was praying for some intervention of some kind, but they avoid interventions like the plague at that hospital.

          • Young CC Prof

            Actually, there is a place for “common sense” in evidence-based medicine. Controlled trials are the gold standard, but we don’t always have them. In the absence of proper controlled trials, we rely on weaker types of studies. In the absence of any studies, that’s when it’s OK to use things like anecdote, basic science plausibility, and, yes, good old common sense to make decisions.

          • LMS1953

            Yeah, right. I had a 19 y/o G-2, P-1 at Unicorn General. She had chosen the ‘physician” rather than the CNM service. She came in with SROM at 35 weeks and required Pitocin augmentation. Unicorn General does not provide labor epidurals. She slowly and agonizingly progressed to complete and she pushed for three hours. The rules used to be that a multip without an epidural should deliver within a 2 hour second stage, then you need to start to make plans to “do something”. It was obvious to me that she was cutting back on her pushing efforts when her perineum stretched to the point of tearing and she did not like that sensation. I assessed that she needed some local lidocaine and a small episiotomy. Every time I looked over to get the syringe, needle, lidocaine, etc the ‘nurse”?, “service provider”? gave me a scowly look as if I was using a power drill to put holes in the baby’s head. I cut a small episitomy – you could barely fit a sugar cube in it. The baby delivered uneventfully on the very next push – as it probably would have an hour earlier if I had intervened then. I was pariah from that point onward in that L&D. You see, EVIDENCED BASED MEDICINE says episiotomies are BAD and your 30 years of experience are worth jack squat, “Doctor”

          • Medwife

            No labor epidurals? Are you in the US?

          • LMS1953

            Yes. It was in Vermont. I had asked the same question. They said they were getting an epidural service. They did not. We parted ways.

          • JC

            With my first, my OB held a mirror up and showed me that the baby just wasn’t coming out. Close, but not quite. She asked if she could cut a small episiotomy. I said “Sure!” She did it, the baby came flying out. I healed just fine. No problem. I understand that this used to be a fairly routine procedure and didn’t always need to be done, but I don’t understand why it has the reputation of always being bad.

      • C T

        Tahitian? The kind where you’re quickly straightening your legs alternately and so your hips wiggle like crazy? Perhaps she taught you more hula style. At least I hope so. Ever since my OB told me about a woman in labor who bounced on her birthing ball at the hospital and broke the umbilical, resulting in a dead baby, I’m more cautious about jerking movements while pregnant.

    • Lori

      The “client” business is a general nursing profession thing. It depends on the age of the nurse whether s/he was exposed to it in school. I think it leaked over from the philosophy that patients are actually customers or whatever. Anyway, I stopped using the term as soon as I was out of nursing school because I despised it but now that I’m doing my masters of nursing I’ve had to trot it out again because the term is very popular in academia it seems.

      • Dr Kitty

        They like “service user” in psychiatry, which is even more clumsy.

        I still like patient and will use it unless the patient tells me that they prefer I don’t.

        • AlisonCummins

          I don’t like someone who isn’t a doctor or being supervised by a doctor calling me a patient. Ever.

          In other circumstances it depends. If I’m sick and need treatment I’m definitely a patient. If I’m getting a preventive flu shot on my own initiative it’s less obvious. I appreciate that in a clinic everyone who isn’t staff is a patient and I don’t object, but “patient” does have connotations that I don’t always appreciate.

        • AlisonCummins

          I am an SDM (Substitute Decision-Maker) for a user of psychiatric services. “Service user” might feel clumsy to you but for someone with a chronic illness who requires different kinds of services whether well or not, it’s better than “patient.”

          Need help finding a place to live? Lots of people do. Need help getting regular meals? Lots of people do. (Are Meals on Wheels clients all called “patients”?) Need someone keeping an eye on you to see if you need medical intervention? Now we’re getting closer, but the person keeping an eye on you is not a medical professional. Oh, now we’re in jail behind bars – definitely not a patient. We’ve been moved to a hospital and under chemical restraint? Ok, a patient now but… given that all these other services are often simultaneous and people from different professional domains collaborate to help the same person, it can be clumsy to refer to the person as a client, service-user or self-advocate most of the time and all of a sudden switch to referring to them as a patient depending on who’s talking or what their bundle of needs happens to include at a particular moment.

          In a chat with a social worker I worried that I tend to err too much on the side of self-determination. The social worker laughed and reassured me that this was fine, that in psychiatry most everyone else is erring on the side of intervening in someone’s life for their own good and that my error probably brings needed balance. I think “service user” is another way of bringing in needed balance.

          • fiftyfifty1

            I agree with you on this. If changing language will help people feel better about the services they receive and help my interaction with them go smoother than I’m all for it. People may call it Orwellian, but I don’t think so because it isn’t about hiding or lying about what’s going on, but rather using a term that is more respectful or nuanced. Getting upset about having to change terminology with the times is a waste of energy: Yes I know that the terms “retarded” and “negro” used to be the standard terms. Now they are not. Time to change.

      • LMS1953

        My response was that “clients” were served by people like lawyers, card readers, hair dressers and prostitutes. Since I am a “doctor” I serve “patients” and I will refer to them as such. Of note, at that institution, I was referred to by my first name on ALL occasions by EVERY level of staff. It came across as a Chairman Mao cultural re-indoctrination. And I was treated like a Capuchin monkey on a chain to come do a C-section or repair one of their complex, stellate lacerations (all episiotomies are BAD) whenever the CNM decided to pull it. My input was otherwise disdained – except by an occasional “patient” who was delighted to finally see a well-trained, friendly, caring “doctor”. But the stench of unicorn farts was overpowering.

      • LibrarianSarah

        Something very similar has occurred in librarianship but instead of “clients” they use the term “customers.” I remember when I was at a conference and one of the librarians from one of the “cutting edge” schools said that they switched to calling students “customers.” I remarked that the customer is always right but students only think that they are always right and we shouldn’t encourage them.

  • Are you nuts

    OT but I love this story – mom with a PhD in neuroscience learned that the flu shot has been deemed safe for people with egg allergies. She walked through the scientist rationale and the mom rationale, and eventually vaccinated her egg-allergic son because she felt that strongly about him being vaccinated against the flu.

    http://www.slate.com/articles/health_and_science/medical_examiner/2014/01/flu_vaccine_is_safe_for_people_with_egg_allergies_why_i_vaccinated_my_child.html

    • thepragmatist

      As soon as I was given go-ahead by two peds allergics, I shot my kid full of the evil flu vaccine. Too bad it didn’t stop him from having every single daycare borne illness this year. At least it wasn’t influenza! Whoot!

    • The Computer Ate My Nym

      Off the off topic, but…I got the flu shot early this season. And got the flu a couple of days ago. Proof, PROOF, that the flu shot’s a failure, right? Well, no. I was sick for two days, not a week, did not go into cytokine storm, did not get secondary pneumonia, and no one else in my household (so far!) has contracted it. Pretty damn effective, if not the 100% I would have liked (especially a couple of days ago!)

      • Are you nuts

        I got mine early too. I have since become pregnant and every time I see someone hacking or hear about a co-worker with the flu, I think THANK GOD I got one! I would be a nervous wreck as bad as this flu season has been.

    • PollyPocket

      My eldest tested positive for egg white, egg yoke, and whole egg (yes, all three are tested separately). But he was born at 35 weeks and respiratory stuff scares the crap out of me. So we gave him the flu shot with epi handy, and didn’t need it. Repeat x 7 years!

  • Siri

    OT: (Certified Hamster Midwife, please look away): My daughter’s science teacher kept a hamster called Enzyme in a cage in her classroom. Recently, Enzyme ate some Blutack and died. Teacher, wanting to check he was really dead, BROKE HIS BACK and put him in the wastepaper basket. She considered dissecting him, but decided against it.

    Later, some kids heard rustling, and spotted a ‘ginger rat’ in the wastepaper basket. It was Enzyme, alive and well. Teacher had already got a new hamster, so bought Enzyme a palatial new cage to make amends.

    I don’t know whether to laugh, cry or find another teacher for my impressionable 15-yr-old daughter.

    • Amy M

      If you don’t know how to CD, don’t do it. If you DO know how, it’s a very humane way to euthanize.

      • Siri

        Thanks, Amy! What’s CD, confirm death?

        • The Computer Ate My Nym

          Cervical dislocation?

        • LovleAnjel

          You pop their neck vertebra apart – the lab hubby works at uses it after they’ve used carbon dioxide to sacrifice the animal, not as the primary method. It’s easy to screw up.

      • Certified Hamster Midwife

        Yes, it’s a quick and easy procedure IF YOU KNOW WHAT YOU ARE DOING.

    • Certified Hamster Midwife

      Some hamsters just weren’t meant to die.

      • Siri

        Lol!

    • Rochester mama

      obviously she should become a chiropractor, a simple adjustment allowed his body to clear the toxins.

      • Young CC Prof

        You have won the Internet today.

      • Siri

        Haha, that’s brilliant! A round of applause for Rochester mama. :-)

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

    OT – but knowing many of those here are doctors and mothers, thought many of you might appreciate this “How Motherhood Made Me a Better Doctor” – https://medium.com/p/d369025d9aa1

  • Scrunchy mom

    Truth is, you can have a great birth experience at the hospital. I had 2, and they were amazing! The nurses were very caring and supportive, the doctor discussed every intervention with me. With my first one I went into labor at night, and my OB who took care of me throughout the pregnancy drove to the hospital at 2am to deliver the baby (my OB delivers all “her” babies). My second baby cried every time I put him down, so the nurse offered to hold him so I could take a nap.
    Some of my friends watched business of being born, and they believe that everyone in the hospital is out to get them and push all kinds of interventions, but reality is (at least my reality was) quite different.

    • guest

      Me too, and my doctor was even supportive of my wishes to have a natural birth. The difference, though, was that she told me when it wasn’t safe anymore, and “interventions” were necessary. (Note: interventions didn’t mean a C-section.) I didn’t get my all-natural birth, but I got the closest thing I could get to a natural birth while still having a healthy baby. I am very grateful to my doctor for both her medical expertise but also that she wanted to respect my wishes as much as possible. Not exactly the picture painted in BofBB of doctors trying to rush things along on their terms with no consideration for mom’s wishes.

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

      It is the definition of insanity….

    • The Computer Ate My Nym

      Let’s see: A woman dies of a (probably pregnancy induced) PE, she has a living will that states that she does not want to be on life support, she’s DEAD–brain death confirmed, the fetus has virtually no chance of being neurologically even slightly intact, the husband wants her taken off…and a bunch of old, white men* decide she has to be kept “alive” to torture her poor husband because fetus. Yep. Pretty enraging.
      *Who would, almost certainly, have denied her coverage of, say, lovenox, which might have prevented this whole episode in the first place and will certainly deny the child coverage for any care it needs if it survives. Because they’re so pro-life, you know.

      • The Bofa on the Sofa

        Are you sure she has a living will? I don’t that is established. Her husband says it was her wish, but I don’t know that there is anything in writing.

        • The Computer Ate My Nym

          I’m not sure, but I remember reading that she did. Of course, I could be wrong or they could be wrong. In any case, her husband is clearly stating that they discussed it and she made her wishes clear. He is next of kin and his word should hold, in the absence of any reason to suspect that he is not acting in her best interests.

          • Carolina

            Her parents side with him too. The three people who loved/knew her the best agree on what she would want. Her poor mother has said she can’t visit because the condition of her daughter’s body is too upsetting. It is a sick, sick science project to see if they can bring a viable baby to term.

        • AlisonCummins

          It shouldn’t matter. She’s dead. They don’t have her on life support, they are ventilating a corpse.

          Excellent commentary:
          http://drjengunter.wordpress.com/2014/01/12/who-is-keeping-a-pregnant-woman-on-life-support-against-her-wishes-john-peter-smith-hospital-or-texas/

          • Dr Kitty

            Here’s the test…

            Would you continue to ventilate a woman who wasn’t pregnant?
            No?
            Then, barring evidence that she explicitly wished to be used as a human incubator after brain death, or the expressed wishes of the next of kin, you don’t do it.

            She’s not in PVS, or a coma, she is medically dead. If she wasn’t pregnant they could legally take her organs at uh is point,

            You certainly don’t inflict this AGAINST THE WISHES of the next of kin.

            Living wills…important to have, and to think through every scenario you can.

          • thepragmatist

            And even still, THE NEXT OF KIN should have the first say in what happens to the body of the diseased. It’s a travesty. I would expect were I to die tomorrow that my family (namely my first husband who is tasked with holding my living will) would do as I requested. I would be mortified to know that something like this would be happening to my body after I died. Shades of Handmaid’s Tale.

          • Dr Kitty

            It is worse than that…from the linked article Texas law mandates that even if there is an advanced directive in place, life sustaining treatment MUST be provided to a pregnant woman….at any stage of pregnancy…no matter how futile, or painful, or undignified, or degrading, or unwanted that treatment is.

            In Texas, if you’re pregnant and incapacitated you lose your autonomy and your wishes are subsumed to the presumed “right to life” of a foetus.

            I don’t have a problem IF IT IS CLEAR THAT THE WOMAN AND HER NEXT OF KIN want that. If, on the other hand it is manifestly clear that imposition of “life sustaining treatment” would have been against her wishes…yuck.

            Women are people and should not be treated as vessels

          • LadyLuck777

            Agreed. They are ventilating a corpse. I could see doing this if the father wanted to try and save the baby, but he is pragmatic in the fact that the baby is most likely damaged as well. This woman could have legally chosen an abortion. I’m curious why her husband could not make that same decision since she is unable to do so for herself. I balk at the fact that just because this woman was pregnant when she died she and her husband automatically lost all their decision making rights.

      • Zornorph

        How do you know it’s old white men? Some of them could be women, some could be young and some could be Asian, black or Latino. I find your comment is bordering on racist.
        For the record, I do think what is being done to her and her family is very wrong, but not sure why you felt the need to bring race into it.

        • The Computer Ate My Nym

          We’re talking about Texas. Noticed who the governor is? Who the lieutenant governor is? Who most of the legislature are? (Ok, so the lege isn’t all white or all male, but they’re a majority.)

          And racist? Seriously? You think there’s a big problem with anti-white racism in the US, much less Texas? Not in this reality.

          • Zornorph

            I’m well aware of the make up of the Texas legislature. The law was passed in 1989, though, so the current governor and LG are irrelevant. The governor was a man at that time, though two years later, they elected a woman.
            I simply don’t see what race has to do with it – I don’t think there’s a huge anti-race problem in the US, but you taking a slam at white men was unnecessary and irrelevant.

          • LMS1953

            Well, the governor is certainly not Gov Cuomo who thinks that only ultra left-wing radicals are fit to live in his state. Don’t worry, Abortion Barbie will soon be governor and she won’t rest until term babies crowning on their due date are pithed on the perineum. After all, sugar daddies you can dump your unwanted and inconvenient offspring on are not easy to come by.

          • thepragmatist

            I’m sorry, but “pithed on the perineum”? Have you ever read any of the interviews with the very few doctors willing to perform very late term abortions, what their experiences are, and who they serve? Women from Canada come down to the States to have late term abortions because there are so few doctors willing to perform these. A doctor is a human being. Very few human beings could be convinced to perform a late term abortion for shits and giggles. When you have a 14 year old rape survivor or a woman with poor fetal outcome come through your door and you have to make that judgment call, I do not think you’re in the backroom counting the dollar signs. I’d like to think physicians have more integrity, and as for the few (RIP those who have died to perform such a service) who DO, I would say that everything I’ve read of their lives, work, and their own words would demonstrate a deep caring for the patients and concern for the very difficult ethical line they must walk. And they give their lives for it. Tiller, gunned down in his own CHURCH? I just don’t see how this kind of rhetoric belongs anywhere when discussing late term abortions and is posited on a slew of stereotypes that make me sick to read here, of all places, where we are looking at childbearing and the politics of women’s health through the lens of EBM/SBM, not scare-mongering. I don’t know who “Abortion Barbie” is but protecting a woman’s access to a private relationship with a physician during pregnancy is, in my mind, necessary to a free and democratic state for women.

          • http://housefulofchaos.com/ Christy

            I suspect “Abortion Barbie” is a reference to Wendy Davis, a female politician running for governor, who stood up for abortion rights earlier. The mention of “sugar daddies” whom one can dumb unwanted children on is a reference to Ms. Davis having allowed her husband custody of their teenage children when they split up. Apparently people are up in arms declaring her an awful mother because she didn’t demand custody.

          • toni

            http://ethicsalarms.com/2014/01/22/ethics-quiz-rank-the-unethical-politicians/ this is all I’ve read about her. one of those people that just cannot resist embellishing. Not trustworthy.

          • Carolina

            Oh good lord. I read the DMN article and shrugged. So she was separated at 19 rather than actually divorced. So she didn’t live in a trailer forever and ever. So her mother had a 9th grade education rather than just a 6th grade education. That’s hardly even “embelishment” The attacks on her “lies” are some of the silliest political mudslinging I’ve ever seen.

          • toni

            I guess lying is okay when it’s your side. Not even real lies at all in fact! People who lie about pointless shit like that are the most dangerous, it means they’re liars to the core and that statement she released just demonstrates further how disingenuous she is and that she will lie in the future and try to rationalise it.The correct response to being caught in a lie is to apologise not cry sexism. She is standing for office and has misrepresented herself to the people how dare she play the victim

          • AlisonCummins

            “How did Wendy Davis get her divorce date wrong? (hint, it’s easy)”
            http://drjengunter.wordpress.com/2014/01/22/how-did-wendy-david-get-her-divorce-date-wrong-hint-its-easy/

          • toni

            That’s great and all but the divorce date part was the least of it. And I’d already given her the benefit of the doubt on that one as I can see how you could easily forget the year you got married but the other stuff not so much! Didn’t you read the ethics alarms post?

          • LMS1953

            No, I haven’t had the opportunity to read the court transcript of the murderous Philadelphia physician who was convicted of pithing term babies on the perineum. But I have read that you can check yourself in to a hotel in New Mexico at any time up to your due date and have a physician murder your baby with an in utero injection of potassium chloride. And I think you get a steak dinner too as part of the package deal.

          • Dr Kitty

            Cite? Extraordinary claims require extraordinary evidence.

            AFAIK since the murder of Dr Tiller there are fewer than 5 physicians in the USA performing abortions after 24 weeks.

          • MFM Doc

            In training, Dr. Tiller was the physician we sent a few late cases too. They were horribly emotional cases, and were in no way about the “inconvenience” of a pregnancy. In fact, they were all very much wanted pregnancies with such poor prognoses, that I was happy to help the moms.
            Not all problems are present at the 20 week ultrasound. Some conditions develop later. I have seen terminal CMV, complication of a demised co-twin (mono-mono and mono-di) and rare brain anomalies that just aren’t visible until 24 weeks. On occasions, we have even facilitated the delivery of those infants at home, because I can’t imagine how much additional stress we add to these women by making them travel away from their homes during such traumatic times.
            We don’t advertise performing terminations after 24 weeks, nor do we act as a referral centre, but if possible, I would like to provide a service to reduce stress for my patients.
            The irony is, I don’t perform TA’s earlier in pregnancy, only the complicated later one. Patients also have to agree to an induction of labour, because I don’t recommend a D&E after 24 weeks.
            In my personal life, I am very pro-life, I don’t think there is anything I would terminate for (I have seen a lot and been through very complicated pregnancies, my husband and I actually had to have these discussions more than once), but I am adamantly pro-choice for my patients.
            p.s. I needed to post under a different name because I use my normal discus account in other places and I try to keep this part of my job quiet

          • Mishimoo

            Thank you. I have never been in this situation and hope never to be, but I imagine that it would be heartbreaking as a doctor, let alone as a parent. So thank you, for doing an extremely difficult job as kindly as possible.

          • Dr Kitty

            Thank you MFM doc.
            That’s what patient centred care looks like.

          • moto_librarian

            Do you really think that his abortion clinic was/is the norm? Of course what he was doing was horrible and illegal, and now he is in prison (as he should be).

          • Certified Hamster Midwife

            Can you buy that package on Travelocity?

          • LMS1953

            http://www.lifesitenews.com/news/new-undercover-video-hotel-gives-special-rate-to-mothers-having-late-term-a
            I’m not sure about Travelocity, but the hotel gives a discount. They might even gas a Jew for you if you slip the concierge a Benjamin.

          • Certified Hamster Midwife

            Lifesitenews does cover some items that don’t really surface in the mainstream media, but you have to scratch away a few layers of hyperbole first.

          • The Computer Ate My Nym

            That reminds me. Time to go donate to Gov to Be Barbie’s campaign again…Texas does spawn a good one now and again. Actually, Texas has spawned quite a few good liberal politicians and political commentators. Molly Ivins, Ann Richards, etc. You have to be hard to be a liberal there…

          • Carolina

            I cannot wait until this state is fully blue, and it will happen. I truly miss Molly Ivans and Ann Richards, but the tides are perhaps changing again.

          • The Computer Ate My Nym

            One can hope. A lot will depend on whether the voter suppression laws get upheld or not.

          • LMS1953

            Actually, it depends on how many dead people and illegal aliens the Democrats get to vote for her.

          • Certified Hamster Midwife

            It’s not Chicago, so maybe not too many?

          • anion

            If you miss Molly Ivins, there’s an easy solution: get yourself some books by Florence King, whom Ivins plagiarized.

          • Aussiedoc

            Wow.

            I may have made the personal decision not to perform terminations, but I certainly help my patients facilitate them as needed. Because its not my body or my decision. That level of vitriol is horrifying to see in a medical provider. I have never seen a woman make the decision to terminate lightly.

            And I have never seen a woman make the decision for a late term termination based in “inconvenience”.

            And the white part I choose not to comment on, but yes – this is men. Always men, making decisions about women’s bodies for them. And you have NO RIGHT.

          • LMS1953

            The corollary to Godwin’s Law (playing the Hitler card) is playing the Spewing Vitriol Card. If you do not think that murdering babies on or shortly before their due date is WRONG, you should have your license revoked.

          • Aussiedoc

            I live in an area where we’ve had decriminalised abortion for several years.

            Despite many people coming out with vitriol (yes vitriol) precisely along those lines, strangely enough noones been doing terminations on healthy babies on or just before their due dates. The vast, casts vast, vast majority are performed prior to 12 weeks. The remainder are for congenital abnormalities.

            But you know, keep using that imagery as a reason to attack women. After all we all only have abortions because its convenient and we hate babies, and its as easy as getting a haircut, and were all going to go out at 40 weeks and kill our kids.

            Almost the same as saying all obstetricians are evil surgeons in terms if rhetoric isn’t it?

          • Certified Hamster Midwife

            I live in the People’s Republic of Cuomo and I have no idea what the heck you’re on about. Unless you’re talking about the SAFE Act. That was an atrocious piece of legislation that needs to go away.

          • MaineJen

            There’s an Abortion Barbie? ……What *can’t* that woman do?

          • LMS1953

            “You think there’s a big problem with anti-white racism in the US,”
            Yes, yes I do. You need look no further than POTUS and FLOTUS. Their obsession with “white privilege” permeates nearly ever word that comes out of their mouths and ever scowl that crosses their faces and every edict that flows out of his pen.

          • Carolina

            I thought this was sarcarsm until I read your other posts. Sorry a black president is so hard on you, bro,

          • LMS1953

            I guess you are one of the 30% who approve of our Thief-in-Chief. I don’t give a rat’s a$$ that he is black. But HE sure as hell does – he and his Obamavich toadies plays the race card at EVERY possible opportunity.

          • Certified Hamster Midwife

            Sorry, “Thief-in-Chief” belongs to people who voted for Gore-Lieberman in 2000 when they want to refer to George W. Bush. Find another derogatory title.

          • toni

            I was about ten during that election an am not American but what happened exactly? Gore won the popular vote but lost the electoral college something or other which is how you decide the winner as you are not a direct democracy (good thing too IMO). What thievery? If they were the agreed upon rules and Gore and his supporters would have been happy to win by those same rules how is it fair for them to decide they dont like those rules because they lost and accuse the other side of foul play? I must be missing something because it just seems incredibly childish and embarrassing from the outside.

          • Certified Hamster Midwife

            The Electoral College vote was incredibly close, and the results in Florida decided the entire election. Florida’s ballots (or was it just Palm Beach County?) at the time were, frankly, ridiculous – they required voters to punch holes next to their chosen candidate’s name with a stylus. If the voter didn’t punch all the way through or clear the paper they punched out of the hole from the ballot, or any other crimes against hole-punching, their ballots would be thrown out. Literally. Their vote would not count.

            The results were so close (less than 2,000 votes) that they counted the ballots again, and the election was even closer. Some counties began to count the ballots by hand, but the federal Supreme Court put a stop to this recount and called the election for Bush.

            At the time, there were several factors that made leftists see Bush as a thief.

            - The Supreme Court was mostly Republicans at the time, some of whom had been appointed by Bush’s own father, which made the whole thing look like an exercise in partisanship.

            - They didn’t like the guy.

            At the time, the common narrative was that the Supreme Court and Republican officials in Florida appointed Bush as president, which is why people believed that he stole the election. History has shown that this may not be the case.

          • anion

            Especially given the large number of voters in the Florida panhandle who left the polls without voting when CBS(?) called the state for Gore, even though the polls were still open and their own numbers at the bottom of the screen listed Bush 50, Gore 47. (I believe those numbers were why Bush specifically said he didn’t understand why they called the state for Gore, which was later spun into “He didn’t believe it because he knew his brother was going to commit fraud for him!” And then all the sexist appearance-shaming of what’s-her-name, Katherine Harris?)

            The irony was, in the weeks leading up to the election the theory was that Bush would win the popular vote and Gore the electoral vote, and I remember countless newspeople and media pundits reminding us that the electoral vote was what counted, that this was our system and it was the best way to do it, and explaining all of the (very sound) reasons why we have an Electoral College.

            I lived in FL at the time, and I remember all that nonsense very well. Still irritating.

          • toni

            Thank you for explaining that

          • The Computer Ate My Nym

            Also, when the media got the ballots under FOI and recounted, Gore won. However, if they had counted only the counties that Gore thought should be recounted (the ones he expected to support him), Bush would have won on the recount. It was a tie. The Supremes played the role of the coin to be tossed to decide things. Creepy, but democracy in the US has survived far worse.

          • Certified Hamster Midwife

            Also, I feel really old.

          • toni

            Sorry! Haha

          • The Computer Ate My Nym

            Waffler-in-chief? Wimp-in-chief? Overestimated-by-both-supporters-and-opponents-in-chief? (Yeah, I know, doesn’t roll trippingly off the tongue, but it’s probably the most accurate. Obama’s a middle of the road politician from Illinois. He does not want your gun, he is not going to make abortions mandatory, he is only going to propose the most timid possible versions of health care reform–in fact, the plan proposed by the Republicans in the 1990s. He’s also not going to bring about peace, prosperity, and above all HOPE. For better or worse, he’s just not a radical.)

          • Certified Hamster Midwife

            Really-should-have-stuck-to-middle-management-in-chief?

          • The Computer Ate My Nym

            I saw Dr. Tuteur’s request to avoid getting further into the political argument after writing a couple of posts, including the one above, on the political argument yesterday, so I apologize and will stop…with one exception. I just have to say, “SNARK! Good one!” to CHM. Really-should-have-stuck-to-middle-management-in-chief it is!

          • baileylamb

            Since this blog is science based, why dont you go and take the impliit test on race, then get back to us with your results :)

          • Amy Tuteur, MD

            LMS, please, let’s not have a repeat of the immigration argument where I had to delete posts. You have every right to your political views, but I’d appreciate it if you didn’t derail the discussion about the risks of homebirth.

          • MaineJen

            What do you call ‘playing the race card,’ exactly? Being black?

          • The Computer Ate My Nym

            According to the Gallop Poll, Obama’s current approval rating is about 40%, having ranged from 38% to 69% over his presidency. Congress’ is about 9%. Guess the Tea Party isn’t winning hearts and minds too well. Can’t imagine why not.

          • AlisonCummins

            So the marxist-leninist terrorist obstetrical practices you referred to earlier (but did not give examples of) would be what, choosing to practice in an area with a primarily african-american population, thereby denying one’s skills to deserving white people?

          • Certified Hamster Midwife

            I think you’re mixing up the residents of the White House with 19-year-old university students on Tumblr.

          • LMS1953

            Sorry, I have no idea what you are talking about. I am talking about the POTUS and FLOTUS who put up barricades at the open air WWII memorial to keep out 90 year old veterans in wheelchairs. Who put up cones on a STATE road to block the view of Mount Rushmore. Who is gifted with a $500,000 Hawaiian vacation on our nickel because she got her panties in a knot after the Thief-in-Chef took a selfie with Blondie. What 19 y/o university students on Tumblr are you talking about?

          • Certified Hamster Midwife

            I see a lot of complaining about the excesses of the ruling class, but absolutely nothing that you cite has anything to do with race or fighting “white privilege.”

            Any leader does things that enrage you, as long as you already hate that leader to begin with.

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

            …what?

        • Carolina

          The lawyers and admin at JPS Hospital are all white dudes. The Tarrant County DA is a white dude. I could bet huge amounts of money that the legistlature that passed this law was almost entirely white and male. Your sensitivity on this is misplaced.

        • Carolina

          If you’re curious about the make-up of the Texas Legislature. http://www.texastribune.org/2013/01/11/legislators-are-younger-little-change-diversity/
          Mostly white, mostly men. It’s gradually starting to reflect the diversity of the state, but we aren’t there yet,.

      • Carolina

        I don’t think she had a written living will, advanced directive, etc. She was an EMT and had had discussions with her husband. In any event, the way the Texas law is written, it overrules even a written advanced directive. It’s insanity.

        • Certified Hamster Midwife

          Thank you for reminding us all that advance directives are a really good idea as soon as you confirm a pregnancy. Birth plans are nice and all, but not a living will.

        • Vyx

          It’s interesting, the law in question here specifically states that life-sustaining measures should be continued if a woman is pregnant. Since she is dead, this law really shouldn’t apply. How can life-sustaining measures be used on a dead person?

  • attitude devant

    OT, but has Steven Gaskin died? I keep seeing sort of hints about it on Facebook

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

      omg who will run the creepy sex cult now?

    • LMS1953

      If so, it was probably from overwhelming sepsis from pubic lice.

    • Siri

      Not according to his Wikipedia page…

    • drsquid

      tenpenny’s husband did

      • Karen in SC

        who is tenpenny?

        • Mishimoo

          I don’t know, but the name made me think of Pennywise the Clown

  • Ash

    Somewhat off topic, but it seems like the “experience” of birth has really spread throughout US society. It seems relatively common for birth announcements to include “mom had a natural birth with no medications!” rather than a simple “Baby X was born today at noon, 7.5lbs the family is doing well!”

    It’s a little odd to me to bring up the method of delivery as a part of every delivery announcement without prompting.

    • The Bofa on the Sofa

      A little odd? Seems pretty loopy to me.

      There are the occasion comments around where people have gotten these types of announcements. They can get downright bizarre.

      And be sure to mention all the MWs, doulas, and MW assistants by name, and make a crack at the hospital staff.

    • Trixie

      Given her screen name and her references to drug use in her reddit profile, I have to wonder if she was also avoiding drug screening.

    • Erica

      On reddit, in the babybumps subreddit, I think it’s a little less “odd”. I’m about as far from woo as you can get, but leading up to my deliveries, I liked reading stories about what others did and experienced, regardless of the method of birth.

      I wouldn’t, say, announce my baby’s birth to my friends and family that way (or even in a more extended list of “friends” on facebook), but I can see doing so in a forum populated by pregnant women, because many of them actually ARE interested in the how and what happened. (And the babybumps subreddit is in general very welcoming, my post about my scheduled repeat c-section seemed just as “liked” as any other random birth story)

      • Ash

        Oh yeah, that’s not weird, but I remember when a supervisor when I was a student announced the birth of his child “Baby XY, born [date], with a natural unmedicated birth”

        Unprompted!

  • Paloma

    I know there are some commenters from the UK in the blog, so I was just wondering. Can anyone guide me on where to get some info on OB/GYN practice in the NHS and what the system is like? I’m seriously considering moving to the UK and applying for Specialty Training over there, and I would like some other info than the official site and the BMC. Thanks!!

    • Dr Kitty

      Ok…
      What, specifically, would you like to know?
      Is it about the practice, the training programmes or something else?

      • Paloma

        I think I understand the training programmes, more or less. I still have to do F2 if I want to train there. It’s more what someone who know the system thinks about it and what the day to day is like, because it is hard to learn that from the NHS jobs website and the ST guides. I still have my doubts about choosing between Spain and the UK. Thanks!!

        • Dr Kitty

          Ok… Things to know.
          If you’re doing a standalone F2 you’ll get the bottom of the pile choices that the people doing linked up F1-F2 don’t want, either because of the location or combination of specialties in the year (I.e. Dermatology, Geriatric psychiatry and OBGYN in three different small district general hospitals would be very few people’s ideal year).

          You apply to deaneries, so you have to choose the area of the UK as much as the specialities.

          I did 4 months of OB Gyn as an F2.
          In practice there was little difference between my duties and that of the GPST1s and GPST2s or OBGYNST1-3 in the job. We all took turns doing the clerk ins of admissions, saw patients in Gyn and Antenatal clinics, were on duty on the labour ward, assisted in Gyn theatres etc.

          • Dr Kitty

            Sorry, to continue…
            As an F2 I was expected to ask a senior about anyone I wanted to add to a waiting list for surgery, and feedback at the end of every clinic. The supervision got less as the training increased.

            We had a 2A rota. Every other weekend on (one 13 hr shift, one 9 hr shift), one week of nights (7 13hr night shifts followed by 7 days off) every six weeks, an average of 3 long days (13 hr day shifts) a week. It was pretty gruelling, but I enjoyed it more than any other hospital placement I’ve done.

            Quite often at weekends or in the evenings it would be one junior trainee (I.e. Me) and a Reg (senior trainee) with a consultant on call from home. This was in a hospital with a gynae operating list five days a week, and 3500 deliveries a year.

          • Dr Kitty

            For obstetrics, the midwives handle everything, it is up to them to call the doctor if there is a problem, so if you were paged the proverbial was hitting the fan. Your job on labour ward as a Dr is to sit and watch the EFM traces for anything hinky, see any pregnant ladies who turned up (women with reduced FM, possible PTL or PPROM etc) to see if they needed admission, do the sections and forceps and run very, very fast if a midwife yelled for help.

            As a junior trainee I was “the bottom end” at laparoscopies, held a lot of retractors and got to do a few hysteroscopies, D&Cs, coil insertions and laparoscopies with help and supervision, but I had seniors who were very keen to teach and have friends who got to do much less on their OBGYN placements.

          • Paloma

            Thanks!! That helps a lot. I tried to apply for F1 but because I did my University training in Spain I’m able to do a full registration at the GMC so they wouldn’t allow me. I can’t apply for ST-1 either because I have no previous experience, so my only option seems to be a stand-alone F2. I’m taking the exam needed in Spain to go into Specialty Training next week and then I have a couple of months free to really look everything up and choose. Thank you so much!

          • Dr Kitty

            An exam would be better than the UK specialty training system.
            You have to apply to each specialty in each deanery separately and it is an interview with OSCEs, presentations about why you want to do that specialty and what you, as a person, bring to the table. Hated it.

            At the end of F2 you could still find yourself in the position of not having a training place in OBGYN, or of having a training place in a deanery you don’t want to move to for 7 years, or of having a non training (LAT) contract for a year and having to reapply all over again…

            You have to pass MRCOG part 1 to move from ST2 to ST3 and MRCOG part 2 to move from ST5 to ST6. The pass rates, BTW, are less than 50%.

          • Paloma

            That doesn’t sound that good… In Spain we take an exam and based on our score the give us an order from 1 to how ever many people took the exam (this year, 12000 people are registered) and we choose specialty and hospital in that order. For OBGYN I would probably need anything lower than a 3000 from what I’ve seen on previous years. I think I can achieve it based on the practice tests I’m taking to study for the exam. Then it is 4 years of specialty training and that is it. You get some tests, but most are evaluations from your tutor, nothing like that. Thanks so much for the info! I never really got all of that from the ST web (they didn’t even have an email I could write to for more info).

    • LMS1953

      Dr Amy had a recent article where the BMJ castigated the midwives of the UK for their deplorable care and outcomes – because of the typical woo and unicorn sprinkles that are so important to them. Good luck!

      • Paloma

        That’s what scared me a little and why I’m asking ;) I’m really hoping that is not a common thing because I really like how the training is structured.

  • Therese

    I’m in a devil’s advocate sort of mood today…you say that this never happens in the hospital, but doesn’t it happen that babies born in the hospital will sometimes need resuscitation with no warning of it during the pushing stage? I’m finding numbers from the NHS that a third of babies who need resuscitation at birth gave no warning signs during labor…so could it be that the reason it doesn’t happen in the hospital is due to immediate access to resuscitation rather than due to superior monitoring?

    • Trixie

      She was in labor for 4 days though — that’s one red flag. I’m sure there were many things that were mismanaged that we don’t have the full story on.

    • Paloma

      I don’t know about the NHS, but in Spain there is constant monitoring during labour, so if a baby is in distress you are very likely to know before it comes out. To the point where if you get certain signs of distress you either use an intervention to accelerate the delivery or just go directly to a CS, because the danger of depriving a baby from oxygen is too high. It is rare to have a oxygen-deprived baby inside their mother for longer than 2-3 minutes in a hospital. Also, since the resuscitation is immediate after delivery it increases very much the chances of having a good outcome.

    • attitude devant

      Therese, the way I am reading this is that baby was born unresponsive, with a heart rate of 90. Typically in a hospital we could resuscitate that baby pretty effectively. The fact that the baby died suggest resus efforts were poor, ineffective. Transport (‘we’re just minutes away from the hospital…’) was not quick enough to help. I am NRP certified (to the top level) and I can tell you that I am appalled when I see youtube videos of births that wind up with a resus. The people doing the resus are doing it so poorly I end up screaming at my computer monitor. So yes, babies in hospital need resus too. But we do it effectively, and we have more resources to help.

      • AlisonCummins

        attitude devant, Amy Tuteur, MD says above: “That’s 17 times in the past 3 years alone that a baby unexpectedly dropped into a homebirth midwife’s hands either dead or nearly so. I have never seen this happen in a hospital. I have never even heard of this happening in a hospital.” She also says below, “What do they think? They think they know how to monitor a fetus but they don’t, and they tell themselves that the same thing would have happen in the hospital.”

        So I think Therese’s question is why — if hospitals always know when a baby is in distress, that when babies are born dead or nearly dead it’s never unexpected — she’s “finding numbers from the NHS that a third of babies who need resuscitation at birth gave no warning signs during labor.” How can both be true?

        • attitude devant

          Well, I can’t speak about the NHS. I know nothing about it. In the US. We use the NRP, and under those guidelines, 10% of babies need some help to start breathing, and that’s not a big deal. A little positive pressure ventilation and you’re good to go.Those babies aren’t really sick, and what’s happened is acute and easily remedied. If you don’t get a good effective resus, those babies will not make it, however. About 1% need extensive resus, with chest compression, intubabion, IV meds, etc. These kids are much sicker and heaven help you if don’t have the whole bag of tricks right there waiting. Time is brain and time for transport is time wasted. I would say we can identify that vast majority of that 1% before they are born. These are the babies, the ‘dead or nearly dead’ that Dr. Tuteur is referring to. So I think the best answer to your question is that there are different levels of resus. An unresponsive baby with a hr of less than 100 (like this one) is a very sick baby. We would have expected that baby to need resus in a hospital. Honestly, we might have hurried that delivery with an unnecessarean or an unnecessoperative delivery for that reason.

      • fiftyfifty1

        “Therese, the way I am reading this is that baby was born unresponsive, with a heart rate of 90.”

        Hah, either that or the midwife mistook the feeling of her own pulse in her fingertips for the baby’s pulse and/or the sound of her own pulse in her ears when she listened with stethoscope. Baby might have been dead for a long time during pushing with the heart rate in the 70s that they say they heard actually belonging to the mom. With these clowns, anything is possible.

    • Young CC Prof

      I suspect it’s a little of both: Quite a few babies in trouble are identified before it gets serious, and those who are unexpectedly born in distress can be immediately resuscitated.

    • Amy Tuteur, MD

      There’s a very big difference between needing resuscitation and being born dead or nearly so. It takes a long time a baby to become that profoundly compromised. Fetal distress would have been picked up on the monitor and emergency c-section or forceps/vacuum undertaken. And if the baby is born compromised, it would not be unexpected.

      • LMS1953

        Amy, you have said that you have never seen nor heard of a baby being caught dead by a provider in a hospital. Probably not in the United States, but you have recently provided a link to a BMJ article that deplored that very thing happening under midwife care in hospitals in the UK. I have sensed that you give more credit to CNMs than CPMs because of their training. In my experience, CNMs are all Ina Mae wannabes who revere her as a patron saint and would gladly attend to home births with all the attendant woo and unicorn sprinkles if their CNM licensure did not prohibit them from doing so.

        • The Bofa on the Sofa

          That’s not what she said, is it? She said they don’t go from normal FHTs to suddenly being caught dead. That’s the story we hear over and over again from MWs.

          • LMS1953

            Outside of omitting the word “unexpectedly”, that is precisely what Dr Amy said. Please see AlisonCummins cut-and-paste direct quote below. In my 30 years of practice in the US, I too have never seen a case where a term baby (without congenital anomalies) had “normal” heart tones in active labor and subsequently delivered a dead or soon-to-be dead baby vaginally. Yet it seems to happen monthly at homebirths attended by midwives in the US.

          • The Bofa on the Sofa

            Why would you omit the word “unexpectedly”? It’s kind of the key to the whole thing.

          • Haelmoon

            I have seen it in hospital, but it was mimicking a homebirth. A patient under a midwife. I was consulted for IUGR at term, with low PAPP-A in pregnancy and mild hypertension. Took some convincing, but patient agreed to an induction. We started with cervidil (not my first choice given the circumstances, but she did stay in hospital). That put her into labour, so I sat back to watch, with a plan to intervene only for lack of progress or heart rate concerns. It was a busy night, and I really didn’t have time to check on her, but I thought she should be in good hands. Nope – once labour was established, the midwife unilaterally decided to switch to IA, and wasn’t that good at it. She let the mom into the shower for 30 minutes near fully dilated. When she was back in bed, she was check, and the head was on the perineum, fetal heart rate (which was previously “normal”) was sixty. I was called STAT, used a vacuum and baby was flat. Gases were 6.9, so something was going on for a while. Baby was cooled, but has actually done ok (he is now two, and in the developmental follow-up clinic with no deficits yet).
            These homebirth stories always get my hair up, because this women wrote many nasty letters about me. It was my fault the baby was depressed, not the lack of monitoring by the midwife. My notes clearly documented the risks of continued pregnancy, induction risks and the increased risk for operative or assisted delivery. Baby was IUGR, only 4 something at 38 weeks.
            It is the same mentality as these women delivering at home. Its all about their autonomy, but they never think about those taking care of them. We have professional autonomy too, and we care about outcomes. UGH, it makes me so mad.

          • aly

            That’s the story my CNM gave me, and I was at the hospital, and my baby died. There was nothing wrong with my baby. She was just under 9 lbs.and healthy (autopsy, amnio, all the testings). She said that all of a sudden her heart rate dropped, but that was after a “burst” of meconium came out of her. All hospitals are not the same. There needs to be awareness when using CNM’s in hospitals that have a standard that the Doctor needs to be within 30 minutes from the hospital.
            When hospitals use CNM’s there needs to be an OB right there on the premises. Only a Doctor can help when there is a true emergency.

          • anion

            Aly, I am so sorry for your loss.

            I’m sure others here will have some questions/could offer some thoughts on what happened to you, if you’re up to answering such questions or hearing such comments? (I have questions/thoughts, too, but I don’t want to offer them if you’re not feeling ready to discuss.)

          • aly

            Thank you.
            I do have a couple of questions.
            1. Why would a hospital continue to allow this person to deliver babies?
            2. Wouldn’t the health dept. get notified? or is that my job?

          • Squillo

            I’m sorry for your loss, Aly. If I were you, I would start with a letter to the chief of obstetrics outlining your case and asking what kind of reviews took place after your baby’s death and what prodedures, if any, were put into place to ensure this doesn’t happen again. if you don’t get an adequate response, you may need to do a little digging–look for patient grievance procedures at your hospital. You may also want to write to the hospital’s chief medical officer. You may or may not get a satisfactory answer, in which case you have two possible avenues. If you believe the midwife was negligent or provided sub-par care, you can file a complaint with the state nursing board. You can also try to find a malpractice attorney to review your records. (If the midwife has hospital privileges, she has med-mal.)

            Best of luck.

          • Karen in SC

            If you are saying an OB needs to be on the premises when CNM’s have a patient in labor, I agree. I’d even go so far as require an OB to check the EFM, review progress, etc.

            There was a Grey’s Anatomy episode where every room has a camera and there was a back-up doctor observing and commenting. The purpose was standardizing care and of course reducing costs. I think this would be an excellent plan for midwife births, though I doubt many would agree with me.

          • Captain Obvious

            If I have to be in the hospital as back up for a CNM, I may as well manage the labor and perform the delivery and get paid for that. Delivery of a baby pays better than stand by pay.

          • aly

            I figured this is the reason why they allow this to go on.

          • aly

            This would have certainly saved my baby’s life.

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

        And isn’t the rubbing of the baby by the nurses considered resuscitation?

      • Therese

        I’m having a hard time understanding why it would necessarily take a long time. For the already born, it just takes a minute or two with no oxygen to pass out and become unresponsive, so why couldn’t it only take a couple minutes of the cord being pinched off right before delivery for a baby to be born unresponsive?

        • Young CC Prof

          As I understand it, a full-term fetus is pretty well equipped to survive a little oxygen deprivation, simply because it’s inevitable during delivery. Of course, there are limits!

          • Therese

            I understand that it might not have any long term effect, but wouldn’t the baby still become non-responsive as a means to further conserve oxygen? So how do you tell the difference between non-responsive because the baby was lacking oxygen only for a minute before delivery and non-responsive because the baby was receiving inadequate amounts of oxygen for hours at a time? I mean, how do you tell the difference just by looking at the baby, if you had no strips during labor to guide you?

    • moto_librarian

      Where do those numbers come from? Does that include homebirths? I am wondering if maybe there is inadequate EFM being done in hospital, and HB doesn’t have it all.

      • Therese

        Here is where I found it, it seems to be directed towards midwives who work in the hospital: file:///home/chronos/user/Downloads/WAHT-PAE-031%20V4.pdf

    • The Bofa on the Sofa

      It seems to me that Amy is giving the MWs the benefit of the doubt in that statement, that if the baby is resuscitatable, then the MWs would be able to pull it off, and that the reason the babies are dying is because they are beyond hope.

      I don’t think it is a complement to say that the babies the MWs are getting aren’t that bad, it’s just that they suck at resuscitation.

      • Amy Tuteur, MD

        I’m focusing on the fact that the midwives had no idea the baby was in distress. Although EFM has limitations, it also has a very low false negative rate. In other words, when EFM shows the baby is fine, it’s fine. In these situations EFM would have shown the compromise. The claim espoused by most of these mothers and midwives, that the same thing would have happened in the hospital, is absurd.

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

          That depends on the hospital, in Canada and I think good portions of the UK EFM is not standard practice for low risk women. Intermittant ausculation might be more common, and with it more babies unexpectedly needing resuscitation.

    • MaineJen

      Even if all of that is true, that STILL means that it’s safer to deliver in the hospital, where there is immediate access to staff and equipment for resus. Any way you slice it, if you have a baby at home that needs resus, you are in trouble.

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

      Your talking about the midwife led care of the NHS – this means intermittant ausculation, avoiding epidurals, etc. I don’t see why it wouldn’t be a common event under those conditions.

  • Trixie

    She writes that she had 4 DAYS of back labor. At no point in, say, the first 3 days did it occur to anyone that she should go to the hospital? I’ve had back labor with a posterior baby that wasn’t progressing, and less than 1 day of that, half of it with an epidural, almost broke me. I can’t imagine 4 days — and I can’t imagine she was in a state whete she was able to perceive anything clearly by the time she got to the hospital.

    • Trixie

      Also, here (prior to birth) she talks about how birth is going to be the “ultimate psychedelic experience.” http://www.reddit.com/r/BabyBumps/comments/1rq4st/culture_of_pain/cdq0ke8cdq0ke8
      I’m very sorry for her loss, and the pain that she is now going through, and she’s probably regretting those words now.

      • anion

        All of her comments in that thread are so painful to read, especially the ones about homebirth.

    • fiftyfifty1

      I am starting to believe that saying you have back labor is part of the script that you have to recite in order to win NCB performance points. You see, having back labor makes you even more of a birth warrior than having regular labor. And it’s some sort of proof that giving birth “unhindered” was the right thing to do because back labor is an indication for immediate C-section in the hospital supposedly, while at home it is merely an opportunity to move your pelvis and have an instinctive “dancing birth” to help rotate the baby.

      Oh the conformity of it all. It’s so predictable. It’s such BS.

      • The Bofa on the Sofa

        I agree with 50501. In fact, I deleted my comment, but it was basically, back labour? Who diagnosed that? Her?

        She also thought that the cervical exams were unnecessary, so I don’t know if her medical opinion can be considered reliable.

      • OBPI Mama

        Can anyone other than the mom realize it’s back labor? For me,I never felt a contraction in front of me. It was all so concentrated in my back. My sister also has back labor. Anyway, to this day (and 3 more babies later), I still have no idea what a typically described contraction feels like. Even though the other 3 kids were c-sections, I did go into labor with my 3rd and the only time I felt contractions it was all in my back, nothing ever came to the front of me… And no dancing helped, I can say that! haha.

        • fiftyfifty1

          You are right. In reality, back labor is just when you feel like the pain is in your back instead of (or in addition to) pain in the front. So it’s a subjective thing. It’s similar to how some women feel their menstrual cramps in their low backs rather than in the front. There are some common myths about it in the NCB community. One idea is that it is So.Much.Worse. than pain in the front. The other idea/myth is that it is a sure sign of an OP positioned baby, when in reality there is some correlation but it’s not strong.
          So I have seen NCB moms use it an an excuse for why they “caved” to pain meds: It was Back Labor! Or why their not caving should get them extra points: I did not give in even though it was Back Labor! Or to explain why their decision to stay at home was a good one: She had mec but we didn’t go to the hospital because we knew that they would just insist on a C-section right away because it was Back Labor! Or to make their birth seem like an active accomplishment rather than just a biological process that the body does on its own “I moved and danced and if I hadn’t, the baby never could have come out because it was Back Labor!”

          • OBPI Mama

            My midwife was shocked my baby was in the correct position because I had back labor… and she really wanted his shoulder dystocia to be due to a bad position and not because he just physically wouldn’t fit through me. So annoying.

          • Trixie

            I had back labor both times — one OP and one OA. So, sucks for me I guess. I do think the OP one hurt more but memory is funny so who knows.

          • CognitiveDissonaceHurts

            I had 3 back labours and they were excruciating. I remember thinking that I was dying, and that if given an option to end the pain by ending my life, I would have taken it. :o But no, I wouldn’t take any pain relief because I was afraid it would hurt the baby. (I was obviously not thinking clearly). My last labour I felt all in the front, and I was very comfortable right up until the 2nd stage. It was definitely much easier than the back pain. I wish this blog had been around back then. I wouldn’t have had to endure the torture of NCB.

  • Stacey

    A 2nd degree tear, plus more, and she think the exams for unneeded?

    FHTs were perfect until crowning? I don’t know what they think happens. That crowning kills babies? seriously, what do they think happened?

  • Mel

    Taking a wild guess on the two “unnecessary” pelvic exam along with the missing placenta….

    When I read between the lines, I’m hazarding a guess that mom and midwife end up at the hospital with baby by some form of transportation – hopefully an ambulance. I imagine that the two priorities are a) restarting or increasing baby’s heart rate/breathing and b) verifying that mom isn’t about to bleed to death from PPH, retained placenta etc. I don’t know of any way to check for retained placenta besides a pelvic exam. Plus, honestly, once the placenta has been looked at for intact margins, it’s not a huge priority – not compared to caring for mom and baby. I also suspect that the tears were from the birth and pre-existed the vaginal exams. (I don’t think the poster meant to imply the pelvic exams caused the tears, but it could be read that way.)

    • The Bofa on the Sofa

      I didn’t read it that way. I assumed the tears were the result of her beautiful labor and delivery.

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

    Heres part one of the posts about the meeting of midwives in response to a death.

    http://safermidwiferyutah.wordpress.com/2014/01/23/remember-this-meeting-is-being-recorded-part-one/

    The grosses part is where one of them says “we need to figure out a way to open our hearts to these midwives. How do we say ‘we love you, but you are hurting us.’ ” How the fuck does someone love a monster like valerie el halta? Jesus. Also, I am astounded at how stupid all these midwives are. The technical problems with recording and running their own meeting makes it extremely irritating to listen to.

  • Paloma

    These posts keep making more and more surprised each time. I’m not a mother yet, but even before even planning a family (I’m 24 and just out of med school) there is something I know very clearly: the day I get pregnant, my child comes first. No matter what. I do not care what happens to me as long as my child is safe, the fact that I may or may not get more pelvic exams than I might prefer, or a CS or any kind of intervention is the last thing on my mind. I just keep reading about these women who would rather put their children in danger just to be more comfortable at home and I want to go over to them and scream “ARE YOU OUT OF YOUR MIND?”
    Again, I have no kids so I know nothing about being a parent, but I can only imagine that if I feel this way now, when I do have them it will be that much more clear.

    • meglo91

      You are correct! After going through 9 months of anticipation, probable discomfort, and definite inconvenience, after hearing your child’s heartbeat, seeing them on ultrasound and feeling them kick, after picking out names and buying baby clothes and supplies — after all that, the only reasonable thought is that you’d like to ensure your baby’s safety and your own safety and that’s about fucking it.

    • The Bofa on the Sofa

      From our perspective, yep. Our concern was first and foremost healthy baby. Any other part was distant behind that.

      Moreover, the gap between healthy baby and other stuff grew as the time went on. By the time we got to due date, my wife was telling me she’d die for him.

      I don’t know what I would have done faced with the situation, but that’s the extent to which we were willing to go. Now, of course, it’s not even close. I’d die to save my children without a thought.

      • Meerkat

        I felt the same way. I would die for my son. I clearly remember having this thought right after they told me I needed a C-Section. I even felt like I was dying. I also remember thinking that I would rip him out of me with my bare arms if I could. Instead I ripped out an earring that has lived in my ear for the past 20 ears and I could no remove any other way. I was afraid it was taking the nurses too long to bring the wire cutters.

      • anion

        Slightly OT, and I don’t mean to be controversial, but this is the “argument” I use when people tell me their pets are exactly like children and it’s exactly the same. I loved my dog a lot, but I wouldn’t have died to save his life. Whereas with my children it’s not even a question; I’m taking the bullet, without hesitation and without a thought.

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

      Its not just about comfort though. Midwives sell natural birth as a way to heal your relationship with your body, to feel powerful, etc. It preys on women who have eating disorders, have experienced abuse (sexual or domestic), or who have just been told they are weak and stupid all their lives. Its pretty cruel of them to sell it as something any woman can control, but I totally understand the appeal. When you want it to be just as safe as hospital, when so many things would be solved in your life if it were true, its easy to believe it. If you don’t understand the appeal it might be because you were lucky enough to avoid some common sources of disempowerment for women (or maybe you just reacted to it differently than me).

      • Paloma

        I get why a NCB might be appealing because you feel more in control. However, you can go without meds, bring a midwife into the hospital if that makes you feel better, etc. However, you cannot bring a OR into a home, and I would certainly feel a lot more comfortable knowing that I am seconds away from it and not a car ride away from the hospital, should anything happen. You don’t have to be a doctor to know that if the baby doesn’t breathe or doesn’t get oxygen, the faster you get it out, the better the outcome.
        I do realize that I am not just anyone passing by, I am a doctor (my mom is one too and my grandmother was a delivery nurse for 30 years), so I have never had a bad experience with a hospital of any sort. But still it just amazes me. Also it clashes with my culture, in Spain healthcare is free so nobody even considers a homebirth, they just go to the hospital. I had never even heard of all this before I found this blog. I just hope this never gets popular here.

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

          You aren’t thinking rationally when you make a decision based off emotions (like fear of being powerless). I think there is a book about why smart people believe stupid things that goes into great detail about how people rationalize bad decision making. We all have our blind spots. I certainly was humbled learning that NCB was one of mine.

          • Paloma

            Yet you realized the danger of it and changed your mind. I don’t understand how someone can describe a birth as beautiful when they lost their child. Anyone can make a bad decision based on irrational thoughts, we all make mistakes all the time, but sticking to them like that… Some even go back and have a second birth at home. Wouldn’t the fear of losing a child be more powerful than the fear of anything at the hospital?
            PS: I’m sorry you fell for it. I hope you didn’t have to go through something like the story in this post. If so, I’m very deeply sorry :(

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

            My blog is shame on better birth. If you google it you can find my story. Everyone is physically fine, but I do have PTSD now. Scammers know that psychologically victims who have invested a lot in the scam are more willing to give in to outrageous demands. Admitting that they sunk something important (like thousands of dollars, or in this case the life of the baby) can be personally unbearable to the person who did it. They usually double down on their position to avoid the guilt. Its not a pretty side of human nature, but its common. I don’t really know why some people realize it was a problem and others don’t.

          • thepragmatist

            I got sucked into a woo practitioner who had a lot of credibility in the community (who was, incidentally, sexually abusing patients). So I can relate to this. He took a lot of time to groom his patients (for me, six months) and by the time I was in, I was so over my head and so attached to him, and so confused, the guilt was overwhelming. It took me two and a half years to go to his board and to the police. But I went. And even in going I still wasn’t sure if he’d actually done anything wrong, if it was just part of treatment, if I was to blame, etc. So, I really can relate to what you’re saying, there. And I thought I was wiser.

          • thepragmatist

            At the time that I went to the midwifery community, I had just been raped, six months prior. I didn’t want men to touch me. I had had an unfortunate encounter with a very inappropriate provider (who I’ve since taken out of business– at least, he’s not practicing openly) as well. I was raw and I didn’t want ANYONE who was a man other than my husband near me. It took a lot for me to allow my midwife to touch me. Even more when I realized I couldn’t have a vaginal birth. I’m lucky in the sense that I had a midwife who was fresh out school, smart, and who really did respect the patient first modality. So when I said I wanted a c-section, she went, Ok, let’s find a good match and connected me with OB consult, and I had dual care, with her as primary provider. The c-section WAS healing. I was in control of that show and it was really a good experience. It was a watershed moment. The irony being that, of all birth experiences, the c-section is supposed to be the least empowering.

            I am so different now. I work with a lot of specialists because of health issues and have got better and better at coping as years have passed, but it all started with that c-section. For me, an NCB birth would’ve been a catastrophe.

          • Cellist

            I’m so sorry for what happened to you.

            For anyone who is in a similar situation, or knows someone who is it is worth knowing that most (though sadly not all) centres against sexual assault/rape crisis centres have lists of ‘approved’ obs/gynos/GPs/Dentists/health care profs who will be supportive of you.

            There is no need to go into ANY details with the health care worker if you do not wish to. You can simply say that you had a traumatic experience in the past and because of this you feel uncomfortable/afraid with ‘X’.

        • Curial

          hi,
          Paloma, also in Spain there are people who choose homebirth! I know a case that end in the dead of the baby…but the mother didn’t chance her ideas…

      • thepragmatist

        Bingo SB! And also, the midwifery community here claims, as all woo-practitioners do, that they are practicing The One and Only True EBM and that all other modalities are not evidence-based. They attract educated women. They attracted me. Our local hospital is NOT a pleasant place to be and the idea of a homebirth with outcomes similar to the hospital seemed reasonable and the midwives I met seemed very down to earth, offered the same tests and so on that I would get at the OB/GYN. Hindsight is 50/50 as I’ve slowly realized, through hanging out here and reading, that I think my MW completely missed the development of GD and that my MW sent me to chiro and worsened a disorder of my ligaments that’s now taken three years to even get close to healing. So uh, EBM? I should’ve gone to specialist care. My OBGYN intervened at 9months pregnant after I’d been throwing up for the entire pregnancy while the midwife kept telling me there was nothing to do, and identified (in the lobby of the hospital none-the-less) that I was having heart burn, prescribed a PPI, and I put on 10 pounds (which mostly went to bubs). Anyway, I’m just saying, woo practitioners always present to the educated clientele as having evidence-based medicine and if you’ve not spent years hanging out on the internet reading studies, or you’re not statistically inclined, what they are selling sure sounds good. Until it isn’t!

  • anion

    I am so sorry for this family’s loss, though. How awful. It looks like a few people have given her links to online support for mothers who lost infants during birth; I hope she finds her way to one if she needs it, and finds some comfort there.

  • Antigonos CNM

    Three tears — and she feels it was unfair that she had pelvic exams. Perhaps she had internal damage too, such as a vaginal or cervical tear [which could have serious sequellae in future pregnancies such as incompetent os].
    I wonder if anyone told her that. But it wouldn’t matter, since she’s such an expert that she knows they were unnecessary.

  • Karen in SC

    For all the midwives that claim they are Evidenced Based – why aren’t they furiously studying this unique homebirth problem and trying to find a solution?

    • The Bofa on the Sofa

      They’d have to concede that it is a problem. It’s not. It’s just a variation of normal.

    • Young CC Prof

      What unique problem? “Babies die in hospitals, too.” *sarcasm*

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

      They would have to admit there is a way to improve on nature if they did that.

  • AmyH

    For crying out loud she could have had it in the hospital. Nobody forces you to get pain meds. Oh, I forgot. They might have done a C/S and saved the baby’s life, heaven forbid, and then that would have caused a painful recovery.

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

    I am blogging the utah midwive’s association meeting that took place in response to valerie el halta killing a baby. Its equally devoid of compassion for the family and the baby. wtf is wrong with these people?

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

    That poor family – I do not care what experience any woman wants, no woman wants to be the woman who a is a mother without a child. I imagine she is trying to cope in the ways she can and trying to understand how such a thing can happen when she “did everything right” according to what everyone may have told her about birth, or at least what everyone who she trusted told her about birth. This is where I really think a very big disservice has been done – instead of having an approved curriculum of childbirth education taught long before women have children- we have a bunch of folks who have no business teaching women the ins and outs of childbirth doing just that at a time when they may be vulnerable to misinformation. Maybe a meme with Lisa Barrett’s picture asking : Would you want this woman to teach your daughter about childbirth?

    • thepragmatist

      And this is where we could make a difference. A real curriculum, that teaches girls more than just the standard “You’re going to bleed. You ovulate 14 days after (lie). You get pregnant if sperm meets the egg. Pregnancy is 9 months. Labour hurts. Here’s a really scary video of some lady screaming through labour: USE A CONDOM OR YOU WILL DIE.” Ha, I mean, that basically sums up the highschool education I got. And I did use a condom, religiously, thanks to that education for the first years of my sexually active life anyhow, until I discovered other ways to prevent conception. But I think our focus is a bit heavy on preventing STI and teen pregnancy (fair enough) and a lot light on explaining to girls the nitty gritty of how their bodies actually work. I learned so much in a Women’s Health class in college that I regularly find myself advising women in their 30′s that, no, having sex on the 14th day of their cycle will not assure a baby and trying to explain the hormonal interplay involved in a menstrual cycle (most of the time, people ask me questions related to fertility– and it’s kind of staggering what grown women do not know about their own bodies)… The rest of the time, I’m explaining (or rather demystifying) some aspect of pregnancy. And I know going into pregnancy that what I did not know, even after two years of consecutive (and requisite to my program) Women Health classes, was appalling. For example, I’d never heard of the pubic syphisis until mine failed me. How disabling a pregnancy could be. I had visions of pregnant yoga and slow walks in the woods. These things became out of my reach for a long time. Nobody told me that a baby could wreck my pelvis the way mine did: I’m still doing daily physical therapy and had to relearn how to walk after months of bedrest!!! Geez. It wouldn’t have made a difference to whether I had a child, but at least I would’ve known better than to let a chiropractor manipulate me. I still feel totally sold short by educators through the years. Even common pregnancy books.

  • Box of Salt

    My condolences to the baby’s family.

  • thankfulmom

    I don’t see anything beautiful about a birth that ends in a dead baby. The whole process is to GET

  • Ripley_rules

    LMS1953, Thanks so much for clarifying that for me. As you can tell, I’m not a medical professional. Until now, I thought the second stage was the third stage. I won’t make that mistake again.

    • LMS1953

      Ripley, no problem. The rules change every decade. I finished my training in 1983. We laughed then about a recent story that a resident had cut an episiotomy AFTER the baby delivered. You see, episiotomies were so de rigueur those days that the resident feared he would be kicked out of the program when the attending finally arrived to care for his patient to discover an episiotomy had not been done. Nowadays you get your episiotomy rates reviewed because “evidence based studies” show that episiotomies are bad – 30 years of experience in the “art” of medicine and common sense be damned.

      • Antigonos CNM

        I have seen so many accepted theories and treatments changed — and often changed back — that sometimes my head spins. Hospital protocols on ruptured membranes, for example.

      • toni

        I hope he was at least reprimanded for that!

  • LMS1953

    http://myobsaidwhat.com/2014/01/23/thoughtful-thursday-it-is-not-your-fault/

    This is the link to the forum I previously made a post about. It fits precisely with Dr Amy’s article today.

  • LMS1953

    I wandered on to a site called My OB Said What? It seems to mainly exist to provide a forum to post snarky comments to statements made to women by various levels of providers during their pregnancies – not just the “OB” as the title implies. Anyway, they have “Thoughtful Thursdays” where they pay homage to “sensitive” providers. Today’s topic is “It’s not your fault” said by a Pedi in the ER to a home birth mom whose baby had been transferred because “the baby needed treatment for a freak occurrence that could have happened in the hospital as well.

    Amy, I promptly posted the 2012 Oregon stats you had given in a prior log topic. The denial is astonishing. It is worth a visit and perhaps some other comments.

    • Amy Tuteur, MD
      • LMS1953

        Amy, that is terrific background info! Thanks. BTW, could you please give me the link to the article you wrote about a year ago that showed there has been an increase in still births at 38+ weeks because they were not “saved” by the horrors of an iatrogenic “preterm” delivery in the 38th week. I need it to show 39 week Nazis (generally the Nurse Director of the Maternity Unit whose sole qualification seems to be the ability to count from 1 to 40). Thanks!

        • AlisonCummins
          • LMS1953

            Thanks Alison. Dang it but you guys are quick!

          • LMS1953

            You know, if I routinely did anything (other than giving a sharp Seig Heil to the 39 week Nazi) that QUADRUPLED my perinatal death rate from 37 to 39 weeks, I would likely have my Board Certification and hospital privileges revoked.

            In 2012, I tried to schedule an induction at 39 weeks 0 days on a Friday because a multiparty was 3 cm dilated at lived an hour from the hospital. The 39 week Nazi would not permit it. She said that my patient was only 38 weeks 6 days. I calmly explained that February 29th added the extra day. I showed her the iPhone app (Perfect OB wheel) that showed she was indeed 39weeks 0 days. She remained adamant and I had to reschedule for the following Monday.

          • AlisonCummins
          • Stacey

            She should be fired.
            If we ALL don’t get loud about these changes, we will see more and more of this crap.

          • araikwao

            All that over ONE day?! That she was wrong about anyway?! She sounds verrrry hard to work with, to put it mildly.

          • Meerkat

            Wow, how scary! Could the patient have done something to advocate for herself? Like threatening to sue the hospital if something happened to the baby as a result of this stupid policy?

        • Young CC Prof

          Can I just say how glad I am that no 39-week nuts got in the way of my “elective” 37-week CS?

          Nope, wasn’t an emergency yet. The doctors determined that we were at high risk of placental failure, and intervened appropriately. No crash CS to save a terribly brachicardic baby who then needed days or weeks of respiratory support, just a nice calm surgery, with plenty of screaming on Baby’s part and no screaming from anyone else.

          Maybe it was unnecessary. But I’m glad I didn’t have to take the gamble and find out.

          • LMS1953

            Young CC Prof, you bring up an excellent point. Hospital nursing staff seems to love to lord policy over OBs and treat us like Pinocchio on strings . More than once I have handed them my pen saying, “Fine. YOU know so much YOU take over the case and write the orders and YOU go tell the patient why everything I just discussed with the informed consent on why it is best to do the C-section now is wrong and how YOUR judgment is so much better than my BOARD CERTIFIED obstetric judgment” Guaranteed to get you written up for being a “hostile physician”. Just like Amy posts here, Many L&D head nurses push the goal posts just like midwives (be they CPMs or CNMs). The pre-eclampsia isn’t THAT bad. The contractions aren’t THAT hard. Her diabetic blood sugars aren’t THAT high. The variability is pretty good; correct Doctor, the NST is non-reactive. The AFI isn’t THAT low. All the labs are good except the uric is just a LITTLE elevated (it was 8.2, the highest I have seen in 30 years when using it to monitor pre-eclampsia – typically it is around 5 to 6).

            Just like home birth nuts – breech is a variant of normal, I’ve only had one prior C/S, the twins aren’t THAT big and even though they are both breech my expert midwife assures me she can make them turn with moxibustion…. The list goes on, but you catch my drift.

          • drsquid

            ha im not ob but ive been written up for stuff like that.

            and oy moxibustion. someone in my twins group just recommended that to someone. well.. at least it is cheap if you do it at home as she recommended

          • Meerkat

            I don’t understand why they care.

          • MaineJen

            Because there are “too many” C sections nowadays, didn’t you know? I had a nurse tell me I didn’t ‘really’ need pitocin last time, even as she hooked up my IV bag on doctor’s orders…just because my water had been broken for an unknown time, I was GBS+, baby was tachycardic from low fluids, and I was only 3cm dilated thus far. I was happy to take the doc’s advice, myself. :) Nothing like inspiring confidence in the patient, though. Sheesh.

    • Ennis Demeter

      I don’t understand the logic. if pro homebirth people except that there are hospital transfers, why doesn’t it make sense that it’s safer to start off in the hospital in the first place.

      • theNormalDistribution

        Defiance of authority. The actual reason for home birth.

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

      I posted the icky comments from my midwives on that site too. It is full of NCB, I won’t deny that, but the owners will put your comment up regardless of what provider a person used.

      • LMS1953

        Betterbirth, I have found that it is mostly an opportunity for snarky comments taking the case completely out of context, since context is rarely provided, leveled against generally well-meaning professionals. Maybe one in ten have any validity at all. Most of the rationale is along the lines of, “My grandfather smoked three packs a day since he was twelve and he died of natural causes at age 95. So THERE, smarty-pants doctor, you think you know everything.” And the OB part is disingenuous to the extreme. You have to be pretty savvy about the site to realize thatOB pertains to ANYONE they might have encountered during their pregnancy from office receptionist on up.

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

          Well its like a support group for people who feel like they have been wronged. Sometimes they were, sometimes they just felt like they were. I think that it is valuable in that there are few places (outside of a therapists office) where people unconditionally support patients and their feelings. 99% of the time if you tell someone in real life about these kinds of things they just tell you that they are the dr and you should always listen to them or they minimize it or tell you that you probably imagined it. It is nice to not feel alone or feel like someone is on your side about things. There are a lot of problematic things about MOBSW if you are using it as an actual source of information about various topics. I don’t see a problem with it being used as a support group, however.

          • T.

            I see it as a problem if it supports woo-filled ideas that will end up in damaged/dead babies or women…

          • LMS1953

            If you try to give any rational explanation, it takes about three posts before someone tries to castrate you with a dull knife.

          • fiftyfifty1

            “I think that it is valuable in that there are few places (outside of a therapists office) where people unconditionally support patients and their feelings. ”

            Nope, not valuable. Dangerous. There is a big, big difference between “unconditional support” and therapeutic validation. Therapists are carefully trained NOT to do the first while doing the second. It can cause a world of harm to do “unconditional support” when what is needed is validation. It’s one of the reasons we ended up with the whole “recovered memory” fiasco.

            Here’s a concrete example of the difference between the 2 approaches:

            Person with Anorexia: “They are pushing me too hard and making me fat. They have chosen a goal weight that is totally wrong for me. I’m naturally thin”
            Unconditional support: “That’s unfair! They should treat you as an individual, not force you into some “average” body type that’s not right for you”.
            Validation: “It makes sense that restoring weight feels really bad and scary to you right now. You’ve been the one controlling the food for a long time and now you’ve handed that control over to someone else and it feels powerless. You’re worried they will choose a weight that isn’t right for you. Would you be willing to have a conversation with your doctors about why they’ve chosen the goal weight they have?”

          • Young CC Prof

            Hmm, yes. I’m thinking of another site where people post things their doctor said/did that were biased against fat people. Some of the posters describe incidents that, if true, really are outrageous, like a doctor chalking all your health problems up to your weight, including, say, an infection, and refusing to do anything for you until you lose.

            Others, though… If you have a BMI of 40, and your doctor points out that this is having a deleterious effect on your health, he’s just doing his job!

  • The Computer Ate My Nym

    That’s 17 times in the past 3 years alone that a baby unexpectedly
    dropped into a homebirth midwife’s hands either dead or nearly so.

    That you know about from cases found on the internet. 17 is a minimum number, not a maximum.

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

    Ugh!!! The heartbreak is turning to frustration!!

    I can’t believd how often this happens… “The baby was fine until….” I recently was reading the Birth Center study and 3 of the deaths were unexpected stillbirths. The mother was in labor, all was fine, then baby born still. Why must birth out of hospital be so “hands off” that babies aren’t monitored properly??

  • The Bofa on the Sofa

    I am struck by the way she lists her 3 tears (1 of them 2nd degree) and 8 stiches. And oh, the baby died.

    • The Computer Ate My Nym

      It may be that the baby’s death was too overwhelming to discuss so she’s focusing on minor things like the tears. The period just after birth is a strange time emotionally, even for a birth with a happy outcome.

      • Young CC Prof

        I think you’re right. It actually doesn’t sound to me like she doesn’t care, more that she’s too upset to express herself properly.

        • The Bofa on the Sofa

          Maybe. Then again, I don’t think you need to invoke trauma to explain her lack of perspective. Her comments (at least those quoted) paint the picture of someone who was all about the process, and you can see that tears and stitches are going to be super bad because they have ruined her great experience, just as does pelvic exams.

          It may be shock, but I’m not convinced.

          • LMS1953

            I can’t figure out what was “unnecessary” about the pelvic exams. What did she say, “My highly qualified CPM (with her high school degree) who just caught my dead baby had already done one and you certainly don’t need to inconvenience me with another one. I might be subject to a “cascade of intervention” (like a D&C for retained placental fragments or the surgical repair of an unrecognized laceration).

          • The Bofa on the Sofa

            Apparently, OBs like to go around shoving their fingers up there just for no reason.

            The concept of “more information on which to base decisions” is foreign to these folks, it seems.

          • anion

            Well, you know, that’s why they went through all those expensive years of schooling: just to get to play with ladyparts. Totally worth it!

            It’s completely different from the beautiful, honorable CNMs, who do a correspondence course or whatever for a couple of months in order to have a chance to play with ladyparts.

            It’s clear which side is actually dedicated to health, and which just likes to play with ladyparts.

          • The Bofa on the Sofa

            Well, you know, that’s why they went through all those expensive years of schooling: just to get to play with ladyparts. Totally worth it!

            The stupid thing is that there are people who actually make that accusation, and think that the only reason a guy could want to be a gyno is to look at lady parts.

            I always wonder what they think about the motivations of male urologists, who spend an awful lot of time dealing with old dude dicks, or, for that matter, any proctologist. Pervs. Gotta be pervs.

            It’s completely different from the beautiful, honorable CPMs (fixed for you), who do a correspondence course or whatever for a couple of months in order to have a chance to play with ladyparts.

            Shoot, Ina May takes “playing with ladyparts” to a whole new level.

          • fiftyfifty1

            I think you meant CPM not CNM.

          • anion

            I did, sorry; Bofa corrected me (thanks Bofa)! The bit below about the CNM and the episiotomy confused my eye-finger connection.

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

    Poor baby. Poor babies.

    I’m an atheist. But these horrifying fake midwives make me wish I could believe in Hell.

    • Stacey

      Me too.

  • Ripley_rules

    What a sad story. I wonder what some of the commenters on this thread will think of this:

    http://www.startribune.com/lifestyle/health/241512581.html

    What makes this unique is that this is about an American woman who claimed she was harmed by a CNM working in a hospital. She claims a botched episiotomy performed in second stage labor left her incontinent and unable to work. I’ve never heard of episiotomy done in the second stage. Is that common?

    • LMS1953

      The first stage of labor is from the onset of labor to when the cervix is complete at 10 cm. The second stage is from complete and pushing to the delivery of the baby. The third stage is from delivery of the baby to delivery of the placenta. Hence, the second stage is logically the ONLY time an episiotomy is done.

    • Zornorph

      I don’t understand how it could cause flatulence, but I haven’t got a woman’s body so I may be missing something obvious. As for incontinence stopping her from performing, wouldn’t one simply use Depends if you had that issue?
      I don’t mean to sound unsympathetic and if somebody did something wrong which caused her an injury, she has a right to pursue for damages, but I’ll admit I’m a little perplexed by the nature of the complaint.

      • AlisonCummins

        If she’s incontinent of stool then I can’t imagine anyone wanting to be on stage with her while she’s singing an aria.

        • Zornorph

          Oh, I see. I thought it was pee. So with an episiotomy, they cut all the way down to the backdoor?

          • AlisonCummins
          • auntbea

            Well, they really, really try not to and sometimes will do an epi if it looks like the other option is an uncontrolled tear that might reach that far. As my OB put it, “My job is to protect your rectum.”

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

            Dr. Amy did an excellent post about tears and the degrees of them. A fourth degree tear extends to the anus. It is a very unfortunate risk of vaginal birth.

          • Zornorph

            Okay, those baby T-shirts that say ‘I tore Mommy a new one’ make better sense to me, now.

        • DaisyGrrl

          My voice teacher told me stories about a tenor who wore adult diapers on stage for precisely that reason. His singing method involved bearing down hard enough that stool was occasionally the result.

          • auntbea

            This image made laugh really hard. I’m so immature. A dozen years of classical training and I never heard about such a thing!

          • DaisyGrrl

            :) I have extensive classical training and the stories in voice lessons were definitely the strangest!

      • Rochester mama

        I worked for a GI research doctor at Mayo as a non clinical research assistant. I did nothing but track down birthing records for women in his studies. His main focus at the time was women with fecal and gas incontenance after childbirth, especially those with difficult deliveries requiring forceps.

    • moto_librarian

      I feel terrible for this poor woman! If the CNM felt that it was necessary to perform an episiotomy, she was required to get consent. And if she was unable to repair it, the proper course of action would be to get the attending OB to do the repair, in the OR if necessary. Pelvic floor problems can cause different types of incontinence, including bowel, urinary, and flatulence. I think the latter is one that few people really want to talk about. I did a stint in physiotherapy because I was having urgency when I needed to move my bowels, and I still have issues with gas escaping with no warning. It is embarrassing, particularly when it occurs in public. I have heard very few good things about the maternity care provided at army bases. I hope this woman is able to make a full recovery.

    • Medwife

      The epis must have extended to a third or fourth degree tear that the CNM failed to identify and bring in an OB to eval and repair. Poor lady.

    • AlisonCummins
    • Antigonos CNM

      When I hear something very unlikely from a patient, I often wonder whether the patient understands what she has been told, and find that she doesn’t. I’m not saying that this story is impossible, but the perineum is SO thick –indeed, until crowning it is still thick enough that cutting an episiotomy to facilitate a breech birth is pretty difficult, as the tissues haven’t thinned out from the pressure of the presenting part — that I can’t really imagine it [especially since the scissors in delivery sets tend to not be very sharp, for unknown reasons]

      The episiotomy might have extended into a 4th degree tear, but I’m willing to bet that the woman was at the end of the third stage. 2nd stage is before full dilatation!

  • moto_librarian

    I just can’t wrap my head around this. The baby doesn’t even warrant “son” or “daughter” – it’s just “the baby died.” There is no acknowledgment of the humanity of this child. I find it unbelievable. I am going to hope that this is merely because of where she is at in her grieving, but if not, well, I hope she doesn’t have any more kids.

    • Ash

      I don’t think her post indicates that she didn’t recognize the humanity of the child…she made a brief post on an Internet forum while she was going through a lot of grief and suffering. I don’t think saying “son” or “daughter” matters much here.

      But yeah. Another “it was fine until it was not! Babies and women die in the hospital! Homebirth had nothing to do with it!”

      • moto_librarian

        I am giving her the benefit of the doubt, but I still find the treatment of the baby as an afterthought to be odd.

  • Zornorph

    What do these homebirth midwives think? That the act of coming down the vaginal passage suddenly causes the heart rate to drop? Wouldn’t that be a good reason why you’d want a C-section, then? (Not that I think that’s what’s happening, but if they think all is fine until that moment, then that would ‘prove’ that a vaginal birth is dangerous).

    • Amy Tuteur, MD

      What do they think? They think they know how to monitor a fetus but they don’t, and they tell themselves that the same thing would have happen in the hospital.

      • LMS1953

        Precisely. That is exactly what is going on at MyOBSaidWhat where a “sensitive” Pedi said “the same thing could have happened in the hospital. I think some of us doctors are falling prey to a Stockholm Syndrome of sorts. Sorry Mr Sensitive Pedi Guy, but the blood of these senseless newborn deaths and lifelong infirmities is partly on your hands as well.

        • fiftyfifty1

          Or the parents are hearing what they want to hear. I can imagine conversations along the lines of this:

          Doc: “We have found that your placenta had a lot of calcifications in it so it wasn’t transferring oxygen well”.
          Mom: “Why did it have calcifications?”
          Doc: “There are risk factors like postdates and hypertension, but you didn’t have any of those. Sometimes placentas just develop calcifications over the last weeks of pregnancy.”
          Mom thinks…The doctor said it was a random placenta problem that never could have been predicted because I had no risk factors and it had nothing to do with the homebirth because it developed weeks before. Therefore it would have happened in the hospital too.

          And yes, it would have happened in the hospital too, but it also would have been detected as late decels on the strip and the baby would have been born by c-section and come out screaming and mom would have assumed she had had an unnecessarian…

          • anion

            Very true.

            I suspect, too, that some of it may simply be the wish or desire not to further add to the family’s trauma by (correctly) pointing out that had they given birth in a hospital, they’d almost certainly have a healthy baby at that moment. Or the desire not to engage with woo-filled people who might sue or have fits if a doctor or nurse looks at them sideways. “The doctors told me medical facts that made me feel bad! I’ll tell everyone how evil they are!”

      • OBPI Mama

        Then they put a nice spin on the tragic thing that happened by convincing the woman that if she’d been in a hospital she would have ended up with a c-section AND a dead baby. Or they point out that the mom could have died if she’d been in the hospital. Once you are in the cult, a midwife is very convincing about such things so you remain just “thankful” you are alive, without a c-section. My midwife was very quick to point out that I would have had a c-section at the hospital (never mind that annoying birth injury my son deals with!)…

    • Stacey

      Think? They don’t think.
      They feel, and are crappy at that as well.