Aviva Romm, if homebirth is so safe, why don’t you attend them?

Stethoscope and question on white background. Isolated 3D image

Aviva Romm, MD CPM has a new post about the safety of homebirth, entitled Home Birth: Why This Doctor Would Still Choose One.

In the post, Aviva waxes rhapsodic about the beauty of homebirth:

Having home births – and being a midwife – were congruent with how I lived: as close to nature in my lifestyle choices as possible. During labor I felt the most comfortable being in my home, walking on the golf course behind my house, squatting during contractions, and eating & drinking freely to maintain my energy and stamina. It was where I felt the safest and could take the path of least resistance to how I wanted to birth. I also knew I was making an educated decision based on extensive research into the history of birth in many cultures, and the evidence for obstetric practices at the time.

In fact, if she had to do it all over again, she would still have homebirths:

Now that I am a physician many women ask me if I would still have my babies at home.

My answer is unequivocally: “Absolutely.”

… [Y]ou might say, “Well that’s easy for you to say since you’re long past your childbearing years” and don’t have to make that choice …

Exactly! But there is a choice that is still available to Aviva, yet, as far as I can determine from her promotional literature, she didn’t make it.

Aviva could attend homebirths as an MD, back up local homebirth midwives, get privileges to admit her obstetric patients in transfer to local hospitals, and forge relationships with local obstetricians to perform needed C-sections on her patients, and care for her high risk patients.

Yet now that she could actually provide physician services for homebirths, she chooses not to do so.

So my question is this: Aviva, if homebirth is so safe, why don’t you attend them?

Could it be that you don’t attend homebirths as an MD because they aren’t really that safe at all? Could it be that you don’t want the liability concerns that attending homebirths would entail? Could it be that you don’t want to back up local homebirth midwives because you don’t want to be responsible for their screw-ups? Could it be that just like nearly all family practice and obstetric practitioners, you don’t want to put your career on the line just to help women have homebirths?

I don’t know your reasoning. Perhaps you feel that you want an easier lifestyle? Perhaps you prefer to cash in by practicing “functional medicine” on the worried well who can pay out of pocket. I don’t blame you. You probably have massive amounts of debt and a high profile, high profit practice is the best way to clear that debt.

But don’t you think it’s rather hypocritical to promote homebirth while refusing to attend homebirths?

I prefer to judge people by what they do, not what they say. And by refusing to attend homebirths as an MD, your actions speak far louder than your words.

  • B

    Jeez…you people are harsh on Aviva. She just wants the best for people. The culture on this website is just as bad as the one on hers. You all are preaching to the choir here. I bet the reason Aviva doesn’t attend homebirths anymore is the reason why she chose to be an MD to begin with. She wants to focus on life and health after birth. She’s done with homebirths. Just because she supports them does not mean she needs to dedicate her career to them. I’m sorry to see a skeptical OB that is so biased and one-sided that you can’t write a balanced article. I listen to BOTH sides of the homebirth debate and both sides make really good arguments. I have not had kids yet and I’m not sure what choice I would make. Maybe I’ll have it in the car on the way to the hospital…oh the horror!

    • NoLongerCrunching

      There is a difference between supporting a woman’s right to choose where she gives birth and deliberately encouraging a dangerous choice. She even acknowleges that there are many inadequately trained lay midwives out there, but blithely encourages women to homebirth anyway, without helping mothers understand how to figure out who is a good MW and who is a quack. She is abusing her role as a doctor, IMO.

  • fiftyfifty1

    So she has now changed her post from saying that WHO recommends a c-section rate under 7%, to saying that it recommends not going over 14%. So obviously she is reading this blog. So why doesn’t she respond to your questions?

    And she writes that she is a family physician with a “specialty in obstetrics”. Unless she is lying, that means she must have finished one of the Family Medicine Obstetrics Fellowships. There are a couple dozen of these accredited programs nationwide that can be tacked on after finishing your family medicine residency to get extra training in C-sections and forceps so you can get full L&D privileges. A couple of my professors in residency had done this. So presumably she can already do c-sections. So why doesn’t she list HER c-section rate on her website?! Why not be transparent!? Come on, Aviva, show us the numbers!

    • Amy Tuteur, MD

      That’s funny! She’s down graded it from lying about both the recommendation and its substance; now she’s just lying about the recommendation, since it has been withdrawn.

      Is that supposed to be better? Personally, I think it’s worse. She calibrating what lies she thinks she can get away with when writing for lay people, while simultaneously keeping an eye on what lies she is called out on by professionals.

      • GuestingIt

        She’s just like Robert Sears with The Vaccine Book. Promoting an unsafe idea such as homebirth or vaccine refusal to sell books, promote themselves, make money, etc. They sell misinformation to lay people while trying to stay in good standing with their peers. Does the medical community ever censure these types?

  • Captain Obvious

    So Aviva is so educated she is still quoting the old WHO recommendations for a particular CS rate. She doesn’t know that they retracted that statement? She slams EFM stating it has no benefits other than raising the CS rate. Does she not know of the studies showing it has lowered the intrapartum stillbirth rate and the neonatal seizure risk? She claims she would still have a Homebirth, but states she knows of bad midwives out there risking baby’s and mother’s lives. And she doesn’t perform homebirths or covers Homebirth midwives? She claims Homebirth rights are a “It’s a public health and safety issue”. Oh, and that vaginal flora issue again. I just read an article about treating resistant C. difficile with duodenal infusion of donor feces that works 81% of the time. Couldn’t you just wipe the cesarean born baby down with some of the mother’s vaginal discharge? But I digress. She slams ACOG (her own college now) for changing their practice bulletins and committee opinions. Isn’t this what you want of your organization? To change with the times according to evidence based medicine. MANA publishes their survey and make no changes to their Homebirth practice guidelines. They just stand their preaching how great and safe Homebirth is.

    • Siri

      Donor feces….now those are two words you don’t often see next to each other.

      ‘Oi mate, you gonna finish those feces all by yourself? Or could you spare a smidgen for a little ol’ lady who hasn’t got any?’. Or, ‘Look, Daddy, see what that nice lady gave me! I think it’s donor feces!’.

      • Captain Obvious

        I guess you don’t get more natural than donor feces. The study screened the feces for every imaginable contamination. Yet lactivists give breast milk away without any screening.

        • Trixie

          To be fair, real milk banks actually have extremely comprehensive donor and milk screening processes in place. But I understand your point.

    • anh

      technically they haven’t retracted it. they just admit it’s not based on any empirical research

    • LMS1953

      Capt, great points! What I have never understood was the notion that EFM doesn’t make a difference when compared to (a well defined method ) of auscultation (that is seldom done because of its impracticality). Now, I have heard that spiel for about 3/4ths of my 30 year career. I have NEVER practiced in a hospital where it would have been considered appropriate to have tied up a nurse with q5m auscultation. Not that I doubt you (the current stats on HB conclusively PROVE it) – but do you have the specific citations about intrapartum stillbirth?
      How was it ever said, “EFM has no value. All it does is lead to the cascade of intervention and more C-sections, as long as you are not worried about your baby dying inside of you when you are in labor.

      • The Bofa on the Sofa

        We thought the EFM that the nurses could watch down at the nurse’s station was really cool.

      • Young CC Prof

        There was a study like 15? years ago that got a lot of press. It claimed that EFM increased c-sections without improving outcomes for babies, but it was underpowered to detect relatively rare harms like intrapartum death or brain injury. Later studies confirm that it does save babies, but I don’t remember seeing them in the newspapers.

      • http://www.antigonos.blogspot.com/ Antigonos CNM

        “Q5 minute auscultation” is a joke for purely practical reasons. Between contractions, locating the fetal heartbeat, listening to it for a minute [sometimes more, if a decel is suspected], charting it, and beginning all over again — believe me, it takes more than 5 minutes each time.

        Re a question about the difference in medical and nursing approaches: a doctor orders something like “Q5 minute ausculation” while the nurse tries to figure out how to manage to do it. :-)

    • Jessica S.

      So EFM may increase the CS rate but in favor of less dead babies? And she views this as a negative? I’m sure she refutes the idea that it saves any lives. But unless she’s proffering (legitimately) that an increase in CS rate leads to more death, I have to ask – in the end, so what? I feel like a one-hit wonder here, constantly pointing this out, but in the grand scheme of things, erring on the side of a live baby greatly outweighs any lack of fill-in-the-blank-with-magical-vaginal-delivery-properties. At least, for me. I’m not a professional, I’m just a woman who doesn’t think it’s a huge deal how the baby comes out, rather THAT it comes out, preferably alive. (<—- Again, my one-hit-wonder.)

      I guess I'm just less enlightened. Or lazy. Or un-empowered. Or the like.

      • The Bofa on the Sofa

        feel like a one-hit wonder here, constantly pointing this out, but in the grand scheme of things, erring on the side of a live baby greatly outweighs any lack of fill-in-the-blank-with-magical-vaginal-delivery-properties.

        Shrug…

        You’d think so.

      • NoLongerCrunching

        It sounds like you’re deficient in unicorn sparkles, to put it technically.

        (formerly LynnetteHafkenIBCLC)

        • Jessica S.

          That’s what I missing!!

    • fiftyfifty1

      “She slams ACOG (her own college now)”

      Actually it isn’t her own governing body. Her website is carefully written to give the impression that she is an OB (she says she has a “specialty in obstetrics”) but actually her CV shows that she started residency in internal medicine but switched after one year to family medicine and finished there. I also find NO EVIDENCE that she completed a Family Medicine Obstetrics Fellowship. Her Family Medicine residency program (Tufts/Cambridge Health Alliance) does not even offer such a fellowship according to either the ABFM or ABPS. Her CV also claims that her first year of residency (Yale internal medicine) had an “Area of Specialty: Women’s Health”. I was not able to find any such program on Yale’s website.

      I think what she is actually doing is claiming she has “specialties” in areas that she has merely spent any time studying as part of a Family Medicine’s normal (broad but *shallow*) training program. I’m a family physician myself, and have my own areas of interest, but I would never say I have “a specialty” in these areas unless I actually did. Obviously her website is meant to deceive.

      • The Bofa on the Sofa

        Hey, it seems that her basis for her claimed “specialty in obstetrics” is that she is a CPM.

        • fiftyfifty1

          pathetic and unethical

          • KarenJJ

            I wonder why she didn’t choose obstetrics if she was interested in women’s reproductive health and bringing babies into the world.

          • AlisonCummins

            I suspect she is only really interested in caring for well people. If it can’t be treated with herbs, she’s not interested.

            Pregnancy is not a disease, but it probably turned out to be more complicated than she really wanted.

          • http://www.antigonos.blogspot.com/ Antigonos CNM

            I suspect it might have been due to the fact that OB/GYN [you can't separate them] is a surgical specialty with a long residency [5-6 years]. She probably wasn’t all that interested in the gynecological component, either with an eye to doing office gynecology in future, or doing gynecologic surgery. Anyone with an MD who has completed an internship can hang out his/her shingle, although most GPs today have additional training in family or internal medicine. Not having her CV, I don’t know whether she did a residency or in what field. {now, reading upthread, I see that fiftyfifty1 actually answered this]

          • fiftyfifty1

            OB/Gyn is a 4 year residency in the United States.

          • http://www.antigonos.blogspot.com/ Antigonos CNM

            Thanks for the correction. It was 4 years back in the 70s; I thought it had become slightly longer.

            I think it is longer in Israel, but our system [no pre-med; med school is 6 years] is different from the US.

            Either way, it’s more than a sneeze.

  • Lena

    I wonder if this is the same MD/Midwife that was featured on, iirc, TLC several years ago (at least 10). They showed her preparing for a c-section as well as attending the unmedicated vaginal delivery (in a hospital)-complete with squat bar-of her daughter. The one thing I vividly recall is how she referred to natural birth as “real birth” as opposed to–and she was sneering as she said it–”medical birth.”

    • Jessica S.

      Puh-leeze. “Real birth”, “medical birth” – Doesn’t really matter how or even where it comes out of, the end result is a REAL HUMAN BABY. Which method offers the best odds of a healthy one, I’ll take it. Too much navel gazing! Or, ahem, elsewhere. (In my case, lower abdomen – I’ll be going in for a repeat “medical birth” *sneer*.)

      • The Bofa on the Sofa

        My description is always “to have a baby.”

        • fiftyfifty1

          That’s my favorite too. As in “Jane had her baby yesterday! It’s a boy!”

    • theadequatemother

      until the majority of people get past this unevolved idea that there is morality attached to how a baby exits, we’re never going to get to a place where women get optimal care through pregnancy, delivery and the postpartum period.

      • The Bofa on the Sofa

        Do you really think that the majority of people care? Remember, HB is still only about 1%. I know there are people who are not happy about c-sections, but is it really a majority who care?

        Aren’t most people really just happy to have a baby?

        • Stephanie

          I think the majority of people don’t care as long as you don’t request a C-section. Then you are considered “too posh to push”. But I do think the number of people that thinks it matters is starting to grow.

          • The Bofa on the Sofa

            How many people even ask why you had a c-section, though? Even in those cases where I know they had a c-section, I’m not probing as to why.

          • fiftyfifty1

            A fair percentage ask. A fair percentage also ask about whether you had an epidural. I don’t hang with a super crunchy crowd but there is, at a minimum, asking going on.

        • KarenJJ

          The majority of people aren’t into homebirth but a large percentage of people seem to have an opinion of what women are doing with their bodies, including how they give birth and how they feed their babies.

    • fiftyfifty1

      It can’t be her. She just graduated in 2012, and she’s not an OB.

  • Amy Tuteur, MD

    You can follow (and participate in) my Facebook conversation with Aviva:

    https://www.facebook.com/AvivaRommMD/posts/532856290145708?stream_ref=10

    • R T

      Whoa, did she really just say that some HB midwives practice so dangerously she would have to cherry pick which ones to support?! How can she say that and then wax on about the safety of HB in the US? How are women supposed to know who these dangerous midwives are?

    • Lena

      Gah, another one with the “if doctors weren’t so mean midwives would be quicker to transfer” excuse! How is that anything but an indictment on midwives? They’re putting their comfort over the safety of their patients.

    • Captain Obvious

      Shoot, I don’t have FB

      • theNormalDistribution

        Neither do I, but the conversation is public, so you can at least read it. :D

    • LMS1953

      I saw something about a $2000 herbal medicine course led by the ever cheery Aviva. It wasn’t that long ago that she would have been called a “snake oil salesman”. I guess it would be senseless to ask for EVIDENCED BASED peer reviewed proof of what she says herbs can do.

      • Allie

        There’s lots of evidence-based, peer-reviewed proof of how dangerous they can be.

  • Mel

    Slightly OT: What’s the obsession with breast-feeding immediately after birth? In reading the comments on Dr. Romm’s blog, several women complain about not being able to breast-feed for hours after birth. This seems off to me since all of their ‘prolonged’ times seem well within the time frame accepted for cattle…..

    In the oodles of studies done in dairy and beef cows, colostrum absorbance in calves is most effective 4-8 hours after birth. The effectiveness drops after 12 hours, but much of that is due to the fact that cows start producing “true” milk much faster after delivery than humans do. I also thought baby humans have a much higher fat reserve at term birth than calves do. (Baby cows remind me of a shaggy rug slung over a skeleton) In bad weather, we feed the calves quickly so they have the calories they need to survive. That doesn’t seem to be a problem in newborn humans especially in a climate controlled house or hospital.

    Am I missing something real or is this a new NCB hell I missed?

    • Josephine

      There’s this obsession with getting the baby on the boob as quickly as possible. It doesn’t actually have any bearing at all on breastfeeding success as far as I have read. There’s even this fixation with the first “crawl” to the breast to root around and latch on. It’s one of the reasons c-sections are so “bad” – because you can’t immediately rip down your hospital gown and pop your baby on.

      • Trixie

        With support and help, it’s possible to nurse the baby on the table. If I had had an RCS, I’d have requested to be able to do that. Whether or not it impacts long-term breastfeeding success, if it’s something the mother wants, and it can be done safely, why not?

        As far as the crawl — I am convinced that the mother in a reclined position is a very conducive position for most babies to latch. Whether the baby crawls there or not. The baby really can find its way to the nipple, and having to lift its head up and open its mouth actually puts the baby in a great position for a comfortable latch because it forces the baby to open very wide. Also, the baby feels more supported and is less likely to startle. It makes their hand grasping productive as they grasp the breast instead of trying to shove fists in their mouth. Some babies don’t like the backs of their heads held, so it eliminates that as well. Not that any other way is wrong, but I do think that position is one of the easiest for a mom and new baby to master. Much easier than mother sitting upright and trying to bring baby’s head to the breast.

        • Mishimoo

          My first two loved the standard cradle position, but the third insists on laying down for feeds. He simply can’t latch well in any other position and ends up gulping air even at 7 months. He has an upper lip tie, which is what I think is causing the problem.

      • Mel

        Hmm…. you’d think if it was so critical to reproductive/breastfeeding success women would have a much more instinctive response/urge to initiate breastfeeding with great urgency after birth.

        Cows have seem to have one instinct after (and sometimes during) delivery – Lick! Lick the calf! Lick! Since the calf needs dry-ish and fluffed fur to stay warm, dams have a strong instinct to lick the calf for the first hour or so after birth. The calf, on the other hand, is trying to stand up, walk and nurse. This leads to the hilarious situation where the calf has finally gotten up – after nearly epic strugggles – and the mom licks it causing the baby to flop over back into the straw.

        • Trixie

          I can only speak from my own experience, but I actually did have an urgent instinctive response to breastfeed right after birth. This does not, of course, make me a better mother than anyone who didn’t have this urge.

          There was actually a moment right before crowning where I realized my milk was letting down every time I pushed. I was full of milk and had the feeling of urgently wanting the baby to nurse.

          • R T

            Yeah, I also felt a very strong urge!

        • Jessica S.

          This reminds me of a video we watched on our zoo’s website of a baby giraffe being born. My three year old and I giggled and giggled watching the little thing trying up walk for the first time. It was super cute.

        • http://babyandbump.momtastic.com/wtt-journals/1424393-because-journaling-message-board-cheaper-than-therapy.html Proserpina

          They (as in the family practice docs who delivered my son in September) told me breastfeeding ASAP would make my uterus contract and help prevent postpartum hemorrhage.

          For me, wanting my son on my chest right away was mostly an emotional thing. When I birthed my daughter in 2006, the OB-GYN who delivered me didn’t want me holding her until the placenta was delivered and episiotomy was stitched. In retrospect I realized, hey, I’m the one who just did 9 months of work making that kid. Refusing to let me hold her absent a medical reason for separation just strikes me as needlessly cold and disrespectful.

      • Staceyjw

        My baby did the breast crawl and latch- a week later, in the NICU! Not being able to BF the first week made no difference, she is still BF at 2.

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

          Talk about a boob monster!

      • R T

        I was able, with assistance from the nurses, to rip down my hospital gown and nurse my son in the OR. It was about 15 or 20 minutes after he had been born. They tried to help me do it minutes after he came out, but I realized he was not breathing well and insisted they take him and bring him back to me when he was a better color and breathing better. I was right because a NICU team rushed in and started working on him for about 10 minutes. Then he was handed back to me nice and pink and not laboring to breath. He immediately crawled to my breast and nursed like a champ. He was a hungry little guy because when they first gave him to me and I kissed him, he attempted to suckle my nose! I’m still nursing him at 15 months…I would like to wean him, but haven’t developed the backbone to withstand his tantrums when I try. We call him the “Boobie Monster” lol! A csection certainly didn’t damage his ability to nurse!

    • Trixie

      Well, on an emotional level, you tend to want your baby right there with you right after you have it regardless of how you are feeding it. I was separated from my first for 4 hours while in c-section recovery (further delayed because the were busy and didn’t have a postpartum room ready). That was upsetting to me. I needed him with me, even though intellectually I knew he was okay. That hospital has since changed its policy to keep moms and babies together in recovery unless there’s a medical need, and I think that’s a good thing.

      Also, babies tend to go through an alert period right after birth, and then get sleepy after a few hours. So it’s nice to be able to nurse for the first time during that first alert phase.

      • Mac Sherbert

        That is the one reason I even thought about a VBAC. I didn’t want to miss that alert period or be separated for hours like I was with my first. My hospital still doesn’t have a policy for keeping the baby with you (although, they are trying to eventually I think). Anyway, I cried about it to my LD/operative nurse and she promised to get me out of recovery as fast as possible. I mean I had waited 3 years for that baby and having wait 3 hours to get my hands on it seemed like an eternity!! She got me to my room before they finished with the baby (husband giving bath).

        I also made a big deal about them not letting my BP drop out like it did the first time! They all thought I was nuts, but hey I didn’t have the same problem I did the first time around.

        • Young CC Prof

          They let me say hi briefly during the surgery, immediately after birth, then whisked him off to make sure he was healthy and do all the standard newborn stuff. (There were legitimate concerns about his health that made the immediate exam appropriate.)

          They did that pretty quick, though, and brought him to me in the recovery room, just a few minutes after the doctor finished stitching me back up. There’s a picture of me holding a tiny red-faced creature with heart-monitor pads still stuck on my chest.

          • KarenJJ

            I didn’t have my babies with me in recovery either. It is one part of having a c-section that I wish would change (and looks like it is changing where it can).

          • Dr Kitty

            My husband held the baby while they finished sewing me up, but I’ve checked my notes and I was in the OR 20mins TOTAL from first incision to being wheeled into recovery, so guessing it took 5 mins to get her out and she went straight over the curtain into my arms for about 5 minutes, I’d say I was away from her for 10-15minutes total.

            From the OR to recovery and onto my breast within a minute or two ( spinal=no nipple sensation, which was nice). I was only in recovery for about half an hour before going back to the ward, and she was only taken (with my permission) for a bath after we got back up there (it gave me a chance to have a wash and get out of the theatre gown into nice nightwear to receive visitors).

            My experience was very positive and time away from the baby was minimal.

          • FormerPhysicist

            I didn’t have mine in recovery, and I didn’t want them there. Each time, their father was great with them. And I had no problems breastfeeding any one of them.
            Be careful what policy changes you wish onto everyone. Options are good.

          • R T

            I had a choice between my baby and husband going for baby check up and eye goop and vitamin K shot while I got stitched up and taken to recovery or nursing in the OR and having both of them stay with me the entire process. I don’t think it has to be one or the other. I think all KarenJJ is saying is she wishes she had options. Options are good.

          • Trixie

            To be clear, I wasn’t wishing for mandatory babies in recovery and I doubt CC Prof was either. My issue was that I wasn’t allowed to have him there.

          • FormerPhysicist

            To be clear, I don’t wish for it to be disallowed (though mandating a healthy adult with you to hold the baby is fine with me), just hoping it doesn’t go the way of rooming in and breastfeeding “support” in some hospitals. Options are good.

          • KarenJJ

            I would have liked the option. That said the reason given was that they needed to have someone for me as well as a trained person to observe the baby and if they were busy there wasn’t typically someone from the maternity ward that would be free to stay in recovery to watch the baby. My second did show signs of breathing problems that were picked up by the maternity nurse so it was good that he did have trained people watching out for him.

          • An Actual Attorney

            I don’t even really remember. I remember thinking (possibly saying, but I hope not), “give me my fucking baby” when he was getting checked post CS. And then I had him with me in recovery. Maybe they took him away. At some point he had a bath and was under warming lights. I really have no idea. I know I was nursing as I was wheeled to the post-partum unit, because I locked eyes with my mom at the door and we had a moment. But that’s all.

            I’m clearly a failure as a mother.

    • Susan

      I have always worked in places that recover mom and baby together and get baby breastfeeding, if possible, in the first hour. In the past 5 years or so that’s extended to being routine for C/S as well. What we are taught is that there is a quiet alert state in the first hour ( and I see that there is ) and that babies that feed early tend to have less breastfeeding problems. I don’t know for sure if there is solid research on the breastfeeding success but I can say that it makes moms very happy to not be separated from their babies so for that reason alone it makes sense.

  • Young CC Prof

    This woman went to medical school? Recently? I’d like to have words with her teachers. I mean, if she deliberately kept her ears closed the whole time, that’s one thing, but that she passed anyway?

    No, that’s too hard to believe. She HAS to know what she’s saying is factually wrong. She has to be a scam artist, not a believer.

  • Mel

    I did some counting. Twenty-two paragraphs on the imaginary and generally disproved evils of hospital birth.

    Two sentences on the dangers of home-birth.

    “A poorly planned home birth or a less than competent midwife (or physician, though most home births are attended by midwives), in the rare event of a complication, can be disastrous. There’s no romanticization about that from me – I’ve been in the birth trenches for 3 decades and I know some firsthand horror stories from the mouths of the moms and midwives themselves!”

    She must not have been listening very well…..

  • Mel

    “In fact, growing numbers (though still not the majority) of OBs are women who would like to see birth practices be democratized and evidence-based. ”

    Dr. Romm uses two adjectives to describe the changes in birth practices – democratized and evidence-based. I find this incredibly odd because the two words aren’t synonyms or even related.

    I understand evidence-based. Set up trials, collect data, publish results, set up best-practices and repeat.

    Democratized? WTF….. So, we vote on what happens in the delivery room?

    • Squillo

      I suspect she means democratized in the sense of ensuring everyone has equal access.

      Her real problem seems to be with her definition of evidence-based.

    • Young CC Prof

      Yup. We take surveys of the general public, or all mothers, and we base birthing practices on those. And we do the surveys really scientifically, see, so then it’s democratic AND evidence-based!

      Or, you know, we could use evidence related to actual medical outcomes, like OBs do now. But where’s the fun in that?

      • Mel

        Yay! We should apply that to teaching. I’ll set up a really nifty Survey Monkey quiz to test my students what they think is important to learn in biology and chemistry class. I can then align all of my units to popular demands.

        You’ll see me on TV when I’m arrested for teaching students how to make meth and growing marijuana…..but hey, it’s democratic and has high student engagement.

    • Jessica S.

      “Evidence” may not necessarily equal “science” in her mind, doctor or not. She may mean anecdotal evidence, within her own experience. I don’t know this for certain, just a wild guess. I’ve seen the term used before as a contrast to “science based” or the like, as if SB is too rigid.

  • PoopDoc

    In what culture is it the norm to labor on a golf course?

    • Certified Hamster Midwife

      Scotland?

      • Ra

        My family heritage is predominantly Scottish, and I’m very familiar with their life histories. I don’t remember reading/hearing about anyone laboring on a golf course. I do remember several stories about stillbirths. Who knows though–maybe I need to embrace my root” and labor on a golf course. I wonder–can I have dolphin midwives in the water feature? Perhaps I’ll have to go with trout midwives.

    • Trixie

      Nothing like lumbering around the fairway with balls flying at your head.

    • deafgimp

      The houses around golf courses are often pricey. I could see someone on a doctor’s salary with a house that backs up to a golf course, assuming she makes more than 30k or 40k a year. It’s often considered prestigious to have a house that backs up to a golf course. I have no idea why, because of the windows that break.

      • The Bofa on the Sofa

        Mainly because you don’t have neighbors in the back yard, and that there is a lot of manicured grass there.

        We looked at a house on a golf course once. Golfers were walking past the house while we were looking at it. It was anything but appealing. Really annoying, in fact. Didn’t help that they were making snotty comments toward us.

  • PrimaryCareDoc

    She’s anti-vax, isn’t she?

    • perpetual lurker

      Basically. She wrote this book called “Vaccinations: A Thoughtful Parents’ Guide” that is cherished by the crunchy liberal end of the anti-vax spectrum, because it basically goes through each vaccine and disease one by one and creates this false sense of balance, then essentially minimizes the need for most vaccines and offers less proven alternatives to strengthen the immune system. Grr, argh, etc.

      • Jessica S.

        That’s enough for me, then. I don’t get – or respect – doctors who are fast and loose with vaccinations.

    • PoopDoc

      Yes she is. She is a quack of the highest order who sells snake oil and bad advice at a premium price.

  • Guest

    There are some doctors that seem to sleep through their lectures. I had, until last week, an acquaintance (one of a few) who is a doctor. I posted on Facebook about my annoyance with antivaxxers, only to have her go off pop at me about evil vaccines and how I should prove that herd immunity exists because she knows it doesn’t. She is an actual real medical doctor who works in a hospital. She should have to give her degree back.

    • Guest

      Just had to get that off my chest on seeing the post. Sorry, it was off topic.

      • Jessica S.

        Seriously, tho! I get it. I just replied to a comment above with the same sentiment. If I ever happened into an appt with a doctor who started in on the evils of vaccines, I’d seriously get up and walk out mid-speech.

        • Dr Kitty

          Sleeping though the lectures, not turning up for lectures, too hungover to pay attention to the lectures…we all had our own ways of getting through medical school :)

          Some of us aren’t exactly credits to scientific thought.

          • Ob in OZ

            Guilty, and yet the one thing I learned is that I’m still learning. Now that I don’t have the comfort of being a student (hard to kill a patient at that level) or resident (hard to kill a patient as someone is looking over your shoulder preventing you from succeeding) and am now actually responsible for a patient and their child’s welfare, I pay attention much more to the literature, latest info and technology, etc. The last thought I ever want to have is that a complication ocurred and if I was a better doctor it would have been avoided. I am not the best or brightest and never will be. The best and brightest still have complications. But I want to at least try harder than anyone else to do the right thing so I have no regrets at the end of the day.

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

    When’s you’ve got “luminaries” such as Dr. Weil and Dr. Oz who have demonstrated the high-profit nature of selling this kind of medicine and a certain “personality” – who can blame those who seek to walk along that path? I’m guessing homebirth is not really profitable unless you happen to be a birth junky who doesn’t have any of the “grown-up” expenses of real health care providers – you know frills like an actual medical office with actual equipment, insurance, and maybe even a medical office assistant who is trained to actually code medical records.

    • attitude devant

      Very OT, but could SOMEONE please get Dr. Oz to a voice coach? I mean, if he’s going to do this whole media thing as his career, could he please speak with a less grating tone production?

      • attitude devant

        LOL, someone bothered to vote that down?

        • auntbea

          Dr Oz’s voice coach reads this blog.

        • The Bofa on the Sofa

          It may be someone who is thinking don’t bother with the voice coach and just get him the blazes off tv

          • Mishimoo

            While waiting for an antenatal appointment, I once had fun ranting at Dr Oz with one of the L&D nurses.

  • AlexisRT

    Wow, the WHO target got lowered to 7% now! I’m sure she won’t mind being asked for a citation, then?

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

      WTF – there was no evidence to back the 15 percent target and now allegedly there’s some mythical 7 percent target? How many moms and babies are going to be sacrificed to meet this artificial target? Or is this going to be like the breastfeeding mantra “almost everyone really can breastfeed” that is then used to imply that those who don’t just didin’t try hard enough? We have to care about moms and babies, we have to care about their physical health, and we have to care about their emotional/psychological health as well.

      • AlexisRT

        I seriously think she just invented it.

        http://www.cesareanrates.com/blog/2013/1/8/world-health-organizations-15-percent-cesarean-rate-recommen.html

        So… 5-15% = 7% in Aviva’s mind.

        • attitude devant

          Is she weird, or what? This whole ‘essential oils for women’ and ‘ultra wellness’ racket she has—PUH-LEEZE. It’s all aspirational, a little cult of personality centering on fab little Vivi. She can’t be dumb enough to believe her own press so I figure she’s just running the con as long as she can.

          • Mel

            As a chronically itchy eczema sufferer, the idea of a medical doctor telling me to add essential oils to anything makes my skin crawl.

  • The Bofa on the Sofa

    Oh, I know what the answer is going to be. She is going to blame the insurance companies. You know, they won’t cover her.

    Of course, the question is, why won’t they cover her? She’ll conceded that they are afraid of lawsuits.

    But why are they afraid of lawsuits? Because they know it is a lawsuit that they will lose. Why will they lose? Because HB is clearly outside the standard of care, and no one could defend it in a malpractice suit.

    So you see, the problem is those nasty doctors. Since they all refuse to do homebirths, they can claim that they are outside the normal standard of care. If more doctors would be doing homebirths, then they would be considered standard. It’s all their fault. They all fail to appreciate the greatness that is homebirth, like she does.

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

      No it’s those nasty lawyers…lol.

      • Carolina

        We just ruin everything!

    • Staceyjw

      Actually, many insurance companies will cover HB, as will Medicaid in some states, thanks to the HB MWs effort. She has zero excuse to not attend HB.

      • The Bofa on the Sofa

        No, I’m talking about her malpractice insurance. Will her insurance cover her for damages that result in a HB? I suspect not. It’s just like how our life insurance won’t cover death caused by skydiving.

        A doctor practicing HB is a serious liability when it comes to malpractice, because every adverse outcome is going to be a malpractice suit that will be lost. Almost by definition. All the plaintiff has to do is to show that attending births at home is outside the accepted standard of care, and the doctor should know better.

        Since it IS outside the standard of care, as evidenced by the fact that pretty much no doctor is willing to do it, she should know better. Plaintiff rests. What’s her defense? “All those other doctors are wrong”? “They won’t do it because they are afraid”?

        Make no mistake, a lawyer will make sure the jury understand that “afraid of a lawsuit” means “afraid of bad outcomes.” So the claim that doctors won’t do it because they are afraid of the liability is an admission that it is too risky. There is no defense.

        What insurance company would cover that?

  • Trixie

    She lives close to nature by living on a golf course? Lolololol

    • attitude devant

      Sort of like the people I nannied for in the 1970s who left the NE to get back to nature in their RV as they relocated to Arvada, Colorado.

      • The Bofa on the Sofa

        That just cracked me up.

    • anonymous

      For people as disconnected as her, the golf course is nature.

      • resaurus

        It has grass, sand, birdies (and in some cases, gophers)! It’s a veritable wonderland of flora and fauna.

        • KarenJJ

          Our local golf course has kangaroos. Like birthing with dolphins but less soggy. Just watch out for the kangaroo ticks.

    • OBPI Mama

      As a farmer, that made me laugh too! Forget field work, livestock care, forestry… manicured lawns is real nature!