Aviva Romm is in a bind over the hideous MANA death rates

Bound hands

Earth to homebirth advocates:

Have you noticed that you are being treated like gullible fools?

It appears that everyone in the universe knows that the MANA homebirth statistics paper shows that homebirth with a non-nurse midwife has a horrific death rate except for you.

Melissa Cheyney, Wendy Gordon and other MANA executives presented the data but simply told bald faced lies about what it means. They figured you are so gullible that you’d willingly lap up the lies and pretend they were truth.

MANA itself cannot find a single obstetrician, neonatologist, pediatrician, epidemiologist, or ethicist who is not directly affiliated with the homebirth movement to support their claims. But they imagine you are too stupid to notice.

Lamaze is so convinced the study is a piece of utter crap that their “references” to support it are The Daily Beast and The Huffington Post, as well as their own blog, Science and Sensibility.

GBWC link round up

No problem. They figure you guys are such morons that you will Facebook and tweet these links as if they are actual reference.

Now Aviva Romm, MD finds herself in a bind about these MANA statistics.

Dr. Romm is no fool. She received a prize for graduating at the top of her class at Yale Medical School. No doubt she values her reputation for academic achievement and isn’t about to risk it by lying to support MANA in their own prevarications. So when I asked her point blank about analyzing the MANA paper and the Grunebaum abstract, she dithered:

Aviva Romm 2-7-14

Awww. Statistics are too hard for Aviva. And if you believe that, I have a bridge in Brooklyn I’d like to sell you.

I jumped on her “inability” to analyze the statistics for herself (although I restrained myself from pointing out that if she doesn’t understand statistics, how does she know homebirth is safe?):

Tuteur-Romm 2-7-14

It’s not easy to find someone willing to go along with this little charade since, as a variety of math and stats people pointed out to me, there are no statistics involved in the analyses. It’s all elementary school math.

Fortunately, a math PhD did come through and volunteered to analyze the papers. I promptly notified Aviva on Facebook and Twitter and prepared to be ignored. No professional homebirth advocate can afford to be part of an independent analysis of the data because they KNOW the MANA paper shows that homebirth has a perinatal death rate at least 450% higher than comparable risk hospital birth. I never believed that Aviva would go through with an independent analysis and the only reason I suggested it is to show other homebirth advocates the truth … that American women are being taken for chumps and fools by people who know that homebirth kills babies and don’t want them to find out.

After being ignored for more than 24 hours I sent a tweet this morning and got a prompt reply, weaseling out of the agreement, just as expected.

Tuteur-Romm 2-14-14

Actually, Aviva, the title of the piece is Stupid is the new black and, in case you haven’t noticed, I’m not interested in papering over the preventable deaths of babies at homebirth with faux “courtesy” even if you are.

And I hardly think that lying about whether you can analyze the MANA paper, which you KNOW shows that homebirth kills babies, was showing me courtesy in the first place.

So thank you, Dr. Romm, for doing exactly what I always expect you quacks like you to do. No self-respecting quack homebirth advocate would ever be caught in a position where she couldn’t delete the truth. It’s nice to know that for professional homebirth advocates, their ability to fool the gullible public is more important to them than whether innocent babies live or die.

So professional homebirth advocates will continue to lie about deaths at homebirth. The only outstanding question is whether lay homebirth advocates will continue to believe them.

  • Lizzie Dee

    Slightly OT, but I came across this today

    http://nigelpooleqc.blogspot.co.uk/2013/01/birth-injury-and-material-contribution.html

    Medical Negligence trials in the UK are far more about the forensic examination of what happened, rather than juries being swayed by sympathy. This rather cold-blooded examination of the effects of minutes does rather undermine the “hospital is only 5 minutes away” argument.

    • LMS1953

      QUOTE:
      In fact the trial judge had held that but for the negligence of the midwives who had conduct of Nathan’s mother’s labour and his delivery, “I am satisfied that an episiotomy should have been performed by no later than 14.35 and that Nathan would have been delivered then or shortly thereafter – and, in any event, before 14.39.” Thus, but for the negligence, he would not have had more than ten minutes of HIA and would not have suffered any injury at all.
      ************
      An episiotomy should never be done, say the crunchies. Yet the judge knows to the MINUTE when one should have been done.

      • Susan

        I have a hard time with a judge being so sure of when an episiotomy should be done, whether or not it would have changed the time of delivery so much, and quantifying brain damage so exactly. The certainty only someone who has never actually done any of this stuff can have.

        • thepragmatist

          I imagine this was with much consultation with expert witnesses, though? Have not had time to read the entire thing today.

          • Susan

            The experts would have to be lying to say they knew things with such precision and of course that never happens because experts have such incredible ethics… ( not saying it could not all be true, and I know little about Britain’s legal system except that it is quite different)

          • thepragmatist

            Mrs. W might correct me, but I am pretty sure there was a similar assessment of time done in the case against Victoria General Hospital. Where is she? I don’t know the details, but I’ve seen it down to minutes before. I only vaguely remember that case.

      • LMS1953

        Therein lies the rub. Judges and juries don’t like to see children with CP and dangling arms brought before them. Those almost always become res ipsa locquitur cases that are very difficult to defend. Regardless of birth plans and so called evidenced based guidelines and benchmarks, in the individual case, birth attendants are expected to step up and do the right thing, even if it requires a crystal ball to do so. We don’t have access to one, so at critical moments, we have to rely on experience and intuition. CPMs don’t have much training and often not much experience and their intuition is little more than the dogma of woo.

  • Expat

    http://avivaromm.com/labor-induction-choosing-whats-best-for-you-and-your-baby-and-the-low-down-on-natural-approaches-part-1 I really don’t like this Aviva person. She uses her newly acquired MD title to support: going past 42 weeks, blue cohosh, ignoring 10 lb baby measurements at 39 weeks, all the time admitting that there are increased risks but the absolute risk is small. She believes pitocin causes autism based on a survey of mothers of autistic kids, ignoring the causation/correlation bugaboo and the fact that babies destined to become autistic have larger heads at birth on average and she manipulates people into trusting her by telling stories where she is the wise women who knew all along that all of those other doctors and nurses had it all wrong. The ultrasound said 10 lbs and Aviva said 8.5 lbs based on measuring the belly diameter.. Aviva turned out to be right, so we should trust her about everything. Any time there is a smart person deliberately manipulating the stupid, it smacks of sociopathy. If not that, it is at least something very unsavory. It calls to mind the story of a medical student kicked out of training during his last year for a breach of ethics. That stuff is important. Aviva should know better and she won’t be able to play stupid for ever.

    • LMS1953

      Notice how deftly she deals from the Deck of Woo. When confronted with increased risk she plays the absolute risk card. We routinely encumber our lives with measures to reduce (low) absolute risk (airport security measures, seat belts, head gear for every imaginable childhood activity, vaccination, etc) that are several orders of magnitude less than the risk of a primigravida HB, a breech HB, a post dates pregnancy, a HB VBAC, etc. Yet she thinks she can trump that by playing the absolute risk card melded with the maternal autonomy and trust birth cards. What a load of bullshit!

      • Susan

        Cool graphics!

    • fiftyfifty1

      “Any time there is a smart person deliberately manipulating the stupid, it smacks of sociopathy. ”

      I agree.

      • Expat

        Is she different from quacks like Hyman? While profit driven and narcissistic, I think hyman is not a sociopath, but a true believer, a wacky thinker who connects *everything* together with weak evidence, and he would just patch together a new, weird idea if evidence changed, pretending that the old idea never existed. He is what happens when you mix a bit of crazy into an intelligent mind. Aviva Romm is different in this respect. She doesn’t have that essential crazy element; she knows the evidence about immunization, dangerous herbs and obstetrics, but she ignores it in order to present a consistent image to the world and preach to her choir.

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

      If you look at her clinic she uses her MD license to squeeze 1500$ out of patients for an initial consultation (and they don’t accept insurance). Its mega gross.

      • manabanana

        I think this is what she was charging for her herbalism workshops while she was in medical school.

        It seemed disingenuous to me that she would charge an exorbitant fee, not because her workshop was worth $1500, but because that’s what she needed to charge in order to pursue her personal agenda.

        But it looks like she found people to pay, and who are still willing to pay.

      • KarenJJ

        Wow. That’s just.. Wow..

      • LMS1953

        What? C’mon, snake oil doesn’t grow on trees ya know? Yale must be so proud of their golden haired wunderkind. To put it kindly she is a…..never mind, I’ll just have to let it go. But it would be nice to see someone knock that schmaltzy grin off her face.

    • KarenJJ

      I agree. It’s a type of mindset I’m very wary of. She is choosing to be a big fish in a little pond and choosing the position of back-seat driver as opposed to taking the responsibility doing the driving herself. She’s no fool and I don’t trust her.

      • thepragmatist

        It’s such an obvious ruse. Back away, Aviva, from critical debate… even the critical debate that is in keeping with the “tone” you are willing to listen to…

    • Captain Obvious

      You can take this woman out of the CPM community, but you can’t take the CPM out of this woman, or something like that.

    • moto_librarian

      She has also started deleting comments on her FB page by anyone who disagrees with her bullshit. I called her out on her support for HBAC, and voila, it disappeared.

      • Amy Tuteur, MD

        Apparently Aviva doesn’t understand irony.

        She deleted comments from her post that claimed “words are powerful.” So powerful, in fact, that she has to censor, delete and ban them.

  • Amy Tuteur, MD

    In the ongoing discussion about my tone, no one has picked up on what seems most noticeable to me, the dramatic difference between the way that laypeople talk about me and the way that professional homebirth advocates talk about me. Rarely does a week go by that some lay homebirth advocate does not refer to me as “mean” and explain why no one should listen to me.

    What do professional homebirth advocates do? They don’t talk about me at all … which is pretty remarkable if you think about it. They fell all over the Wax study and will tell you in great detail what is wrong with it, but they don’t mention my posts because they CAN’T rebut them. There is nothing factually wrong with what I write and they know it. They don’t dare mention me because they know how very persuasive the truth can be.

    Not a single one will publicly debate me because they know they will be eviscerated in short order. They ban me and delete me and they ban and delete anyone who has learned the truth from me, regardless of how nicely those other people tell the truth.

    This, to me, is the ethical scandal at the heart of professional homebirth advocacy. Sure there are some professional homebirth advocates who are buffoons, like Jennifer Margulies or Judy Slome Cohain. They don’t understand science and they have toddler level reasoning abilities: if something makes them happy, they believe it. But people like Melissa Cheyney, Wendy Gordon, Aviva Romm, and Henci Goer KNOW that they are hiding hideous homebirth death rates and they simply don’t care. If they put half the energy they use to hide the truth into improving homebirth safety, there would be no need for this blog in the first place.

    Professional homebirth advocacy has no safety standards of any kind, because it is not about caring for babies. It is about improving the employment opportunities and reimbursement rates for high school graduates who want to “play” midwife but find it too hard to get a real midwifery degree.

  • Trixie

    It’s worth noting that Lamaze didn’t even link to the actual studies (as shown in your screenshot above) until someone in the comments called them out on it.

  • Jocelyn

    Ot: Shameon Betterbirth of Utah, I have a question specifically for you: I’ve been talking to an acquaintance for the last couple days, and from what she’s said about the midwives she sees and their birth center, I think she might actually be talking about Better Birth of Utah. Did they recently just add a CNM to their staff? And did they just start offering nitrous oxide?

    If that IS Better Birth, I want to tell her all about your experience with them, but I can’t get through to your blog! I’m guessing you have it down due to the lawsuit, but I really want to talk to you.

  • fiftyfifty1

    “She received a prize for graduating at the top of her class at Yale Medical School.”

    Where did you find that info?

    The only thing I could find was that she received an Internal Medicine award for “outstanding academic achievement and community service,”. But that doesn’t say where she ranked in her class because every department hands out an couple of awards to students who are pets in that department.

    • LMS1953

      Her major award

      • LMS1953

        From her CV
        http://avivaromm.com/romm/wp-content/uploads/2013/09/Aviva%20Romm%20CV%20Sept%202013.pdf
        • Graduated with award for most promising Internal Medicine Physician in Connecticut, 2009
        • Received $5,000 grant for research on Blue cohosh use in pregnancy
        • Established and developed Yale Integrative Medicine Curriculum for
        2nd year medical students

        • Expat

          I wonder if her research on bkue cohosh convinced her of what allopathic medicine has long suspected/known: blue cohosh causes heart attacks in neonates. Untested and plant based does not mean better, nature worshipers.

          • expat

            The answer to my question is, no. She acknowledges that both the the pharmacology and case reports support that it causes serious heart problems in the neonate, but she still prescribes it because she beleives in ancient herbal wisdom and uh autonomy and stuff. Not kidding. http://avivaromm.com/labor-induction-low-natural-approaches-midwife-md
            I don’t care when this junk comes from a lay person, but when it comes from an MD it is downright dangerous because it reinforces all of the diy medicine women out there who prescribe all kinds of dangerous stuff to themselves and their kids.

          • expat

            I really hate how she trots out the nonsense that people are going after the autonomy of pregnant women. In the first world, there is no place where a woman will get thrown in jail for refusing an induction or a c section. She might get treated rudely, but those are the breaks when you want to risk your child’s life because of some crap you read on the internet. Hell, if you deliver a drug addicted baby, in most cases, you get to go home with it as soon as it is healthy.
            Trying to convince women that they are persecuted by a hostile establishment is so manipulative.

          • Staceyjw

            Actually it’s not true that you get to take a drug (illegal ones) addicted baby home. They generally are removed to foster care straight from the hospital, even if mom eventually gets them back.

            Pregnant addict moms are given preferential treatment and express admissions to drug treatment as well as support services if they want them.

            This still isn’t proof of lack of autonomy.

          • expat

            I have family with drug issues and know how easy it is for a drug addict with a criminal record to keep her baby as long as someone promises to try to help her stay sober. They never went through the foster system, they just got visits from a case worker.

          • expat

            She tried to get into rehab at 4 months, but only 1 month of inpatient treatment was paid for through a high-end insurance plan paid for by her md father and it was not enough. The baby had severe heart/breathing problems, barely lived, and will hopefully be normal.

          • Medwife

            Staceyjw, I wish that were the case everywhere (that drug addicted babies do not usually go home from the hospital with their drug addicted mom). Where I live and work, unless you have already had a baby die under your care, you’ll go home with your baby once it’s detoxed. There are simply not enough foster homes to go around.

          • Anj Fabian

            My rule is that the more effective any drug/herb/whatever is, the greater the risk of significant adverse effects.

          • LMS1953

            Exactly. There is rather long list of medications that had their start in the bark of some tree or the oils of leaf or the offal of animal or in the fungus on a Petrie dish. But there were always noisome side effects to obtain the desired medicinal effect. Enter medical science to identify the active ingredient, then purify and standardize its dosage. Granted, the drug is now devoid of woo and sparkles but its efficacy is much improved. And millions upon millions of lives are indebted to medical science for that.

          • Captain Obvious

            Zofran is great with little risk

          • thepragmatist

            Zofran is just starting to be prescribed more and more here. As a kid, we got gravol. Now my son has zofran when he gets norovirus. THANK GOD FOR ZOFRAN! Gravol makes me and my kid insane (he hallucinated and so do I) but Zofran is like being on nothing (for me) and makes him just sleep, instead of getting hyper and crazy. Ditto on all the great advances we’ve made in allergy meds. Gravol and it’s cousin are not my friends, ha.

          • LMS1953

            You would think that with her experience as a CPM and having completed a Family Practice Residency “with Obstetrics” she would be the most ideal person in the United States to provide backup to homebirths/CPMs if not provide the service herself. Instead, she runs a concierge clinic of herbal hypochondriasis. Why so? A few reasons: according to the MANA map, MA does not license CPMs. Kinda hard to backup CPMs in MA if they don’t exist. Her CV and MA license registration does not acknowledge any hospital affiliation. Kinda hard to backup homebirths by providing hospital transfer and subsequent care if you don’t have hospital privileges. It has been my experience that hospitals will often not grant OB privileges to FPs because of the burden of having OBs back THEM up. Also, many FPs don’t do deliveries because the malpractice insurance rider is more costly than expected revenues from OB care. One crunchy VBAC that takes them out of a 30 to 40 patient office schedule is cost prohibitive and disruptive to the flow of an FP practice.

          • Young CC Prof

            She actually admitted (on her promotional web site) that she doesn’t deliver babies because it would make her malpractice insurance too costly.

          • LMS1953

            Join the club. EVERY obstetrician faces that obstacle. WE choose to make that sacrifice to make the lives of women and their offspring demonstrably better than the “natural” alternative.

          • fiftyfifty1

            I agree LMS.

            For a doc to criticize OB care but not provide an alternative is cowardly. It’s like she’s sitting in the backseat simultaneously being an obnoxious backseat driver while at the same time urging her fellow passengers not to wear their seatbelts.

            She could do a Family Medicine Obstetrics fellowship and get C-section privileges herself or deliver in a hospital with an OB in house 24/7. Then we can see how she does. Then we will see if her own CS percentage is below the 7% level she claimed it should be (initially before she changed her post to 15% after reading Amy’s takedown).

          • LMS1953

            How in hades does she come up with 10% as an acceptable induction rate? Plucked out of thin air – just like the WHO’s C/S rate of what, 10%. Now, oxytocin is a nonapeptide. Nine amino acids linked in a chain. Pitocin has the identical formula, all it lacks is the woo and sprinkles of endogenous secretion. Pitocin is evil. Aviva does not countenance ANY elective inductions, even to anticipate and prevent mom from delivering in a snow drift an hour from the hospital. But she fudges – wink, wink, maternal autonomy allows herbs and acupuncture and semen and blue cohosh and nipple stimulation and castor oil belly massages and membrane stripping – anything in her self-anointed bag of woo. Yours for 3 easy payments of $9.99. But wait, be one of the first 100 to call and you will get a coupon for one free placenta encapsulation AND a trial pack of blue cohosh, evening primose and raspberry tea. Call1-800-IKNOWALL.

          • Guest

            Does her training including performing c/s and hysters? If she can’t even apply for those privileges her backup wouldn’t be worth anything.

          • thepragmatist

            MY GOD, the cohoshes have been known to be dangerous for a long, long time… by HERBALISTS! My former MIL (a herbalist) would go on long rants about cohosh and its misuse by people. It really makes me wonder where the intelligent people are. Generally, my friends who use herbs know these things. Midwives here, though, are recommending cohosh at times, much to my chagrin. But you can’t stop these people with evidence. I can’t tell you how many times I’ve advised a mom against cohosh to bring on labour. But, but, but “my midwife told me to!”

          • Susan

            So true! the same people who go nuts about us using meds in the hospital to induce labor, in a safe setting with monitoring and emergency equipment on hand, for real reasons– same people that use those dangerous herbs in hard to quantify doses without monitoring… makes me crazy…..

          • LMS1953

            Oh ye of little faith :-)

  • An Actual Attorney

    Also, OT, but I saw a story today that Ricki Lake is working on a new “documentary.” This time about the pill and how it’s killing us.

  • An Actual Attorney

    So, to deal with the annoying argument that Dr A is just too meeeen, I decided to pick some other bloggers to see if they call BS.

    Andrew Sullivan: http://dish.andrewsullivan.com/?s=bullshit

    Ta-Nehisi Coates: http://goo.gl/yYGm5k

    But, guess what, people keep reading those blogs, and take both men seriously.

    • Jessica S.

      Yup. I can think of several others, now that you mention it.

  • Mac Sherbert

    And in related, but still slightly OT news. My MIL told about a woman she knows who recently had a stillbirth. She refused the doctor’s advice to induce. When will this craziness end? :(

    • Jocelyn

      :(

  • Amy Tuteur, MD
    • fiftyfifty1

      Wow, that really is good.

  • R T

    Her response is so juvenile! You hurt her feelings so she won’t agree to a 3rd party analysis of the study? What a poor excuse!

    • LMS1953

      I imagine she has a pocketful of herbs that will cure us of our delusions … like maybe hemlock, ricin, foxglove, nightshade, mescal …..

    • KarenJJ

      I like her little attempt at word play to paint Dr Amy as a racist. She’s no fool, certainly. Hands up who thinks Dr Romm did that one deliberately in order to antagonise…

      • KarenJJ

        Actually why don’t people pick up on passive aggressive insults better? Is it because it is more “normal” behaviour for women? There’s a tone troll down below saying Dr Amy is too abrasive, yet Dr Romm gets off the hook for saying something that is just as insulting but delivered in a “nicer” way.

        But oh of course it was a simple mistake, a slip of the tongue, I’m just such a silly woman, don’t mind me… Maybe it’s just that time of the month…

        • Jessica S.

          I know!! It stuck out like a sore thumb to me, whether it was an intentional slip up or not.

          • KarenJJ

            It reflects badly on her either way. I can’t imagine typing that without it giving me pause for thought.

  • Jessica S.

    Did anyone happen to point out to Romm that she tweeted “Black is the New Stupid” instead of “Stupid is the New Black”? May seem like a trivial point, but you never know.

  • Brock Aun

    Dr. Tuteur, I’m new to this discussion but have followed your work and your commentary on this issue for quite some time. Much of my insight has come from my wife, who was once a homebirth advocate before seeing some scary things happen at homebirths as a doula and entering nursing school with the goal of becoming a Nurse Midwife (she now is staunchly anti-homebirth). I say all of this to first establish that I come from a place of agreement with your premise: that homebirth is dangerous, and that advocating for homebirth puts women and children at risk.

    After my wife showed me this unfolding discussion and today’s post, though, I have to say that I think your insistence on confrontational rhetoric has, at least in this case, robbed you of an enormous opportunity to actually achieve a goal. What began as a chance to have someone who claims to be a homebirth advocate participate in a thorough, public, and impartial analysis of this data and ultimately force them to confront the reality of the situation ended in both sides retreating to the usual spaces, and it all happened because your tone and language eliminated all opportunities for the other party to engage without feeling attacked. I was truly excited at the chance to see, at least once, someone that appeared to have good intentions and a credible medical background that somehow ended up on the pro-homebirth side willingly reassess the publicly available data and consequentially come to a public conclusion that the data tells an important and dangerous story.

    I’ve read many of your responses here and elsewhere, and I have a sense of how you might respond to this, though I don’t want to put words in your mouth as that would be both rude and detrimental to the discussion. I also follow other cultural group debates (such as the far-reaching feminism community online) enough to know that “tone policing” is itself a very meta distraction that typically serves to simply reinforce everyone’s existing notions of what language is proper and effective.

    I only want to comment, then, that it is my belief that some strategic and gracious diplomacy here might have helped you accomplish much more – or at the very worse, exposed Dr. Romm as someone unwilling to engage in a true analysis while simultaneously robbing her of the convenient excuse that her opponent was simply too brash to bother engaging.

    Nevertheless, I wish you the best of luck with your continued efforts, which I do believe to be important and worthy of praise.

    • theNormalDistribution

      I doubt it. The facts are not on Aviva’s side, and it’s probably safe to say that she knows it. There are only so many reasons one can come up with to weasel out of facing the truth, and complaining about how something is said is one of the easiest. And clearly the most sympathetic.

      • Laura

        Because I’m in nursing school and have been out of the loop here, I may not have seen when you first came on the scene, but I have to say, I love your screen name and picture! I had to take statistics 3 times and then only got a C. I do have an appreciation and awe for those who can handle all that stats stuff! I’m assuming you are keen on statistics or math? (Sorry, I know TOTALLY OT. I couldn’t help myself – I love that screen name!)

    • NoLongerCrunching

      You could be right. I suspect Dr Romm was bluffing from the start though, and just seized onto an excuse. Like I said downthread, Amy published two even more scathing pieces about her BEFORE she agreed to the impartial statistical analysis. In the grand scheme, I think Dr Amy’s tone has brought more awareness and thus done more good than would have been done by retracting the claws in the hopes that Romm would follow through.

      • Jessica S.

        Totally agree! I suspect Romm was not seriously considering it in the first place. I’m skeptical in general of these types of arrangements, in that they are usually used and/or viewed as “gotcha” moments anyhow.

        • Jessica S.

          Not to say I don’t like the idea of debates, etc. – I’m referring to certain head-to-head match ups that, at least for the side that’s light on the facts (e.g. creationism v. evolution), the aim isn’t necessarily a quest for truth. But that’s a bit of a digression. :)

    • Monica

      Who cares if someone is brash. You know what happens when someone calls me on my intelligence? I fight back and try to prove them wrong. How could Aviva have done that here? Well by accepting this 3rd party analysis. She knows she’s in the wrong though otherwise she would have happily accepted this. She knows that there are woefully undertrained midwives out there. She said as much in the comments on her FB page, but it’s up to us to find the right one. Except with so much hiding of facts and not giving out the information and burying cause of death in dead babies happening I’m really not sure how any woman is supposed to know for sure she’s getting a trained midwife. Aviva knows the numbers are not on her side and that’s why she backed out. Is it convenient that Dr. Amy said some not so nice things about her? Perhaps, but there would have been plenty of lame excuses which all would have pointed back to Dr. Amy’s tone on this blog. She could have chosen any number of posts to complain about from here because that’s what homebirth advocates do. They point at Dr. Amy and say she’s a quack because she doesn’t have a license and she’s a big meany head to loss moms. So it would have been this post or another one that she would have pointed to as a reason to back out because she never intended to do it to begin with. She wanted Dr. Amy and all of those people on her FB page to stop making her look like she’s doing exactly what she’s doing, burying the information and saying I don’t like your tone.

    • Guest

      Dr. Romm would not have taken her ball and gone home if she’d thought she was going to win.

    • Amy Tuteur, MD

      Thanks for your candor. I appreciate you sharing your concerns because it reminds me that much of this is “inside baseball” and I need to do a better job of explaining what is going on.

      The MANA paper and the Grunebaum abstract are both simple and straightforward. The only people who have criticized Dr. Grunebaum’s research are homebirth advocates and the only people who have accepted MANA’s interpretation of its statistical analysis are homebirth advocates.

      I start from the perspective that Aviva Romm, like the MANA executives are privately in total agreement with what both studies show, especially since both studies show nearly the same thing: homebirth increases the risk of perinatal death by 4-6 fold. The difference between Dr. Romm and myself is that she wishes to hide this information.

      I do not for a moment believe that she “doesn’t understand” these very simple studies or their results. I do not for a moment believe that we need an independent statistician to analyze the papers. I do believe that Dr. Romm, unlike Melissa Cheyney, Wendy Gordon and other MANA executives, is NOT willing to lie and destroy her credibility with other medical professionals.

      Therefore, I publicly asked her to explain what she thinks the MANA paper shows. That put her in her first bind. She attempted to get out of it by insisting that it is too hard for her to understand the results, that only someone with special training in statistics could understand it.

      Then I called her bluff. I offered to come up with an independent statistician to “help her” understand what the paper shows. She agreed, probably because she figured she would be able to find some evidence that the statistician was not impartial.

      Then I called her bluff again. Someone volunteered to do the analysis with both of us. Apparently she couldn’t find anything to complain about when reviewing the math PhD who volunteered. What option was left to her: to complain that she couldn’t participate because I am not a nice person.

      We could argue whether or not I am a nice person, but that’s really irrelevant. If you check out my website Hurt by Homebirth, you will find stories of babies who were injured or died at homebirth; almost all happened within the 5 years that MANA has been hiding its death rates. Had those parents known about the death rates, it is quite possible that they would have made a different choice and their babies would be alive and unharmed today.

      That’s a very long way of saying that Aviva’s behavior is a desperate attempt to avoid acknowledging that homebirth kills babies. She cares enough about her own reputation to be unwilling to lie and claim that the paper shows homebirth is safe. So she is desperately trying to avoid addressing the data at all.

      • LMS1953

        http://www.mana.org/about-us/statement-of-values-and-ethics

        To experience an immediate Godwin moment, read the MANA statement on Values and Ethics. It completely explains the reason Aviva ran away.

        • Amy Tuteur, MD

          This is mind boggling: “We recognize the limitations of traditional codes of ethics that present a list of rules to be followed. Therefore, a midwife must develop a moral compass to guide practice in diverse situations that arise from the uniqueness of pregnancy and birth as well as the relationship between midwives and birthing women.

          • C T

            Standards can exist and still be flexible. I teach my children not to lie. At the same time, I recognize and teach them that in certain circumstances (i.e., to save an innocent life, etc.) it is better to lie than not to. But I don’t dispense with standards altogether.
            I wonder how the drafters of this statement would feel if their mechanics felt the same way about fixing cars as they do about helping women and babies have a good outcome at births.

          • LMS1953

            A reading of their manifesto is best done with background music such as Ride of the Valkyries and other Aryan classics.

          • Captain Obvious

            Define moral compass

          • LMS1953

            Good pole – Midwife
            Bad pole – Doctor

          • Anj Fabian

            Translation:
            We could give midwives rules to follow, but we choose not to.

            We could provide leadership, but we choose not to.

            We pass the buck to the individual midwives, and by doing so, imply that whatever they decide is acceptable.

          • Dr Kitty

            I don’t think MANA understand what traditional ethics involve.

            Ethical dilemmas are dilemmas precisely because it isn’t clear what the “best” outcome is.
            Traditional ethical frameworks try to help you to make judgements calls, there are few absolutes (no lying, no stealing, no killing).

            For example, when I call my defence union for advice about an ethical dilemma such as whether or not to break confidentiality they DON’T tell me what to do.
            They explain the situations where it MAY be ethical to breach confidentiality, but that the breach would have to be justifiable, and then they leave the final decision up to me. They don’t tell me to listen to my heart, but they don’t give yes/no answers either.

        • NoLongerCrunching

          To contrast, you could look at the Code of Professional Conduct and Clinical Competencies for Lactation Consultants. http://iblce.org/resources/professional-standards/

          LCs have been criticised on this blog for overvaluing process of feeding and overstating the benefits of breastfeeding, which is analogous to homebirth midwives valuing the process of birth and overstating the benefits of homebirth while giving misleading information about the risks. However you feel about LCs and the BF/FF debate, at least we have a clear statement of ethics including honesty, collaboration with HCPs, and accurate information. We have minimum clinical competencies that include protecting the infan’s health and the mother’s health.

          MANA could and should do this, and would get a lot more respect from other professionals, which they claim to want. Sorry, but respect is earned, not given.

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

      I appreciate and concur with these sentiments. I would add that it’s been my experience that, when someone knows their position is weak and hopeless, if you give them the opportunity to argue tone, they will argue tone. Of course, tone has absolutely nothing to do with the rightness and wrongness of one’s arguments; but when someone is cornered, they’ll use that as an escape hatch if they can, and their followers will cheer them on feeling vindicated.

      The question becomes, what audience is it that Dr. Amy wants to reach with her message about home birth being dangerous? The people who comment regularly here obviously have no problem with the biting wit and frequent insults. Homebirth enthusiasts, likewise, are pretty entrenched in their beliefs and are going to accept whatever excuses are offered for someone like Aviva Romm to not engage here. The group that I fear Dr. Amy alienates by launching posts like “Stupid is the New Black” before dialogue with the target has been shut down is exactly the group she should be trying to reach: low-information readers who are not entirely decided on one side or the other yet. Those are the people most likely to say, “Dr. Romm was being super-nice and that mean ol’ Dr. Amy couldn’t keep it civil!” Because while I definitely think Dr. Amy had the better arguments here, I’m also someone pretty skilled at cutting through sentimental bullcrap and argument-by-emotion. Most people aren’t. And to those people, Dr. Amy just came off looking like she kicked a puppy.

      I’m not really advocating that Dr. Amy needs to be nicer. I’m advocating that she needs to learn the fine art of patience and giving someone enough rope to hang themselves with before striking.

      • theNormalDistribution

        I don’t know. I think Dr. Amy often sounds more like a strict, no-nonsense schoolteacher chastising students who should know better rather than someone who kicked a puppy. The problem is, there’s no rope for homebirth advocates to hang themselves on. You can’t catch them in a lie when they’re straight up dishonest about everything. Dr. Amy calls the lies for what they are and gives direct links to the evidence so you (the reader) can evaluate them for yourself. You don’t see that kind of transparency often, and I think that’s exactly what the audience who hasn’t been indoctrinated by the homebirth crowd needs.

        • C T

          I know the studies and anecdotes she posts are the most useful to me. Name-calling and mocking posts are ones I just scan and then look below to see if the comments have more interesting information. We already get plenty of name-calling and scary stuff (a al BOBB) from the NCB crowd. What fence-sitters need is straight-up facts, accurate interpretation of studies, and warning stories, and as they start to realize their crunchy friends are misinformed, they need loving, strong support of the decision to NOT homebirth.
          I didn’t become anti-homebirth until I saw a friend lose her baby to one and the awful sorrow she experienced afterward. Until then, this blog was just helpful to not feel bad for having been “too weak” (and squeamish) to try for a homebirth.
          The NCB-leaning crowd craves beautiful, wonderful, mystical ideals. It’s possible to acknowledge their human need for beauty and intimacy while laying out clearly why it’s worth it for safety reasons to cooperate with hospital protocols.
          Because of the tone, it’s impossible to link to Dr. Tuteur’s blog in an effort to convince my homebirth/alt med friends of anything because her tone has turned them so thoroughly off and they feel that when I do so, I am personally attacking them.

          • Amazed

            I disagree.

            In the storm of pro-NCB and homebirth sites, we need someone who isn’t afraid to attack them strongly enough. There are lots of blogs that are polite and informative. Why don’t you point your homebirth/alt med friends to them? Why do you think the problem is that Dr Amy is Dr Amy?

            Should this blog change its tone, it’ll stop getting this many views and comments. It her ‘vitriol’ that keeps the discussions going and pro-homebirth people coming in droves. Nice and factual sites don’t get this much attention or comments, so it’s easy for the homebirth/alt med crowd to dismiss them. Should this blog turn into one of them, it’ll lose its audience.

          • C T

            Oh, I never said “nice.” I think niceness is overrated when you’re dealing with telling the truth about observable facts and the progress of medical knowledge.
            I have never come across any blog or site besides this one that clearly dissects the NCB and homebirth myths and shows the movement for the danger that it is. For example, the Mayo Clinic site says homebirth is more risky, but then says that the risk of infant death is still low, making homebirth look like a reasonable, safe choice. Dr. Tuteur does a valuable service which no one else replicates.
            Unfortunately, the tone of this blog is too much of a deterrence to those who want that beautiful birth experience their good friends and “supportive” (till things go wrong) midwives tell them they can have. Attacking falsehoods and people’s wrong-headed and/or deceitful actions can be done without resorting to mockery and low-level name-calling, but she chooses not to restrain herself from that. Her tone definitely keeps many people away. I’ve been following this blog for over 2 years now, and pro-homebirth people do not “come in droves” to this website, if the comments are any indication. Dr. Tuteur can do whatever she wants in her blog, but my experience and what I’ve read online in message boards and article comments has convinced me that her tone limits the penetration of her message into NCB-leaning circles.

          • Amazed

            Still, compare this blog to Sara Snyder’s or Doula Dani’s. Which one gets more pro-homebirth comments? Or comments at all? They, too, dissect homebirth myths but as you say, they don’t do this as “clearly” as this one. Why not? They are factual. My take is that they are too nice and caring to everyone’s feelings, so it’s easy to dismiss them.

            I do know what you’re talking about when you say people in message boards and online communities insist they don’t listen to Dr Amy because of her tone. Unfortunately, those nice spiritual people recently banned Doula Dani from the NCB or homebirth, I am not quite sure, board of babycenter because she wasn’t nice enough. I’ve read the threads. She simply explained things without being nasty or anything. Her fault was simply disagreeing.

            There isn’t anything that would be loving and supportive enough for those women who are simply looking for an excuse not to hear the message.

          • Jessica S.

            And frankly, I find that sort of behavior – banning people/deleting comments that are in no way inflammatory but simply not “on message” – far more offensive that anything I’ve read of Dr. Amy’s.

          • Amazed

            I quite agree. Their echo chamber is a nice one, for sure, so they can pat each other on the back and boast how supportive they are. When a tragedy stikes, it’s all “So sorry, mama, hugs to you”. Then, they can go back to being offended by the fact that the messenger of the bad news wasn’t as considerate to them as they were to that poor mother.

          • thepragmatist

            But really, they’re also not there for the mothers when the shit hits the fan. I am. I know, because in our local community, before the forum I posted on was closed when I incidentally started posting again, I would get all the trainwrecks private messaging me because they knew I wouldn’t judge them and could give them accurate advice about how to get help for various things, from formula feeding to prolapse, etc. They came to me because they didn’t dare go to these “supportive women”. If my local hospital didn’t despise me, I’d be a c-section duola, just to get women through that experience who might otherwise not be supported in such a highly NCB dense community. I’m still actually turning it over in my head, to be honest, based on how much demand I had when that forum was open prior to women’s births.

          • Amazed

            But they think they are. There for the mothers, I mean. To them, being there clearly means writing, “So sorry mama” and then going back to their own living children, feeling that they had done their duty.

            To them, supporting the mother means applauding her choice and saying that every mother would have made the same choice.

            God help the mother if she ever doubts her choice. Those nice women will tear her apart for scaring people away from nature.

          • thepragmatist

            This has happened to me too, on a couple of boards. And all I did was cite data. I had admin once tell me she knew it was true, she just didn’t want it spread. She was actively filtering the truth while suggesting the forum supported ALL POVs… what it came down to was that she was a duola, and I was taking her down in thread after thread for disseminating completely false information. She didn’t want her clients to know the truth. Now THAT is criminal, if you ask me. I got the “tone” argument, too. My tone was too harsh, even when I was being quite nice but passionate about what I care about– and really, it’s not just birth, but the rights of women in child-bearing AND parenting.

          • Guesteleh

            what I’ve read online in message boards and article comments

            Keep in mind those message boards are heavily modded. I’ve seen it myself–people raise uncomfortable issues and poof, their comments disappear (or never get posted in the first place). Over at MDC, entire threads get flushed on a regular basis. So those threads aren’t an indication of anything except the willingness of the hardcore believers to purge even a hint of dissension.

          • thepragmatist

            Exactly… there are plenty of informative medical sites that discuss the risks of homebirth. But who gets all the hits? The one person who can stir up enough heat to get the kitchen warm. You know, we already knew home birth was riskier than hospital birth. But, what we didn’t have was anywhere or anyone taking on equally loud, equally vibrant personas as Dr. Amy chooses to. I value it and this blog. It was like a whirlwind of fresh air. And I’d say the harshest criticism either is at stunt birthers, who knowingly are risking their lives and their babies lives and proponents who make money from the ignorance of their clientele… and I have no doubt they know better, especially those who attend a lot of births. They know but they hide the truth, just like Cheney has done with the MANA study. And the strong language is language they deserve. Sorry it harshes their mellow. I’m always accused of taking too harsh a tone. I’m not down with the “other mother” kind of mom. The kind who doesn’t want her little feathers ruffled. I can take criticism of my ideas and I can dish it. Perhaps this has come from years of debating online, where this debate seems rather tame, amongst women of professional persuasions, and men on skeptic forums and political forums. I’ve been called out on my own mistakes, made to justify my own arguments, and have learned to not let an accusation of one of my *arguments* being stupid.

            I do believe, not so long ago, I spawned a whole post directed at a post I wrote in the comments about TV that made me sound sanctimonious. And here I am. LMAO. Why? Because I’m not immune to getting arrogant, either (no one is) and because I LIKE generating debate, conversation, and ideas.

            If these women were really worth their degrees, they’d be answering the questions and challenges demanded by the claims THEY MAKE. Instead, they hide behind tone because they’re a bunch of cowards. Oh, and profiting mightily and personally from both being cult-leaders of a movement divesting women of birth autonomy (the very thing they say they want– LIARS!) and causing intrapartum and neonatal death that is entirely preventable as if one baby is worth their philosophy. Instead of present homebirth as an option with all of the facts and all of the risks, they intentionally lie about the risks of things like breech and post-dates. And we can’t use the word asshole to describe a person who does that? And expect them to answer for their lies? Maybe a court of law will, and no one will hurt their soft little hearts over it. It makes me so angry.

          • Amazed

            It’s the court of politeness here, clearly. They can sprout any dangerous nonsense they want, as long as they keep it “nice”.

          • theNormalDistribution

            I really don’t think that’s the fault of Amy’s tone. The reality is that your home birth and alt med friends have some very cherished, very wrongheaded beliefs. There’s pretty much no way you can show them how wrong they are without making them feel attacked. Those beliefs are a part of who they are and how they view themselves in the world.

          • C T

            While they do have some wrong-headed beliefs, I’ve seen that several of them are open to learning more and changing their minds when they’re not being called stupid (yesterday), assholes (Oct. 14, 2013), stooges (Sept. 30, 2013), totally clueless (Sept. 9, 2013), crazy (Aug. 16, 2013), lunatics (July 17, 2013), morons (June 24, 2013), sufferers from a pathetic lack of self-esteem (June 4, 2013), hypocrites (May 15, 2013), morally grotesque and ethically bankrupt (April 4, 2013), selfish (February 14, 2013), etc.
            No matter how justified such epithets may be, they will turn off anyone that has a pro-homebirth friend because no one is going to be comfortable with having a dear friend called a grotesque, hypocritical lunatic devoid of any intelligence. You can’t generally get through to people while calling them and their loved ones names like Dr. Tuteur does. She can win on the facts (the facts speak for themselves as to people like Cheyney anyhow), and her most helpful posts are the ones that stick to facts rather than mocking and name-calling.
            Let’s also consider how journalists treat information from Dr. Tuteur. Because of her blog’s tone, they often mention in their articles on homebirth that she is a harsh or controversial critic of homebirth, and that causes many readers who knew nothing about her previously to automatically view her as a biased, less credible source of information whose statements should be taken with some skepticism. It would be better if reporters just said “expert long-time birth researcher and Harvard-trained OB, Dr. Tuteur” instead of describing her as demagogic, harsh, or fierce.

          • theNormalDistribution

            Find me a person who is more upset by my saying that their dear friend is behaving in a morally corrupt manner than they are by their friend actually behaving in a morally corrupt manner and I will eat my underwear.

          • Melissa

            Maybe she’d win over some people by taking a nicer tone, but it probably wouldn’t be authentic for her. And I find that authenticity is important. I’m a lawyer. I’m also a bit of a bitch. So much so that I figured out really quickly that I can’t go in front of judges because I lack the ability to act deferentially. That’s not exactly true. I CAN do it when I have to, but in those cases I’m usually told by people who watch me that I seem fake or deceptive. I might not lose the audience because of my gruffness, but I just lose them because I seem dispassionate.

            So, I’ve found a place where I can be myself and still do my job. And I think that’s what Dr. Amy has done. If someone else wants to be more sensitive then they certainly can do that. I just don’t see what it should be Dr. Amy’s job to be that person, anymore than why it should be my job to be a trial lawyer when it isn’t something I’m good at. Let someone else do that.

            Besides, I don’t feel like this blog is to really convert current homebirth supporters. I feel that it is for people who have just seen the Business of Being Born or who have been told by a friend that doctors love giving c-sections, or something like that. The aggressive nature of the blog really makes the importance of the issue clear. A nicer tone might win over some people, but it might lead others to think this isn’t a big deal. Besides, it isn’t as if homebirth supporters are told that they need to watch their tone when they say that doctors love giving c-sections because they want to play golf.

          • Monica

            Have you ever heard Dr. Amy speak? I think she comes off much better in speaking. You can hear her concern for those mothers and babies. However, *nice* doesn’t get you page views. And these comment sections are often filled with women saying her ways have turned them, so it does work. Not for everyone no, but nothing works for everyone. The thing is Aviva is a Yale trained doctor, she should know whether homebirth is safe. She does know it’s not, but to admit that she would lose her audience. in a way I think Aviva might be worse than the likes of Cheyney because she’s working both sides. What she views as being middle of the road is really just lulling more people into a false sense of security. She says the right words and keeps the right ones up and deletes whatever makes her look less than. She doesn’t care about women and babies, she cares about herself and throws her education in people’s faces. You will rarely see Dr. Amy falling back on anything, but her experience as a doctor. She easily could list off reasons to people of why she’s an expert on this, but she doesn’t. When I have heard Dr. Amy speak I could hear the kind of doctor she likely was and it’s a very far cry from her persona on this page. Still with all the knowledge and experience, but with far more empathetic tone. Listen to her talk about homebirth and maybe you’ll hear a different tone too when you read these blog posts.

          • Trixie

            I didn’t feel like going back through all your citations, but it general the worst insults are hurled at the people making money off of home birth. Not the parents.

          • KarenJJ

            I agree. “Grotesque and morally bankrupt” is just calling a spade a spade in terms of Melissa Cheyney as far as I’m concerned. What phrase would you use for people who misrepresent the truth, lie to women and work against any attempts to make homebirth as safe as it is in other developed countries?

            Seriously, I’m trying to think of something nicer that also covers the anger I feel towards people like herself.

          • Amazed

            I have yet to see a truly pro-homebirth person being convinced to change sides just because of someone’s rational arguments. Generally, they find a way to wave them all away and not take them into consideration. The interesting thing is, some of them are not swayed by Dr Amy but are impressed quite unfavourably by the NBC attempts to shut her up. Not answering her questions, tiptoeing around the matters she present – some of these women notice that and it makes them think that there might be something to Dr Amy’s message.

            The fence-sitters aren’t all so swayed by emotions as to dismiss anything Dr Amy says just because she’s harsh. The majority of those who do are pro-homebirthers and alt-meds who would not change their ways until forced to – either by a tragedy close to them, or MANA’s desperate attempts to reframe the conversation without answering the hard questions.

          • NoLongerCrunching

            I never link to her either. My colleagues would just think I must be too “uneducated” to fall for her “lies.” However, I link to things that she has linked to.

          • Karen in SC

            Okay. Please link to the “nicer” blogs listed at the right which convey the same information – What Ifs and Fears, Safer Midwifery for Michigan, Mama Doc and Exhomebirthers.wordpress.com. The Adequate Mother has discussed evidenced based findings about epidurals. Hurt by Homebirth and Childbirth without Guilt are written by mothers themselves.

            You need to search around for specific posts but they are there. Note that these excellently written and researched posts have almost zero comments.

          • Guesteleh

            The four blogs I’d link to instead of Amy’s:

            * http://www.dreamhost.com/dreamscape/2011/03/09/wren-jones/ , which is
            Josh Jones’ account of the death of his son Wren to GBS infection after a
            homebirth.

            * http://navelgazingmidwife.squarespace.com/ , especially the posts where she discusses why she no longer attends homebirths

            * http://whatifsandfears.blogspot.com/ , which is Doula Dani’s blog. Another person who no longer attends homebirths.

            * http://safermidwiferyformichigan.blogspot.com/ , written by Sara Snyder, who lost her son Magnus to incompetent birth center CPMs

          • Staceyjw

            Too bad all those blogs added together don’t have the reach of this one. I Wonder why?

            Few people read the nice blogs.

            Nicer blogs are just as easy to ignore as Dr Amy as far as info goes, but Dr Amy will get read simply because she’s “meeeean”. Countless NCBer has come here just to see what the fuss is about, then stayed.

            Conflict brings readers, readers bring conversation, conversation brings more attention, debate and even understanding. There is a reason why screaming pundits do better than quiet ones.

    • Allie

      I would agree with you, Brock, except that Romm was never going to participate in that agreement regardless of what Dr. Amy did or said. She would have found some other excuse if it wasn’t for Stupid is the New Black. For her to claim she doesn’t understand statistics has got to be the lamest thing I have ever heard. And to back out because of Dr. Amy’s discourteousness is just plan pathetic. If I were in charge of Yale, I would revoke her degree.

    • auntbea

      Generally speaking, people have a tendency to act in their own interest, rather than in the common good. Sometimes, this doesn’t really matter (cutting in line or failing to donate to public radio), and sometimes it does (lying about the safety of homebirth and providing substandard care for mothers and babies). From the social science literature, we know there are two ways to get people to act in the common good instead. The first is regulation. Dr Amy, along with many others on this board, are pushing for stronger regulations for midwifery and homebirth. But that will take some time. In the absence of regulation, the other effective mechanism is social sanctions — which are exactly what they sound like: making people feel emotionally uncomfortable, with shaming or isolation or insults. Not always pretty, and not always used for good, but nevertheless highly effective at changing behavior.

      In other words, it is not AT ALL empirically clear that Dr. Amy WOULD be more effective by being patient and pleasant.

      • KarenJJ

        Good point. And who would benefit by Dr Amy being more patient and pleasant? Who would feel more comfortable if Dr Amy were to stop writing her blog? Would more homebirth mums really then choose to read here and feel better informed about homebirth? Or would homebirth advocates feel a little bit more comfortable spreading BS?

    • wookie130

      Look, no one ever got anything accomplished by

      being “nice”…particularly when the subject at hand deals with such things as midwives who are relentlessly unprofessional, and mothers and babies who die, when that probably didn’t need to happen at all. It’s hard to skirt around this stuff, and remain “polite” and amicable.

    • KAndrews

      We had a bad outcome under midwives care. I also am very polite, empathetic and friendly. My advocacy for safer midwifery practices has led to me meet with a lot of people with the power to actually help. The most frequent comment I have heard is that the midwifery community is just to difficult and unreasonable to try to deal with – so they are trying to ignore the problem. We need an equally strong voice to counter balance theirs. This is a dirty fight. Dr Amy is doing what most of us can’t.

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

    But Aviva has other ways of knowing and math is just a tool of paternalism – the alternative maternalism offers women the opportunity to experience some of mankinds most powerful emotions – those that are often labelled as anguish.

    • C T

      Math really doesn’t care who’s using it, male or female.
      It really irks me when people seriously (so not you :) ) talk as though seeking correct answers via mathematics is somehow diminishing to women. What’s really disrespectful of women is acting as though we can’t handle objective, measureable reality because of our tender feelings.

    • Trixie

      It’s not a tool of the patriarchy when you’re figuring out whether or not you got paid, though.

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

        That’s not math – that’s money, at best it’s accounting…and I imagine even then there’s probably a lot of CPM’s that would offer a “cash discount” for their services, there might even be “cash only” ones out there.

  • LMS1953

    Just wondering. Merck got slammed with huge damages for hiding the adverse cardiac effects of their rainmaker drug Vioxx – as Dr Amy blogged about last week. What culpability might Oregon State University have analogously to Merck? Missy Cheney is a professor in the Department of Women’s Studies. How intertwined is MANA with OSU? Does OSU have any culpability if it, as an institution conspired to suppress data that was unfavorable to the reputation of a golden haired faculty member/siren of the woo whose agenda they wanted to foist upon the world?

    • Amy Tuteur, MD

      I think the analogue to Merck in this setting is MANA. Cheyney is an anthropology professor at OSU, not a midwifery professor.

      • LMS1953

        Quote:

        Anthropology
        Associate Professor

        Melissa Cheyney is a medical anthropologist and licensed midwife. She began her studies in anthropology as a Master’s student in bioarchaeology with a focus on health and disease patterns in classical antiquity. As Melissa entered her doctoral program, her focus began to shift to the health of living populations. While working on her Ph.D. at the University of Oregon, Melissa decided to pursue a clinical degree in midwifery while completing the requirements for her doctorate in medical anthropology. Her research focuses on a subfield of medical anthropology called evolutionary medicine. It examines contemporary health conditions, including maternal and infant health patterns, in cross-cultural and evolutionary perspective. Melissa continues to attend home deliveries while teaching in the Anthropology Dept. at Oregon State University.

        • theNormalDistribution

          What’s your point?

          • LMS1953

            That OSU might be culpable in the MANA deception. They might be a deep pocket. And that with enough bad PR they might fire her. That would look good on her resume.

            See: “Including maternal and infant health patterns” – sounds like the MANA study to me:

          • theNormalDistribution

            I don’t think so. Which part of your quote is supposed to support that theory?

          • LMS1953

            “…It examines contemporary health conditions, including maternal and infant health patterns, in cross-cultural and evolutionary perspective.”

            Like maybe home birth babies dying from breech birth in pursuit of cross-cultural woo.

          • theNormalDistribution

            Yes, I can read. I’m just not sure how you can reason that the university could be responsible for her activities elsewhere.

            Oh wait, what? Are you saying that she wants babies to die in homebirths so she can study them?

          • LMS1953

            So she can practice the “art of letting go”

          • Expat

            And eugenics

          • thepragmatist

            Bingo. It really feels like that. Gross. We had a loss mom here before who expounded on what was just straight out eugenics at length before flouncing and taking her disturbing posts with her. I think it was before the site change too. But she was very disturbing, as she let her baby die.

          • MaineJen

            I got the same vibe, actually. “Evolutionary medicine” could be taken to mean that those who are fit, survive.

          • LMS1953

            From the MANA section on values and ethics:

            QUOTE:
            III. The Nature of Birth:

            A. We value the essential mystery of birth.
            B. We value pregnancy and birth as natural, physiologic and holistic processes that technology will never supplant.
            C. We value the integrity of a woman’s body, the inherent rhythm of each woman’s labor and the right of each mother and baby to be supported in their efforts to achieve a natural, spontaneous vaginal birth.
            D. We value birth as a personal, intimate, internal, sexual and social experience to be shared in the environment and with the attendants a woman chooses.
            E. We value the right of a woman and her partner to determine the most healing course of action when difficult situations arise.
            F. We value the art of letting go and acknowledge death and loss as possible outcomes of pregnancy and birth.
            ******
            There it is in black and white. They value woo over the life of the baby and value the death of the baby if it occurs on the sacrificial altar of woo.

            Contemplate for a moment: “the art of letting go” CNMs are veritable Picassos at doing that.

          • Trixie

            That is so, so appalling. Birth is a mystery we can’t understand, so we aren’t going to try, but if someone dies, well, letting go is an art.

          • thepragmatist

            Holy shit, that’s chilling. I don’t know what to say there. F is just TERRIFYING to me. If my provider told me she valued the art of letting go and acknowledged mine or baby’s death might be a possible outcome of (normal) birth, I would fire that person. I cannot believe these people are allowed to continue to operate anything. They had me right up to that part. Yes, we should have autonomy in setting, etc. No, we have a right to providers who will acknowledge that they have to determine whether it is SAFE or not. Patient autonomy and provider safety is at times a difficult balancing act, I get that, but to not have safety as a primary concern is appalling. And then to go and tell women, it’s as safe as the hospital, just makes it murderous and misleading. THIS IS NOT WHAT FEMINISM IS, LADIES. At least, not the kind I fight for– nor the professional women who broke glass ceilings, laws, and rules in my family to hold positions of power and authority. Thanks.

          • MaineJen

            “D. We value birth as a personal, intimate, internal, sexual and social experience to be shared in the environment and with the attendants a woman chooses.
            E. We value the right of a woman and her partner to determine the most healing course of action when difficult situations arise.
            F. We value the art of letting go and acknowledge death and loss as possible outcomes of pregnancy and birth.”

            Jaw. On. Floor. Can you even *imagine* a professional medical organization publishing something like this?

          • The Bofa on the Sofa

            I hadn’t looked closely before, but their organizational statement on values says that they value birth as as “sexual” experience?

            That’s just creepy.

          • Trixie

            Sure, therefore the only logical conclusion, if you’re really good at birth, is for birth to end in an orgasm. If you don’t orgasm during childbirth, it’s because you’re doing it wrong!

          • Rabbit

            Leaving aside the issue of sovereign immunity, you’d have to show that OSU had a duty towards the public at large with regards to the writing and speaking of its professors. I don’t see that ever happening. As a society, we value academic freedom to much to ever allow that to happen. We don’t want our public universities choosing what and how their professors can research and write about.

            Merck had an unquestionable duty towards the people it sold its products to.

          • LMS1953

            There are lots of cases where medical researchers at public universities fabricate data and when they are caught the university is obligated to reprimand if not fire them and disassociate. To do otherwise is to make the university complicit in the fraud. Missy Cheney is a self-described “medical anthropologist” involved in health research. She has hidden and obfuscated data. She has lied about its most elementary interpretation. OSU has not reprimanded her. OSU is complicit in the fraud.

  • The Computer Ate My Nym

    Why do the exchanges between Dr. Tuteur and Dr. Romm remind me of the exchanges between Sylvia Brown and various people asking her why she didn’t apply for the JREF prize? The excuses, the hedging, the stalling, the sudden taking of offense and refusing further contact…

  • perpetual lurker

    I still can’t believe her advice to women when it comes to picking a homebirth midwife was “Caveat Emptor.” Jaw drop, followed by face palm.

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

      I commented directly on this, both here and on her facebook. She never replied, AFAIK

  • Ash

    OT: Is it common to have a 36 yr old wait until 42 weeks without scheduling an induction or c-section?

    • The Computer Ate My Nym

      No. I’m not an OB and the OBs can correct me if I’m wrong, but in general a pregnancy should not go beyond 42 weeks. Arguably, not beyond 41. Certainly not without close follow up and monitoring.

      • AlisonCummins

        When I was born, “term” was considered to be 38-42 weeks. That was 1964, before imaging and with less data.

        “Term” has been 39-41 weeks since the eighties. I think that these days with the availability of good NICUs, many OBs are more comfortable with 38-40 weeks considering that the risks of waiting outweigh the risks of a somewhat early delivery.

        (Please correct me: this is not my field!)

        • LMS1953

          It was my impression that the EDC way back when was an estimation with a +/- of TWO WEEKS. You would first go by the LMP and question how regular menses were, did mom conceive on OCAs, etc. Then you would measure fundal height and ask about Quickening (around 20 weeks for a primigravida). Oh, you would also figure the earliest you could hear FHTs by Doppler and “term” could be deduced IIRC – if 30 weeks had passed since FHTs were first auscultated. The point is, you had to consider that someone ostensibly at 42 weeks could have just been 38 to 40 weeks and the goal was to avoid iatrogenic prematurity.

          Nowadays, most woman get a transvaginal sonogram at 7 to 9 weeks which is accurate to +/- TWO DAYS. That is quite valuable. Unfortunately it has led to the notion of 39 weeks 0 days superseding any other judgment of the obstetrician. An attending laughed at me when I was a first year resident in 1979 when I presented a patient as 28weeks and 2 days, saying, “The OB wheel ain’t a clock, Doc. The best you can do is tell me what week she is in and even that could be off a week or two”.

        • fiftyfifty1

          ““Term” has been 39-41 weeks since the eighties”

          “Term” is actually 37-42 weeks. Within the last year they have further defined it into “early term” (37-38+6days) and “late term” (41-42). This is because both early term and late term have their risks.

          Personally I highly prefer the risks of early term to the risks of late term (and especially POST-term!). I would rather have a baby who spends a day in the nursery for observation than a baby who is stillborn due to an old placenta.

          • AlisonCummins

            Thanks!

          • resaurus

            I can grasp the risks of early term (being a very premature baby m’self) but what are the risks of late term? Does the body stop supplying nutrient to the placenta, does the placenta start dying off, does the amniotic fluid start reducing…?

          • Young CC Prof

            Failure of the placenta is the main one, yes. And if it fails completely, the consequences of that tend to be kind of permanent.

            Thing is, post-dates babies who aren’t stillborn still tend to be less healthy on average than babies born at 39-40 weeks. Drop in nutrient supply from a less healthy placenta may cause issues. They’re more likely to have aspirated meconium.

            The most common problem with early term babies is something called transient tachypnea of the newborn, that is, rapid shallow breathing because the lungs failed to fully dry out before birth. (This isn’t the same as the severe breathing problems faced by babies born two or three months early.) It requires monitoring, maybe extra oxygen, but tends to clear up in a few hours to days.

            Overall, it’s pretty unusual for a baby born at 37 weeks to have a major health problem solely because he or she was born slightly early.

            Of course, the other reason to avoid elective early delivery is an uncertain due date. If you did IVF, or had a first-trimester ultrasound, or otherwise can be certain of your due date to within a few days, a 37-week delivery ain’t bad. If your due date could be off by a week or two, then your 37-week baby could actually be a 35-week baby, and they sometimes have “real” preemie problems.

          • Playing Possum

            Not only is there a risk of still birth, but post term babies waste their fat and stress reserves compensating for a crapping out placenta. So they start behind the eight ball before they’re even born.

    • Medwife

      No

    • fiftyfifty1

      no

  • Guesteleh

    Ellen Mary = Tone troll. Y’all are tiring out your typing fingers for no reason.

    • Ellen Mary

      Name call much? I thought there was no name calling here?

      • The Bofa on the Sofa

        Hey, if the shoe fits….

        If you don’t like being called a “tone troll” then the answer is, stop tone trolling.

        • Ellen Mary

          Had to look that one up. You say ‘tone troll’, I say advocating for civilized & productive dialogue.

          • theNormalDistribution

            Productive dialogue does not include whining about choices of language instead of addressing the actual points made.

          • C T

            This isn’t politics or a society luncheon. This is a blog dealing with medical issues. Scientific advances don’t require that anyone be “nice” to each other.
            How is Dr. Romm’s running away from engagement on this issue productive? And as for civilized, Dr. Tuteur has always been less interested in politeness than many would like; nothing new here, and she’s unlikely to change after all the times that people (including me) have said that she sometimes comes across as too harsh. Having to see grieving parents after their baby dies an unnecessary death from a homebirth they’d been told was “just as safe as hospital birth” tends to bring out powerful emotions that are much stronger than “civilized dialogue” can handle.
            It sounds more like you’re defending Dr. Romm for running away from an argument. As others have pointed out, Dr. Romm agreed to put something to the proof and then backed out of a valuable scientific debate because she didn’t like how Dr. Tuteur spoke about her, even though Dr. Tuteur’s been using the same tone all along.
            When humans can’t win on the facts, they attack the messenger. But the facts outlive the messenger.

      • Guesteleh

        You responded to my comment but not to Monica’s below calling you out for hairsplitting the number of books Aviva wrote while ignoring substantive issues: http://www.skepticalob.com/2014/02/aviva-romm-is-in-a-bind-over-the-hideous-mana-death-rates.html#comment-1244589508. Again I say: Tone troll.

  • Captain Obvious

    Must feel good for total vindication!

    http://mamabirth.blogspot.com/2011/10/obstetric-lie-87-home-birth-is.html?showComment=1392404578078&m=1

    I would like to see mama births’ comment on the MANA survey and the Cornell study now.

    • Captain Obvious

      It would be fun to see a compilation list/links of blog threads where Homebirth advocates have feverishly defended Homebirth and MANA over the years now the the MANA data is out. Dr Amy could smugly say “I told ya so”.

    • Birthbuddy

      Has anyone contacted Mamabirth for a comment?

      • birthbuddy

        OK, someone just did. No response yet.

  • Kazia

    Have you heard about the Berkeley student who contracted measles, but went to class and used public transportation? I just hope that there weren’t any antivaxers and their kids nearby.

  • mydoppleganger

    off topic: dopplebaby was born perfectly healthy via csection last week. my spinal wore off in the or and i have been battling a spinal headache for days. despite that, he is good and i know i will eventually be great as well. the nurse encouraged skin to skin in the or despite me saying i was too out of it. none of the interventions i was told to be scared of happened in the hospital. they could have not been more helpful and supportive. in fact, i had to beg for a tiny bit of formula the first night so i could rest. the lactation consultants were like ninjas pounding down the door everyday. sorry about the lack of caps lock, my phone is apparently having a hissy fit.:)

    • kimi721@rocketmail.com

      while this was a potential vbac, my body never went into labor. the doctor said my cervix was closed at plus 41 weeks. baby’s skin was peeling and he looked so ready to be out. just happy he is here and healthy:)

      • thepragmatist

        Congrats!

    • Young CC Prof

      Congratulations! So glad he’s here and healthy!

    • Josephine

      Congratulations on your healthy little boy and a safe birth! Hope your headache heals soon. Have they talked about doing a blood patch?

      • OBPI Mama

        I loved my blood patches! Both times I had a spinal headache and the anes. did the blood patch, my headache was gone in 20 minutes! Magical…

        Congrats on the baby!

    • The Computer Ate My Nym

      Yay! Congratulations on the dopplebaby!

    • Zornorph

      Congrats!

    • Trixie

      Congrats! Sorry about the headache.

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

      Congrats!

    • Dr Kitty

      Congratulations! Enjoy him.

    • araikwao

      Congrats, and welcome dopplebaby!

    • Amazed

      Congrats to your family!

  • Dr Kitty

    I say get the independent analysis, post it here, facebook, link to it on twitter, post it on the MANA site and Sciene and Sensibility and send it to Huffpo and the Daily Beast.

    You show your workings step by step and be as transparent and up front as you can.
    If HB advocates can’t counter it with mathematics (they can’t) they’ll try and blind us with bullsh*t, but at least people who aren’t familiar with statistics will have an opportunity to see the numbers and work it through for themselves, then they can reach their own conclusions.
    I do not believe “math is hard” is a reason to prevent people from having a chance to analyse statistical analysis, especially if, as in this case all you need is a calculator, a notepad and simple arithmetic.

    • MaineJen

      I could not believe my eyes when I saw a medical doctor using the excuse “Math is hard…” to explain why she could not discuss these very incriminating statistics. Really?? Top of your class at Yale and you can’t understand something that I, who never went beyond Calc 2 and floundered my way through Biostatistics, can understand. Riiiiight.

      • Dr Kitty

        BTW I’m horrible at maths, really awful.
        But WHEN IT IS IMPORTANT I will do what I need to do to understand it.

  • The Computer Ate My Nym

    Like so many situations where someone is deeply wrong, there is a little core of truth here: Statistics are often misused in medicine and doctors rarely have a deep understanding of statistics.

    That being said, these are not hard statistics. For example, the breech data. There’s no way that the death of 5 non-anomalous, term infants born to healthy women in a first world country is going to look good, no matter what comparison group is used. And the finding is consistent with prior research: the term breech trial established that c-section is safer for breech presentation. There’s no real need to look harder to explain an entirely consistent result.

    But since the issue has been brought up, maybe we _should_ look further. The original paper states that only 127 of the breech presentations were delivered vaginally, though I can’t find any definite information on whether the others were emergency transfers or the mother decided to go for a primary c-section after finding out that the baby was breech. If the latter, these should have been removed from consideration since they are no longer home births.

    Additionally, there is a little footnote stating that 3 women with breech presentation transferred to the hospital during labor and were lost to follow up from the midwife’s point of view. Possibly up to 3 more deaths that weren’t recorded in the database.

    If I were a home birth advocate, I’d just admit that some situations were high risk and inappropriate for delivery at home and be pushing for the claim that low risk home birth is still safe. I’m not impressed that it is, but that might be a supportable claim, at least.

    • thepragmatist

      Yes, MANA could wiggle out of this by making it clear that, indeed, it is inappropriate for “providers” (I will use that term loosely here) deliver breech and twins (or VBAC) at home, and move on. They could do that while still holding onto the “safety of homebirth”. They could exclude those births as accidental, inappropriate, provider fault, or whatever. They could change policy. There’s a lot they could do that would be a response to why those babies died for no good reason whatsoever, since they would be alive if born in a hospital. Those are five (at least) babies who would be in mama’s arms if mama had just gone to the damn hospital. I hate the hospital, I get it, I hate mine terribly… I still delivered there.

      • The Computer Ate My Nym

        They could change policy.

        They could. If they now said, “We formerly thought that breech births at home were safe but these data show otherwise and we’re going to recommend that any breech presentations be transferred to the hospital immediately” they would be well within their rights to keep arguing that home birth was ok for other situations (multipar, cephalic presentation, singletons, etc). The very fact that they don’t is disturbing.

        Back in the 1990s, people in oncology thought that bone marrow transplant helped people with certain solid tumors. Then better data became available that indicated that it didn’t. BMT for solid tumors stopped, even though that was a major source of income for hospitals and practices. If Big Medicine can give up an income source, why can’t midwives who are supposedly in it for the love of the thing and to help women?

        • thepragmatist

          I know, right? What is so difficult about accepting what the rest of the world ALREADY KNEW? Breech, VBAC, and twins at home is just bloody stupid. That’s why Dr. A’s post called it like it was. Do we see MANA changing practice? No, they would rather watch babies die, and that is reprehensible.

    • manabanana

      OK -but home birth advocates DON’T do this. The don’t advocate for risky births to be handled by medical professionals. They do the exact opposite.

      https://www.facebook.com/jan.tritten/posts/10152585973923696?stream_ref=10

      And I quote:

      “WE
      ARE MIDWIVES! Let the docs do their thing and we do ours! We are not
      medicine! We are health-focused providers and should not be subjected to
      their world. Breech, Twins and VBAC are pillars of midwifery care.”

      • Jessica S.

        Unbelievable. I can’t believe that sort of crap can be prominently posted as an exalted position and yet there’s still debate as to which is safer: delivery at home or delivery at a hospital. Or that there’s still a debate as to whether home birth advocates are promoting risky practices. It defies all logic and highlights the fundamentalism involved in their thinking.

        • manabanana

          “About Carol Gautschi

          “Carol Gautschi is a Certified Professional Midwife (NARM certified) and is also licensed by the state of Washington. The longest continuously practicing home-birth midwife on the Olympic Peninsula, she
          has been a birth attendant for more than 25 years and has attended hundreds of births for families in her community and abroad.

          “Mrs. Gautschi is well-respected in the midwifery community, and has served as Chairwoman of Childbearing Ministries in Washington State.
          Currently she chairs Birth Matters, a collective of families interested in increasing the awareness of the safety and sanctity of birth at home.
          As a senior, well-experienced midwife she has taught midwifery skill workshops and passes on her expertise and wisdom in the time-honored
          tradition of apprenticeship. She also teaches for Midwifery Today.”

          http://gentlebirths.net/

          Really? She’s a licensed and certified midwife who advocates for increasing the safety of birth at home – yet she believes ‘breech, twins and VBAC’ are ‘pillars of midwifery.’

          I have no words.

          • Young CC Prof

            “Some of the complications I have dealt with are fetal distress, prolonged labor, dehydration, meconium, breech presentation, twins, shoulder dystocea, prolapsed and occult cord, postpartum hemorrhage, uterine inercea, abruption of the placenta, birth defects, and respiratory distress in the baby.”

            *inertia
            *dystocia

            If you can’t spell it (on a website that you are using as advertising for your business!) then how could you possibly know how to treat it? And does “dealt with” mean seen? How exactly were these complications resolved, and was anyone dead at the end of it?

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

    who cares about giving accurate information to women when the person helping you wrote something mean on the internet? Great ethics there dr romm

  • veggiegal

    Ah, Dr. Amy, don’t forget you’re talking about a person who also wrote two “wonderful” books about vaccines, touting homeopathic remedies over actual vaccines. Take a child, give them a home birth, assuming they survive, use homeopathy instead of vaccination, and lactivist and inactivist your way through their lives. Who has time for actual statistics, or even elementary school math, when you’re so busy chasing “the latest black”…??!! Oh, I guess you *didn’t” forget – she did come through with an excuse, as expected. If she was so upset with the “stupid is the new black” entry, maybe it’s time for her to down some more “Rescue” remedy…

    • Mel

      I really don’t want to know her homeopathic remedies for cattle. Vaccines are so easy to administer – just a quick shot. I’d probably have to convince a cow to drink some rank tea mixture or shove a pill down their throat. (It’s kinda like giving a cat a pill except the cow is way bigger than a cat and can spit up the pill if it ends up in the rumen instead of the reticulum) Of course, the cow is probably healthier for avoiding the nasty homeopathic remedy.

      • Trixie

        No, it’d be easy. Just put it in their water. Actually, homeopathy IS nothing but water, so you could say they’re getting a homeopathic remedy as we speak.

        • Young CC Prof

          I’m going to go drink some tap water now. And get all the homeopathic remedies at once! Ah, efficiency.

          • Ellen Mary

            And plenty of Homeopathic pharmaceuticals & pesticides too, just factually. ;)

    • Ellen Mary

      Aviva wrote only one book on Vaccines. She doesn’t advocate homeopathics. Homeopathics are totally different than Herbs. Not saying herbs are better, I don’t suspect I’d ever be able to convince you of that, but they just are not at all the same.

      I personally did not expect Aviva to continue to engage when Dr. Amy went off the rails with the name calling in the intervening days. I don’t expect any professional woman would continue to engage. It is one thing to say ‘something mean on the Internet’, it is another to defame someone by name on a very public blog.

      It is too bad, because I was looking forward to the exchange, but it appears to me that neither side wants it. Debate requires courtesy & ‘rules of engagement’. Otherwise it denigrates into the type of Guirella warfare we saw with Dr. A vs. Feminist Breeder.

      • Karen in SC

        Whatever. Dr. R had her feelings hurt, who cares what an independent analysis would say?

      • NoLongerCrunching

        “Defame” v.: “to attack the good name or reputation of, as by uttering or publishing maliciously or falsely anything injurious.”

        Dr Amy quoted Dr Romm’s own words. True, she called those words “stupid” and “a load of bullshit,” bur that is still not defamatory or even name-calling. Name calling = “you are a stupid cow”; what Dr Amy said was more like scorn, derision, or mocking Dr Romm’s words, not her person. Very common and accepted in debate, unless you are a wilting violet who can’t deal with criticism.

        • Ellen Mary

          IDK what type of debates you engage in, but ‘BS’ & ‘stupid’ are not the terms usually employed in professional or academic debates. The Gas Industry is currently engaged in some debates, in which human lives are definitely @ stake. Yet no one has called even their industry POV ‘BS’.

          • NoLongerCrunching

            I think it depends on the venue. An academic debate published in a journal is going to have more reserved language than a blog designed to get page views.

          • thepragmatist

            Ms. Ellen may want to avoid town hall meetings, too, if she thinks this page is rude… Just listen to a hundred people yell, “LIES! TO SHAME! GET OUT OF OUR TOWN!” at a bunch of oil execs… poor analogy, lol.

          • Ellen Mary

            That is not a debate. Was Aviva invited to a town hall meeting? A community pitch forking? Or an academic debate?

          • Rabbit

            The academic debates I’ve seen, and read in journals, can get downright nasty. The insults may be less pedestrian than “idiot” or “bullshit,” but they’re there just the same. Have you ever read oral argument transcripts from the Supreme Court? Some of the justices (on both sides of the political spectrum),get downright vicious.

          • thepragmatist

            Are you involved in that debate? Are we talking about fracking and bitumin? Because, indeed, the words “BS”, “liars”, “murderers”, and “poisonous murderers” are bandied around quite a bit. I’m an activist opposed to a very hotly contested pipeline and indeed, “Declaration of War on Our Peoples” has been used to describe that pipeline. You don’t get out much, do you?

          • auntbea

            Uh, do you know many academics? I AM one and I hear ideas called bullshit everyday. Although, admittedly, we do often use more academic words, like “inane” “asinine” “completely indefensible” and “fucking moronic.”

      • thepragmatist

        Dr. A write pithy, sarcastic and satirical analysis. Why did Dr. R agree in the first place? She knew exactly who Dr. A was and what she DOES. Sounds to me like a case of taking one’s ball and going home. Dr. R shouldn’t care one way or the other. She should care more about what WOMEN need to know. Either she supports a statistical analysis of the data by an independent source OR NOT. So, let’s do it without her.

        • Ellen Mary

          I would suggest that Dr. Romm did not know too much about Dr. Amy or her MO prior to this. Not everyone follows every blog on the Internetz.

          • thepragmatist

            Oh, I find that hard to believe, given the crowd. They are all well aware of who Dr. Amy is given her very public persona as the voice against homebirth in the USA.

          • Amy Tuteur, MD

            They know this: I will speak for the babies who cannot speak for themselves because they are dead or brain injured due to homebirth. They know I cannot be intimidated and I will not be silenced. Scariest of all for them is that they know I speak the truth. They know I will go to the mat for these babies and their suffering parents. And, honestly, if I don’t speak for them, who will?

          • al

            Dr. Tuteur, I’ve been lurking here for ages and have learned so much, but never felt that I had anything to add to the discussions. I just have to say thank you for your dedication.

      • Amy Tuteur, MD

        You seem to have missed the point entirely: BABIES ARE DYING preventable deaths at homebirth and Dr. Romm and her homebirth buddies are trying to hide it.

        Let’s suppose for a moment that instead of challenging Aviva Romm, I challenged one of the executives at Merck who claimed that Vioxx was safe when they knew it increased the risks of heart attacks. And let’s suppose he (or she) announced that he could no longer participate in a 3rd party analysis of Vioxx safety data because I wasn’t treating his lies courteously. Would that be okay with you? Or would you be demanding that those who promote and profit from Vioxx not hide behind bogus “hurt feelings” to justify refusing to participate in an independent safety analysis?

        • Ellen Mary

          If you called names to a Pharma spokesperson in a public forum, you would be escorted out by security, right or wrong. They would in no way engage on those terms, give it a try.

          • theNormalDistribution

            Calling something someone said “stupid” is not name calling.

          • Ellen Mary

            It is though. So is calling something someone said ‘idiotic’ or ‘a f**king lie’. It is inflammatory language that basically prevents further civilized conversation. You can choose to not believe that, but then you will experience others slowly backing away. The first rule of debate is to show your opponent respect.

          • theNormalDistribution

            Just like everyone backed away from Christopher Hitchens? Oh wait, no. They were clamoring to debate him. Huh.

          • Trixie

            Oh, but he was a man, so when he was mean it was because he was a great thinker.

          • Ellen Mary

            Dawkins actually has gained far more traction & was invited to many more debates that Hitchens & influence than Hitchens, who struggled not only with discourtesy but with personal vices that ‘damaged his witness’.

          • NoLongerCrunching

            Whoa. “A f*cking lie” is a far cry from “idiotic.” I have never heard Dr Amy drop the F bomb. She has questioned whether certain people are stupid or lying, and yes that is (intentionally) inflammatory, but I disagree that it stifles debate. Dr Amy’s detractors frequently call her every profanity in the book, plus make plenty of libelous claims about everything from her mental health to her sexuality to her fitness as a mother. But she just keeps on keeping on, because she believes what she is doing saves lives.

            I have been following this blog for years, and I have seen time and time again that people start debating Dr Amy, fail at proving their points with evidence, then either start insulting her or leave the conversation because she is “mean”.

          • Ellen Mary

            In this case, it did stifle debate. We can debate if correlation coincides with causation in this instance, but the correlation is there. Having followed the work of both of these doctors for years, I chose to believe that Dr. Aviva would have engaged. I was deeply disheartened when I saw that Dr. Amy continued to make defamatory posts & anticipated this outcome.

          • Amazed

            I choose to believe that preventing babies from dying would be the primary objective of any physician worth their salt. I find it disheartening that people can prioritize a physician’s hurt little feelings over that.

            I am sorry if I sound irreverent but if Jesus had strutted away in high dudgeon because people mocked and insulted him, we wouldn’t have Christianity today.

          • fiftyfifty1

            “but if Jesus had strutted away in high dudgeon because people mocked and insulted him, we wouldn’t have Christianity today.”

            Jesus actually flounces a lot in the New Testament (although granted does not flounce during the crucifixion). Flouncing in general is very big in the New Testament: Lots of stalking off from unworthy towns that are skeptical of the Good News. Lots of shaking of dust off of sandals on your way out. Lots of “Oh ye of little faith” in response to straightforward requests for facts.

          • Amazed

            But eventually he persisted. Maybe there is hope for Ms Vivi yet. Not that I suggest crucifying her, let’s be clear. But for a woman of her sensitivities this blog might be equal to such a torture.

          • AlisonCummins

            I think Paul was responsible for Christianity. He developed the doctrine of redemption and wrote lots of surviving letters, though he and Peter both travelled around founding churches and Peter is given credit for founding the church. Jesus mostly let people come to him as far as I recall; charisma but not much persisting required.

          • AlisonCummins

            I believe Dr Romm is jewish. She might be unconvinced that Christianity was much of a blessing, or that Jesus’ example is one she needs to feel bad about not following.

          • NoLongerCrunching

            The way I see it, Dr Romm’s withdrawal from the debate was what stifled the debate. She had many choices if she disapproved of dr Amy’s tactics: such as continuing to argue her point in a calm manner, retaliating by calling Dr Amy out on her inflammatory language, agreeing to disagree etc.

            Running away from the debate really calls into question whether she is afraid of staying in it.

          • Trixie

            I think Dr. Amy showed restraint by saying that she “writes things that aren’t true” instead of just calling her a liar. Which she is.
            All Aviva had to do was bring the facts. If she had irrefutable facts on her side, supported by evidence, I’m sure Dr. Amy wouldn’t be above admitting she was wrong.

          • Mel

            I find Dr. Romm’s inability to face the sobering reality of increased risk of neonatal death because “she’s not good at math” far more insulting than anything Dr. Amy has said

          • Trixie

            This whole conversation is insulting. Aviva gets out of this by pretending her lady-brain is too tender for teh maths, and that she’s too fragile to talk to someone who’s mean. So basically a Yale-trained physician uses the “I’m nothing but a silly woman” play to get out of answering questions about why she promotes things that kill human beings (home birth, not vaccinating, using homeopathy instead of actual medicine).

          • manabanana

            EXACTLY. If she had the truth and some factual evidence on her side, she wouldn’t have to shirk away because her feelings got hurt.

          • thepragmatist

            Yes, I just want to get this straight Ellen Mary: are you defending the fact that babies died for no other reason than lack of an OR in the MANA study? Because breech babies DO NOT DIE AT THAT RATE ANYMORE. They only do so when they can’t be born in a hospital– either vaginally with OR on standby (usually in the OR) OR by c-section. So, is that cool with you? I’m just wondering? Or is it “f-ing stupid”? Because, I’m not Dr. Amy, so I won’t mince words and be polite enough to call it idiocy: I’ll just say it’s “f-ing stupid!” (And murderous…)

            Dr. R. are babies lives more important than YOUR OWN EGO?

          • Ellen Mary

            The absolute numbers here are fractions of 1%, which falls squarely in the realm of maternal choice. I am all for regulating claims, but not women’s choices. Tell me, are y’all concerned that 1 in 5 women on PLANET EARTH can be subject to forced abortion or sterilization @ the hand of government officials? Because babies are dying en masse over One Child Policy, so if the argument is ‘save the baaabies’ I would expect some concern to be thrown that way as well.

          • NoLongerCrunching

            No one is talking about limiting maternal choice. We are talking about consumer protection from unsafe practioners who are willing to deceive and outright lie to protect their market share.

          • thepragmatist

            I smell a red herring.

            Back on point: five babies died in a small study. Those five babies absolutely would’ve LIVED in the hospital. What is so hard about accepting that BREECH, TWIN, AND VBAC births belong in a hospital setting? I’m from a country with integrative midwifery. I had a midwife. Here I am and I’ll echo Dr. Amy yet again to say, it’s utter BS to pretend it’s safe to do these things. Our midwives don’t. When will MANA stop senseless deaths?

            When the will of the North American people can influence public policy in CHINA, do let me know. Also, you seem to confuse term babies with abortions or babies who don’t even yet exist, which perhaps explains your position on this issue.

            Are we force sterilizing anyone en masse still in the Western World? No, we’re not. Red herring, moving along.

            I’d love to stay and play but I need to make a fake volcano with my kid before he tears apart my house.

          • Young CC Prof

            “The absolute numbers here are fractions of 1%”

            True, except in the high-risk subgroups, like breech babies. If the study authors had simply condemned home birth for certain clear risk factors, I’d still have some respect for them.

            And it’s not just home birth, it’s the entire natural-childbirth movement.

          • Trixie

            No one here is trying to regulate a woman’s choice to have a home birth. Just the right of an unqualified attendant to charge money for it.
            Changing the subject to China is not going to save you here.

          • The Bofa on the Sofa

            Wow, you are scrambling hard to salvage anything, aren’t you?

          • Ellen Mary

            Nope: just saying I would respect this blog more if it concerned itself with baby’s rights in birth generally (for example weighing in on the Oliver’s Law/Forceps controversy) or women’s choices in childbirth/reproduction, rather than being 100% on attack mode.

          • The Bofa on the Sofa

            Yep, the ultimate dodge. “There are such worse things you could be working on….”

            Better known as, “I can’t actually refute your points, so look at that over there instead….”

            The problem is, there are ALWAYS worse things that you could focus on, instead, so there is no end to this.

            With your blog, you focus on what you want. Shoot, most here would support you,

          • Rabbit

            Ah Bofa, I’m sure Ellen May has already solved world hunger, and stopped the crisis in the Sudan. Otherwise she wouldn’t be here wasting time talking about reproductive choices of relatively well off women in the U.S., when she could be spending her energy on those other causes! Right?

          • thepragmatist

            Well, we do actually do that. You’re just not present for those conversations. And nowhere did Dr. Amy say she was calling for midwifery to be banned, or even homebirth: only that those who provide it be regulated and properly trained and forced to admit the true risks to women. I’m here because it’s the only place online where I feel like I can openly discuss my OWN birth choices.

          • thepragmatist

            Further to that, there is a lack of online information from a skeptical perspective on women’s health issues ANYWHERE. So to attack the one female blogger who has a narrow focus for not having a wider focus begs the questions as to why YOU are not hosting such a blog. Also, in the sidebar, you can find many interesting blogs on Dr. A’s roll, including one to a doctor in rural India who provides care for women who are very poor and discriminated again. I mean, if you cared to look. Attacking MANA at this point is a reasonable enterprise given the utter lies and contempt for informed consent they have shown.

          • Amazed

            What makes you think we need YOUR respect? Of all people in the world…

            Come on, folks, this is getting too civil for my taste. Everyone who thinks we need the respect of someone who defends hiding the truth from mothers and when tragedy strikes, hiding behind words like “maternal choice!” raise their hand.

            Pity we don’t have an emoticon of a hand pointing down.

          • NoLongerCrunching

            If MLK could be civil and accomplish what he did, given the violence and hatred coming from the other side, so can we :). I think there is a place for all kinds of comments, from the outraged to the cloyingly sweet to the calm and dispassionate. Some people will ONLY listen to angry rants; others will only listen to gentle nudges. I appreciate that there is room for any tone commenters want to take.

          • Amazed

            I don’t have issues with anyone’s tone. I, however, do have some very strong issues with stances like, “Death rate was less than 1 % and besides, it was maternal choice!”.

            It’s victim blaming that I have issues with.

          • NoLongerCrunching

            Quite right. So reprehensible to hide the risk data and then claim to be just supporting mothers who want to homebirth.

          • Amazed

            Actually, my take is that she claims the mothers knew the risks were greater and chose to accept them, not that they were unaware of them.

            Read her answer to an earlier post of mine in regards to Sara Snyder. It speaks volumes.

          • An Actual Attorney

            Totally OT, but I hate this idea that Dr. King was just was big fuzzy teddy bear.

            Dr. King believed passionately in the power of civil disobedience, which is a far cry from always being “civil.” He called out the evil of segregation and discrimination. Read his speeches and writings.

            Also, he wasn’t alone in the struggle. There were many parts. Not everyone believed in the power of civil disobedience. Malcolm X was also of vital importance.

          • Jessica S.

            And he extended his belief in non-violence and passion for social justice beyond our borders. His speech where he came out against Vietnam and the foreign policy of oppression was masterful, given exactly one year to the day prior to his assassination. He made a lot of powerful enemies – the President was one – with that speech, and he knew it going in. But his convictions moved him forward. Remarkable, even more so back then.

          • resaurus

            I’m recalling this from a fantastic civil rights course I took at university. It’s interesting to note that, as both MLK Jr. and Malcolm X aged and evolved their approaches to their fights for justice…the former became more aggressive and the latter more calm. Both these very important men had ways of addressing the issues as they saw fit…and what they saw as fit changed as they aged and learned…

          • thepragmatist

            I love this blog for that, and it’s why I keep coming back. It brings me such joy to share a space with such a wide variety of women. This blog has a large readership and I know that there are many people who do not post and lurk instead because it can be a very harsh place sometimes… aye, but it’s fun, even though the subject material is so very difficult. It’s actually one of the few woman-health focused blogs on the internet (the only?) where such a diverse group of women congregate to hash it out and occasionally disagree in heated ways. I really appreciate that. I am so tired of blogs and forums that allow civility to stifle impassioned discussion on things that matter. These issues all matter. Informed consent for women is something that really, really matters, and we don’t need a bunch of Luddites dragging us backwards and calling it feminism. And I love that I can express how much that angers me somewhere online and have the companionship of others, because for a long time I was really a lone wolf.

          • thepragmatist

            Or a finger pointing up? LOL! I’m getting heated just catching up on this thread… ha!

          • Rabbit

            It falls squarely in the realm of maternal choice when that choice is informed. But MANA hid the breech death rate for years, while its members spewed nonsense on blogs and webpages and conferences that it was just a “variation of normal.”

            I went to my sons’ school during lunch recess today to bring cookies for his class to celebrate his birthday. There were probably 200 kids out on the playground. If someone told you that if all 200 kids stayed out there, 5 of them would die by the end of recess, but if they moved recess inside, they’d all live, would you consider it a reasonable choice to let them stay? What if the person telling you about the choice new that 5 of the kids would die, but chose to tell you all the dangers of having recess inside, while denying that there was any real risk to staying outside. Would your choice of where the kids should stay be informed?

          • Ellen Mary

            Only issue with your analogy is that none of the children’s parents have to have their uterus cut into to move them inside. None of them will get a life threatening complication if they decide to come to school again, having moved inside. None of their parents will get a blood clot or require a transfusion moving them inside. If that were the case, I would expect to be told both the risks to me of moving my child inside AND the risks of letting them stay outside.

          • Rabbit

            How many parents do you think would leave their kids outside, even they were guaranteed to have all of the possible complications of moving inside? My child, who I carried for nine months, felt moving inside of me, have so many hopes and dreams for. Tell me moving him inside requires that you cut off my arm, there’s a possibility I’ll need a transfusion, and taking possible future kids to school might be more complicated. My only question at that point is where is the scalpel and how soon can you start cutting.

          • Ellen Mary

            Right, but you don’t get to say what another woman would decide. Women are even entitled to end their pregnancies for any or no reason to 24 weeks in most states. Suggest that they shouldn’t & you will have women storm your building, prepared to throw tampons.

          • Rabbit

            How many women (who at term, we can fairly assume have opted against an abortion) would make that choice though, if they knew the real numbers. They didn’t know, and the people who did know, and who were trying to influence the decision, were lying to them. They were insisting that breech was a “variation of normal,” while playing up the smaller risks, both in terms of the rate and severity of the risks of c-section.

          • thepragmatist

            Exactly: the hyperbole around c-sections make it almost impossible for any normal lay-person to make a reasonable choice unless they’re prepared to spend many, many hours sifting through the original research. Only recently have we Dr. Murphy’s book to reference– prior to that, I was borrowing passwords and reading journals and slowly coming to the same conclusion he did… wait a second, those morbidities are in the wrong cohort!

          • AlisonCummins

            That’s not the question. Read the questions again:

            [W]ould you consider it a reasonable choice to let them stay? What if the person telling you about the choice knew that 5 of the kids would die, but chose to tell you all the dangers of having recess inside, while denying that there was any real risk to staying outside. Would your choice of where the kids should stay be informed?

          • Trixie

            …which is why hospitals make you sign factual consent forms before procedures such as VBAC and c-section. Just like home birth midwives…oh, wait.

          • MaineJen

            Are you kidding me with this? You would not risk harm to yourself to save your child’s life? Cause I’m telling you right now, if my child were at risk of dying I would let someone cut into my uterus, get a blood txf or risk a blood clot for myself IN A HEARTBEAT. By your own argument: The risk of keeping them outside = death. The risk of moving them inside = possible, repairable harm to you.

          • thepragmatist

            Alas, my child got distracted by his train set… so back I am… and I can just say this, I WOULD get a child “cut out of me” FOR NO REASON AT ALL, if it saved my neighbour’s child from death. And especially if there was even a 1 in 100 chance it would save mine.

            You write about the gross injustices of mass sterilization in other countries, yet show the same level of contempt for others (and especially babies) as the anti-vaxxers… We aren’t even asking all the hypothetical children to come inside, just the ones who are standing on their heads. So indeed, I think it’s a fair request that MANA stop spouting the nonsense that breech is a variation of normal when it isn’t.

            ETA: sorry, directed at Ellen Mary, Maine Jen… flipping Discus…

          • auntbea

            Transplant doc: Hey, this kid’s mom’s a great match for him. Let’s let her know the great news right now.

            Lay organ healer: No, we should just tell he’ll be fine. We don’t want to impede her right to make choices about her own kidneys.

          • MaineJen

            And that is called ‘Reframing the argument.’

          • Amy Tuteur, MD

            The absolute numbers of people who suffered fatal heart attacks as a result of Vioxx was small, too. Merck was pilloried not because Vioxx was terribly unsafe; it wasn’t. They were pilloried because they HID the fact that Vioxx increased the risk of heart attacks by a small amount, thereby denying people the ability to make an informed choice based on risks as well as benefits.

            Professional homebirth advocates are doing the same thing. Homebirth isn’t terribly dangerous, but it does increase the risk of death. MANA and Aviva Romm (among others) KNOW this and continue to hide it. By doing so they rob women of the chance to consider both the risks and the benefits of homebirth. They should be pilloried for doing so.

          • Amazed

            Hahaha. Maternal choice? Go to Sara Snyder’s site and say it to her face (or her blog) that she chose for her son to risk death. She was misinformed and outright lied to. And if there is one mother, what makes you think there weren’t 2, or 22? That’s what you defend by the classical homebirth advocate approach: steer the conversation away to something else, anything else but the pile of tiny dead bodies.

            Go there and say it to her face, Go and sprout your hipocrysy and lies there. Oh, and before you do, call Ms Vivi of the hurt tiny little feelings (I refuse to call her Dr Romm, real MDs are more thick-skinned. They have to be.) and ask her for a herb to soothe raw nerves and tiny hurt pride over someone daring to call your writings hypocritical.

            Bye-bye, Ellen-Marie. I don’t suppose you’d choose to keep visiting a place where louts like me frequent. So – bye.

          • Ellen Mary

            Did she not have Internet access? Being real: I’ve been exposed to the ACOG & Dr. Amy’s position for @ least 8 years. IDK if any woman can claim anymore that they have ‘no idea’ that HomeBirth is fiercely debated & inherently controversial. And that there are people like Dr. Amy disputing anything their midwife tells them. I am not disputing that there should be regulation of claims, however to act like women absolutely do not have access to both sides of the debate is foolish, IMO.

          • theNormalDistribution

            So it’s totally okay to lie to women in your care, because they have access to the truth if they want to look for it? That’s your angle now??

          • Ellen Mary

            This thread is about Aviva. Just because women follow your blog on the Internet does not mean you have established a caregiving relationship with them. Likewise MANA is not a care provider & we do not know the extent to which individual midwives lie or tell the truth except through forms they provide or accounts by their patients. It is alway important to tell the truth in a caregiving relationship, but it is also important to seek the truth as a patient. I was not told about increased risks to my life in future pregnancies before consenting to a cesarean, however I don’t think my provider LIED to me, I think she didn’t tell the entire story.

          • Amazed

            The thread was about Ms Vivi of the tiny hurt feelings before you derailed the conversation with your claim that it was maternal choice to risk their babies’ lives. When asked about the nature of caregiver-patient relationship, you were fast to steer the conversation back in place?

            Cute.

          • theNormalDistribution

            SO you get to say awful, insensitive, horrific stuff about how a mother who was misinformed by her midwife had access to the truth if she wanted, and so that midwife did no wrong, but I don’t get to respond to it because, oh, I’m sorry, but this thread is about Aviva.

          • Ellen Mary

            I don’t know the person you referenced & my posts never referenced an individual. YOU suggested I visit her blog & say some horrible, insensitive things. I declined & continued to discuss the thread topic & the concept of informed consent & HomeBirth in the Internet age. If Dr. Amy didn’t think her blog could provide some measure of informed consent to US women, I doubt she would be working so hard on it.

          • theNormalDistribution

            Maybe you should go back and read the whole thread, because you seem to be confused about who said what. I didn’t tell you to go anywhere. I simply responded to your comments vindicating midwives and MANA of responsibility for their outright lies because women have access to the internet and could have researched it themselves.

          • Amazed

            Ellen Marie means me. I was the one who suggested that she went to Sara Snyder’s blog and explain it to her how Sara chose to risk her son’s life with a breech homebirth. I actually meant it like going to the site and read about Sara’s journey to her truth before keeping those horrible, insensitive comments going.

            After I read her reply (aka mother guilty for not getting a Master degree in Google University. midwives should be left to lie left and right), I realized how futile it was.

          • Rabbit

            Aviva Romm, a Yale-educated doctor, finds the numbers in the MANA data release to be too hard to figure out. But your average pregnant woman should be able to “seek the truth as a patient”? Do you even see the contradiction there? And how was Sara to seek the truth, when MANA was hiding the stats? How is a newly pregnant person today to seek the truth, when MANA is still lying about the stats?

          • thepragmatist

            It’s all about lying and misrepresenting the data. I remember what brought me here. I went to the Unnecessarian to read about c-sections as I was thinking about getting a MRCS. I went there because it popped up high in my google ranking and I wanted to see what they said. While I was reading it, I caught an interpretation of a study that was really glaringly bad. They’d managed to take out a couple of zeros, let’s just say that. So I went to get the original research. Behind a paywall. I kept following up their citations, and hit paywalls. So I borrowed my nurse friends’ journal passwords and went to town on the original research. Suddenly, I realized I was being pandered to and lied to. The statistics didn’t say what the authors tried to make them say. They inflated the risks. So I started looking elsewhere, and realized it was all around me. Not just re: c-section, but any “intervention”. And then I found Dr. Amy. I am not sure if I was still pregnant or not. I think I had just had my baby. But I had figured it out by then– that I had been lied to the entire time. And I was piping mad. And this thread is tapping into that anger I first felt coming here. I lost friends for my maternal choice c-section. I have no complications from that wonderful surgery. Not even much of a scar now.

          • thepragmatist

            Wrong! They represent midwives. It’s their responsibility to tell the truth and to produce quality review data. They did it to “prove” the safety of home birth. Of course, that study was deeply flawed, so they sat on it. This is all about them not wanting to say what everyone knew (in the medical community– not on the street). CPMS and DEMs are really dangerous. They should have their licenses yanked. Oh my goodness, I can’t believe what an apologist you are. You’re actually riling me up! I think I need chocolate. A yoni cupcake or something.

          • Karen in SC

            What exactly is the increased risk to your life in future pregnancies after one (or more) c-section? In what published scientific study did you find this risk?

            How does it compare to the risk to your life in future pregnancies based on other factors?

          • Ellen Mary

            Placenta Accreta is a risk which increases in each subsequent pregnancy. I don’t need to spoon feed you a study, google it. The risk is well established & directly related to number of Cesareans. Prior D&C/Es & Parity play a more minor role in increasing risk. Placenta Accreta is life threatening, even with planned management @ medical center.

            I appreciate your perspective on HomeBirth but to act like because you believe one side, you have to discount or diminish the real risks on the other side is not intellectually honest.

          • Ellen Mary

            Direct from ACOG: Placenta accreta is a potentially life-threatening obstetric condition that requires a multidisciplinary approach to management. The incidence of placenta accreta has increased and seems to parallel the increasing cesarean delivery rate. Women at greatest risk of placenta accreta are those who have myometrial damage caused by a previous cesarean delivery with either an anterior or posterior placenta previa overlying the uterine scar.

          • Ellen Mary

            ACOG on Incidence: The incidence of placenta accreta has increased and seems to parallel the increasing cesarean delivery rate. Researchers have reported the incidence of placenta accreta as 1 in 533 pregnancies for the period of 1982–2002 (5). This contrasts sharply with previous reports, which ranged from 1 in 4,027 pregnancies in the 1970s, increasing to 1 in 2,510 pregnancies in the 1980s (6, 7).

          • Young CC Prof

            And the incidence of maternal DEATH in the very first birth in populations where caesarian delivery is unavailable is over 1 in 100. Keep in mind, that’s another important comparison, and obstetrical technology doesn’t just save babies, it saves mothers too.

          • Ellen Mary

            I always knew there were great reasons for attempting to limit uterine surgeries. No one told me about the possibility of uterine scarring when I looked into a D&C for a m/c & no one told me about Placenta Accreta before I consented to a Cesarean.

            Now if I ever get lax about Family Planning, or my method allows a pregnancy, or I happen to want to use my uterus again, the chance I don’t survive that is higher. Especially if I don’t have access to money for travel & fancy, high level care. No one can really predict where one’s placenta will implant.

          • Amy Tuteur, MD

            And how much higher is the risk of death at homebirth compared to the risk of a placenta accreta after a C-section?

          • Ellen Mary

            Incidence of intrapartum death @ HB 2-3/1000

            Current Incidence of Placenta Accreta in the US
            1/533

            Maternal Mortality when Placenta Accreta does occur: up to
            7/100

            Pregnancy rates when using Family Planning: 1-10/100

            Quote:
            ‘Patients presenting with a placenta previa and an unscarred uterus had a 5% risk of clinical placenta accreta. With a placenta previa and one previous cesarean section, the risk of placenta accreta was 24%; this risk continued to increase to 67% (two of three) with a placenta previa and four or more cesarean sections.’

            Individual risk of Previa/Accreta would vary by age, parity, surgical history & isn’t it higher with multiples?

          • Amy Tuteur, MD

            So the incidence of death at homebirth is MUCH higher than the incidence of death from placenta accreta. So why aren’t you worried about death at homebirth?

          • Ellen Mary

            Did I say I wasn’t worried about it? Did you miss the part where I planned a hospital birth that ended surgically? Those are the actions of someone who is pretty worried about it!

            Thx for inviting me to look over the Placenta Accreta numbers: now I am totally scared to ever conceive again, as the incidence seems to be 0.4-0.8% . . . That seems like it is 4-8/1000. That means that I have a greater chance of turning up with PA now than I have of losing a baby @ a HB. If you never run out of HB casualties to blog about, seems like PA in post C pregnancies happens pretty frequently by those numbers.

            However, just like ABO: I don’t think you will ever eliminate the need for the HB service. And I don’t see anyone on here advocating for greater access to CNM OOH care. In every state I have lived in, CNMs are extremely rare or absent & it isn’t by their choice, but by laws & MedMal policy. I know you say no one is under any obligation to permit HB, but doesn’t every other industrialized nation? So in advocating for the elimination of CPMs, without advocating for the availability of OOH CNMs, isn’t there a vacuum created that will fill with Unassisted & not even a CPM attended birth

          • fiftyfifty1

            ” I know you say no one is under any obligation to permit HB, but doesn’t every other industrialized nation?”

            Industrialized nations that pay for home births are actually in the minority.

          • Ellen Mary

            UK & Canada definitely do. What developed nations are you referring to that do not, but do pay for hospital birth? I don’t generally think a service has to be fully subsidized to be available though, just legal & integrated ( like transfers can happen ).

          • KarenJJ

            Parts of Australia do. I can have a homebirth for free (except they would risk me out due to prior c-sections) attended by two university trained midwives. I can also attend a midwife led birth centre attached to the tertiary maternity hospital, book in under midwifery led care at hospital (although I personally would need obgyn consults due to my medical history) and all that is for free. It hasn’t made it a particularly popular choice, however it is available. Once you’re more then 30 minutes drive from the designated hospital you no longer can access this homebirth program.

            So it’s available and it’s chosen around 0.5% of the time. The way that MANA does homebirth is not how homebirths are done here (unless you fly over Lisa Barrett to attend your homebirth after being risked out of the government homebirth program – it’s happened and didn’t end happily). If MANA were pursuing the type of homebirth program we have here then, well, I wouldn’t support it but wouldn’t be wildly against it either. MANA has shown absolutely no indication that they want to pursue a homebirth program in the way that it is done in any other industrialised country. It is all about “protecting granny midwives”, whereas the rest of the industrialised world has largely done away with granny midwives.

          • AlisonCummins

            Home birth is allowed just about anywhere, I believe. It’s being allowed to call yourself a midwife when you aren’t, and to charge money for it, that is only permitted in the US.

          • Amy Tuteur, MD

            Wrong!

            A woman who chooses homebirth has a 2-3/1000 risk of her baby dying.

            If she goes to the hospital instead she has an approximately 20% chance of having a primary C-section. If she gets pregnant again she has a 2/1000 chance of developing an accreta. If she develops an accreta she has a 1% of dying. Therefore, the risk of downstream death from accreta is 20% X 2/1000 X 1% = 4/10,000,000 or 0.004/1000. Therefore, the risk of the baby dying at homebirth is 500X higher than future death from accreta.

          • Ellen Mary

            Where are you getting 2/1000 & 1%? Everything I have read says mortality can be up to 7% even with the best medical management AND being okay with a planned Cesarean/Hysterectomy. And everything I read said incidence is between 0.4-0.8% so I would like to see your source for 0.2% as the incidence following Cesarean.

            Also some women will have different risks for Accreta ( more than one prior C ), different risks for a surgical birth (ending up in a hospital/practice with a high section rate, a VBAC Ban) . . .

          • Young CC Prof

            0.2% is the incidence in pregnancy after 1 c-section. (see my citation in the other reply.) The 0.4% number includes women with many prior surgeries to the uterus.

            And keep in mind, the section rate of a particular hospital or doctor has very little to do with the probability of YOU having a c-section at that hospital or with that doctor. A really good obstetrician who manages lots of very complicated pregnancies will have a high c-section rate. However, she might be quite willing to let her lower-risk patients deliver vaginally, and even enjoy those less stressful deliveries.

            To take an extreme example, one hospital has an 80% c-section rate! Why? It’s Children’s Hospital of Philadelphia, and the reason is that they NEVER take normal deliveries. They only deliver babies who are severely premature or have been diagnosed prenatally with serious problems.

            The one exception is, like you said, VBAC. Some hospitals and doctors simply don’t permit it. If you want to VBAC, find a hospital with the resources to support it, and discuss with your doctor early in pregnancy whether you are a good candidate.

          • thepragmatist

            AH! This is even better. Thank you.

          • theNormalDistribution

            I wish you would say 500X as high instead of 500X higher…

            “A is 5X higher than B” could be interpreted to mean “A is equal to 5 B’s” OR “A is 5 B’s bigger than B”. Whereas “A is 5 times as high as B” is unambiguous.

            I can see why in the MANA stats articles you were using 450% and 5.5X, because when we talk in percentages we generally refer in additional terms, (i.e. 200% more, 50% less.) and when we talk in multipliers we generally refer to them in multiplicative terms, (i.e. 3x as much, half as much.)… But you “higher” every time and it confuses the hell out of me.

            The internet tells me that they’re generally accepted to mean the same thing, so maybe it is only confusing for math nerds and pedants, but it took me a good week of checking back to see what the numbers were before I could remember what the actual increase in homebirth risk was.

          • fiftyfifty1

            “So in advocating for the elimination of CPMs, without advocating for the availability of OOH CNMs, isn’t there a vacuum created that will fill with Unassisted & not even a CPM attended birth”

            This is not a problem for 2 reasons:

            1. If homebirth midwives were not available or greatly reduced in availability, the vast majority of women who choose homebirth now would choose hospital birth instead.

            2. There would still be a fringe percentage of women who would still choose to homebirth. However what studies we have on the subject (e.g. Oregon stats) show that planned UC is equally safe as planned homebirth with CPM. That’s pretty damning, isn’t it?!

            (In other words, hiring a CPM is every bit as UNSAFE as just deciding to deliver alone. At least when you are alone you can follow your own intuition and call 911 if you feel you need to. With a CPM she’ll be there telling you against your better judgement that everything is fine and to keep going at home.)

          • Young CC Prof

            http://www.ncbi.nlm.nih.gov/pubmed/16738145

            This study examines the risk of placenta accreta by the number of prior caesarians. They find that the risk with ONE prior caesarian is only very slightly higher than on an unscarred uterus, but when you get to 3 prior caesarians, the risk climbs sharply.

            So basically, a second pregnancy after one c-section isn’t a major hazard. (I’m certainly not afraid of getting pregnant again, other than the 20% chance of a recurrence of the complication that my first baby suffered, which he ultimately came through just fine.)

            If you want 4 or more children, c-sections early on might make that harder. But two children are pretty safe.

          • Karen in SC

            I appreciate your reply to my post; I almost missed it due to the user unfriendly way Disqus works.

            The OBs who post here can hopefully comment on the prevalence of placenta accreta, as 1/533 is a high number to me – I assume that is the risk after a c-section. Not sure I can believe the maternal mortality rate, but will look further. Maybe it’s my ignorance of statistics though.

          • Ellen Mary

            1 in 533 represents the overall incidence & would include women with more than one prior Surgical Birth. :)

          • fiftyfifty1

            “Quote: ‘Patients presenting with a placenta previa and an unscarred uterus had a 5% risk of clinical placenta accreta. With a placenta previa and one previous cesarean section, the risk of placenta accreta was 24%; this risk continued to increase to 67% (two of three) with a placenta previa and four or more cesarean sections.’”

            What’s the point of this quote? It’s not about a woman’s overall risk of placenta accreta. It’s a tool to predict accreta if she also has another abnormal condition: placenta previa. My guess is that you used this quote for one of two possible reasons:
            1. Because you wanted a quote with high numbers in it to scare women who might not have the scientific knowledge to understand what it means.
            2. You yourself don’t have the scientific knowledge to understand what it means.

            Placenta accreta is a real risk and must be taken seriously. However when deciding to do a C-section for fetal distress or a stuck baby it is only a *theoretical risk*. The reason is that this baby NOW is in distress, while who can say if a woman will ever even get pregnant again much less develop the accreta.

          • thepragmatist

            Thanks for this! This is an excellent rebuttal and explanation of exactly what a level-headed lay-person has to wade through to make sense of anything about c-section complications. Neither complication were of large concern for me, as I just wanted 2 children (and I still hope for the second, although I have a lot of barriers in the way…)

            Anyway, it’s exactly this kind of cherry-picking data and using it to scare the shit out of women that makes it hard to make clear choices. And of course, we’re not mentioning AT ALL the risks of vaginal delivery. You’re focusing on intrapartum *death*, but what about disability? What about hypoxia? What’s the rate of hypoxia to compare to the rate of accreta? Who the f cares at the end of the day, since mostly all birth by competent professional providers is generally safe, except for ONE: birthing with an incompetent midwife or birth attendant, away from care. According to Oregon’s data it is just flat out highly unsafe. Period. And that’s the best data we have because it’s not self-reporting.

            (Myself, I was way more worried about brain damage and damage to my sexual organs, as I was pretty confident my providers would get the baby and me out of it alive. As someone with an anxiety disorder and extremely narrow focus when I want it, I spent most of my pregnancy terrified of, well, everything… ha… but especially of the health of my baby, and of the delivery. Beyond terrified. I researched the hell out of placenta accreta to be honest: I even watched a how-to series of videos on youtube for physicians performing surgery to correct it. I can’t imagine life without the kind of narrow focus/anxiety someone like me can manifest, lol, so I don’t get just accepting data at face value. I wanted to know ALL about it. And I asked my OB/GYN all about it and all kinds of questions, right down to what kind of suturing she was going to use, etc. Somehow she didn’t scream. LOL.)

          • Ellen Mary

            Incidence of intrapartum death @ HB 2-3/1000

            Current Incidence of Placenta Accreta in the US
            1/533

            Maternal Mortality when Placenta Accreta does occur: up to
            7/100

            Pregnancy rates when using Family Planning: 1-10/100

            Quote:
            ‘Patients presenting with a placenta previa and an unscarred uterus had a 5% risk of clinical placenta accreta. With a placenta previa and one previous cesarean section, the risk of placenta accreta was 24%; this risk continued to increase to 67% (two of three) with a placenta previa and four or more cesarean sections.’

            Individual risk of Previa/Accreta would vary by age, parity, surgical history & isn’t it higher with multiples?

            Text above from: http://www.ncbi.nlm.nih.gov/m/pubmed/4011075/

          • thepragmatist

            I hate Discus, so I don’t know if this will actually get to you, directly, but I don’t know why you weren’t informed of the risks in subsequent deliveries: that falls firmly on the shoulders of your provider, who should’ve informed you of all risks. Of course your admitting papers for the surgery wouldn’t, because they’re focused on consent for the procedure, so they’re not going to list a complication that isn’t going to manifest directly from surgery, even if it is a complication of surgery down the road. But you and your OB/GYN should’ve discussed risks in future pregnancies and especially family size when discussing risk/benefit of c-section. Mine did. I felt well informed. She also made me promise not more than two kids, and an ERCS for the next one, which was fine by me. ETA: So, actually, the “other side” was far more honest, actually. I was terrified of having an OB/GYN but she’s turned out to be the most honest, thoughtful and thorough doc I’ve ever had and changed my life even after she delivered my son by helping me get medical care I’d needed for a very long time.

          • Amazed

            Go there and discuss it with her, Ellen Mary. Ask her.

            While we’re at it, ask MANA whether they had the data about death rates at the time she had to make her choice. Hint, hint: at the time, they were releasing important bits of information like rates of intervention, C-section rates, and breastfeeding success rates. Why bother with death rates? It’s only a fracture of 1 % and it’s maternal choice, I suppose they were thinking. Just like you.

          • C T

            OK, try going to some of those “supportive” message boards and telling women that homebirth is more dangerous than hospital birth. Get back to us with the results of how quickly you’re demonized and booted off some of them….and then contrast it with how your posts on here keep showing up. Dr. Tuteur lets people disagree with her without worrying about hurting people’s feelings; the people promoting homebirth tend to “spiritualize” it and get very angry when someone detracts from their fairy tales.

          • thepragmatist

            That’s not true. Here midwifery is integrative. And as someone who fell prey to a different type of woo and got caught up in it, the fact it is legitimized by the government, that the midwives can and do say it is safe, that they frame the “debate” and control it in a way where the midwives have freedom of speech and the physicians must be quiet because of their own regulatory bodies and government edict… no, I wouldn’t say *most* women understand. We’ve been pummeled with the NCB bullshit for the last decade, especially those of us who went to arts-based university programs, where NCB propaganda has managed to adhere itself fully to sociological and feminist schools of thoughts. No, I was not informed and when I went online, I didn’t find the kind of information I needed to make an informed choice. I had to dig. I had to go and borrow my friend’s passes to read original research. I had to really try and the average person is not going to spend the time. So happens I have a very narrow focus when something interests me. Besides which, the onus should be on the PROVIDER to provide safe care. When I go a mechanic and he tells me my brakes are safe, I don’t go under there to double check. I’m not a freaking mechanic. When I went to my midwife, I completely trusted her. Luckily, she risked me out of homebirth. I can’t even imagine what a disaster that would’ve been.

          • Karen in SC

            Blaming the victim???

          • An Actual Attorney

            “The absolute numbers here are fractions of 1%,”

            First, absolute numbers are not expressed as percentages. Second, the death rate for breach babies in the MANA data set was 2%.

          • thepragmatist

            AND THAT’S THE CHERRY PICKED DATA! That’s the data sent in by the midwives accountable enough TO SEND IT IN! *face crashing through desk and hitting floor*

          • R T

            You’re a little behind the times. “One Child Policy” isn’t enforced much in China anymore. Ethnic Chinese were never held to it and now if you can afford to pay for the permit to have more than one child anyone can. They also have “black children” which are multiply children born to the same family. Their mothers weren’t forced to abort, but the children can’t receive any government benefits. If you lived in a city with 22 million plus human beings you would understand the “One Child Policy”. After the time I spent in Beijing I know I do! The largest city in the United States has less that 9 million residents. If we were ever to reach the population figures of the cities in China, a one child policy would be supported here too. http://world.time.com/2013/12/28/china-eases-one-child-policy/

          • Ellen Mary

            OT: OCP is absolutely still enforced. It is a policy, and has various complexities & exceptions, but that does NOT mean it ‘is not enforced’ or that it doesn’t still involve forced abortions. ‘Black babies’. The fee is exorbitant . PP believes it restricts women’s choices even if a woman has to pay $400 to terminate. So it doesn’t constitute a economic draft into ABO to have these fees?

            I am super glad there are conditions under which you believe Government Control over women’s choices is morally acceptable.

          • theNormalDistribution

            Oh, I’m sorry, this post is about Aviva. Please stay on point.

          • thepragmatist

            Excuse me, Ellen Mary, but I believe I’ve already addressed this. I am a feminist. Women and children concern me. I am as concerned about the plight of those women as I am about the plight of women being lied to and misled by NCB. I’ve already answered you, as have many others. I have no confidence that we can change Chinese policy one way or the other. I would, however, support Chinese women, whether financially or otherwise, in doing so themselves. They are not mutually exclusive ventures.

            This said, “Save the BABIES” =/= forced abortion and sterilization. The latter is an atrocity, but is not about saving *babies* because an embryo is not a baby, nor is the thought of a baby, a baby. A fertile womb is not a baby. Woman’s bodily autonomy is not a baby. I like to be precise. These midwives are killing at term, intrapartum BABIES and neonate BABIES. These are babies who would’ve survived in hospital. It is, more technically, infanticide. Murder, even, in some cases, where midwives deliberately prevent women from seeking help when they beg. So, you are correct, it is not forced sterilization or abortion.

            What does mass sterilization and NCB have in common: cult-like “thought leaders”; rigid dogma; strict adherence to dogma despite evidence of its destructiveness; and a thought leaders that deliberately mislead, lie, and oppress women. So thank you, perhaps Dr. Amy will do a comparison?

          • Ellen Mary

            Using the term ‘embryo’ to describe a forced ABO is as intellectually dishonest as anything. MANA & NARAL actually operate in similar ways @ times, seems to me. You should know that an ‘embryo’ becomes a fetus at TEN WEEKS. Therefore, many, many ABO, including those for anomalies including T21 happen to FETUSES, not embryos & certainly not to a clump of cells or ‘thoughts’. Those are human beings. You can argue that they don’t have personhood, some bioethicists now argue that even infants don’t have that.

            I recommend you see Dr. Fogelson’s essay: ‘Why ProChoice is Losing’. He discusses how futile & ‘vampiric’ it is to use terms like ‘blastocyst’, ‘zygote’, ‘product of conception’ & ‘uterine contents’ around anyone who understands fetal development.

          • theNormalDistribution

            You’re saying that as long as women are allowed to abort unwanted pregnancies, we can’t hold health care practitioners accountable for killing a woman’s wanted baby.

            Totally makes sense.

          • Dr Kitty

            IMHO, no, no it isn’t.

            Look at the victims here.
            Women and their families who opt to end pregnancies by their own choice are not victims of crime, and have redress if they suffer harm through negligence or malpractice.

            Women and their families in the USA who opt to have a Homebirth and lose their child as a result have lost wanted children, have suffered harm as a result and have no redress.

            One is not related to the other.
            I’m pro choice, so that if parents choose to have a baby, and want that baby born alive and safely their health care providers have a duty of care to make that happen and there has to be a system in place to ensure adequate systems of care.

            If families choose not to continue a pregnancy they are entitled to similar safeguards to ensure adequate care.

          • Ellen Mary

            It is an industry euphemism to say ‘end a pregnancy’. The practitioner (after 10 weeks) ends the life of a fetus, and the value of that life is not defined by how someone feels about it, though we may wish it to be. Plenty of children are also ‘unwanted’ but that changes nothing about their value.

            A mother may want a fetus at term to survive, to have a 99.8% chance of survival, but not at the expense of her bodily integrity, not at increased risk to her future health. She might find her local birth climate unacceptable. We don’t have to agree, we can even think she is a bad mother, but she still retains that right, especially in situations where she is exposed to excess risk above what is strictly necessary to produce a live infant by hospital/provider policy (as in VBAC bans & way higher than average Cesarean rates in certain geographic areas). Do you believe women will continue to seek out of hospital birth if CPMs are outlawed? Real question.

            Dr. Amy is savvier about this than her fans seem to be: she understands that to be ProChoice necessarily means you can’t force submission to birth interventions. That is why she opposes the CPM credential & HB midwives, but her rallying cry is not ‘forced hospital birth’.

            I

          • Dr Kitty

            I work in the UK.
            We don’t have CPMs. We have properly trained midwives and offer homebirth to APPROPRIATELY LOW RISK WOMEN, which is the kind of culture Dr Amy wishes to promote.

            In the UK it is illegal for anyone other than a midwife if doctor to deliberately attend a birth.

            There is no culture of UC here.
            There aren’t large numbers of high risk women demanding HB.
            VBACs are offered when appropriate.

            When you have an integrated system provided by properly trained professionals then no, I don’t think women will still choose OOH birth with unqualified, dangerous birth junkies.

          • Young CC Prof

            Nope. Her rallying cry is “accurate information about the real risks.” Both the risks of out-of-hospital birth and the risks of caesarian birth, which you seem disproportionately concerned about.

            If someone understands the risks and still chooses OOH birth, so be it. If she chooses home birth because she thinks it’s safe, and then loses the child she desperately wanted due to an easily preventable complication… Yeah, I’m going to be outraged on her behalf.

          • Ellen Mary

            I don’t think I am ‘disproportionately’ concerned about the risks of Cesarean birth. I happen to have just had that type of birth & came home to learn of a pretty big risk that I was not informed about during my preSurgery work up. It also was not on the forms I signed. I might have asked for a little more time if it was mentioned. I did specifically ask about what future gestation was going to look like & the only thing that was mentioned was that it might be a little more difficult to conceive & m/c might be a little more likely. I am slowly putting it into perspective, but it took a few weeks to grapple with the fact that I could now find myself unexpectedly in a position where the odds of me presenting with a life-threatening, life-altering pregnancy complication are similar to the odds I didn’t find acceptable for my baby in birth.

          • Young CC Prof

            May I ask why your doctor recommended a Caesarian birth with your first child?

          • thepragmatist

            We aren’t talking about reducing rates from under 1% when we’re talking about dangerous practices, like for example the kind of births Gloria Lemay promotes. These are births with higher than 1% mortality rates for TERM infants. And your abortion argument is a red herring and a separate issue, altogether. You can’t win on breech births. I don’t know how you can justify it. If you’re taking the Cochrane Review, those studies occurred in hospitals with highly trained medical providers, not in someone’s bathroom with a DEM/CPM.

            I support women’s rights to informed consent. Bodily autonomy can’t exist without informed consent. We are doing women a disservice if we do not give them full access to the information.

            Telling women that breech birth at home is safe IS a load of BS. If you want to be intellectually dishonest, keep telling women that breech is just a variation of normal, and then go tell it to the mothers here who would have healthy infants if not for under-trained midwives not risking them out as they would in ANY OTHER COUNTRY. You don’t seem to understand the purpose of our activism here. It’s not to end women’s autonomy in provider choice or even end homebirth (I originally was going to have a homebirth), it’s to force providers to be honest about the risks, to have insurance, to have higher standards, or NOT call themselves midwives if they do not have the same high standards of midwives in comparable countries. They lay claim to those statistics, but their death rates are appalling even when SELF-reporting. Nowhere else does a regulatory body allow their midwives to self-report. If you’ve not noticed we have midwives here, too, who are appalled at MANA.

            I’m not getting drawn into another argument about abortion here. Most (90%) of abortions happen in the first trimester. There is a tremendous difference between an embryo and a term infant, and having carried a child to term AND also had an abortion, I know so intimately. The number of abortions that happen when the pregnancy has progressed into later term is small, and mostly for medical reasons, and is already a difficult ethical dilemma. If you actually read the interviews with providers who do late term abortions you will come to understand that they wrestle with the ethics of what they do, as well. Exploiting that grey area in medical ethics to advance a cause such as the completely preventable death of breech infants at home is, to borrow your phrase, intellectually dishonest.

          • Ellen Mary

            But no one here is advocating for the creation of an integrated CNM situation for OOH birth in this country, which there are considerable barriers to in the US but which exists in the UK, CAN, AUS, etc. So just like taking away clinics is thought to empower shady ABO providers, doesn’t preventing CNMs from working OOH & closing Birth Centers empower CPMs?!? So you advocate for a crackdown & sure, YES, limit speech about breech, but the implication is, when that crackdown occurs, US women will be left with fewer options than UK, AUS & CAN women.

            Guttmacher, which is arguably biased toward ProChoice does NOT agree that most terminations of Fetuses (vs. embryos) happen for medical reasons. They state that a fairly small percentage are for medical reasons. And a reminder that an embryo becomes a Fetus before the end of the first trimester.

            I am also a woman who is post-abortive, definitely. I also planned two Homebirths before planning a hospital birth, however, what finally inspired me to do so was waking up from a ProChoice mentality & realizing that I felt that the fetus’ right to life & health superseded my own. The issues are deeply related even if we don’t want them to be because they both involve the question of women’s rights vs. fetal rights.

          • Young CC Prof

            Thepragmatist didn’t say that most abortions in the USA occur for medical reasons. Most abortions are performed in the first trimester due to, essentially, unwanted pregnancy, although up to 25% of women cite medical concerns as one factor in their decision.

            ThePragmatist claimed that LATE abortions (second-trimester) are pretty rare and usually performed for medical reasons. This is entirely true. There are some complicated medical and ethical dilemmas there, and I don’t think anyone involved takes it lightly. Many of the pregnancies were very much wanted.

            Still, back to your other question.

            Should the USA have an integrated system of CNM-assisted home birth? That’s a good question.

            There are some technical obstacles. For one thing, our medical system is currently very far from integrated. Such a program would have to be supported by a specific hospital or hospital system in conjunction with its major insurers and payers, for example, and many of the areas where home birth is popular are low population density.

          • Ellen Mary

            Yes, the majority of post 9 week abortions ARE not performed for fetal indication or maternal medical indication. Ask Guttmacher. That is a myth, as those abortions are the most sympathetic, they are featured in the media most often, they represent a small percentage *even of later abortions*.

            I recognize that this is a bit of an off topic rabbit hole, however it is a persistent myth that not even a ProChoice think tank affirms, so . . .

            As far as arguing that CPMs should be outlawed, but access to first world CNMs out of hospital is a question for the philosophers to ponder while women have no choice to play my way or the highway with their local hospital, well that is precisely THE issue.

          • NoLongerCrunching

            >while women have no choice to play my way or the highway with their local hospital, well that is precisely THE issue.

            Of course they have a choice. No one wants to outlaw homebirth. No one is saying these CPMs can’t legally be invited by women to be with them in labor; they just shouldn’t be allowed to misrepresent their training, charge thousands of dollars to rub the mom’s back and catch the baby, and be licensed by the state as if they were qualified HCPs.

          • thepragmatist

            Sending someone to a practitioner who might kill them or their babies because there is no framework yet in place (and there ARE places in the USA that integrates midwifery and onsite birth centers with hospital care) is a bogus reason. If you are in favour of protecting fetal rights, then your argument falls counter, entirely, to bodily autonomy of women. If that is the case, all babies should be born at 39 weeks by c-section, problem solved.

          • Ellen Mary

            If you succeed in muddying the waters about whether CPMs are unsafe or actually HomeBirth itself is, there won’t ever BE such a framework in the US.

            A policy of universal Cesarean @ 39 weeks would only protect fetal rights (which I am not in favor of to the extent that mothers are completely ignored) if every woman was only to have one pregnancy, because fetuses are in danger in the type of complicated pregnancies that can happen post uterine surgery. That policy would also increase materal mortality & IDK the mortality of motherless babies, but I suspect it isn’t as great as the survival rate for babies whose mothers survive their births.

          • Young CC Prof

            “If you succeed in muddying the waters about whether CPMs are unsafe or actually HomeBirth itself is”

            CPM home birth is terribly unsafe. Properly-run home birth is somewhat more dangerous than hospital birth, but not outrageously so. (By the way, in properly-run home birth, all first-time mothers are excluded as well. Only healthy women who had an uneventful pregnancy and an uneventful prior delivery are acceptable.)

          • thepragmatist

            But it’s less than a 1% risk in subsequent pregnancies! In fact, up to 4 pregnancies is consider *very* safe. You need to brush up on your stats around c-sections. I know, it is terrible when the conclusions lead to where you don’t want them to…

            Find me the blog post where Dr. Amy calls to an end of ALL homebirth. This is not what she is calling for. And the FACT that it is more dangerous for a first time mom has been replicated now in multiple very large studies in both the UK and the Netherlands. My friend who is a ped in the Netherlands has been talking about how unsafe the homebirths were far before the last study came out and no one wanted to believe her, but she was right. People on the ground there saw it coming. I see it coming to Canada. And in the Netherlands they have a public health system that has delegated TRANSPORT for births. How’s that? And they still see a three fold increase in neonate death for first time moms.

            Still, they will offer homebirth, because, as you say, it is a very small absolute risk. But let’s not just pretend the risk isn’t there. And that is in a highly controlled public system. Once you start introducing midwives with very little training and start taking on clients who would be seen in any other country by an OB/GYN, then YOU are the one muddying the homebirth waters with dangerous birthing practices.

            I don’t pretend to know what to do with the women who really want to birth at home but can’t because they are risked out. I was one of them. My solution to many of the issues I had with the hospital (such as the variability of staff and so on) was to have a planned c-section at term (just a little before, actually, because of some health issues) and I was quite satisfied with that choice. But when you have a huge contingent of thought leaders like Ina May and Henci Goer and Missy from MANA muddying the facts about hospitals, interventions, and c-sections, and promoting the dissemination of information that is far more dogma than evidence, how are women to choose ANYTHING? For example, when I chose a c-section, I thought I was being selfish. I thought I would hurt my baby. I was horrified when I found out it was totally safe for the baby, and the risks were highly inflated. That’s how I ended up here. I was a supporter of NCB: I didn’t know any better because it dominated my Women Studies curriculum at the university level. It was a complete load of rubbish that the science doesn’t support. NCB is literally brain-washing women with hysterical statements, and they KNOW so. The members of my local community who are most vocal about NCB beliefs KNOW they are lying because I’ve had private conversations with them. They are quick to make caveats and excuses but challenge them publicly and they will retreat to the tried and true. I’m tired of the lying. Women deserve better.

          • thepragmatist

            Again, if you exclude all women for whom surgery would be dangerous, then it would be very safe. Also, don’t forget to exclude emergency c-section from your stats, because they belong in the vaginal birth cohort NOT in the planned c-section cohort. In the Term Breech Study in Canada THERE WERE NO MATERNAL DEATHS. Period. They had to pull morbidities to estimate a death rate for women. It’s extraordinarily rare that a healthy woman dies from a c-section: the death rate is less than having your appendix out. Who knew? We didn’t, because we’re awash in NCB rhetoric. Like that it’s the c-sections that’s causing the abysmal outcomes for women in the USA and not the USA standard of living. Other developed countries have MUCH higher rates of c-section and low maternal death rates because they have a much healthier population over all. Americans are not fit and have gross socioeconomic inequity. (Sorry Americans). Italy, for example, has a much higher section rate and does not see the kind of numbers the USA has.

          • thepragmatist

            Thank you for clarifying my point. Late term abortions are a different cohort than early abortions. Sorry if I was not clear enough in my post.

          • theNormalDistribution

            Stop trying to reframe the issue to be about women’s rights vs babies’ rights. It is only about women’s rights. Women have a right to choose homebirth, if that is a risk that they are willing to take. But there’s a reason why we have the concept of “informed consent” and there’s a reason why midwives lie. They realize that the vast majority of women who actually understand the risks of homebirth would NEVER choose to go through with one.

            Someone with your twisted view of morality may not be able to understand why a mother would not choose to take massive risks to her baby’s life and well-being for the sake of her own comfort, but thankfully, most women are not like you.

          • thepragmatist

            I don’t even get her circular argument, because she just claimed to have moved from a pro-choice position to a pro-life, fetal rights position, in which case, home birth is total lunacy, and she should embraced c-section at 39 weeks as the norm. LOL. I’m only half joking.

          • Expat

            Well, if the person is truely acting like a lying sociopath, feigning stupidity or blindness in the face of evidence that makes her look bad, calling her a liar in no uncertain terms is called for. Once someone pulls the bald faced lie card, you’ve entered new territory. Dr Amy did not imply that she thinks Dr Romm is stupid, just devious. I would go so far as to say that in this context she deserves no professional respect. Liars do not deserve respect.

          • Ellen Mary

            It might not be useful to play that card BEFORE you expect someone to show up @ a public debate. Even strategically, it was a poor move, *unless* the strategy was to not actually to have the debate.

          • Expat

            She was never going to show up. She is smart enough to know when she has a losing hand.

          • Box of Salt

            Ellen Mary “play that card BEFORE”
            Read the timestamps. Dr Amy called for the debate on Feb 7th. The Stupid is the New Black post was published on Feb 11th. Which event was before the other?

          • NoLongerCrunching

            And Dr Amy published even more scathing critiques of Dr Romm on 2/5 and 2/6, so it makes no sense that she is suddenly offended by Dr Amy’s tone.

          • Amy Tuteur, MD

            I never asked for a debate. I proposed (and she agreed in principle) to a 3rd party analysis by a statistician or mathematician. At no point is Aviva required to engage with me. She simply has to give her approval to the idea that we should trust a 3rd party analysis. THAT is what she is refusing to do.

          • Monica

            While Pharma would not allow it on one of their sites, that doesn’t mean they would entirely disengage especially if they felt they had a leg to stand on in the argument. Trust me, I know.

          • Amy Tuteur, MD

            I didn’t ask you what security would do. I asked you whether you would be so concerned about “courtesy” if Big Pharma were lying about deaths. You didn’t answer.

          • Ellen Mary

            If Big Pharma were lying about deaths, I would be concerned, but I wouldn’t expect them to recant because an activist called them out. I would expect them to work to undermine that activist, as history has shown. I would expect them to recant only after the data was presented in an establishment way, by some very sober & mainstream source. I would be concerned about courtesy insofar as it would allow Pharma to write off the activist & postpone the resolution.

      • C T
        • The Bofa on the Sofa

          Um, ouch.

          I just get annoyed when people play fast & loose with easy to verify facts. It wasn’t a defense, it was a correction.

          So, Ellen Mary, will you consider this a “correction” to you bullshit about her not advocating homeopathy?

          • Ellen Mary

            Sure thing, Bofa. She actually speaks out against ‘Homeopathic Vaccines/Nosodes’ for the record. But I will surely accept a correction. Herbs do in fact constitute the main body of her work, rather than homeopathics. But I will gladly accept a correction before saying ‘someone else got a fact wrong too that one time!’

          • Ellen Mary

            I don’t anticipate I will get anywhere advocating the cause of civility here, but the term ‘you bullshit’ is very, very close to name calling.

          • Trixie

            Tone trolling is a lonely job, isn’t it?

          • NoLongerCrunching

            I agree completely that civility is important. Just not as important as babies’ lives and honesty by health care providers.

          • Jessica S.

            Clearly he was saying “your bullshit” not “you”. And even if he had said it in the nicey-wicey-est way possible, I’m pretty sure you’d still have a problem with the supposed lack of civility.

          • thepragmatist

            Would that be, “Excuse, madame, but you have appeared to have fallen in a pile of bovine feces and cannot get up? May I help you get up with this yardstick I made from facts? It may help you stand in your knee-deep pond of feces.” Would that be nice enough? Oh, I love days like these.

          • The Bofa on the Sofa

            From HER website

            The book also suggests ways to strengthen children’s immune systems and maintain optimal health and offers herbal and homeopathic remedies for childhood ailments.

            Are you going to stand by your “she doesn’t advocate homeopathy” claim yet? How is your statement not bullshit?

            She says on her own friggin website that she “offers…homeopathic remedies” in her book.

          • Ellen Mary

            I own her medical textbook & most of her other books. Their focus is Herbal medicine.

          • The Bofa on the Sofa

            Maybe, but her vaccination book apparently, according to her, advocates homeopathy.

            SHE says it right there that her book “offers homeopathic remedies”.

          • Trixie

            Pray tell, in which medical schools do they use this “textbook”?

      • Box of Salt

        Ellen Mary “Homeopathics are totally different than Herbs.”

        True. Herbs actually have active ingredients, while homeopathics have been diluted down to just water.

      • Mel

        Herbal medicine scares me much more than homeopathy. In undergraduate botany and plant taxonomy classes, you learn very quickly that not everyone is capable of identifying plants accurately and that taxonomic abilities are not strongly correlated with any other academic skills. In plain English, many great pre-med students were clueless about identifying plants even after 16 weeks of intensive study. Some shaky students were as bad at plant identification as they were at cellular biology.

        I’m quite adept at plant identification and cultivation. As such, I would never accept any plant for medicinal purposes that I could not positively identify – seeds+flowers intact with leaves and/or roots still attached. No dried materials without visual confirmation on a fresh plant.

        • thepragmatist

          Ditto. And I use some herbs to treat some of my own symptoms. I do use echinacea, despite mixed studies, but I use it from a farm I know well, and because my former MIL (the first, good one) was a herbal therapist. Herbalism is pretty neat, over all. For example, milk thistle helped one of my cats for a very long time, and is routinely prescribed at our VERY traditional vet clinic. There are herbs that are useful. What many people do not understand about herbalism is that not all tinctures are created equal, and at least in North America, they are not governed as medicines, so you have no idea what you’re getting. If you don’t personally know the producer or have it on good authority, and if they choose not to standardize the product, you could be getting a very small amount of what you’re actually buying… or a very large amount. But let’s not completely discredit herbalism– the most recently and most effective anti-malarial drug came from Chinese herbalism. There are uses for these plants.

          I like to think I’m pretty good at identifying native plants in this region and there’s no way I would eat anything other than berries (and we have SO MANY) without running it past someone like my former MIL who had many years of experience and was licensed. I’ve taken herbs that were very helpful– for example, kava kava for anxiety. So I can’t throw the baby out with the bathwater. And I didn’t get sick for years when I was taking the tincture of echinacea my MIL hand-made. It has to be harvested at just the right time, and only certain parts of the plant used. What you get at Walmart is NOT anything like what a herbalist would make.

          • Ellen Mary

            Herbal tinctures & such for commerce are actually subject to GMP guidelines, established by the FDA. Gaia, for example, provides a tracking number on each bottle. Their herbs are cultivated, NOT wildcrafted.

          • thepragmatist

            Those guidelines, to my knowledge, are pretty weak. Here, in Canada, the industry fought back very hard against efforts to regulate them. And won. And there’s still no standardization.

          • Mel

            I have no problem with using herbs as long as people aren’t taken in by the fallacy that “Natural is safe.” Watching fellow undergrads struggle through basic plant identification gave me a much needed wake-up call that not everyone can ID plants (or mushrooms .. yikes) safely. I will never forget a well-meaning student confusing a wild sweet pea plant for garden peas.

          • thepragmatist

            Don’t even get me started on mushrooms! Every year people die here. I don’t even claim to be able to do wild mushrooms. You need a lot of experience out there, and I just don’t have it. My first husband was very good but he’d grown up doing so at the side of his mother, who grew up doing it at the side of her mother. Me, I was just a city girl who ran to the bush to escape the city. I can do plants within reason. Berries, for sure now. Berries are easier, mushrooms scare the shit out of me! But we have some viciously poisonous mushrooms here.

          • Expat

            Watch out for kava kava and valerian. If it comes from a bad source, it is poison for your liver. Says a non drinking person with a very bad liver in her 30s who took random herbal stuff in her 20s.

          • Expat

            I also know some people who were eating raw thistles (brenessel) every day later to learn that cooking is required to neutralize the poison.

          • thepragmatist

            Kava kava was banned here for that reason. Came from China. Much to my dismay as it was so helpful with my anxiety, it replaced benzodiazepines for a time, and then was yanked. I hate valerian. Gives me a bad headache. You have to be careful with sources… interestingly, there’s parallels here, because that’s another industry that refuses oversight, yet wants to be called medicine!

          • Young CC Prof

            Did you guys see that study a few months back, where they did DNA tests on some “herbal supplements” and found that almost half the bottles were either contaminated with species not on the label, or contained none of the supposed active ingredient?

            It’s one thing to sell a remedy that hasn’t been proven to be safe or effective. But when the label doesn’t even accurately describe what’s inside it, that’s pretty bad.

          • LMS1953

            Terrific point! I have this image of Aviva swinging in the trees with Sean “Medicine Man” Connery like some kind of latter day Tarzan and Jane.

      • Trixie

        When the best defense you can give of her is that she only wrote one book of lies about vaccines, that’s not saying much, is it?

        • Ellen Mary

          I just get annoyed when people play fast & loose with easy to verify facts. It wasn’t a defense, it was a correction.

          • Trixie

            You mean playing fast and loose with the facts, like Aviva does about vaccines? And home birth?

          • Ellen Mary

            So you are saying that because you don’t agree with the facts Aviva cites about HomeBirth & Vaccines, you are under no obligation to know if someone wrote 1, 2 or 10 books on a topic? Welcome to the wild Wild West! Facts need not apply. Woohoo!

          • Trixie

            Well, she’s written other books with advice on things like “natural remedies” for whooping cough in children. So I’d argue that more than one of her books contains dangerous anti-vax info, and that therefore veggiegal wasn’t exactly wrong. If anything she under counted the number of anti-vax documents Aviva Romm has produced.

          • thepragmatist

            I had a friend recant, publicly, on Facebook, after her unvaccinated daughter actually GOT whooping cough while there was an infant in the house. Talk about a nightmare. Well, that served as a cautionary tale, right there. It ended okay. The baby had to be isolated from her older sister though. Luckily the very new baby didn’t contract pertussis.

          • Monica

            The fact that she wrote 1 or 2 books is really meaningless in this. It’s not killing mothers and babies. Her advocating for homebirth on the other hand is killing mothers and babies and she has no interest in proving it’s safety because someone was “mean” to her on the internet? Grow up! This is not a playground. It doesn’t matter if Dr. Amy was right or wrong to call her stance stupid. As a woman, a doctor, a mother she should want to know what the numbers of that study says so why the hell wouldn’t she work with a 3rd party to see what the numbers say? I mean if homebirth is so great, then she can easily prove that with the MANA study, right? But she refuses to look at the numbers because her feelings got hurt? What about all of those mothers who lost their babies because doctors like her said it’s safe to have a homebirth? She is not interested in helping people and quite frankly this to me seems like a violation of the oath she gave to do no harm when she became a doctor. And whether she wrote 1 book on vaccines or 2 or 200 it doesn’t matter she is covering her eyes to the facts that are available to her right now all because she wants to save face and not be proven wrong about the safety of homebirth. This tit for tat nonsense needs to stop. Just look at the numbers and be honest with yourself and the thousands of people you are writing to about what they say.

          • The Bofa on the Sofa

            It’s not killing mothers and babies.

            I disagree. Her anti-vax nonsense is just as dangerous.

          • Trixie

            I think she meant that veggiegal’s accidental false statement isn’t killing any babies, but Aviva Romm’s intentional false statements are.

          • Monica

            I’m just saying whether it’s 1 or 2 it’s splitting hairs really. And you reporting that she wrote 2 books when it was in fact one is not killing anyone. However, Aviva saying homebirth is safe when she admittedly hasn’t even looked at the latest study and understood its numbers is in fact killing moms and babies. But hey, what can we expect someone who’s in the wrong to do? Of course they’re going to split hairs that well you falsely accused her of writing 2 books on anti vax when it was really just 1 book so there. That’s what the argument boils down to here and it doesn’t matter if she was misrepresented that she authored a million books on something there’s no argument that the woman has not looked at the MANA stats and really can’t say whether or not homebirth is safe and now she’s saying I’m not gonna find out because you’re a big meanie head. She was never going to do it, but the only way she feels she can save face here is by saying Dr. Amy you’re too mean so I can’t analyze those numbers. What a professional doctor she is. One does have to begin to wonder how she did with stats to write one anti vax book or however many she wrote. She clearly is not interested in evidence, if she were she would look at the evidence with or without Dr. Amy it doesn’t really matter.

          • thepragmatist

            If not more so, because it impacts others than just the mother and immediate family. Anti-vax nonsense can kill innocents who have absolutely nothing to do with the choices made. Like my son who had to go without any vaccines after he had an allergic response, and was on a delayed schedule. I lived in fear, knowing that many of my peers have drank the kool-aid. I think we’ve made some inroads though, as some of the crunchiest have started telling me I changed their minds. The tetanus one always gets ‘em, I tell you! Tetanus, the gateway vaccine. LOL. Usually, if I can just convince them to go get tetanus, I can usually bet that they’ll get more after thinking about it, or while there. I know that’s a bit sneaky, but hey, it’s worth it!

          • Box of Salt

            Monica ” It’s not killing mothers and babies”

            I could argue that writing even one anti-vaccine book is contributing to killing both mothers and babies:
            http://www.cnn.com/2014/02/11/health/flu-miscarriage-death/

            Her OB fell for flu shot fearmongering, and advised her to wait before getting it. But she ended up contracting the flu first.

          • Young CC Prof

            Every time I think about that story I want to cry. So horrible, so preventable.

          • Jessica S.

            I know, I know! It’s heart wrenching. Her poor husband.

          • resaurus

            It’s stories like this that remind me to get my flu shot. I got mine back in December, after honestly…just being lazy about getting off work to go to the doc! But getting your shots isn’t about you – it’s about keeping everyone safe from whatever risks you pose (unintentionally, as is often the case with disease vectors – I don’t mean to be a walking pile of germs!).

          • Medwife

            You say “citing facts” like she’s telling the truth.

  • Vyx

    There was an interesting typo in that Lamaze piece that made me smile.

    “How can it be that two studies evaluating the same thing reported results that are so vastly different? Well, the answer is lies…”

    • The Bofa on the Sofa

      Good typo, yes, but the real answer is…they DIDN’T find anything all that different!

      In fact, that was the most notable thing to me, how the two studies pretty much found the same thing.

      The difference, of course, was in how they interpreted their results.

      • KarenJJ

        That’s the frustrating thing. If people reporting on this read more than the conclusions they would find that. So if the numbers are similar, what is the driving motivation for the different conclusions, and most importantly – are you happy to take that type of risk with your children? It appears that some people are.

        • The Bofa on the Sofa

          Ironically, the same people who lament the terrible state of childbirth care in the US, and point to wrong things like infant mortality, turn around and proclaim how “homebirth is safe” despite the fact that their own stats show it to be worse than mainstream US care.

  • Mel

    At the risk of belaboring the obvious, the statistics involved in the study are not that complicated. It’s not a PCA or anything terribly scary. With a 15 minute refresher course from Khan Academy or Wikipedia, I’m betting anyone who took undergraduate statistics – applied or theoretical – could figure it out. I’m willing to hazard a bet that Dr. Romm took statistics at some point in her undergraduate career or in preparation for medical school since it was required for all science/math/pre-med majors at my small midwestern alma mater.
    To me, Aviva Romm is playing a dangerous – and insulting – game. We should listen to her as a trained MD – from Yale! – when she KNOWS home birth is safe. We should excuse her from thinking about safety studies because the math is too hard for her…. a trained MD from Yale. Plus, there’s that whiff of math is too hard for girls…..

    • The Bofa on the Sofa

      I’ll repeat what I said below:

      Does anyone think that she would be this hesitant if the results, at least those that “meet the eye” showed that hb was as safe as hospital birth? Would she be saying, “Oh, we can’t draw any conclusions from that”?

      Of course she wouldn’t. And that’s how you know this is all smokescreen. The only reason she thinks there must be more to it is because she doesn’t like the result.

  • The Bofa on the Sofa

    “Statistics are generally a lot more than meets the eye”

    Interesting comment.

    Basically, she is admitting that the stats look awful, because you know damn well that if they didn’t, she wouldn’t be trying to find ways around them. IOW, if the stats did look to show HB was safe, she wouldn’t be looking for more to them.

    Second, it’s a major logical fail. Even if we accept her assertion that there is generally “more than meets the eye” (which I don’t, for the most part, the stats are what they are), there is no reason to think that what’s missing in the cursory view is at all favorable to your side. Thus, even if we accept her premise that there is more than meets the eye, it is just as likely to be even worse as it is to be better. It’s completely illogical to dismiss data that are unfavorable because “they could be wrong in our favor” unless you have an actual (legitimate) reason to think that they are distorted in that way.

    Yes, there could be more than meets the eye in these data. In fact, HB could be a hell of lot worse than it is already suggesting. For some reason, I don’t think that is her objection.

    • Amy Tuteur, MD

      At no point does Romm, or any other professional homebirth advocate, want to get to the truth. Who doesn’t want to analyze statistics to determine if babies are dying preventable deaths? Only someone who wants to hide those deaths.

      Romm’s behavior is unethical in the extreme; she doesn’t care how many babies die preventable deaths as long as she and her buddies can make money from letting those babies die.

      • The Bofa on the Sofa

        I’ve said it before and I say it again: I don’t even know what “analyze the statistics” means in this case. The numbers are what they are. You can ask the question of what’s the proper context, but that doesn’t require a statistician. For example, many have called into question your choice of comparative set, and how you arrived at your 0.38 value. You’ve defended it, but that is a far question to ask, “Is that the proper comparison?”

        But you don’t need nor would you really WANT a pure statistician for that. You want someone who understands the attributes of the samples to be able to assess whether they are actually comparable.

        The rates we are talking about are simple arithmetic. Any first year stats student with an excel spreadsheet can calculate the significance of the data using standard statistical tests. However, this all involves defining a question first so that you can use the data to test it.

        You don’t need a statistician to ask the question “is the death rate in HBs higher than that of hospital births” if you have both numbers.

        • theNormalDistribution

          Agreed. You really just need another obstetrician. And I doubt there are any reputable OB’s around that are”neutral” to homebirth. Facts are fact.

      • manabanana

        I want to get to the truth. I don’t know if I can count myself a ‘professional homebirth advocate’ any more.

        But I want to get to the truth. Very much so.

  • stenvenywrites

    Wait. First a Yale MD says the statistics are over her head (but I thought anyone with a computer and a high school degree could “educate herself” to a level of expertise?) and now she won’t even consider an expert evaluation a topic of importance in public health, because one of the other discussants was *impolite* to her? (How did this woman get through medical school?) This is troublingly similar to the position that NCB advocates take with regard to science and evidence — we should not look at data, and only trust the advice of people who are nice to us.

    • Elle

      But you know, she’s all about creating a “safe space” for women, and telling them that maybe they shouldn’t do something they WANT to do is just sooooo contrary to that!

  • NoLongerCrunching

    Wait, she agreed to the 3rd party statistician AFTER you wrote two blog posts specifically attacking her. But Stupid Is the New Black, in which only one paragraph at the end mentions her, offends her so much she is taking her ball and going home? How convenient.

  • areawomanpdx

    Bummer. I was looking forward to the statistical smackdown!

    • Amy Tuteur, MD

      If the math person agrees, she could still do the analysis and I could post it here.

      • Monica

        I would love to see that. I would have loved even more for Aviva to have to admit that homebirth is not safe, but that was unlikely to happen anyways.

        • thepragmatist

          What cowardice.

        • Melissa

          I just want them to admit the truth about the death rates. They can still put on all the spin they want about the fact that the increased deaths are acceptable because of the reduction of c-sections or that process is more important than outcome. Women would still pick homebirth because of those process reasons, but those who are looking into it would be able to make REAL INFORMED CONSENT!!! If homebirth is so great then it can stand up to the truth!

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

        Yes, I think you should get the analysis. it is one thing when you, an interested party, do the math, and quite another when someone neutral does it, even if the results are the same.

      • Trixie

        That would be awesome!