Aviva Romm writes things that aren’t true

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Yesterday I pointed out that Aviva Romm, MD encourages women to risk the lives of their babies at homebirth, but won’t take the risk of attending homebirths.

Today I’d like to correct the myriad of mistruths in her piece Homebirth: Why This Doctor Would Still Choose One.

Aviva says:

Yet the World Health Organization states that C-section rates in an average, healthy population should never need to exceed 7%!

No, the World Health Organization never said anything of the kind. The only recommendation it ever made for an optimal C-section rate is less than or equal to 15%. But even that recommendation was withdrawn in 2009, with the WHO acknowledging that there had never been any scientific evidence to support it.

Aviva says:

Birth by cesarean can make it more difficult for mom to breastfeed successfully because of physical discomfort.

Yet there is simply no evidence for this assertion.

Aviva says:

chorioamnionitis, an infection in the “bag” that holds the water around the baby … This infection is due almost exclusively to bacteria acquired in the hospital, and is commonly transmitted to the mother when excessive vaginal examinations are performed to assess labor progress.

Wrong. According to the paper Chorioamnionitis: from pathogenesis to treatment:

Chorioamnionitis is generally the result of a polymicrobial infection, with Ureaplasma urealyticum, Mycoplasma hominis and Gramnegative anaerobes being frequent causative organisms.

These organisms are present in the mother, not introduced by vaginal exams.

Aviva says:

Obstetric Evidence Is Reliable Only 30% of the Time.

Wrong. Aviva is deliberately misrepresenting the results of the paper Scientific Evidence Underlying the American College of Obstetricians and Gynecologists’ Practice Bulletins. The study found that 30% of ACOG recommendations are based on “highest quality evidence” (such as randomized controlled trials). But “highest quality” evidence is not always available and decisions must be made anyway.

Not only is Aviva’s claim wrong, but it is rather brazen considering that ZERO % of recommendations exclusive to homebirth midwifery are based on ANY evidence, let alone highest quality evidence.

But Aviva is right about some things. She explains:

As a midwife with 30 years of experience in the birth community, I will also readily admit that there are quite a few not so great home birth midwives contributing to not so great birth outcomes. In fact, in reaction to the problems found in medicalized birth settings, there’s a bit of a midwife ‘wild west’ out there – anyone can get “the calling,” attend some births, and call herself a midwife. Caveat emptor! It’s not black and white. A poorly planned home birth or a less than competent midwife (or physician, though most home births are attended by midwives), in the rare event of a complication, can be disastrous. There’s no romanticization about that from me – I’ve been in the birth trenches for 3 decades and I know some firsthand horror stories from the mouths of the moms and midwives themselves!

And what is the homebirth midwifery community doing about these “not so great” midwives? Nothing. What is MANA doing about the “not so great” midwives among their members? Nothing. Is there any homebirth midwifery organization that offers recommendations on how to tell those “not so great” midwives who preside over “horror” stories from competent midwives? Are you kidding. The first thing that happens when a midwife presides over a preventable death is that the “friends of homebirth midwives” hold a rally to raise money on her behalf. The dead baby and the bereaved family are utterly ignored.

For some reason, homebirth advocates can’t manage to promote homebirth without spouting mistruths, half truths and outright lies about both homebirth and modern obstetrics. For some reason homebirth advocates think it is justified to hide the real death rates from homebirth, protect rogue midwives who precipitate horrors, and lie about what obstetric evidence actually shows.

But call them on it and they respond with plaintive calls for girls to be nice:

…[E]verything I do is about creating a safe space for women … Therefore I reserve the right to delete comments that are irrelevant or hostile …

A safe space? Safe from what? Scientific evidence? Rational debate? Isn’t that a bit misogynistic? Why does Aviva think women are so weak that they cannot handle scientific evidence that doesn’t support their beliefs.

Men don’t need “safe spaces” to be protected from facts that they don’t like. Why doesn’t she respect women enough to assume that they are just as capable as men in dealing with scientific evidence, even with evidence that might make them “sad”?

I don’t think that grown women are so weak that they need to be protected from reality, including the reality that homebirth sacrifices the lives of babies who didn’t have to die. I’m not interested in behaving like a “lady” and creating a “safe space” for deadly lies.

Aviva Romm is happy to encourage women to risk their babies lives at homebirth. And she’s happy to twist, misrepresent and otherwise mangle the truth in her efforts. But she doesn’t dare take the risk of attending homebirths as a physician. And she thinks women must be nice and ladylike, creating “safe spaces” to exchange deadly lies, carefully “protected” from grownups who tell the truth.

Nonetheless, she has every right to refuse to attend homebirths. They are so dangerous that most other family practitioners and obstetricians won’t do it, either.

  • MLE

    Aviva Romm, Certified Professional OB

    • Young CC Prof

      WIN.

  • thin_red_line

    Home births are dangerous and deadly, that is the truth! I work as an ER nurse and have seen one too many babies and mothers being rushed into the ER bleeding to death with an anoxic baby stuck in their birth canal and a hack job, CPM episiotomy , or they have been in labor for 8 days with some quack-ass CPM telling them this is normal labor, only to give birth to a dead or dying baby that could have been saved with an IV in mom’s arm, a little pitocin and some oxygen 7 days prior OR the insanely ridiculous women trying to have a VBAC at home with a breech baby being rushed into the ER by ambulance with the baby’s body hanging out of her vagina, head stuck in the birth canal, and the poor little baby was BLUE and dead. Then she had the nerve to thank her CPM and doula doing everything they could to save her baby and giving her the birth experience she wanted! Um….WTF!!! A necessary, life saving c-section and she would have a living baby instead of a mutilated corpse wrapped in a blanket, I felt no empathy for this woman because of her moronic and selfish decision.

    CPMs and Doulas have little to no real medical education and are pretty much birth-junkies putting naive women at risk. If you want to be a REAL midwife, go to college, get a BSN, go to graduate school to become a Certified Nurse Midwife and work in a hospital or birthing center. Instead of putting women and babies at risk, they can advocate for their patients in a safe environment to have natural births (if that is what mom wants) and if something goes wrong they have all the equipment, medication, oxygen, access to surgical suites and DOCTORS to save mom and baby, and if everything goes right, they can go home in 6-8 hours. You do not have to stay overnight unless you want to or if there were complications that need to be monitored. (I would suggest staying 24 hours after birth, unless you have a c-section.)

    If giving birth in a safe environment, like a hospital is inconvenient to you then don’t get pregnant. Homebirth advocates, that crazy lotus birth/unassisted birth lady and CPMs who advocate homebirths are dangerous to society. MANA own data proves CPMs and home births are an inherent risk to society. People planning home births should be reported to DCF/CPS for being a danger to themselves and their unborn children.

    • The Bofa on the Sofa

      I think I’m in love….

    • Avivatf

      Dr. Tuteur,

      In my experience, women who refrain from snarky ad hominem attacks while engaged in intellectual debates aren’t usually struck by a bolt of lightening by the feminists in the sky as a punishment for their restraint.
      I am interested in what you have to say but I find your vitriolic writing style difficult to read and emotionally exhausting. I can’t continue to read your blog until you start writing in a more adult style.

      • AlisonCummins

        Are you hoping that thin_red_line will pass your message on to Amy Tuteur, MD? Not sure what your point is.

        • KarenJJ

          Bizarre that this rant was in reply to what appeared to me to be a heart felt rant about a particularly distressing episode from someone at the coal-face of caring for birth emergencies.

        • thin_red_line

          Actually, I stumbled across this site and finally found someone who writes and tells the absolute truth about homebirthing. I don’t know Dr. Amy, but would love to meet her considering her no-nonsense approach to nonsense.

      • theNormalDistribution

        I am getting really effing tired of seeing comments like this. I don’t think you understand what an ad hominem is, or what ‘vitriol’ means (hint: it’s not the complement of ‘sugar coated’).

        Seriously, I am baffled by people like you. You can overlook the horror of babies dying or being seriously disabled at the hands of untrained midwives who misrepresent themselves as professionals and lie to women about the risks… and yet you’re bothered by Amy’s lack of delicate tone.

        Grow the fuck up, already.

        • herbaled

          You should take your own advice in your last sentence.

      • Trixie

        Oh look, a tone troll. Zzzzzzzz

      • MaineJen

        I find it emotionally exhausting to imagine a woman losing her child in a home birth, because of a complication that could have been easily dealt with in a hospital.

      • KarenJJ

        It’s OK, we keep a fainting couch handy for people like yourself. Take a break, enjoy some finger sandwiches and a cooling beverage and maybe try again later.

      • Sally RNC-NIC

        Here’s a thought – Instead of announcing your departure, just depart. I promise no one will even notice, so sleep tight. We’ll be just fine.

    • JC

      I wish I could copy and paste your first paragraph onto every Baby Center thread about homebirth. There’s some serious magical unicorns and rainbows thinking going on in those posts. I had two easy births at the hospital and I’ll have another (hopefully easy) hospital birth with this baby. Why? Because you never know. And if this shit does hit the fan, so to speak, I’d rather be around trained professionals than squatting in a foul kiddie pool of tepid water surrounded by birth junkies who can do nothing to help me but dial 911.

      Oh, and guess what the majority of these women have in common? Past c-section or epidural birth that left them disappointed and/or recently watched The Business of Being Born. I went off on a commenter the other day that said some people have the “nerve” to call BOBB one-sided. People call it that because it is one-sided! And it is certainly NOT a “documentary.” That is making it sound way more important than it is.

      • thin_red_line

        The Business of Being Born is pure propaganda and is right up there with Triumph of the Will (propaganda movie made by the Nazi’s). It is certainly a one-sided movie with no real scientific data or purpose. Ricki Lake should be ashamed of herself because BOBB is killing babies by promoting homebirth as safe and better than delivering in a hospital. No hospital is close enough to prevent a brain injury or save the mother from hemorrhaging to death.
        I was physically unable to have a vaginal birth due to a spine and spinal cord injury and I did not shed one tear because I had to have a c-section. I was happy that my son was born alive and healthy due to the c-section and the team of educated and responsible doctors and nurses. I gave birth through an incision in my abdomen and was totally and completely fulfilled by my son’s birth. I am currently 7 weeks pregnant and will be giving birth by scheduled c-section again.
        To me it does not matter how one gives birth, what matters is the baby in their womb and that baby being born healthy and uninjured in the hospital. There is nothing disappointing about a healthy baby and if they can’t bond with their baby because they had a c-section, an epidural, pain meds, forcep/vacuum assisted birth then they obviously had prior mental health issues and should run to the nearest psychiatrist to work on their issues instead of putting the next baby’s life at risk by trying to have a dangerous homebirth.

  • B

    Dang…I just found this site today. A whole site dedicated to discrediting homebirth??? You must really hate it and you must not know any CNMs personally because here in Illinois there are a ton of people working to make homebirths safer, more regulated, and more popular. Are you scare of losing your job? What if we had OBs at homebirths instead of midwives? Would that be OK? I’m just confused on why you are so against homebirths. Babies die in hospitals too and mother mortality rate in the US is pretty bad for western countries so it can’t be because babies are less safe being born at home.

    • NoLongerCrunching
    • The Bofa on the Sofa

      What if we had OBs at homebirths instead of midwives? Would that be OK?

      Why do you think OBs don’t do homebirths?

      • NoLongerCrunching

        Pick one:

        1. Because they are surgeons
        2. Because they can’t be bothered to come until the baby crowns
        3. Because homebirth isn’t profitable for them
        4. Because their insurance overlords won’t let them
        5. Because there are no straps on the beds to restrain mothers to the lithotomy position
        6. Because they have never seen natural childbirth before and have no idea how to deal with the awesome power of an unmedicated birthing Goddess in all her glory

        • thin_red_line

          Actually, I know plenty of OBs who have attended many natural births in hospitals and advocate as little intervention as possible. It is actually inconvenient many times for the OB to do a c-section because they have other laboring mothers to attend. If the doctor didn’t show up until your baby was crowning it was probably because their was another woman who was having life-threatening complications and needed a doctor more than you did. They do not need to sit by your bedside and hold your hand throughout labor, that is a nurse’s job. Obviously you have no understanding of what an OBs really does and it is illegal to strap a patient to a bed regardless of position. Apparently your birthing position is more important than a living and healthy baby. So stop being a scare-monger a get the facts straight.

          • Trixie

            I know you’re new to this site, but NoLongerCrunching was being sarcastic. She was repeating tropes of the natural childbirth movement on purpose.

          • thin_red_line

            Well, that is a big LOL! Sorry for the sarcastic remark

          • NoLongerCrunching

            No problem! This stuff can make you so angry you can’t think sometimes!

          • thin_red_line

            It really can!

    • The Bofa on the Sofa

      Babies die in hospitals too and mother mortality rate in the US is pretty bad for western countries so it can’t be because babies are less safe being born at home.

      You need to look up the phrase, “non sequitor.” Actually, don’t be surprised if you find this statement as an example, because it is about as much of a non-sequitor as you can get.

      • Guest

        Actually, you are quoting the wrong statistics. look up perinatal mortality statistics before you start quoting information. Babies die in hospitals, but they are 5.5x more likely to die during a homebirth. A CPM does not have the education or skill to monitor a laboring mother and unborn baby properly. Just because they have a hand held doppler and hear a heartbeat does not mean that everything is going great.

    • thin_red_line

      Actually, you are quoting the wrong statistics, try looking up perinatal mortality stats. Infant mortality is the baby dying when it is less than 1 year old, they do not include babies who were stillborn or who died before 6 weeks of age. infant mortality rates have nothing to do with the birth of an infant. Dutch midwives who attend low-risk birth have a higher perinatal mortality rate than Dutch Obs attending high risk patients. So, before you spout off non-sense about the safety and quality of CPMs and home births, google the right stats. Home births will never be safe because CPMs are not trained or educated enough to be delivering babies.

    • The Computer Ate My Nym

      Babies die in hospitals too

      But a low risk baby is about 3-4x as likely to die if it is born at home than if it is born in the hospital. Possibly more, since the uncorrected confounders tend to falsely lower the home birth mortality rate.

      mother mortality rate in the US is pretty bad for western countries

      True. Maternal morbidity and mortality in the US is pretty bad. In what way would more home births improve either?

      • LMS1953

        A thought experiment: The US is a salad bowl of ethnicities. Scandinavia, not so much. Compare the maternal mortality of Swedes in Minnesota to Swedes in Sweden. Then compare the maternal mortality of the sizeable Somali community in Minnesota to Somalis in Somalia. Do the same for Haitians, Mexicans, Hindu Indians, Pakistanis, Subsaharan Africans, etc. I’d bet every group has a better rate here than in their homeland. Now, take countries in the Europe with a substantial influx of Muslims – France, Holland, Germany and the UK. My hypothesis is that the Muslim maternal mortality rate is higher than that of comparative nationals, but lower than Qatar, Iran, Iraq, etc.

        • Think first

          You had me there for a minute, what with hypothesizing that those with ethnicities from developing countries are likely to have better care in the USA and thus a lower mortality rate. You definitely lost me at ‘Muslim’ countries though…

          In case you haven’t noticed, many Muslim dominated countries are actually quite affluent, even more so than the USA, hence why your country is so adamant at invading these countries and stealing their natural resources..

          Regardless, your comment really brings to light what others have stated about you before: you’re a bigot. And you should work on rectifying that.. It’s not attractive.

          Furthermore, pray tell, does the USA fund all students tertiary education in addition to providing funds for materials as well as giving students a salary just to study?? Does the USA have truly FREE medical care for all?

          Not on your life…

          Too bad you weren’t born Saudi lollll

          Btw I’m not Saudi, but I recognise affluence where I see it.

          • Trixie

            That would be a great argument, but our US neonatal mortality rates are better than Saudi Arabia’s. Theirs isn’t appallingly bad, but ours is better.

          • Think first

            That really wasn’t the point. The point is that before making sweeping racial generalisations, especially in an educated context, sensitivity may be better employed by LMS. However he has demonstrated his bigotry time and again against different cultural minorities so I’m trying not to be too offended.

          • LMS1953

            @ Think first – No, and we don’t pay our students to take flight lessons in other countries so they can crash planes into their tall buildings either. Or did you miss that memo dated 9/11/2001?

          • Think first

            OK now you’re derailing the thread. And in case you have been living under a rock, the Muslim attack theory has been widely discredited and at the very least questioned.

            It sure was convenient though that no WMD we’re ever located but it was too late to turn back at that point.

            Methinks you’re one of those sheep who blindly believe mainstream media. Seriously, you need to employ more critical thinking. Especially if you think the Saudi gov funded 911…

            Btw your gov is the one who can’t even get their own citizens in line… Super sad mass shootings anyone? Maybe if the economic situation was less dire, there would be less tragedies.

          • auntbea

            Wait. Are you offended because he should have said Arabs (an ethnicity) rather than muslim (a religion)? Middle eastern countries are generally wealthy and their health expenditure is high. But they are also mostly dictatorships with substantial discrimination against women, so I don’t see that it is necessarily out of line to suspect there may be poor birth outcomes.

          • Think first

            Actually they’re not mostly dictatorships.. Some are, some are monarchies (the countries I referenced) and some are democratic. That’s beside the point. It is offensive to lump them all together…Asian countries have far more dictatorships that are conveniently Ignored by the press and the UN.

          • auntbea

            Actually, they ARE mostly dictatorships. Political scientists classify monarchies as autocracies (they are certainly not democracies). The only Middle Eastern country that is clearly a democracy is Israel (excluding Gaza and West Bank; they’re not very democratic). There is debate over Lebanon, Kuwait, Yemen and Iraq.

            And yes, Asia, especially Eurasia, has a lot of autocracies too. But that doesn’t negate autocracies elsewhere.

          • Irène Delse

            Not all Muslims are Arabs, by far. Muslim immigrants in Sweden may well be ethnic Turks, South Asians or Black Africans.

          • auntbea

            Of course. But Think First was specifically discussing countries that are affluent. The only majority-Muslim countries that have wealth equaling ours are the oil states of the Middle East.

          • Irène Delse

            True, which by the way shows that GDP by itself is not predictive of good public health outcomes. Inequalities, including gender inequalities, infrastructure, level of of education and other variables can make a significant difference.

        • The Computer Ate My Nym

          FWIW, Sweden’s neonatal mortality is 1.5-2/1000 for most sources I’ve seen and Minnesota’s is 3.35/1000 for all Minnesotans, 2.91 for whites only, 2.87 non-Hispanic whites only (I couldn’t restrict to Swedish only on CDCWonder).

          Sweden, BTW, is about 89% “Swedish” ethnicity, 11% or so others. It’s not exactly monoethnic any more, though I think still doesn’t have as much ethnic diversity as the US.

          • LMS1953

            FWIW, I was responding to your assertion about MATERNAL MORTALITY, not perinatal/neonatal/infant.

          • The Computer Ate My Nym

            Sorry. The CDC gives maternal mortality for white women in the US as 11.7/100,000 in 2009. The CIA factbook gives a rate of 4-5 per 100,000 for all Swedish women (about 90% of whom are of “Swedish” ancestry.)
            I suspect that differences in health care access and education (the Swedes are big into education for education’s sake) account for a lot of the difference, but that’s speculation. I’m quite certain that the difference isn’t more home births in Sweden since the only source I can find on this says that home birth isn’t an option in Sweden. At least not attended, insurance covered home birth.

          • LMS1953

            http://www.maternaloutcomesmatter.org/does-this-happen-in-mn.html

            1985: Committee disbanded due to consistently irreducible minimum numbers of pregnancy associated deaths (which was 5-6 per year until 2009).However, the determination was made to continue surveillance for trends in maternal mortality.

            In 2009, the most recetn year for which statistics are available, there were 21 pregnancy associated deaths in MN using the broader definition used by the CDC (as opposed to the WHO definition which uses 42 days from the end of pregnancy versus 1 year) making the reconvening of this committee ever more pertinent.
            **********
            Three points: 1) the maternal mortality rate in Minnesota is the same as in Sweden. 2) Maternal mortality rates in such populations have hit an asymptote of diminishing returns. Some things simply cannot be prevented. 3) the US gets crucified for its maternal and infant mortality when the effect is mainly due to the fact that we use a different definition than WHO. It is hard to get the gold medal when all of your judges are from Bulgaria, as it were.

          • LMS1953

            Sweden has a population of about 10 million. MInneaota’s population is 5.3 million.

          • Young CC Prof

            Sweden does really well on all sorts of measures of health and quality of life, even just compared to other countries in Europe. Low poverty rate, solid health care system with universal access, etc.

          • LMS1953

            89% is pretty monoethnic, don’t you think. Oregon is 89% Caucasian, but obviously not monoethnic. I don’t know the answer, but what percentage of people in Sweden don’t speak a word of Swedish? I think that for all of its ethnic and geographic diversity the US stats for moms and their babies are pretty darned good.

          • auntbea

            On official measures of diversity (which measure the likelihood that two people randomly selected from the population are of different ethnicities) the Scandinavian countries are nowhere as diverse as the us.

          • fiftyfifty1

            CAMN, is there a way to check *perinatal* mortality for the same groups? IIRC, some of the scandinavian countries count micro-preemies born alive as “stillbirths” (and thus not captured in a neonatal mortality rate) but in the U.S. they are considered live births and if they die (as they typically do) they greatly increase the neonatal rate.

          • Young CC Prof

            USA perinatal mortality is 7, Norway and Sweden both 5, so Sweden is genuinely doing things right even after you control for accounting methods. (Britain and the Netherlands, so beloved of home birth advocates, are both 8.)

          • Expat

            Swedes in Sweden have a higher standard of living/income than Swedes in Minnesota, I think. That would need to be controlled for. People with more money are usually less stressed out and healthier.

          • LMS1953

            That is exactly right. With both maternal mortality (we stretch it out to one year post the end of pregnancy, WHO cuts it off at 42 days) and perinatal mortality (like you said), the US sets the highest bar. The problem was that asymptotic levels were reached and it became pointless to track the same ol’ 450 to 500 maternal deaths per year. So we went on a different standard than WHO to alter the graph to see if we could make our already superlative care even better. It is like comparing apples and foie de gras

          • Irène Delse

            Immigration is likely not the only factor in that 11% of ‘non Swedish’ ethocity in Sweden: iirc, there’s also the Sami people, an indigenous ethnic group in the north of the country, the Lapland.

          • Dr Kitty

            Norwegians, Finns and Danes also count as “non Swedish”, right?

    • Trixie

      She’s retired. So no, she’s not scared of losing business.

  • ihateslugs

    Ok, I’ve followed the Aviva Romm story a bit and after some pondering, finally figured out what is bothering me most about her post, responses, and quite frankly, entire take on homebirth. In a nutshell, she is not acting as a responsible physician. Let me clarify:
    As a physician, I actually started medical school after a prior career in dietetics. At the time, I had a lot of ideas about food, nutrition, and the healing or adverse affects they can have on the body and had a rather “holistic” approach to medicine. What I discovered over the four years in medical school and additional three in residency (pediatrics) was that some of my ideas were, in fact, right on. And a lot of others were totally not. A key part of a physician’s early education involves gaining a much deeper and thorough understanding of pathophysiology of the human body–what can go wrong? Why do things happen the way they happen? The clinical years are then spent acquiring not just the appropriate diagnostic and management methods, but also learning how to apply the most current evidence to the care of patients.
    At the end of it all, the expectation is that a physician should be a competent, well-educated, and trusted individual in whom patients can feel confident in their care and advice. Oh, and incidentally, there also a little oath taken along the way to do no harm. That’s not to say that all physicians will practice the same, but there is a definite expectation to be well-informed, trustworthy, and current in one’s knowledge that accompanies being a doctor.
    Aviva clearly loves touting her MD credentials and advertises herself as a physician. However, in reading her views and advice, much of which is outdated, ill-informed, and inaccurate, it is clear to me that she is still primary a lay midwife. How can she as a physician ignore the mounting body of evidence that demonstrates the inherent risks of homebirth? How can she as a physician continue to support a practice that is without question causing harm?
    If she were a midwife, posting about the benefits of homebirth, I wouldn’t give her another thought. But, by touting her medical credentials, she has put herself in an entirely different level of responsibility, and THAT is why I am so upset with her post.
    It’s interesting, though, that despite a lengthy pedigree in alternative medicine, she is really in her first year of practice after training as a doctor. I know that over the years, I have grown and matured in my practice. I can only hope that with a little more time and reality spent practicing as a physician, she will come to understand the incredible honor and obligation that accompanies the title “Doctor.”

    • Playing Possum

      “It’s interesting, though, that despite a lengthy pedigree in alternative medicine, she is really in her first year of practice after training as a doctor.”

      Oh, now I’m embarrassed for her. How naive can you get? I wish her good luck at job interviews – I can’t imagine that prospective employers wouldn’t google her name, and then be shocked at her unripe drivel. I can’t believe she actually used her real name! Unless she has the resources to establish a solo practice, I imagine she’ll have trouble down the track, being a liability who has no self-restraint in spouting off.

      • AlisonCummins

        Oh, she has a job, don’t worry.

        Her business:
        http://avivaromm.com/

        Her employer:
        http://www.ultrawellnesscenter.com/

        • Playing Possum

          Oh gross. Yuck. Just yuck.

          • Dr Kitty

            One thing I REALLY like about the UK’s medical system?

            You HAVE to complete a training programme before you can work as a self employed Dr.
            That’s 5 years post grad in the NHS before you can be a GP and 9 before you can be an OB or surgeon.

            You CAN do private Botox and fillers before that, should you wish, but then so can dentists and nurses.
            You certainly can’t set up as a private GP one year out of medical school.

          • Playing Possum

            Galling, right? I’m nine years post graduation from med school and still don’t have my college qualification!!! (Although tantalizingly close…)

          • Dr Kitty

            Good luck for those exams!
            OSCEs are the worst.

          • ihateslugs

            Oh, Aviva did a three year residency out of medical school in family medicine, but is in her first practice from that. Here in the US, the days where physicians can set up shop with just a one-year internship following medical school (as a “GP”) are largely over, as most states will only license you upon completion of a full accredited residency in a specialty, which are at minimum three years. Many insurance companies are starting to require board certification as well for reimbursement and coverage, which adds an additional layer of “protection” for patients. I suspect we will continue to see more changes in physician education and training as our physician shortage and changing work environment progresses. We do have a growing number of mid-level providers in practice, (physician assistants and nurse practitioners), and many now do so completely independently with no physician oversight. Definitely an interesting system!

          • Dr Kitty

            Three years…just thinking whether I would have been competent as an independent Practictioner at the end of my ST1 year…nope.

      • ihateslugs

        Yeah, it appears the good doc is all set in her ideal practice. If you peruse their website, it also becomes clear why she isn’t doing any obstetrics. Babies just don’t come at convenient hours, and showing up to your holistic practice with bags under your eyes just doesn’t exemplify the picture of ideal “health.” My hunch? She works a nice 9-5 gig, maybe a few days a week, doing a lot of “consultations” for affluent, well-insured individuals, who eagerly hang on her every word and have the money to spend detoxifying themselves, shopping exclusively at Whole Foods, and attending yoga retreats in Costa Rica.
        Join us in the trenches, girl, and then tell me all about your perceptions on maternal and child health in this country. Work in a border state, a free clinic, or IHS for awhile and see what we are REALLY facing in this country. It ain’t pretty.

        • Playing Possum

          Yuck. It’s the only way to describe how I feel about professionals who use their credentials to peddle bad medicine/ science/ beliefs. Not to mention tarring the rest of the profession with their behaviour. Yuck

  • Sue

    How about a new style of campaign:

    HBMWs who:
    - Are not hospital affiliated or insured
    - Don’t follow safety guidelines
    - Don’t audit their practice
    - Accept first-timers, VBACs, Breech or twins
    - Don’t have evidence-based outcome information in their patient info
    - Don’t obtain signed consent following full outcome disclosure

    …are uneducated, irresponsible, and risking their client’s and babies’ lives.

    • Captain Obvious

      And fear monger against hospitals that actually show less risk than Homebirth.

    • AlisonCummins

      — Who do not carry malpractice insurance

  • SarahBee

    Completely OT, but has anyone seen the stories on this site? WOW.

    I’m pro “embrace your normal postpartum body” sites but this is a more “victimized by hospital birth I then went with midwife care” site and most of the empowering birth blubs include things like hemorrhages…. ” After delivery Hannah hemorrhaged and was able to be treated at home
    with pitocin. After 2 days of being so exhausted she could barely lift
    her head from her pillow, let alone care for her baby, Hannah had to go
    to the hospital for a blood transfusion.” and still births……
    “She went into labor at 42 weeks, labored for a couple of days at home
    before she ended up transferring to the hospital. Everything continued
    to go well as she labored and her doctor decided to assist with the
    vacuum rather than repeating a cesarean. Her sweet boy Isaac was,
    however, born sleeping for reasons unknown.”

    http://4thtrimesterbodies.com/

    • Mishimoo

      And where is the other parent? It’s all just “mamas”

      • Sue

        Probably too busy grieving or looking after the rest of the family…

        • Mishimoo

          That’s just it, most of them are posing with their kids. There are a few couples, and some multi-generational photos but I don’t see any dads and that seems unfair.

          • Guest

            Maybe dad took the photos?

          • Mishimoo

            Unfortunately, it would appear not according to the ‘About’ section: http://4thtrimesterbodies.com/about/

            ETA: I understand that it’s about celebrating the beauty of the changes that motherhood brings, I just think that not having most of the partners standing with the mother is exclusionary.

    • Jessica S.

      So Pitocin is fine for life saving measures after birth but it’s cheating before? That’s probably not a fair slam, since it’s not being used exactly the same way.

      • Therese

        It can’t give the baby autism if it is used postpartum, you see.

        • Jessica S.

          Oh, well then. ;)

      • Medwife

        Some crazy midwife in Utah killed a baby by giving a nice big IM injection of pit to a laboring mom.

        • C T

          Seriously? That’s the sort of thing that Jeevan in rural India says happens, too. :(

    • Jessica S.

      And “born sleeping”, seriously?

      ETA – to clarify, I don’t mean “seriously” as in “wow, a baby can be born sleeping?”

      • SarahBee

        I know! the tone of that site is so cheerful and pro NCB, and yet every single story I read in the months of Jan/Dec had huge complications mentioned; stillbirths, placenta retention that required a D&C, 6 hours of pushing, a doula wet nursing for a hospitalized mom (!!!).

        For a site that sells homebirth they’re doing it wrong.

        • Young CC Prof

          In prior generations, the custom was for a new mother to spend a few weeks in bed cuddling the baby (lying-in). Many modern women think this is silly, but the other day I realized something:

          In a less well-nourished population, with no IV pitocin, disabling blood loss and anemia during those few weeks would be downright commonplace. Maybe the lying-in custom was more practical than I thought.

          • LMS1953

            Hence the term “milk leg” – DVTs with the occasional death from PE

          • Medwife

            Oh my, this solved a family mystery. What got passed down was that my great-grandmother (or great great grandmother?) almost died from “milk leg”. Had no idea what it was- I thought maybe pressure ulcers :P

          • Josephine

            Psh, I don’t think it’s silly at all. Yes please to that. People bringing me cups of tea and home-cooked meals in bed while I peruse the offerings of my Netflix account? Okay.

            On a serious note, though, I do wonder if, anemia and blood loss aside, those first few weeks of full-time support would help with issues like PPD even now.

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

            When I was in the UK, since midwives were legally required to follow up their patients until the 10th postpartum day, and one of our tasks was to see that the home was suitable for early discharge [48 hours PP], we had a substantial number of women who stayed, with the baby, of course, in hospital for 10 days. In Cambridge this was rather nice, because the Mill Road Maternity Hospital [now an old age home] had been a Victorian workhouse, only two storeys, with enclosed gardens, dining room for each ward, etc. and the women could stroll outside in their robes if the weather was good.

            More than once, when booking a woman for a second homebirth, I would be told that “no thanks, this time I want a hospital birth AND THE FULL 10 DAY STAY!” The aftermath of a homebirth, with tons of laundry, a hungry baby along with 2 or 3 other children clinging to Mum, a house that needed cleaning, and husband who was feeling ignored, was less than the romantic idyll she had anticipated. I would often make a home visit and find an exhausted woman on her feet less than 24 hours after birth, trying to cope with all the housework.

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

            It also gave time for lacerations to heal, before suturing was invented, and keeping one’s legs together and allowing tissues to approximate was probably the only solution.

          • Guest

            After my first baby I just wanted to be up and about, after the second I felt like telling everyone I needed a time of lying in. My first was already school going age when I had the second, so I just told him he could sit on the bed to do his homework but I was going to be sleeping, reading and breastfeeding (baby was in a small crib next to our bed), so I sort of got a time of lying in.

        • Jessica S.

          Unless those selling homebirth think that’s the happy norm of it, I guess, but then how to reconcile “it’s safe”? I guess it depends which argument they’re in. :)

      • realityycheque

        I don’t mind the term. Having known a couple who lost a baby at full term, I wasn’t about to pick on them for using the words “born sleeping” when announcing their little one’s birth, as saying, “Our baby was stillborn” or “Our baby died at birth” may have felt too confronting for them in those early days/weeks/months. It’s a pretty major thing to come to terms with, and ‘born sleeping’ seemed a gentler sentiment for them during that devastating time.

        “Born sleeping” was also a less in-your-face term for others to use when they felt concerned that using terms like, “dead” or “died” may have been too brash, or caused further hurt to the parents. I know I certainly didn’t know what to say, and I wondered if using the word “died” in reference to their baby may have been less sensitive than something similar to “born sleeping”. It’s a difficult time to know what to say or do, both for the parents and those close to them.

        • Jessica S.

          I was thinking that, as I posted it, my displeasure was not really with the term and I might even come across insensitive to those who have experienced a stillbirth. (My apologizes to anyone, if so.) In fact, I’m no stranger to such tragedies. My brother’s first born was a stillbirth. They were a week away from the due date, went in for a dr visit and there was no heartbeat. I don’t remember all the details, as it was over a decade ago, but it had something to do with his cord. Nothing they could’ve prevented. It was tragic and painful. And you’re right, using softer terms can help in many ways.

          Two weeks before my own due date, I started obsessing about the same thing happening with my son. I had myself so worked up that I made an appt for the very next day and had a whole speech laid out for why I wanted the baby out NOW! My doctor was so wonderful, she listened and didn’t make me feel silly or crazy. As it turns out, she was slightly concerned about excess amino fluid so she ended up ordering NSTs and an ultrasound both weeks leading up to my due date. I really thought I’d make it through without a freak out but alas, no. :)

          • realityycheque

            So sorry to hear about your brother’s loss :( to lose a child is just beyond cruel.

            I understand feeling a bit iffy about the term though – especially when it’s so often used by people within a community that seems to have a very blase, sometimes callous attitude towards babies dying. I imagine it might seem like another way to try and sugarcoat, or perhaps trivialise the preventable nature of such a tragedy, particularly when it’s used by midwives who have blood on their hands, while they spew crap about the birth that led to a preventable loss being “beautiful and spontaneous”, and try to manipulate the parents in the aftermath to believe that there was nothing that could have been done, even when the evidence suggests otherwise.

          • toni

            yes some people have a different motive for using that phrase. I think it’s called ‘whitewashing’. I used to take a short cut from my dorm to the sports grounds past a church and in the graveyard there was a fairly new and tiny headstone with ‘born into heaven’ inscribed on it. 1995, a little girl.

          • Jessica S.

            Yes!! You took the words out of my mouth. Trivialize is the perfect term. But again, that’s within the context of home births and such. The term itself, especially if it helps with grief, is not offensive. (And thank you for your kind words!)

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

          Try reality. A child is dead. Not “born still” or “sleeping”.

          It used to be thought that it was kinder not to show a dead baby to the parents, until it was discovered that they then often fantasized that the child was still alive, had been kidnapped, etc. and some parents would even begin to search for it.

          Sometimes, to initiate grief followed by healing, you have to be a bit tough and unkind. Unless someone who is bereaved grieves, the long term effects can be much worse.

          • realityycheque

            I definitely think it’s important for parents to see their babies, and I also think it’s a good idea for people to encourage things like photos of the baby – even if the parents don’t feel up to it at the time – but people often use gentle, non-literal terms to refer to death, i.e. “lost their life”, “passed away”, I don’t necessarily think it’s a bad thing, and context is important. In this particular case, the parents knew their child had died – they understood it, they continue to understand it in every waking moment, but they prefer to use words like, “born sleeping”, “lost our child” and “___ went to heaven” as it is easier on them for whatever reason that may be.

            I don’t really see it as my place to initiate anyone else’s grief, I would rather leave that sort of thing in the hands of grief counselors, psychologists and those most close to the individual(s).

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

            It would be nice if those specializing in grief counseling were always available, and also available right away, but that’s not always the case. In fact, I have rarely found it available at all, but that may be because so much of my career has been outside the US. It is most often the nurse/midwife who is the person who is both on the scene, and best known to the family. There is usually a doctor around somewhere, but he is rarely skilled in dealing with such issues [tends to leave it to the nurses]

          • Dr Kitty

            In the “breaking bad news” scenarios Drs are actually told SPECIFICALLY to say “died” or “dead”.

            While a family can choose whichever euphemism they like, the medical staff must be clear and unambiguous.
            There can be no room for misunderstanding when you’re giving that kind of information.

            You can work up to it with warning shots, you can do is sympathetically and sensitively, but you can’t use euphemisms that can be misinterpreted to give false hope.

            What is worse than having someone tell you your loved one has died? Having to be told a second time because you didn’t get it the first time.

          • realityycheque

            That’s fair enough. My initial comment to Jessica wasn’t really considering the use of the term by HCPs, rather friends/family, acquaintances or the parents themselves, but I can see how in a clinical setting it would be important to be clear about this.

            In terms of initiating the grief process, I think ‘those most close to the individual’ would probably include primary health care providers – particularly those who were there at the time of the birth – so I don’t necessarily see it as a problem within that context, as long as things are handled with compassion (the people I knew didn’t have such a good experience with this, unfortunately).

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

            My mother lost a son at around the same gestational age I did – 24 weeks. In ’76, they didn’t let her see my brother – who lived a whole day, which she found out through the hospital bills! 30+ years later she finally had closure on her son’s death by holding my sweet son’s tiny body.

            Yeah, confronting death matters.

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

        “Sleeping” is a very common euphemism for “death” in the pages of the Bible, appearing there around 50 times or something, often pointing to the idea that death is regarded as a temporary state that will be countered by the resurrection. I’m not sure why it is so common in birth vernacular, even for non-Christians & non-Jews, but that is the likely etymology of the phrase. It isn’t peculiar to the NCB movement, either. I see it used all the time over at BabyandBump, whether the user is an NCBer or not.

    • Young CC Prof

      So can you post there if you thought your “birth experience” was unremarkable, and are presently happy but just a little self-conscious about the fact that you still don’t fit into your pre-baby pants? Like the way a huge percentage of new mothers actually feel?

      Or do you have to have had a traumatic hospital birth, a healing VBAC, or a triumphant natural birth?

    • toni

      Gosh. One says she thought she had a good birth experience having her first but then realised after her second (a water birth) that is was actually very disappointing.

    • Josephine

      Is it just me, or do pretty much all the stories with c-sections say something along the lines of “She struggled with feeling like she had actually given birth.”?

      What the hell does that even mean? Is that a common phenomenon that I’m unaware of? I had a c-section and didn’t feel like that for a second considering I was right there hearing my baby’s first cries as they pulled him out…

      • Jessica S.

        I’m with you! Although I was so exhausted by the time they got him out, I don’t remember much else but I don’t feel like I’ve missed out on any grand experience. :) I still love my son as much. (Although today, he’s trying my last nerve… Three year olds – argh!)

      • rh1985

        I am having an elective CS in two weeks (the horror!!!) and I don’t really feel I will miss out on anything. I just want to meet my baby. That is the only part I care about….

        • Pillabi

          I had a c-sec and two vaginal births, and I DO love all my children. Something must be wrong with me. ;)

        • thin_red_line

          Trust me, you aren’t missing out on anything. Except, maybe a combo vagina-butthole, lol!

      • Danielle DuBois Gottwig

        I think people are prepared by the natural birth literature to feel this way about their experience. As you know, the language is so loaded: “real birth” is natural birth, good mothers wouldn’t ever elect an epidural for something as trivial as their own comfort or fear and of course the epidural is an inevitable cause of the “cascade of interventions”; c-sections are surgeries, not births; c-sections are the failure of the feminine body to perform; and on and on.

        And then there were the threats that the epidural or c-section would interfere with the special ability to bond in the precious few minutes after birth.

        A friend attended a natural birth class in which they showed a bloody video of a c-section to show what would ‘happen to you’ if you got a c-section, a move that was clearly strategized to make it seem violent and dramatic and scary – which what purpose I don’t know: to make women too afraid to wimp out on giving birth sans medication? To stay out of the hospital? I don’t know.

        This whole approach bothered me so much. Partly of it was because I didn’t trust the way the authors I was reading were handling evidence. But that important fact aside, the whole way these issues were handled felt manipulative. They were basically arguing that if I didn’t do just as the author suggested, I was a bad mother or would miss out on a critical experience with my baby. Why so much effort to make someone feel bad about their birth? Why would you set out to make someone feel guilty or inadequate about such an important event?

        I cut myself off from reading such material (after I’d dutifully checked their footnotes to make sure I wasn’t an evil person for wanting an epidural). I even decided not to attend a birthing class because the detailed ones in my area (Bradley method, etc) were all out of the natural birth camp, and I felt like people in the class were going to stress me out. I felt great about my doctors, I knew I was probably going to ask for pain relief, I was OK with a vaginal delivery, I was OK with the idea of a C-section. I just didn’t need the mental harrassment disturbing my happiness. (Perhaps the class would have been fine; but that’s how the books I’d read already struck me, and I’d had enough meddling.)

        In the end, I gave birth vaginally, but only after a rough time. Baby was in distress, inhaled meconium, and as a result I got to hold him for a few seconds only before he was taken to NICU for monitoring. And you know what: screw those 5 “precious minutes” to cuddle and breastfeed; we bonded just fine. I’m so glad I didn’t have some paradigm in my head that made me feel there was something “wrong” about my wonderful experience with my baby.

        And that is what annoys me. If I felt pressured, as someone who didn’t even believe the hocus pocus, how much more so might a mom feel inadequate if she believed it? It’s just cruel to set people up to believe everyone’s experience has to play out a certain way to be valid.

    • Trixie

      So now it’s only okay to be okay with your lumpy body if you also subscribe to a certain wacky childbirth philosophy? I mean, really?

    • The Computer Ate My Nym

      I’m much happier with the idea of embracing your body after childbirth than the “what’s your excuse” thing, but…42 weeks gestation, labored for several days, did not have an emergent c-section…there’s no mystery about why this baby was born dead. Hypoxic brain injury from prolonged labor or maybe no one realized that he was already dead from placental failure or whatever exactly kills fetuses after week 40 before labor started. It’s a known risk, not the mystery implied. I do wonder if the doctor chose to do a vacuum because the fetus was dead and he or she didn’t want to do a c-section for no good reason or if the mother refused a c-section or what, though.

  • LMS1953

    http://en.m.wikipedia.org/wiki/Flexner_Report

    About a century ago, in 1910, MD medicine was in disarray in America. The situation was completely analogous to the panoply of “midwives” who are killing babies and mothers today. The Flexner Report was the watershed moment from whence the bounty of modern medical marvels have flowed. What is needed now is a similar report on the licensing/credentialing/scope of practice of midwives. Perhaps these neonatal mortality stats in the hands of CPMs will spur such an investigative report that will cause a similar house cleaning.

    • KarenJJ

      Exactly. Humans have much more in common then they are different and unregulated midwives are behaving exactly as unregulated doctors did in the past.

  • Leslie

    Hey, did anyone else notice that on her FB page, she sort of admitted that the reason she doesn’t get involved with homebirths is because her malpractice insurance won’t allow it? Could that be because, oh, I don’t know, maybe it’s too …. RISKY??

    Tellingly, she thinks it’s okay to gamble an innocent baby’s life or health on a homebirth turning out okay, but she’s unwilling to risk her future financial stability on same by doing it without malpractice coverage. (Not that I blame her.) Somewhere, some baby likely owes its life or good health to the fact that an insurance company said, “No.”

    • The Bofa on the Sofa

      Hmmmm, I seem to remember that someone, just yesterday, predicted that would be her excuse….

    • LMS1953

      EXACTLY. As a CPM she must know that lack of physician back up is the rate limiting factor for the acceptance and widening of HB by CPMs. There probably aren’t a half dozen people in her position (MD/CPM) to help out her CPM sisterhood and the desperate HBers. Considering the obstetric “crisis” she wails about, what more rewarding career path could she take than to lead our system to the Promised Land. But, alas, the siren song of peddling herbs and snake oil to holistic hypochondriacs proved too irresistible to pass up. Not only that, at any time she can ride in on her high horse to feed woo to a stable of unicorns.

      • Mishimoo

        Those poor unicorns! I’ve heard that woo tastes like kale, so I prefer to feed mine on marshmallows. Makes them more tender and juicy.

        • LMS1953
          • Mishimoo

            How are they minimising the risk of prion disease? Besides, I’m not sure if I want to give my unicorns a power-up, they have more than enough energy as it is.

          • LMS1953

            Mishimoo, that is an excellent point re: prion disease (like mad cow disease and slow virus and kuru -CJD). I had midwives invite a placenta encapsulator to the hospital. Mind you – placenta is HUMAN TISSUE. Consumption of human tissue by humans is usually defined as cannibalism. In the South Pacific some culture’s woo is to have the family to eat dad’s brains to preserve his spirit => CJD/Kuru. In the UK it was customary to feed cows the offal of dead cows => mad cow disease . EVIDENCE BASED MEDICINE suggests that it is poor form to eat the offal of your own species. So, without a SHRED of evidence, without a scintilla of government oversight, a woo farmer can process human offal for human consumption.

          • Mishimoo

            Thanks! They always seem to promote it as a beneficial item without mentioning any risks whatsoever. Personally, I’d be concerned about the potential bacterial load as well as whether it is actually my placenta. Not to mention, cross-contamination from lack of sterility. Also, what about OH&S?

          • Guest

            Also, on a purely practical point, animals eat the placenta so that predators don’t sniff out their young and ea tthem. Now, I’m not sure, but they possibly wouldn’t eat it if they didn’t have to? When I had my children, both in hospital, there were no roaming predators (and I live in Africa), but perhaps it is different with home birth, perhaps predators are a concern?

          • Trixie

            Also, many animals eat it to recover some of the nutrients lost during gestation and birth. In fact, most of the “studies” they cite are just studies of the benefits of postpartum iron consumption.

          • Trixie

            I’ve said it before, but the USDA approved method for making your own jerky involves a lot of food safety steps (and a LOT of salt) that are lacking in all of the placenta dehydration instructions I’ve ever read. You’ve got an organ delivered into warm, fecally contaminated water, handled by multiple people, sitting around for a while before being sliced up in someone’s kitchen. This person has no food safety training let alone training in handling biological waste. She then uses a regular home food dehydrator that lacks any sort of accurate thermometer to show her what temperature the meat is while drying. The warm air slowly dehydrates the placenta, but in the meantime, lots of moisture is drawn to the surface, which is warm but not hot enough to kill pathogens. In fact, it’s just the right temperature and humidity to encourage them to grow (this is where the salt comes in when you’re making jerky). Oh, and she’s used the same dehydrator to dry other people’s placentas the same way. Those dehydrator shelves are tough to clean thoroughly (I know, I use mine a lot for fruits and vegetables), and I suspect the top piece that contains the fan and heating element really can’t be satisfactorily cleaned at all if we’re talking about needing to clean it enough to reuse with human waste. So prions aside, someone is going to get very, very sick with food poisoning from this. If they haven’t already.

    • Ob in OZ

      I do blame her. You advise patients as if they were you or your family. My favorite question is “if it was your wife/mother/daughter, what would you do?” It says to me that they want my recommendation based on my knowledge of the condition for which they seek treatment. In Obstetrics the answer frequently is “it depends”, because peoples priorities differ. For example, abnormal screening and amniocentesis. But at least it is an aknowledgement that they are seeing a health professional. The patients that walk in with the 3 page birth plan or demand for c-section after three normal vaginal deliveries
      (But it is my right!) make me wish I could politely ask them to leave. Instead it is an hour long discussion of which they have no interest in what I say and neither of us are happy at the end.

      • Dr Kitty

        Just out of interest, what is you issue with CDMR?
        If someone has had three NVD presumably she knows exactly what she’s opting out of…

        • toni

          Yes don’t you sustain more pelvic floor damage the more vaginal deliveries you have? Even easy, uncomplicated ones? I can very well see myself deciding after number three or four that I’d like a caeserean to save myself from exhausting my body so to speak. I’d want my obstetrician’s honest opinion but would be upset to be shot down as a ridiculous request. I think it’s reasonable

          • Ob in OZ

            The damage done to the pelvic floor is greatest from one labor, even if the result is a c-section. Future labors have a much less impact. That being said, we treat individuals and not textbooks. Every pregnancy involves a discussion of the pros and cons of labor, delivery, c-section.

          • toni

            But mightn’t the damage have an accumulative effect? Even if the extent of it is lessened each time?

          • Ob in OZ

            depends on circumstances. An example would be a prior third degree tear. the damage is done. the resultant repair may be good or bad. The liklihood of a recurrent tear is small (<5%) and yet we offer her what is considered a medically indicated cesarean section if she does not want to accept that risk. By and large, a routine vaginal delivery does significant long term perineal damage, that may or may not be symptomatic in the future. Future pregnancies are less likely to make matters worse for most women

          • toni

            I don’t *think* I had any damage from having my first eight months ago. Like i don’t feel any different. It was pretty easy and quick and I did not tear at all (he was 6lbs and had a smallish head)but couldn’t that just be a fluke? Or because I was 25 and that is the optimal age for childbirth? I’m Roman Catholic so I’m expecting I’ll have six children at least, surely five or six vaginal deliveries would result in worse pelvic issues than three normal followed by two or three c sections.

            Also I know of a couple of women who had uncomplicated first deliveries and shoulder dystocias for their 2nd

          • Siri

            Your body, your decision! But bear in mind that with an easy first delivery, and in the absence of any other complicating factors, you’re about as low risk as it’s possible to get. Don’t underestimate the impact of an elective section, especially if you’ve got three toddlers already! In my own anecdotal case, my first delivery was horrendous, but each one was easier than the previous one. I now have five, and my pelvic floor is in great shape! Had I been offered a section for my second, I would have jumped at the chance; in retrospect I’m so glad I didn’t.

            Say you end up having eight children – I don’t know how you plan your family, but if you leave it to chance, you’ve got plenty of time to have 8-10 children. That would mean three normal deliveries and five sections.

            I’m sure you’ll discuss these issues with your obstetrician though, so I’ll just wish you good luck! I sometimes get broody for a 6th…

          • OBPI Mama

            I agree with Siri. Just my two cents (1 vaginal birth, 3 c-sections). C-sections carry there own long term effects for some women (such as me) and it’d be a good idea to discuss those with your doc. I don’t regret mine in the least… I am very thankful for them (severe shoulder dystocia resulting in injury to baby and me… more for baby). After my 2nd c/s, I had a lot of issues with adhesions though. Stuck to my bladder and I had a lot of pain when every time I urinated for the whole year before I had my next child. That was a very long c/s, they knicked my bladder trying to remove scar tissue (they patched it up and I did get feeling back though), but they did manage to remove a lot of scar tissue. I haven’t had that same level of pain since my 3rd c/s, but I still have intermittent pain on the inside of my incision. Dealing with that though is much easier than dealing with my first son’s issue though, so I hope it doesn’t sound like I’m complaining. Just wanted to point out that adhesions are no joke! whew!

            I’m at the point where much of my debate about having a 5th baby is due to figuring out if we really want another c/s and recovery. It’d be my 4th c/s and I know the risks go up at that point. I wish you ladies could do your fancy mathematics and give me actual numbers of the risks! haha. My OB has preformed 7 c/s on a mom before and so he’s supportive of me deciding on my risk to benefit ratio.

            And I agree with Siri saying you could easily have 8-10 children (jealous! haha). We did not prevent for the first 5 years of marriage (I was 21) and we had 4 children in that time! Taking a break now to figure out this whole 4th c/s thing.

          • Ob in OZ

            Shoulder dystocia is another example of a medically indicated c-section for the next delivery if the patient chooses. Each delivery is different to a degree, but track record is very importnat. An example is most people have babies of similar weight, but if diabetes develops in a future pregnancy then the baby may be bigger and thus at risk of complications beyond what is otherwise anrticipated. In your example, I would not recommend having 3 babies vaginally and then start having c-sections to protect the pelvic floor. If a person had 4 c-sections but then wanted a vaginal delivery to lower the risk of complications during surgery would similarly not be appropriate medically.

          • AllieFoyle

            You would not recommend it, but that doesn’t make you right in every situation. Vaginal delivery is generally viewed as preferable, so women may find themselves having vaginal deliveries without every really making a choice, or indeed, knowing that they even have a choice, and they may find the process traumatic in ways they find difficult to discuss (particularly if they think the person they are discussing it with will not be sensitive to their feelings or will judge them negatively for feeling that way), or they may have experienced for themselves a distressing increase in pelvic floor related problems with each delivery, and they may not wish to discuss these. And despite your apparent desire to be sensitive, you do seem to believe strongly that once a woman has had a vaginal delivery her pelvic floor is already damaged and there’s nothing left to preserve. Issues of continence and sexuality or previous sexual abuse or trauma may be extremely difficult for women to discuss, they may fear having something embarrassing written into their medical records. Because of the potentially distressing and private nature of issues surrounding the decision, I think sensitivity dictates that women requesting CS should not be required or expected to disclose every reason they may have for wanting one. No one asks women to justify their desire for a vaginal delivery, why subject women desiring cesarean delivery to a higher standard? The risks are distinctive but comparable in magnitude. As the doctor, you can and should have a conversation with the patient about her preferences and expectations and attempt to develop a relationship of trust, but once you have ascertained that she understands the risks and benefits, I don’t see that it’s your business to ferret out her every motivation and fear, particularly if you are going to try and talk her of it.

          • AllieFoyle

            That’s absolutely ridiculous and untrue.

            I know you’re an OB and I’m not, but I just cannot let this one pass. Think about it logically. Research clearly shows that women who have only delivered by cesarean have measurable stronger pelvic floors, less incontinence, less prolapse, less risk of rectal damage, and thus less need for reconstructive pelvic surgery. I won’t even discuss the possibility of sexual dysfunction. Each delivery is different and presents new opportunities for damage.

            There is also increasing understanding of the fact that labor and delivery can be psychologically traumatic in some cases, particularly if it is painful, invasive, humiliating, or the woman has a history of sexual trauma or anxiety.

            There are many reasons women might prefer cesarean delivery, and many of them are quite sensitive and may be difficult for a woman to broach with a caregiver who has a bias toward vaginal delivery.

          • Ob in OZ

            Sorry. You got the wrong guy. No bias here. The mental health of the patient is important and is part of the discussion of pros and cons of each option. If the patient wants that discussion to be honest and specific to her individual needs, then hopefully she feels comfortable with her choice of caregivers to be honest about an history that is relevant.

          • fiftyfifty1

            I think the problem was that she refused to give a reason. The doc has to know where a patient is coming from. It’s not that Ob in OZ is trying to sit in the position of deciding whether her reason is “good enough”. It’s that the doc needs to be sure a surgery isn’t being requested for a truly *bad* reason. An important example would be asking for a section based on totally mistaken information. A different example from my own practice was a woman who I was doing a pre-op exam on for a tummy tuck. The plastic surgeon was totally prepared to do the surgery (after all it’s the patient’s choice, no?) But I got a weird vibe from the woman and did ask her why she wanted it. Her answer revealed that she was actually having psychosis! She believed her pannus (overhanging tummy flap) contained the evil voice that she had been hearing.

          • Jessica S.

            Good Lord! That must have been a weird moment!

        • Sue

          Good question. In my view, a mother has the right to request planned C/S, provider has the right to refuse, but the family can then seek another provider, no?

        • Ob in OZ

          When I start writing and get longwinded, I sometimes provide brevity in the wrong places. I am very supportive of maternal request cesarian sections, but they are an informed decision. I made the comment elsewhere thatwe should treat our patients as if they were a family member, such that it would be completely hypocritical to refuse to perform a c-section but support my wife/mother/sister/daughter in their decision to do so. A very interesting study years ago exposed this hypocracy in that female ob’s said they would perform a maternal request c-s about 15-20% of the time but more than 50% would request one for themselves (long time ago but the numbers are close). When I asked the patient why she was requestinga c-section she would not say, other than “it is my right”. This was an early in pregnancy visit, but I tried to explain that there was a consent process of risks and benefits and I would like to know what her reasons for a c-section would be after 3 uncomplicated vaginal deliveries. She felt it did not matter. Like someone else stated, I have to agree to the surgery as well, and can offer her a second opinion with another Obstetrician. THat is what she did and that doctor regretted his taking on the patient (but did not blame me) for many reasons. The point was more about patients who are demanding a service as opposed to seeking information and making an informed decision.

          • AllieFoyle

            I’m kind of disgusted by the lack of sensitivity in your anecdote. As an obstetrician, can you really not imagine any valid set of circumstances in which a woman would prefer a c-section after having previous vaginal deliveries? And can you also not see how the sensitive nature of some of those circumstances might make her reticent about disclosing them to you? I hope you will be more open-minded when discussing MRCS with future patients.

          • Ob in OZ

            Of course there are valid circumstances. But it would be wrong of me to assume the patient has one if she is not willing to tell me what it is. It is called informed consent. You seem to hate antedotes, but if her 3rd vaginal delivery was complicated by a shoulder dystocia, and the next baby was predicted to be one kilo SMALLER than her smallest baby, then I might reassure her that an attempted vaginal birth would be a very good option. But, guess what, if she said it was too traumatic an experience and requested a cesarian secion, I would do it. This is an easy antecdote because it falls under the heading a=of a medically indicated c-section, even though there are obstetricians who would have issues with performing the c-section. Which is the point. If the patient has a complication after surgery, I have to look them in the eye and explained what happened and apologise. I also have to look in the mirror and remind muyself that complications happen. But if I’m thinking “why in the world was I doing this surgery as it was unindicated”, it is tougher. And believe it or not, some patients afeter surgery will say that if they knew that complication could occure, they would not have chosen that option. So it is complicated, and if the patient isn’t forthcoming, it is that much harder.

          • AllieFoyle

            I respect the complexity of the situation and your sense of responsibility for the outcome, but I still feel that in the case of a woman with previous vaginal deliveries requesting a CS– as opposed to, let’s say, an elective knee surgery– that you have to assume that it’s likely that part of her reticence to discuss comes from the sensitive and highly charged nature of the issues involved. I see from your other posts that you are sensitive to the effects of domestic violence and assault and I think that’s admirable, but I also think you should consider that a woman hoping to avoid a vaginal delivery and unwilling or unable to disclose her reasoning may very possibly be dealing with issues that require the same kind of sensitivity and compassion.

          • Dr Kitty

            Thanks for the clarification.
            I get it.
            It is hard to ensure someone is truly informed if the won’t discuss the pertinent issues.

    • An Actual Attorney

      Serious question — can docs practice w/o malpractice insurance? I know some states require lawyers to have it, some don’t. I would never practice law without it. And since I don’t do death penalty defense, no one even dies if I make a mistake.

      • LMS1953

        In Florida, OBs can go bare, but they have to put money away that exceeds their salary to keep a lawyer on retainer. Every hospital I have ever held privileges at required at least $1million/$3million coverage. I think you can go bare if you just hang a shingle and practice without hospital privileges. I have never had to show proof of malpractice coverage to obtain or renew a state medical license.

  • Stacy21629

    “Safe space” AKA an echo chamber of ignorance.

    • staceyjw

      The idea of a “safe space” was to provide women with an areas to talk about things like rape without assholes and men. It is also used to keep general nastiness and such from groups when they are about sensitive topics. This is fine.

      The HBers abuse the concept by using it to ban everything they don’t want to hear, no matter how politely worded. I get that you might want a space where you aren’t constantly challenged, but when you cannot even tolerate facts, you have a serious issue.

      • Ob in OZ

        I am a trained male Obstetrician and Gynecologist. I am a safe space for women. I ask every patient at some point if they feel safe at home and have they been assaulted or abused. I ask them if they need help, have they involved the police, do they need counseling. I make it clear that if they have no history of problems that my door is always open at the office or through the emergency room as a safe place to come if they need it. I was frequently surprised that after seeing a patient a few years in a row for their yearly exam that on year 2 or 3 they might tell me about their prior history that they did not want to reveal on their first appointment. I am no longer surprised. 105 of patients have a history of assault/ abuse. We screen for other issues have have a much smaller rate and a much smaller impact on their health and wellbeing.
        My point. This is essential to our care and you don’t have to be a female to help women be safe and stay safe.

        • Medwife

          Compassion isn’t gendered. Thanks for doing what you do.

        • Sue

          Well put, Ob in Oz. For all that the medical system is pilloried by these people, we remain ready in the background to accept all-comers when they have the need – greedy and arrogant as we allegedly are!

        • OBPI Mama

          Thank you for the work you do. Because of my past history, I never thought I’d be comfortable having a male obgyn, but when I met mine I knew I’d receive competent, compassionate care. And I have and remain so thankful.

          • Ob in OZ

            Thank you for giving us men a chance, or second chance as the case may be. Good luck

        • Siri

          I think I love you! That’s beautiful. In the UK, GPs are being encouraged to ask all women about their home life; there is a lot of resistance until they read the testimonies from victims of domestic abuse. ‘I attended your surgery every week or two; I sat in that chair across from you; you treated me for headaches, depression, stomach pains, minor injuries etc. You never once asked me what life was like for me in my home. You never asked about my relationship. I kept going back, hoping that one day you would ask the question that would allow me to tell my story’.

          There is also a lot of hostility among the public, who choose to see this as ‘assuming every man is a wife-beater’. Well, if your marriage is so happy, and you are asked about it, just smile, say Yes, it’s fine, and move on! Victims find it so hard to disclose abuse; we should all be a bit braver and ASK THE QUESTION! !

          • Ob in OZ

            Thank you. Your comment means a lot to me. It was awkward at first as some patients left the room and asked the folks at the front desk why I would ask about these things and think that it was inappropriate. I learned to get better at how I asked and look for clues as to whether it made the patient uncomfortable and go from there. But comments like yours and the way too many ” I never told anyone but yeas I was…” remind me that it an importnat part of my job.

  • Something From Nothing

    I was out to dinner with a friend last night, and as we looked around the room, she pointed out that no one in the room cares one bit about how they were born, vaginal or section, or whether they were breast or bottle fed. No discernible differences that we could see. It’s likely that most adults haven’t had a conversation about how they were born with anyone other than their parents or their doctor. Because, for the most part, it isn’t relevant to our lives. Yet, women have so much emotionally invested in the process of birth. It’s challenging to navigate the path with patients who, for example really really want a VBAC, but they are post dates with an unripe cervix. Wanting doesn’t make it so. Especially when it comes to having a baby. Unfortunate to start out with your new baby feeling disappointed and underwhelmed. I’m getting full up with women who shamelessly promote these ideas.

    • R T

      Awe, but don’t you know it’s a subconscious scar that haunts you for your life time? You don’t realize being born by csection is a birth trauma you must heal to reach your full potential in life. You also need to heal your own trauma from being born by csection or you’ll end up having a csection when you give birth because you didn’t open a pure space in the world for your baby to come into. This is what I heard a CPM in LA tell my client when I was a doula.

      • Mishimoo

        That is eerily similar to what I was told growing up.

  • ChrisKid

    “And what is the homebirth midwifery community doing about these “not so great” midwives? Nothing. What is MANA doing about the “not so great” midwives among their members? Nothing.”

    Oh, no, they’re not doing ‘nothing’. They’re starting public protests against Hawaii’s effort to license birth practitioners, or even to study the probable effect or feasibility of such licensing.

    • KarenJJ

      Midmidwife’s.

      “With midwife”

      not “with women”.

      • ChrisKid

        I may be overly tired here, but I think I must be missing something in your comment. Can you explain, please?

        • Josephine

          I think she means to say that these midwives are not actually “with women” (the etymological basis of the word) because the women they are supposed to “be with” are thrown to the wolves if they have a less-than-glowing report about their midwifery care (even when they’ve sustained terrible injuries or watched their babies die). Instead, modern midwives actually just stand with other midwives.

        • fiftyfifty1

          The word “midwife” has linguistic roots that mean “with woman”. Midwives loooooove to point this out. They sell themselves as being there for you. But really they are there for themselves.

          • ChrisKid

            Ah. That makes perfect sense, then. Thank you.

          • KarenJJ

            Dumped a comment and ran out for the school run. Come to think of it, what the heck is it doing with an apostrophe? Should be Midmidwives.

  • Votre

    Be interesting to see how long it takes some enterprising State AG’s office to decide clearly preventable birthing disasters need to be treated as a civil rights (the chlid’s) or felony (criminal negligence/fraud) issue – and takes legal action accordingly.

    We do have an elections approaching so the time is ripe.

    • LMS1953

      Cognitive dissonance or It takes two to tango but only one partner gets to pick the music.

      A crime is committed upon a pregnant woman. If the fetus is harmed by the crime then the offense/punishment can be augmented. Recall the case of the OB’s son who slipped his (first trimester) pregnant girl friend a Cytotec and she had a miscarriage. A woman has complete autonomy over her ovulate, the man has no control over his ejaculate.

      No right is absolute nor inviolate. But a woman’s autonomy over her genitalia comes pretty close. If a driver caused harm to her term fetus in an accident, the driver would be punished for it. If mom caused her fetus to die because of a stupid, negligent intrapartum decision – oh well, autonomy, it can be a bitch sometimes.

      • fiftyfifty1

        “the man has no control over his ejaculate.”

        You have no control over your ejaculate LMS?!!!? My how distressing that must be! Is it like you are just walking down the street and then you get a spontaneous boner that pokes through your fly and then you ejaculate all over and women rush to the scene and scrape your sperm up off the sidewalk and poke it up their yonis and you are stuck paying child support on hundreds, if not thousands of bastard children you never wanted? Poor you!

        • LMS1953

          Now THAT was funny!

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

          There actually was a court case a few years ago where a guy claimed his girlfriend retrieved his semen from the garbage and used it to impregnate herself, therefore he shouldn’t have to pay child support. The girlfriend claimed things happened the old-fashioned way. I believe the girlfriend won.

        • auntbea

          A male friend of mine apparently spent a large portion of his childhood traumatized because he didn’t understand that a) sperm only look like tadpoles; they are not tadpole size and b) their exit from one’s body does not happen without warning.

        • Siri

          That’s why I always ask men to ejaculate into a clean receptacle; if you scrape the stuff up from the pavement it gets full of grit. Plus the vessel can be pre-warmed to optimise survival of the little beggars.

      • AlisonCummins

        There are ways around that. In countries where they have easily accessible abortion on demand and good, universal birth control education, the genetic father is not necessarily liable for child support. He’d be liable if he were living with the mother in the six months before the birth, or if he’d signed the birth certificate, but not after a drunken tumble with a stranger.

        If you want men to have any say in whether or not they will be liable for child support in the case of an unintended pregnancy then lobby for free, universal abortion on demand in every county, and complete and accurate sex education and birth control information for everyone (including young teens). Then we’ll talk.

  • Squillo

    chorioamnionitis, an infection in the “bag” that holds the water around the baby … This infection is due almost exclusively to bacteria acquired in the hospital, and is commonly transmitted to the mother when excessive vaginal examinations are performed to assess labor progress.

    So I guess death from sepsis or preterm birth due to chorioamnionitis is very rare in the poorest countries, where the vast majority of laboring women never set foot in a hospital.

    • staceyjw

      I know of a HB baby lost due to the MW first missing the chorio, then missing the abruption it caused. Aquila Paparella. Thankfully, the awful MW is now working as a secretary or something. No more HB, no more BC. Cold comfort, but better than nothing.

  • LMS1953

    The selective use of WHO is hilarious. In Africa there is often very rudimentary OB care managed by uneducated providers – not unlike the situation with HB in Oregon. WHO has attempted to promulgate the concept of the Partogram. It is essentially a Friedman Curve with diagonal lines instead of curves for simplification. If mom does not make progress over a 4 hour period, you need to DO SOMETHING – if nothing over than cranking up the Range Rover for Nairobi General.

    If you dare mention the use of the Friedman Curve in the management of labor to ANY level of MW, you will get hit with a veritable DECK of cards:
    1. Trust Birth
    2. Moms and babies know more than you
    3. This is a birthing center, not a train station, Doctor
    4. How did we survive as a species
    5. Cascade of intervention.
    6. Nosocomial infection
    7. Limited vaginal examination due to modesty/prior sexual assault
    8. EVIDENCED BASED MEDICINE says the Friedman Curve is invalid
    9 It will make you use pitocin which will interfer with bonding
    10. Ina Mae doesn’t use it
    11. It interferes with positive affirmations such that unicorns and butterflies will be repelled as if you sprayed Raid.

    • Medwife

      Uh, I think the Zang curve is more accurate with epidural use, but it’s not really fair of you to toss “any level of midwife” around like that.

      • LMS1953

        Sorry – each and every one of those statements were thrown in my face by no less than 10 CNMs in my career. It is complete fair.

        • Siri

          So the current standard of proof is ‘ten people have said it to me’. Most impressive.

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

    “safe space” is a social justice concept where oppressed groups have their own space to talk without interference from the majority. It is important because minorities deal with the perspective of the dominant group constantly. It has nothing to do with being “weak” and everything to do with being sick of having every conversation about feminism interrupted by someone saying “WAIT WHAT IS ‘THE PATRIARCHY?’ ARE YOU ALL ON YOUR PERIODS? SANDWICH JOKE!” or conversation about race interrupted by someone saying “WHAT ABOUT REVERSE RACISM? WHY CAN’T I USE THE N WORD WHEN THEY ALL CALL EACH OTHER THAT?” etc etc. It doesn’t make much sense when aviva uses it. NCB people hijack parts of feminism that suit them and toss the rest in the garbage. I don’t know how another woman with birth experience could be expelled in the name of ‘safe space’ for the exact same demographic.

    • Young CC Prof

      A safe space for a particular group to discuss their opinions and experiences is fine. A safe space for people to build their own facts and be protected from objective reality is really freaking dangerous.

      • auntbea

        See my note on “feminist methodology” below and the (apparently) inherently anti-feminist nature of assuming there IS an objective reality. Everything in homebirth rhetoric makes so much more sense to me now that I know this way of approaching knowledge is being actively taught in universities throughout the US. Scientists = men, therefore empirical statements = oppression.

        • LMS1953

          Boy, you nailed it. I had a daughter graduate from Oregon State University as a Women’s Study major in 2008. Missy Cheney was a frequent lecturer. It was all a bunch of post modernism, white privilege, institutional sexism blah, blah, blah regurgitation. The graduation ceremony was an exercise in self-flagellation over the internment of the Japanese in WWII. Oregon is about 90% Caucasian. A significant percentage of the African American population in Oregon is there to play sports. Minorities to most white Oregonians are an opportunity to beat their breasts with mea culpas to show everyone else how much better they are than the rest of us. It is the same attitude that pervades the self-righteous, sock it to the man
          Home Birth Movement.

          • auntbea

            Just to be clear, I have NO PROBLEM with identifying and pointing out privilege and institutional sexism/racism. I just have a problem with the idea that because science has to this point largely been the province of white men that using science is in itself inherently sexist or racist.

          • Sue

            Fascinating perspectives. In childbirth, it seems to be a feminist-anti-feminist issue, but is not necessarily gendered in other anti-science areas, so much as anti-establishment.

            Take some of the non-science-based health providers – like chiropractic or naturopathy. (Disclaimer – some chiros are rational and only treat musculo-skeletal issues, but many believe that ”subluxation” causing ”nerve interference” is the cause of all ”dis-sease”).

            These people are entrenched in their philosophies, and reject both orthodox medical science and proper research methods as tools of the oppressor (many chiros who think like this are men).

            Many chiros are anti-vax and pro-HB/anti-obstetrics, but also believe that newborns have ”subluxations” due to the ”traumatic” birth process (yes, you CAN have it both ways!).

            I think the siege mentality, chip-on-shoulder and magical thinking are the things in common, the gendered part of childbirth has the additional aspect of being female dominated in both its workforce and customer base.

            What do all you sociologists think?

          • Young CC Prof

            I’ve thought about how gender plays out in health-woo-space generally, and I’ve made a few observations.

            It seems to me that the consumers of health-woo are disproportionately women. After all, women consume more medical care than men in the conventional sphere and are more likely to make health care decisions for the family. I’d have to see numbers, but I suspect the woo purchasing is tilted even more strongly in favor of women, except when it comes to “male enhancement” crap, and possibly energy drinks and sports supplements.

            The people writing about and promoting woo without getting paid are VERY likely to be women. The mommy bloggers, the “warriors” at Age of Autism, the top posters on Natural News, etc.

            The people making a modest living as acupuncturists, herb sellers, energy healers etc may be male or female.

            But the people getting really filthy rich off of woo? MEN. Dr Oz, Dr Jay, Mercola, Gary Null, I could go on and on and find very few women at all.

          • AlisonCummins

            You must be aware of the reason that there aren’t more african-americans in Oregon: it was illegal for them to live in the state until 1920.

        • Young CC Prof

          As a female mathematician (Who, by the way, only had one female math professor in all of college or grad school) that is just so offensive. What, you can’t beat the boys at their own game, so you just pretend reality doesn’t matter? How’s anyone ever going to take you seriously that way?

          Yes, the tools of science were built by the patriarchy and have been used to oppress. Quite a few of the earliest statisticians were eugenicists. But the tools WORK, and if you want to end oppression, you’d best turn them to your own purposes. Otherwise your vaunted “safe space” is no more than a knitting circle. Without even nice warm socks to show for itself.

          • KarenJJ

            Agreed. Like learning another language in order to communicate (maybe similar to the English upper classes speaking French a couple hundred years ago). The problem is not the language, the problem is the way it is used to alienate others.

          • theNormalDistribution

            Only one? I took a lot of math when I was in university, and there was a good mix of men and women. For some reason, every single discrete or combinatorial math class had a female professor. I have always wondered if that was a coincidence or if there’s something about those topics that attracts women.

          • Young CC Prof

            Huh. That one WAS my female professor. And that’s my favorite “real math” class to teach. (My other favorite class is Statistics 101, but that’s pretty light on the actual math.)

            There does seem to be a pattern of topics that attract women mathematicians. Logic is another one. Fewer women in the geometrical areas of mathematics.

          • The Bofa on the Sofa

            There does seem to be a pattern of topics that attract women mathematicians. Logic is another one. Fewer women in the geometrical areas of mathematics.

            The only woman math prof I had was for Complex Analysis, so there’s one counter anecdote.

          • Young CC Prof

            Hey people out there who are afraid of math: Complex analysis scares me. Ten years later, I shiver, remembering how weird and incomprehensible that class was. And I’m a mathematician.

            Being afraid of math is normal, and it doesn’t mean you can’t do it.

          • The Bofa on the Sofa

            How can you not like Complex Analysis? :)

            I thought the Fundamental Theorem of Algebra was the most fascinating thing (and the ability to solve all the roots of any polynomial).. e^pi*i=-1? How cool is that?

            Awesome stuff!

            I thought Complex Analysis was so cool philosophically. You start thinking about that question that I always had: what is above and below “the number line”? We learn about the number line in first grade. But it takes a long time to get to the question of what happens when you step off the line. It’s amazing what all you can do.

          • Young CC Prof

            Oh, the philosophy and the Big Ideas of complex analysis are awesome. It’s the details and the nitty-gritty calculations. They get pretty ugly.

            Although apparently I can do it if someone tells me it’s really number theory, since they come together in certain areas.

    • AlisonCummins

      Yes. This.

    • LMS1953

      A prime example is “My OB Said What” . They demand their safe space to be snarky and stupid .

    • staceyjw

      Thanks for the thorough explanation, I should have read the comments first :)

  • LMS1953

    I loved the comments on the FB page. One of my hobbies is to give an over/under on when certain “cards” will be played. Whenever there is a discussion of neonatal death and HB. It usually takes no more than 3 posts before the “now there you go playing the ‘DEAD BABY CARD’ card is played. BTW, the Ace of Death Card on the HB blog was extraordinary – kudos. Then we play the “well, what is the whole point of pregnancy if not to end up with a healthy mom and a healthy baby” card. At this point in the game, there are two possible HB plays: 1) (the relatively standard) “cascade of intervention” card, followed by the “tethering ” card, the “strapped down on your back” card and the “I need to do the Hokey Pokey” card – these are usually played as a meld. 2) (the less common) “how did we ever get here as a species” card. However, this can easily be trumped by playing the “by marginally out-living members who succumbed to childbirth, appendicitis, cholera, dysentery, malaria, tuberculosis, predator attacks, etc for hundreds of thousands of years until medical advances caused an exponential explosion in our species numbers” card. A more elegant play is to first bring out the “momma hyena” card – hyena’s have about a 25% maternal mortality. For momma hyena it is akin to trying to birth through a penis. You see, hyenas have “survived as a species” by having the more aggressive females getting the most pregnancies. They are aggressive because they have more testosterone than their more docile sisters. And the testosterone has a masculinizing effect on the genitalia.

    Anyway, I think it would be great to develop a short hand notation for these “plays” akin to Chess Notation. That way we can quickly review and replay debates such as Tuteur v Aviva 02/05/2014

    • sieraci@healthcaresd.com

      Beautiful, LMS1953. Much like anti-vax standard tropes, one can play Hb or anti-vax bingo, or just reference the handbook:

      “That’s a 13, a 24(a) and a 53 from chapter two!”

    • auntbea

      I have repeatedly asked for such a shorthand to be created and entered into the permanent links on the sidebar. The plea has fallen on deaf ears (or, more likely, ears that are just as busy as I am and therefore have no time to create such a thing.)

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

    CAVEAT EMPTOR???!?!?! Aren’t we talking about life and death and disability? WTAF???!?!?!?!?! @$#!!@$!!!!

    • Siri

      That expression always makes me think of Gone with the Wind, where Rhett Butler suggests to Scarlett that she call Frank’s shop the Caveat Emptorium. She thinks it’s got something to do with Emporium, and even has the sign made before Ashley tells her the real meaning. Sorry, OT.

  • Jessica S.

    “I don’t think that grown women are so weak that they need to be protected from reality, including the reality that homebirth sacrifices the lives of babies who didn’t have to die. I’m not interested in behaving like a “lady” and creating a “safe space” for deadly lies.”

    Yes. Perhaps if less “safe spaces” were created, women – and men, if applicable – wouldn’t be led down the path of such deadly choices. And if they still did, at least the evidence was there. The only “safety” that’s need is simple decency towards the person (I.e. refraining from personal attacks) and a realization that an attack on beliefs is not personal. That’s not as simple when you are arguing for something that has no logic or evidence to back it.

    • Sue

      There is a well-organised network of ”safe places” for birthing mothers – those places are called ”hospitals”.

      • Jessica S.

        Ha! Yes!

  • The Computer Ate My Nym

    And she thinks women must be nice and ladylike, creating “safe spaces”
    to exchange deadly lies, carefully “protected” from grownups who tell
    the truth.

    And that the gas lights aren’t really flickering…

    • Life Tip

      Yes, if you check the MDC thread about the Dr. Amy/MANA stats, posters were commenting that it made them “sad” that it was being discussed on a homebirth forum and it was not “supportive”. And yet, they are perfectly ok with passing on information prefaced with, “My midwife told me…” or “I’ve read that…” or “I had a homebirth and I did…”.
      When I was little, if there was a problem with gossip or something among the children, our teacher would make us sit in a big circle and play “Telephone”. The first student would whisper a message to the kid next to her, who would whisper it to the next child, etc., until it got back to the first child. Everyone would be surprised and laugh about how the message changed as the story passed from person to person. Basically, these women are content to make life or death decisions for themselves and their babies based on information they get from a giant game of Telephone played with strangers on the Internet…with the added bonus of not even knowing if the original idea is verifiable or not.
      “Educated mamas” indeed.

      • LibrarianSarah

        My teachers tried the same thing but the message always was the same. It could be that my class was smaller. Or that autistic kids are REALLY good at telephone. I like to think it is the latter.

        • KarenJJ

          I was starting to struggle to hear at that age. Telephone always got messed up. I hated it and felt so anxious that I was getting it wrong.

          • LibrarianSarah

            That sucks. I am sorry. If it makes you feel better I always thought it was supposed to be messed up because that is what always happened on TV. So messing it up would have made my day but I guess we have to learn that tv is not like real life at some point.

          • KarenJJ

            I got over it. Towards the end I deliberately started making it ridiculous. I took ownership of the messing up properly instead of doing it accidently because I wasn’t hearing the whispering as well as I could.

  • The Computer Ate My Nym

    She seems to have changed the statement about c-sections to “never exceed 14%”, which I guess at least reflects the outdated and discredited WHO recommendation of less than 15%. Sort of. But even if the recommendation had been based on something other than someone pulling a number out of the air, there were caveats: “…in a normal, healthy population”. Not every woman giving birth is “healthy”. And only “some hospitals” exceed that rate, according to Dr. Romm. Hospitals that take more patients with risks, perhaps? In short, she doesn’t even make it clear that there is a problem by her own definition of “problem”.

    • The Computer Ate My Nym

      I left a very polite comment asking simply, “Which c-sections are unnecessary and what is the evidence that they are unnecessary?” Who’ll bet me an internet “I told you so” that this comment is considered “too negative” and not posted?

      • Jessica S.

        I certainly am curious if it’s disappeared. Please do update! :)

      • GuestB

        Good luck with that. There is not one negative comment posted for that article. Not one.

      • LMS1953

        In the course of my career, I have created several aphorisms:” OB care is filling in the blanks”, Nobody knows nuthin’ bout birthin’ no babies but everybody and their sister wants to tell me how to do it” “It will most likely not get done unless you do it yourself”, “At EVERY OB visit the patient will either ask or be thinking – Doctor, when are you gunna gimme another ultrasound?”

        As pertains to your post: “The only C-section you will ever regret is the one you did not do”.

        • Ob in OZ

          Oft quoted by me as well. And I do not have a high c-section rate because of it.

      • The Computer Ate My Nym

        And…no go. It’s disappeared. Apparently, asking which c-sections are unnecessary is too negative for the site.

        • MaineJen

          This makes me really mad, for some reason. It’s NOT a negative question, at all. It’s merely a query, asking for clarification of a very broad statement. If she (or anyone else) is going to make an assertion like “The C section rate should be no more than 14%”, they should then be able to go in and give specific examples of which sections were/are necessary and which weren’t.

          Spoiler: they will *never* be able to do this. You notice how, even when an NCB advocate ends up with a section, she’ll explain it away with, “Oh well, MINE was actually necessary…it’s all those other, unnecessary sections I have a problem with.” But they won’t get specific. Do they have a problem with ‘failure to progress?’ Exactly how long do you want to let that lady go on with her labor stalled at 8cm, as was the case with my sister in law? Exactly which breech babies (as was the case with two of my friends) are safe to deliver vaginally? Do you really want to let that 5’1″ woman with the tiny pelvis (friend’s wife) try to deliver a baby that’s clocking in at 9 pounds? They’ll never get specific. It’s easier to go all armchair-quarterback on us and tell us how they would have done everything differently. Infuriating.

          • Amy M

            Well, I know of a few who insist their Csections were absolutely un-necessary, they just consented because they didn’t know any better at the time, or the doctor played the dead baby card. If they’d just had a little more time, that baby would have been born vaginally just fine! “Proven” by the fact that the NEXT baby was born vaginally just fine, of course.

        • Sue

          Nym – some questions, no matter how polite, are just not ”safe”.

    • staceyjw

      Where is there a normal, healthy population? Not here.
      She doesn’t even realize that for healthy, low risk moms, the odds of a first CS is somewhere around 10-12%. The higher number includes all the other scenarios, but I don’t expect her to mention this, so bad is her misinformation.

    • AllieFoyle

      And what if a significant portion of women actually want, and are good candidates for, c-sections? Should they be denied that choice in order to keep the rate to some arbitrary standard?

  • auntbea

    Scratch that. Reading comprehension fail.

    • Anj Fabian

      While that would be a good way to study self selection bias, it would be a terrible way to study anything else.

    • Jessica S.

      Lovely. And interesting!

    • DaisyGrrl

      I took a feminist methodology course at the graduate level several years ago. I found it interesting, but as you pointed out, there are issues with using the methodology to *replace* existing approaches. Now, I come from a humanities background so I am not versed in the sciences or social sciences so I hope I’m getting this right. From an academic perspective, if one notes that a group of people consistently falls outside the norm/parameters it can be illuminating to conduct some in-depth interviews to better understand the experience of marginalized people. This can provide a fuller picture and inform decision making, especially when dealing with these populations. However, I don’t believe that it should ever replace proper evaluation and quantitative processes. If conducting interviews with women to better understand why they would choose process over outcome in childbirth can improve the quality of care and their perception of quality of care then go for it. Just don’t forget that numbers also matter.

      I suspect that the feminist movement and patient rights movement greatly improved the hospital birth experience over the last 40 years. In part, feminist methodology and small qualitative studies would have contributed to the body of knowledge in this regard. But the NCB community has forgotten that there is another side to the coin that is just as important. Informed consent means providing women with meaningful information that can allow them to weigh risks themselves according to what they value. Informed consent does not mean providing women with information that the provider considers meaningful while underplaying information that the patient considers meaningful. I think this error is fatal to the NCB movement because by underplaying the risks to the baby in choosing out of hospital birth, they are depriving women of the ability to give informed consent.

      So yes, aspects of feminist methodologies can supplement the work of mainstream research but should not exclusively relied upon in fields where rigorous methods are essential to advancing the body of knowledge.

      • auntbea

        Oh, no doubt there is a time and place for in-depth interviews, especially when you are making an argument about how people reason and want to trace their thought process (as you suggest), or when you are starting with something you don’t really understand, and trying to lay the ground work for hypotheses. The problem is with the idea that *only* experiences matter and that there is no truth outside those experiences. In other words, there can be no such thing as “risk” because that would imply there is such thing as an objective reality.

  • Durango

    I can’t wrap my head around her beliefs that home birth is great and spiritual, and yes there are some truly bad midwives out there. How on earth is a woman to know who the bad ones are? Aviva apparently knows, but she’s not telling. She’s absolutely sacrificing some babies and women on her altar of home birth.

    • Anj Fabian

      People definitely know who the bad midwives are, or at least suspect that certain midwives have far more bad outcomes than they should.

      Why don’t they call those midwives out or at least actively discourage women from using them?

      • The Bofa on the Sofa

        I’m sure the others practicing are aware, but how does a pregnant woman make that assessment?

      • Durango

        Or, to set a truly appallingly low bar, not hold a fundraiser for the killer midwives when those midwives kill a baby? And maybe, just maybe, support the loss families who dare to question their care?

  • Mel

    Her statements on chorioamnionitis made me do a head-slap as a dairy farmer’s wife.

    We don’t do vaginal exams on cows with any sort of frequency – ever. (It’s easier to check for pregnancy through the rectum than the vaginal canal in cows. We only do vaginal exams during labor if second stage seems stalled – that’s maybe 10% and delivery happens within 1 hour after the exam at most) And, yet, calves die from prenatal infections. Logic predicts that the calves, then, were exposed to the infectious agent from something besides a vaginal exam.

    • Jessica S.

      “It’s easier to check for pregnancy through the rectum than the vaginal canal in cows.”

      Yikes. Glad I’m not a cow. :D

      • Mel

        Me too!

        • KarenJJ

          Reminds me of watching James Herriot as a kid.

  • attitude devant

    I think the evolution of her thought is interesting. The stuff at the top of the piece (WHO recommendations for c/s rates, the particularly and peculiarly ignorant statements about infection and its causes) are pure undigested CPM stuff. She apparently acquired that ‘knowledge’ prior to med school, and since, in spite of her claims to be a family doctor specializing in obstetr.ics, she actually didn’t have an OB residency (for whatever reason), she’s never examined all that cant.

    On the other hand, her thought HAS evolved since starting med school: she has come to realize that lay midwifery in the US has a big fat problem. She puts all the disasters down to bad midwives. I think she’s wrong, of course. Bad midwives are part of the problem, but even a really smart, honest, well-trained midwife can run into big problems at home that don’t leave enough time for transport, or (because of the inadequacies of monitoring) are missed until it’s too late.

    So, I don’t know if she’s so much a hypocrite (and I have criticized her very sharply elsewhere for her con-artist type practice in oils) as she is full of unexamined ideas. I’d like to see if this convo changes her mind at all.

    • The Bofa on the Sofa

      Great, so the problem is “bad midwives.” As Dr Amy asks, what are you doing to get rid of them?

      Dr Amy has advocated starting by eliminating the CPM designation, and requiring all midwives to have education comparable to those in the rest of the world – CNMs will cut it.

      And if there are CPMs who aren’t all bad, then great, let them get the knowledge base required to practice.

      And Romm’s approach has been?

      • attitude devant

        Point well made Bofa. I do think she’s put herself in a pickle. If she honestly examined this issue, she’d probably lose some part of her business. After all, she’s selling woo AND Ivy League medicine.

  • Monica

    Apparently she’s happy to be a hypocrite too. I’ll tell you to have a homebirth, but I won’t attend it because I’ve got better things to do. Apparently those better things do not include creating standards of education and accountability for homebirth midwives either though. Oh that poor Yale educated “doctor”. I doubt that’s what she was taught at Yale.

    • auntbea

      Actually, I delivered at Yale, and while the doctors were great, the prenatal information sent out by the hospital was FULL OF THE WOO.

    • MLE

      They don’t give out grades at the YSoM, so she could have been dead last in her class. Although I am not sure when she attended, so that might not have been the case when she was there.

  • PrimaryCareDoc

    “Men don’t need “safe spaces” to be protected from facts that they don’t like. Why doesn’t she respect women enough to assume that they are just as capable as men in dealing with scientific evidence, even with evidence that might make them “sad”?”

    Amy, you hit the nail on the head with this! That is so true. This is exactly why so many seem to cry “foul!” when they read your blog. They say that you’re mean, sarcastic, and hate women. It’s clear to me that nothing could be further than the truth. You treat women as grown-ups, capable of reading the facts and coming to their own decisions.

    The truth is that it is the natural birthing community that is mysogynistic, treating women as children incapable of dealing with facts and evidence.

    • mollyb

      Exactly! So much of the NCB community revolves around infantilizing women. A woman can make the sensible decision to breastfeed, be totally committed but oh, no! If a formula company sends her a tiny can of formula what else can her tiny mind do but use it?! Let’s not refer to adult women as mothers or pregnant women, let’s call them all “mamas”, just like a little toddler would!

      • Mel

        I see it in the “Birth Warrior/Goddess” who will crumble if a L&D nurse asks her if she wants an epidural.

        The vast majority of my high school students by grade 12 are capable of holding an opinion or a course of action in the face of opposing view points. Many can do that by grade 9. Why does NCB related theories assume that any opposition will cause a woman to cave when a teenage boy or girl can hold firm? I suspect the ‘weak woman’ argument is a sneaky form of poisoning the well so when women do have real doubts they project the cause of the doubts outwards onto the ‘un-supportive’ people around them rather than examine what they are feeling.

        “Unsupportive” reminds me of a Mothering.com thread about how a mother-in-law was undermining a DIL by buying a baby swing. Instead of the DIL thinking “Oh, that’s nice!” or “Let’s return that for some cash!” or even “I’m gonna show her and never take that out of the box!”, the poster started whining about how she was being undermined – because a gift can do that…..

        • Jessica S.

          And the “weak woman” argument is an excellent way of protecting their business model, too.

    • Squillo

      When did the “safe space” morph from being a (useful and important) private place for groups of individuals to discuss issues of personal importance without fear of judgement or more tangible repercussions into a public place where groups of like-minded individuals can opine on topics without fear of being criticized or challenged?

      • Busbus

        I know – it’s crazy! I wasn’t even aware how much censoring and deleting went on in these forums and discussion groups until I started writing stuff that didn’t jive with the NCB/home birth consensus. It’s a truly disturbing trend.

        • The Bofa on the Sofa

          I don’t bother with such groups anymore. Not surprisingly, when I have in the past, I haven’t lasted long.

          Nowadays, I won’t bother participating in discussion forums unless everyone is on board with the principle:

          This is a discussion group, and everyone’s opinion is welcome. However, that means everyone’s opinion, including the opinion that your opinion is nonsense.

          If you can’t accept that, then I have no interest in participating.

          I really get tired of the “I thought this was a place where we could express our opinions?” complaint. Of course you can express your opinion. That doesn’t mean everyone has to agree with it. And just as you are allowed to share your opinion, so are they (this is the biggest problem I have with it – the contradiction of it all. “I am allowed to share my opinion. You are not”)

          I generally figure that anyone resorting to “I thought we were allowed to share opinions” is only saying it because they know they can’t support it. Maybe I should call that the “Bofa Opinion Postulate.”

          Add that onto Pablo’s First Law of Internet Discussion and Pablo’s Scenario as internet meme’s that I have created.

          Although I’m guessing the Bofa Opinion Postulate is not new. Liz probably knows of something already out there.

          • Sue

            This ”everybody’s opinion is equally valid” culture in some of our societies is becoming ridiculous.

            it’s well described in the article “The Death of Expertise” by Tom Nichols in The Federalist Jan 17th – easy to find (I can’t post the link). Worth reading!

          • PrimaryCareDoc

            I just read it. What an amazing article.

          • The Bofa on the Sofa

            This ”everybody’s opinion is equally valid” culture in some of our societies is becoming ridiculous.

            The problem is, it really ISN’T “everybody’s opinion is equally valid.” Remember, the motivation behind it is to squelch others’ opinions.

            This is why I find it so bloody annoying. If it were really “everyone’s opinion is valid” then that would mean include my opinion that your opinion is bullshit. But that “opinion” is apparently not acceptable, or at least considered meen.

            So that’s the basis of my statement. IF everyone is entitled to express their opinion, then you can’t complain when others do.

            But that is exactly what happens. Waaaaaaahhhhhhh! You made a point that I can’t refute! Your meeeeeeennnnnnnnn!!!!!! It’s my opinion, you’re not allowed to disagree.

      • Josephine

        Yes, the abuse of the “safe space” concept really irritates me. Safe spaces can be valuable to survivors of trauma or people who are in an oppressed group (or probably plenty of other things that aren’t coming to mind right this moment), but I’m not sure how that morphed into “I can deem any public forum a safe space. I refuse to listen to evidence or reason, and I’m being attacked by anyone who disagrees.”