I was interviewed by journalist Lindsay Beyerstein on the subject of homebirth and the recent publication of statistics by the Midwives Alliance of North America.
You can find the interview here:
http://www.pointofinquiry.org/amy_tuteur_md_-_the_skeptical_ob/
It’s a long interview. There’s just as much after the commercial break as before.
Thanks to Point of Inquiry and Lindsay Beyerstein for the opportunity to share my thoughts!
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Dr. Amy Tuteur is an obstetrician gynecologist. She received her undergraduate degree from Harvard College in 1979 and her medical degree from Boston University School of Medicine in 1984. Dr. Tuteur is a former clinical instructor at Harvard Medical School. She left the practice of medicine to raise her four children. Her book, Push Back: Guilt in the Age of Natural Parenting (HarperCollins) was published in 2016. She can be reached at DrAmy5 at aol dot com... More
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Nice interview. Listened while I folded and put away laundry, glamerous I know.
New York Times, LA TIMES, Chicago Tribune ect Amy, get as much exposure as you can. And it would be helpful for CNMs if you would question WHY this has been allowed to go with the leadership of the ACNM being aware of all the deaths, ie prosecutions of midwives 300 were counted by the associated press between the years 1982-1992 that resided over either a mortality and or a morbidly by reviewing court documents, and 75 midwives WERE indicted in Texas on birth certificate fraud by selling fake certificates to Mexican immigrants.
And all the studies by ACOG that show increase in mortality rates at homebirths attended by non nurse midwives, and all the deaths that you have exposed. Not to mention all the blogs and website by the poor consumers who share a wealth of qualitative data describing relational trauma “the midwife spell” that so eloquently describes PTSD after being exploited by a perpetrator.
I thank you Amy for all your work and for your ability to stand up to the injustice that is currently occurring within midwifery. I myself am leaving the profession because of the corruption but plan to continue active in the fight to expose this everyway that I can. However, you are the leader and expert and midwifery needs you right now to be as LOUD WITH AS MANY AS POSSIBLE.
CURRENTLY IT IS CRITICAL BECAUSE OTHERS WILL BE MANIPULATED INTO BELEIVING THE ARTICLE IS ABSOLUTE, THUS, INNOCENT MIDWIVES WITHIN THE COLLEGE ARE HAVING THEIR REALITY DISTORTED BY ACNM LEADERS ALSO. THIS IS OCCURING IN ORDER TO FEED OTHERS PERSONAL GAIN. THE HOMEBIRTH LIST SERVE WITHIN THE COLLEGE IS ACCOMPLISHING THIS AS WE SPEAK DISCOUNTING YOU AND ABUSIVLY LEADING OTHERS THROUGH EXPLOITING THEM EMOTIONALLY. I AM NOT ON THIS LISTSERVE I WAS JUST INFORMED OF THIS YESTERDAY BY ANOTHER MEMBER.
Science & Sensibility: postpartum psychosis is caused by eating too much processed food and can by fixed with B12 injections. Also, Prozac contains fluoride and we all know how evil and toxic that is. http://www.scienceandsensibility.org/?p=7942
Um…what? B12 injections don’t fix any psychosis not caused by B12 deficiency and prozac is fluoxetine (not fluoride) HCl.
Talk about a big, basic chemistry FAIL! It should be an internet law that if you confuse “fluoride”, aka the compound HCl, with the element fluorine (whose atoms are part of many useful everyday products, including NaCl, best known as table salt), nothing you write about science, health or medicine is to be ever taken seriously again.
C’mon, 7/8 letters isn’t bad, is it?
I blame the English language 😉
In French, Spanish or German, the words have more than one letter difference.
But HCl is hydrogen chloride, not fluoride.
Oh gosh, you’re right! My bad. So much for posting in anger ><
Indeed HCl is hydrogen chloride, and NaCl sodium chloride. Both are compounds with a chlorine atom (Cl), not fluorine (F). Both are halogens and share some properties but are different in other respects. And of course table salt has no fluoride, but fluorine compounds can be found in toothpaste.
Toothpaste is evil? Are they into worrying about contamination of Precious Bodily Fluids with fluoridated water?
I wouldn’t be surprised. Evil fluoxetine, evil fluoridation of water… Chemistry is scary! But in toothpaste, AFAIK, no-one objects, even Boiron, a big manufacturer of homeopathic products, offers fluoridated toothpaste. They just don’t emphasize that. Instead, they market it as an alternative, “herbal” paste. If you don’t read the list of ingredients, you won’t notice that there’s no difference from most of its competitors: same active ingredients, different herbal extracts for flavor.
Oh no, there’s a big market for non fluoridated toothpaste.
Wow. Precious bodily fluids indeed!
Doesn’t the magic pink Himalayan salt these people are always on about have fluoride in it?
Anti-fluoxetine woo/eugenics is one of my pet peeves as I have a major dog in the fight. You know, the one where I’d be dead without it?
Was very surprised in a good way to see this come up in my podcast player while taking a walk today. Great interview! I feel like the Point of Inquiry audience would have enjoyed a lot of wackier anecdotes from lay midwives, but might not have thought they were real. The cinnamon candy comes to mind.
Great work Dr. Amy and Lindsay Beyerstein!
I’ll check it out right after I post this:
http://abog.org/news.asp
When I was doing my MOC for ABOG back in Dec 2013, there was a new policy instituted in Nov 2013 that a Board Certified OB/GYN could not take care of males except for doing circumcisions and taking care of the transgendered. The reason: there are too few Board Certified OB/GYNs to take care of all the women who need such services. We only make up 5% of physicians in the US.
About 50% of all deliveries in the US are covered by Medicaid. Medicaid reimbursement barely covers the overhead to provide the service, if that. So some OB/GYNs have sought to augment their income by doing cosmetic surgery (liposuction) and doing hormone replacement therapy in the office for both females and males (low T). The policy change was met with much protest and at least two lawsuits based on anti-trust (which the policy clearly was). Week by week Dr Larry Gilstrap, executive director of ABOG, would issue amended edicts until the policy was completely reversed and abandoned on January 31, 2014.
The reason this is pertinent is that it is next to impossible to get hospital privileges in whatever speciality without board certification or board eligibility. If we insist on hospital birth, which is the safest place, this little brouhaha supplies lots of ammunition for the promulgation of alternative providers. At BEST that will mean a considerable influx of CNMs. In my experience the vast majority of CNMs are Ina Mae wannabe’s who are as dedicated to the woo as the crunchiest of CPM/DEMs. These are ill political winds blowing
Hehe, not to make light of the difficulty you may be having, but at the rate women are taking over the medical profession, pretty soon this will be a non-issue.
At the rate women are taking over the medical profession, it will only exacerbate the issue. The Dr Amy’s of the world are by no means unusual. They get the brass ring and then…..well, it is time to raise a family. All those hundreds of thousands of dollars that go in to training a doctor – poof- all wasted. That is a mighty expensive brass ring. I cannot imagine a more demanding lifestyle than being an OB. For a women who wants a family, it is next to impossible. The shortage of boad certified OB/GYNs is augmented by the fact that at least 75% of OB residents are female, but they will work fewer hours per year and fewer years per career than will a male OB.
It is no less possible than it is for a man, and I think you’ll find that family dynamics are changing to reflect that as well.
To use a familiar Dr. Amy quote – You don’t know what you are talking about.
The world that you and Amy grew up in is not the one we’re in now. The fact that Amy stayed home to raise her kids does not prove anything about women today. Strict ideas about family composition and gender roles are changing and the question of whether or not a woman can “have it all” is on its way to one day becoming meaningless. Men are more and more accepting the fact that the benefits of having offspring are equally shared and the responsibilities and sacrifices should be too. Families are even, (gasp!) adopting hyphenated names. These days, women aren’t forced to make the choice that Amy made. And unlike when you went to school, universities are FULL of women. Demographics are changing. If you don’t think that’s going to change how we do things in the future, then you are just deluding yourself.
As more people like you get over the idea that a woman’s place is in the home, the average hours worked by female physicians will go up. I would be highly surprised if they haven’t already. Hell, even the infosheet you linked attempting to prove your point showed that the average hours worked by women, although fewer than men, is increasing every year. So I’m thinking it may be you who doesn’t know what you’re talking about.
That’s even assuming that women are choosing to work fewer hours. In many other cases, if we see women working fewer hours, we interpret it to mean that women are being discriminated against in high-powered jobs and have to take jobs that are more routine or even part-time.
Your sexism is showing. How many male obstetricians have given up OB in the past decade? And why have they given it up? Because of malpractice claims, insurance aggravation and a climate that encourages women to think that birth is safe and if anything goes wrong it must be the doctor’s fault.
How many male doctors have given up practice to go into more lucrative areas like Pharma or insurance companies, or to become physician executives?
When male doctors leave medicine they do so for “other opportunites,” but when women leave medicine for their children you chastise them for abandoning their profession. Why the double standard?
Amy, when was your last delivery? When were you last Board Certified? Do you have an active medical license?
QED.
http://www.schoolofpublicpolicy.sk.ca/_documents/_Tansley%20Lecture/2013%20/Doctor%20is%20not%20in_final.pdf
Amy, check out this graph and try not to play MANA with it.
1) That appears to be a project for a Master’s degree student, not a primary source. I don’t know what study the graph came from, whether it’s a survey or a comprehensive count of some kind, or whether it’s one hospital, one province or all of Canada.
2) There is a graph that shows female physicians work slightly fewer hours per week on average (48 vs 53) but I didn’t see any mention of women doctors dropping out of the profession, nor a comparison of the frequency with which female physicians change careers or retire early compared to male physicians.
(Attention para-trolls on the breastfeeding post, THIS is how adults debate!)
I don’t know anything about the medical profession other than as an observer, but I’ve always maintained that as a patient, I don’t want an exhausted doctor treating me. I make mistakes at my job when I am very tired. If 48 hours a week is considered unproductive, then there is something wrong with the profession.Also, as personal preference, I won’t go to a male gynocologist, and a lot of women won’t.
I think the trend to working fewer hours is going to increase as more doctors find themselves in salaried jobs — certainly this is true here in Israel, where nearly all doctors are salaried and the demand for private medicine is small. It’s still true that residents work horrendous hours, but even that is changing, and it has nothing to do with the gender of the doctor.
I had a super male GYN resident when in hospital with a m/c. He was really great, professional and excellent bedside manner. He was being supervised by a female GYN, she was super too. It doesn’t bother me in the least to have a male OB/GYN
But CC, look at those mad Excel skills. Those bars are 3-D and everything!
If you think taking care of kids is not meaningful work you’ve undone many years of feminism.
Currently I work 8 sessions a week. I will be starting a new job working 5 sessions a week (job share with another female Dr), but, because of the nature of the new job I fully expect to be taking work home with me, logging on remotely in the evenings to finish paper work and coming in on my “days off”.
Sometimes part-time working undercounts the amount of work done, because it is done “off the clock”, or at home.
There is also a good chance that even if both members of a couple work 48hr weeks the woman will still be doing the lion’s share of the housework and childcare in addition. Few couples have completely egalitarian housekeeping and childcare arrangements.
5hrs less at work probably means 5hrs more cleaning, cooking and taking care of the home.
Just a thought.
Needs confidence intervals and control for subspecialty. For example, surgeons tend to work longer hours and more men than women go into surgical subspecialties.
SERIOUSLY, LMS? SERIOUSLY??? Why are you bringing up the most pathetic defense of the crunch trolls? Why not throw it in scare quotes? “Dr.” Amy. You are really becoming offensive in your mansplaining and paternalism and plain old sexism.
I am completely serious. Amy was identified as an obstetrician/gynecologist. This is not a profession where you get an eternal appellation like calling Newt Gingrich “Mr Speaker” for twenty years. You have to do yearly Maintenance of Certification to remain Board Certified. And you have to be Board Certified/Board Eligible to get hospital privileges to do deliveries and gynecological surgery. I have no problem with “former”, “ex”, “retired”, but the use of the present tense borders on misrepresentation and is frankly offensive to those who spend a heck of a lot of time and expense to earn the appellation. Likewise, if you don’t maintain an active medical license the use of the title comes off as presumptuous – like the PhD who wants to be introduced as “Doctor” at a Christmas Party.
You know, LMS, I’ve noticed that your posts written during the day are fine, but after work hours you start writing inappropriate bigoted trash. Why do you seem to lose the ability to distinguish between appropriate and inappropriate after the work day ends?
EtOH?
That is a bit rude,
But plausible.
Why is that rude? It’s actually a pretty likely explanation for why someone is coherent and appropriate during office hours but obnoxious after hours.
Feel free to criticise his beliefs and call him sexist – he’s definitely earnt it – but taunting anyone about alcoholism makes you a piece of shit.
Dr Amy implied it (which is fine), but you’ve made it overly personal.
I’m also pretty uncomfortable with everyone piling on as a group bonding exercise, and it’s been going on for a while.
Let’s keep some perspective here.
It does seem that there are a few people who are quick to pull out the MRA-sexist-mysogynist pitchforks, but I don’t think anyone was implying that he’s an alcoholic. Just in vino veritas, yanno?
Please show me exactly where I said he was an alcoholic. Or where I taunted him.
Possibly. But less problematic than the explanation that doesn’t involve alcohol, which is that he is sexist and racist while perfectly cogent.
“Why do you seem to lose the ability to distinguish between appropriate and inappropriate after the work day ends?”
By his own description of his multiple run-ins with work colleagues it sounds like he has problems with being inappropriate at work too.
“Amy was identified as an obstetrician/gynecologist.”
And it appears to me that she is still using her training in that capacity. Can you imagine this blog being written by someone without that training and experience? It would be impossible.
I have never heard of a retired Doctor not still referred to as a doctor.
I know an OB who went out on disability ten years ago and I would not dream of calling her anything but Dr. M if I were to not call her by her first name. And if my retired grandfather were called anything but Dr. I would be disgusted. I also never have seen Dr. Amy using FACOG behind her name anyway.
Do I stop being a CNM because I retired last year [Israel has mandatory retirement for women at 67]? Is my brain wiped clean of all my knowledge, education, and experience because I am now at home?
Of course not. The system I’ve been working in since moving to Israel in 1976 is based very largely on part-time employees: nearly all nurses are, because the requirements of family life and hospital work rotas make full time extremely difficult. The doctors working for the health funds seldom work full time at a single location; even my [male] GP works “banker’s hours” because night and weekend calls are handled by a different arrangement [there are emergency walk-in clinics open 24/7 for health fund patients who need out-of-hours care]
BTW, I refer to Amy as Dr. Amy not because I feel she “needs” the designation but because there have been several Amys on the forum at various times, and this is a way of making sure it’s clear to whom I am referring.
I have also encountered, in my career, doctors in active practice who have barely read a medical journal or kept up with new developments from the time they completed their Board Certification. There have been times when I told patients who wanted advice that they were better off with Dr. Young Resident than with Dr. Pompous Ass who is 20 years older, or Dr. Old Fart with shaking hands who brags that he’s delivering the grandchildren of his original patients. There is no reason a person can not keep up with his/her education even if it’s been some time since he/she put on sterile gloves.
I’m going to defend LMS here for a minute: He hasn’t suggested barring women from medical school or requiring legally binding pledges of childlessness. Yet.
Oops. Irony detection fail.
“You are really becoming offensive in your mansplaining and paternalism and plain old sexism.”
Becoming? He’s always been that way.
(That said, I would still have him deliver my baby over any CPM in the entire U.S.)
Between him and Joe Kano, I am beginning to understand the condescending, bullying male OB stereotypes who populate crunch-land. Really thought those guys were gone 30 years ago.
No, hang out on Reddit for a while. There’s a whole new crop of them in their teens, twenties, and thirties.
Oh, I am quite aware of the Men’s Rights Redditors. I just didn’t think they still selected into being OB’s.
Me either. It’s a job where you have a tremendous amount of power over women, so I can see the appeal for sexists. Wrong-minded appeal, but still appeal. Men aren’t really flocking to the profession, though.
Joe Kano is not an OB. He’s a nurse or a tech or something.
As humble as I can post, about 10 years ago, I have heard of some statistics showing that females going into OB/GYN have chose less call, better hours, and some with part time practicing in larger practices. Maternity leave only made the remaining partners work harder. Nothing wrong with that. The study quoted something like you would need 1.7 new female OB/GYN to cover what one “old” male OB/GYNs did in hours of practice. That goes along with that old style male doctor on call 24/7 and missed so many family outings.
Now we are seeing the males coming out of residency demanding the same more optimal easier lifestyle and working less as the females did years ago. So I see the current total OB/GYN “presence” working less as the old time workaholic mindset OB/GYNs retire.
“So I see the current total OB/GYN “presence” working less as the old time workaholic mindset OB/GYNs retire.”
So graduate more of them then. Times change.
Those old time workaholic obgyns had someone else (perhaps also a workaholoic but in a different sphere to them) to wash their clothes, make dinner, pick up the kids from school, get kids to sports/haircuts etc, etc. Not just in obgyn but change is happening in other professions too. I know two managers in an IT project firm where I live that work 4 day weeks. One spends a day with the kids. The other plays golf. Both men.
Captain Onvious is right – what used to be identified as ”feminisation” of the medical workforce has now become ”humanisation.”
In Australia we have always worked less total hours and had more leave than our US colleagues, but now we have Gen Yers who want to work more humane hours for all sorts of lifestyle reasons – not just families and kids. And good luck to them – why do OBs have to be the absent fathers of the past?
Agreeing with Dr. Amy here: I just delivered with an all female OB/CNM practice & all but one of each provider (4 CNMs/3OBs) had families. Some even had large families.
As resident barren spinster around here, I’m going to interject to point out that while not every adult raises children, every person has or at one point had a family.
Might have just been accidental poor word choice on your part, but we aunts and uncles and daughters and sons of the world have family responsibilities too. Please don’t erase us.
Interesting. I’m a woman. I have the highest productivity in my group, which is made up of multiple practices, and has more men than women. 3 doctors have left my practice in the past 10 years. All went into non-clinical careers. And yet, here I remain.
Yeah, and I am sure there is a woman somewhere sitting in a home birth kiddie pool with a healthy breech birth baby in her arms, But go ahead, play MANA with the stats.
That’s weird. I’ll have to mention that to the chair of obstetrics at my local hospital next time I see her picking up one of her 4 kids at preschool. She’ll be grateful to know that she can’t do her job and have kids at the same time.
I smell MRA!
But for a man who wants a family, no problem. …do you see why this comment is getting a bad reaction? 😉
–woman who has a family and works on call
In my experience the vast majority of CNMs are Ina Mae wannabe’s who are
as dedicated to the woo as the crunchiest of CPM/DEMs.
Possibly that is the situation in the US; I have not worked there since 1976 except for a brief period in 1999. That was not the situation in the UK, when I was there, nor is that the situation in Israel at present.
CNMs may well be much more crunchy than OBs, but they are trained specialist nurses and if they work within hospital policies and governance structures, they can be held to account for deviations. Hospital CNMs are also part of health care teams – not lone rangers.
Are there CNMs who are into woo? Absolutely, but I don’t think they are the majority. My CNMs practiced evidence-based care. I had all of the recommended tests, including an early dating ultrasound, the quad screen, anatomy scan, and GD testing at 28 weeks. I got my flu shot at their office during my first trimester with my second child. There were a couple of CNMs who were a bit more into woo than I would like – one recommended chiro over PT for SPD, and another had a “concoction” for inducing labor that included castor oil – but I never felt like they were reckless during my prenatal care or labor.
This is why I periodically claim that the crisis in health care isn’t that we’re spending too much on medical care but that we’re spending too little. If OB/GYNs can’t make a living doing obstetrics and gynecology there’s a problem. A major problem that isn’t going to be solved by performing a little liposuction. Medicaid needs to reimburse better. Private insurance needs to be required to reimburse in a sane amount of time and without major harassment. Medicare needs to be more consistent. There’s no reason why this can’t be done, we just lack the political will. But we’d better find it if we want to live and be healthy. There’s no going back to the “good old days” of independence, self-reliance, and allowing the “weak” to die if they couldn’t give birth on their own. Not without a massive population crash anyway.