Grounded Parents does a hatchet job on my analysis of the MANA statistics paper

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Jamie Bernstein, in a guest post at Grounded Parents, has performed a hatchet job on my analysis of the paper from the Midwives Alliance of North America (MANA), which claimed that homebirth is safe when it’s own data showed the opposite.

The worst part is that Bernstein, described as Skepchick’s resident stats junkie/guru, was incredibly sloppy. There are at least 8 separate errors of fact, of numbers or of math. Frankly, I think Berstein and Grounded Parents owe me an apology and well as owing their readers a correction of the many egregious errors.

Jamie failed to understand the most basic fact about the MANA data. This is not a study; it is a non-randomized survey, which was ignored by more than 70% of the midwives who were supposed to participate. Even then, 25% of the respondents did not provide complete data. Far from being a “study,” this represents MANA’s best efforts to cherry pick it’s own data. That’s what makes the high mortality rate so concerning.

Let’s go through Bernstein’s error one by one:

1. Bernstein wrote: “I clicked the link Dr. Tuteur gave where she got the Citizens for Midwifery quote but didn’t see anything with that quote or numbers on the linked page. I did download and read the study which these numbers supposedly came out of …”

How could you not find it? I gave an exact quote in my piece and linked to the place where the original can be downloaded? It is on page 3 of the 5 page CfM press release, the beginning of the second full paragraph. Please check to confirm.

2. Bernstein wrote: “I’m not really sure exactly where this quote came from and these numbers don’t seem to match anything in the study.”

Wrong again. On page 7 of the study, under the section Fetal and Neonatal Morbidity and Mortality, second full paragraph, last sentence: “When lethal congenital anomaly-related deaths were excluded (n = 0 intrapartum, n=8 early neonatal, n = 1 late neonatal), the rates of intrapartum death, early neonatal death, and late neonatal death were 1.30 per 1000 (n = 22), 0.41 per 1000 (n = 7), and 0.35 per 1000 (n = 6), respectively (Table 5).”

1.3+ 0.41+ 0.35 = 2.06

Bernstein quoted those exact numbers but never bothered to add them together to get the total.

3. She wrote: “First of all, can I first point out that it’s a 4x increase, not 5.5x (1.6/0.4 = 4).”

Except that the correct number of MANA deaths was 2.06/1000 not 1.6/1000.

4. She wrote: “I seriously have no idea how Dr. Tuteur came up with 5.5x or 450% increase in mortality from the numbers that she cited.”

That says more about Bernstein than about me. I explained how I got it in my post and I just explained it again.

5. Bernstein wrote: “What we’re really looking at here is a risk of death increasing from 0.0004% to 0.0016%. This is a difference of 0.0012 percentage points.”

No, that’s not what we are looking at. Bernstein is off by more than 100 fold. 0.4 deaths/1000 is 0.04%. She added two extra zeros. The homebirth death rate was 2.1/1000, which is 0.21%. So the difference is 0.17%. That sounds like a tiny number, but when you are talking about thousands of births, it’s the difference between 4 deaths for every 10,000 babies born in the hospital and 21 deaths for every 10,000 babies born at home.

6. Bernstein wrote: “All we know about the info Dr. Tuteur got from the CDC website was that it was for white women with low-risk births. This includes hospital births, homebirths, and births in locations other than the home and hospital (though she labeled them as hospital births on the chart she posted).

Clearly she never bothered to look at the CDC Wonder database, which contains an complete description of contents. I specifically noted that I looked at white women, 37+ weeks, 2500 gm babies.

7. Bernstein wrote: “This includes hospital births, homebirths, and births in locations other than the home and hospital (though she labeled them as hospital births on the chart she posted).”

Wrong again! I did not include locations other than home or hospital and label them hospital births. I don’t know where she got that idea.

8. She wrote: “Women who choose to have a homebirth are likely very different from all white women giving birth, so it’s not really a fair comparison.”

Really? White women who give birth in the hospital tend to be younger, poorer, of lower socio-economic class and more likely to smoke than the homebirth group, which means that the 450% higher homebirth death rate actually UNDERCOUNTS the difference in deaths between home and hospital.

Finally, Berstein wrote: “The “homebirths are killing babies” review by Dr. Amy Tuteur was less “focusing on some parts of the study while downplaying others” and more just a sloppy and unscientific attempt at calculating relative risk by using two completely non-comparable data sources in order to scare readers away from homebirths.”

No, what’s sloppy and unscientific is Bernstein’s hatchet job. She is WRONG about the numbers, WRONG about the math, WRONG about the quotes, WRONG about the CDC Wonder database, WRONG about the differences between the home and hospital group and therefore, completely WRONG about her conclusion.

I hope Bernstein and Grounded Parents will acknowledge these errors and correct them. I’d like to see them apologize.

It’s the least they can do after writing and publishing this sloppy hatchet job.

  • Whatnow

    I think it’s important to note that the skepchicks are primarily concerned with social justice and feminism. Medical intervention to, I dunno…save a baby or a mother? is seen as violating poor womyns. Skepchick’s writers will always take a political side over science even if those politics conflict with science, like the supposed hospital birth war on womyns. Anybody can call themselves a skeptic. Make no mistake, skepchick is a feminist group first and foremost.

    • Guestll

      Okay, duly noted.

      How does this change the fact that Bernstein’s hatchet job is just that?

      Is there NO OTHER Skepchick who can math?? They published this dreck, they own it — irrespective of their agenda.

      • sdsures

        This makes me sad.

  • drmoss

    My reply over there:

    silverfeather13 wrote:
    “There have been a lot of posts on this site about the authors being
    judged harshly and treated badly for having a c-section, or an epidural,
    or not breastfeeding. I support every one of those choices and would
    not try to shame you for them. Now here many of you are trying to shame
    me for mine.
    I’m not going to engage on this thread… it is really hostile here.”

    In general when people want to make choices that differ from mine
    it’s none of my business. When they make stupid or dangerous choices
    that will run the risk of harm to themselves alone, I would warn them
    but if they are competent adults it’s still not my business to stop
    them. We have perfectly clear evidence that homebirth is several times
    more dangerous to both infants and mothers (especially the former) than
    hospital birth. Even the MANA study shows that, and it was a
    self-selected groups of providers voluntarily reporting (would you
    report your disasters if you didn’t have to do so? The real perinatal
    mortality rate will be higher in all likelihood that shown in this
    paper.) Given that we are now talking of people making bad choices that
    run risk not only to themselves, but to their babies that have no say in
    the decision. It seems right to me that we should speak up a bit more
    loudly. And when it comes to egregiously bad choices, such as breech,
    twin, primip, VBAC at home, I think shame IS appropriate. I would
    actively stop a parent from harming their child – I’m certain you would
    too. I would speak up if they let their child do something dangerous –
    and so, I hope, would you. Why wouldn’t we do the exactly same just
    because the child is in utero? For untrained people to encourage and
    facilitate high-risk deliveries at home shows either great callousness
    or great ignorance, and I would do more than shame them. They deserve
    prosecution. I used to deliver in a rural hospital with no anesthetist,
    no surgeon/OB, and no blood bank. An hour’s drive to those things won’t
    work for a cord prolapse or a PPH. I saw my predecessor’s deliveries
    scissoring down Main Street, those that had CP mildly enough to be able.
    I stopped it as I knew it wasn’t safe enough. I was not prepared to
    live with the knowledge that I had caused such things. I simply hope
    that others have the decency and the foresight to see what they are
    letting themselves in for and understand their own limitations when they
    make these choices. Hostility – nothing personal; I just have a thing
    about people who are careless with the lives of others.

    In moderation, so may never see the light of day.

  • giliell

    While I completely agree with you on this very bad post and the nonsense some commenters write, could you please stop referring to ALL of us like this? Most of the bloggers and regulars are quite with you

    • KarenJJ

      Is this in reply to someone? Disqus can be buggy and random at times.

    • OttawaAlison

      I know most aren’t, it’s just a shame that the first two posts on GP dealing with Home birth were friendly to it in a way. There is so much woo in the ncb communities it would have been nice to see that called out rather than seeing an Axe to grind against Dr. Amy, a fellow skeptic.

      • giliell

        THere are also posts that are quite against it, and those weren’t the posts that got much disussion

        • OttawaAlison

          I saw Chris’s second post and the Portlandia one. I guess it will be full of short articles but seeing tweets saying “I was antihomebirth but now I’m not due to anti-homwbiryh activists (aka Dr. Amy) seems petty and irresponsible from someone who runs a site that is supposedly against woo.

          I think that the article against Dr. A was unnecessary and people were free to criticize the Dr.A piece here when she published it instead of highlighting it on an evidence based site – sure challenging skeptics from skeptics isn’t a bad thing per say, but when you do it you pretty much have to ensure your rebuttal is air tight. Tbh it ended up just looking like lots of infighting. Dr. A isn’t against being corrected, I have been following her for the past 5 years. I have seen her correct things, she doesn’t become angry and beligerrent when she knows she has made an error.

          Now MANA is guiding people to the article and going ‘ha ha’ evidence people know that Dr. Amy was wrong. We’re right.

          For a new site just getting its feet wet, I hope the next 10 articles just take the woo head-on instead of skeptic to skeptic fighting (next 10 articles dealing with home birth).

          I get most of the GP writers are anti-homebirth but are entitled to their own opinions, but honestly it was disappointing to see 2 of the first 4 articles (and long articles at that) creating an ambiguous image for the site.

          • OttawaAlison

            Giliell – sorry for the rantibg, it’s not against you at all. It’s just frustrating – first the Grounded Midwives one, then this. Elyse needs to tread carefully. To some of ud honestly it looks like “well since only 1 in 1000 die with measles some of the vaccine, while vaccination is generally good, it’s okay to not to when you see the absolute risk is low and people who insist it is necessary often use fear-mongering rather than the reality”.

            I get you’re on our side :-)

          • Jessica S.

            “Now MANA is guiding people to the article and going ‘ha ha’ evidence people know that Dr. Amy was wrong. We’re right.”

            Great.

      • sdsures

        “Are you the Judean People’s Front?”
        “**** off! We’re the PEOPLE’S FRONT OF JUDEA!”

    • auntbea

      I read your posts and agreed with them– so much so, in fact, that I assumed you were one of us under a different name and therefore left you to it. Sorry!

      • KarenJJ

        Same. Glad to see the discussion happening and not just here. It gets deleted a lot elsewhere..

  • Elrond Hubbard

    Dr. Tuteur would have done a much better job overall if she hadn’t stooped to replies such as “seriously?” , “…you couldn’t be bothered” , and so on. Doing so makes Dr. Tuteur not only look no better than anyone making assumption/factual/math errors, it makes her look petty, and angry. If she is able to let someone like Bernstein, who doesn’t seem to be a professional statistician or medical professional ruffle her feathers this much, I’d question her judgement in plenty of other situations, professional and personal. Also, she spelled Bernstein’s name wrong and least once, and made multiple grammatical errors. Seriously.

    • Elrond Hubbard

      Oh and, that’s a picture of an ax, not a hatchet.

      • KarenJJ

        More very critical errors by Dr Amy..

      • Box of Salt

        Splitting wood, or splitting hairs?

      • Anj Fabian

        No, it’s a picture of a maul. I have one. I use it to split wood.
        [rolls eyes]

    • theNormalDistribution

      she spelled Bernstein’s name wrong and least once, and made multiple grammatical errors.

      very critical errors indeed.

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

      Tone troll. Boring.

    • Box of Salt

      Elrond Hubbard, could you explain to me why, if Jamie Bernstein “doesn’t seem to be a professional statistician,” was her guest post introduced as by “Skepchick’s resident stats junkie/guru” ?

      We wouldn’t be having this conversation at all had Jamie Bernstein “done a much better job overall” at both reading the piece which she critiqued, and at writing her own. Minor math erros? Simple, maybe, but minor – no.

      • Box of Salt

        ^error, not erros.

        See how easy it is to make corrections?

      • KarenJJ

        stats junkie, birth junkie… Just put your money where your mouth is and get the degree.

      • sdsures

        Everyone seems to be a self-appointed guru these days.

    • Captain Obvious

      When I talk to some patients, I need to talk so they can understand me. If I use big medical terms, it goes right over their head. I believe Dr Amy was talking in terms even so Jamie could understand. Reading through Jamie’s quick lazy response, Dr Amy fired back a similar simple easy understandable response for this stats junkie who posted a blog junkie post about birth junkies.

    • auntbea

      Jamie accused Dr. Amy of intentionally manipulating numbers to maintain an ideological stance, with a hearty heaping of snark. The pettiness and stooping were already there in spades, AND without any actual evidence to back them up. Incredulity and a degree of scorn were entirely appropriate responses.

    • Starling

      You must be new here. If you go back and read a few of Dr. Amy’s previous posts, you’ll realize that this is pretty much the tone of the blog. Dr. Amy IS angry. Very, very angry. Something about the preventable deaths of infants really pisses her off. A lot of people hate it, but it’s the voice Dr. Amy has chosen to use. I don’t think she owes Bernstein any special courtesy or deference.

    • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

      You know, Dr Amy is just a person with some facts. She doesn’t really owe politeness or sugar coating to random internet people who decided not to do basic fact checking before writing an article critical of her. Funny how dudes get chided about their tone way, way less than women who state their opinions outright. I wonder why that is?!

    • ngozi

      She is angry about dead, maimed, brain-damaged babies and mothers who are mislead about homebirth. Sounds like good reasons to be angry.

    • sdsures

      But if someone points out a grammatical error, she will usually correct it.

  • Amy Tuteur, MD

    Here’s Jamie’s response:

    “Thanks for your concern about there being a ton of errors in my post. I’ll
    go through these one-by-one.

    1. Thanks for letting me know where that quote came from. I felt it was a waste of my time to click on every single link on the page you linked to and read everything on each page of those links. Instead I just read the study. I
    assumed the page you linked to must have changed since you first linked to it and made it less clear. I also assumed that it was a legitimate quote that I
    just didn’t know the source of. It would have been easier if your link went
    directly to the source, but understandable that pages on the internet get
    changed over time and what may have seemed obvious at the time you wrote your post wasn’t a couple days later.

    2. I did add up the numbers from the study. However those were numbers for what the paper deemed as the “low-risk” cohort. In your post you said the 2.1 in 1000 number was from the cohort including high-risk births. I assumed you wouldn’t purposefully mislead. I apologize for making this clearly incorrect assumption.

    3. I did do this calculation and in fact I wrote that in my post in the
    sentence after the one you just quoted. However, I didn’t believe you would
    possibly attempt to compare the cohort of low-risk-only hospital births to the
    cohort of low and high-risk homebirths because that would be purposefully
    misleading. Again, I apologize for making this clearly incorrect assumption.

    4. I’m not really sure how this is a separate item. Please see my response
    to #3.

    5. Yes! I really fucked this one up. I originally had a longer sentence that
    included the raw numbers and the percents. On a later edit I decided that was misleading my making the numbers seem smaller, excessively wordy, and more confusing for the reader, so I edited the sentence down. In doing so, I mixed up the numbers and didn’t notice my mistake until after the article was posted. The worst part is that the wrong numbers were extremely misleading making the risk seem orders of magnitude smaller than they really are. As soon as this was pointed out, I asked GP to fix it and posted my response in the comments. Unfortunately the GP admins were all busy yesterday with their kids and didn’t see my request for an edit until this morning. Had this been my own blog, I could have fixed it immediately but because it was just a guest post I don’t have access to edit the post directly. This doesn’t change any of my analysis because it doesn’t change any of the actual risk numbers. It was an editing error. I fucked it up. I’m sorry. I got it corrected as soon as I could.

    6. I did look at the CDC Wonder Database. However, you have to set the
    parameters of which data you want. I was certainly not going to assume I knew the restrictions you used so I went with what you wrote in your post which was “low risk white women at term from the years 2004-2009.” I apologize if this was incorrect. Next time I’ll be sure to read your mind and know that you actually meant something that you did not write.

    7. Again, see #6. I assumed that you provided all the restrictions you used
    in your database and was unable to read your mind and know that you used more restrictions than you wrote.

    8. Yah. Those are all possibilities that may make the datasets not
    comparable along with like a million other possibilities I could think up.
    That’s why you’ve got to be really careful when comparing datasets from two
    different sources that are using non-comparable cohorts and different definitions.

    My post was a review of one study, and a rather weak study at that (for all
    the reasons I mentioned in my post). I was hoping to spark a discussion here on the relative risks/benefits of homebirths. There has been some good discussion (like the commenters arguing whether or not less medical interventions should really be considered a benefit) but lately it seems that you and the rest of your anti-homebirth ideologues have taken over all potential discussion and refuse to debate actual facts. If you think that even a small base risk is not worth it, then go ahead and argue that. That is a perfectly legitimate argument and one I personally agree with. However, there is no excuse for manipulating data and fearmongering in order to make the risk seem even bigger than it is and I’m not going to apologize for calling you out on that.”

    • Amy Tuteur, MD

      My response:

      OK, let’s see if I get this straight.

      1. You couldn’t bothered to click on a link? Seriously?

      You accused me of fabricating a quote because you couldn’t be bothered to click on the link that contained it?

      2. You said that you didn’t know where the numbers came from. They came from the paper. Just because you don’t like them does not mean that you can imply that I made them up.

      3. “I didn’t believe you would possibly attempt to compare the
      cohort of low-risk-only hospital births to the cohort of low and
      high-risk homebirths because that would be purposefully misleading.” Here’s a crazy thought: why didn’t you ask me why I performed the analysis the way that I did? Let me guess. You couldn’t be bothered

      I would have told you that the reason that I include the high risk
      births is because what MANA writes in the paper is different from how MANA counsels patients. They tell patients that breech, twins and VBACs are “variations of nomal” and that’s why they should deliver at home. I figure that if they counsel the patients that these complications are low risk, they should be included in their stats.

      4. See #3.

      5. Yes, you acknowledged your mistake and corrected it.

      6. It doesn’t matter whether or not you knew the restrictions. No
      matter how I restricted it, the women in the hospital group were HIGHER risk than the women in the homebirth group.

      7. It has nothing to do with my restrictions. It is a characteristic
      of the database. Had you bothered to read the description, you would have known that other out of hospital births were not in the hospital group, but … I know … you couldn’t be bothered.

      8. The hospital group is higher risk than the homebirth group for the reasons that I explained above.

      Finally, you wrote: “there is no excuse for manipulating data and
      fearmongering in order to make the risk seem even bigger than it is and I’m not going to apologize for calling you out on that.”

      By I did NOT manipulate the data. You didn’t understand what I did
      and you didn’t bother to ask. I did NOT make the risk seeming bigger than it is. In fact, I probably made it seem smaller. In 2012 the state of Oregon hired homebirth advocate Judith Rooks, CNM, MPH to review every homebirth in 2012 and compare it to low risk hospital birth.I used the same methodology she did. She found that homebirths had a 800% higher risk of death than comparable risk hospital birth (700% if you removed congenital anomalies from the homebirth group, but not the hospital group). My analysis is in keeping with every other analysis of homebirth in the US EXCEPT the paper written by MANA on its own statistics.

      You need to correct the misstatements that remain above, and you
      ought to apologize for making them. Wait, let me guess. You can’t be
      bothered.

      • The Bofa on the Sofa

        This is the point where I gave up

        1. You couldn’t bothered to click on a link? Seriously?

        You accused me of fabricating a quote because you couldn’t be bothered to click on the link that contained it?

        She complains that she couldn’t find the quote, and uses that as a criticism of the analysis, but then admits that she didn’t even look for it?

        What a hatchet job.

        • auntbea

          Perhaps she mistook a blog post for an undergraduate textbook? With all the background information in a little box in the margin?

        • sdsures

          Expecting a Lizzie Borden joke any day now.

    • fiftyfifty1

      English to English translation.
      1. Real reporting is WORK, and I’m too lazy for that!

      2. If I make mistakes it’s got to be your fault somehow. You must be purposefully misleading….or something.
      3. See, you must be purposefully misleading again!
      4. Umm again!
      5. I totally had that math almost right and it was just an editing typo and I totally knew it but the editors were busy with…um their kids…so they made me look bad!
      6. Look at the data myself? Like I said in #1 above, I’m too lazy for that.
      7. ditto
      8. “Apples and Oranges”! that excuse worked for Aviva Romm, I hope it will work for me too.

      I’ve been humiliated in public, but as long as I stay SASSY I’m sure to keep a bunch of my sassy fans-and I’m not going to apologize for that.

    • realitycheque

      “I felt it was a waste of my time to click on every single link on the
      page you linked to and read everything on each page of those links. Instead I just read the study.”

      Talk about sloppy! If JB were planning on sharing her own interpretation of the data, “just reading the study” would have been understandable, but if you’re going to publicly critique someone else’s analysis, you should try and understand exactly what it is you’re critiquing before accusing the person in question of deliberately manipulating the numbers so as to mislead/fear-monger.

      If you can’t even be bothered to read/properly investigate what it is you’re critiquing, then don’t bother sharing.

    • Jessica S.

      “there is no excuse for manipulating data and fearmongering in order to make the risk seem even bigger than it is”

      Wha…? Her conclusion is completely divorced from her mea culpa.

    • Captain Obvious

      Lay statistician, lay journalist.

      • auntbea

        Would explain why she’s down with the lay obstetricians, then.

    • theNormalDistribution

      raaablarghatweg!!!

    • Anj Fabian

      So she totally supports mandatory of outcomes so we can do a proper study without the self selection bias?

    • Guestll

      Wow. She really does not math. Or logic.

  • Bomb

    Oh she finally decided to respond to dr Amy’s points, unsurprisingly with total bullshit. Apparently calling her out on her completely sloppy and pathetic attempt at discrediting Dr Amy is “shutting down discussion”. Why do all of these idiots say the same idiot things?

    • Jessica S.

      From what I’ve read of Skepchics and about Skepchics, I’m not surprised. I have been left with the impression that they don’t take kindly to being called out. And that’s evidence enough for them, or something. It’s sad, really.

      • auntbea

        Okay, obviously we need to start our own skeptical women blog. We’ll call it SkeptiXX, subtitled, “Evidence-based opinions on everything.” Mrs. W and I can handle politics and economics; you medical people can fight over who gets to handle that; I am sure we can find someone to handle pyschology and biology and other controversial things; and it should be a piece of cake to get hold of a grammar pedant to explain why “I feel badly” is JUST NOT CORRECT, PEOPLE.

        Who’s with me?

        • Young CC Prof

          I’ll handle decimal points.

          • auntbea

            *snort* There might need to be a couple of posts on that.

          • realitycheque

            Thank god someone’s volunteered, I hear that even expert statistical gurus/junkies find those difficult to navigate.

        • fiftyfifty1

          Although he doesn’t qualify for the “XX” part, we will let Bofa guest post whenever drunk driving comes up.

          • auntbea

            Only if he wears a dress and talks in a really high voice.

          • fiftyfifty1

            How do you know he doesn’t do that already?

          • auntbea

            Even better! We can accept 100% of his guest posts. Or perhaps 1000%? 0.01%? 1.101/10,000%? Whatever.

          • The Bofa on the Sofa

            Is it that obvious?

        • Jessica S.

          I don’t know, I’m skeptical.
          ;)

        • theNormalDistribution

          OHH my god my mother in law says “I feel badly” so much I want to choke her. YOU’RE A TEACHER!!!!

          • auntbea

            Well, she is your mother-in-law, so I if I was you, I would just keep this between you and I.

          • The Bofa on the Sofa

            Where does that discussion take place at?

          • sdsures

            A teacher friend of mine writes this grammar blog: http://carolusgrammaticus.blogspot.co.uk/

          • theNormalDistribution

            GAHHH!!!

          • The Bofa on the Sofa

            Hungry eyes…I feel the magic between you and I….

            Damn you Eric Carmen!!!!!! How can you sing a great song like Go All the Way and then put out this grammatically offense drivel?

            Just because Eddie Rabbit and Crystal Gayle did it, doesn’t mean you have to! If Crystal Gayle let her hair grow out to hit the floor, does that mean you’d have to do it, too? Obviously not.

          • The Bofa on the Sofa

            Maybe she has lost the feeling in her fingertips after smoking for 40 years?

            (seriously, that is the thought that always comes into my head when I hear “I feel badly”)

          • Young CC Prof

            I for one smell badly during allergy season.

          • Whatnow

            Actually, Grammar Girl says it’s acceptable to say bad or badly.

          • theNormalDistribution

            I’m pretty sure Grammar Girl knows the difference between adverbs and adjectives. I read her article on “I feel bad” vs “I feel badly” and she said no such thing.

            Let me be clear; we’re specifically referring to situations where a person says “I feel badly” when they really mean “I feel bad”, which is almost always what is meant when that sentence is used.

            If you read Grammar Girl’s article and it still doesn’t make sense why “I feel badly” is wrong (most of the time), here’s a short explanation that may help:

            http://www.pearsonlongman.com/ae/azar/grammar_ex/message_board/archive/articles/00075.htm

          • sdsures

            Badly vs poorly, perhaps? “Poorly” is used more often in British English.

        • Mer

          I don’t have any areas of expertise so I’ll just be a reader, very happy to provide page views and shares!

        • OttawaAlison

          SkeptiXX/XY

        • areawomanpdx

          I think this is an awesome idea.

        • sdsures

          There’s a group on Ravelry for knitters and crocheters. Men are welcome too, of course. http://www.ravelry.com/groups/evidence-based-parenting

  • OttawaAlison

    What gets me is that GP could have been talking about MANA and its stats before hand, they could have written about the woo that is an integral part of the ncb movement instead? They chase a skeptic and try to discredit her, because she dared criticise a home birthing post that was made a while ago.

    I’m not saying that skeptics shouldn’t challenge each other, but there is something that seems very “off” about this. Then Elyse goes off and says she’s not anti-homebirth now because of Dr. Amy’s tone WTAF? I thought they were supposed to be evidence based there.

    Us skeptics aren’t always going to get along on every point, however if you’re going to take another skeptic to task, please for the love of all things, have a solid argument, put things in proper context and you better be beyond clean about your facts and figures.

  • realitycheque

    OT: Discus appears to have logged me in under someone else’s username this morning.

    Refreshing the page didn’t do anything and I had to physically sign out to correct the issue. I didn’t post anything under this person’s username to test whether it showed up under her comments, or mine, but thought it might be worth mentioning and something to be aware of. I wouldn’t want someone to potentially post something I didn’t agree with under my username.

    I’m not particularly tech savvy, but the fact that her comments, profile and information showed up when I clicked the username button at the top of the comments section made me think that it was more than just a case of Discus jumbling names.

    • theNormalDistribution

      Weeeeird.

      I love discus but EFF is it buggy.

  • realitycheque

    This is seriously embarrassing stuff coming from the ” resident stats junkie/guru”.

    If she can’t even manage the numbers in this survey, what chance does she have of making an accurate, critical analysis of other (far more complex) studies?

    • MLE

      It’s like she skimmed it and did the analysis from memory.

  • Bomb

    Oh FFS I’ve seen high schoolers turn in better pieces of work that still got an F.

    • Bomb

      The more times I read the post the more pissed off I get, and she wasn’t even picking apart my own work. I find her attempt at ‘skepticism’ utterly offensive.

  • Amy Tuteur, MD

    Looks like Grounded Parents has no intention to correct the multiple fact and math errors in their piece. You won’t be surprised to hear that MANA is now promoting the piece. I’d like to see the piece retracted.

    • LMS1953

      Unbelievable. These people shouldn’t be allowed to shuck field peas much less deliver babies.

      • Trixie

        I live near an Amish pea-shucking service. They do limas too. The thing is, they’ve at least got a firm grasp on 8th grade arithmetic, or they wouldn’t make any money at it.

    • alannah

      Do you at least get to post a reply on the blog?

      • auntbea

        Yes. It said, in a nutshull, “So sue me!”

    • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

      Holy shit elyse, really? I thought that the pin up calendar was the worst skepchick would get, but here we are.

    • Jessica S.

      fifty-fifty had it right when she said these “chicks” misconstrue sassiness as skepticism. It’s embarrassing, for them.

  • auntbea

    Holy crap. Several people in the comments are accusing various of us of being combative and harrassing the OP. No one is using bad words and many of us have just posted math. There are a grand total of 140 comments. Maybe I have high tolerance for disagreement because I am in academia, but wow, for skeptics who want a conversation they seem to not be very interested in hearing critiques of their own arguments.

    • PrimaryCareDoc

      I really hate this idea that disagreeing with someone means that you a harassing or being a troll.

      • Anon

        As a prolific troller I take offense at such lazy insults. Disagreeing/presenting factual information is no kind of trolling.

    • The Computer Ate My Nym

      I’ve also noticed a certain level of hyperskepticism, with people arguing, essentially, “The study isn’t perfect, therefore it should be completely dismissed.”

      • Anj Fabian

        Logical fallacy.

        • auntbea

          The fallacy fallacy, in fact.

          • anion

            Straw man.

            . ;-)

          • theNormalDistribution

            So’s your face.

            (I win.)

    • Amy Tuteur, MD

      In the world of homebirth, disagreeing or demanding proof is “harrassment.”

      • auntbea

        But are these people even IN the world of homebirth? Aren’t they just random readers on a blog? What’s got their panties all in a bunch?

        • Jessica S.

          It feels almost territorial, for lack of a better term.

          • KarenJJ

            I’m more skeptic then that other skeptic?

          • Jessica S.

            Or maybe we all have to be skeptical of the same thing? :)

    • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

      What is so weird is that skepchick was on the other side of hyperskeptic/don’t-hurt-my-feelings-with-your-facts arguments when it came to sexual harassment policies at skeptic conferences. They should know better.

      • anion

        It’s not weird at all, sadly. Lots of people are hypocrites. Facts are all-important when those facts support whatever side of the argument the hypocrite favors; facts are just a construct designed to harm when those facts contradict whatever argument the hypocrite favors.

        • theNormalDistribution

          I just don’t get it. When I think (or I’m not sure) I’m right about something, 90% of my investigation time is devoted to looking for evidence that I’m wrong. Why is everyone not doing that?

          • Vera

            I was told of a pending paper that refutes one of the major benefits of my work – my response was that this was great (people are paying attention!) and I’m really interested in seeing the methods and results because if it’s valid, then my practice will change. If I am making a claim, I want to be right and how will I know if I don’t look for evidence that I am wrong?

    • realitycheque

      “You guys are so mean, with your facts and your numbers! Basic mathematics and accurate data representation aren’t everything, you know!”

  • Guesteleh

    From Jan Tritten’s page:

    Marlene Waechterposted to‎Jan Tritten
    Yesterday
    So sorry “she” is picking on you. “she” is to Midwifery what the devil is to our souls. Begone Satan!
    Jan Tritten I been praying for her!!!
    2 hours ago · 1
    Barbara Covington you know i do , too. i pray she works through her personal trauma .
    2 hours ago
    Barbara Covington well you know i lump her in with that prayer lol i figure spirit knpows who i mean…
    2 hours ago

    • theNormalDistribution

      Ironic how often the truth and honest inquiry is attributed to Satan. He sounds like a pretty cool guy.

      • Trixie

        If Marlene’s against him, he’s got to be pretty great.

      • Anj Fabian

        Devil’s advocate?

      • auntbea

        I hear he has wealth and taste as well.

    • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

      ugh the birth center that mistreated me pulled the same ‘she makes me soooo sad’ shit when I sued em. I wish it would make them think and consider instead of doing something useless like prayer.

      • ngozi

        Earnest prayers within their proper context are not useless. But there are A LOT of hypocrites who misuse Christianity.

  • LMS1953

    This is where I have such a hard time with informed consent/informed refusal. If CPMs have such a hard time with elementary arithmetic, absolute vs relative risk and percentages, what abilities do their gullible patients have? Imagine being an OB trying to explain the screening nature of the Quad Screen or the autosomal recessive inheritance of Cystic Fibrosis and Sickle Cell Disease. This week’s NEJM has a great article on noninvasive prenatal testing with the use of massively parallel sequencing of maternal plasma cell-free DNA (cfDNA testing) in high-risk vs low-risk pregnant women. Whew! It is taking me a while to digest it and translate it to lay terms so I can give my patients appropriate informed consent.

    At the heart of it, I think many HB moms choose that route due to needle phobia, white coat phobia and hospital phobia. Much better to think you can just insert garlic into your vagina for GBS or take a smorgasbord of herbs to induce labor rather than getting an IV started for IV antibiotics or IV pitocin. It reminds me when I had to chase my 10 year old son into a corner of my office and have three people hold him down so I could give him a tetanus booster after he got a deep cut on his knee playing Pop Warner tackle football. From his perspective, I am sure he would rather that we just “trust football”.

    • OBPI Mama

      So true. And the interesting thing is, is that so many of them (at least in my circle of friends) have never even been to or talked with an OB/GYN. Never been admitted to the hospital. It’s a lot easier to be scared of the unknown… especially if you are constantly being brainwashed.

    • anion

      OT, but my mom had to do almost the same thing with me when she gave me a tetanus booster when I was eleven. I think we ended up in the exam room for like forty minutes while I cried and steeled myself and then panicked and ducked away, etc. ad nauseum.

      Of course, she finally just iron-gripped my arm and gave me the stupid shot, whereupon I looked at her, surprised, and said, “You mean that was it?”

      So yeah, I think the buildup of fear, combined with way out-of-date hospital stories and anti-medicine propaganda, makes these women honestly believe that the hospital is like a gathering place for homicidal maniacs in white lab coats. I totally thought I’d be shaved and given an enema at the hospital, and that my baby would spend most of the time in the nursery. (When I was about four months along, I told my FIL’s girlfriend that I was basically hoping for a c-section. She told me that was a horrible thing to hope for, because they would slit me right down the middle and I wouldn’t be able to walk or hold my baby for two weeks and I’d be in tremendous pain from all the gas I would have [her extended detailing of that last point, as we sat at the dinner table, was an especially nice touch]. Luckily I already knew that wasn’t true, and even if I hadn’t known the facts I knew she was a complete idiot, so it didn’t faze me. After my daughter was born it was very hard for me not to smugly point out that everything she’d said to me was inaccurate, but I managed.)

  • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

    yay finally registered and makin comments all over the place.

    • KarenJJ

      Drat, I made one and went to bed. Wonder what I’ll find when I go check it out..

  • guest

    Well, this crosswalk birth story is quickly becoming a comment fest for homebirth: http://www.myfoxny.com/story/24809320/woman-gives-birth-on-manhattan-sidewalk

    • LMS1953

      I thought that too when I saw the story. I always like how New Yorkers get praised for being Good Samaritans. Their first instinct on 9/11 was to jack the price of bottled water up to $5 to $10 a bottle when people stumbled into the bodagos asphyxiated by the dust cloud of the collapsing Twin Towers. Here, her doorman tried to flag several rush hour taxis for her, but they were promptly hijacked by the typical pricks that live in NYC. Anyway, here is another one; an “in-hospital homebirth” attended by dad in South Florida:
      http://abcnews.go.com/m/blogEntry?id=22665936&ref=https%3A%2F%2Fwww.google.com%2F

      The female OB (I think another story said she works at Women for Women) had to go do an emergency C/S. The patient in labor was allegedly “abandoned” – she was in the throes of a cascade of intervention induction; the pit was dc’ed but she precip’ed. There are conflicting stories as to whether or not a nurse was in the room. But dad’s bullshit attitude is precisely why nurses used to bind women’s legs together with bedsheets so they would not deliver before the doctor arrived. Why a precip delivery made national news, I’ll never know. I think the jerk is just trying to punch a lottery ticket. The baby was perfectly fine.

      • Jocelyn

        Woah woah woah, you say that like binding legs together was a good thing. I don’t see anything wrong with the father’s attitude in that article you linked – he said that he was upset that they were alone in the hospital room when his wife delivered. If I was alone in the hospital room when I had my baby, I would have been terrified. So many things can go wrong – that’s why unassisted childbirth is such a stupid option. Having an unintentional unassisted childbirth in the hospital would suck.

        • LMS1953

          Whoa indeed. I did not mean to imply that leg binding was a good thing. I was just trying to illustrate the stupidity of thinking only a doctor can attend a delivery. You know, sometimes you really can “trust birth”. Since she was being induced, the OB had confirmed a vertex presentation and an adequate pelvis and she was being continuously monitored. There was very little chance that anything would have gone wrong with the delivery witness the woman who delivered on the NYC sidewalk. The OB’s duty was to the emergency C/S. The fault is in the hands of the L&D nurse – ANY L&D nurse should have the skills to control a precipitous delivery. But the malpractice environment in Florida is such that the nurse thought it better to leave the room to track down the OB. That was ridiculous.

      • Jocelyn

        Furthermore, when the urge to push hits, it HITS. My second baby was kind of precip. I went from not being sure I was in labor to having the baby in less than an an hour. And after my water broke, my body started involuntarily pushing. The nurses told me stop pushing because the doctor wasn’t in the room yet. I COULD NOT STOP PUSHING. My body wouldn’t let me stop. If my legs had been bound together, my baby would have been in serious trouble.

      • Gene

        I did my OB med school rotations in a very busy inner city hospital. There were women delivering in the hallways some nights. Great as a med student for learning, but not so good for moms. The ward was staffed overnight by one intern, one resident, two students, and an attending sleeping somewhere. On a busy night, we were spread pretty thin. Good training for my ED lifestyle.

  • Trixie

    The Jan Tritten thread on Facebook is down to 2 comments now.

    • attitude devant

      She deleted the whole thing AGAIN!!! Will she never learn?

      • Amazed

        Jan is back from her holiday with her family and available for all her internet friends. Joy!

        • Awesomemom

          I wonder if her family was confused about her sudden need to spend a lot of time with them.

          • Amazed

            Not if they have internet.

          • Young CC Prof

            Not the ones who are Facebook friends with her, anyway.

          • Amazed

            Hmm, my mom has expressed a sudden desire to come and visit me. Thank God, she isn’t a “midwife”, a midwife, an OB, a HCP or anything. Otherwise, I might have suspected she had other motives…

      • Trixie

        The 29 week thread is still there.

    • attitude devant

      It’s really a funny read, constantly evolving. Some twit named Sara Price-Arora has defended the midwife, saying some fetal deaths to ‘mother error’ and now everyone is howling.

      • Guesteleh

        It’s not so funny. The comments some of Jan’s supporters are making to the loss mothers are horrible:

        Alison Murphy hostility begets defensiveness. Righteous anger has to be experienced, put down, and examined. Anger is a secondary emotion, what is underneath? Jesse, you are still angry. Our own pain focuses us inward and we are unable to understand other points of view. Bambi, you are in pain, until you have released the bulk of that pain you will be unable to care about the pain of women who have been harmed by the system you now embrace.

        • attitude devant

          Damn! I get all Mother Bear when someone goes after Bambi. Went to comment and it’s gone again. I think this is the third time

        • Trixie

          Oh, fuck these women. Bambi lost a baby. How dare they speak to her about the pain of hospital births where babies lived.

        • Anj Fabian

          Oh, release the pain?

          Can I have a volunteer to assist with “releasing the pain”?

        • OBPI Mama

          I am not a cussin’ woman, but after reading that… quite a few flew around in my head. The nerve of some women! GAH (purple minion style)!

        • Jessica S.

          What. A. Bitch.

  • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

    Why the hell are they treating a voluntary survey with a 30% reporting rate with the seriousness of the CDC database? Do they not understand the problem when cherry picked numbers *still* show an increase in mortality? Reality is much, much worse, I’m sure.

    • Danielle

      I think they are in a bit of a corner here. There are some problems with comparing the CDC numbers to MANA’s numbers. This begins with the fact that MANAs statistics are just suspect out of the date due to collection method, And even if 100 percent of MANA members reported their outcomes, I imagine there are some systemic issues relating to the the fact that data collected and collection methods differ between the CDC stats and the MANA surveys. Nonetheless, the MANA study is being trotted out as proof of safety, so one simply has to compare it to some data set for hospital births to see what one gets. As it is, we’ve got statistics subject to self-selection bias and self-interest that suggest outcomes at such variance with the CDC data that claims to safety seem dubious at best.

      And if MANA really wants us to stop comparing THEIR numbers to the CDC database, the next logical step is to ignore the MANA numbers entirely and look at Amos Grunebaum’s numbers, which are all drawn from the CDC. And what do we get there? Nothing good.

      One can then can attack the CDC numbers, which like all sets of data have limitations. But since we can isolate out planned home births that didn’t transfer to the hospital, the CDC sure looks useful to me. The only thing that would be really interesting that we don’t have are stats for the transferred home births. It would be really interesting to be able to isolate those from both home births attended by midwives from beginning-to-end, and from births that began in the hospital.

      • Danielle

        Caveat: By isolating out “planned home births”, I don’t mean there is a field for “planned place of birth” but rather than searching for home births attended by midwives should give us pretty much the same result. There must only be a few outliers where a home birth that was planned is somehow attended by a midwife.

  • fiftyfifty1

    “Jamie failed to understand the most basic fact about the MANA data. This is not a study; it is a non-randomized survey,”

    Yes, this is a major oversight on her part. Commenters on the thread are raising concerns about the data possibly being biased because “the study was commissioned by MANA”. If they only knew! It’s far worse! MANA didn’t commission an outside research group to do this study, they collected the numbers themselves AND reported them with no outside oversight. It’s not even a study, it’s a voluntary self-reporting of outcomes from midwives with ZERO requirement for fact checking. And the death rates are still atrocious!

    • anion

      And given the serious lack of basic written communication skills evinced by a large number of the midwives I’ve seen, there’s zero guarantee that they even understood the questions being asked, or answered them in a way that others could understand.

  • stenvenywrites

    Every time you confuse a percentage with a decimal, a kitten dies.

    • Zornorph

      1.0 kittens die or only 0.01 kittens?

      • attitude devant

        1 in a 100. 1%

        • Young CC Prof

          1% of all kittens???????

          • attitude devant

            I know. Very sad. But some kittens weren’t meant to live.

          • ngozi

            Some kittens weren’t meant to be earthside. Someone should have given them some stevia.

          • Amazed

            OK, a serious voice in here: I remember how crushed my brother and I were when my grandmother’s outdoor cat gave birth to her dead kittens. She was heartbroken – and so were we, the kids. We sobbed and wanted to bury the kittens as we imagined they should before Grandma explained that we should leave them to their mom.

            Heartbroken. Over kittens. What the hell is wrong with those women that they are so flippant about human babies?

          • Trixie

            Letting go of kittens is an art.

          • LibrarianSarah

            It is always sad when a kitten dies…

          • GiddyUpGo123

            Oh my God, I just laughed for like 10 minutes straight.

          • anion

            Prayers for them!

          • auntbea

            Peace and light, mama.

          • fiftyfifty1

            No dummy, “1 in a 100.1%” means 100.1% of EACH kitten.

          • auntbea

            Everyone knows that get to real number out of percent, you move the decimal two places. OMG! 100,100 KITTENS ARE DEAD!

          • theNormalDistribution

            That was an awesome joke until I was reminded of every person I’ve ever heard say “I gave it 110%!” THAT’S NOT HOW PERCENTAGES WORK

    • Guestll

      I just spit out my tea. You win the internet. :)

  • Trixie

    This is just BASIC math. It is really depressing that not only can she not do basic math, but that no one else seems to be able to either. This isn’t fancy stuff. I’m depressed about the state of our education system now. A 10 year old kid in Singapore could do this analysis more reliably.

    • Owl

      Math is Hard.
      The ironic thing is, apparently home birth is the politically correct feminist thing now, so the so-called skepchiks ignore actual facts and evidence to hang with the cool kids.

  • lola

    I got an account there specifically to point out Navelgazing Midwife’s post on how you could just choose not to report bad outcomes. I think that’s a really important thing for the commenters to realize.

    • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

      Yes, and its incredibly sloppy for them to not look into how the data was collected or the reporting rate. They spend all their time attacking dr amy for being ‘sensational’ or being unable to find a relevant quote in a link when the MANA press release straight out lies about what the numbers demonstrate. “less intervention with no increase in adverse outcomes” (i’m paraphrasing here…) because they don’t think death is an adverse outcome.

  • The Computer Ate My Nym

    It’s notable to me that the three most vocal and prolific defenders of Bernstein’s post all appear to be men whereas the majority of the people correcting the math and arguing logically against the post are women. Probably meaningless in the grand scheme of things, but notable.

    • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

      I think its pretty meaningful. Most men are in favor of natural birth, from what I can tell. Its easy for them to be I guess! Creepy patriarchal cults like quiverfull and FLDS are all about it- scientology too (you have to be *silent* during it, even).

      • The Bofa on the Sofa

        Most men are in favor of natural birth, from what I can tell.

        Not been my experience. When I was doing Dad’s Boot Camp, the message from the experienced dads was always “Get the epidural! It’s wonderful!” For dads.

        Maybe single guys not faced with having to see someone they love go through the pain of childbirth may wax on about it, but from my experience, real fathers to be, when faced with that situation, are all supportive not having to see her suffer.

        • Young CC Prof

          Men who are neither fathers nor medical professionals are in favor of natural childbirth? So in other words, the people least likely to have any clue.

          • The Bofa on the Sofa

            Men who are neither fathers nor medical professionals are in favor of natural childbirth? So in other words, the people least likely to have any clue.

            1) I said maybe. I really don’t know for sure. I was being conciliatory.
            2) That being said, I wouldn’t say those “least likely to have a clue” but more that it’s those who have no stake in the matter. It’s real easy to expect other people to put up with the pain, but when it is the person you love, seeing them in torturous pain is pretty disconcerting.

          • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

            I’ve just heard a lot of dudes talk about how great NCB is, how they wish their wives would try it, etc. I don’t know of any data to back it up, was just an opinion. I am in Utah and it has a pretty strange culture so that may have a lot to do with it.

          • The Bofa on the Sofa

            I think they may say it at the beginning, but when faced with it, they realize, this is not pleasant.

          • Are you nuts

            I think it must be region specific. I know if my husband had a choice between me screaming and grunting (no epidural) and not screaming and grunting (epidural), he would choose the latter! He also has this bizarre belief that it’s my body and I’m smart enough to figure it out on my own.

          • MLE

            Yes I made it to about an 8 before I got the epidural, and was told by my husband that I looked like a wild animal up until that point. I think he prefers the non wild-animal look.

          • The Bofa on the Sofa

            Time and place, pal, time and place…

          • MLE

            It was ok, I actually laughed because I was so glad to have the blessed epidural. I was a little sad though bc I thought I was doing my best earth mother goddess impression by rocking and making primal noises through the surges, but apparently I was more like a spooked wildebeest.

          • theNormalDistribution

            I think Bofa was making a dirty joke.

          • MLE

            Understood. My friend, who could not care less about childbirth, just had his first baby with his wife. His thoughts on NCB were indifferent but on home birth, he was baffled why anyone wouldn’t want to be around technology, etc. He was by no means passionately against it though. He thought it was a little eccentric of me to be FED UP! with NCB. Then his wife actually had their baby, plus a moderate PPH. She had a textbook pregnancy and labor. The first thing he said when his son was born after sending a picture is that he has a white-hot rage towards the home birth crowd now that he has seen a “perfect” pregnancy and labor go south.

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

            The LDS community can be brutal about the gender roles. My college roommate and still close friend is devout LDS but definitely vocal about the issues she observes. I imagine comparing to, say, Eugene, Oregon, you’d get a lot of push for the NCB agenda with WILDLY different justifications.

          • Anon

            I’m LDS and my labor nurse was LDS and my anesthesiologist was LDS (we were having a conversation about Imagine Dragons when our faiths all came out, normally I don’t talk religion with HCPs) and they were both prompt, supportive, and professional in getting me my epi. Anecdotes go both ways, which is why they are pretty worthless.

          • Jocelyn

            I’m LDS and have never seen any LDS/NCB connection. I even was pregnant and had my first baby in Utah and didn’t run into any of it then, from anyone. It was only pregnant with my second down in CA that I really started to run into it (and only from non-LDS people). Yes, now that I’m aware of the whole movement I can see a couple (literally less than five) people that are LDS that I know that are pro-NCB, but they’re in the same proportion you’d encounter them in the non-LDS population.

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

            I don’t mean to offend, if I have. I’m echoing a statement by an LDS friend only. :)

          • Jocelyn

            Yeah, no worries, I know you have no ill feeling. :)

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

          Every dad I know thinks NCB is absurd, unless his wife forced him to drink the koolaid. And most of them shrug and say, “well, she must know better; it’s her body and the baby will probably be fine”

          • The Bofa on the Sofa

            Overall, most guys are just going to defer to their wives, as you say. “She must know better.” Outside of that, I would think that, a priori, they are equally likely to deviate either way – some will want NCB others will encourage pain relief. That’s at least as the outset.

            However, in the end, I think most guys, regardless of their initial thoughts, when they see their loved ones in pain, their personal response is going to be “make it stop!”

            But seriously, what kind of monster would NOT think that?

            If she has been adamant about doing it naturally, he will suppress that feeling and support her, but if you left it up to him, he’d much rather have her not have to suffer through it.

          • OBPI Mama

            My husband hates seeing people he loves in pain. He was a wreck for the 30 hours of my labor at home. Couldn’t eat, couldn’t rest. Says it’s the worst feeling in the world for a man. Not being able to do anything to help the person you love most from suffering. They are such protectors! He also hates seeing me recover from c-sections. So much so, he’s unsure if he wants to see me recover from anymore of them (it’s a big factor in deciding on a 5th baby or not).

          • The Bofa on the Sofa

            Not being able to do anything to help the person you love most from suffering.

            Well, it’s certainly how I feel about the wife and kids.

            I hate not being able to make the kids feel better when they are sick. Kills me.

          • OBPI Mama

            Because of my first son’s birth injury, I’ve had to shelf a lot of my feelings when he is hurting. Sometimes it seems like what causes him temporary pain is helping him get stronger whether surgeries or strengthening or stretching (years of repeating that to myself helps). But my husband does not like to push him as much as I push him. It’s okay though. I think it’s sweet of him.

      • MLE

        Most men are in favor of natural birth? I would think most mainstream men are indifferent about the birth experience, and only really care about getting their kid and partner out of it alive.

        • MLE

          And by “indifferent,” I do not mean indifferent to suffering. I mean that they do not think that suffering confers any benefits to the mother or baby, and they are indifferent to the lights/candles/movement aspects as opposed to the lifesaving interventions aspect.

      • Trixie

        I don’t think most men think at all about childbirth until they’re absolutely forced to. And then they pretty much defer to the woman except (hopefully) for insisting on safety.

      • Mariana Baca

        I think FLDS is only in favor of it because they don’t want witnesses to plural marriage or who they write down as “father” on the birth certificates.

    • giliell

      You mean like when Will refuses to define “necessary” by simply repeating “medically necessary” as if that means shit on itself? And then picks up his ball and leaves . OR better said refuses to engage the irrational woman…

      • The Computer Ate My Nym

        I admit I was largely thinking of Will when writing that comment. But I didn’t think Chris was doing very well either.

        • giliell

          NO, but he’s at least wiling to engage in what I believe to be good faith

    • theNormalDistribution

      Chris Brecheen is yapping up a storm because he couldn’t get any traction over here. Too many “facts” and “logic”.

    • auntbea

      It is also the men who are complaining that the commenters are mean.

  • Lawyer Jane

    I just want to say that watching Dr. Amy in action is an amazing lesson in how one energetic person can use the internet for good. Kudos!

    • Amy Tuteur, MD

      Thanks!!

  • Lawyer Jane

    lawyer jane

    • Zornorph

      Architect Tarzan

  • Giliell

    I hope that people are also reading the comments, where in fact most of the other bloggers as well as commenters called out the shoddy math and vehemently disagreed with the post itself.
    It might not be the place that always produces perfect posts, but its also not a community where people just nod.

    • Amy Tuteur, MD

      It’s pretty disappointing, though, that no one has acknowledge the factual errors that I pointed out.

  • MLE

    Now I am just a simple musician-turned-workaday slob who care barely balance my checkbook, but maybe this illustration would help with point #2:

    • Meredith

      Don’t you realize that by adding numbers, you’re destroying their community????

      • MLE

        OH, the COMMUNITY! It’s all crashing down around our ears and now women will never community!

      • Trixie

        I just had a similar conversation with my 5 year old. He is refusing to learn subtraction because he “only wants to make numbers bigger, not smaller. Making numbers smaller is creepy.”
        Must have been the c-section.

        • The Computer Ate My Nym

          I agree with your 5 year old. Subtraction is creepy. And don’t get me started on division…

          • Trixie

            Oh I didn’t even bring up division. He’ll freak out.
            He’s interested in multiplication.

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

            A little precocious for that, surely?

          • Trixie

            Well, he can’t exactly do multiplication, but we’ve shown him how it works with manipulatives. He knows it makes numbers bigger faster than addition, so it’s okay in his book.

          • The Computer Ate My Nym

            I suppose you could spin it as adding negative numbers…4-2=4+(-2) and so on.

          • Trixie

            I had to come back and let you know I tried this this morning. He thought it was hilarious! And he started subtracting!

          • auntbea

            I could never understand why, if multiplication tables were so damn important, I didn’t know them already.

          • Julia

            Division tears us apart

        • Meredith

          Ahahaha, that’s great!

          • Trixie

            His teacher had to mark down that he “doesn’t understand subtraction concepts.” Oh, he understands the concept, he just chooses not to do it.

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

            That recalls the time when my daughter in kindergarten insisted on coloring tomatoes pink because she “didn’t like red”. Her teacher was worried she had problems with reality testing. That year EVERYTHING anywhere near my daughter had to be pink. She’s now 31, and knows tomatoes are, or should be, red, so I guess she is now dealing with reality OK.

        • R T

          OMG, I felt the same way as a child! Subtraction is so negative, lol! I also refused to handle uneven numbers. Uneven numbers are super creepy too! P.S. I was born at home unassisted so it can’t be the csection! ;)

          • Meredith

            Calculus always used to annoy me because the answers often weren’t whole numbers. C’mon, if you’re making up the questions to put in the textbook, why can’t you make them up so they come out pretty??

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

          Mine hates negative numbers. He gets 0 but -1 and beyond deeply bother him.

          • LibrarianSarah

            I don’t know why but this reminds me of the Beavis and Butthead line “I’m angry at numbers. There’s like, too many of them.”

          • FrequentFlyer

            Younger Son is doing his homework right now and seems to be a little but angry with numbers too. He has just been introduced to the horrors of long division.

    • Guesteleh

      Please post that in their comments!!

      • MLE

        I can’t post a picture even by copying/pasting. I am sure they will be visiting and reading even if it’s silently.

    • CognitiveDissonaceHurts

      Hahahahahahahahahahahahahhahaha!

  • Meredith

    Number 5 is cracking me up. I guess Bernstein remembers vaguely learning in school something about moving two decimal points over to make a percentage, so now she just moves the decimal points over whenever she has to manipulate a percent. Can we combine this with misapplied quantum mechanics and declare that you can’t observe a percentage without changing it?

    • LMS1953

      Funny!

    • LMS1953

      Perhaps if Bernstein took encapsulated placenta qid for a week it would disentangle the cobweb of synapses in her frontal lobe and restore her grade school arithmetic skills.

      • araikwao

        And breastmilk. She definitely needs some breastmilk with that.

    • The Computer Ate My Nym

      It’s the correction of #5 that really gets me. The correction was made and it was noted as “minor math” error. Two orders of magnitude is MINOR? Though that change was probably made by the editor, not Bernstein, so she should not be blamed for that particular bit of wording.

      • Meredith

        My husband has a degree in math, so I called him up and explained the situation to him (why should I suffer alone, after all?) and asked him, “Would you call this a ‘minor math’ error”?

        His response: “Only if I were a Nazi propagandist.”

        • The Bofa on the Sofa

          I don’t necessarily call it a “math error,” and would probably classify it more as a typo, but regardless, it still shows sloppiness and carelessness.

          • Meredith

            Given the rest of the incompetence on display, it’s hard to tell what exactly the issue is.

      • Are you nuts

        I wish someone at my bank would make a minor math error on my bank account to turn me from a hundred thousandaire to a ten millionaire.

        • theNormalDistribution

          I wish I were a hundred thousandaire. :)

      • theNormalDistribution

        I think when the calculation relies solely on correctly adding and multiplying a handful of numbers, and you fail to do that correctly, that’s not a minor math error. Besides, it doesn’t make a lot of sense to define the severity of the error by anything other than how much or how little it affects the final result. Two orders of magnitudes is definitely not minor.

      • Box of Salt

        Per the comments section, Bernstein did make the error, and she had to email the editor to request the corrections: ” I was original doing things as decimals, then thought it might be
        confusing and switched to percentages and forgot to move the decimal.
        I’ve asked Elyse to edit the post (with proper mention of what the
        change was).” (Jamie, February 26, 2014, 8:13 pm)

  • attitude devant

    The longer I participate in this debate, the more I come to realize that NCB fans are not amenable to reason. Their beliefs are so fixed, and their reasoning skills so poor. God help their poor children, born and unborn, having cultists for parents.

    • Stacey

      Amen

    • MLE

      You’re sounding understandably despondent. Remember that many many people here were deep in the woo but have gone through some pretty amazing transformations!

      • theNormalDistribution

        True. But reading stuff like this gets to you eventually. I wanted to crawl into bed and never get out after reading that article. I wonder how Amy has managed to endure years and years combating the nonsense. I certainly couldn’t do it. She must have incredible emotional strength and faith in humanity.

        • MLE

          I know TND. I feel the same, but Dr Amy’s comment on a random NCB blog had the butterfly effect on me, so you just never know what tiny spark you are lighting in someone’s mind, even if it’s not apparent at the time. Dr Amy also says that she gets lots of private emails and messages thanking her, so that probably helps keep her going! Think about all the babies saved!

  • Amy Tuteur, MD

    I find it interesting that no one has addressed my comments about the math and factual errors. Many of them are very easy to check.

    • LMS1953

      CPMs in several states aren’t even required to have a high school diploma. And even if it were a universal requirement I seriously doubt 1 in 4 high school graduates could read your straightforward article and perform the simple arithmetic calcations. I doubt 1 in 10 could convert .0N% and come up with N/10,000

    • Guesteleh

      Someone further down in the comments did their own analysis with the CDC database and came to similar conclusions. Which is good, because it’s coming from someone who isn’t Satan!Amy.

  • LibrarianSarah

    What really stuck out to me was this quote in the comments. “For many women, any slightly higher risk to their child, even if very
    small, is not enough to outweigh the potential benefits of homebirths.”

    Never mind that the sentence makes no sense the way it was written (“any slightly higher risk to their child, even if very small” wtf?). What potential benefits of homebirth? The benefit of not being able to get effective pain control? Of having to clean up your own blood and placenta afterwards? Of forever associating your own house with whatever possible tragic occurrence that could happen? What the fuck does homebirth offer that could possibly out way an even slight increase in the likelihood of death or disability?

    I hate going to the doctor as much as anyone and I am not even a big fan of kids but that is some seriously callous shit right there.

    • Ennis Demeter

      Scented candles.

    • Ash

      Such BS. Only a tiny fraction of women plan homebirth in the first place. And she is telling us that some sort of transcendent vaginal birth would be outweighed by a dead or disabled baby? Try conducting a poll on that one….

    • Melissa

      The only benefit of homebirth is that it greatly reduces the chance that you’ll have a c-section. A fact directly related to the increase in bad outcomes for the baby. But if a woman is terrified of c-sections (and other medical inventions like pain relief) then stay at home.

      I suppose if you want a large family this can be a real concern, but generally I think it is that so many women think that giving birth is the thing that defines being a woman, and if you need some assistance in doing it that makes you a failure. It’s gender essentialism and fear of not being woman enough. They can have their homebirths. I’m just worried about the lies they tell to justify their decisions to others (it’s safer!) which may convince other women to take a risk they wouldn’t otherwise engage in.

      • ngozi

        I was one of the women that was terrified of c-sections, and I am not the biggest fan of medicine as a whole, but I knew better than to try to have my babies at home. I am more terrified of dead babies.
        And as I have said before, I wish there was more education about c-sections. I worried myself literally sick about c-sections and it wasn’t NEARLY as bad as I thought it would be. A c-section doesn’t have to be a nightmare.

        • The Bofa on the Sofa

          One of the things that doesn’t get emphasized enough about c-sections is, what’s the alternative?

          Doctors aren’t recommending c-sections for grins, they are doing it because the alternative has concerns.

          From my perspective, it is absolutely normal to be uneasy about having the doctor suggest a c-section, because that means that there is something that is a concerning him/her. Obviously, you’d much rather be in a situation where you didn’t face a risk that makes a c-section the better option.

          Then again, if you are in that situation, what really is the alternative? Put the baby at risk? As you note, you certainly don’t want to do that. Although there are those (like my wife) who would ask for a c-section regardless, most of the time, when women are faced with a c-section, it is because they are facing a higher risk situation. You are not going to have the option of a low-risk delivery at that point, would you rather have a higher risk delivery or the c-section?

          No one is going to be recommending a c-section for you unless they think it is actually better and safer than the alternative. In that respect, the c-section is actually a safety net for you, something that will always be available when the situation starts getting too risky.

          I think if you can keep viewing that way, you can appreciate the c-section for what it is.

          Of course, what doesn’t help is the attitude that the c-section is something that needs to avoided at all costs. As if you have some control over whether your pregnancy is at risk.

          • CognitiveDissonaceHurts

            When I had my homebirths, I did it because I believed that it was less risky for the baby and less risky for me. And I believed that going to the hospital was going to put me in a situation where interference and the domino effect would mean my chances of winding up with surgical delivery would be far greater. Believe me, if I had thought that there was no negative effect to having an epidural, I would have been all over it. But I believed that it would slow down my labour, and I would end up with forceps or a cesearean and a slow recovery. It was a great fear and I was happy to stay home (but not so happy about the torturous back labours). I don’t believe we lit any candles. I knew that wasn’t going to change a thing!

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

    I have been deeply disappointed by the “Skeptic” movement when it comes to pregnancy and birth (and parenting to a lesser degree). It’s a pit of faith in a supposedly fact-driven place.

    As an atheist raised by atheists, I never had a “lost faith ergo shunned by the faithful” experience. Until I dared to not have blind faith in midwifery.

    • lola

      I would totally agree with this. I was a poster on jref for years, went to TAM for several years, but I’m astounded at the way they’ve talked about childbirth. Harriet Hall is generally pretty good when she’s touched on it. I’m not keen on the skep chicks, and a lot of people have issues with them/rebecca.

    • theNormalDistribution

      I have never been a fan of the Skepchicks. Setting aside how wholly offensive I find the moniker (because I could rant about that for a while), I’m really not surprised by this article; I’ve never found them to be particularly skeptical. They’re just capitalizing on the “fad” of skepticism and rationalism.

      Grumble.

      • fiftyfifty1

        “They’re just capitalizing on the “fad” of skepticism and rationalism.”

        I can’t comment on the quality of their non-biomedical articles, but the medical stuff they produce is low quality. Sadly it reminds me a little of The Feminist Breeder who had confused having a “you’re not the boss of me” attitude with being a feminist. Skepchick is confusing skeptical with being sassy.

        • Jessica S.

          Well said – I completely agree about the sassy point.

    • MDP

      Agreed. And it’s very frustrating because the Natural childbirth dogma is anti-science to its very core. Skeptics should be all over this.

  • Zornorph

    Don’t hold your breath. They have other ways of knowing how to add numbers up.

    • no longer drinking the koolaid

      Another version of new math?

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

        Don’t remind me of Tom Lehrer, please.

        • attitude devant

          It’s simple. So very simple! That only a child can do it!

        • Jocelyn

          I just want to tell you (because I am proud of the fact) that I can sing the entire elements song from memory.

    • attitude devant

      Very witty, Z!