Homebirth midwives (CPMs) don’t give a damn about safety

Sweet small baby

It’s no secret that I am strenuously working for the abolition of the CPM (certified professional midwife credential). And it’s no secret that I am confident that the bogus “credential” will be abolished eventually. The only outstanding question is how many babies will die at their hands before they are put out of business.

Why should the CPM credential be abolished?

I have given many reasons in the past including the fact that CPMs have less education and training than ANY other midwives in the first world and the fact that they would be ineligible for licensure in the Netherlands, the UK, Canada, Australia or any other industrialized country. In fact, if you’d like to know all of the many reasons, you can watch the video in the sidebar of this blog.

Today, though, I want to give the simplest possible answer, one that legislators, doctors, public health officials and even homebirth advocates can understand:

CPMs don’t have any safety standards of any kind.

  • The American Congress of Obstetricians and Gynecologists have published 152 Clinical Bulletins to establish parameters for safe practice for all obstetricians.
  • The American College of Nurse Midwives has published 11 Clinical Practice Bulletins to establish parameters for safe practice for all real midwives.
  • The Midwives Alliance of North America (MANA) has published ZERO bulletins to establish any parameters, safe or otherwise.

Can you think of any other group of professionals that has never published a single guideline for safe practice? I can’t.

MANA is not a professional organization. It is a special interest lobby and special interest lobbies don’t concern themselves with safety.

It would be bad enough if MANA and CPMs ignored safety, but the truly chilling fact is that MANA and CPMs actually OPPOSE parameters for safe practice.

Consider the recent paper published by MANA executives, Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009. Let’s leave aside for the moment the fact that the authors lied about the fact that their data show that homebirth increases the risk of perinatal death by at least 450% and probably a whole lot more.

Let’s look at the appalling death rates that the authors didn’t lie about.

For example:

Of 222 babies presenting in breech position, 5 died either during labor or the neonatal period.

So the homebirth death rate for breech was 20/1000 compared to approximately 0.8/1000 in the hospital. That’s a breech death rate 25X higher (2400%) than the hospital.

MANA has known about this astronomical death rate for 5 years. What have they done to mitigate it? NOTHING!

At no point during those 5 years did the executives at MANA let women know about the extreme risk posed by breech homebirth.

At no point during those 5 years did MANA publish a clinical practice bulletin to inform their own members about the extreme risk posed by breech homebirth.

In fact, homebirth midwives continued to lobby to extend scope of practice to INCREASE breech homebirths.

And even today, in the face of publication of the exact magnitude of the extreme risk posed by breech homebirth, homebirth midwives and their allies are CONTINUING to lobby against an efforts to restrict breech homebirth.

Typical of these efforts in this Change.org petition:

The Arizona State Legislature is considering adopting a new bill that would make it illegal for home birth midwives to attend breech, VBAC, and multiple births (SB1157)…

A recent study published in the peer-reviewed Journal of Midwifery and Women’s Health shows that current science supports home birth for breech and VBAC patients.

I don’t know if the author of the petition is a liar or a fool, but the study showed that science (current or otherwise) does NOT support breech homebirth because the death rate is an appaling 20/1000.

Where is MANA and its executives in this attempt to void any safety regulations in Arizona? They are nowhere to be found. Even though MANA knows that its OWN DATA shows breech homebirth has a hideous mortality rate, they are silent.

The CPM should be abolished because CPMs are not health professionals; they are business women who don’t give a damn about safety and care only about their bottom line. They have literally NO standards for safe clinical practice, which is unfathomable for a purported health care organization, but entirely predictable in an economic lobbying organization.

The CPM credential is a public relations ploy designed to trick legislators and laypeople into believing that homebirth midwifery a profession. It’s not and the sooner the CPM is abolished, the sooner the deaths at their hands will end.

  • Ash

    From Mary Cooper, lay midwife, in trade journal “Midwifery Today”
    “Each visit she was spilling protein and her blood pressure was creeping
    up and she was swelling. During our last visit, I talked to her once
    again about flushing her body with fluids and eating well. Toxemia
    developed quickly and it was hurtful to both mom and baby. Her husband called me and told me how swollen her face was and that she
    had a headache and ringing in her ears. I told her husband to take her
    immediately to the family doctor. I went to see her the next day, but
    she was not home. Two days later the University Hospital Neonatal Unit
    called me to ask about the tests the mother might have completed with
    me. Baby was born three months early weighing 1 lb 14 oz and was 15 in
    long. The mother was in a coma. She awoke and healed, but baby was still
    in the hospital three months later.”

    Irresponsible. A charlatan pretending to give healthcare. Instead of immediately advising the patient to seek medical care in the setting of proteinuria and increasing blood pressure, the lay midwife told the client to drink fluids. And yet, Midwifery Today says “. The moral of the story is this: find a really nurturing and skilled
    midwife for your birth and eat well; this is the best prevention for
    prematurity.” Look how far that got this mother and child.

    • Young CC Prof

      If she’d referred that lady to a hospital at the first sign of pre-e (In the second trimester!!!) the baby would absolutely have had lung steroids, and the mother wouldn’t have wound up in a coma. This idiot has no idea how close she came to killing both of them.

      • Ash

        Well, “Mary believes in all aspects of the birthing process, birthing women and
        the full circle of birth (which at times includes death).” She’s aslo happy to delivery breech babies at home. I surmise she’s quite experienced with death.

        • fiftyfifty1

          Holy shit!

    • fiftyfifty1

      What issue??!! This is shocking! This needs a post all of its own.

  • eleanore

    Are you FUCKING kidding me?
    Europeans still do home births and have a higher success rate than hospitals.
    YOU ARE A DUMB. BITCH.
    I don’t even care if you approve of this or not, you’re so ignorant.
    Get the fuck off the internet and stop writing nonsense. You stupid bitch.

    • Amy Tuteur, MD

      Wrong! The Netherlands, the country with the highest rates of homebirth, has one of the worst perinatal mortality rates in Western Europe. Dutch midwives attending low risk births (home or hospital) have a HIGHER perinatal mortality rate than Dutch obstetricians attending HIGH risk births.

      Looks like you are another one of those gullible fools that believes anything that other homebirth advocates tell her.

    • birthbuddy

      you are obviously a delightful person. Are you just having a bad day?

  • koffeewitch

    Could someone explain this a bit better to me? I am sorely lacking in statistics skills. I seem to read this as: of those 222 births that presented as breech that Dr. Amy cites, nearly half (95) were delivered by cesarian and were obviously delivered in hospital…. is that a correct interpretation?

    • manabanana

      That is correct, but to clarify: according to the study, these were ‘planned home births’ that ended up being transferred to the hospital, and not transferred prior to labor. (Transfers before labor were not counted). So these were either planned home breech deliveries, or undiagnosed breech presentations during labor.

      Planned hospital births for breech presentation diagnosed prior to labor were not counted.

      Nearly 1/2 of these planned variation-of-normal breech home births ended in cesarean.

      • koffeewitch

        Thank you. I had assumed that these were transfers…just not sure if the babies deaths in these cases were due neglect of the midwife, neglect of the hospital staff in the case of transfers) or just unfortunate deaths that may not have been due to neglect.of any party. I’ve seen recent studies that indicate that vaginal breech deliveraries are safe in many cases…the problem is finding a doctor willing to attempt to deliver one (in my city, I know of only one such OB willing to perform a vaginal breech). I am a big proponent of vaginal breech deliveries being taught in medical schools again.

        • Young CC Prof

          Please name one study published within the last 20 years that shows vaginal breech is as safe (for baby OR mother) as planned caesarian delivery.

          “just not sure if the babies deaths in these cases were due neglect of the midwife, neglect of the hospital staff in the case of transfers) or just unfortunate deaths that may not have been due to neglect.of any party”

          Realize the number of deaths is so extraordinarily high that the “unfortunate coincidence” explanation is basically impossible. It’s about as likely as winning the lottery twice in a row.

          As for neglect of hospital staff, we don’t know how many, if any, of the deaths occurred in the hospital transfers. (I suspect none, as they didn’t count as “home births.”) Even if they did, did the death occur because the hospital staff failed, or because caesarian was delayed due to laboring at home for so long? If the baby is already close to death when you walk through the hospital doors…

        • AllieFoyle

          >>>”I am a big proponent of vaginal breech deliveries being taught in medical schools again.”

          With which babies? I would never consent to jeopardize the safety of my own baby for a training exercise, and I suspect most other women feel the same way.

        • http://thefresstyler.blogspot.com/ Hannah

          Why? With whose babies? Where are these studies?

          Sorry, but from what I have read, there is nothing that has been studied in recent years that indicate that vaginal breech birth is safer than a caesarean section.

          I understand that abdominal surgery isn’t ideal. I’d love to avoid a section if I can, largely because my recovery from a full cut appendectomy was extremely painful but if the choice is between me having to take some Tylenol 3 and my baby being in distress on her way out, I will choose the Tylenol 3 every time.

          It seems to me that, like so much else related to the NCB movement, none of the concern is about is what is safest for baby and mother from a medical perspective. It is all about nebulous definitions of maternal welfare with things like not getting a spiritual or raw or whatever ‘experience’ being a key factor.

        • AlisonCummins

          “I am a big proponent of vaginal breech deliveries being taught in medical schools again.”

          Why?

        • Guestll

          I’m in Canada. The SOGC Guidelines for vaginal breech delivery (which are interpreted by many NCBers as “they’re all for it!”) are fairly stringent. The selection criteria for labour ends up ruling out a number of dyads, as do the guidelines on labour management (for example, move to section if delivery is not imminent within 60 minutes of pushing.) The evidence demonstrates that breech delivery is risky, not that it is “safe in many cases.”

          As an anecdote, my mother helped to deliver thousands of babies between 1963 and 2003 at a large teaching hospital here in Canada. Out of twins, breech, and VBAC, guess which one caused her the most anxiety? And this is back when the dinosaurs of OB were reasonably-to-extremely practiced at delivering vaginal breech…

  • saramaimon

    i don’t know if you are erroneously or deliberately differentiating between Certified Nurse Midwifes and Homebirth midwives but the distinction is artificial as there are many CNM’s who are proud to be homebirth midwives.

  • AmyH

    My take on it is that any death rate below 49% is safe in their eyes. You’ll probably make it ok…

  • AngryAtMANA (aka staceyjw)

    I cannot stop thinking about Magnus Snyder, who died due to an OOH breech birth. Had his mom, Sara, and his dad, seen these stats back when they were first available, I know she would never have attempted an OOH breech birth. (Informed consent? Whats that??)

    THIS INFO EXISTED FOR YEARS PRIOR TO HIS DEATH, BUT WAS NOT AVAILABLE TO HER BECAUSE IT WAS NEVER SHARED OR UTILIZED!!!

    They were talked into it with promises of a nice VB, told repeatedly about the MWs “expertise”, with not one single mention of added danger. The parents simply didn’t know enough to know the MWs were wrong, and that they were being lied to by so called “professionals”, who were desperate to try out a breech birth IRL.

    One more time, for emphasis now:

    THIS INFO EXISTED FOR YEARS PRIOR TO HIS DEATH, BUT WAS NOT AVAILABLE TO HER BECAUSE IT WAS NEVER SHARED OR UTILIZED!!!

    His death falls squarely on MANA, for hiding those numbers, as well as failing to make even a cursory attempt at educating their members or moms about the increased risks of breech birth OOH. I am sure some moms would have gone ahead, but I know some would not.

    Magnus would be here today had Mana not hid these deaths, and had MANA bothered to make even basic safety guidelines.

    I can think of many other babies that would be here had this info been available. While many were hardcore NCBers who might have disbelieved this data, many were simply mainstream moms that wanted something different, something extra special (like Wrens Mom, Tweeny, and Shazhads mom, Margarita). NO WAY would they have gone ahead if they had any clue HB was NOT “as safe, or safer!”

    Last time now, for all the babies:

    THIS INFO EXISTED FOR YEARS PRIOR TO ALL OF THESE DEATHS, BUT WAS NOT AVAILABLE TO ANY OF THESE MOMS BECAUSE IT WAS NEVER SHARED OR UTILIZED!!!

    • Susan

      Their story was one of the hardest to take I have ever read.

    • Karen in SC

      Do we need Nancy Grace to do an expose? Or could we get Dr. Amy on The View?

      • Trixie

        If you want to be taken seriously, those are two of the worst outlets I can think of.

        • auntbea

          But if you want to make a stink….

          • Trixie

            Really? You think Dr. Amy sitting next to Jenny McCarthy is a good idea? That’s a horrible idea.

          • auntbea

            Depends on the goal and the intended audience.

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

            I would pay good money to watch Dr. Amy go to town on Jenny McDeadBabiesPlagueBitch.

          • http://thefresstyler.blogspot.com/ Hannah

            I can’t think of a more excellent idea, honestly…

        • Karen in SC

          But people watch those shows. However, I’ll concede they are not the most “journalistic” for lack of a better term. What about 60 Minutes?

        • http://thefresstyler.blogspot.com/ Hannah

          People watch them. People listen to them. I’d pay money to see Dr Amy slamdown ‘Dr’ McCarthy while educating women that OOH birth is not safe.

  • Lisa from NY

    Make it illegal for a CPM to attend a homebirth and mothers will write “unassisted” on birth certificates.

    • MLE

      Can you elaborate? Are you making the argument that this would make HB less safe or even more underground than it is today? But wouldn’t those mothers who chose to go ahead with an illegal midwife be pretty much unstoppable anyway? And in truth, aren’t they essentially unassisted if their attendant has no skills? Making the CPM illegal would signify to the mainstream parents that this is a fringe decision to make and not all it’s cracked up to be on the internet.

      • Amazed

        I think Lysa means that they’ll keep having a CPM homebirths without acknowledging it. Like Sarah Kerr did. Lisa Barrett only “held the space” while the second twin was dying.

    • AllieFoyle

      So? You can’t stop people from breaking the law, but you can set some standards in the name of safety and responsibility.

      Why should the government concern itself with accommodating potential lawbreakers? It has a responsibility to protect the public by not allowing unsafe practitioners to give negligent or dangerous care or to present false or incomplete information about the risks potential patients can incur by using their services.

    • Allie P

      Some certainly will — you can’t stop crazy people from doing crazy things. But a lot of reasonable people who are being actively lied to by the very magazines that appear in their OBs waiting rooms that claim HB is “as safe” as hospital birth will no longer be snookered. There a ton of people who have been hurt by homebirth who were mistakenly convinced that they were NOT doing anything dangerous. Look at the case of Wren (http://hurtbyhomebirth.blogspot.com/2011/03/wrens-story-on-1st-anniversary-of-his.html) — these are parents who thought Homebirth was a privileged choice, like buying organic at Whole Foods — they had no idea how dangerous what they were doing was because the CPM who serviced them lied and was allowed to. And their daughter paid the ultimate price. I think that even the few people who have homebirth now would be cut drastically if the casual “crunchy” realized how dangerous what they were doing actually is. (just as a lot of people casually didn’t vaccinate before mainstream media stopped paying so much lip service to the anti vaccine movement.)

    • AlisonCummins

      A CPM will still be able to attend a home birth, she just won’t be able to call herself a midwife or charge money.

      Mothers will write “unassisted” on birth certificates but sooner or later someone will spill the beans after a bad outcome. Not everyone who likes the idea of practicing midwifery will be as cavalier about breaking the law, so the number of CPMs can be expected to drop.

  • Captain Obvious

    After seeing all those bad drug lawyer ads on tv, I have switched a few words to create an ad I would love to see on TV.

    Homebirth Linked To Severe Complications.

    Homebirth has been linked to several complications including , low or absent 5 minute APGARS, inability to completely deliver babies from breech or shoulder dystocia, hypoxic ischemic encephalopathy, intrapartum death, and increased neonatal death with breech, HBAC, or twins. Parents experiencing birth complications at the hands of CPM homebirth midwives have begun filing Homebirth lawsuits against the organization, MANA.

    Homebirth with a CPM is a birth with a “midwife” that is undertrained, uninsured, usually not licensed that was approved by the Midwives Alliance of North America (MANA) since 1982. The CPM midwife maintains an undertrained version of the CNM credential and is said to be as effective at delivering babies at home as at the hospital (if not safer).

    In 2014, Dr Amy Tuteur issued several warning blogs to MANA stating that their special interest organization “presents unsubstantiated claims, minimizes the risks of using CPMs, and includes false or misleading presentations regarding Homebirth.” These warning blogs were issued in response to MANA online blogs and other birth junkie echo chamber blogs published on the social networking websites.

    Parents filing lawsuits against MANA allege that the organization knew about the risks associated with CPM Homebirth and failed to provide adequate warnings to women considering homebirth. Some complications caused by homebirth require transfer to a hospital, while other complications, such as HIE, low APGAR scores, and neonatal seizures, can lead to prolonged NICU admissions, permanent injury, and death.

    If you or a loved one suffered from a hospital transfer without an accompanying midwife, new born with seizures or HIE, thousands of dollars of NICU bills, neonatal or intrapartum loss, or other serious side effects after attempting a Homebirth with a CPM, contact the lawyers at Safer Birth to learn more about your legal rights. You can contact us by calling toll-free at (866) 555-5555, or by filling out a free case evaluation form to the right of this page.

    • Susan

      And they WOULD have those ads if MANA had assets. Messed up system that those ads are aimed often at things many factors less dangerous because the manufacturers have deep pockets. Any of you read the King of Torts? Is that like acquiring your medical knowledge from ER or House?

      • Dr Kitty

        DON’T get your medical knowledge from House.
        The episode where a patient had a liver biopsy, CT scan and various weird treatments BEFORE someone did a liver function blood test…nope.

        Scrubs had the most accurate medicine, usually.

        • KarenJJ

          I love Hugh Laurie but detest House. They did an episode on a rare syndrome that I actually know something about. It was a complete hash job and very bizarre how the symptoms were shown. Decades of organ/nerve damage condensed within a week. It was cringeworthy watching it.

        • mom of 2

          Yeah, I’ve always thought that as silly as it is, scrubs is by far the most accurate medical show on TV. Its also the best one, IMO.

    • LMS1953

      The CPMs may not have much in the way of assets, but the states that licensed them do. Dr Amy had a blog about a CP baby at a birth center and the mom named her state as a co-defendant. Anybody know how that case came out?

      • staceyjw

        It was Abel Andrews’ parents, they sued the state of Oregon. Turns out, states CANNOT be sued over this type of thing, they are protected from their mistakes by law. They got part of the way into the process, and then it was dismissed, just like that.

        It did scare the shit out of legislators though, which helped get some new laws passed. They aren’t great laws, but are better than what came before, which was NADA.

        It gets worse, but I’m not sure what all is public, so I will stop here.

    • Susan

      Dr. Amy this might be a good guest post?

      • Captain Obvious

        I am sure Dr Amy can tweek it so that it sounds better and includes the State’s deeper pockets as LMS1953 suggests. Including a few other supportive studies and statistics could actually have something like this serve as a basis for some possible real actions.

        • Amy Tuteur, MD

          For better or for worse, the doctrine of Sovereign Immunity means that it is nearly impossible to sue a state or the Federal government. They aren’t really the problem anyway. It’s MANA who perpetrated this and, if anyone ought to be punished, it’s MANA.

          They apparently have very little money, so the goal would not be a monetary award, but an end to the lies and deaths that result.

          • Captain Obvious

            I still believe a well worded mock advertisement for “BAD BIRTH” (instead of Bad Drug) would get some hits on google and make some women and others think twice about the reality of the risks.

          • CarrieC

            Great point.

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

            I think the vast majority of your readers would rather see MANA held responsible publicly than paying out. As nice as it would be for some money to reach the families of injured children/mothers who have been harmed, it’s getting them straight up BUSTED for their unconscionable lies.

        • LMS1953

          There was a landmark case involving wrongful birth (the first legal exercise of that concept) and Sovereign Immunity. It involved a 34 y/o gravida who was a military wife (on the Tri-Care military insurance of the time). She received OB care at a military clinic. The crux was that she turned 35 about a week before she delivered. The standard of care was to have offered a genetic amniocentesis to ALL gravidas who would turn 35 BEFORE their EDC due to that risk being the cut-off for evaluation for Downs. She did not receive such counseling. Naturally, she delivered a baby with an extra chromosome 21. The argument was: “If I was appropriately counseled per the standard of care I would have opted for an amniocentesis. The amniocentesis would have diagnosed that my fetus had Downs Syndrome. With that knowledge, I would have aborted my fetus. Now I have a special needs child (wrongfully born) which needs are very expensive to care for. I need compensation to be made whole.”

          The government had to waive Sovereign Immunity (from what I understood) to permit the lawsuit to proceed. Mom won a multimillion dollar judgment.

          An analogous argument: The state government was remiss in licensing CPMs without doing due diligence. They should have discovered the deplorable neonatal death rate of CPMs and if they had, it would have been negligent to have certified and licensed that class of midwife. The home birth morbidity and mortality of breech birth is well beyond the risk any reasonable gravida would take. Absent the negligence of the state legislature, I would have known of the risk and I would have opted for a hospital birth.

          I don’t know what goes in to a governmental entity waiving Sovereign Immunity. But that is how the concept of wrongful birth took root.

  • Susan

    Great post Dr. Amy. The special interest statement made me think of when Arnold Schwarzenegger called nurses a “special interest group”! We of course made buttons and posters in response that say “patients are our special interest”! So I looked at the CNA site hoping there were position papers on safety and YES THERE ARE! Even the most powerful nurse’s union has position papers.

    • Amy Tuteur, MD

      Exactly. There is no legitimate group of medical providers that doesn’t have safety standards. MANA is not a professional organization, it is a lobbying group, pure and simple. And one of the things homebirth advocates lobby hardest against is safety standards.

      • The Bofa on the Sofa

        What is MANA’s “mission statement”? Every big organization is going to have one.

        • NoLongerCrunching

          (Per their websites):

          MANA: promotes excellence in midwifery practice, endorses diversity in educational backgrounds and practice styles, and is dedicated to unifying and strengthening the profession, thereby increasing access to quality health care and improving outcomes for women, babies, families, and communities.

          ACNM: Advancing the health and well-being of women and newborns by setting the standard for midwifery excellence.

          ACOG: provide the highest quality education worldwide, continuously improve health care for women through practice and research, lead advocacy for women’s health care issues nationally and internationally, and provide excellent organizational support and services for our members.

          • The Bofa on the Sofa

            promotes excellence in midwifery practice, endorses diversity in educational backgrounds and practice styles,

            So the first two components contradict each other (or, at the very least, fall to the gambler’s fallacy)

            dedicated to unifying and strengthening the profession, thereby increasing access to quality health care and improving outcomes for women, babies, families, and communities

            Followed by a non-sequitor

          • Young CC Prof

            Diversity in educational backgrounds? I wish that meant something other than it does: Than a CNM with a Master’s degree is supposedly the same as a CPM with a couple months’ apprenticeship.

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

            I’m sure Dr.A has done this, but is there an article comparing these three organizations a bit deeper than your comment here?

  • Leesah

    “care only about their bottom line”

    I can promise you this is not true. They also need their ego fed. Many of them do births for cheap or free when they can’t get paid, and it’s because they thrive on the worship and admiration they get as a result. That’s why it is worth it to risk arrest and prosecution in some cases as well: nothing feeds an ego better than being hailed as a martyr.

  • Concerned Mom

    thank you for writing this blog! There has to be a sane point of view on home births: midwives proudly state (heard with my own ears), that they would attempt breech births at home even if traditional medical professionals would recommend a c-section… how irresponsible is that???

    • Sue

      If a provider who assists you during childbirth does not improve safety, why pay them to attend at all.

      Family and neighbors can provide all the company, comfort, cooking, knitting and childcare you need, for free. And they probably won’t get in the way when you decide to go to hospital.

      (Title for a paper: lay family and friend childbirth attendants associated with better birth outcomes than CPMs)

  • no longer drinking the koolaid

    Has anyone seen the victory in Hawaii? The CPMs and supporters were commenting on the sensible new law which would have restricted CPMs, home birth, etc. the bill sponsor agreed to gut the bill and set up a task force to study things. Posting from my ipad, so I can’t add any of the links at the moment.

    • Sue

      Can someone from Hawaii launch a counter-petition in favor of the bill?

  • Jocelyn

    OT – what are some good rebuttals to the argument that the “failure to progress” diagnosis is given too often, leading to too many c-sections, and that a new Friedman’s curve should be made for today’s birthing populations because someone could “still be in early labor” and not really need a c-section?

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

      I bought into that, and then realized the error of my thinking during that super long labor. Laboring is exhausting, and not everyone can eat or wants to eat for energy. I puked up juice I drank basically instantly, so there was no way solids were going to stay down. There just wasn’t enough energy to keep going, and that was after an exhausting pregnancy.

    • The Bofa on the Sofa

      a new Friedman’s curve should be made for today’s birthing populations because someone could “still be in early labor” and not really need a c-section?

      It’s the same old question:
      Which prolonged labours are not going to need a c-section?

      The only way to know whether a c-section is actually “needed” is to wait until that happens. The problem with that is that it’s a much higher risk to do an emergency c-section.

      Remember, the goal of intervention is to prevent emergencies. Sitting around waiting until an emergency occurs is a very bad idea.

      • LMS1953

        This is precisely why I have tried to develop a quantitative estimate of the “work” done by a mathematical assessment of the Sigmoid Curve of the Friedman Curve. See the discussion over the past couple of days. The physicists and mathematicians don’t think it can be done but I still think it is a reasonable hypothesis.

        • GuestingIt

          If you go back and read my first comment to you, I said the following: 1) It might be interesting to plot the integral of the bell curves of each contraction, so make the plot and see. 2) Has no one done this before?

          I think you get off on having this pet theory but don’t want to do any “work” to look into it, such as searching pubmed for similar research, or bothering to learn the definitions of simple physics terms like work, force, and pressure.

          • LMS1953

            Likewise, you might do a little research to understand the difference between hypersystole and precipitous labor. We each have our training and expertise. No need to be a snotty prick about it.

          • GuestingIt

            At least I do not have the hubris to pretend I know what those things are. I’m annoyed that you would ask for help, treating this blog like your own private research farm. Then say everyone discounts your idea, when in fact there was support for it, you just didn’t follow up.

          • LMS1953

            You said the work would be the same whether it was a precipitous curve or a protracted one. And that was after a lot of discussion. Sorry, I did not perceive that as “support”. I wasn’t looking for support. Science usually advances best with skepticism and devil’s advocacy. I think we all learned a lot from the give and take. I know I did. I appreciate your and others input.

          • GuestingIt

            Ummm, no. That was another commenter. You don’t even want to do the work of going back to look at the original thread.

        • Amy Tuteur, MD

          I appreciate the desire to elucidate the biomechanics of labor, but the Friedman curve can’t tell us anything about that except in the most general terms. Starling’s law of the heart applies to everyone because everyone’s heart is the same and an increase in venous return leads to a predictable increase in stroke volume.

          Childbirth is governed by a myriad of factors that differ between women and within the same woman in different pregnancies. These factors include the weight of the baby, the resistance of the cervix, the molecular remodeling of the cervix, the resistance of the vaginal tissue, the position of the fetal head, the rotation of the fetal head, and the ability of the fetal head to mold, among other factors.

          The Friedman curve basically tells us that takes more work to dilate the cervix at the beginning of labor, and more work to force the presenting part down at the end of labor, than it takes to dilate the cervix during active labor. It can’t really tell us much about the biomechanics of labor.

          • Amy Tuteur, MD

            Oops, I forgot one of the most important factors: the maternal bony pelvis.

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

            Tsk, tsk.

        • AllieFoyle

          How would you get accurate and reliable real world inputs for all of the variables though? Even if it were possible, given the current state of technology, wouldn’t it be too expensive, time-consuming, and invasive to be practical?

    • Ob in OZ

      The friedman curve is fine the way it is, as long as you use it as a guideline. Every once in awhile you can justify a bit more time and put yourself out there if you have a good reason. If you are convinced vaginal delivery is still a possibility, or the baby is fine and the patient just needs a bit more time to accept the inevitable.

      • Dr Kitty

        The Friedman curve is quite crude.
        Philpott’s partograph (which what the current WHO model is based on) was developed in Zimbabwe specifically to know when to transport or intervene for obstructed labour in resource poor settings.

        When my mother was a medical student in Zimbabwe she was involved in some of the initial data gathering that produced the curve. She has interesting stories of being unable to turn on the generator for the operating lights needed for a CS in a remote clinic because some lions were eating their kill beside the generator (which was some distance from the clinic building).

        The partograph is particularly helpful in situations where you need to decide where to operate by candle light and kerosene lamps, fuel up a jeep for a 6hr ride to the nearest hospital or can leave things alone until the lions go away.

        • Ob in OZ

          Exactly right. Guidelines for those kind if decisions are critically important. A closely observed patient and an extra hour here or there is unlikely to result in harm. Of all the off topic conversations on this site, wish one was about your family background. Already sounds more interesting then most

    • Amazed

      Aaaah! Spitting on tradition! I can see why Friedman’s curve would be considered a scam but what about all those midwives who said the same thing about 200 years ago? The saying, “The sun should not rise twice over a woman in labour” was popular far before science invented said curve. And it was coined by midwives who couldn’t do much but stand by and watch helplessly as the sun rose over women in labour as many days as it willed. Usually not with good results.

      Relying on tradition when it suits us and spit on it when it no longer does, huh? Typical.

    • Susan

      I think this is happening already?
      http://www.nytimes.com/2014/02/06/health/childbirth-study-sees-longer-labor-as-normal.html?_r=0
      I am not sure you need to rebut that other than to say that in early labor there really isn’t a place for the curve ( at least the doctors I work with don’t do a c/s for failure to progress at less than 4cm) and that in reality many doctors have already adopted different guidelines ( especially with epidurals).

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

        I had a C/S after 48 hours of strong contractions without a dilatation of even 2 cm.

        Each case has to be decided individually. GUIDElines are meant to GUIDE practice, not force compliance. That’s why the “39 wk rule” is so absurd. How, exactly, can one be absolutely sure of the length of the gestation of the pregnancy [unless it is IVF, or IUI]?

        • Susan

          I should of said it’s very rare. Of course there are exceptions. There should always be room for good judgment I agree!

      • Dr Kitty

        My mother never made it past 3cm before she got her CS with me. Of course she was 42w, with ROM for 24hrs and no sign of labour when she was admitted and when they increased from the lowest dose of pit after 6hrs of painful labour without any progress she got tetanic contractions, I went bradycardic, and she had a crash GA section.

        I don’t think keeping the pit at the lowest level, or not using pit at all, and waiting it out would have resulted in a future outcome where I would have been able to write this.

        • Medwife

          You can certainly call a section before 3cm but if it’s an induction I would call it “failed induction” rather than FTP. Difference being we never got the pt into labor in the first place.

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

    I am thinking of calling myself a midwife to prove a point on my safer midwifery for utah blog. Legally I can say I am despite only having taken one doula class and never delivering a baby. I think that would really piss off the CPMs here that are trying to keep things this way. I’m legally a midwife the minute I call myself one, and they can’t do a damn thing about it.

    • The Bofa on the Sofa

      If you brush up on your tv references, I can make you a PCM (Pablo Certified Midwife). I can send you a diploma with sparkles on it and everything.

    • Young CC Prof

      You could even go into business! Post a price list! (Do charge extra for sparkles.)

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

        I was going to make up really weird birth services that were absurd and dangerous. I’ll crowdsource at the fed up with natural childbirth group later :)

        • Young CC Prof

          IUD implantation, with homemade devices. (Infection control sold separately.)

          • resaurus

            Like a blow dart gun? Extra points for romanticizing and profiting off the noble savage myth/natural native lifestyle. Oh, and the infection control comes from the cinnamon breath with which you propel the IUD. :)

        • VeritasLiberat

          Offer vegetarian plasagna.

    • Ra

      I’ve seriously been debating paying for a friend with no medical experience/training to go through CPM “school” just so that we can see first-hand how ridiculous the whole thing is.

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

        I am planning a post on how ridiculous some of the classes at midwives college of utah are. Homeopathy? reflexology? federal grants go into putting people through a school that teaches those classes. Its so stupid.

        • areawomanpdx

          The Birthingway “College” of Midwifery in Oregon is horrible, too. They accidentally posted some of their students papers online a couple years ago, and it was truly frightening how little they understood about how the human body works.

          • Dr Kitty

            Details please…

    • Ash

      Found a link for the proposed legislation

      http://legiscan.com/HI/bill/SB2569/2014

    • manabanana

      You could join MANA as a “direct entry midwife” – no credential required – and be a full voting member.
      http://mana.org/pdfs/joinMANA.pdf

      I seriously don’t know why a bunch of people haven’t done this. It wouldn’t take much to get a solid voting bloc of “midwives” to shake things up a bit over there at MANA HQ.

      An aside – what stupidity in the bylaws that would allow self-anointed ‘midwives’ (aka ANYONE) full professional membership.

    • Jocelyn

      Please do! Really! I was talking to someone today about homebirth, and you doing that would be a perfect example to hold up to someone and say, look! Look how much midwives are NOT regulated!

      • KarenJJ

        Didn’t Dr Ben Goldacre get a nutrition degree for his deceased cat? It was from a specific diploma mill that someone was using to add weight to their “nutrition advice” on UK tv.

        • resaurus

          He did! He got a certificate for his dead cat, Henrietta, from the American Association of Nutritional Consultants (AANC). It’s the same certificate/association membership that British nutrition quack Gillian McKeith, PhD (from a non-accredited distance-learning college that’s now defunct) proudly claims.

          • KarenJJ

            Thanks for the details! I wonder if getting a CPM is at all harder?

          • resaurus

            I’m not sure. Do you have a cat? If you don’t, well, excellent excuse to get a cat!

          • jenny

            I have a cat I’d be willing to donate for, er, science.

    • staceyjw

      I thought about doing this in Oregon as well, as there is no law (yet) mandating you have a license at all, and the new law has a loophole for “traditional” Mws that do not advertise.
      DO IT!

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

        Count me in; I’ve actually been planning to do this too.

        • Jocelyn

          Man, we should all become midwives. Wouldn’t that be funny?

          • Amazed

            99,5 % method of payment recorded. As we know, payment is in advance and not refundable, no matter the outcome.

            Sound much better than my current job. Where should I sign?

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

    OT – I need a minor miracle and have come to the conclusion that the only way for that miracle to happen is to raise awareness about this story and hope that someone who can make a difference reads it and helps a different outcome materialize. She’s 36/37 weeks, so time is ticking and absent an alternate care plan/provider she will be subjected to a vaginal delivery she does not want. http://awaitingjuno.blogspot.ca/2014/02/like-watching-movie-when-youve-already.html

    • theNormalDistribution

      I read this last night and it made me sick to my stomach. I wish there was something I could do.

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

        Right now I’m throwing a social media hail Mary and hoping for the best…but it really is an awful situation that was entirely avoidable and really should not be happening.

        • fiftyfifty1

          ideas:

          Does her insurance pay for care out of the country? Or at least partial care? Could she travel?

          ANY pre-existing conditions that could be considered reasons for a CS? e.g. previous herpes.

          Mental health professional who can say she has a mental health reason.

          Sorry, I know these aren’t really helpful.

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

            Right now all reasonable ideas are being entertained and passed on. Generally speaking Canadian insurance does not covery out-of-country care unless it is something medically required and unavailble here – most travel insurances will not take on pregnant women beyond a certain point in the gestation (I think 32 weeks). It will cover out-of-province care but I do not think that would help much at this point.

          • thepragmatist

            She should call her MP and MLA. For real. Sometimes they do things that are surprising. And she should get a mental health DX right away. Then she can claim she needs out of country care. As much as I hate the fact that a woman has to be declared “crazy” to obtain a c-section in this country, if it gets her a c-section, then it does. STANDARD OF CARE would dictate that if she’s not mentally competent to give birth vaginally, then she should not. The rules in BC are: if you cannot get standard of care in BC, you MUST be permitted to go out of province/country on taxpayer dime. I know, because I came close to going south with my son when the wait list for his surgery exceeded standard of care by 6 months. ??? Instead I went to the media and made the biggest fuss ever. LOL! Anyway, I’m just throwing that one down. But first, she should figure out if her MP or MLA will help in anyway and keep looking for an OB/GYN. There has to be someone. And the media is an option, too, though I know it’s way more intimate than going there for your own child.

    • Zornorph

      Okay, I’m a dude so I confess right up front that I am not capable of understanding all the issues here. With that in mind…WTF? She’s afraid of giving birth but she chose to get pregnant anyway? She comes across just as nutty as those Vag-birth-at-all-costs types except in reverse. She wants a C-section but doesn’t have the ability to pay for it and there’s no medical necessity for it. I don’t know if she watched Alien too many times or something, but I don’t see why other people have to pay for her medical procedure just because she has a preference. Couldn’t homebirthers start demanding others pay for their stunt births too, because they are ‘afraid of hospitals’?

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

        Zornorph – in Canada there is no private pay option and 2. as a dude you really are clueless. There are two ways to birth a baby, vaginal birth is not risk free, the woman must live with the outcome of the care that is given, the cost difference is actually pretty minor when downstream consequences (like urinary incontinance – or birth asphyxia) are taken into consideration, even NICE has recognized it as a reasonable care option for some women. The health care system pays for lifestyle choice all the time – and the next time you have a kidney stone how about you pay for pain relief out of pocket, or go au-natural?

        • Zornorph

          I’ll confess I don’t understand the Canadian health system – so there is no way to pay for something if you want it?

          • Canuck

            If the Ministry provides a service, it’s forbidden to charge for it. There are people who offer quasi-legal surgery centres for simple stuff with big wait lists, but for this you’d be SOL.

          • AlisonCummins

            Not quite. A provider must choose between either only taking public insurance and never taking public insurance. This means there are doctors who do house calls, take cash, prescribe antibiotics and make referrals, and there are clinics that take cash and offer eye surgery or imaging. But anything like hospital care is never cash, it’s always public insurance.

            And yes, that means you have bureaucrats making financial decisions for you. Solution to making these decisions easier and more flexible: pay higher public insurance premiums. Which we choose not to, for various reasons.

            I like our system. It’s worked extremely well for my friends and family. We have always gotten excellent care when needed. The upsides and downsides are different from the US system, that’s all.

          • Canuck

            In bc it is contrary to legislation to provide a service that MSP theoretically provides. I think provisions to this effect exist in all provinces. People do it but it’s quasi-legal at best.

          • theadequatemother

            It contravenes the canada health act. So if the provinces do not crack down on physicians providing insured services on a private pay basis for canadian citizens (medical tourists are another story), the federal government docks the transfer payment that is used to fund provincial health care plans.

            I imagine there would be difficult issues to get around when trying to access a private cs in another country…esp the US who would probably have objections to that baby having the rights of american citizenship. Inserts a wrinkle when comparing the (relatively) easier ability to travel to access other kinds of private surgeries.

          • C T

            Nah, the US wouldn’t care. We hand out citizenship like knitted hats in this country. (Former consul here)

          • Canuck

            Sorry, on my phone. The relevant provision is s. 17 of the Medicare Act.

            http://www.vancouversun.com/touch/story.html?id=6953468

          • mtbakergirl

            I feel like I must add, “quasi-legal surgery centres for simple stuff with big wait lists (AND BIG PROFIT MARGINS)”. Based on some of my reading my understanding is that C-sections are not a high profit surgery (contrary to what natural birth enthusiasts will tell you), this may be another reason there is no alternate pay option for C-sections here in Canada.

            My sympathies are with this poor woman, is there any chance of her getting a diagnosis of tokophobia at this late date? In my circle of friends I know one person who was able to access a MRCS due to this diagnosis.

            Can she access emergency prenatal mental health assistance (possible options here:http://www.womenshealthmatters.ca/health-resources/mental-health/perinatal-mental-health/mother-matters/resources-for-new-moms/)? I cant imagine she wouldn’t qualify as severely anxious and distressed. Even if she didn’t manage to access an MRCS she might get some mental health support pre-natally to assist her in her recovery afterward.

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

            Not for anything covered under the provincial health system – which includes childbirth. There is no parallel system in Canada.

          • Zornorph

            Yikes – and people are okay with that? I guess there’s upsides, but I don’t think I’d like that.

          • VeritasLiberat

            Zornorph, we’re not allowed to criticize government-run health care on this site. We’re supposed to pretend that it makes sense to expect that you’ll get what you want instead of what the State has decided you should have.

          • fiftyfifty1

            Do you seriously think that getting a maternal request C-section here in the States is all hunky-dorey just because of our patchwork as opposed to single payer plan? Ha ha ha ha ha! You’re right, here the State doesn’t get to decide what you should have. Here it’s the insurance policy executives instead!

          • VeritasLiberat

            But insurance is at least an industry, so they have to at least sort of pay attention to how pleased their customers are. The government does not have to.

            Why is is that almost all of the “can’t access pain relief, denied an epidural, can’t get a c-section, can’t get a hospital bed, etc., stories that I read on this site happen in countries where the government has a monopoly on health care? Can someone explain, because I don’t get it. Point me to some stories on this site where mothers are forced into natural deliveries because the insurance won’t pay and they have no option to pay themselves.

          • T.

            I live in Italy. We have a double system. You can either pay for it or accept public care.
            I don’t know about birth in particular, but I remember some data about the majority of bankruptcy in the USA being from not being able to pay for medical bills. I will never have to worry about it. Since both my mother and my father had heart attack, I am pretty damn grateful.
            And I DO know of stories where people had not get medical attention they deserved because their insurance wouldn’t pay for it. Not related to childbirth, I admit.
            But to each its own I suppose. If you really prefer your system, be my guest.

          • VeritasLiberat

            I would need to know more about it but that kind of a system might be ok… if I understand it right the public system would be like our Medicaid and the private would be like what the majority here have. The problem here comes mostly with the people who don’t qualify for Medicaid but can’t get regular insurance. And it seems like there must be a way to help that segment of the population without disrupting a system that 85 percent of people are happy with. As it is, with the amount of money that has been wasted on the Obamacare bureaucracy, we could have just sent every uninsured person a check to buy insurance with. I just cannot wrap my head around the idea that a woman in Canada wants a perfectly legitimate medical service and is not ALLOWED to have it EVEN IF SHE WERE TO PAY FOR IT HERSELF. She can’t use her savings, can’t get a loan, can’t borrow money from her sister, can’t even hold a 5k. She just CAN’T HAVE IT. This may be a cultural difference here, but I don’t get the appeal. And it is coming here, and I’m dreading it.

          • KarenJJ

            Everyone can access medicaid/medicare and it provides a very decent level of care and then those who want it can buy private health insurance separately (and it isn’t tied up to your employment – you just buy a policy out of pocket – and the premiums are also subsidised by the government).

            The government has encouraged this form of health care through its medicare levy paid via the tax system and its health insurance rebates paid to people with private health (and if you don’t have private health cover and earn over a certain threshold you are penalised via the taxation system).

          • KarenJJ

            Similar in Australia. For my maternity care I went private with my private health insurance covering most of it. The private hospital had more private rooms and better food as well as a 24hr well baby nursery. I also got faster access to IVF via the private system.

            For my rare immune system issue I go to the public hospital. Public/private are generally the same doctors, in fact my immunologists I started off seeing privately but he recommended I switch to his public clinic so I could access a much wider range of tests and medication without it costing me a small fortune.

            I don’t fully understand the US system, but having a wide reaching medicare is great and having some choice via the private system is also nice. It doesn’t have to be all or nothing.

          • MaineJen

            …Insurance companies by and large DON’T pay for epidural. You pay out of pocket for that. Worth every penny, too :)

          • VeritasLiberat

            I’d like to see evidence for that claim that most insurance plans won’t pay for epidurals. Nobody I know has gold-plated coverage and this was never an issue.

          • MaineJen

            Caveat: I made the mistake of speaking from my own experience. There may be other, more awesome health plans out there which do pay for “not medically necessary” frills like pain relief. But mine did not. Like I said, best $300+ I ever spent. I can see it being a huge financial consideration, though. Sad, right?

          • Young CC Prof

            But I have heard of women who went without epidurals because they had no insurance at all and were trying to keep costs down.

            Basically, socialized medicine works better on average. Private medicine works better for those who can afford it.

          • Trixie

            Or chose a home birth because they didn’t have insurance and it seemed cheaper.

          • thepragmatist

            What I don’t understand is why we can’t have a mix of both and maybe try to move away from being obsessively ideological about it. In Canada, you can’t even criticize the current system without being accused of trying to destroy it, but it’s clear to me, as a patient with long-term health issues, it’s totally and completely broken.

            Would we pay (my family) for better care for me? Hell yes, we would, but it doesn’t exist. And I have petitioned against privatized care because it IS unfair as it would currently be offered. Instead, we deal with extremely long wait lists. At one point, it took me five months to see my OB/GYN and it regularly take a year to even start seeing a specialist, then add to that any diagnostic tests. Meanwhile, you are left to your own devices, and maybe you have a family doc and maybe you DON’T. It’s not okay. But there is not the will to change it because it’s frightening to imagine a US-style healthcare system replacing it, so we would need to invent something else. The UK hasn’t exactly solved their problems either, by introducing a parallel private system. So the question remains unanswered. And leaves someone like me in a sort of limbo, because I will not let go of a system to at least provides care for one where I might not get any at all (because I would have pre-existing conditions or might not be able to pay premiums). I have too many American friends who have it worse for not having any insurance at all. Or who are on Medicaid, which is like Canada, but even worse. SO… it’s not so easy to find a solution.

          • fiftyfifty1

            “so they have to at least sort of pay attention to how pleased their customers are. The government does not have to.”

            Voting. It’s what citizens do to ensure that the government pays attention to what pleases them.

            In contrast, most insurance companies do not care whether they please the policy holder. They only have to please the employer who chooses the policy.

          • AlisonCummins

            Yes!

          • Dr Kitty

            I don’t think an uninsured woman in the US who hasn’t got the $ for a MRCS is going to get one either…

            “If you want it YOU have to pay for it” assumes that you CAN pay for it.

            I am firmly of the opinion that a person’s healthcare options should not be limited by what they, themselves, personally, can afford.

            This is because, simplistically, poor people are sicker and sick people are poorer.

            Health inequality is a thing.

          • VeritasLiberat

            Thanks for the downvote!

          • fiftyfifty1

            The original downvote actually wasn’t from me, but I’ve added on another since apparently you are thankful for them.

          • thepragmatist

            People are militant about it, including me, because what happens when doctors are allowed to go off grid and into the black market is that everyone else suffers for the few who can pay, since we do not have enough specialists in any field. Huge brain drain to the States here.

        • fiftyfifty1

          ” as a dude you really are clueless.”

          I disagree. Zornorph is clueless as a PERSON. He has a habit of reverting to that “just a dude” excuse whenever it suits him.

      • Canuck

        She’s in Ontario. She has no option to pay. C-sections aren’t available on the open market in Ontario and BC. And she probably wanted a baby, not a birth, so she got pregnant.

        • Zornorph

          Okay, I didn’t understand that part. I had always assumed if you wanted something other than the care you get in the socialized health care system, you could find somebody and pay them. I can’t say that I’d like that, but don’t want to get into politics as that’s a different game.
          So it’s entirely up to the whim of the hospital how you get the care you get? You have no say at all? Do you have to go to the hospital that covers the area you live in or can you go to any one?

          • Canuck

            It depends where you live, but rarely do you have a choice. You might have some wiggle room with doctors, depending on how much demand there is for the type of doctor you want.

          • thepragmatist

            You mostly have to go to the doctors and hospital in your area. It’s entirely up to the doctor and the hospital that admits that doctor. There is very little choice where I live. I have a terrible hospital here, and I am stuck going there whether I like it or not. In fact, people refer to it as “St. No’s”. They sent me home, walking, at 4am with pneumonia once. That’s just the tip of the iceberg. AND another reason I wanted a c-section, because I didn’t believe I’d get adequate pain relief.

      • fiftyfifty1

        There are real risks to “letting nature take its course” with birth (just as there are different risks to having a CS). This woman has looked at the risks and decided they are not for her. That seems reasonable to me and not “nutty”. Just because you want to be a parent doesn’t mean you should also want to leave it up to chance whether or not you end up with fecal incontinence or your child gets a birth injury.

        It’s especially ironic that you think women should have to do it the natural way, when you yourself were not willing to do so. From choosing surrogacy to pre-implantation sex selection, you yourself rejected the natural way.

        • Zornorph

          I think people should be able to birth however they want, my issue was about who is going to pay for it. But I didn’t understand how the Canadian health system apparently works. Doesn’t seem as if she is allowed to make a different choice – I find that creepy in a different sort of way. I guess unless she lives close to the US border she’s stuck arguing with bureaucrats. I do have sympathy for that.

          • Young CC Prof

            The part that really bothers me is that the doctor let her believe she could have her MRCS for almost the entire pregnancy, denying her the time she’d need to search for another option.

          • Zornorph

            I didn’t really catch that reading the article the first time – if she was upfront about what she wanted and he (or she?) said that was okay and then changed their mind as things got close to the end, that’s not cool. This sort of thing really puts me off the idea of a single-payer system.

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

            She was very upfront with what she wanted from the beginning of her care.

          • Zornorph

            Well, shame on them for not being honest with her.

          • thepragmatist

            This terrifies me about the thought of ever having a second child, even if I could make it through pregnancy: we have such a strong push to have mandated TOLAC that I’m not entirely sure I’d be safe, even with my history. I stay close to my OB/GYN, let’s just say that. Too bad the original woman didn’t live near her.

          • Young CC Prof

            Mandated TOLAC? WHY? For everybody? That would make no sense, because if the first c/s was for failure to progress, it’s really likely that a second labor will end the same way, so just scheduling the section is better for everyone, including the fellow paying the bills.

          • fiftyfifty1

            So I see you’re changing your tune pretty fast here. Now you say your only objection is the $, but you originally had a couple of other objections:

            1. the argument that by getting pregnant, she had already made her bed, and now she should have to sleep in it, so to speak.

            2. That she was crazy.

            Here were your words:
            She’s afraid of giving birth but she chose to get pregnant anyway? She comes across just as nutty as those Vag-birth-at-all-costs types except in reverse.

          • Zornorph

            There were a couple of things in the article that I read that raised flags with me – particularly her giving the doctor the book about C-sections and asking him to read it. I still think she’s probably a little nutty, but my objection is always based on either (a) cost or (b) risk to the baby. Since there is no real risk to a baby via C-section (contrary to what Vag-birth nuts would have you believe), the only objection would be cost. I misread the post as a hope for people to pony up to help pay for a C-section. Seems that’s not an option in Canada short of flying to the US. I don’t know how one would go about changing things in the system as it’s been explained to me.
            It seems to me that if you get pregnant, the odds of having a vaginal birth are high enough that you should realize that this is quite likely a possibility and be something you are prepared to deal with.

          • fiftyfifty1

            “but my objection is always based on either (a) cost or (b) risk to the baby. ”

            Sure those are your only 2 objections once you’ve been called out on your post and had time to change your tune. But I would argue that your real objections came through loud and clear on your initial reaction…

          • Zornorph

            I’ve re-read my post and I honestly don’t see where I have changed my tune. The way the original post is written, it did seem to me that her desire for a C-section was more about mind than body, but I was going on the assumption that she lacked the ability to pay, not that she was dealing with a Kafka-esque medical system.

          • fiftyfifty1

            “It seems to me that if you get pregnant, the odds of having a vaginal birth are high enough that you should realize that this is quite likely a possibility and be something you are prepared to deal with.”

            It seems to me that when you ejaculate, the odds of making both X sperm as well as Y sperm are high enough that you should realize that a girl baby is a likely possibility and be something you are prepared to deal with.

            And yet you didn’t want that. You wanted to be a parent, but you didn’t feel you were prepared to parent a girl. You wanted a boy. Safe technology to ensure that outcome existed and you used that technology. Why didn’t you just let nature take its course? Aren’t you nutty?

          • Zornorph

            Am I nutty? Well, any number of people have thought so, though it was usually over the whole idea of becoming a single father in the first place and not so much the sex selection bit. But I put myself in a position where I could make those choices and I did. But I also didn’t have to deal with a medical system that restricted my choices and/or was dishonest from me at the start.

          • theNormalDistribution

            This comment really stinks of blaming her for putting her own self in this situation.

            “But I put myself in a position where I could make those choices and I did.” No you didn’t. You trusted that things would go your way, and you were lucky that they did. The tech responsible for sexing your embryos could have just as easily and just as wrongly decided that you were frivolous for wanting to choose the sex and given you a girl.

            “It seems to me that if you get pregnant, the odds of having a vaginal birth are high enough that you should realize that this is quite likely a possibility and be something you are prepared to deal with.”

            In the past, women who didn’t want to give birth had to choose between not giving birth and not having children. With current technology, you don’t have to risk having a girl to get a boy. Why should she have to risk giving birth to get a baby?

          • thepragmatist

            You could say the same of vaginal birth then– if you have a baby born with brain damage from an obstructed labour, you better be ready to pony up the costs. Find that offensive? Is it more reasonable because it’s natural? What if we’ve improved on nature? Shouldn’t we take advantage of that? We don’t let out teeth just fall out of our heads anymore, we get help. Look, I know I’m getting extreme here (and not meaning to be offensive about vaginal birth– I don’t think all women should want a c-section or are derelict for not getting one) but let’s be frank: birth is dangerous anyway you slice it, and bad things happen to babies during birth. From a financial perspective, Mrs. W has given some good points on her blog, since she’s a health economist herself, about the costs of vaginal vs. c-section. Where do the real costs occur?

            Personally, I think it’s not really relevant. We can’t be viewing birth through a financial lens PERIOD because there’s no way to predict which woman and which baby (in a first time birth particularly) will suffer the worst complications, and we shouldn’t be blaming women for choosing any mode of delivery, except when they completely disregard medical advice.

            My anger is that we don’t inform women fairly. My OB/GYN did, but only because I was an abuse survivor. My anger is also that it is so easy to pass over the physiological and psychological costs to women as less relevant than the financial costs, although they are intertwined. Just because they are more difficult to quantify doesn’t make them not there.

            Also, don’t refer to women as “a little nuts” or “crazy” on a blog mostly populated by women. Firstly, this is a common slur against women running up against the accepted status quo (at this point, in Canada, it’s NCB) and secondly, there are actually women here who suffer from mental illness. Like me.

            I met people with this attitude while I was pregnant and awaiting a c-section: I should’ve known better and not got pregnant at all. Well, shit happens. I personally thought I’d be doing pregnant yoga and shooting kale out of my eyes at people, but I ended up on bed rest, took almost three years to be able to walk properly again from the damage to my pelvis because it was so loose as to make carrying a baby disfiguring (I had to have physical therapy to put it back together it separated and was so unstable), and I discovered vaginal birth disgusts me at a deep level I can’t even really describe with words. I’m glad I had my son: he’s the light of my life. I am glad he came out of a now almost invisible scar on my tummy.

            Now, that might be because I’m crazy or maybe I’m just pragmatic about these things. All I can say is I am a fan of my intact vagina on a daily basis, and given how much I went through with the other changes in my body, I was pretty much over the moon that I didn’t have to cope with any more.

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

            This smells like libertarianism. Ew.

          • Zornorph

            Um…okay.

      • Young CC Prof

        Actually, you CAN have home birth paid for in Canada, with real midwives, not the Cracker-Jack box kind, although you have to qualify as low risk.

      • theadequatemother

        Y chromosome or not you are perfectly capable of understanding the issues here.

        Babies come out one of two ways: vaginal or CS. There are risks and benefits associated with each and for a first timer, they are pretty balanced. a prelabour CS results in less babies dying or having birth injuries (like brachial plexus for example), less pelvic floor problems that need future therapy +/- surgery (Number needed to treat 12-17 depending on the study) compared to a planned vaginal birth.

        The NICE study shows that the costs are fairly comparable if you include all the costs associated with the future treatment of pelvic floor damage.

        Nowhere did the lady in question or Mrs W write that she was “scared to give birth.” That’s rhetoric you’ve picked up, most likely from popular media outlets and articles with the phrase “too posh to push” in them.

        In Ontario, where the lady in question resides, if you are low risk the universal health insurance scheme will pay a midwife to attend you at home, birth center or hospital or a FP to attend you in hosp or an OB to attend you in hospital. An OB can bill for a cs without having to provide the “indication” for the surgery. They will not be denied by the provincial insurance plan. The overhead for said plan, btw is about 2%. The overhead for US plans is 15-25% mostly because they spend a lot of time and manpower trying to figure out how NOT to pay for care. You guys waste tons of money.

        There is no ability to pay for care in Canada that is covered by the provincial plan. If Ontario would delist CS by maternal choice as a covered entity, then women could pay out of pocket without contravening the canada health act. But they haven’t, so they can’t.

        In a system with universal insurance other people pay all the time for patient preference…say an open inguinal hernia was cheaper, should we refuse to let the GS fix yours laparoscopically just because we don’t see the benefit to you having a “better” experience? Maybe we shouldn’t give you the better artifical knee joint. I know you’re a young guy who probably wants to do sports..but tough luck! It’s more money so forget it? Should we leave you to tough it out through multiple episodes of biliary colic when you have a preference for a cholecystectomy? You have a preference for having your cerebral aneurysm coiled by an interventional radiologist rather than clipped by a surgeon? Tough titties! Those coils are $20 000 EACH. Ditto for your abdominal aneurysm. You want a stent in that rather than an open procedure? Don’t you know that those stents are like $80 000? HOW LONG DO I NEED TO GO ON?

        this VAG vs CS area is subject to more paternalism than many other areas in medicine in Canada where we seem to happily pay for patient preference. But you know, it’s just women’s health so who cares? And if sexual dysfunction results, well, her husband can always marry someone younger and nulliparous. SNARK.

        • Zornorph

          I got the idea that she was afraid of vaginal birth from this portion of the post:
          “…as the idea of a vaginal delivery causes her a considerable amount of
          anxiety, they are declaring they won’t do the caesarean without a
          medical need – without recognizing that the mental health impact of an
          unwanted vaginal delivery IS a medical need.”
          I have heard the expression ‘too posh to push’ but I had thought it was mostly about mommy wars and one upmanship. I certainly don’t believe that women must suffer in childbirth because of the sin of Eve or any foolishness like that.
          I can’t see any reason why women can’t choose a elective C-section if they want to – as it’s an additional expense, I do see why an insurance company might question it but I assume they can be negotiated with.

          • theadequatemother

            “that the mental health impact of an unwanted vaginal delivery IS a medical need”

            Consider for a moment if something was done or allowed to happen to your body that would be painful, and forever change it and you didn’t want it to happen in the first place. How would you mentally feel after that kind of violation?

            It’s not necessarily “fear of childbirth” the way you are thinking it. It’s more the real ramifications of pain, helplessness, loss of bodily autonomy, and potentially feeling violated.

          • Zornorph

            Well, this comes back to my inability to really understand it in an emotional way. I can sort of grasp it in an intellectual way, but I’m aware that it’s not the same thing. I’ve been lucky in my life that I’ve had few medical issues – the doctors did have to go into my balls once to fix a double hernia, but that’s just nowhere near the same. Though – fun fact – said Doctor forgot to prescribe me painkillers and this was on a Friday afternoon and he was off for the weekend and nobody else would prescribe them because they thought he might have had a reason not to give me any. Needless to say, it was a most uncomfortable weekend and his ‘Ooops!’ on Monday morning didn’t give me a lot of satisfaction.

          • theadequatemother

            Zornorph I can give you a pill that will cause you to grow a bar of gold in your descending colon. Now when that bar of gold is big enough your body will naturally want to shit it out. 75-85% of the time men can shit their gold bars out perfectly fine. It might hurt but you can have a support person hold your hand. Periodically I’ll need to do a rectal exam to see how things are going. If you find it hurts you can have some pain relief but it will take about an hour to get that set up and if we are busy you might have to wait longer…or go without. And we don’t like to give you drugs cos it could tarnish the gold.

            Now lots of men shit out their bars of gold without problems but about half will tear their anus a bit. 1% will have problems with gas and stool continence. Afterwards you might find erections and ejaculation painful but that usually gets better over time. Some men can’t get erections afterwards at all but that may also get better but we aren’t sure because we haven’t felt that’s important to study.

            If the bar of gold gets stuck well remove it surgically in which case you’ll probably have excellent pain management and no risk of fecal incontinence and lower risks if sexual dysfunction.
            What? You just want to go straight to surgery? Forget it. It’s not up to you.

            Does that help?

          • Zornorph

            Well, not really because it’s just an intellectual exercise and I can’t really grasp the true emotions of something unless I go through it or know I might. The closest I could come was I remember once a medical TV show where there was a (male) doctor who was very quick to order a total prostate removal in the case of prostate cancer and the nurse got him to try a partial my asking him to imagine what he’d want done if it were his prostate.
            btw, I always think of it as trying to crap out a bowling ball when thinking of what it must be like to give birth.

          • theadequatemother

            I’m not sure you need to grasp the “emotions” of it. It can be a logical risk-benefit analysis. To say that the decision is emotional appears pretty mysogynistic.

          • Zornorph

            Oh, Lord, that wasn’t what I meant at all.

          • Susan

            That…. is a total gem!

          • thepragmatist

            LOVE THIS! Ha. I like to use the “hitting your penis with a hammer” analogy, but this one is better.

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

        Zornorph You should have stopped at your first sentence. You are a dude and are not capable of understanding, but you are apparently capable of judging other women for the choices they make about their bodies. Its gross to basically say “I know better than she does what she should have done”. Its even worse to say something about her choice to stay pregnant when she literally cannot do anything this late in the pregnancy. I also would like to point out that none of us know the circumstances of her becoming pregnant, she may not have chosen it at all (or in a meaningful way).

      • VeritasLiberat

        Now you’ve stepped in it! The giant inflatable baby is coming for you!

      • rh1985

        I didn’t develop a serious fear of labor and attempting vaginal birth until late in this pregnancy. My doctor offered a c-section so I will be having one next week at 39 weeks. Mental health is a medical reason. If a woman has a panic attack in labor it may lead to a CS anyway if she can’t progress as a result.

        • Zornorph

          I see. Well, I’m very glad your doc offered you that option. Is this something that happens often? I’ll confess I’ve never heard of it, but people don’t generally discuss this sort of thing casually – I mean, you might know if someone got a C-section or not, but not the reasons why – it would seem impolite to ask.

          • thepragmatist

            There’s even a word for it: tokophobia. I thought I was going to be okay with a vaginal delivery until I started throwing up every time I watched a birth video. Then I watched a video of a c-section, and was like, “Where do I sign the consent form?” Really. It seemed much less cruel. Mother nature doesn’t care what state she leaves you in, as long as the offspring survive. Medical science… well, they’d rather not f it up.

        • VeritasLiberat

          I’m glad you’re getting a c-section. Mental health reasons are certainly valid. I planned all along that I would have an epidural for the same reason… I panic during a routine filling and I figured labor would be rather worse.

      • An Actual Attorney

        This may have been covered in the thread already and if so, I apologize. Zornorph, what’s your thoughts about insurance paying for epidurals? Or any other pain relief?

        • Zornorph

          I think it should and I was unaware that they sometimes did not. I don’t get this – if you have an operation and afterwards the doc prescribes pain relief, does the insurance not pay for this? Isn’t one of the main reasons for medical care relief from pain? Why should one type of pain be different from others? I do know in the case of my son’s birth that the Edi was paid for and it didn’t come out of my pocket, so I had never heard of this. Actually, I find it kind of offensive that it’s not paid for.

          • An Actual Attorney

            So why is a MRCS different? Neither are medically necessary.

          • Zornorph

            Well, it’s a whole different ball game it seems to me. One is pain relief and the other is a major surgical procedure. A C-section isn’t done primarily for pain relief – I could be wrong but my understanding is that in the long run, recovering from a C-section causes a lot more pain? I really don’t have a problem if insurance pays for it – my issue was in that I misunderstood the post and thought that the mother in question was wishing others to pay for something she wanted but couldn’t afford.

          • An Actual Attorney

            The docs can address, but I was pretty sure that CSs aren’t really that “major,” that there’s a clear differentiation. Recovery depends. Maybe in some cases a little worse, certainly in some, it’s much better. On balance, it’s probably about the same on a population level.

          • Zornorph

            I’m not at all that knowledgeable in this area. I had understood that it was a lot more painful in the long run. If this is no longer the case because of improved medical practice then that would change the equation.

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

            I’m genuinely disappointed in you, Zornoph. I’d think you’d have seen enough about c/s just reading this blog to know better. Particularly your initial comments that she got pregnant so too bad – I realize you’d misread/misunderstood, but as someone who wishes she’d had a MRCS and has been socially isolated because of the (quick and easy recovery) c/s. It’s good that you’re funny and nerdy because this comment thread makes me sad.

          • Zornorph

            I really don’t understand why anybody would care how anybody delivered. Are people really being rude to you because you had a C/S? That’s beyond bizarre. To be perfectly honest, there was a little part of me that wished my LO would be born via C-Section because it seemed to me that it would be a bit less risky for the baby but I thought it was a selfish thought to wish that on my lovely surrogate. I really did have the idea that a C/S had a harder recovery than seems to be the case.

          • fiftyfifty1

            For a first time mom, there is no way to predict whether they will have an easy and safe delivery. They have an “unproven pelvis”. A planned C-section recovery is harder than an easy vaginal birth, but much easier than a bad vaginal birth or the recovery from an experience that consists of failed labor ending in emergency C-section. So deciding to go with the planned CS can be a very reasonable choice.

            On the other hand, women who are professional surrogates are almost always multips who have had easy, straightforward, pregnancies and deliveries. Because who would sign up for the job and also who would hire the surrogate if that were not the case? They have pelvices that are very “proven”. So for these women, another easy vaginal birth is far and away the most likely outcome. For them, a c-section is likely to be a comparatively harder recovery, and also limits their future surrogate potential.

            These are basic concepts about surrogacy that I’m surprised you don’t know as you are the one who has actually hired a surrogate!

          • Zornorph

            Well, I did know that my surrogate had previously had an easy birth – as you say, it’s more or less a requirement to be accepted as one by a reputable agency.
            But beyond that, there was a lot of information for me to absorb and learn – I understood that a C-section was an undesirable outcome for her based on the extra fee for it, but I had thought it was about the recovery time – I had honestly not understood that it limited future pregnancies. I didn’t really study that part of it because I was focused on learning other things. I always tell people I know way too much about the female reproductive system, but this was one area I’ll confess I was pretty ignorant about. So now the people who make such a huge deal about a woman having to have a C-section seem even stupider to me.

          • Dr Kitty

            “Limiting family size” in effect means that most OBs recommend against more than 4CS.
            If you’re only planning on 2 or 3 kids, like the vast majority of women in the developed world, it isn’t a concern.

          • AllieFoyle

            I wanted a c-section and was not allowed to have one. I was told I could have pain relief instead… which never materialized. My child’s birth was painful and violating. I screamed for hours. Nonstop. The most private parts of my body were damaged and will never be the same. I’ve been through humiliating physical therapy and reconstructive surgery. For the first two years I was suicidally depressed, wished I were dead, had horrible nightmares. I’m better now, but still have periods of nightmares (both of the birth and the surgery) and depression.

            Why couldn’t I have just had a c-section? Why?

          • Zornorph

            Well, I have learned a lot from this thread. I am sorry you didn’t get what you wanted. :(

          • thepragmatist

            I was socially ostracized by a large segment of my peer group for mine. And I wasn’t initially vocal about it, but became louder the more I was bullied and told to stop telling women… well, facts.

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

            Ive been almost completely socially isolated and rejected by my former circle of friends, mainly because I’m anti-hb (actually, I am am as always actually a against lying liars who lie) and also because I am *shameless* in my enthusiasm for pain relief and c/s (and science in general). I mean, I get *offended* when they say “I’m so sorry” about my c/s!

            I don’t get it either. I didn’t withdraw from them because THEY believe differently than me – even when THEIR ideology hurts me directly! *le sigh*

          • Zornorph

            There really do seem to be elements of cult like behavior in the HB movement. I have friends with all sorts of different beliefs, some of which are totally opposite to mine. But unless someone is like openly Nazi or something, I don’t let things like that define who I will and won’t be friends with.

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

            Agreed; I don’t believe in thought crimes. And as a cult survivor I 100% agree that the NCB mindset is cultic.

          • Young CC Prof

            I think those attitudes are less common around here. In the later part of my pregnancy and since my son’s birth, birthing practices have been discussed. There was only one person who was weird about it, this lady at work who would not shut up about some sort of breathing or meditation thing or other. Everyone else seemed pretty open to either VB with pain relief, VB without pain relief, or CS if appropriate. Actually, I had several people tell me how wonderful their epidurals were.

            So yeah, it’s not the whole planet that’s into woo, although in certain places it can seem that way.

          • thepragmatist

            It really depends. I know women who have had both. It really depends on how badly you’re damaged by your vaginal birth. My mother tore into her rectum. It took her many months to recover. I had a complication from my c-section and it took me about a month. And that was with a complication. I had some serious other physiological issues going on– a dysfunctional pelvis– so that took much, much longer. I loved my c-section.

            I still hold that if men had babies we’d long ago been done with all this nonsense about passing a baby out of our sexual organ. I mean, just on that ALONE. For me, there were many reasons.

          • auntbea

            But isn’t pain prevention better than pain relief? Many women who want a c-section want one because the type of pain you can get with a c-section (abdominal pain, scarring) seems better to them than the type of pain you can get with a vaginal birth (tearing, pelvic floor damage, incontinence). Especially if the c-section is planned and therefore the woman doesn’t need to have any labor pains at all.

          • Zornorph

            After being enlightened over the past 24 hours on this issue, I am changing my view on this issue. I do think that a C/S should be covered by insurance regardless of if it’s an emergency one or not.

          • AllieFoyle

            Thank you. You’ve taken a lot of flak here and I appreciate that you’ve been graceful and open-minded about it.

          • Zornorph

            Well, I always feel that if you express an opinion you should be prepared to defend it and if you are presented with information that changes your mind, you should acknowledge it. You know, just like Homebirth advocates do. :)

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

            Thank you.

          • AlisonCummins

            Note that a vaginal delivery is not medically necessary either. Just a birth in one way or another.

          • An Actual Attorney

            Good point.

      • theNormalDistribution

        I find it bizarre that the majority still views women who want a MRCS as being radical in some way. It’s a bloody sensible choice.

        • thepragmatist

          It actually seems downright barbaric, to me, to NOT inform women who want a small family that c-section is as safe as vaginal birth when all factors are considered. Safer perhaps. Safer for baby. If mom is a good candidate for surgery, safer than most routine surgeries. Don’t forget: a planned c-section is safer than an emergency one, and an emergency one is a consequence of… trail of labour!!!

          • resaurus

            I always thought that C/S was more difficult to recover from than a NSVD because it’s an invasive abdominal surgery.,,and that’s why it’s not promoted? Can’t lift more than 5 lbs, can’t drive, etc, afterwards. Is that necessarily true that it’s always more difficult recovery-wise than a vaginal delivery?

          • Young CC Prof

            As I understand it, s planned c/s is a harder recovery than an uncomplicated vaginal birth, but easier than a difficult VB, especially with bad tearing. And of course no one wants a long and exhausting labor followed by emergency c/s, that’s the worst way to do it.

          • Wren

            I have a few friends who have chosen a planned C-section for their second after a complicated vaginal birth for their first. They all claim recovery from the C-section was easier. From my personal experience, recovery from an uncomplicated vaginal delivery was certainly easier than recovery from an unplanned C-section, but I know I was lucky.

          • Dr Kitty

            You’re told not to lift anything heavier than your baby.
            I took pain killers for a week after my CS, was was driving in 2 weeks.

            Surgeries are unpredictable in terms of recovery.
            My elective CS was harder than my emergency laparoscopic ovarian cystectomy and appendicectomy, but easier than my elective diagnostic laparoscopies and resections of endometriosis.
            There is no reason why that should be the case, given what was done each time and the number, position and size of the incisions, but that was definitely my experience.

          • rh1985

            My doctor said planned CS recovery is typically worse than an easy vaginal birth, but better than recovery from a difficult vaginal birth or an unplanned CS after labor started.

      • LMS1953

        A difficult vaginal labor and delivery is more costly than an elective C-section. A FTP C-section is the most expensive of all. Transgender surgery is being established as a basic human right. Can’t we at least allow a woman the autonomy to chose a C-section on demand if that is her educated and informed choice? The baby has to come out somehow. It’s not like she is asking for an elective breast augmentation.

        • Zornorph

          Honestly, I was basing in on the fact that it would have cost me an extra $5,000.00 in compensation to my surrogate if she’s had to have a C-Section. I assumed from that that it was something most women would rather avoid.

          • rh1985

            It may be to compensate for a potentially longer recovery. Although planned CS is usually easier recovery than emergency one.

          • Trixie

            Sure, but a c-section, or multiple sections, limits a surrogate’s ability to be a surrogate in the future, because you can only have so many c-sections. So that’s a unique circumstance.

          • Zornorph

            Oh, I didn’t know that. I also didn’t know that there was a limit to the number of C-sections you could have.

          • Trixie

            Yeah. Or the risks go up with each subsequent section (and the risk of vaginal birth goes up after each section, also). So, not only were you paying for her additional recovery time, you were paying for her loss of potential income for future gestations and/or limits to the future number of her own children that she could have. Which obviously is a bit different from this woman who is not a surrogate.

          • Zornorph

            Thanks. I’ve learned something I didn’t know.

          • Susan

            A little OT but have you seen “Google Baby”? I was very disturbed by the outsourcing surrogacy and that the surrogates have a 100% c/s rate and at a sort of sketchy looking clinic to boot to have the C/S. And then these poor women may go on to have more babies with needlessly scarred uterus. It’s very much worth watching.

      • thepragmatist

        Are you willing to pass a golf ball through your penis with, let’s say, a 10% chance it may never function the same again? What if there was a reasonable and safe alternative– safer than having your appendix out and safer than vaginal birth for the baby– would you rather have that? I would. And did.

      • Ceridwen

        It’s not clear to me that she waited until after she was pregnant to bring this issue up with her doctor.

        What if she had a this fear, discussed it with her doctor, was told that a MRCS would be able to be done, and only then made the decision to get pregnant with the understanding she would not have to have a vaginal birth? What if she got pregnant on accident?

        Homebirthers *do* demand that insurance pay for their choice, and in Canada (where this woman is) homebirths are in fact paid for by their healthcare system. Why shouldn’t this woman have access to a c-section?

    • AllieFoyle

      Mrs. W, for some reason my comments never show up on your site, so I’ll ask you here: what about a letter-writing/email campaign? I’m worried about the potential consequences for this woman if her relationship with her care providers becomes adversarial, but maybe some public support for her request and MRCS in general, directed at the appropriate parties might be helpful. I’d be happy to write an email and I’m sure others would as well, if that would be at all welcome or useful.

      The only other thing I can suggest is that she look into emergent mental health options–though I think it’s horrible that that has to even be on the table and of course will come with its own set of problems. I know you have suffered long-term mental health consequences of your forced delivery as I have, and I hate the thought of any other woman being forced into that situation unnecessarily.

      • AlisonCummins

        CAN she see an OB associated with a different hospital?

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

          At this point I think she’d be limited to the on-call OB of the hospital that has emergent mental health services on hand.

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

        AllieFoyle – I wish I knew why your comments don’t show (I generally love comments on the blog) – I’ve looked into the settings and can’t figure it out. At any rate I think one of the few viable options this woman has at this point in time is emergent mental health. It is incredibly unfortunate and really should not be needed – but given our system, how it works (by now getting an elective surgical slot would be challenging), and how late she had the proverbial rug pulled out from under her, I really do not see much option. Sadly, I think it will likely entail some travelling due to the size of the community she lives in – but it would be a small price to pay for a potentially harmful outcome to be avoided. I do not think there are very many (n<3 I think) OBs in Alliston…but it is within an hour of Toronto. I definitely think her chances would be better accessing emergent mental health and the oncall OB in a different centre.

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

    No they do not seem to care very much about safety – just as peddlers of alcohol, tabacco and firearms are not overly concerned with safety. And that is why they are regulated as a harm reduction measure.

  • Amy Tuteur, MD

    Hey, Lamaze, you know your study is crap when your supporting “references” are The Daily Beast and The Huffington Post.

    http://givingbirthwithconfidence.org/2014/02/evaluating-the-research-on-home-birth-safety-a-link-round-up/

    • NoLongerCrunching

      Lol. Before you comment you have to read this:

      “I confirm that my comments are constructive to the present conversation, my words are neither inflammatory nor defaming toward an individual or to the community as a whole, and I understand that deletion of my comment is at the sole discretion of the Community Manager, should I disregard the above-stated policy.”

      • Jessica S.

        Translation: “Nooooo meeeeeeenies!”

    • Trixie

      I’m wondering when we will hear from Henci Goer on the new MANA numbers. How do you think she will spin it?

      • Amy Tuteur, MD

        Her silence speaks volumes.

        It’s just like Aviva Romm insisting it is “too hard” for her to interpret the MANA study. She knows it shows that homebirth kills babies and she’s desperately trying to avoid acknowledging the truth.

        • Trixie

          Yeah, you’d think they’d have trotted her out by now if she had anything good to say.
          I feel like maybe, just maybe, Henci has a conscience. She’s built a career on promoting home birth, and she’s painted herself into a corner.
          Come out, Henci. It’s okay to admit you were wrong.

          • PrecipMom

            And not admitting that you were wrong, not trying to set the record straight makes you complicit when babies keep dying because of an alternative health option that you sold their parents as being a reasonable choice to a “thinking woman.”

    • no longer drinking the koolaid

      I went over there to check it out. She states that the links to the full articles are at the bottom of her post. they aren’. Just the press release and summaries. I questioned this in a post and here is her response.

      Hi Linda,

      I responded to your comment on my blog, but wanted to send you a quick personal note as well. My not including the original study link was an oversight on my part (albeit a critical one). I had so many links open when compiling this piece yesterday in the midst of several power outages in my area. When I searched for the studies, I had thought they were included on a subscription only journal (as many are) and that I could not include them as a link to the complete information. But when I dug a bit further today, I found them instantly. I feel like a dunce! I consider myself a very transparent person and, despite the finger-pointing tone in your comment, I felt compelled to let you know what happened.

      Thanks,

      Cara Terreri
      Lamaze International
      GivingBirthWithConfidence.org
      678-463-4557

  • Amy Tuteur, MD

    Home birth Twitter Contest!

    • Trixie

      What do we win?

    • The Computer Ate My Nym

      My brother-in-law’s friend from high school’s cousin knows someone who had a home birth and it totally worked out fine and would have been absolutely peaceful if the paramedics hadn’t insisted on running the siren and the transfusion hadn’t ruined the mother’s chakra balance and the pediatricians hadn’t been so NEGATIVE about the baby being blue (it was totally oxygenated because the placenta was still attached) so home birth is absolutely safe.

      Sorry, I failed to resist the temptation.

      • Young CC Prof

        Actually, my Facebook friend just made a crack about home birth, the unplanned kind. She’s at term with like 2 feet of snow blocking her door and driveway, poor thing. Here’s hoping the baby stays in for another couple days at least!

        • Trixie

          In our state the national guard is deploying 4WD ambulances. I hope her baby holds off!

        • Jocelyn

          I know a girl whose husband delivered her baby on the side of the freeway this week, on the way to the hospital. Whoops! But they’re both doing fine. :)

    • KarenJJ

      Worried that they are losing their business share to obgyns?

  • Ash

    Homebirth CPMs don’t have to worry! All they have to do is shrug their shoulders and say “babies die in hospitals too.” No need for practice guidelines, babies die here and there so no need to evaluate safety!

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

    Besides Change.org are there any other lobbies actively promoting safety in childbirth [although CPMs are a big problem, they aren't the only problem]?

  • manabanana

    Thank you! I’ve been trying to say this for YEARS. (Before I picked up my toys and left the CPM sandbox altogether)

    Where the F are the CPM professional standards? Where are our safe practice guidelines? How can we claim to be professionals worthy of licensing, 3rd party reimbursement, and respect of other healthcare providers without an iota of professionism?

  • Karen in SC

    How awful it must be for the parents who lost babies during a breech homebirth since 2009 to learn this fact.

    I’d bet the number is even greater than 5 – many breech births probably transferred to the hospital and the midwife didn’t report the outcome. Dr. Amy usually does a summary of what she’s blogged about at the end of the year; it would be interesting to compile that data for the years available.

    • Amy Tuteur, MD

      They could probably sue MANA and possibly win.

      • The Bofa on the Sofa

        I think there’s a case there, yes.

        • An Actual Attorney

          No, probably not. No privity, no duty.

      • areawomanpdx

        Let’s find them and fund the suit.

        • GuestingIt

          Where’s the donate button?

      • attitude devant

        Could we name Missy as an individual defendant? She’s been hiding this data forever and a day.

        • moto_librarian

          Could she hide behind her university? She could be judgement-proof as a state university employee.

          • NoLongerCrunching

            Then sue the university. That would probably get more publicity anyway.

          • Amy Tuteur, MD

            Her role at the university is separate from her role at MANA. The university has nothing to do with MANA, as far as I know.

          • Amazed

            Hmm, we had a student a few posts behind. Missy Cheyney charmed her students with bragging of her MANA study.

            I think that no matter her official separation of roles, she interchanges them quite regularly to suit her best.

          • Josephine

            That seems a little weird and a lot inappropriate to bring up in an anthropology class. I know I’d be annoyed as hell, anyway.

          • Amazed

            The worst part is, I don’t think I’d be annoyed. If I hero-shipped a professor of mine, I’d probably be flattered to be included in such a major thing.

            I think she’s using her students to promote her agenda. Many of them will repeat the news about her great results to many people and they’ll be considered authorities because, you know, they talked to the researcher herself. Not to mention that she probably have students who are currently pregnant and she might sway them to homebirth.

            I think she’s taking advantage of her students.

          • moto_librarian

            Public universities are typically limited to very low amounts of financial indemnity in these types of cases.

      • GuestingIt

        To continue the the tobacco company example cited earlier, how were they finally held accountable? Can the same strategy be used to go after MANA?

    • http://thefresstyler.blogspot.com/ Hannah

      Yes, I would be interested to see how many women were transferred too late to save their babies, leaving the hospitals to ‘eat’ the statistical hit of the baby’s death in their care.

    • MrG

      These CPM’ers have no liability insurance. There won’t be a lawyer going after them because there’s no money. So why is it that a plumber and hairdresser must have liability insurance but not the CPMers hurting/killing little babies?

      • The Bofa on the Sofa

        That’s why you go after MANA

  • moto_librarian

    If a woman really wants to give birth at home, that is her right, but she does not have the right to expect a medical professional to attend her. The CPM encourages reckless behavior because you can almost always find one who is willing to take on a patient no matter what her risk level. There are good reasons why most CNMs practice in a hospital-setting. They know how quickly a perfect birth can turn into an emergency, and they want the facilities, medications, blood products, and expert staff that are part of the hospital setting. I truly believe that there would be far fewer high-risk home births going on if there were not people that were not only willing to attend them, but actively encouraging them. There will still be a fringe few who UC, and while I think it is incredibly stupid and unethical, I am not going to suggest that it be criminalized.

    In terms of breech births, the MANA numbers clearly show WHY c-section is the preferred delivery method. Do you think I could go to a hospital with appendicitis and tell my surgeon that he must use ether and make a large incision to remove it, when modern practice uses general anesthesia and often laparoscopy for the procedure? I see breech birth in a similar light. We know it is dangerous to attempt vaginal birth, and the standard of care is now c-section.

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

      i think the equivalent would be that you instructed your doctor NOT to operate to remove your appendix but to treat it with herbs and acupuncture and compresses.

      • moto_librarian

        I was struggling to find the right analogy. Thank you, Antigonos. That is much better.

      • fiftyfifty1

        Or even antibiotics. Some appys do actually resolve with just antibiotics.

  • NoLongerCrunching

    I think they would say that they are only giving mothers what they want — low intervention births in the comfort of their homes. However, it is grossly unethical to trick these women into thinking that they are making a safe choice. As a lactation consultant, if I had a client who wanted me to help her exclusively breastfeed when she had low supply and her baby had failure to thrive, it would be my ethical responsibility to give her accurate information about the danger to her baby of failing to give enough calories, despite how much she does not want to supplement.

    When you are a paid health care provider, the mother is paying you for your expert advice; not to be a yes-man for anything and everything she dreams of. Mothers have the right to give birth anyway they want, yes, but they do not have the right to have their births professionally attended by incompetent providers.

    (formerly LynnetteHafkenIBCLC)

    • Amy Tuteur, MD

      Tobacco companies say the same thing: they are just giving people what they want.

      • Anj Fabian

        Perhaps the alcohol industry is a better parallel. Humans have been brewing alcohol since they had grains and fruit to use for that purpose.

        Women have been giving birth at least that long.

        People will drink alcohol no matter what any individual or government will do, even to their detriment. Ditto for women and choosing home births.

        Alcohol is heavily regulated. The government controls who can sell it. A restaurant must monitor the state of their customers and stop serving alcohol in order to keep them safe.

        CPMs? Nothing. No oversight. No regulation. Not even mandatory reporting of outcomes.