Oooh, Dr. Amy is “meen”

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

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

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

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

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

Am I “meen”? I wouldn’t call it that. I would say that I am very, very angry… and I let it show. I feel I have a responsibility to speak out against what I see as the moral corruption at the heart of homebirth advocacy, the willingness to bury dead babies twice. First to put them in little coffins in the ground because homebirth “midwives” can’t be bothered to care as much about safety as about reimbursement. Second, to bury them from the public conscience so as not to affect the economic bottom line of homebirth midwives.

That’s why I came down so hard on Aviva Romm. I deliberately maneuvered her into a position where she had to choose between lying or running away. She chose to run away, and leave those little dead bodies scattered wherever they may fall. It is more important for her to preserve her credibility within the crunchy community, and keep selling quack books about quack subjects, than to speak the truth. Frankly, that willingness to place profits over truth makes me nauseated.

I started this blog because I couldn’t abide the lies from homebirth and natural childbirth advocates, but I keep at it, because I feel I have a responsibility to babies and mothers. Who will speak for babies like Wren Jones, who died of group B strep sepsis on the day he was born, because his parents would hoodwinked by a “midwife” who told them to treat a dangerous bacterium with cloves of garlic in the vagina? Who will speak for Magnus Snyder, who died after a protracted struggle to live because the “midwives” who cared for his mother relished the thought of delivering a breech baby for the first time and were more concerned with their “opportunity” than a baby’s life. Who will speak for Abel Andrews, who cannot speak for himself because the “midwives” who cared for him didn’t know how to perform a resuscitation and left him with a severe brain injury?

I can tell you damn straight who won’t speak for them. Melissa Cheyney won’t speak for them. Wendy Gordon won’t speak for them. Aviva Romm won’t speak for them.

So I ask you, who will speak for Wren, Magnus, Abel and hundreds of others if I don’t? Who will open everyone’s eyes to the suffering and deaths of babies at homebirth if I can’t? Who will rhetorically grab everyone around the throat and force them to look at what they would prefer to ignore if not me?

Am I “meen”? Maybe, but if that’s what it takes to get mothers, homebirth advocates and legislators to look at the truth, I’m proud of it.

  • Ashley L.

    Wait – why all the hate on natural childbirth advocates? I understand homebirth advocates…but why natural childbirth advocates? And I am assuming that this hate does not transfer to mothers hoping to have an un-medicated birth in the hospital, correct?

    • Stacy21629

      Yes and no.
      Women that are planning to deliver in a hospital but have bought 100% into the “natural childbirth” mantra can and do decline recommended procedures, tests, etc. Believing that “babies know when to be born” and being 42+2 and 0 amniotic fluid kills babies and repeatedly declining an induction kills babies – no matter the intended birth site.
      I’ve had 2 “natural” births…but “natural” is not the goal. A live, healthy baby is. I am not so married to the idea of a “natural” birth to ignore when UNnatural birth would save my child.

    • Lost

      Death is natural. A sexually transmitted disease, if you will.

  • mike

    Amy as a fellow physician I agree with your premise 100%. I fight the good fight on a daily basis to teach my patients how to filter out the noise of pseudoscience which permeates the airwaves and our culture as a whole.

    I have to say though that I do not agree 100% with your approach. You are voicing the anger and frustration that many of us feel but as professionals I think we need to elevate the discussion above that. Not only to keep the conversation civil but to differentiate us from the fear mongering, conspiracy advocating, pseudo-scientific community we rail against. We are professionals and the best way to differentiate ourselves from the uneducated and misinformed opposition is to act professional. We need to keep the conversation factual and avoid ad-hominem attacks.

    I realize it can be difficult. There are times I find myself yelling at the TV as they interview someone spewing out crazy pseudoscience on the evening news, but if we are going to win the hearts and minds of those who are rational and reachable we need to remain rational ourselves, otherwise we start looking like the charlatans we are trying to defeat and patients will see us as two sides of the same coin.

    Its just my 2 cents. I think you’re doing a good job and providing a needed service but you might reach more people if you didn’t let the oposition drag you into the mud with them.

    Michael Melgar, MD
    http://www.doctormelgar.com

    • NoLongerCrunching

      But being nice doesn’t make you the talk of the blogosphere, thus driving more traffic to your website, resulting in more people having access to your information. Many of us came here at first to rail at Dr Amy for being mean and wrong about everything, and were won over to accepting the science.

      • mike

        You do have a point. Unfortunately in our society its not enough to be right, you often have to be outrageous to get the attention of the public.

        The problem is that once you get that attention you may have lost the high ground necessary to win the argument. I don’t pretend to have all the answers Maybe there is a place for Dr Amy as well as a more measured approach. It often takes more than one weapon to win a war.

        • AlisonCummins

          Bingo.

        • Trixie

          Dr. Amy is in a position where she is retired and therefore not interacting with patients, though. I’m sure she was a compassionate doctor and didn’t ever talk to patients with the same language she uses in her blog.

          • NoLongerCrunching

            I’m sure that was usually true…but sometimes her patients needed a hard kick in the ass, SOB style. Hence: http://www.skepticalob.com/2012/02/dr-amys-dead-baby-card.html

          • Trixie

            Yeah, to me, that’s not mean. Just factual. But I’m sure to the NCB crowd it would seem mean. I’m saying I’m sure she never called her patients clueless idiots, even when they acted like it.

        • Durango

          I’m so so so tired of the tone trolling. There are some “nice” anti-NCB blogs, but have you ever heard of them? Do they get discussed? You didn’t hold them up as examples, so i suspect you haven’t heard of them either. Nice counts for nothing if no one receives your message.

        • AllieFoyle

          No one “wins” arguments anymore. The internet isn’t a church social or junior high debate club. Think about the nature of social media. Your message first–and most critically–has to be noticed. Then you have to engage people sufficiently to ride the tide of popularity/notoriety into the public consciousness. Once your message is actually out there, people will hash it out themselves and consensus can change. Being polite and gentle is an excellent practice for a practicing physician but it’s the kiss of death for a blogger who wants to reach a large audience and influence public perception.

      • onandoff

        Personally, I needed a slap in the face. I have a science background and tend to go first to the primary literature for information. But the woo is so pernicious in my circle of friends that when I got pregnant, I was swayed and considered using a birth center with a midwife. I needed someone to say loud and clear: this is ludicrous, this is insane, this is STUPID to bring me back to my senses. And while Dr. Amy is initially off-putting, her articles seem relatively measured once you start learning about the atrocities that some midwives are getting away with.

    • Andrew Potter

      I appreciate your clear candor. This is exactly what I feel. Maybe they don’t talk about her because you can’t discuss or debate with an angry person and she openly claims to be that. I feel that if you fight fire with fire you end up with a charred forest.

      Even if her blog attracts more attention I doubt that it will rarely change lives. Lives are changed one at a time and not by a heated mass media blog. As interesting as some of her information is, they way she presents it turns me away from reading it because of the way she slanders and pulls others down.

    • beautifuleyes73

      Frankly I really wish more of you would get mad and SHOW IT. Pseudoscience especially quackery spreads by appeals to emotion not rationality. The aura they build up can sometimes be mesmerising….overcomes rational thought….sometimes the best antidote is ridicule…snap the fingers…break the spell…get real.

      • mike

        I think you’re missing the point. By stooping to their level this becomes a battle between equals. Patients see this as a fight between two opposing but equally valid points of view.

        Its just as important to show that our approach is different as it is to show that our ideas are different. People need to understand that we arrive at our conclusions through rational thought not emotional magical thinking. How do we accomplish that if we resort to emotional attacks?

        • beautifuleyes73

          Hmm…..but then emotion can be rational too…an emotional argument is not necessarily irrational…like “There are times I find myself yelling at the TV as they interview someone spewing out crazy pseudoscience on the evening news”…nothing irrational about that..an honest emotion..and speaking as a patient I really want to know what u yell..means u care…if u are offended at being unfairly accused …defend yourself..show it…its expected…
          And actually my point was that the emotional psychological manipulation and brainwashing used by them can sometimes be fought best by using the opposite emotion ..ridicule.

          • mike

            I disagree. Ridicule may make you feel better but it doesn’t change minds. It devolves into name calling so that rational people who might be sitting on the fence will quickly decide that neither side is worth listening to

          • beautifuleyes73

            Ok …went through a few more of yr comments here and on disqus…get what ur saying…..actually sometimes when Im looking for articles to refute some of the woo posted online have to pick the ones with the snark toned down even if the snarkier articles are more convincing to me personally……..Just as a tactic …not specific to this blog…most skeptic sites have a heavy dose of snark too….it can be effective when those who have fallen for the woo have abandoned rationality…or for those who are just on the verge of being sucked in….
            And aIm talking of woo on a totally different level than dr Oz….th Secret…law of attraction…Louise hay…Bruce Lipton biology of belief…Steiner Anthroposophical medicine manifestation of Karma…Conciousconception trust birth birthwithoutfear rachna shivam lotus birth …Finnrage…feminists whove lost the plot….overmedicalisation of birth….birthrape….comparing ICSI to the planes crashing the twin towers….the ovum and feminine essence being raped…..
            Bith godess and mommy instinct…who needs ultrasounds ……not real women
            If someone posts a photo of unicorn poop ….

        • The Bofa on the Sofa

          Um, getting angry WOULD BE different. I agree with beautifuleyes, we need more people expressing absolutely no acceptance of nonsense. No more of this, “Oh, well, I respect your opinion” crap.

          Get pissed and speak out. Shun the anti-vaxxers, and let them know why you are blowing them off.

          This isn’t about how we came to our conclusions, but what we will do about it.

          • mike

            I never said we should accept pseudoscience in any form. You’re confusing emotion with passion. It is certainly helpful to be passionate if you want to persuade people. On the other hand anger that takes us off message and leads to ad hominem attacks are counter productive and lead to an us versus them mentality that polarizes the issue and makes it harder to win converts.

          • The Bofa on the Sofa

            On the other hand anger that takes us off message and leads to ad hominem attacks

            Who’s doing that? It’s not off message to say that anti-vaxxers are killing people, and that we want nothing to do with them until they get their shit together.

            The information is out there. I don’t need to write a web page that explains the benefits of vaccines. That’s all over. What we need to do is get people to read them.

        • Amy Tuteur, MD
          • mike

            I read the post. I understand your reasoning but disagree with your conclusion. You have basically concluded that it’s more important to be heard than to have something meaningful to say. You have surrendered to the lowest common denominator. You accept the premise that this argument is one between us and them while forgetting that 95% of the public is somewhere in between. When you stoop to ad hominem attacks you lose that group.

            It may look like you are popular by your numbers but my guess is your readers largely those who already agree with you or those who are totally opposed to your views. In either case you are not changing minds. You are just preaching to the choir and the infidels

          • The Bofa on the Sofa

            You have basically concluded that it’s more important to be heard than to have something meaningful to say.

            Having something meaningful to say is pointless if no one hears it.

            This the number 1 reason why scientists fail in the battle against woo. They are so confident that they are going to win because they have facts on their side. That doesn’t mean crap. Meanwhile, the woo-meisters who spout 15 lies a minute are the ones being heard, while the scientist who patiently takes 15 minutes to correct one of the lie has left 14 on the table, and just sounds defensive.

            You need to be heard.

          • mike

            First of all I don’t agree that scientists are failing in their battle against woo. I have discussion with patients nearly every day on these subjects and find them hungry for someone to help them navigate the quagmire of medical information and separate fact from woo.

            The problem is not that scientists and doctors use facts. The problem is that most scientists and doctors don’t remember what its like to not understand these things so they aren’t prepared with the skills necessary to make their points understandable. There is actually an effort underway to address this issue. At Stony Brook University they have opened the Alan Alda Center for Communicating Science to help physicians and scientists learn the skills needed to explain complex scientific issues to the public.

            I agree that its difficult sometimes to attract an audience but its not impossible. There are plenty of sensational subjects which in themselves will attract readers especially if you present a point of view they are not getting somewhere else and especially if you do a better job of explaining the subject when they get there.

            Name calling, insults, and humiliation have no place in a civil discussion. People tune out when you do that unless they are already in your corner or have an axe to grind with you. The reasonable people in the middle who otherwise might have listened to your arguments have already moved on. Having 6,000 or 6 million readers a day does no good if you re only attracting the people who have already made up their minds

          • The Bofa on the Sofa

            First of all I don’t agree that scientists are failing in their battle against woo

            Seriously?

            Let’s see….vaccine refusal. Increasing or decreasing?
            Alternative medicine – increasing or decreasing?
            Homebirth (subject of this blog) – increasing or decreasing?

            Biologists have had a 50 year head start in their battle against creationists, are they winning? Look at the acceptance of creation in the US. The only thing that has helped evolution is that the courts have helped them rid the creationists from public school teaching. And they STILL can’t get half the country on board.

            You seriously think scientists are winning? We’ve got woo crap showing up in med schools being accepted as legit.

            Why do you even have to teach patient after patient about it? Because the woo have their mitts in them solid.

            You can fight this one person at a time, or you can do something productive. Marginalize those that are causing all these “questions” in the first place. They don’t deserve to be taken seriously. That’s the message.

          • mike

            I agree that all of these things exist at much higher levels than we would like but show me solid data that they are increasing.

            Below is a graph of the percent of people who have believed in evolution vs creation. The only line that is not overall flat is the line showing the percent of people who believe in classic evolution which has gradually increased.

            Statisitics on CAM medicine use have shown an increase over time because there is a lot of money to be made and we have people like “Dr.” Oz promoting it on TV. This is the reason physicians have had to address these questions more lately. When we are involved in the argument we almost always win. The problem is that some physicians Like Oz have adopted and supported CAM medicine because they see the profit in it. I personally have done a lot in my own practice to discredit Oz but I do so with reason not name calling and I have seen a big conversion rate among my patients who used to look to his show for medical advice.

            Its important to understand there is a problem here but hyperbole and scare tactics are not useful tools here. They merely excuse bad behavior.

          • NoLongerCrunching

            I seriously doubt that Dr Amy would use this tone when speaking directly and privately to someone. Many of us, me included, came here because we were outraged by her “vitriol”* and wanted to knock her down a few pegs by sending her a bunch of bibliography salad and personal anecdotes about the joys of unmedicated birth etc… But we ended up being the ones who got schooled.

            *I now realize that vitriol is a lot different than blunt criticism; vitriol is when someone parachutes in here spewing profanity at her because she dares to have a strong opinion that differs from theirs.

          • Box of Salt

            mike, looking at your graph
            “The only line that is not overall flat is the line showing the percent of people who believe in classic evolution which has gradually increased.”

            Therefore we can ignore the fact that the line representing “God created humans in their present form” is also increasing? And the fact that the line representing classic evolution is dipping for the first time?

            I don’t think so.

          • mike

            You don’t read a graph by looking at one point. You need to look at the overall trend and if you do you will notice that there is a steady climb in the percent of people who accept evolution without god while the other two graphs are essentially flat.

          • Box of Salt

            mike, you don’t read a graph by only looking at the one line you like.

            While I too am encouraged by the increase in folks who agree with classical evolution, I worry about the other two lines. You see flat. I see the NCSE battling the state of Texas to keep creationism out of the nation’s textbooks.

            Your graph does not show the side of science winning.

            I worry.

          • The Bofa on the Sofa

            So you first question my premise, but then admit that CAM is increasing?

            Then again, you prove the point. Why is CAM increasing? Because of folks like Oz. So how do we battle it? Do we try to engage Oz and address his nonsense one show at a time?

            Or should maybe the medical community come out and make it clear that Oz is a publicity whore who will sell out to anything, and can’t be taken seriously. Moreover, go after the media who prop him up?

          • mike

            I still question your statement that science is losing the debate. CAM is the one area where there is an increase in public acceptance and that is partly because some scientists and doctors have been silent or on the wrong side of the debate.

            I have no problem with attacking someone’s position or their logic but attacking the person is a no win situation. For every insult you throw at them, they can legitimately hurl one at you. Attack dr Oz for being a media whore and he will just attack you for being a big pharma shill. Even worse he can take the high road and be the nice guy telling his viewers that they should not get angry simply because some people are close minded. Once we give up the high ground we can’t get it back

          • beautifuleyes73

            “The problem is not that scientists and doctors use facts. The problem is that most scientists and doctors don’t remember what its like to not understand these things so they aren’t prepared with the skills necessary to make their points understandable” Yeah and it doesnt help that a lot of medical news available in the media is sensationalised and the actual full text of the studies in the legit medical journals is too expensive for a casual reader…

          • Durango

            i had the incredibly risky HBAC years ago and had never thought about the danger. This blog changed my mind.

          • Amy Tuteur, MD

            The demographics of the readers are very different than the demographics of the commentors. Only a small fraction of the readers are actually commentors.

            Moreover, I don’t prevent anyone else from blogging about these subjects. If someone can do it better, I would be anxious to copy what they do.

  • CDN Guest

    Better mean than stupid (or dead).

  • anonymous

    Amy, you’re not mean. No matter what these birth nutters say. You exhibit the same responses that my dad and I both have with some crunchy anti-vax nutjob whips out some BS decade old study about how vaccines cause autism. We’re both just so tired of hearing this crap. There’s no defense other than “Waaah this is what I feel and I need you to reinforce my stupid beliefs.” Dad has fired many a patient from his practice for not vaccinating their children. The last one actually brought her “friend” who was an “expert” on things while I was visiting his office to have lunch with him and the other doctors in his practice. It was just sad watching these two graduates of Google U drown spouting rumor after rumor and debunked study after debunked study.

    Don’t let anyone tell you otherwise Dr. Tuteur. One lost life is one too many and if you save one baby your blog is doing the right thing.

  • Deena Chamlee

    When I reviewed the ethical standards for all four midwifery organizations the lights came on and denial was no longer possible. I am sorry the leaders know about the blantant defying of ethics by MANA AND NACPM. Yet they continue to lead by encouaging states to implement ICM guidelines of a three year educational standard. Any standard is worthless wothout the practice of ethics and morales.

    Women are left with PTSD from the abuse. I cant support a profession that continues tp accept members who are blantly honest about not practicing ethics. CNM OR CPM. The leaders melissa cheyney and susan moray say “we are against licensing because it won’t create more safety”. They are being blantantly honest. No it wont creat more safety if others lack ethical and morale codes. They believe ethics cant be taught it can only be learned through personal growth. Once again blantantly honest if you dont have a conscious you are right ethics cant be taught.

    For others to feel this safe in stating such means their existance is quite secure . I cant even believe what I so clearly see. I am telling you there is something not right that they have never been challenged before I started standing up to the abuse. And I mean challenged by another midwife. None of this makes any sense. No other country in the world has accepted these standards, not even one.

    Somebody has something on somebody else or tbis would have been addressed 40 years ago.

  • LMS1953

    What happened to the heartfelt post by the CNM who recently got fired?

    • Karen in SC

      Deleted due to privacy

      • Deena Chamlee

        Im still here though and we all must see through the conning that has gone on for so so long. I mean The ACNM have allowed Ina May to travel the world claiming she is tje most famous and respected midwife in the WORLD. Babies are dying in ENGLAND and Australia also because of all the high risk being practiced in the home. What started on the farm has infiltrated globally with the same disastorous affect on women. WHY?

        • Deena Chamlee

          And I am outed from the profession because they see me as a threat. It is very clear to me WHY. I am going to take a course for the LSATS and go to law school at age 53 because of all this. And then maybe just maybe I can make a difference.

          • Melissa

            As someone who is currently in law school, I would say that you might want to look at MPA programs as well as law school. The MPA (masters of public administration and policy) allows you to work for government and non-profit organizations where you can help change the policies directly. 25% of lawyers don’t actually end up working in the law and they probably would have been better served in getting a masters or PhD in a more specialized field than just getting the JD. By all means, if you’re interested in law in general pursue the law degree, but if you are specifically interested in public health policy you might do better in the MPA program since law school also means learning a lot of other types of law before you can pick your area of interest. (I started law school at 32 and have a classmate who was in his 60s. Age is not really the issue, but I have seen classmates who come in wanting to change one specific area of the law struggle since they have to sit through tax and international law classes along the way).

  • Mac Sherbert

    You know the old saying you catch more flies with honey than vinegar. Of course, I don’t think Dr. Amy is trying to catch any Homebirth midwives or true believers. I think she is trying to warn unsuspecting women that the honey these Homebirth believers are selling is more like molasses.

    • The Bofa on the Sofa

      You know the old saying you catch more flies with honey than vinegar.

      Leonard Hofstadter: I’m just saying, you can catch more flies with honey than with vinegar.

      Sheldon Cooper: You can catch even more flies with manure; what’s your point?

      • Susan

        And if you pour honey all over the manure?

        • The Bofa on the Sofa

          “If you pour honey all over manure, you don’t get sweet smelling manure, you get honey that tastes like shit.”

          But it should be very effective at catching flies.

          And you can quote me on that one.

      • Mac Sherbert

        And how did I know someone would find the source and the exact quote…Sheldon is always quotable! :) Go Bofa.

        To answer Sheldon. The point is that Dr. Amy isn’t trying to sweeten things up and make them what they aren’t. Meanwhile in NCB land they are trying to catch women with honey…without the women fully knowing the consequences of trying the honey.

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

          Aaaaand now I am going to read all of Dr. Amy’s articles in Mayim Bialik’s voice. Which is kind of hilarious really, given Bialik’s inexplicable tendency towards quackery when it comes to motherhood and her kids, being a home birther and anti-vaxxer. Seems that her education in science didn’t extend to any common sense when it comes to health matters in her own life.

      • Jocelyn

        I totally heard those lines in their voices.

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

          Me too. Lollerskates.

      • me

        So many carry-overs from Roseanne in that show (and not just the actors, lol). There was an episode of Roseanne where something very similar was said. I think it was the “Chicken Hearts” episode, where she was trying to suck up to her teenage boss at a fast food place to get better hours.

        I’m revealing my age here…

    • LMS1953

      With that crowd you have load the rifle for bear and make sure you keep pepper spray in your pocket.

    • ngozi

      But as I have always wondered, who really wants to catch…flies?

  • The Bofa on the Sofa

    I can ask this question:
    We discuss a lot about how bizarre it is that the ACNM is accepting of CPMs, and seem to do nothing to oppose them, despite the fact that they a) don’t meet the standards that the ACNM expects for midwives, b) compete with CNMs for clients, and c) ultimately tarnish the entire profession with their crap. How can CNMs sit back and accept this?

    It seems that whenever someone brings up problems with midwives, the defense turns into “we aren’t all bad, there are some good midwives, CPMs included.” I have averred that this statement in itself is an indictment on the profession, but even if we accept it, how does that explain the indifference being paid to the bad ones?

    Although the members of the ACNM probably aren’t aware of the problems, we know for a fact the leadership is. What are they afraid of? Jeez, it’s really easy for them to come clean now, and basically throw CPMs under the bus, as it were. They can announce how they have tried to be supportive, but that the CPM concept has clearly gotten out of hand. It was supposed to be a transitional designation, but that has been abused. Now, it has gone too far, and the ACNM cannot stand by and let the noble profession be taken down.

    Then again, if the leadership are so entrenched that they can’t see the problem, then this has to happen through the membership. It’s time to get a grassroots movement of the members to advance the profession.

    Who can honestly be against getting rid of bad practice? Even if we accept the claim that “we aren’t all bad,” then shouldn’t we all agree that we want to get rid of the bad ones? Who could be against that?

    My fear, as I’ve stated before, is that the problem in the ACNM is NOT just the leadership, and that it hits a little too close to home for too many members, who share a lot of the beliefs with the CPMs. There is a danger in actually setting high standards – that means EVERYONE will have to follow them. How many CNMs agree, in principle, with the ideals of the CPMs?

    But even from a professional standpoint, their support of the CPM doesn’t make sense. There is a problem in the medical community in that doctors are hesitant to criticize their colleagues, their equals, but that doesn’t apply here. CPMs are not equal to CNMs, and should not be considered colleagues.

    I just don’t get it.

    • moto_librarian

      I don’t get it either, Bofa. I don’t understand why they don’t do everything in their power to flush these quacks out of the system. They go through years of school and must meet strict clinical training requirements to become CNMs, and I don’t know how the existence of CPMs and DEMs doesn’t rankle them.

      To be honest, the ACNM’s silence on CPMs makes me question midwifery care in general. I loved the CNMs who delivered my children, but there is no way that I would offer a blanket recommendation of all CNMs because I know damned well that some of them are steeped in woo. I caught the occasional whiff of it from my practice, and if I were to have a 3rd child, I”m not certain that I would deliver with them again unless I could be certain that two of the midwives in that practice would not be on call when I went into labor. This is extremely problematic, and should give everyone pause.

    • Susan

      When I think of the CNMs I myself know– about half have had homebirths, were former homebirth midwives or have done a homebirth. Some of those, even though we disagree on this subject, are people I like and respect. In fact, as I think about it, it could actually be more than half. I may though have a bit of a skewed sample because I did have a homebirth myself, unlike most of them, I have since changed my opinion on the safety of my choice. Two CNMs attended that birth, and they are both really great smart people, who both have also been nursing/midwifery professors. I am not in touch with either of them anymore. It is my strong impression, as I have shared before, that the more political of the nurse-midwives, and the one’s most likely to support homebirth, may be drawn toward leadership positions. I think it’s a very complicated thing to understand but may well be worth trying to investigate. The history of nursing and nurse midwifery is sort of complex and I am not really surprised that either profession would almost instinctively want to be open to helping midwives. However, I do think it’s time that both RNs and CNMs faced that supporting CPMs has become ethically untenable. We shall see….

      • The Bofa on the Sofa

        Yes, Susan, and THAT is what I think the problem is. The reason the ACNM doesn’t take a stand against CPMs is that far too many members actually agree with CPMs.

        • fiftyfifty1

          “The reason the ACNM doesn’t take a stand against CPMs is that far too many members actually agree with CPMs.”

          Yep, and this is why I no longer recommend CNMs when my patients get pregnant and ask for a recommendation. It’s sad. I know that many (most?) of the CNMs are level-headed and professional. But the fact that they don’t police their own and that they don’t speak out against dangerous woo is a major problem. What if my patient goes into labor when one of the quacks is on call?

          • The Bofa on the Sofa

            The surprising thing is that, despite the fact we have been asking this question for years (why don’t CNMs actually stand up against the CPM), we’ve never really had anyone come by and defend it. Oh, we’ve had many who have tried to _explain_ it, but no one has actually tried to actually defend it. Pretty much everyone concedes that it is a bad idea.

            I realize that we have a select group that is here, but with all the interlopers coming through, you’d think there’d be some actual CNM trying to defend the ACNM’s lack of teeth when it comes to CPMs.

          • Sue

            Without meaning any disrespect to the nurses here, I suspect that the nursing profession as a whole has a history of feeling under-appreciated or victimised, and so it is easier to consort with fellow-victims than it is to team up with the perceived oppressor.

          • expat

            I suspect that many cnms view the spectrum of choices as a good thing, even if some are obviously more dangerous. They like that when some total whack job walks in the door and isn’t even going to consent to a hep lock or any vaginal exams or any continuous monitoring as she tries to deliver her breech vbac twins into the birth center’s tub that there is another whack job out on the curb who will keep her from doing it all unasissted in her bathroom if/when she leaves in a huff due to all of the pestering about safety. The cnm likes that she has the possibility to decline to go along with shenanigans because there is someone outside who will. Say said cnm is at a hospital and dealing with a nutso client. Can she say, ” if you don’t like how we do things, go elsewhere”?

          • Medwife

            Just saw this comment. I personally do NOT feel that way because I think it makes the woman see her plan as reasonable- after all, she found a real professional to attend her, right? And she could roll onto my unit with a blue breach baby half delivered, and she’s still my and my backup’s problem.

            And I really don’t want her or her baby to die.

          • Jocelyn

            Pretty sure my sister had a CNM quack for her pregnancy/delivery. Not only did the CNM completely miss that my sister’s baby was over 9 lbs, she had my sister push for 4 1/2 hours before consulting an doctor. The doctor immediately delivered the baby with forceps. The baby was blue and not breathing, with an Apgar score of 3. (He’s okay now.) Thanks for keeping my sister and her baby safe, CNM! Oh, wait…

    • Karen in SC

      Something analogous is going in nursing education. There is now a push for more BSN degrees vs the ADN (associate degree nurse). My SIL is a nursing manager and told me that she can’t hire any more ADNs for their office, saying that studies showed that ADNs made more mistakes and now more critical thinking skills are desired.

      In my area hospitals, there is the same push. My university now has an “ADN to BSN” program. It’s mostly online, except for chemistry and our department head is adamant that chemistry class & labs need to be taught in person. However, only one semester is required for the ADN-to-BSNs while the BSN program has two semesters.

      • The Bofa on the Sofa

        My SIL is a nursing manager and told me that she can’t hire any more ADNs for their office, saying that studies showed that ADNs made more mistakes and now more critical thinking skills are desired.

        And I’m glad that they are taking moves to correct that. That’s the key difference.

        Thanks for the info, though. My sister is an LPN (ADN, of course), my brother is an RN (ADN), and I have nieces that are both RNs, but one is a BSN and the other is an ADN. IOW, I know a lot of nurses.

      • Susan

        I think the BSN as a standard for nurses would be good but I disagree on ADN’s making more mistakes and being less critical thinkers. I would like to see that research. My experience is that at the beside you can’t tell the difference, and that a lot of ADN schools have higher boards passing rates. It’s also important to note that as an entry to nursing, the ADN schools are usually more geographically spread out because they are at community colleges. Thus people with strong ties to a community such as second career people, single mothers or married mothers, are overrepresented. To me, it’s one of the beauties of nursing, that women can start over as nurses. I used to be a clinical instructor and I know that community colleges offer opportunity for very smart individuals who may not be free to pick up and move. So for that reason I would hate to see things change. It’s a hard one. But honestly, most ADN programs have more clinical than BSN programs, and they don’t usually take only two years, the prerequisites take at least a year full time then the programs take two years full time. So sure, it’s less than a four year degree but it’s a lot more intense and represents a lot more sacrifice and work than a two year degree.

        • Karen in SC

          As that is not my field, I don’t know the research. I only know that it *is* happening, that there is movement for ADNs to convert to BSNs.

          From my SIL, admittedly that was hearsay evidence. :)

          • Karen in SC

            Found this on a nursing website (NSNA):

            ” Many voices are calling for a more educated nursing workforce to better meet complex patients needs. Motivating factors for these voices are likely related to the results of three studies that took place recently in the United States and Canada that consistently linked an increased proportion of RNs with baccalaureate degrees in acute care hospitals with significantly decreased patient mortality rates (Aiken, Clarke, Cheung, Sloane & Sliber, 2003; Estabrooks, Midodzi, Cummings, Ricker & Giovanetti, 2005; Tourangeau, et al., 2006). Combined, these studies examined almost 300 hospitals, about 300,000 patients and almost 23,000 nurses. The data is compelling and cannot be ignored. No one to date is able to explain why having at least a baccalaureate degree in nursing was associated with a lower mortality rate, but there are some possible explanations based on other studies of RNs returning to school.”

        • Young CC Prof

          Actually, the ASN programs, especially those at public community colleges, tend to be quite competitive, since space is strictly limited and tuition is so low. I personally know of some people who planned to pursue an ASN at my institution and transferred to a BSN program instead, because they couldn’t get in to our nursing program!

  • MaineJen

    Go right on being meen, Dr. Amy…I’m getting there myself, too.

  • Deena Chamlee

    noted and appreciated.

  • Deena Chamlee

    Now that I am unemployed and the trauma from that exit left me in shock for several weeks, I realize I can’t see ever going back into midwifery. Think about it. Why in the heck have this been allowed to go on for greater than 40 years?

    The College, The American College of Nurse Midwives officially knows about all the deaths because I informed them. And after I informed them via the paper Midwifery in the United States Verification of Facts and Data, a barrage of electronically abusive emails ensued from the leaders I sent the paper to. Then I was informed that I was exploited for the president and the elders by a well known published midwife. So I deduced, if I was exploited for others this infers again anti social behaviors in our leaders at the ACNM. In fact if you want to advance in leadership within the College you have to be willing to groom, exploit and discard members to sit in important national positions.

    The ACNM knows about MANA and NACPM as organizations who dismiss western ethics and moral values, thus, practicing contextual-sensitive approach when applying ethics to the practice of midwifery. Yet they publish a paper in the journal that spins data and misleads the public in regards to the safety of homebirth? they know about the midwives in Texas who are selling fake birth certificates to Mexican illegally. They know 75 were indicted on fraud charges. They know about the LA Times journalist that counted 300 mortalities and morbidities by midwives who attended homebirths between the years 1982-1992 by reviewing court documents.
    They know Vermont’s Health Department could not comment on the safety of homebirth in their state because of dishonesty with the data from MANASTATS. They know about Arizona’s struggles also and how their state collected data is worst than Oregon’s and yet the homebirth midwives had the narcissistic nerve to continue to lobby for VBAC, TWIN and Breech to be inclusion criteria for homebirths.
    I am sorry but none of the midwifery leaders that currently hold positions of power in The United States are ethical or morale. All exhibit pathology of sociopathy. And that is the honest to God truth.
    So while AAP and ACOG try to implore change within this profession by recommending CM and CNM attend homebirth,ONE sees the defiance of such employing with the publishing of the MANASTATS nonsense in the Midwifery and Women’s Health Journal written by members in power at the ACNM.
    The profession of midwifery in the United States is in a sad state. And I for one AM crushed to finally understand WHY CHANGE HAS NOT OCCURED FOR FORTY YEARS. IT HAS NOT OCCURED BECAUSE IF IT DID THOSE WHO SIT IN POWER CURRENTLY WOULD BE OUTED FOR COVERING UP THE ABUSE.AND THAT IS CORRUPTION AND IT EXIST AT THE HIGHEST LEVEL WITHIN MIDWIFERY.

    • Trixie

      Deena, do you have a blog or website that summarizes your research?

      • Deena Chamlee

        nope, just tons of info and proof of my statements.

        • Trixie

          It sure would be interesting reading if you had the time to put it up on the web.

    • Susan

      Deena that’s so scary. Are you saying essentially you lost your job because they were retaliating against a whistleblower?

      • Deena Chamlee

        yes I cant even think of trying to get an attorney because my ability to trust is 0.

        • Susan

          It sounds like you have been to hell and back. It does sound like something you need a good attorney for. Dr. Amy has my email if you need someone to talk to; I am not an attorney but I respect you and what you have tried to do. I know I myself had a hunch that the ACNM leadership is suspect. Mostly from talking to level headed CNMs.

      • Deena Chamlee

        delete please in fact anything that has deena in it would be great. thanks

    • Karen in SC

      I can’t say I am surprised after reading this blog for two years. But I am sorry this happened to you.

    • Amy Tuteur, MD

      Deena, I caution you to be extremely careful what you share in a public forum like this. If you are having an employment problem, you will harm your efforts to resolve it by airing it here.

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

        I’d consider deleting the majority of this comment, much as I value the info

        • Susan

          I agree.

      • Guest

        tried to delete so can you delete for me, now you know what happened

  • LMS1953

    Kinda OT:

    Exhausted after an intensive labor and grueling cesarean section delivery of identical triplets, a Mississippi mother was ready to breathe a sigh of relief, but the doctor threw her for loop when he announced that he saw “more feet,” ABC News reports.

    ******
    Boy, don’t you know a couple dozen CPMs had wet dreams at the thought of putting THAT notch on the handle of their gun.

    I detest how the news can’t get the simplest concepts. She no doubt had preterm labor – unless the NIH came out with an evidence based recommendation that it is OK to labor triplets/quadruplets. And what was so “grueling” about the C-section?? She probably got a spinal and didn’t feel a thing. But the woo says ALL C-sections are grueling and that is the song news outlets have to sing. Why not call it “life-saving” or “expertly coordinated” with 3 teams of neonatal support and a dozen well trained professions dedicated to the best outcome for her babies. No, it’s more the implication – see there, you can’t trust medical technology – that stupid doctor couldn’t even count to four.

    • Trixie

      To be fair, being 42 and gestating quadruplets probably leaves a person exhausted!

      • fiftyfifty1

        Yep, they should have said “Exhausted after a grueling pregnancy…”

  • guest

    So, kind of OT, but this article on “14 Tips To Avoid a Cesarian” is … exactly the kind of thing that deserves to be ripped apart. One thing it doesn’t mention? Getting the kind of great prenatal care that lets you detect and control gestational diabetes. Instead, the author suggests you might want to avoid OBs (all that surgical training), avoid negative comments, (like your sister who loved her c-section) and birth in a place where you are “extremely comfortable,” because a “mother who is terrified of the hospital will likely be unable to open and birth vaginally there.” http://class.birthbootcamp.com/corigentry/2014/02/14-tips-to-avoid-a-cesarean/

    • Elizabeth A

      Her comment on breech is really indefensible. The reason obs don’t “inform” their patientsabout moxibustion, acupuncture and chiropracty is that these things don’t actually do a damn thing. Some babies flip, others don’t.

      When my first was suspected to be breech, the doctor talked to me extensively about external version and c-section. Things that were available to me, and effective. No doctor should waste patients’ time discussing quackery, or unavailable or inappropriate treatments.

      • guest

        My OB informed me about moxibustion when my baby refused to turn over. The OB’s stance was that it wouldn’t hurt anything to try if I wanted to. She also mentioned that if it didn’t work then they would try external version, and if he still wasn’t turned over then a C-section would have been necessary. Fortunately he turned over on his own at about 37 weeks–no moxibustion, version, or c-section necessary.

      • LMS1953

        Click on view to see how moxibustion is done. You need to get moxa sticks which are tightly rolled leaves of hugwort. You give yourself a hot foot on the outside of your little toes. I am not sure if it is due to the heat, the pungent smell or the effect of hopping up and down on one foot like Wile E. Coyote until you fall into the canyon.

        I simply can’t bring myself to discussing that gris-gris with a patient.

        • Elizabeth A

          Nor should you.

          As an accountant, my standard is not to recommend a course of action that’s illegal, useless, or more expensive then the end result is worth. I want my doctors to have standards at least that high. I had placenta previa – you would not believe the bull that was recommended to clear that up. About 90% of previas clear on their own before delivery, so as far as I can tell those “harmless” acupuncture, herbal massagewhatevers represent nothing but an opportunity for charlatans to take a crack at a frightened woman’s wallet. Please, continue to decline to act as a referral service for that crap.

          Once upon a time, the recommended treatment for lots of things was prayer. As far as I know, that’s still a better plan then having yourself stuck with needles. And it’s free.

          • Young CC Prof

            Breech is exactly the same deal. Most babies who are breech at, say, 32 weeks, turn before delivery, and woo-believers credit whichever woo they tried last. Hence, the anecdotal evidence pours out.

        • anonymous

          Oh, and the actual moxibustion paper, which is referenced heavily on that page states clearly that it does NOT help to make babies turn, contrary to what is said on birth:

          http://www.ncbi.nlm.nih.gov/pubmed/15924530

        • deafgimp

          I think she’s standing on paperback copies of the Twilight series. My mother sent them to me after she read them and I read them so I could mock the series with first hand knowledge.

    • AllieFoyle

      >>>a “mother who is terrified of the hospital will likely be unable to open and birth vaginally there.”

      If only this were true.

      • Jessica S.

        You mean it isn’t scientifically proven that vaginas are scared of hospitals? :)

        • Kelly

          I was terrified of giving birth without drugs and it did not prevent me opening up and giving birth in three hours. I think my body failed me.

    • Jessica S.

      Dr. Amy should write a counter-article: “14 Tips To Avoid a Dead Baby”

      1. “Giving birth” is about delivering as healthy a baby as is technologically possible with today’s medical advancements (thank goodness for them), not about the mother’s pet method.

      And so on.

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

      My cousin’s wife was terrified of hospitals. So much so that she put off having children for years. In the end, she spoke to a therapist about it, and she gave birth to three babies, vaginally, in a hospital. Instead of encouraging fear of hospitals in women because it is profitable for them, the NCB movement could help to educate women that birth in a hospital does not have to be scary. They choose not to because it doesn’t fit their agenda.

  • Don’t get it

    The tone of this blog is super harsh but it’s an agenda based blog. That’s sort of the nature of the beast and dare I say it’s likely why you have so many readers. I don’t understand the whining about meen-ness. That said, it clearly alienates women you are ostensibly trying to help and is polarizing. But then again for some reason these women must be reading. Humans are so odd…

    • anonymous

      Yes, telling a woman that a home breech birth really, really helps.

  • koffeewitch

    While you’re speaking for the dead, please don’t forget to mention the victims of cytotec and DES. I think the US death rate due to iatrogenic causes is estimated at around 225,000 per year. Of course even during the times of blood-letting and leaches, doctors hid behind their professional status to deny their ignorance and fallibility. It has always been the trend to point the finger at midwives instead of just cleaning your own house.

    • MLE

      Whereas midwives are completely transparent and forthcoming about their mistakes *ahem MANA ahem*.

    • Stacy21629

      Yea…and DES is banned now. I mean, I can get it compounded for dogs, but it’s tricky.

      So if we can equally prove the dangers of homebirth or breech home birth…can we subject it to the same fate as DES?

      • koffeewitch

        ACOG still champions cytotec in spite of all evidence of danger.

        • Amy Tuteur, MD

          Wrong! You seem to have no idea what you are talking about.

          • koffeewitch

            So…OBs are not using it on pregnant women? Or it’s perfectly safe or what exactly is wrong?

          • KarenJJ

            Well they’re using it on pregnant women to get a baby out, which is the main reason why it is contraindicated for pregnant women to start with…

          • anion

            Well, we know of at least one case where a midwife was using it, procuring it illegally from her pharmacist son, so do you have the same complaints about midwives? How about those who recommend inserting garlic into the vaginas of pregnant women to “cure” Step B? Or who administer castor oil or cohosh to start labor?

          • moto_librarian

            I was given cytotec. Not for induction, but to try to stop the massive pph that occurred immediately after I delivered the placenta. I had already had pitocin and uterine massage. Since you clearly don’t know what the hell you’re talking about, I’ll give you a pass.

        • Guesteleh

          U.S. practice guidelines for inducing labor. Information includes maternal and fetal conditions in which inductions are appropriate, a list of induction methods, including non-drug methods such as foley catheters and stripping membranes, and ratings for the strength of evidence to support an intervention. It also lists the potential risks of different induction methods and the circumstances in which they shouldn’t be used.

          CPMs do not have any practice guidelines. They give no guidance for safe practices to their members whatsoever. They conduct “research” but they don’t use it to try to change or improve how CPMs are delivering babies. So why would you trust the group of providers with no standards over the group of providers with detailed, evidence-based national standards?

        • Medwife

          EVERY method of induction has risks to it. Cytotec has a slightly increased risk of uterine rupture and/or c/s done for fetal heart rate than pitocin or cervadil in SOME- not all- studies. It does give you the best chance of vaginal birth of all the methods of induction. Stuff that works has side effects. Cytotec should be used with caution but it’s not inherently evil.

          • The Bofa on the Sofa

            Hey, don’t you bring your “thoughtful insight” around here? Don’t you know that koffeewitch is trying a gotcha? How dare you provide actual information that demonstrates that some people actually understand how this stuff works and actually know the benefits and risks!

      • Young CC Prof

        Ah, my favorite natural-health fallacy. Medicine did something totally wrong decades ago (and stopped as soon as the evidence of harm became clear) therefore doctors today must be wrong about everything.

        • Durango

          Or, as the post at SBM said,The “Oh yeah? thalidomide!!!!” Gambit

          • anion

            Ironic, considering it was that meeen FDA who refused to okay thalidomide for pregnant women in the US despite all of the “But the Europeans have it!” whining.

          • Young CC Prof

            Indeed, Thalidomide is a great NON-example of the past failures of the US medical establishment.

          • Sue

            This comes in the same category as ”but doctors used to advise people to smoke”.

            Well, some (not all) did, for the anxiolytic effects), but medical science showed that smoking carries many harms, and doctors not only started advising against it, but started campaigning for tobacco control and effective quit programs.

            Similarly, modern midwifery and obstetrics grew out of the desire to improve the fate of both mothers and babies in childbirth, while HB MWs remain at the ”advising ppl to take up smoking”stage.

            The rest of the world has moved on (along with the irony of tussling with them on the oh-so-modern internet).

          • resaurus

            Related: This year we celebrate 50 years since the groundbreaking Surgeon General’s report that connected smoking with cancer. Reducing smoking along with improved maternal/child health are two of the greatest public health achievements we have in the world.

        • Jessica S.

          No kidding! Never mind that this statement “Of course even during the times of blood-letting and leaches, doctors hid behind their professional status to deny their ignorance and fallibility.” could easily be applied (and actually more applicable to) to the home birth crowd.

  • The Bofa on the Sofa

    I wonder how much of the complaints about the “tone” of this blog refers as much to the comments as it does to Dr Amy herself? I certainly don’t tapdance around, and many other commenters here don’t beat around the bush, either.

    And given that, how much of the fact that the comments are blunt is due to the fact that they aren’t moderated with a heavy hand? As has been pointed out, other places that run more NCB and HB are warmer and fuzzier, but then again, they are so heavily moderated to squelch any hint of dissension that of course there’s no “meen” comments toward each other. Everyone looks to be rah rah happy because anything negative is immediately purged. It’s easy to make yourself look really good when you remove anything that is negative against you. Here, however, that doesn’t happen. We actually get debate and argument, because everyone is allowed to contribute.

    • KarenJJ

      That’s a good point. Dr Amy hasn’t cultivated a community of sycophants. I do find that refreshing. So many NCB advocates set themselves up to be a type of figurehead for a cause with adoring groupies.

      • thepragmatist

        This is definitely not an echo-chamber. I’ve been harshly criticized here. And I’ve also had great conversations here. And maybe I’m “offensive” but if being myself and having a vicious sense of humour (and a strong ethic) makes me offensive, so be it. Don’t read it.

        This blog is well-read but it takes guts to post here. It took me a long time to get the courage to enter the arena. I know that I could at any moment get skewered for something I’ve said, and I don’t mind. I made some off-handed comment about TV and woke up to find I’d provoked an entire post. LMAO! I came back the next day, because you all don’t have to like me all the time. Just like I totally disagree with some of the pro-lifers here and others who hold political positions that I could never imagine, but I will still like your posts when you’ve made a good point. I have genuine affection for some posters but even the ones who irk me I still learn from. Because, this isn’t about LIKING each other, this is about *discussion*.

        It’s one of the few forums left like this, it seems. Everything else is so overly moderated so no one’s feelings get hurt or it’s full of trolls who just lob slurs at each other. Debate is discouraged as being “not nice”. Comments sit and sit in moderation, disturbing the flow.

        I’ve been online for 18 years (wow)… and back when the Internet was full of geeks I never got called on TL;DR (it didn’t even exist as an insult) and we could be roaringly, totally vicious in debate and then happily switch “sides” the next day on a different subject. It was for the love of the topics. It wasn’t a popularity contest. Real life was the popularity contest a lot of us geeks were escaping online.

        Also, now everyone expects a debate to be parsed into 120 word segments for their convenience and for everyone to be nice, like we’re in elementary school. I’ve never heard so many complaints about people “having” to read my posts as I have in the last couple of years: this is a new thing. Also, complaints about my tone. If I just said it “nicer”… oh FFS. Prior to that, I constantly heard the opposite, and would receive long replies back, picking apart my points item by item, in great detail. I miss that. I miss being skewered on factual inconsistencies by people with great passion.

        It’s like the Internet is being reduced to the lowest common denominator and it makes me long for the old Internet. Sighs. It also makes me feel really old.

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

          I think I love you. :)

    • AlisonCummins

      Some of the commenters are really quite offensive.

  • Anonymous

    The thing that bothers me about the “mean” comments is that it is sexist. I can’t imagine anyone telling a man who had a scientific argument and facts to back it up that he shouldn’t be listened to because of his tone. Only women are supposed to be simpering and deferential to other people all the time. We’re supposed to hold hands and sing and act like we all get along rather than try to figure out what’s right. What a bunch of BS.

    • Stacy21629

      This. 1000%.

      This difference in acceptable attitude and speech is well-documented in the business world. Women that are self-assertive are bossy. Men are confident.

    • SuperGDZ

      Have you ever read what people have to say about Richard Dawkins?

    • anion

      YES. THIS. It’s nothing but sexism, and it infuriates me.

      I get the same shit in my professional life; I’m a writer, in a subgenre whose readership is mostly female. I’ve had things I’ve said torn apart for my “tone” numerous times, whereas a man in my genre has said exactly the same thing, in exactly the same way, and been cheered for his no-nonsense attitude and championing of common sense. He’s a god and I’m a bitch; because I’m a woman–and a feminine-looking woman with a feminine name–I’m supposed to couch my statements in gentle language and equivocate and simper.

      ANY woman, like these homebirth advocates, who claim they’re “standing up for women” while at the same time ruthlessly attacking and dismissing women who speak their opinions plainly, is not standing up for women at all. They’re reinforcing the idea that women shouldn’t have serious thoughts or speak of serious things, that women should put emotions above logic, and they should be ashamed of themselves.

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

    Any woman who would risk both her own life and her innocent baby’s because a blogger was “meen” is beyond idiocy. It’s disgusting and offensive. Wake the fuck up – babies are dying and injured for life, women are dying and injured for life! Get over your pwecious feelings, put on your big girl panties and DEAL.

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

      You could try actually understanding why someone might think its important to them. It isn’t that doctors are mean, its that they are mean and have authority over you and your body while you are in their care. That can be very dangerous to some people. I know it was for me. My main goal was to avoid PTSD from childbirth, and I failed. Hard. I went about it the wrong way, perhaps it could not have been completely controlled, but I do believe that more sensitivity would have helped me be more receptive of information that showed out of hospital birth was not as safe. I felt like a fool for even having such a concern when I read this website, although in retrospect it was entirely justified. Commenters here repeatedly insinuate that women are selfish for being afraid of abusive providers in a hospital setting. Its pretty damn hard to take care of a newborn when you are trying to cope with trauma too. It terrified me to think of people doing things to me without my permission or using verbal abuse to get compliance. You have no idea what you are talking about if you think that I am some sort of exception- there are millions of women out there like me. It just smacks of immaturity to berate people who are making unconventional choices instead of actually trying to understand them.

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

        No, shameon, I am speaking directly of the women, like the commenter below, who say they knowingly risk their baby because of Dr. Amy’s tone. Women, like ones i know, in real life, personally, who view hb as defiance against “meen” doctors. Not ALL women struggle with emotional issues around birth – although I did. And I stand by my words – if you risk *anyone’s* life out of defiance, you’re a fool.

        • AlisonCummins

          That’s nice, dear.

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

        Furthermore, I am getting a little tired of you being the emotional police here. I have tremendous sympathy for what you’ve been through, am a supporter of your blog, and appreciate your kindness in these debates. However, you react to so many comments – ones by regulars who are known to be sympathetic, kind, empathetic etc as if they’re ignorant meanies too. I’m starting to be offended by *that*.

        • Cellist

          Agreed.

        • thepragmatist

          Shame on, most of those likes were from guests, not regular posters. Do not take them seriously. You are in the middle of a big fight, and it’s normal to shadow box with allies sometimes. Kumquat, when you clarified the point about defiance it made a lot of sense to me. So I see what you meant originally, and I can see how she would’ve taken it differently. Don’t let this make you stop feeling safe to post here. You have people who support you.

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

            Appreciate the sentiment. Admittedly, these rounds of internal tone trolling (or shadow boxing, as you put it) do push me right into lurking. After all the social isolation (because I’m not tenderly coaching facts in unicorn farts) I don’t have much endurance left for this stuff.

        • AlisonCummins

          She’s standing up for herself. She’s sharing information. I’m not sure why facts would offend you, or why you think that when you are offended by facts that the problem is her.

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

            And where, pray tell, is MY safe space to post?

          • AlisonCummins

            If you need a place where everyone’s life experience parallels yours, maybe you should put on your big girl panties, start your own blog and moderate it heavily. That should do it.

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

            I do have my own blog, thanks. Though I do not censor comments there either. Lovely, that in an article about how dr. Amy is meen there’s an awful lot of this.

          • AlisonCummins

            What’s “this”? Information? Yeah, it’s pretty ironic that you’re getting your pwecious feelings hurt when people share their life experiences.

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

            No, Allison. I do not mean I’m hurt by information. Nor do I mean that I am hurt by other people sharing their experiences. Nor by being wrong – I’ve been wrong plenty and am up front with that. I *am* on occasion hurt by regular commenters who (a) make unexpectedly stinging comments (oh, like I did here, for some people) or (b) “tone trolling” or “emotional policing” of regulars by regulars. And hey, on most occasions where I’ve been called out for tone, I’ve apologized. I don’t agree in this case.

            It’s a shame (hah!) because I don’t want ShameOn to be marginalized either. I think she has a tremendous amount to offer in this endless battle to stop the killer CPMs. And I like and respect her. Doesn’t mean I won’t speak up if I don’t agree. That’s why I love this board 90% of of the time. And if I think ShameOn is being oversensitive I’ll say that too – you know, like you’re saying to me.

            I’ve been through the social wringer due to not toeing the party line of NCB. I’m tired of tiptoeing. I’m angry as hell about the anti – science and anti – rationalism this blog addresses, and I will speak about it here, in the only forum that kind of dissent is allowed. Well, unless you’re too “meen.”

      • Karen in SC

        Unfortunately, women who might be afraid of abusive providers jump to other providers (birth junkies) who abuse in a different way.

        I don’t know if you have discussed this before but did you get help for your fear of being abused in a hospital before turning away from that model of care? What do you recommend for these women – interviewing OBs, visiting hospitals ahead of time?

      • Trixie

        Yeah, but in hospitals, if one person behaves inappropriately, there are safeguards and controls and mechanisms for dealing with that person. I had a bad experience with a mean, arrogant, condescending, inappropriate neonatologist in the hospital. I complained and hospital administration believed me and took me seriously and addressed the situation (it was clearly not the first time this person behaved that way, all the nurses were on my side).
        I put on my big girl panties and I dealt with it. I didn’t respond by leaving the system of western medicine entirely because one person was mean to me.

        • thepragmatist

          I am not sure you understand how difficult it actually is to be a survivor in a hospital setting, especially if you have a chronic condition. I am open about my history and have very specific limitations about what kind of behaviour I can tolerate from staff around me, and a hospital with a “my way or the highway” attitude. I’ve been downright abused in my hospital, even as I earnestly tried to work with them. I dread every ER trip. I used to be accused so frequently of being a drug addict that I had to carry a letter from my doctor. I had a physician chase me around a room, until I hid under a sink in terror, to give me a rectal exam. I openly identify as having PTSD in the hope that they treat me as if I have a comorbidity that actually is real. Instead, they’ve used this to say I just want special treatment, and if I don’t like it, I can go somewhere else (there is nowhere else). I’ve had an IV yanked out of my arm so hard it made a big round ball. I’ve complained and it made it worse. I’ve been left screaming in a ball on the floor with blood pouring out of my ear from a ruptured ear drum, because now they are not even giving me a bed. So you know, you don’t actually know what it’s like. I have giant big girl panties. I was brave and did everything I was supposed to do. I did complain. I did try to rectify the situation. I tell the truth. I try to be respectful. It’s useless. There are just some people who lord their power over others in an abusive way and in a system with no checks and balances, there is no point complaining. I am glad it worked for you, but people (women) here are scared to complain, because we have nowhere else to go. When my OB weighs in, she gets abused in our stead. She gets told she’s coddling her patients, etc. She gets marginalized, too. Believe it or not, I call the safe house for women every time I go to that hospital, because I am never sure how it’s going to end. One time, they booted me out– with pneumonia– at 4AM. No way home, as I came in by ambulance and in winter. The safe house paid for my cab home. The safe house has witnessed, over the cell (that I kept running), the way a nurse dressed me down. It’s a terrible situation. It’s well acknowledged it’s abusive, but there’s nothing more I can do to fix it and at times I am afraid they are going to kill me one day, because they just give me the most bare treatment now that I DID complain. So, like going to the cops (which I’ve also done), it’s easier to say than do, and you never know what will happen to you if you dare to speak out. I’ve always been an advocate and activist so I just assumed if I addressed the situation with a solution-focused approach, that it would work. It didn’t.

      • auntbea

        Shameon, there are reasons why women might choose hb over hospital, even knowing the risk. Which is why no one here advocates taking away the right to homebirth. But the fact is I know several hb mothers and none of them has ever been abused, in a hospital or not. They are doing it to be different and better. We are allowed to criticize those people for passing the risk onto their child in order to be cool.

      • Amazed

        But the commenter isn’t you. She was not abused or anything. She was basically saying, “You’re a big meenie, unknown blogger, and that’s why I would happily risk my child’s life and health.” That was her reasoning – that Dr Amy should care more about her and her baby that she did herself.

        You’re placing yourself in a difficult situation here. If that’s the kind of woman you relate to, be my guest. Somehow, I don’t think that’s your goal.

      • Allie P

        When I read the horror stories about homebirth, it seems like it’s the midwifes who are being mean and abusive, calling women who ask for pain medication wimps and etc. Is there fear of hospitals and people in white lab coats? Sure. I’m a lot more afraid of uneducated quacks in my living room in a life or death situation, though.

      • AllieFoyle

        Shameon, I don’t always agree with you, but I appreciate your perspective and I’m glad you’re a part of the conversation. A significant portion of women are afraid of childbirth for a number of reasons (past abuse, assault, trauma, shyness, modesty, etc.) and that fear can be a factor in their becoming more vulnerable to adopting unsafe approaches to care in an effort to avoid trauma. Efforts at understanding and compassion are more likely to be helpful than judgement and shaming.

      • thepragmatist

        See, I’m that woman too, and I don’t find Dr. Amy mean, at all. I find the physicians at the hospital here mean when they treat me like a piece of garbage because of medications I am on, or because I have PTSD/Bipolar fueled anxiety, but I’ve had nothing but good experiences with my OB/GYN… even though she also would be considered MEAN. She’s called mean by some, especially by midwives, and her tone reminds me a bit of Dr. Amy. She regularly calls bullshit on things, but she’s the gentlest doctor I’ve ever had. If I told her something that was factually inconsistent she wouldn’t hesitate to tell me how wrong I was. But she stands up for women like you and me. And I feel like Dr. Amy would, too.

        And she is: Dr. Amy IS standing up for women like us by taking down people who would exploit a sexual abuse survivor. And I suspect that Dr. A would stand up for sexual abuse survivors in a hospital setting, if one confided her history.

        I do not experience invalidation here, ever. And I get it a lot elsewhere. When Dr. Amy is writing about women who value experience over safety, she’s not talking about a woman who has been raped who is terrified of the hospital, she’s talking about women who are bitching and moaning because they don’t like the food. She’s talking about advocates of homebirth who tell women they can’t have a moving, joyful c-section just because it’s surgery. What she does here isn’t to minimize OUR experience of hospitals (as survivors), because she’s not talking about sex abuse survivors who get mistreated, and she’s not denying there are providers who are terrible in hospital. It’s not her job to talk about those people.

        Correct me if I’m wrong, but I think that Kumquat here has always shown herself to be an ally of mine, so I don’t think she meant her comment as it was, that we– those who have suffered provider abuse or who are survivors of rape or incest– suck it up and like the hospital. I’ve had terrible hospital experiences, none of which were the result of my OB/GYN and many of which would’ve been far worse had it not been for her interfering.

        When a woman is called “mean” it usually means she’s a FIERCE advocate. I think that Dr. Amy would probably have your back in a fight for you to have a good birth experience as a survivor. Nowhere has she ever condemned any victim of sexual abuse and as a survivor I feel comfortable posting here and received a ton of supportive posts. I’ve always hoped that by posting here about my experiences, maybe physicians can take something away from it and me, I’ve learned to humanize my physicians and try to see things from their perspective (if only some of them would return the favour).

        My two cents…

      • Irène Delse

        To be fair, Kumquatwriter was talking about a *blogger* being “mean”, not doctors in general. I think we can all agree that a bad experience with a rude, abusive or otherwise unprofessional OB can understandably turn off a woman from even trying the hospital again. However, that’s not the same thing as reacting that way to one blogger who happens to be an OB, and dismiss her as “mean” just because she calls out NCB nonsense for what it is.

  • Jessica S.

    Great post, Dr. Amy! I’ve been following you for years and feel you’ve stayed consistent in message (based on evidence), which is more important than tone.

  • stenvenywrites

    I read plenty of skeptic and educational policy bloggers, male and female. I do not find your tone any more abrasive than that of the anki-crank, anti-woo, anti-quackery, bloggers, and it is far less vitriolic than some of the political bloggers. I wonder if you aren’t being held to a different standard than say (to choose one example), Orac at Respectful Insolence, because your audience is female, or because you are.

    • Sue

      Well said, stenveny. I participate in many anti-science in health forums where I correct misinformation in a no-nonsense style. Opponents in the discussion who cannot argue against the information I provide (in my own profession of health care) commonly resort to accusations about style, as if being nice and friendly makes your nonsense more credible.

      Well, everyone can contribute to the campaign against disinformation in their own style. If ppl prefer sparkles in their on-line activism or discussion, let them broadcast that way, but provide accurate information and corrections. Maybe that will convert some. Every bit counts.

  • Michelle

    I just have to say, that I am a person who does value honesty, and I believe in informed choices based on accurate information. I am a reasonable person. I am not a homebirth advocate, and I had my baby in a hospital. You can mock those that take issue with your tone, but let me tell you this. The way you write about women and natural childbirth, scares the crap out of me. If I had a choice between you as my OB and a home birth, I’d choose a midwife in a hot minute. And you make me think twice about trusting any OB, lest I find myself bullied at my most vulnerable.

    • Karen in SC

      Then you would be choosing the least safe option based on your feelings. Not facts.

      You are also making an assumption that Dr. Tuteur would display her anger at untrained birth junkies causing unnecessary deaths on her regular OB patients. And a generalization that all OBs act the same way.

      Also, pregnant woman are vulnerable? Give me a break!

      • Michelle

        First, I may be choosing a statistically less safe option, but it is not the least safe. I could also choose to have an unassisted birth, or travel out far into the woods to attempt to birth completely alone. So not the *least* safe option.

        Second, I would base it on facts. The fact is, Dr. Amy is hostile to the idea of women making their own choices about birth, she constantly belittles women for their choices and desires related to birth. The fact is, I do not want to be treated by someone who’s approach to this topic is to belittle and be disrespectful women. The fact is, I think a doctor’s attitude toward a person can affect them during treatment. The fact is that a home birth is riskier. The fact is also that the risks of death are low for both home and hospital births, and I would weigh the risks. The fact is that an OB may not display hostility toward an attempt at natural birth, until perhaps it is too late to find someone else. That gives me pause to use an OB. Luckily, I’ve had a child, and found a great OB, after firing my first one, so I know they’re out there.

        Thirdly, anyone pushing a person out of their vagina is currently in a vulnerable state.

        • fiftyfifty1

          ” I may be choosing a statistically less safe option, but it is not the least safe. I could also choose to have an unassisted birth”

          The data from Oregon indicate that chosing to be attended by a CPM at home is just as unsafe as a UC. (At least with a UC, you can listen to your intuition and call 911 if something seems wrong. With a CPM she will be there telling you everything is ok and encouraging you to stay the course.)

          ” Dr. Amy is hostile to the idea of women making their own choices about birth”

          Dr. Amy has repeatedly stated that she would never restrict a woman’s legal right to birth at home. Does that mean she needs to praise women for that choice and pretend it is safe?

          ” anyone pushing a person out of their vagina is currently in a vulnerable state.”

          Speak for yourself. I never felt that way.

          • Jessica S.

            Good point about Dr. Amy not being anti-choice re: delivery options. I was going to point out the same!

          • The Bofa on the Sofa

            “Not accepting the premise that vaginal delivery is better than c-sections, and that c-sections are evil” =/= “anti-vaginal birth”

            We get that all the time. Oh, Dr Amy is anti-natural delivery. Oh, Dr Amy is anti-breastfeeding. Of course, it’s idiocy. Not being anti-c-section or anti-epidural is not “anti-natural delivery.” Similarly, not being anti-formula does not mean “anti-breastfeeding”

            I don’t know where this comes from, that if you don’t demonize epidurals, it must mean you are against natural delivery. Or that if you don’t demonize formula, you are against breastfeeding, but we hear those accusations all the time.

          • Young CC Prof

            Oh, yeah, those conversations are always exciting. And confusing.

            “Formula is an OK food for babies.”

            “What? How dare you say formula is better than breast milk?”

            “Um, no, I didn’t say that, I just said it’s OK.”

          • Jessica S.

            Totally!

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

            Not feeling vulnerable isn’t the same as not actually being vulnerable. One thing you know after a serious trauma is that you are basically not safe, ever. It is a very alienating realization. You are a lot less safe when you have to rely on other people- its just a fact. I have a feeling michelle has some trauma in the past. She is thinking like a trauma survivor, that’s for sure.

          • fiftyfifty1

            This is the great divide isn’t it? For many with an abuse history, abuse seems to lurk around every corner. For those without that history, that idea seems ludicrous. But really, both are probably right. Women with a history of abuse whether sexual abuse or intimate partner physical abuse or emotional abuse are at a statistically much higher risk of future abuse than the general population. Whereas if a woman reaches maturity without abuse, the chance of her every being victimized is very low.

          • AllieFoyle

            There is a lot of truth in this. I often feel that there is an element of unfair judgement in these discussions in that people who–through some accident of fate, biology, and/or environmental misfortune–are more vulnerable to fear and anxiety about the medical environment become ostracized and dismissed as irrational by those who have been lucky enough to have a combination of temperament and experience that allows them to approach the situation with trust and confidence.

            Many of us have vulnerabilities. Many of us have been abused or traumatized. You have to meet people where they are instead of just throwing everyone who isn’t perfect into the trash bin.

          • Michelle

            Well, you may not have felt that way, but you also probably weren’t in any sort of condition to run away from an attacker. If women in labor aren’t vulnerable, why are you so insistent on a hospital birth with an OB anyway?

          • fiftyfifty1

            An attacker running loose in the hospital??!!! What is this, Nightmare on Elm Street?!

          • AllieFoyle

            >>>”Speak for yourself. I never felt that way.”

            Do you think there is something wrong with women who do feel that way?

          • fiftyfifty1

            No, it makes a lot of sense that a someone might feel that way. But not everyone does.

        • Jessica S.

          Yeah, I don’t think this fixation with vaginas, as related to delivery methods, is as universal as you state. Perhaps the concern over health and well-being their yet to be born child is what causes vulnerability. The quickest remedy is to adopt best practices, and delivering at home simply is not the best. Those who try to convince you otherwise as actually preying on that vulnerability. The point of having a baby is having a baby, not the delivery method. And frankly, your acknowledgement and subsequent justification that you know home birth may be a less safe choice but not the least safe choice is disturbing. If you were only speaking of an action that involves solely your own safety, and not that of your child, it wouldn’t matter. But you are in essence saying you’re fine with chancing your child’s safety, even if the risk is small – that is, small in number, but immeasurable in consequence.

          • Michelle

            “But you are in essence saying you’re fine with chancing your child’s
            safety, even if the risk is small – that is, small in number, but
            immeasurable in consequence”

            Do you drive in a car with your children? At all? Do you cross the street with your kids? Ever? Do you know that staying home, and never crossing the street makes you statistically much less likely to be injured by an automobile? Or do you do some sort of risk/benefit analysis and risk your kids dying in a car crash just so you can drive somewhere?

          • Young CC Prof

            Actually, I ran the numbers, based on US death records from 2010.

            The probability of a baby dying from a home birth is approximately twice the probability of a child dying in a car accident at any point from birth to age 25, and ten times as high as the risk of dying in a car accident between birth and age 10.

            Car accidents are the leading cause of death among Americans aged 1-25.

            Yes, home birth is THAT dangerous.

          • Jessica S.

            Young CC beat me to it. In a previous post’s comments, she actual detailed this out and it was exactly as she says. It was really interesting.

            If I wanted to guarantee no car accidents (although I can’t control whether one comes careening through my house, unless I build a moat), then I would be a shut in. The risk/benefit analysis I do is buying a car seat that fits them and the car and matches safety standards, make sure he’s buckled in properly and try my darnedest to drive safe. Since a woman on average (living in a society where car travel is commonplace) deliver a baby less often than riding in a car, hospitals are a good safety seat/seat belt – or at the very least, a birth center adjacent to a hospital (risk is still slightly higher). If I wanted to guarantee not losing myself or a child in childbirth, I wouldn’t get pregnant. But if I choose to, I’ll go with what is indicated as safest.

          • Amazed

            Do you intend to have about, I don’t know, about 10 000 children? Because it’s quite probably the number of times you “put them in danger by crossing the street”.

            I find it ridiculous that someone can argue that a necessity that will come around many thousands times and carry some small risk is the same as the most vulnerable day in a child’s life that is not going to repeat – ever.

        • Jessica S.

          “That gives me pause to use an OB. Luckily, I’ve had a child, and found a great OB, after firing my first one, so I know they’re out there.”

          So, that hypothetically gives you pause about all OBs, b/c by your own testimony you found a great OB after ditching a bad one. That’s a great thing – seriously, it’s important to assert yourself if you think your doctor isn’t serving your needs. The message shouldn’t then be to encourage when to forgo ALL OBs, which by your own admission is the less-safe choice. It really sounds like you found a reasonable solution, but your using this opportunity to rant against Dr. Amy, extrapolating that to ALL OBs, implying that is actually impacting a decision in your life (from your initial comment “and you make me think twice about trusting any OB”) when the reality is, it isn’t. You know there are “competent” OBs out there.

        • Captain Obvious

          I make all my decisions in life based on this…”First, I may be choosing a statistically less safe option, but it is not the least safe. I could also choose to have an unassisted birth, or travel out far into the woods to attempt to birth completely alone. So not the *least* safe option.”
          I don’t always use seat belts for my kids, but at least I don’t let them ride in the back of the pickup.

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

        See, but that’s the thing, no one makes decisions based solely on logic (no matter how much any of us would like to claim that we are doing so). Your feelings play an important role in decision making. That nagging doubt or gut feeling that something is ‘off’ about someone isn’t something that should be ignored. I think that aiming for awareness of your own emotions while making decisions is a much more realistic and effective goal then ignoring them completely.

    • Life Tip

      I find it absolutely shocking that someone would admit that they would chose to knowingly place themselves and their child in an environment that they know is less safe, possibly even deadly, simply because they *might* otherwise get their feelings hurt. You would honestly prefer an incompetent provider who flatters you to your face rather than a competent provider, who has the tools available to handle emergencies, who might not speak to you in a tone you like?

      It’s mind boggling.

      • Jessica S.

        Yup! That was exactly what I thought, too!

      • GuestingIt

        I don’t think it’s genuine. She’s being hyperbolic to make a point, but it’s not working because she admitted she didn’t run into the arms of HB midwives, but rather a nice OB.

        • Jessica S.

          You said that much more succinct than I did over several posts – well put! :)

    • The Bofa on the Sofa

      For sure, Dr Amy does not have much patience for idiocy and deceit, nor suffers fools lightly.

      Then again, I don’t know why anyone would think she should or why anyone would want her to. We shouldn’t have patience for idiocy or deceit, and we should not accept foolery.

      Now, we need to distinguish idiocy and foolishness for ignorance. Ignorance in itself is not a problem, and we all face it. The foolishness is when that ignorance is paraded around as being “educated”.

      So here’s the question: is she wrong? Should we really be having more patience for fools and deceit? Or should we be more tolerant of lying?

      • Michelle

        Well, what is the point of her blog? If it’s just so she can call women idiots, and you can all feel superior about yourselves for being just fantastically intelligent, then it’s working. If it’s actually, as she claims, an attempt to help women rethink home birth, it’s not working as well as she thinks. She’s only alienating the women she supposedly wants to reach. Scare tactics have been shown to not be effective in changing people’s minds.

        • Jessica S.

          She’s not using scare tactics, she’s using actual data. Whether or not that is scary isn’t a tactic. While I would have agreed with you almost entirely on the point of not converting anyone to her side, I’ve read the stories of a few women here who were very pro-home birth and changed their minds in large part due to this site. That’s anecdotal, of course, and a very small sample. But the point is, I now question my assumption that this blog won’t change anyone’s mind. (By and large, I don’t think it will change the majority but that’s human nature. It doesn’t absolve people of their convictions to speak out, if they choose, and that’s Dr. Amy’s point here.)

          • Melissa

            I think this blog is great for helping people who might have just seen BoBB or have been told by a friend that induction leads to autism and so you should have a homebirth. No, it might not work on people who have already accepted the woo. But that’s okay.

            Part of the problem is that the NCB movement has plenty of mean people on their side who post about birth rape and that women will be strapped down and given a c-section against their will. They certainly are mean towards OB/GYNs and can be mean to women who have hospital birth (I’ve seen women called lazy and wimps for using pain relief). If Dr. Amy was neutral in tone there’s a real possibility people would see the NCB people passionately talking about the dangers of hospital births and the coolly logical Dr. Amy and will think that the homebirthers must be right because of their strong convictions. Dr. Amy is just as passionate as the NCBers, but she is the one who needs to watch her tone?

          • Jessica S.

            Not only can they be just as “mean”, or use the same tone that they accuse Dr. Any of using, but many sites and blogs actively work to block out dissenting views that are not voiced “mean” at all. (That sentence is jumbled but I think you know what I mean.) I totally agree with what you’re saying!

        • Captain Obvious

          Homebirth midwives livelihood solely depends on their scare tactics to women about the dangers of hospitals, the cascade of interventions, that they are not good mothers for using drugs while in labor. Talk about not knowing what you are talking about. Stick around then, read some more.

          • Jessica S.

            I’m truly the devil incarnate then, because I’m taking drugs* DURING pregnancy! Mwahahaha! *Under the watchful eye of my regular doctor, my high-risk OB (who happens to be an assistant professor at a well-regarded medical school <— yes, appeal to authority, I know ;)) and my psychiatrist; and at lower dosage than usual. And still, it was and is an agonizing decision. *sigh* So I'm completely discredited! I should've led with that. ;)

            (Oh, and I formula-fed my son and will with this one, too! :O Huge NCB point reductions from every angle.)

        • The Bofa on the Sofa

          If it’s just so she can call women idiots

          Again, if they are acting like idiots, why SHOULDN’T she call them out on it?

          And I find it pretty insulting that you think that this constitutes calling _women_ idiots. Aside from the fact that she will just as likely apply it to men, why do you assume that it applies in a blanket sense to women? There are plenty of women here who are not in the least insulted by it, mainly because they understand that it doesn’t apply to them, or that they realize they WERE foolish before, and now understand how wrong they were.

          Again, I want to know, why should she not call out people for doing foolish things?

          you can all feel superior about yourselves for being just fantastically intelligent,

          I don’t know anything about intelligence. Ignorance, however, is very different. Even the most intelligent people are ignorant about many things. The key is that intelligent people are far more likely to recognize that.

          • Michelle

            Whether or not they are idiots is her opinion. Whether or not she should constantly point out that that is her opinion depends on what her goal is.

          • The Bofa on the Sofa

            Why shouldn’t she constantly point out that foolishness is foolishness?

        • auntbea

          False. Scare tactics don’t work well when people don’t have the tools to change their behavior (addictions and the like.) But they work great when people just have to make a choice. Like, say, signing in with a doctor when one discovers one is pregnant.

        • Guest

          She may be alienating some women, but please don’t speak for the great number of women on here that have been greatly helped by this blog. Everybody is different.

        • wookie130

          You are fantastically off the mark with these statements. After spending a couple of hours reading her blog, I completely viewed homebirth in a different light. I know there are several other regulars on here who can vouch for this for themselves also. She’s alienating no one, in reality. There are no scare tactics on here that I see, only reality and TRUTH.

        • Lizzie Dee

          I’d say the point is to provide factual, accurate information to counter the fairy tales of NCB – and, as the fairy tales are so much nicer, it may well alienate those who would prefer not to be bothered by knowing the real risks of homebirth.

          You don’t have to be fantastically intelligent to know a fact when you see one. But the dominance of the NCB approach can lead intelligent women to make bad decisions, and I am convinced lead to as much hidden misery as “empowerment” even when the major disasters are avoided.

          Her “tone” is not all that relevant. Those who are alienated may simply not want to let go of the cosy version – but they would still be able to profit from knowing what it is they are choosing instead of being lied to.

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

          Here is a link to a comment thread here where many, many people, including mothers, explain just exactly how they found Dr. Amy’s blog and how it helped them or changed their view. Try reading that a bit before you say she’s too meen to help women. http://www.skepticalob.com/2014/01/thanks-to-my-readers-for-another-banner-year.html#disqus_thread

          • Karen in SC

            I really loved that post. There’s a similar one at the beginning of 2013, too. Heartwarming stuff!

    • Captain Obvious

      I see anti-smoking commercials, tobacco-truth, showing people with cancer, tracheostomies, limb amputation, and other lasting effects of tobacco use. These commercials come off harsh. I don’t see these and think, boy, what mean jerks, I am just going to smoke as oppose to listen to their advice.
      Dr Amy is telling you the harsh reality of morbidity and mortality with homebirth, and you would rather go to a midwife than listen.

      • Michelle

        Anti-tobacco ads that show graphic images have been shown to not be very effective. And Dr. Amy’s words and demeanor come off as harsh, but her statistics do not really scare me. The death rates of both home and hospital birth are low. Triple, quadruple whatever a tiny, tiny rate is still extremely low.

        • Amazed

          It isn’t about you, though. Other women might decide that Dr Amy’s statistics really scare them. And MANA and homebirth advocates are scared that those statistics would scare too many women, that’s why they are trying to prevent women from learning the truth.

          Dr Amy thinks it’s scaring. MANA thinks it’s scaring. Isn’t it a little lonely to be so brave?

          • Melissa

            One slight correction, Dr. Amy things it is scaring. MANA thinks the problem doesn’t exist and, in fact, denies that there is anything to possibly be scared about.

            I believe that many women would still choose homebirth even if MANA reported the true stats. All the MANA posturing about hiding the stats does is make it hard for women to make a truly informed decision.

          • Amazed

            If they thought the problem didn’t exist, they would have published the stats long ago.

            Their very attempt to hide them and explain it away shows that they think there is a problem. Admittedly, their problem is not the same as ours. We are concerned with women not being given accurate information to make choices. The only reason I can think of for MANA to be concerned is that these stats will make them look bad in the eyes of too many women who would have chosen homebirth if they didn’t have this info.

            I also believe that many women will still choose homebirth even with true stats. MANA, though, is clearly afraid that those women won’t be numerous enough.

        • GuestingIt

          Babies dying at a rate of “triple, quadruple, whatever” in HB means that most of those HB deaths would have been prevented in the hospital. I am shocked that any mother would be so callous about the tragic and unnecessary loss life.

          • Jessica S.

            I was going to respond with the exact same sentiment. Not only is the risk higher, but it’s different: the deaths that occur in home births more than likely wouldn’t have been as big a deal (physically, emotionally, financially!) in a hospital because of the proximity to trained personnel and life saving equipment.

        • Amy Tuteur, MD

          There is no greater testament to my effectiveness than the fact that professional homebirth advocates are petrified by what I write. That’s why they censor me, delete me and ban me.

          The truth is very powerful and informed women are NOT stupid. That’s why professional homebirth advocates work so hard to convince women not to read or think about what I write.

          • Michelle

            I appreciate your response. I don’t agree with the tone of midwives and natural birth advocates who talk about “birth rape” and vilify all doctors either. Certainly not all doctors are bad, and not all midwives are good. I would prefer to see a respectful dialog of the benefits and risks. I can see the statistically superior safety of hospital birth, but I think it’s important to acknowledge that other concerns many women have are valid.

            I have reservations about both, but obviously a choice must be made. I object to the hateful rhetoric on both sides.

          • KarenJj

            I agree it would be great if someone could write a ‘what to do’ for the case of women with past abuse history and how to approach medical care. Maybe it does exist? I’m not sure.

            I do hate the thought that women might turn to unscrupulous lay midwives due to a fear of discussing their past history in confidence with their doctor, if that’s what is happening. I know a couple of women with past abuse that have had their kids with obgyns at hospitals and the couple of homebirths I know of have been the hipster/natural/anti-chemicals types – but it’s brought up enough here that I can well imagine there are people turning to lay midwives for past abuse reasons.

          • jenny

            Penny Simkin writes about this, although I haven’t had the chance to read her book. I know some women who turned to home birth bc of a history of trauma, and others who have or plan for unassisted childbirth.

            Sometimes it goes so much deeper than not being able to discuss history with a doctor. Your entire worldview is colored by your need to keep safe. During my first pregnancy, I could not get any prenatal care, not from a doctor and not from a midwife bc of my trauma history. It was all just blank fear and an inability to make or keep appointments. I would have seemed stupid and naive, and I was naive (a friend – rightfully – yelled at me for not getting any care and for not having any plans for how I would have care during the birth, and I told her to back off), but I was really trying to keep my baby safe. I had a totally distorted understanding of how to get that safety.

            I ended up going to the hospital for my daughter’s birth, and subsequently planning a hospital birth with my second child. And currently planning a hospital birth for my third. In between was a lot of therapy and my boyfriend saying he couldn’t agree to have another baby unless I agreed to get prenatal care.

            I would like to see someone write a guide for how to approach maternity care when you suffer from ptsd and related issues. When I was convinced that safety lay in avoiding caregivers I didn’t know how to trust, even my sweet, loving, wise, and concerned friends and family could not have changed my mind. I had to change.

          • Jessica S.

            It takes a lot of courage to take that sort of journey, very inspiring! Stories like yours should be shared loud and often. :)

          • Guesteleh

            I just googled and man, there is a serious lack of information out there for survivors on navigating the healthcare system in general. The majority of hits in the context of pregnancy and birth were on midwives’ sites, which is a serious fail on the part of the OB community. The best thing I found on the subject was a handbook from the Oregon department of health. Even though it’s aimed at clinicians it has a lot of good information. I’m putting it here in case there’s a reader who is suffering from trauma after childhood sexual abuse and needs information on accessing care in a way that lets them feel safe.

          • jenny

            Thank you for that link. I hope it will be helpful to others. Even to me, now, it was helpful and validating to read that. I really had no awareness when I was younger that there was any connection between my childhood experiences and my difficulties navigating perceived authorities, systems, health care…. any of it. I really thought I just sucked. It’s a vulnerable position to be in and the really dogmatic NCB and AP philosophies were so appealing because they promised I would know I was a good mom if I just did all the things the right way.

          • AllieFoyle

            KarenJj, this is a really important issue with regard to everything discussed on this blog. I think health care providers are becoming more conscious of mental health issues, but this doesn’t always translate into better care. Further, women may be legitimately hesitant to disclose these issues because of shame, stigma, judgement, or because they consciously or subconsciously avoid any reference to the past trauma because it is too painful or difficult. Many hcps are sensitive, but they may not know what, if anything, to do with such a disclosure. Women may fear having their history attached to their permanent medical record, which now follow them everywhere and will be visible to every care provider she sees in the future. They may also legitimately fear being labeled and stigmatized for having mental health issues and that this stigma may lead to them receiving poorer care than they would otherwise receive.

        • Sue

          Michelle – if you’re not scare by a 3 – 4X chance of your baby dying (and who knows how many more times risk of hypoxic brain damage), what made you choose hospital birth?

        • Mariana Baca

          Tiny? 1 in 1000 or 1 in 500 is not tiny — there are highschools/mid-size colleges where the class size is that big and having one senior die every year would not be a “rare” event. Even in a hospital, the odds for low risk are like 1:3000 or 1:5000 — much rarer, but still, how many childhood diseases have those sorts of odds over the population?

          We aren’t even talking about how non-rare the breech death rate is.

        • AllieFoyle

          Well, whether or not you personally are persuaded by the absolute risk is not really the issue here. It’s more a question of whether or not you believe women deserve to have accurate information about the risks involved in different choices.

    • auntbea

      Really? I would love to have dr amy as my ob, because I trust she would react aggressively at the first sign of trouble. I wouldn’t have to worry about advocating for my baby. Although I guess if you prefer to wait and see whether your baby will be harmed by whatever the issue is, and then act once it’s too late, that could seem like bullying.

    • AnotherGuest

      This isn’t how I have viewed Dr Amy. I could be wrong but I’m pretty sure that Dr Amy is very keen on informed consent, women owning their bodies, and OBs being professional and respectful.

      • AnotherGuest

        Also, it surprises me that some people forget that midwives can be bullies
        too. It isn’t ‘midwives are nice and kind and OBs are bullies’. There
        are bullies and nice people everywhere.

        • Sue

          Yep – another example of the residual sexism in our world. Authority is known as ”The Man”, lay midwifery brands itself as being feminine-mystical.

          At the same time, more and more OBs, scientists and engineers are women. Time to enter the real world, radical-NCBers. Your sisters are now mixing it with the best of them. We don’t want pretend qualifications, we are capable of obtaining real ones.

    • wookie130

      Michelle, Michelle, Michelle!!! Perhaps Dr. Amy’s writing style reflects her concern and anger over what should and shouldn’t be in the world of homebirth, and how preventable many of the tragedies actually are. You’re saying that you would deliberately choose a homebirth, which poses a SIGNIFICANTLY higher risk of death to you and your baby, to avoid the “scary” likes of an OB such as Dr. Amy? How much more vunerable will you be, if things go south during your homebirth, and you have no OB to help you or your child?

      • anion

        “Well, my baby has a much better chance of survival under her care, but I don’t like her tone so I’d rather risk death or injury to my child than have her maybe say something that makes me feel icky for a few minutes.”

    • Sue

      ”If I had a choice between you as my OB and a home birth, I’d choose a midwife in a hot minute. ”

      Michelle – are you not able to distinguish between on-line activism vs clinical relationships? Do you honestly believe that Dr Amy used the same communication style in a blog as she used to use with patients?

      Think about the logic of what you wrote…are you really thinking that all OBs communicate with individual patients as if they were campaigning on-line against lay HB midwives?

      I am a clinician, and I love dealing with, and helping, other human beings. I can also take on a snarky tone when frustrated with nonsense on on-line forums. I don’t mix the two.

      If you really do come across a clinician that treats you as if they were campaigning on a blog, I would choose another.

    • Allie P

      Then you don’t seem like a person who does value informed choices based on accurate information. If you did, choosing a homebirth under ANY situations seems cuckoo.

    • anion

      One of the things I loved most about my (male) OBGYN was his no-nonsense attitude and dry, common-sense tone. I personally enjoy not being talked down to or treated as though I need to be soothed; I’m an intelligent, grown woman capable of logical thought, not a delicate flower.

      There’s a word for people who treat women like anything they say could cause torrents of tears and feelings must be preserved at all costs: patronizing.

  • Laura

    After years of reading your blog, Dr. Amy, I have come to view you as a tender soul who really does care about the health, well being, and livelihood of innocent, vulnerable babies. I think your tone can be counterproductive at times, but I’ve read enough of your blog posts and comments to know your heart behind the issue. I do appreciate your very important voice. I do want to point one thing out, though: there are midwives who are more motivated by their ideology and passion, however misguided they might be, than money. I don’t think all under trained midwives practice home birth midwifery primarily for the money. I don’t think there is a lot of money to be made, except for a rare few midwives.I could be wrong about this, but I feel it is a point worth bringing up.

    • theNormalDistribution

      Does it really matter whether they are motivated by ideology or money? Either way, they’re putting women and babies second.

      • Laura

        I agree with you.

    • LMS1953

      Far and away they are motivated to proselytize their dogmatic ideology. Their main monetary concern is to obtain legislative mandates to cover their services so as to embed that ideology into the fabric of the health care system.. That is where our fight must be concentrated.

      • LMS1953

        Notice the 90%+ reporting how they were paid. They are obviously trying to track their success at obtaining those legislative mandates. We must target those representatives with a barrage of phone calls, letters and e-mails to get them to explain their support in light of the obvious endangerment of public safety and to demand that they rescind it.

        • LMS1953

          Please review this image to see the 22 states which have not licensed CPMs/DEMs. Notice that the conservative backbone of America from Oklahoma to Kansas to Nebraska, Iowa, South Dakota and North Dakota is firmly entrenched against such licensure. The MANA site states that ACA gives them a golden opportunity to advance their agenda legislatively. There are numerous links to proposed legislature now as bills in Congress. ALL of the sponsoring representatives are Democrats.

          • Laura

            This is really interesting information you share. Here in California I was told that an OBGYN believed that the issue of loose practice standards and accountability of CPMs, LMs and DEMs was categorized under “a woman’s right to choose” and legislators didn’t want to touch legislation to propose limits. I’m sure there are people here that might disagree with that OBGYN, but it does seem to validate the info your presenting here.

          • LMS1953

            A pregnant woman was involved in an MVA where a drunken driver was at fault. She survived after a stay in the ICU, but her fetus died. Ironically she was going home from her last scheduled OB visit before her due date. She is now championing a law named after her deceased daughter that would recognize the fetus as a legal entity entitled to such respect as additional criminal penalties levied against someone who has caused it harm by their criminal negligence.

            Now, it is not much of a stretch to see where CPMs could easily fall under that umbrella. And perhaps even the mother herself, regardless of claims of maternal autonomy. No right is absolute.

          • Mariana Baca

            What do the colors mean?

    • Medwife

      When it comes down to it, the whole direct entry midwife deal only makes “sense” in the context of belief/religion. There are definitely a lot of true believers out there.

  • Guesteleh

    Blog post by formerly antivaxx mother who was shunned by her friends after she started vaccinating her kids. She had a homebirth, so I wonder if she’s reconsidering her stance on that as well.

  • Andrea

    Best post ever

  • The Bofa on the Sofa

    Obviously, “mean” is in the eye of the beholder, along with things like “personal attacks.” Consequently, I don’t take complaints about either all that seriously. Especially after the experience I had on a monthly birthing group where I got chastised for a “personal attack” because I had the audacity to contradict a poster’s claim that “Marijuana’s illegal. Nuff said” by pointing out that, in fact, marijuana is legal for medical usage in some states.

    Apparently, correcting incorrect “facts” is considered a personal attack. At that point, I figured, the concept is meaningless.

    • Jessica S.

      And now, this year, entirely legalized in Washington and Colorado. That would probably get you tarred and feathered now.

      • The Bofa on the Sofa

        The stupid thing was, my conclusion was actually the same as hers. I noted that there wasn’t enough known about the effects of marijuana on pregnancy for me to be comfortable with it being safe, but because I didn’t accept her “it’s illegal. ‘Nuff said” claim, it was a personal attack.

        • Jessica S.

          Ugh, maddening!

  • LMS1953

    What I find so preposterous about MANA’s position is that they “demand” scientific, evidence based precision for obstetric interventions, but their stated ethical position is that birth is a mystery and death and bad outcomes have to be accepted in the process of “letting go” and “healing”. They have no intention of playing by the rules. It is all subterfuge and deception in pursuit of dogma. The very essence of science is skepticism of which they have none for their world view. You cannot debate them, you can only hope to contain them. Hopefully state legislatures will be cognizant of their threat to public safety and withdraw and prohibit Medicaid funding and mandated insurance coverage for CPM and DEM services. Nothing can prevent the crunchy community from home birth, but the rest of us should not be expected to subsidize it.

  • AnotherGuest

    I think this says it all: ‘Am I “meen”? I wouldn’t call it that. I would say that I am very, very angry… and I let it show.’

    Thank you for your site Dr Amy, I really appreciate your viewpoint and you have helped me a great deal.

  • fiftyfifty1

    The only post of yours I’ve read that I really thought was meen was the one about the retained tampon. I feel that the truth about retained tampons should have be something that we docs went to the grave with.

    (Besides, it was your own fault. If you had used the doggy do technique instead of putting in the speculum, it would have saved everybody.But perhaps you didn’t see it coming? Maybe the Retained Tampon is the one gyno problem that we in primary care see more often than our colleagues in OB/Gyn do. As we family physician often say “Retained tampons are our bread and butter”.)

    • Dr Kitty

      When retained tampons become my bread and butter I’m retiring from medicine.
      The ONLY reason I have a bottle of perfume in my handbag is because of the one time I dealt with a retained tampon in a windowless room that had no air-con and no air freshener.

      Tell me about doggy do, I am not familiar with this technique.

      • PrimaryCareDoc

        Is doggy do like reaching in with a gloved hand, grabbing the tampon and flipping the glove inside-out over the tampon as you pull it out? That’s my method.

        And it makes me sad that I see this enough that I had to develop a method. :(

        The only times I have to actively suppress a gag are retained tampons and gangrenous diabetic feet.

        • jenny

          Oh lord.

          • KarenJJ

            I am frequently relieved to have chosen a technical field over a medical field when I read this blog. I’m sure there are a lot of good things about choosing to work in medicine, but the bad seems to be pretty awful IMO.

          • fiftyfifty1

            No way! I love lancing abscesses and debriding toenails and removing tampons.

          • Dr Kitty

            Yeah…I’m happier congratulating people on their wanted pregnancies, freezing their warts and telling them that they don’t need statins because their Qrisk is too low!

            Give me a giant comedone though…

          • fiftyfifty1

            “Give me a giant comedone though…”

            Such as a senile comedone….ahhh. I removed one from the cheek of an elderly woman recently. The size of a pea. Had to do a little cut with an 11 blade to free it as it was held down by a bridge of skin. It had been driving her children and grandkids nuts for years.

          • Dr Kitty

            That sounds AWESOME.

            Comedones are blackheads. Just in case you were wondering.

          • KarenJJ

            Oh the memories. My mum once pinned me down to squeeze one of my blackheads..

          • Young CC Prof

            I used to get cystic acne on my back. My mother’s preferred treatment was a HOT compress (probably about 130 or 140 degrees.) Worked, probably by burning out the infection, but oh heaven it HURT.

          • Jessica S.

            I *was* wondering, thank you!

          • theNormalDistribution

            Ahhhgh my god you guys are twisted.

          • Certified Hamster Midwife

            Lancing abscesses seems pretty awesome.

          • fiftyfifty1

            Yes. It. Is.

          • KarenJJ

            Heh – my mum enjoyed all that too. Hence why she’s a (retired) nurse I suppose.

          • auntbea

            I am totally unable to tell if you are being sarcastic or not. Both options seem plausible to me.

          • fiftyfifty1

            totally serious

        • R T

          Both of my closet girlfriends have had a retained tampon situation occur. One of them smelled so bad right before she went to the door she couldn’t leave the house. I went over to visit her and the smell was just putrid! We didn’t know what it was, but figured she had a major infection! She called me the next day to report it turned out to be a tampon that had been in through TWO cycles, the one she put it in for and the next one! It was in about 6 weeks! How does a woman not get a whole lot sicker from doing that? I’m so paranoid now I check all the time!

          • Susan

            Gee isn’t one closet girlfriend enough?

          • Dr Kitty

            If your lady friends can’t keep track of tampons, perhaps they would do better with menstrual cups.

            The cup is either in its little bag….or it isn’t, and if you lose track the risk of TSS is lower and once you find it you can run it thought the dishwasher or boil it with some vinegar.

            Just a thought.

          • fiftyfifty1

            ” if you lose track the risk of TSS is lower ”

            This is one of the myths of TSS. It’s not about leaving in something too long. Frequent tampon changes can actually promote TTS as they introduce the critical factor: oxygen. TTS is from a toxin-producing strain of Staph which is an obligate aerobe. The reason that those ultra-super-plus tampons caused more TTS was not because they were left in longer, but rather because their material introduced more air.

          • Dr Kitty

            Silicone cups are still better from that point of view, as they aren’t absorbent.

            There was a young lady with a learning disability who would regularly insert foreign bodies and be brought to the ER I happened to be working in at the time. Speculums went by the by, and the sweep-and-snag method was the definite go to. It was always interesting trying to work out what the foreign body might be…

            Although nothing beats the gentleman who waited 48hours (!!) before coming to the ER with a misplaced dildo. He sadly required surgery to remove it.

          • fiftyfifty1

            “Silicone cups are still better from that point of view, as they aren’t absorbent.”

            That it true. They haven’t caught on here in the U.S. though.

          • Trixie

            They’ve caught on elsewhere?

          • fiftyfifty1

            Not sure. Ask Dr. Kitty.

          • Dr Kitty

            Oh hells no, they’re not popular here, but I do try and promote them to the “go through a pad in an hour” ladies.

            From personal experience cups are considerably better than the alternatives, but only if the idea of touching your genitals isn’t going to give you the heebeejeebies.

            If you have a normal/light flow you just empty it out in the shower in the morning and into the toilet at night. Surprisingly little mess. Really.

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

            Ah, the joys of being post-menopausal! :-))

          • Guesteleh

            My problem with trying the cups is wouldn’t the blood get on your hands? And what if you drop it? It just seems complicated with a high risk of staining your clothes, but maybe I’m wrong.

          • Mishimoo

            I’m also concerned that they’d be uncomfortable, otherwise I’d have made the switch already.

          • Dr Kitty

            You just pick the size and softness to suit. MeLuna probably has the biggest range of options to choose from.

            Because of the way they sit I find that my Mooncup is completely undetectable, whereas I can still feel a mini tampon.

            Menstrual cups aren’t for everyone, but they last 5-10 years, cost £10-15, have 25-40ml capacity and no landfill waste.
            For me it is a no brainer, because I get cramps with tampons and I have much less hassle with a cup (first used one 10years ago).

            If you have the spare cash it might be worth trying one to see if it suits.

          • Mishimoo

            Thanks for the suggestion. I’ve been thinking about one for a while, but couldn’t find a decent answer on the comfort level because it is a very individual thing.

          • Dr Kitty

            I think if you have the money to spare you just need to give it a go.
            It WILL take a while to get used to insertion and removal, but if it suits you you won’t look back.

            There is a comfort/leak pay off.
            A bigger, firmer cup will have a better seal, a bigger capacity and will open more easily from folded.
            A softer, smaller cup will be comfier to wear but might not open as easily, will need emptied more frequently and might leak if your pelvic floor is strong enough to shift it out of position.

            Be realistic about your height, weight and pelvic floor strength when choosing a size, that is all I’d say.

          • Trixie

            I’ve tried several different brands and sizes and have found them all to be pretty uncomfortable. They press on my bladder and I feel like I have to pee all the time.

          • PrimaryCareDoc

            I’ve heard that menstrual cups can suction out an IUD. Anyone know anything about that?

          • Dr Kitty

            They can snag and pull it out if the strings are too long.
            I used one with an IUS without a problem (until the Mirenas stopped the periods completely).

            The suction isn’t THAT strong, but I was careful to position it so that my cervix and the threads were always inside the cup,

          • Guesteleh

            I feel obliged to leave this here: http://www.well.com/~cynsa/newbutt.html

          • auntbea

            How dies that happen? I mean I assume you hang out with reasonably smart and competent people. How can they miss something like that? (Although given the comments of the docs it happens a lot.)

          • Young CC Prof

            Perhaps it’s not so much frequent as it is very very MEMORABLE.

          • fiftyfifty1

            “How can they miss something like that?”

            My guess is that it probably happens in the morning after a shower or something. The person may sometimes remove their tampon before the shower, sometimes not. On a time they don’t, they get out of the shower and without thinking put a tampon in. This pushes up the one already in there and typically turns it sideways high up in the posterior fornix.

          • Certified Hamster Midwife

            Here’s a first-person account and one of my favorite blog posts ever.

            http://jezebel.com/388226/ten-days-in-the-life-of-a-tampon

            Added bonus for the doctors: she removed it herself.

          • fiftyfifty1

            Yes, all the better if a woman figures it out and removes it herself at home. If our triage nurses suspect one, they will give the woman instructions over the phone: “Squat in the shower, now reach up…..”

            Retained tampon: Totally safe and appropriate for a UC!

          • auntbea

            This makes me even more confused. Three partners and no one noticed? There is apparently far more room up there than I have ever realized.

          • fiftyfifty1

            I usually find the tampon turned sideways way up deep in the posterior fornix (the part of the vagina that goes up beyond and behind the cervix).

          • Laura

            My poor husband said once during intercourse, “Ouch, this really hurts!” It has never hurt before. Shortly after, I went to the bathroom and found a tampon I had forgotten about. First and last time, I can assure you!

          • Rebec

            My husband and I had a similar accident. The string cut him up a bit. Couple days later, he asked me to go check and make sure I didn’t have a tampon up there. And yes, it smelled worse than I ever imagined.

            I’m not “inclined” to forget a tampon, Joe Kano, but over the course of 500 menstrual cycles, it’s bound to happen.

          • stenvenywrites

            This”’ sound stupid, but how does it not happen with the garlic cloves that some women put in their vaginas to cure group b strep? I’ve lost my grip on garlic cloves when I was inserting them under a chicken skin for cooking. It didn’t matter then, but it sure would matter if I If I tried to put one up my yoo-hoo only to have it end up Lord knows where.

          • Medwife

            Now THIS is a good question! I wonder how often that happens? I strongly urge my patients NOT to stick garlic up their vaginas to “cure” GBS so I don’t have a good sample.

          • fiftyfifty1

            “How does a woman not get a whole lot sicker from doing that?”

            Because the type of bacteria that thrive in the habitat of a retained tampon (warm, wet anaerobic environment) are not dangerous bacteria even though they produce a memorable smell. The dangerous bacteria, such as staph aureus (the cause of toxic shock syndrome) don’t produce an odor. It’s analogous to food poisoning. The bacteria that make food stink nasty as it rots are not actually very dangerous at all. But the really dangerous ones produce little if any small.

        • Dr Kitty

          Oh yes! That is my method and I came up with it after the first one! Tying a knot in the glove is a very necessary thing.

          I hate feet full stop, and really don’t mind gynae, but retained tampons are nasty.

          On any given day I’d rather do a gynae exam than look at an ingrown toenail. I really do not enjoy searching for retained vaginal foreign bodies. I’ll be perfectly professional and empathetic and polite, but it is WAY down my list of things to do.

          • fiftyfifty1

            Yes that’s it. I never put in a speculum when I suspect a retained tampon. Instead I just reach into the posterior fornix with my index and middle finger, grasp it and then turn glove inside out over it. It never is exposed to the air and I never see it. I put it in a biohazard bag and then immediately leave the room and bring it outside to the dumpster.

            I actually like when I see a case on my schedule that might be a retained tampon. When else in your life can you do such a little thing that can make such a big difference for a person? I admit they do stink, but they don’t make me gag.

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

            This whole discussion ought to be published somewhere. The lay public think that doctors, when they aren’t on the golf course or counting their money, just love inflicting pain and suffering on people and have no idea how disgusting a lot of it is; those intending to be doctors ought to get an idea of just how lovely the profession really is, too. Potential doctors see themselves doing heart transplants, not dealing with ingrown toenails, retained tampons, or diabetic leg ulcers.

            My own “wake up moment” came very quickly, as a student nurse. I had thought I’d be dispensing TLC but had to learn NOT to try to put an AC plug into a DC socket on my first day on the wards, as well as clean all the cupboards in the nurses’ station [but I did know where EVERYTHING was, after that]

          • Aussiedoc

            I had a very snooty young lady say to me once – oh I’m either going to do medicine or law, I’m just waiting to see which has the higher entrance marks.

            I laughed very hard, held up my right hand and said, “honey do you know where these fingers have been? I think you need a slightly better reason to do medicine.”

            She did law.

          • Mishimoo

            Hahaha! That reminds me of what my sister did to our parents. She helped to catch my last baby because the CNM offered but my husband was half-asleep still. Later that day, she waved her hands in our parents faces and asked “Guess where these have been?!”

          • Dr Kitty

            It’s part of my shtick when I dip a urine sample to make a quip about my glamorous career in medicine.
            It usually gets a smile from the patient.

            Medical schools underestimate the importance of good patter- a bad joke can help establish rapport with patients better than you’d think (obviously, timing and propriety are everything), and patients like doctors who can make fun of themselves.

      • Joe Kano

        What? I am sure I am not the only one who simply inverts the glove (you do use gloves, right?) as I remove the tampon / sponge, etc…. And I have found that most retained objects (yes objects) are done on purpose as a form of getting attention. Except a geriatric with a retained pessary that has not seen the sun for a few years.

        • fiftyfifty1

          “And I have found that most retained objects (yes objects) are done on purpose as a form of getting attention. ”

          Seriously? I’ve never gotten that vibe. In my experience often the person hasn’t even guessed what they might have. The menses has been weeks ago, so that isn’t even on their minds. The only things I have ever retrieved are tampons and condoms.

          • Joe Kano

            Most patients have had their periods for years and are not inclined to ‘forget’ a tampon. I have removed 4x4s 5+ days post partum. Usually tracked back to a resident who was taught to use the sponge as an aid to vaginal traction when repairing or examining the depth of a tear for a repair.

            As for objects, it seems that people feel a need to copy weird things they see in a video or on the internet. The worst thing I remember was a pear and the woman had to rush home because she left her 5 yr old daughter home alone with the wacko boy friend. The pear was OK, but the sudden exit by the patient and her explanation was uncomfortable. I never knew I was conservative until I started working in OB/GYN. I guess I have no imagination (sigh).

          • fiftyfifty1

            “Most patients have had their periods for years and are not inclined to ‘forget’ a tampon.”

            So my mom tells me she had a retained tampon when she was in her 20s. She sometimes wore just a pad to bed at night, sometimes a pad and a tampon depending on how heavy the flow was. She figured that she probably forgot it was a pad plus tampon night and put a new tampon in in the morning. The old one shoved the new one up into the posterior fornix. She discovered the problem when it started to smell a few weeks later. She actually fished up there and took it out on her own at home.

            So was my mom lying to me? You seem to think that forgetting a tampon is not possible. And you think my mom was doing it for attention?! If so, why did she take care of the problem at home?

          • Joe Kano

            I have never met your mother. I have though concerns about toxic shock issues. Forgetting a tampon for weeks to 2+ months is interesting. Not saying it does not happen, but I am ‘stuck’ between that rock and a hard place. You understand, missing tampon + smell+ deductive reasoning….. what could cause the smell? Vag vault sweep, tampon out.
            Perhaps if I was a woman, I could get away with ‘What do you mean you FORGOT a tampon’ comment that many women who have never forgotten a tampon of if they did, easily figured out the cause of the smell.
            Ask Dr. Amy what happens when a resident ‘forgets’ a sponge and the patient is readmitted with a odor and a fever….

          • Trixie

            You seem to think most women spend most of their periods thinking about and creating elaborate inventory spreadsheets for their feminine hygiene products.
            I know someone this happened to, and she wasn’t attention seeking. She just got thrown off her normal routine, her period was a bit longer than usual…and she forgot.

          • Joe Kano

            OK she forgot. I can accept that. But, was she able to figure it out (deductive reasoning – problem solving skills) or was an office visit needed?
            I am not a creative person. Linear thinking. Assess / plan / implement / re-assess / continue or devise another plan.
            I believe that the number of women who may ‘forget’ a tampon, and those who needed an office visit (not those looking for attention) are I would hope quite a small number.
            But what does all this have to do with Dr. Amy being called ‘meen’?

          • Trixie

            She required an office visit.

            I don’t know, you’re the one who started accusing women of hiding tampons to get attention.

          • PrimaryCareDoc

            What a totally bizarre comment. Really. So, I’m a 40 year old physician. I’ve had my period for, oh, 28 or so years. I “forgot” a tampon last year. Woke up in the morning. Forgot to take out the old one in my drowsy haze, and put in a new one after my shower. I realized it after about 4 days when I had a brown discharge and a bit of a smell. Luckily I was able to remove it myself. I would have hated to have to go to my OB, lest they think I was doing it for attention!!

            Of course, while kegeling and finger-sweeping to get it out, I also managed to snag my Paragard strings and yank that out, too.

            So I guess my little attention-seeking episode really did work, since I had to go anyway to get another IUD. Also cost me $400. But that’s OK, because I got attention. Wheeee!

            Man. I hope you don’t subconsciously cop an attitude with your patients that imply that they’ve left a tampon in on purpose. Because honestly, it’s fucking humiliating.

          • Joe Kano

            I do not believe I accused anyone. I was making an observation. Working in an inner-city hospital with thousands of births and many more thousands of GYN patients, I have some experience in the field. HOWEVER, I think this is turning ugly for no benefit to the thread. So I shall stop now.

          • PrimaryCareDoc

            Right. But you also tried to mansplain having a period and using tampons to a group of people made of mostly of women. Not going to go over well.

          • KarenJJ

            It IS humiliating to not be believed by a doctor. I know there must be some out there and I do know my granny loves to have an appointment with her doctor and a chat, but having been the patient with the rare, weird, periodic syndrome that wasn’t believed, yeah fucking humiliating is a good start… I like my doctors and think they are good doctors and good people, but I really do enjoy doing other things with my time.

          • Dr Kitty

            Not a possessor of a vagina or a menstrual cycle =unable to judge how easy it is to forget a tampon.

          • JC

            You know, I find this insulting. The only time I believed I “forgot” a tampon I had been up ALL night with my toddler who had a really bad case of croup. So I was sleep deprived and completely out of it.

        • Josephine

          My younger sister is…how shall I say this kindly…not very focused on personal hygiene (when we shared a basement as teenagers, she’d frequently forget that she left her pad or tampon on the bathroom counter, vomit). She had a retained tampon at age 19 (she’d had her period for years at that point, obviously) and I believe completely that she just forgot it up there because she is usually more worried about her latest art project than making sure she brushed her teeth this morning, God bless her.

          Also I really think anyone could accidentally forget one and insert another tampon because sometimes you’re just on autopilot. I’ve never done it myself but I’m always slightly paranoid that I will. I don’t doubt some people might insert something for attention, but it seems more likely it would be an unusual object rather than a tampon.

    • BeatlesFan

      I shit you not, I was eating bread and butter when I read that. I’m going to go throw up now.

    • Stacy21629

      Ok, so I deal with ACTUAL doggy do…and this is so disgusting. I’ve never been so glad that the worst I’ve had this week was deobstipating a cat, searching through dog vomit for naproxen and a vaginal exam on a post-partum metritis bitch.
      GAH! I’m SO glad I’m not a “real” doctor! :-P

  • Guest

    Interesting. I used to read this blog quite often but had to pull back as the squabbling in the comments was getting so annoying and often the posts themselves were catty and rude. I’ve flipped through a few posts lately and it seems there are less ‘trolls’. I wonder if that’s because they think you’re mean, or if the angst of the blog just got old as it did for me? I appreciate your passion Dr Amy but I also strongly believe that ‘you’ll get more bees with honey’. I’d love to see some positive posts about how wonderful hospitals and doctors are. If you really want to change how and where women birth, you might want to appeal to the middle road.

    • WhatPaleBlueDot

      Dr. Amy is doing just fine. If she used schmaltz to discuss dead babies, it would be grotesque. The only appropriate tone is angry and judgemental.

      • Certified Hamster Midwife

        I can’t stand overboard sentimentality. If there were any mention of angel babies born sleeping around here, I wouldn’t read the site.

        • KarenJJ

          I also can’t stand talking down to women as though we are idiots that need our delicate sensibilities pandered too. Women are just as capable of doing that to other women as men are.

        • Dr Kitty

          Ditto.
          I’ve had some very early pregnancy losses, but I’m afraid I’m not one for candles and angels and so on.

          Babies die at HB who otherwise would have been born alive. That is a tragedy and they and their families deserve to be remembered.
          They also deserve to have action taken so that no one has to suffer the same fate.

          Nice doesn’t come into it.

    • Melissa

      If you want to see posts that talk about the positives of hospital birth instead of the negatives of home birth then start a blog yourself. Seriously, I don’t see any reason why Dr. Amy needs to adapt her style in order to make people happier. Yes, there are some people who will leave because of her tone, but there are others who wouldn’t be able to see through the NCB BS without this type of tone.

      It’s a great big world wide web. If people are so very concerned about the pro-hospital gap in the marketplace then get a blogger and fill it!

  • OBPI Mama

    Thank you, thank you, thank you.

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

    I respect the hell out of your fearless, blunt style. It might not be easy to hear, but holy hell, not as hard as hearing about all this tragedy! Further, in private communication, you are amazingly kind and enthusuastic. Keep keeping on, Dr. Amy! And as a favorite teacher used to tell me, “Illegitimi non carborundum” (http://en.m.wikipedia.org/wiki/Illegitimi_non_carborundum)

  • Joe Kano

    Well, (mean person) I believe in the individual becoming somewhat a reflection of their environment, rings true. Humans being human, have the right to see or not see, to hear or not hear and to listen and learn… or not to.
    Since this blog is about human life and making choices that, if followed, will, absolutely prevent many bad outcomes, I can see Dr. Amy being frustrated that not only that there are some wing nuts refusing to connect the dots, but to use her term ‘toddler level reasoning abilities’ their intellect is over ridden by their emotional needs to ‘be with woman’ and common sense flies out the window. A wise person once said that if you tell the dog often enough, usually sooner or later, the DOG GETS IT. Sadly, humans often don’t.
    Here is the true issue. People being guided by their emotional needs rather than their intellect and common sense knowledge. They attack those who challenge their emotional needs. This is where ‘bitch’ or ‘mean’ or other emotionally driven labels come from. They are not really disagreeing with you, they are just mad at you for pointing out the obvious. Even though you are correct in what you write, the reality is that IF the masses actually followed common sense logic and acted in the best interests of the PHYSICIAL needs of the mother / baby, while the rate of bad outcomes would drop substantially, their emotional needs are being sacrificed for the physical wellbeing of the mother / baby.
    The entire anti-medical establishment argument can be boiled down into a simple issue. That issues really has nothing to do with the health and well being of the mother / baby. It has to do with the emotional / psychological needs of the LAY midwife, fed by the performance art advocates, and her desire to be ‘with woman’. By removing the ‘with woman’ component, they loose interest and crawl away.
    In the battle for either physical well being OR emotional / psychological needs being met, the physical wellbeing is usually the looser. By demonizing the medical establishment, those with the ‘toddler mentality’ are easily manipulated into risking the health and wellbeing of the baby, and sometimes the mother too, all to satisfy those emotional and psychological needs of the lay midwife, direct entry midwife or MANA member.
    Does anyone really understand what a doula is? In reality a doula is a woman who is a lay midwife who ‘adapts’ herself to fit into the medical establishment, thereby ‘being with woman’. If the doula did not adapt herself, then she would not be allowed into the hospital birthing environment. That willingness to adapt is needed to gain access. The average lay midwife is not willing to adapt, therefore she is at odds with the medical establishment. Again, the emotional / psychological needs to be ‘with woman’ causes the adaption and the physical needs to actually be a baby catcher are muted.
    After 20 years, I still can not get used to the risky behaviors and chances taken, with no actual baby benefit. I have never met a person who said Thanks Mom for having me at home! Thanks for keeping me away from those mean docs!
    Oh, full disclosure, I delivered my youngest at home (2 cats in attendance too) and found the cord around her neck 4 times, loose. I still have that cord frozen in my freezer and it is the longest cord I have seen outside of a text book. My daughter got off lucky. Would I do it again….. I think not.

    • yentavegan

      Mansplain much?

      • Joe Kano

        Ah….. You assume that my comments were intended for you…. Remember grasshopper, just because you understand things it in no way means that everyone else understands things.
        As coming from a teaching hospital and also understanding patient education, I do tend to explain things. There are lurkers who just might see things from a different point or learn something.

        • Dr Kitty

          Can you maybe try to explain with fewer words and better punctuation please?
          The wall of text isn’t that easy to read.

          I’m not suggesting reducing to 120 characters and panda emojis, but dude… people will scroll over your contribution.

          • Joe Kano

            Yes, I do tend to ramble on…….. LOL. The punctuation may be an issues as I suffer from slexdyxia.

        • auntbea

          I am having a hard time coming up with a way for this response to have been any more condescending. Perhaps if you told her not to worry her pretty head?

          • Joe Kano

            Perhaps I paid too much attention to her screen name? I assume you are not a tribe member. When a woman refers to herself as a ‘yenta’ ….. she probably is. But we may have a lot in common. If it were not for chicken and steak, I too would be a vegan. So we really are not that far apart in our views. I am more patricharcial than condescending.

          • theNormalDistribution

            I am more patricharcial than condescending.

            What’s the difference?

          • Joe Kano

            I think that if you have to ask, there is no distinction between the two. This does not apply to you. But from a patient’s perspective, condescending can be irritating while patricharcial can be reassuring.

          • theNormalDistribution

            The next time one of your patients is reassured by you pulling an “ahh, grasshopper” on them, you go ahead and let me know.

            / This post is sarcastic.
            // The last one was facetious.
            /// You clearly don’t understand what ‘condescending’ or ‘patriarchal’ mean.

          • Dr Kitty

            The word you are looking for is “paternalistic”, as in, father-like.

            Not patriarchal, which no-one finds reassuring.

          • Joe Kano

            YES! I was done in by spell check and then simply followed it! I really do have Lesdexia and spelling is an issue. You are correct.

          • Trixie

            Jesus. No. Patriarchal and/or paternalistic are not admirable qualities in women’s healthcare. Nobody likes that. Get a grip on yourself.

          • auntbea

            I am interested how you know your patients find your paternalism reassuring. Do they, by any chance, just shut up and stop asking questions?

          • Mishimoo

            One of our doctors is paternalistic, in the sense of “He acts like the older male members of my family”, which is awesome because they are all very interested in education and sharing information.

            Sadly, I don’t think that will be the answer to your question.

          • Dr Kitty

            Sorry, what does Judaism have to do with whether or not you are mansplaining?

            You’re mansplaining, BTW.

          • Joe Kano

            At your level of training I am perceived as mansplaining. But to others, will a lesser understanding of (topic) I am not. As for the screen name of the other poster, Yenta is both a descriptive term and / or a title. Often a an earned title. Supposed I changed my screen name to ‘Mansplainer’. Simply reading that screen name gives you an impression of the person using that name, the same as people reading Yenta form an opinion. From the patient’s view, would you like a nurse / physician / midwife who refers to herself as a Yenta? I am not attacking, simply making an observation. Describing one’s self in a negative term may result in negative assumptions by others.

          • Amy Tuteur, MD

            I’m perceiving you as rude and I suspect everyone else is, too.

            You have no idea of the education and training of most of the commentors here, but I do. Most of the people you are “explaining” things to have as much education as you do, if not more. Please treat them more respectfully.

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

            From my view, you’re mansplaining, rude and condescending. Your comments grate. I read here regularly.

  • Trixie

    In the comments, MANA claims that Canadian midwives are more similar to US DEMs than they are to CNMs. http://www.mana.org/blog/25/home-birth-research-q-a#comment-5340

    • Amy Tuteur, MD

      That’s not true. But the key point, which I suspect they didn’t mention, is that Canada doesn’t recognize the CPM any longer because they consider them undereducated and undertrained.

      • Trixie

        No, they didn’t mention that part….
        Also, they claimed that they waited 5 years to release the death rate because of a Cochrane Review that showed that it takes 5 years for clinical trial data to be published.

        • Young CC Prof

          Because that was totally a clinical trial, and they couldn’t share it in any way without publishing it in a journal article.

          • Trixie

            If it were a clinical trial, wouldn’t medical ethics have required it to be ended early due to the appalling death rate?

          • PrimaryCareDoc

            Pretty much.

          • Young CC Prof

            Yes. The IRB would have pulled the plug long before five years were up, as soon as enough data accumulated to prove home birth inferior to the standard of care.

            Heck, they’d never have gotten approval in the first place, as that would violate clinical equipoise.

          • LMS1953

            Precisely. That is exactły what happened with the Premarin cardio-protective trial.

          • Anne

            And the Term Breech trial….

        • PrimaryCareDoc

          Whaaaat?

        • KarenJJ

          Yet c-sections and the other data weren’t part of the “clinical trial” and that data could be released.

          Keep them lies coming MANA.

    • manabanana

      Oh, for crying out loud, MANA!

    • Medwife

      Bull. Shit.

  • Jocelyn

    “They ban me and delete me and they ban and delete anyone who has learned the truth from me, regardless of how nicely those other people tell the truth.”

    I guess now wouldn’t be the time to mention that I have a secret account on MDC through which I try to talk sense into the people over there?

    • Amazed

      Hush now. We know they read us. Now every voice of reason might be placed under suspicion.

      • Jocelyn

        Hmmm…should I delete my comment before they see it?

        • Amazed

          I think there is no need yet. But for the next few weeks please be more careful and not take part in any discussion where SOB is the subject. No support for meen, or you might find the gates locked.

          • Jocelyn

            Dang…I tried to delete it, but all it deleted was my name. Darn disqus. ;)

          • Jocelyn

            To any MDC people reading: know that I’m only one person, and haven’t been on in a while.

  • tamara

    Dr Amy is far from mean. and if the definition of mean is to be brutally honest and help educate and keep babies and moms safe… then I’m glad she’s the biggest meanie on earth. there’s a lot of wisdom to the adage that the truth hurts… and Dr Amy makes sure to tell the truth regarding the dangers of homebirth. but there’s also truth in the adage that only a true friend will tell you the truth…. as far as I’m concerned Dr Amy keep up the good work.

  • Amy Tuteur, MD

    I also find the tone trolling to be particularly sexist. People say a lot of nasty things about David Gorski (Orac) because he calls anti-vax blithering nonsense, but I’ve yet to see anyone call him “mean.” Men can have sharp elbows and they are “forceful” and “powerful.” Women have sharp elbows and they are promptly called some variation of “unladylike.”

    • Aussiedoc

      Exactly. How dare a woman have a negative opinion! We’re supposed to excuse it and apologise for it.

      Keep fighting the good fight Amy.

    • Trixie

      Orac’s trolls also don’t busy themselves speculating about his parenting choices and/or fitness as a parent to nearly the same degree.

      • PrimaryCareDoc

        No, but they have tried to get him fired several times.

    • PrimaryCareDoc

      I was going to write the exact same thing. Orac doesn’t pull punches and spends a lot of time calling people variations on “nuclear-grade stupid.” Yet I don’t see anyone telling him that you catch more flies with honey than vinegar.

      • The Bofa on the Sofa

        Oh, pay attention and you’ll see them. Over there, they are called “concern trolls.” They show up on occasion. Not as often as here, but they are there.

  • Staceyjw

    “Tone” may be the way something is spoken, but in this context it really refers to the stating of information thats doesn’t fit the “party line”, no matter how sweetly it’s worded. For this reason, the whole issue of “tone” is used as a way to shut down any possible dissent or even questioning, by NCBers and their ilk.

    It’s a potent form of social control that is used by zealots of all stripes, but it’s been utilized against women for a millennia. We refer to women in disparaging terms anytime they say things that would be ordinary if spoken by a man. This ensures a majority will self censor, in order not to be labelled (unfairly) as the “dreaded bitch, ball breaker, harpy”. Add NCB, and the topics that are allowed, and how you must say them, are minimal.

    You can see the censorship in action, on any NCB forum. I cannot even think of a single one where posts about facts, even when couched in the heaviest of syrup, are welcomed. Even the most “open” NCB/anti vaxx site will not allow too many “non supportive” comments, while other forums will delete and ban any post that’s even by a dissenter, even when they aren’t dissenting! if you are known as anti HB, you won’t be allowed at all, even IF you toe the line.

    (If you have to figure out how to reword every single sentence so it doesn’t offend, and take out things so you don’t “ruffle feathers”, then maybe it’s one of those sites….)

  • Dr Kitty

    What people actually mean when they say that you are “mean” is that they are too fragile to read anything that doesn’t reinforce their own self image or that they cannot cope with critical reasoning.

    “Lay it all out for me so I don’t have to crunch the numbers for myself (math is hard). Apologise that the truth isn’t what I want it to be. Let me know that even though I believed something really dumb without question I’m still super smart and a good person. Do all that and I might be ok. Anything else and you’re just a big meanie who hurted my feelings and lalala I can’t here you”.

    I’m sorry- adults can deal with facts and don’t need sugar coating.
    Adults are able to admit when they are wrong and can use those occasions as useful learning opportunities.

    Children need pretty stories that aren’t true to deal with harsh realities.

    Dr Amy, you write for grown ups, don’t ever stop.

    • Amy Tuteur, MD

      It seems to me that a major motivation for calling me “meen” is to convince women not to READ what I have to say. It’s yet another variation of “don’t listen to Dr. Amy,” because Dr. Amy tells the truth and you will recognize it as such if you read her. Therefore, we must convince you not to read her.

      • Prolifefeminist

        Ha! Well, in my case it backfired. Before I came to my senses, I read on an NCB site about “that horrible awful mean “Dr” Amy,” and being like I am, I just HAD to go look. I WAS shocked when I first read your posts – which was exactly what I needed to shake me to my senses.

        So…thanks, NBC site, for leading me to Dr. Amy!

        • Josephine

          That’s exactly what happened to me. I wasn’t super deep into NCB culture, but I kept hearing on places like BabyCenter that her blog was just AWFUL AND SO MEAN etc. I avoided it for that reason, but finally curiosity got the better of me…and I liked what I read. Nothing struck me as particularly mean.

  • Young CC Prof

    “They ban me and delete me and they ban and delete anyone who has learned the truth from me, regardless of how nicely those other people tell the truth.”

    That’s how an awful lot of the natural-health forums go, not just the childbirth ones. I used to hang out at the forum belonging to our old friend Joe, walking a very fine line, trying to gently point out facts to the fence-sitting visitors without setting the true believers on fire. Just to stay credible, I’d even agree when he posted reasonable stuff about nutrition or whatever.

    I was eventually banned and ALL my old posts deleted. I think I was banned for saying that a book published in 1920 probably wasn’t the best source of information about vaccines invented after 1920. (I guess it was too obviously true to argue with, so the only answer was to shoot the messenger.)

    Some people need a gentle voice of persuasion, others need a smack upside the head. It’s good to have both.

    • DaisyGrrl

      It’s the banning that convinced me that these types (natural-health, NCB, anti-vax) know the truth but don’t want to be called out on their dangerous fantasies. When even the most respectful posters get banned and reasonable questions are deleted, the only reasonable explanation is that those doing the moderating know they’re in the wrong and are desperately trying to hide the fact.

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

    I have a great deal of admiration and respect for you Dr. Amy and what you seek to do – there are those who agree with your message but would change your tone, but I think they are misguided. If you are speaking in the voice that reflects who you are and what you believe – then that is you, and it is authentic and the right thing to do. I think your message would be a lot less powerful if your voice did not match who you were and what you believed – it would lack authenticity.

    I think home birth advocates/believers take what you have to say so hard because it rings true and challenges their core beliefs. That is never an easy thing to accept.

  • Trixie

    Aviva Romm wrote on Facebook on Thursday about nearly being in a car accident. (And for the record, I’m glad no one was hurt). I wonder if she had been hurt, though, whether she’d have shooed away the EMTs and refused hospital care, and instead treated herself with herbs, homeopathy, and intuitive healers? I think she’s smart enough to choose the hospital.https://m.facebook.com/AvivaRommMD/photos/a.425877204138451.100770.425864400806398/644073265652176/?type=1&source=46

    • Durango

      No, because that would be an acceptable time to seek professional care. In birth, NCBers think, you don’t need medical care until it is visibly a catastrophe. Every hb advocate admits that there is a time and a place for ob care, but they want it long after things have gone south, which means that things will much harder to fix than if proper care had been given from the get-go.

    • resaurus

      Reminds me of this comic about “alternative ambulances.” http://www.flickr.com/photos/resq935/7775115882/

  • guest

    Not “meen” at all. You are clear, firm, and truthful. I don’t post often because I am a layperson and don’t have much to contribute to the discussion, but I do want to voice my support for you, because I so admire your efforts to spread awareness of the dangers of homebirth, since homebirth advocates blatantly omit them from all of their materials. I was something of a fence-sitter (leaning away from homebirth), and I am so happy I found your website, because it does tell about the dangers of homebirth when so many others won’t. Anyway, this is a long way of saying thank you and keep up the good work.

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

    Incidentally, I think it is noteworthy that Aviva Romm chose not to pursue a nursing career but rather a medical one. A nurse isn’t a “diluted doctor”, but a different sort of professional discipline altogether — I know; I went to med school for a year [long story but I took a year off from nursing school, and audited some 2nd year med school courses]. She might well have become an excellent CNM; in the main, someone who attends birth enjoys the bedside aspect of patient care.

    But “Dr” before her name, or “MD” after it gives her a lot more status [PhDs in Nursing tend to evoke snickers in some quarters].

    • manabanana

      CPMs don’t see CNMs in any favorable light. For the most part. I’m generalizing. But most of them find themselves superior to CNMs and never hesitate to criticize and denigrate nurse-midwives as ‘handmaidens to OBs.’

      • OBPI Mama

        We, homebirthers, always called them “wolves in sheep’s clothing”… Oh my gosh, I was such an idiot.

        • KarenJJ

          Isn’t it crazy? And yet for the rest of the developed world, that is generally what a midwife is.

    • Dr Kitty

      I don’t have an issue with PhDs in nursing or midwifery.
      I have an issue when those who hold them do not make it clear that they are NOT medical doctors.
      For example, maybe don’t wear a name tag in a hospital with “Dr” on it unless you are a medical Dr.
      “Josephine Bloggs PhD, Chief Of Nursing” no problem, “Dr Josephine Bloggs”…confusing for patients.

      Witness the recent confusion re: Dr Denis Walsh, who is a man with a PhD in midwifery and NOT an OB, as many NCB supporters assumed.

      • KarenJJ

        It happens a lot. I had a relative confused by a Dr that was an audiologist. His Dr was a PhD earned in English Literature. He was an audiologist practicing at a private hospital. As far as I’m concerned he should not have been using the title of Dr in that setting.

        • Young CC Prof

          It’s a classic joke in academia: “No, not THAT kind of doctor!”

          I work at a college, and I use Doctor in formal professional contexts only. (As in, trust this report I wrote, I have a relevant doctorate)

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

    First of all, I don’t think you ARE “meen”, unless it is not politically correct to call liars liars. I don’t even think you are all that abrasive [possibly because I don't avoid confrontation myself when I think it is justified]

    There’s an old joke about “the difference between the psychotic and the neurotic” which describes them as follows: “the psychotic KNOWS 2 + 2 = 5, while the neurotic knows that 2 + 2 = 4 but can’t stand it”. The assumption that Aviva Romm and all the others of her ilk really know, deep down in their hearts and heads, just how dangerous homebirth is, is giving them a compliment. I once worked with a nurse who believed in the Bible literally AND simultaneously could accept evolutionary theory and modern science; don’t ask me how. She compartmentalized a great deal, obviously. I think this is what Cheney, Aviva Romm et al do too. “I want homebirth to be safe; therefore it is, statistical studies don’t count”. “If I want to believe that the sun orbits around the earth, that’s my privilege — don’t confuse me with facts”.

    Aviva Romm does know, however, that she can’t actually rebut your figures because there is no way to do so, or, at the very least, she doesn’t have the energy and/or the means to try and find hard evidence to support her position. [I'm not actually convinced that she really doesn't know her position is false]. Declining to debate is one method of avoiding reality; another is to relate anecdotes instead of actual data. The former is probably more satisfying to her, as she can project herself as “not descending to your level”. The fact that she just looks silly, not to mention ignorant and unethical probably doesn’t occur to her.

    • DaisyGrrl

      I think the big problem homebirth advocates have with accepting the danger is that modern obstetrics has made childbirth so much safer that it’s easy to forget that death is a possible outcome. If you’ve never had a friend or family member lose a child, it’s inconceivable to you that a baby could die in something as routine as childbirth. Women in developed countries start with a living mother and baby as a given. This makes it easier to focus on the dangers of “unnecessary” interventions because death is just not in the picture as a possible outcome.

      I think there are advocates out there who truly believe that the “dangerous” interventions are just as likely to result in mortality or morbidity (see: “all the women dying from unnecessary c-sections!”). They also chose to privilege psychological injuries they believe women are suffering from these interventions over the physical injuries that are avoided.

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

        There is a certain kind of feminist who feels that to be a woman — especially a “womanly woman” is to be continually victimized, and therefore they have to compensate by being as aggressive as possible. No care really satisfies them, because, ipso facto, it must be “inferior” for the simple reason that the recipient is a woman.

        Note that OBs are always referred to as being male, in spite of the fact that statistically this is no longer true.

    • DaftPunkd

      I’m not sure about the intellectual processes going on between her ears.

      Her behavior is classic narcissism: Stir up some shit about how great you and your way is, provoke an emotional reaction by your misbehavior, and then disengage because wonderful you has been done wrong by all these little people who can’t see the sun shining out of your behind. I’ve lived long enough to have this experience with several people. Lather, rinse, repeat. SSDD.

      FWIW, the psych literature, to the degree that one can provoke any introspection from such people, tells us that the internal lives of these people is miserable; consumed by their insecurities. That might be some solace to living people who have been wronged by the narcissists in their lives, but not to the victims led astray into homebirth and the loss of their precious babies.

    • fiftyfifty1

      My guess about Dr. Aviva Romm is that her thinking goes something like this:

      I know that the stats on American homebirth are bad, but I am sure that those stats don’t apply to ME or to anyone who cares about her health as much as I do. I am super healthy and so are those who follow by blog, because obviously if they follow my blog they are interested in following my healthy natural advice and since my own advice has worked out so well for me, it will work out well for them too. As long as a woman is healthy and as long as she is picky about her homebirth midwife, all will go well. And I know my blog readers would only pick a good midwife because they must have good taste in medical providers– after all they picked ME, right?

      So she knows that homebirth, ON AVERAGE, in the United States is unsafe. But she believes that for herself and her followers it would be a different story.

      tl;dr version: Bad outcomes are for nasty people!

  • AmyH

    On the “babies know when to be born” front:

    http://www.counselheal.com/articles/8665/20140214/44-year-old-fetus-found-inside-84-woman.htm

    But we know that every baby will eventually come out.

    • Amy M

      I have heard of these cases before, but I still find them kind of creepy. Interesting though.

    • Mel

      Plus, lots of us were born really, really early.

  • GuestingIt

    I’m angry, too, that I was sold on the idea of OOH birth. I don’t appreciate being lied to where my child is concerned. I didn’t wake up to that feeling until I read your blog. By not hiding your anger, you ignite it in others.

    • KarenJJ

      It’s confusing that people don’t get angry about what is happening. What value of life do we place on women and children when something like this can go unchecked and have so many excuses made for it. I feel similarly about domestic violence.