In the world of homebirth, stupid is the new black.
Homebirth advocates proudly flaunt their stupidity and the saddest part about it is that most of that stupidity is willful. They are so sure that their ignorance and transgressiveness are attractive that they willingly suspend disbelief to accept the most outrageous claims and ridiculous lies from professional homebirth advocates and other laypeople.
As any fashion aficionado can tell you, the key to a great look is the foundation garments. Any fabulous dress requires a great bra and shape-wear to accompany it. Whereas a fashion forward woman might start with a properly fitted bra and Spanx, the homebirth advocate starts with ignorance of obstetrics, childbirth and history. The foundational garment of homebirth advocacy is the bizarre belief in the safety of childbirth, despite massive historical and contemporary evidence that childbirth is one of the leading killers of young women and the leading killer of children.
That ignorance allows the homebirth advocate to layer any amount of stupid claims and bizarre denials over it to complete the look.
Obstetricians, pediatricians, neonatologists, anesthesiologists, epidemiologists and ethicists rarely support homebirth and that’s because they start out with knowledge of the fundamentals of childbirth and the history of perinatal and maternal mortality. You might think that the fact that homebirth is opposed as unsafe by the people who know the most about the wellbeing of babies and mothers would cause homebirth advocates to rethink their position, but you’d be wrong. Just as a fashion model wears a slip over her foundation garments, homebirth advocates wear a profound anti-elitism over theirs. Apparently the superior education and training of doctors make many homebirth advocates feel small; the only way for them to feel better about themselves is to deny that experts know anything.
Now for the actual outfit.
Just like there are many shades of black, there are many shades of stupid among homebirth advocates.
Henci Goer says that homebirth is safe and hospitals kill babies. That’s stupid.
Melissa Cheyney, CPM lobbies for laws in Oregon that stipulate any person call legally call herself a homebirth midwife regardless of education or training. That’s stupid.
Judy Slome Cohain, CNM insists that neonatal group B streptococcal sepsis can be prevented by putting cloves of garlic in a woman’s vagina. That’s stupid.
Marian MacDorman claims that the CDC data on which she she based her own published research “aren’t designed for research.” That’s stupid.
Aviva Romm claims that homebirth is safe but when ask to analyze the MANA homebirth paper says:
I’ll tell ya, ladies, I’ve taking medical statistics ad nauseum in my training and still do not consider myself a skilled statistician by any means. Statistics are generally a lot more than meets the eye — there are issues of power, inclusion and exclusion biases, data collection methodology, and even what questions were being asked. So I will be sitting down with someone who can help me to meaningfully review the stats. Not until then can I give a scientifically meaningful response rather than merely my interpretation (another problem with statistics reporting – who’s doing the interpreting!). This is not going to happen fast, but rest assured, when I am confident in an assessment, I will report on this.
That’s stupid and it’s a load of bullshit.
With the exception of Judy Slome Cohain, who appears to have serious problems with logical thought, I would be willing to bet that the others actually realize that their claims are stupid, but they are so confident in the gullibility of their followers whom they figure will believe any garbage they choose to spew.
And all of this would be fine if wearing the wrong color were all that was at stake. Who cares if women who look terrible in black insist that they look fabulous in black? But when it comes to homebirth safety, the lives of innocent infants are at stake. When women dress themselves i ignorance of childbirth, the anti-elitism of the uneducated, and the stupidity of whatever flavor of nonsense their leaders are currently spouting, babies die.
I realize that for homebirth advocates, stupid is the new black … but that doesn’t mean I have to accept it.
So the increasing rates of maternal and foetal mortality In US Hospitals can be labled as Incorrect, despite the statistics and not stupid?
No, it is correct (well, the maternal part anyway) ,but it is in spite of medical interventions, not because of them. As I am sure you know, there is an epidemic of diabetes, heart disease, and obesity in the US, and many people have lack of access to preventative healthcare. Babies that die in hospitals usually have conditions incompatible with life such as extreme prematurity. None of those babies would have even a snowball’s chance in hell at a homebirth.
Also, more women are getting pregnant while suffering chronic conditions like cardiomyopathy and diabetes so maternal deaths from those causes are increasing. In previous generations, those women may not have survived to childbearing years or were advised to never get pregnant. (See Steel Magnolias)
The women most likely to die are those with:
Preexisting conditions
Difficulty accessing medical care.
One study in New York City found that women with no health insurance were 7 times more likely to die than women with private insurance, and 5 times more likely than women with Medicaid.
Hence, the problem with US maternity care is that not all women access it. The women who are healthy before pregnancy and have good health care before, during and after? They have GREAT outcomes.
Just checking: you are aware that part of the reason that we had a rise in maternal mortality was that we actually started keeping better track of and counting deaths in the year after birth, right?
OT but love:
http://whatshouldwecallobgynresidency.tumblr.com/
Awesome!
That is rich!! Now, back in MY day (when we walked through waist deep snow) those were usually 100 work weeks – no wimpy 80 hour limits for us.
In reply to a poster below THIS is only the first part of getting Board Certifed. Aviva is just an OB Hobbyist.
100 hours? Bah! We regularly ended up at 110 hours in internal medicine. And I really did walk uphill both ways to and from work (there was a river between the hospital and my house and I walked into and out of the valley).
Actually, IMHO, there is a difference between working 80 hours and working 100 hours, but after 100 hours, it’s all just nightmares and fuzziness so 100=110=120=complete insanity. I’m glad that there are work restrictions, though I worry about how people trained under the new rules are going to cope with being attendings and having no restrictions on their hours at all.
So long since I’ve done hospital medicine…but boy that brings back the memories.
Especially the ED and vaginal bleeding. If the patient is 12-54 and her last period was 28 days ago and a pregnancy test is negative, the bleeding and pain ARE HER PERIOD. You do not need a gynae consult and she needs a period tracker app and some mefenamic acid.
Seriously? That happens? Never mind, don’t tell me. Let me keep some little faith in the common sense of humanity…
Too funny!
I am Agree With Disqus’ers…
I did not even read it. I am so disappointed that it was published in the journal. I wrote a 150 page document for the College, it seems it was debated by the elders and I thought the College was going to address the issue at hand with ACOG and AAP.
If one will read the book “Professional Ethics in Midwifery Practice” and carefully assess the side by side comparison between: ACNM, ICM, MANA and NACPM one could easily see there is no need in evaluating anything from others who do not practice by any ethical codes. In fact they state as such in their standards and codes.
The following is an analysis from the book:
MANA has published two documents in relation to the practice of ethics. Neither document is titled or considered an ethical code: Statement of Values and Ethics (1997), Standards and Qualifications for The Art and Practice of Midwifery (2005b). Perhaps the most distinguishing feature on the Statement of Values and Ethic’s is it’s acknowledgement of limitations concerning any inherent ethical codes. MANA rejects any rigid codes on several grounds:
The rules and the skills to follow the code are redundant
Codes are deemed less reliable than practitioners
Thus MANA takes a contextual-sensitive approach when applying ethics to the practice of midwifery. Recognizing the realities of daily practice are incompatible with Western ethics’ demand of objectivity and impartiality. Shortcomings to such an approach are ethical relativity whereby no moral principle, or ethical or theory is considered valid except as defined
by culture and circumstance. Thereby, rejecting modern ethical codes and
leaving midwives without guidance or direction. According to MANA, the process of developing morals integrity and values cannot be taught, it must be gained through personal growth.
Ultimately, MANA turns the responsibility of ethics over to midwives and pregnant clients:
“Individual moral agents unique unto themselves…to follow
and make known the dictates of our own consciences.” This mirrors the last 20th century feminist philosophies, such as, Carol Gilligan’s popularized study of women’s moral thinking. (Professional Ethics in the Practice of Midwifery)
This is another analysis I wrote about after the read:
“Justice for all”: ICM and ACNM; not MANA and NACPM
“Justice” : ACNM only; not ICM, MANA, NACPM
“Advertising and other public statements” ACNM only; not ICM, MANA,
NACPM
“Pursues fairness, justness and equity” ICM and ACNM only; not MANA,
NACPM
“Equity in access to healthcare for all” ICM and ACNM only; not MANA,
NACPM
“Awareness of policies and laws” ACNM and NACPM; not ICM, NACPM
“Self Care” NACPM only
Now why support anything written, analyzed, debated, or denied by others who blatantly defy ETHICS!
IN THE DOCUMENT I COUNTED 86 INTRAPARTUM AND NEONATAL MORTLAITIES AS DEFINDED BY: TERM 37 WEEKS GESTATION TO 6 WEEKS POST NATAL. THESE DEATHS ARE DOCUMENTED BY WEBSITES SUCH AS : SISTER’S IN CHAINS, OREGON MIDWIFERY.ORG, AND NUMEROUS WRITINGS BY JOURNALISTS IN VARIOUS NEWSPAPERS ALL OVER THE COUNTRY. AND I DON’T THINK I WENT BACK AS FAR AS 2004. I WOULD HAVE TO LOOK CAREFULLY BUT MAJORITY OF THE DEATHS WERE FROM 2007 TO 2012.
MORBIDITIES WERE ALSO ASSESSED AND THE NUMBERS WERE ALSO EXTREMELY HIGH. AND THOSE ARE ONES THAT I COULD ABSOLUTELY SAY FOR SURE OCCURRED AND WERE ATTENDED BY CPM’S, DEM,S OR LAY MIDWIVES FROM WEBSITES AND EXTENSIVE WEB SERACHES.
THE COURTS ARE LOST AND JUDGES SIMPLY DO NOT KNOW WHAT TO DO EXCEPT TO LITIGATE AND PROSECUTE TO ATTEMPT TO STOP THE MADNESS. BUT IF OTHER’S ARE ANTI SOCIAL IN NATURE THEY CAN’T LEARN FROM THEIR MISTAKES IF THEY LACK A CONSCIOUNESS. VERY VERY SAD AND AWFULLY TROUBLESOME.
IN ENGLAND AFTER THE COLLEGE DEBATED THE WRITE BEGAN TO ADDRESS THINGS THROUGHOUT THE UNITED KINGDOM IN DECEMBER 2013.
THIS IS FROM THEIR PUBLISHED DOCUMENT:
“We recommend that the NMC works together with NHS England and the Department of Health to develop proposals to put these principles into effect. This will include developing and consulting on proportionate approaches to midwifery supervision and midwifery regulation. We recommend that this is done in the context of the anticipated Bill on the future of healthcare regulation. We also recommend that the Professional Standards Authority advises and reports on progress.
Dame Julie Mellor, DBE
Health Service Ombudsman
December 2013
‘We think this means that the current system operates in a way that risks failure to learn from mistakes.’ ”
TITLE OF DOCUMENT IS BELOW:
Midwifery supervision and regulation: recommendations for change
SO WHY WASTE YOUR TIME ANALYZING ANYTHING COLLECTED AND ASSIMILATED BY MANA? IT IS A VERY POORLY USE OF ANYONE’S TIME.
I have never read a comment more justified in using caps lock than this one. I only wish it were bold face and underlined as well.
So you’re saying that…just by going through websites and news articles from 2007 to 2012, you found more perinatal mortalities than MANA was able to find in alllllll their years of diligent data collecting? If so, Dr. Amy is right in saying that MANA has actually *undercounted* their perinatal mortality rates and the true rate is even more shocking than the one they have published. Holy %^&.
yes Dr. Amy is honest and ethical. She cares and is brutally truthful and that I absolutely respect and admire.
And what about the deaths that those of us know about who have ears to the home birth community? I know about very real homebirth deaths through the CPM grapevine. These deaths don’t show up in newspapers or in state vital stats (because they are not tracking these data specific to home birth!)
At midwife meetings many times have I heard: “Midwife X had a baby death last week…. but shhhhhh! We can’t talk about it.” Or, even straight from the CPM horse’s mouth, “Well, yeah, that baby died, BUT IT WASN’T MY FAULT! And the parents aren’t complaining about *my* care.” “Birth is a as safe as life gets. Sometimes babies don’t make it. It’s not the fault of the midwife.”
It’s infuriating to know *about* homebirth deaths that have occurred locally, but that there is no way alert the public about these deaths because they aren’t tracked, nor are they investigated by any state regulatory body. This is in a state that licenses CPMs!
Undercounted is an understatement.
I also sent an article forward to the leaders that documented 300 mortalities and or morbidities that was documented by a journalist for the LA Times by reviewing court documents. And now I was just abruptly abusively teamed by my CNM owner of the practice and a MD she employs and verbally assaulted and wrongfully fired.
Thus, I now am being blackballed out of my profession. All must rest assured CNMs and CPMs that I will not be silenced. No matter how much abuse I must endure. Because I do have a conscious and I must continue to do the right thing.
Wow, I’m sorry you lost your job! Publish that list as far and wide as you can.
Wow. You really are at the coal-face of this issue, Deena. Whistle-blowers never do get a good time of it. Wish I could hold you a bake-sale…
OK, as long as we have an APB out for mathematicians I need some help. I have kept meticulous Friedman Curves on every labor I have attended for 20 years. OCD? You bet. This is my hypothesis. There are forces that when applied over distance is work. There is only so much work a uterus can do before it fails – just like the heart. Here is a bit of the math:
In general, a sigmoid function is real-valued and differentiable, having either a non-negative or non-positive first derivative[citation needed] which is bell shaped. There are also a pair of horizontal asymptotes as . The differential equation , with the inclusion of a boundary condition providing a third degree of freedom, , provides a class of functions of this type.
http://en.m.wikipedia.org/wiki/Sigmoid_function
Here we go for the good stuff. The Friedman curve is a sigmoid curve. The first derivative of a sigmoid curve is a Bell shaped curve (exactly like the uterine tocometer shows. If you have placed an IUPC, the tracing is an accurate reading of the force produced by the uterus. The area under the bell curve of a uterine contraction is directly proportional to the WORK the uterus is doing. The area under a curve is the INTEGRAL. If you integrate a bell curve you get a sigmoid curve and conversely the first derivative of a sigmoid curve is a bell curve.
Frankly, I am astonished at the direct mathematical connection between what we see with an IUPC and what we observe with the progress of labor as plotted on the Friedman curve. If my hypothesis is correct, then we can quantify the work a uterus has done with relatively simple tools (an IUPC and cervical exams). It can then be studied as to the amount of work we can expect a uterus to do before it fails (FTP). Then, a very objective assessment can be made as to when a C-section is indicated.
Paging CC Prof, paging CC Prof
I’m a physicist, and it’s hard to make sense of your post because I don’t know the units involved in either an IUPC strip (is it force/pressure/distance plotted wrt time?) or a Friedman curve (dilation distance wrt time?) Also you seem to think an integral of force wrt time (duration of a contraction) will tell us work, but that would actually tell us impulse. The integral of force wrt distance would give work. The integral of power wrt time would give work.
It would be interesting to calculate the impulse of each contraction and see whether cumulative impulse can indicate FTP, but I wouldn’t call that work in the sense that physicists use it. I also wouldn’t expect a priori that the impulse vs. time plot look like a sigmoid curve or any other curve. Just make the plot and see. Has no one done this before?
Thanks, I said I needed help!
The Friedman Curve is a Sigmoid Curve plotting time on the X-axis and cervical dilation on the Y-axis.
The uterine tocometer plots a Bell Shaped Curve with time on the X-axis and uterine pressure in mmHg on the Y-axis. The external monitor actually just shows when the contraction starts and stops. The amplitude depends on how tight the belt is. However an intrauterine pressure catheter gives an actual reading like a BP cuff does.
I thought I read that the integral of a Bell Shaped Curve is a Sigmoid Curve and that the derivative of a Sigmoid Curve is a Bell Shaped Curve. Is that correct?
Question: if you integrate pressure (pressure is force, correct?) over time do you get “work”?
Way back in residency I was taught that if you added up all of the squares under the contraction curves of labor, you would have a measure of the work done during labor.
Is this correct: the derivative of Distance is Velocity and the derivative of Velocity is Acceleration. Conversely, the integral of Acceleration is Velocity and the integral of Velocity is Distance.
Thanks!
Yes the integral of a normal distribution (bell-shape) is going to be sigmoid. But I am not sure where that gets us. Are you trying to integrate a contraction and get the Friedman curve (because that’s not going to work)?
That’s where I’m confused also.
A precipitous labor Friedman Curve has very little area under it. Hence very little “work” was required. An FTP curve has lots of area under it – hence more work. There is only so much work a uterus can do.
I have a mental image of an equation that fits the individual FC. Imagine three tuning knobs: P1 – the power of contractions, P2 – the attributes of the pelvis and P3 – the attributes of the passenger and imagine the FC on a video display. Each turn of the knob will affect the slope of the curve and the “bend” at each end. How would such an equation be written? What I do now is establish three points and use my intuition/experience to freehand and extrapolate the curve. This makes a prediction of when we should expect the cervix to get to complete and pushing. That is an invaluable tool to explain the rationale of intervention and to address mom’s momma when she asks: “How much LONGER, Doctor?”
Wait, that’s not right. Moving the baby out of the mother is going to require the same amount of work (term used loosely) no matter how fast it happens. Otherwise that’s sort of like saying it takes less fuel to get a car across the country at 100 mph than the same drive at 35 mph, because it takes less time.
Maybe I am using the terms wrong: pressure, force, power, energy, work, etc: I know these are precisely defined with distinct units but college physics and calculus was 40 years ago
Maybe I wrong. But it seems to me you still have to move the same mass (the baby) the same distance (birth canal). The time in which you do isn’t relevant to what has to happen. You either do it with more, stronger contractions or fewer, weaker contractions. To the extent that women seem more exhausted after a longer labor, I would think it has to do with lack of sleep, lack of food and time for the adrenaline to wear off. Not because they actually expended more energy.
Hmm, I’m not sure that’s right. If a woman is contacting regularly during labor, a twelve hour labor will have four times as many contractions as a three hour labor. Assuming each contraction requires approximately the same amount of energy the second labor is expending a lot more energy.
It’s more than force applied, it’s how the force is applied.
Labor is like trying to push a cork out from inside the bottle. If the force pushes the cork squarely and in the direction of the neck, the cork will be pushed out with minimum effort.
If the force is only partly applied to the cork or if the force is not aligned perfectly with the passage, some energy will be wasted and it will take additional effort to expel the cord.
Position has a lot to do with how effectively the Power
is applied.
“Position has a lot to do with how effectively the Power
is applied.”
To clarify: position of the cork in relation to the neck. Not position of the bottle in space.
Coming from an engineering perspective maybe you could look at it like a PID system
Proportional change that is linear
Integral change – how far something has moved and how far it has to go
Derivate change – the rate that something is changing
Eg labours can have different starting points (thinking of level of engagement in the pelvis)
Contractions have different force and resistance to overcome (maybe think of that as being linear for now)
Derivate change – the frequency of contractions changes and can increase/decrease over time?
You then have a different proportions of P, I and D contributing to each labour.
Dunno, but it worked when filling tanks in mineral processing…
Not really. A more apt analogy is labor is like wringing water out of a wet towel. A uterine contraction is not a linear vector. Rather, it is a spiral vector starting in the fundus and working its way down to the lower uterine segment. Position has very little to do with it as upsetting as those words are to the unicorns.
But I’m NOT assuming each contraction uses the same amount of energy. I am assuming that the shorter labor is shorter BECAUSE the contractions are stronger and more effective.
possibly. Or less robust tissue resistance, bigger pelvis, smaller baby etc.
Auntbea, you describe the clinical diagnosis of hypersystole which is having contractions which are too frequent and/or too strong. This is never a good thing. The contraction of the muscle fibers constrict blood flow to the uteroplacental interface and the placenta does not get perfused much then and baby does not get as much oxygen. This can result in fetal heart rate Decelerations as a physiologic or pathologic response. A persistent problem will result in lowered pH – acidosis, hypoxia and brain and organ damage.
An iatrogenic cause of hypersystole is use of induction agents like Cytotec, prostaglandin, and pitocin. The main pathologic cause is a placental abruption.
The main reason for a precipitous labor pattern is far and away decreased resistance in the passage as fifty fifty 1 discussed.
The resistance is not a constant. The clearest example is the use of an episiotomy which clearly decreases outlet resistance to the point that babies literally slide out after you do them. I have seen midwives have their clients push for four and five hours, refusing to do an episiotomy whereas I can get such patient delivered after an hour of pushing just by doing an episiotomy. Another measure than can decrease resistance is an epidural. Let’s say you are trying to pop a zit. One is ripe and ready. The other is not. Doesn’t one take more energy to pop than the other? And sometimes you have to get a scalpel and lance it.
Sure. But now you’re asking a totally different question. You originally were asking about (I think) the work of the uterus and how it correlates with time and energy spent in labor. Of course an episiotomy can lower resistance, and it will take less energy to overcome less resistance, but that has nothing to do with whether a naturally precipitous labor uses more or less energy than a long, drawn-out one.
” but that has nothing to do with whether a naturally precipitous labor uses more or less energy than a long, drawn-out one.”
He gave an episiotomy as the most obvious example. But a better example might be a multip birth vs a 1st birth. The tissues of the mutip cervix and perineum are already stretched out, so less resistance. It’s like putting on a turtleneck for the first time ever vs after lots of times wearing it, it takes more work. Precipitous births occur mainly with multips. (Very rarely with a first time mom and then only with a very ripe cervix plus ideally positioned baby, roomy pelvis, reasonable size baby, and good contraction pattern)
Yes, definitely if a lack of resistance is the reason that the labor is shorter, then yes, a shorter labor would require less energy. But that has nothing to do with the uterus, then and we don’t need to be taking integrals of any curves.
Which is good, because I hate integrals.
I think his point is he is wondering if there is some absolute amount of work any one uterus can put out during one labor before failing. Like I have a Panasonic cordless drill and there is only so much work it will give me before the battery grinds to a halt. If I understand him right, he is wanting a more scientific numerical way of saying “based on the amount of work we have already measured you uterus to have done combined with how close the baby is to coming out, you will (or will not) be able to deliver this baby before the motor fails.”
Oh. That makes much more sense now.
^^ What 51 said.
Force has units: N = kg*m/s^2
Pressure is force/area: N/m^2 = kg/m/s^2
Energy and work have the same units: Joules = N*m = kg*m/s^2
In human physiology, the work done in a simple physics sense doesn’t have a terribly tight connection to the number of calories burned to accomplish the task.
I don’t know about that. I have seen charts showing calories burned per time (t) of doing things like jogging, gardenin, sex, playing cards, etc
But:
1) Those are rough estimates. The calories each individual burns while, say, running 6mph is a function of their mass, metabolism, and level of fitness. An acquaintance of mine who does exercise and weight loss physiology experiments, complete with collecting people’s exhalations to find base metabolic rate, says most of those estimates aren’t terribly accurate and some don’t seem to be based on anything.
2) Even if I did know exactly how many calories you burn doing particular tasks, it probably wouldn’t have a terribly strong correlation with the fuel burned by machines doing those same tasks.
What is the integral of a Sigmoid Curve? What kind of curve do you get?
The derivative of a sigmoid curve is bell-shaped, the integral is something else, something nondecreasing.
Pressure and force are different. Pressure is a force applied per unit area (which makes a lot more sense for describing uterine contractions, so I buy that). So the integral of the tocometer reading would NOT be impulse as I said earlier. It would be the integral of pressure wrt time, which is not a quantity I know off the top of my head. It would have units kg/m/s (or N*s/m^2), which is a lot different than the units for work: kg*m^2/s^2 (or Joules).
OK, so N*s is impulse (the change in momentum), right? Thus, N*s/m^2 would be the impulse per area. I can’t find any applications of that in my quick google search
(if you look up pressure times time, you get a lot of specs on pressure cookers)
I just figured it out:
pressure*time is a dufresne
Get it?
Get that baby a rock hammer.
And a big goddamn poster.
The uterine pressure monitor actually monitors pressure over time or pressure per time (P/T) which is (I guess) a measure of Impulse (Force/Time), right?
I also don’t entirely understand what you just said. OK, the Friedman curve is a bell curve, but why should women’s uteruses be equally strong? There’s wide variation in the strength of other muscles.
As I understand it, and I might be totally wrong, the Friedman curve and partographs are basically a description of normal progress. If a woman in active labor falls significantly behind normal progress, then labor is probably obstructed in some way, either a badly positioned baby or a baby who’s just too big for the pelvis.
http://en.m.wikipedia.org/wiki/Frank–Starling_law_of_the_heart
CC, my concept is roughly analogous to Starling’s Law of the Heart. One of the first things we are taught are the Three P’s of labor: passage (the maternal pelvis), passenger (fetal size and position) and powers (the force of the uterine contractions). With intrapartum management we only have control over the powers (by using pitocin. Midwives tend to over-exaggerate the role of maternal positioning to improve the passage and the passenger. Epidurals provide pain relef and suppress tightening of pelvic muscles that can obstruct the passage. So we can have some influence there too.
OK, you’re trying to get a mathematical model to better examine the power of the uterus. But the Friedman curve measures the progress of labor overall, and the tocometer or IUPC measures the force involved in each contraction. The Law of the Heart also has to do with individual beats.
How do the individual contractions change as labor progresses? Are they equally strong throughout?
Can someone sent me the link to a post about the unqualification of CPMs. I really need the information, but I am short on time! Thanks!!!
Here’s one: http://safermidwiferyformichigan.blogspot.com/2013/08/certified-professional-midwife.html
Thank you.
I hope you aren’t in labor.
Me too! 😉 I plan on never being in labor again! Well, actually I never plan on being pregnant again, but if I do it will be a RCS at 39 weeks.
As an ob I find it absolutely crazy that I get told frequently that at 38 w 6 d I can’t do an elective procedure at 4 or 5 PM but at 1 AM when the patient is now “39 weeks” its ok. Because you know we can time conception down to 12 hours!!
Lol I can, but I did IVF. Still stuck waiting until 39…. actually 39.1 because the other day was all booked. 🙁
The 39 week rule makes no sense clinically and it is only a matter of time before it is reversed. Of course, first babies will have to die preventable deaths before the powers that be acknowledge what we already know, that waiting longer increases perinatal mortality.
I said before that I was happy to get my 37-week non-emergency c-section and that my OB and I were reasonably sure we made the best choice. Now we’re absolutely sure.
Because my son was growth-restricted, the OB sent the placenta to Pathology to get studied. I don’t remember the exact words, but basically the placenta was unhealthly, had been not-so-great for a while, and was just beginning to seriously break down.
So, there’s no way my son was ever going to be born bigger or healthier than he was. He didn’t know when to be born, but the experts took a good guess and got it just right.
What!? You’re telling me that your body doesn’t know best?? 😉 Thank goodness we don’t buy into that nonsense. Hope your little one is doing well! Out of curiosity, what causes growth-restriction? The first thing that comes to mind is the baby’s size, but I suppose it also depends on the woman’s structure, too. And at 37 weeks, I don’t imagine you were dealing with a 10 pounder? (My guy was 10lbs 10oz, but I was 40wk 4d when they did the CS. I’m really hoping this next baby is smaller, but I don’t think I have much control over that!)
Growth restriction is when a fetus grows much more slowly than normal. A newborn is considered growth-restricted if he was born after 37 weeks but is less than 2500 grams (5.5 pounds).
My son was a hair under 5 pounds at birth, which is the average size of a 33 or 34 week preemie. I had a sonogram at 32 weeks that found he was undersized, and was followed very closely from then until delivery, went to the hospital for tests every week, etc.
What causes growth-restriction? Sometimes it’s because there’s something wrong with the baby, like a genetic or chromosomal problem. More often, it’s caused by maternal health issues, like high blood pressure, clotting disease or malnutrition. But, surprisingly often, both mother and baby are totally healthy, and the problem is that the placenta isn’t working very well. (As far as I know, no one knows WHY this happens, it just does.) When diagnosed prenatally, growth-restriction may be an indication for early delivery, depending on other factors, because growth-restricted babies are at risk of stillbirth if their nutrient supply is compromised further.
Still, my son seems to have taken no harm from it, and he’s growing fast. VERY fast.
Yea! So glad he’s growing well!
It makes even less sense to those of us who routinely go into labor before 39 weeks (but after 37). Our bodies must not have read the memo.
I would imagine it’s somewhat insulting, to a doctor, as if you can’t make case-by-case decisions. Maybe insulting is too strong of a word, but I feel insulted on behalf of you all! 🙂
That made me think. My second was born at 39 weeks exactly, here in the UK. She was conceived in the US though. She was born “naturally”–no induction or C-section. If she had needed to come out earlier, would they have had to wait until 6 am rather than midnight to hit 39 weeks?
And do they account for daylight savings time?
I don’t know about conception, but as I had fertility treatments we could probably give the exact ovulation time!
Totally agree it’s ridiculous!
This is off topic but would love your comments on this recent talk from Society for Maternal Fetal Medicine. Clinically I find it to be pretty accurate.
http://www.medscape.com/viewarticle/820391
BLESS YOU!! More ammo against 39 week-nazis
Summary for those of us with no account? I hate that 39 week rule. I wish I could have my CS this week at 38 weeks. I am so stressed from how sick I feel that I can’t see how that is great for the baby….
It’s what I would expect, but I’m a bit concerned that the authors didn’t tell us how many women were in each group (37, 38 and 39) weeks and whether the results are statistically significant. Without that, unfortunately, it doesn’t mean much.
I agree, nor did they state what the complications are. But I am glad to see some more work being done on this as it is such a hard and fast rule that makes little sense.
Is there a reason you don’t refer to Aviva Romm as Dr. Aviva Romm?
They’re on first name bases … 😉
for all intensive purposes
case and point
Is that the general consensus? 🙂
no, bases is the plural of basis
I didn’t say they were on A first name basis.
You two are rediculous
Or, God forbid, that anyone got to Second Base in this scenario…
If they stay on second base, they won’t be risking themselves with a CPM!
As an MD she is an herbologist which puts her somewhere between a chef on Chopped and a gardener – not unlike Martha Stewart. As an OB she is nothing more than a CPM. Hence her busted rank. Is she Board Certified in anything?
yup, Massachusetts board certified with a valid license. unfortunately, unlike Amy, who’d have so much more credibility if she’d kept hers current. http://profiles.ehs.state.ma.us/Profiles/Pages/PhysicianProfile.aspx?PhysicianID=99260
TG, thanks for the link. However, you don’t understand what Board Certified means.
Quote:
Dr. Romm has reported no board certifications.
ABFM has her listed as board certified in family medicine as of Nov 2013.
Quote:
American Herbal Products Association “Herbal Insight Award” (2011)
What was the “insight”? – that basil is good on tomatoes?
Ugh, I was sent to a pain specialist here, so I did a little research into her background and found she was the head of some quasi-professional body of alternative medicine for some time and believed that honey was as good as antibiotics in treated infected flesh wounds, at which point I refused to see her, and really pissed off my GP. Well, I’m not seeing a physician who identifies with alt-med, sorry. To me that’s mixing religion and science. The woman also was double-billing basically, because she has a thriving acupuncture business going. I really think physicians like that need to be reported for lack of ethic: they lure in unsuspecting clients who think they are going for traditional treatment and then they slide in all the alt-med mumbo-jumbo. Worse, the physician who knows it’s BS, but is sending clients there because they think it’s either going to distract said client long enough for a time-limited injury to heal (at price to the client) OR because they think it’s ethical to send a client to alt-med for the placebo effect. Regardless, it angers me.
Because her name is Aviva Romm. I have a PhD, as do all my colleagues, but when I want to cite someone, I don’t cite them as “Dr. Mary Smith.”
MDs attach a great deal of importance to being recognized as doctors. Amy Tuteur, MD certainly does and her refusal to recognize Aviva Romm, MD/Dr Aviva’s credentials gives every appearance of being a deliberate slight.
PhDs are different. They may not use “doctor” within a hospital and in an academic setting “professor” is often the more relevant title.
Actually she has said she is fine with being called just Amy.
She calls herself Amy Tuteur, MD. Online other people usually call her by a different name, Dr Amy. I have never seen her present herself publicly anywhere as “Amy” but maybe I’m hanging around on the wrong sites?
Aviva Romm, MD/ Dr Aviva also presents herself publicly with her professional designation. If that is what she goes by professionally, it’s a snub to ignore it.
She also refers to me by my first name, and I didn’t that she was being disrespectful.
Ok then!
My OB has her clients call her by her first name. I have to remember, when dealing with other physicians, to use her proper title because there are some who really don’t like that little humanizing part of her practice. I’ve noticed that younger, especially female specialists, are introducing themselves more and more often by first name. I just had a GP do so, too. It’s nice. Ditto on the best profs I had in college– all of them went by first names. None of those with PhD’s required we call them “Dr. So and so”. In fact, I was unaware of who had PhD’s and who just had Masters and were doing their dissertations at the school. Anyway, I call Dr. Amy, Dr. Amy. Or when referencing amongst friends we refer to this site affectionately as Dr. A’s. Or just Amy’s. Or Dr. Amy’s. But never Dr. Tuteur, and I’ve never seen her react in anger to anyone calling her by any of these names. Ditto over on Orac’s blog, and he doesn’t even use his name, anyway. What doctor/bloggers are freaking out at not being referred to as “Dr.”?
1) Dr Aviva Romm calls herself “Dr Aviva Romm,” not “Aviva,” and that’s who we’re talking about. We aren’t talking about your OB. (Personally I prefer a more formal relationship with my doctor — she calls me Mme Cummins, I call her Dre Nally — but informal can work too — Véronique and Alison. I don’t like “Bonjour Alison, je suis Dre Nally” but that doesn’t happen much.)
2) We are talking about what Amy Tuteur, MD calls Dr Aviva Romm in an informal professional context, not what commenters call Amy Tuteur, MD or her reaction to it.
3) We aren’t talking about academia.
4) David Gorski.
Anyway, the point is that the question is reasonable. Amy Tuteur, MD answered it reasonably below.
I told you all this in the beginning….
they are on first name bases….
But I don’t cite my colleagues as Professor Smith or Mary Smith, PhD either. Maybe if I am addressing an invitation to them. But discussing their work? No. The title is assumed.
MDs are different. In a clinical context not everyone is an MD and it can’t be assumed. It’s overtly stated because it’s important to know unambiguously who the docs are.
I’ve seen blogging docs get very ticked off at the snub when commenters call them by their first names instead of “Doctor X,” so respect for the designation is not reserved for masked gatherings around an operating table. By default it’s expected generally in professional settings, even informal ones like a blog. Not every doc may expect that on a blog, and that’s fine, but I take my cue from them.
Dr Aviva Romm presents herself with her credentials on Facebook. She has not signalled that she is rejecting the default. Someone who declines to observe the default in the absence of cues that this is what is expected is doing so deliberately.
I have also seen blogging professors get pissed off when you don’t call them professor. That’s because they are pretentious ninnies.
Yes, agreed. But nobody’s life depends on them.
Well, hopefully no one’s life depends on Dr. Aviva Romm, either.
That’s the problem, isn’t it?
Reminds me of a clip of a congressional hearing I watched once where a congresswoman ripped into someone who was testifying b/c he called her “ma’am” and not congresswoman (I can’t remember which member it was). I’m all for referring to them by titles but the way she laid into him, seriously for like a minute or two straight, about how she had EARNED this title and she was NOT about to be disrespected by being address as “ma’am”. For Pete’s sake, it’s not like the guy called her by her first name or even Ms. So-and-so. I might understand her beef if that happened, but I’ll tell you – I had some choice names for her after her rant, none of them opened with “Congresswoman”. 😀
Search “Aviva” in the blog and you’ll find that every other time she is mentioned, she is introduced as “Aviva Romm, MD” or “Aviva Romm, MD, CPM”. I think sometimes you have a tendency to find malice in Dr. Amy’s writing where it doesn’t exist.
Given that Aviva was not the subject of this blog entry, her credentials are recognized every other time she is mentioned, and Dr. Amy’s blog is not always meticulously proofread, her not having mentioned Aviva’s credentials in this post gives every appearance of being an oversight.
R T raised the question, I didn’t. I didn’t respond to R T.
auntbea replied to R T, asserting that medical doctors are not normally called “Dr.” That was just bizarre and I disputed that.
That’s it.
R T is not the one who claimed that the error was a deliberate slight. You are.
I said it gave every appearance of being one.
Amy Tuteur, MD clarified upthread that they call one another by their first names, that it is neither an error nor a slight.
I think Dr Amy doesn’t really do subtle when it comes to insulting people 🙂
Oh please. You also said
and
Which is why I responded to say, as I said above, that you seem to read malice where there is none, and my point still stands. Why do you do that, I wonder?
Garlic in the vagina?? Sounds Italian to me. Bake at what temp and for how long?
Al dente.
Nice little dig at Judy Slome Cohain. I believe you showed admirable restraint considering her recent MDC tirade.
I wish there were a cheat sheet of all the acronyms used here. What is MDC? I’m assuming it’s not Miami Dade College…
mothering (dot) com
Thank you!
It took me forever to figure that one out. 🙂
How’s it going finding a neutral statistician with Aviva Romm to analyze the MANA data? I take it she hasn’t contacted you again about that except to suggest the woman who was her teacher who herself is invested in all things natural and studying their safety and efficacy? She sure sounded like she would be neutral ;).
It’s not easy because there are no actual statistics involved. It’s all arithmetic.
The MANA “study” isn’t even a study; it’s a non-random self-selected survey. Asking a statistician to analyze it is like asking a statistician to analyze one of those NBCNews.com polls where you click who you are going to vote for. There’s nothing to analyze because it’s junk.
That is why I’m puzzled at the arguments. It’s really not that complicated. There’s no debate, it’s literally addition and division. I see some people are still having trouble with fractions. This was not a sophisticated analysis.
They just do not want to believe it, so they do the mental gymnastics to deny it.
It is striking that so many of the ones who seem not to understand basic middle school math are often the same ones who are homeschooling their children.
This is what I have asked from the beginning: ask a statistician to analyze _what_ exactly? What is there to analyze?
I think we’re not talking analysis but rather getting a statistician to explain exactly why the study is pure horseshit. Amy’s already done it (and so have a few other doctors) but they aren’t statisticians so it doesn’t count. And when a statistician finally does do it, the homebirth leaders will say the person is an ACOG shill. It doesn’t matter what hoop you jump through, they will discredit it. But maybe it will convince some fence-sitters?
Maybe we need to send it to three statisticians with no particular vested interest in the home birth debate (three, so it can’t be a draw). Ask them analyze any the limits of the data collected and the significance of what is there?
Try a PhD in Mathematics?
Try a college freshman who just took a statistics course.
One of my sons works in statistics, but Aviva is obviously not going to agree with that.
I mean, I could do it, but a) I’m a social scientist, not a statistician and b) I don’t think I count as independent in Aviva’s eyes. However, my real name is not, in fact, Aunt Bea, so we could use my real name and plead ignorance.
Aunt Bea, say it isn’t so! That’s gotta be your real name! (or in your professional life, Doctor Aunt Bea).
Actually, it IS my real name, I just don’t like to admit it because it’s embarrassing. When my parents decided to name us after family, they took it literally. My brother’s name is Uncle Chuck. And my little sister is Grandma Pearl.
My son is taking AP Stats. I could send the data to his teacher and it could be a class project. Would totally embarrass my son, though.
You need Nate Silver. 😉 I don’t think he’s taking freelance jobs these days though.
The self selection bias alone would have to addressed.
I’ll post a more substantive comment later, but now all I can do to get out of my head the song lyrics that this column put into it is quote them:
I never wear buttons, but I got a cool hat
And my homies agree, I really look good in black – fool!
“Think you’re really righteous? Think you’re pure in heart?
Well, I know I’m a million times as humble as thou art!”
From Scrubs…
JD:” Have you ever heard the phrase, ‘Delusions of Grandeur’?”
Janitor: “I invented that phrase”
Hitchin’ up a buggy, churnin’ lots of butter
Raised a barn on Monday, soon I’ll raise another.
But even Weird Al doesn’t dare to be THIS stupid..m
I met Weird Al when he was doing his Amish Paradise tour years ago!
We saw Weird Al do Amish Paradise on his Smells Like Nirvana tour. My wife was on the aisle, and he sang One More Minute to her, and gave her his scarves. He signed them for her after the concert.
Swoon….
So, so jealous.
I saw Weird Al when I was in college and he was on his Stupid Tour. It was open seating and I outraced everybody else and got to see him front row, center. I’d love to see him again.
Dare To Be Stupid is the best music video of all time.
that’s my favorite Weird Al song…learned all the words with my friend Jonathan when we were kids.
I met him at a signing in LA, and bumped into him at a grocery store while he was buying “things that would make an interesting crunch when hit by a mallet.” He was in the middle of recording “Weasel Stomping Day.” One of the nicest people I’ve ever met, too!
Do you follow his Instagram? Hilarious.
Also, it’s so nice to find out that all of you are Weird All fans. I knew I liked you people.
I haven’t kept up w other his stuff since Straight Outta Lynnwood, but am otherwise a big fan
I saw a quote from him the other day. There was an article about some singer, whom the article called “the modern day Weird Al.” Al says, “I thought I was the modern day Weird Al?”
He is still touring. Came through locally last fall. I couldn’t make it, though.
My husband and I went to his concert a couple of years ago, he always puts on an amazing show and it was totally worth coming up with the babysitting. I was glad I formula fed because my youngest was only a month old at the time. I have seen him play in various venues many times over the years. He is one of those performers that can keep a show fresh and entertain you well every time.
Alpocalypse (his latest) is hilarious. Parodies of Lady Gaga, Miley Cyrus, Taylor Swift….
SOB readers & Weird Al Yankovic fans: Not a Venn diagram I knew existed.
Nerds.
We like Firefly, Tim Minchin, Sherlock, Discworld, Dr Who and Cohen Brothers movies (and that’s just me).
Weird Al is just a natural extension of the skeptical smart nerd paradigm.
We’re probably all geniuses (in France).
Farscape? Buffy?
No and No.
You know it lady.
My four year old knows the lyrics to “I’ve got a theory”.
We might not be the best parents.
My son’s nickname was “bunny” when he was just a baby, and we still occasionally rock out to Anya’s solo there.
You’re doing just fine.
I’m the idiot who let my seven year-old watch an episode of Sleepy Hollow with me as a treat.
And I’m the idiot whose 5 and 7 year old’s favourite Dr Who episodes are “The Empty Child” and “The Doctor Dances”, so don’t worry.
This is my verse, hello!
Let’s see….
No, No, NO, NO, NO and NO. Sounds like it’s not “We” so much afterall.
Ah, but we still agree on the the fact NCB is stupid, so we’ll always have that Bofa.
It’s okay. We need a token-male-with-bad-taste-in-televsion, so we will let you stay.
Hey, if means knowing about that stupid Mindy the Midwife show or whatever, I am proud to wear that badge.
The only TV Mindy ever worth watching was Pam Dawber.
And that includes Mindy Cohen from The Facts of Life.
Whoa. Did you just classify The Mindy Project with Joss Whedon and the Cohen Brothers?!? I take it back. You have to leave now.
Hey, you all were the ones who told ME about that show, so don’t look at me. You can say I have bad taste in television, but at least I am (still) unaware of anything regarding the Mindy thing.
I also find that show unwatchable.
I went to the same university at the same time as Tim Minchin. Not that I knew that until recently so it doesn’t really count.
Wrapping presents while watching The Hogfather is my favourite Christmas tradition.
That’s a movie?! Cartoon or live actors? I’ve that book (and the entire discworld series) I don’t know how many times. Some of the books more than others, to be sure.
Live actors, two-part miniseries. It’s not book-perfect, but it is really well done.
LOL Growing up our Christmas Movie was “The Life of Brian” (Monty Python) … and people wonder why I’m so f-ing weird.
Actually I first came to this site after a recommendation on a message board I used to frequent…a message board that Weird Al also used to frequent.
No, really.
I just had a nerdgasm.
I have possibly been a Weird Al fan since before many of you were born. Before that, listening to Dr. Demento on the radio. (note: a radio was a small box shaped item that tuned in stations that played music, sports and news. For free)
My Demento days came after my introduction to Weird Al. Intro to Al came pretty much with 3D, so that was 84, but even then, I was aware of some of his first album. But my Demento phase was more 1985 -1987
I listened to Dr. Demento in the late 70s 🙂
I didn’t, but I did listen to (tapes!) of Dr. Demento stuff in high school, so I know some of it. I managed to find some of it on Napster (remember that one?) in college, so I have a few on mp3 now, but most of what I had on tape is lost. 🙁 I wish I could remember all of “The Homecoming Queen’s Got a Gun” which considering the rash of school shootings since 1999, will probably never be found. From a current perspective, I guess many would consider it in bad taste, but at the time it was pretty funny.
Homecoming Queen’s Got a Gun is on Dr Demento’s 20th anniversary, I think. Actually, I have it from a friend, it appears, so maybe it’s not on there.
Not only nice but a truly amazing musician—you know that Led Zep interlude in the middle of ‘Trapped in the Drive-Thru?’ That’s his band!
I think I was at the book signing too — Children’s Book World on Pico?
Parents everywhere: His children’s book “When I Grow Up” is truly fantastic — funny, thought provoking, and I can read it 100s of times to my kids without hating my own life. Borrow it or buy it today!
Actually it was at Virgin Records in LA for the debut of straight outta lynwood. Seen 3 shows too and I agree he’s a fantastic performer!
INteresting. Baby Prof likes Weird Al. He’s very picky about music, for a kid who can’t reliably hold up his head. Thanks for the suggestion, everyone.
Weird Al, Stone Sour, Ill Nino, and Five Finger Death Punch are the current favourites here, but our youngest also likes (pre-American Idiot) Greenday, Sum 41, Blink 182 and of all bands…No Doubt.
My baby bops to Men Without Hats. Particularly ‘Pop Goes The World’.
‘Safety Dance’ has always been popular here.
Birdhouse In My Soul, Last Train to San Fernando, Yellow Submarine, Wake Up Boo, What Shall We Do with the Drunken Sailor, Rhiannon, Frank Turner’s I Still Believe and (G-d help us) Wrecking Ball are the current favourites.
Nope, I don’t see the unifying theme either. Kiddo likes what she likes.