Obstetricians offer care more personalized than that of homebirth midwives

personalization

Homebirth midwives often proclaim that they offer more personalized care than obstetricians. The truth is 180 degrees opposite from the claims.

I suppose that if homebirth midwives mean that they have nicer personalities than obstetricians (more personable care) or that they will spend more time discussing intimate details of your life that have nothing to do with birth (inappropriately personal care), they are correct. But when it comes to care based on the precise medical situation of the mother, obstetricians are lightyears ahead of homebirth midwives.

I’ve always known this, but my recent attendance at an “updates in obstetrics” reinforced the point. Over the course of two days, I attended 16 sessions on a variety of obstetric topics and every single session was, in essence, about the discoveries that allow obstetricians to counsel and offer care to women in ways that are ever more personalized. Almost all the sessions involved case scenarios:

Prenatal testing: the mother is under 35 with no family history of Down Syndrome, over 35, with a family history, with a previously affected child, etc. etc.

Premature labor: the mother is white, is African-American, has no history of prematurity, has multiple previous premature births, membranes are intact, membranes are ruptured, etc. etc.

VBAC: previous C-section for a non-repeating cause, for a repeating cause, previous vaginal delivery before or after C-section, no previous vaginal delivery, baby is big, baby is small, mother has normal BMI, mother is obese, etc. etc. etc.

After each session there were questions from participants and almost all of them were case scenarios (almost certainly real cases that the questioners had faced or were facing). Nearly all the questions took the same form: these are the patient characteristics, this is the problem, what shall I tell her about what is likely to happen and what we should do about it?

Homebirth midwifery, in contrast, is one size fits all.

Personal characteristics are irrelevant. Advanced maternal age, maternal obesity, pre-existing maternal disease? It doesn’t matter because the counseling and treatment plan are always the same: you can and should have a homebirth.

Medical history is irrelevant. Had a previous shoulder dystocia, C-section, postpartum hemorrhage? Who care? You can and should have a homebirth.

Complications are irrelevant. Baby is breech, have gestational diabetes, colonized by group B strep? Who cares? You can and should have a homebirth.

Labor complications are irrelevant. Dysfunctional labor, prolonged rupture of membranes, pushing for 4 hours? Who cares? You should still stay home because you can and should have a homebirth.

Why do homebirth midwives have a one size fits all approach to pregnancy and childbirth?

Two reasons: ignorance and dogma.

Homebirth midwives are lay people. They basically acknowledge that fact by calling themselves “experts in normal birth,” since most laypeople could easily deliver a baby in the absence of risk factors and complications.

Homebirth midwives have literally no idea of the breadth of possible complications, the effect of various risk factors, the many variations of abnormal in pregnancy and birth. Moreover, they are not able to deal with risk factors or treat complications. If they acknowledge them, they will have to transfer the patient to the care of an obstetrician and lose the fee and the birth junkie high. Instead they paper over their ignorance by declaring that whatever happens makes no difference at all. It doesn’t matter that they cannot anticipate, diagnose and manage complications when everything is a “variation of normal” and the treatment is always to forge ahead with a homebirth.

Ultimately, though, it comes down to the dogmatic cult-like believe in unmedicated vaginal birth. They appear to be unable to fathom the concept that childbirth is dangerous for both babies and mothers. Just like the flat-earthers maintain that the world is flat because that’s the way it seems to them, homebirth midwives maintain that childbirth is safe because that’s the way it seems to them. It simply never occurs to them that their relentless emphasis on unmedicated vaginal birth can and does kill babies and mothers. They literally cannot accept the evidence that is right in front of their eyes, so they deny it (“some babies are just meant to die” sounds so much more soothing than “we tried so hard for a vaginal birth that we killed the baby”), or, in the case of homebirth midwifery leaders like Melissa Cheyney, they tell bald-faced lies about it, claiming that their own hideous death rates are “safe.”

Women who are contemplating homebirth need to ask themselves whether they value obstetric care, which is personalized to their specific circumstances in this specific pregnancy, or whether they’d prefer a one size fits all approach. Obstetric care is personalized because the goal is a healthy mother and a healthy baby. Homebirth midwifery is one size fits all because the goal is unmedicated vaginal birth; if the baby and mother survive without injury, that’s simply a bonus.

  • C T

    Have you ever done a post on super heavy and/or painful lochia due to NCB beliefs about avoiding pitocin/Cytotec/etc.? My experience has been that the more pitocin/Cytotec I get, the less I suffer in the way of afterpains while nursing over the first month or two postpartum. Three of my sisters have recently given birth, mostly eschewing interventions, and all of them have complained of those pains and/or heavy bleeding. I, on the other hand, have been moving away from NCB with the last two births and find my pains to be almost nonexistent by the time I’m home from the hospital. Not a very big sample, I know, but are there studies that indicate that avoiding medications to stop hemorrhage causes longer, more drawn out and painful recovery times from birth?

    • Young CC Prof

      Well, the MANA “study” reported a postpartum hemorrhage rate of 15%. Which, for “low-risk” births, is insanely high. There’s a reason they give those medicines after delivery, which is that normal human birth causes an awful lot of bleeding, and in nature, disabling anemia in the weeks following birth is not uncommon.

      Not sure about the relationship with afterpains.

  • schnitzelbank

    When I was pregnant with my first in 2007, I attended a hospital birth class, that was taught by a CNM at the hospital’s “Alternative Birth Center.” The CNM kept pushing her alt care to the entire class. On the tour, we were rushed past the spartan LDR rooms to the “ABC’s” luxe digs on the other side of the ward. Jacuzzi tubs, that freaky looking birthing stool, balls, queen sz beds, a promise of intermittent monitoring, snacks whenever, and check-out as soon as six hours after birth. When I asked about pain control, I was fed a line about how bad epidurals are, “trust birth,” etc. My only choice was to bear the pain. I asked if mothers in bad pain could transfer and was basically told, “Not usually.”

    No one signed up and she seemed pissed at the end of the class.

    Turns out I didn’t have time for an epidural anyways, but I am grateful for the internal monitoring I got, the OB that was able to spin the baby the right way to pull the cord off of his neck, the nursery that took him for observation after aspiration, and the wise old L&D nurse that sat for hours with my grunting, low-sugar baby and expertly cup fed him formula. I’m grateful to those interventions. My little freight train just turned six…

  • pburg

    Your generalizations do not correspond to my experience. I just interviewed with a CPM who has a reputation for being ultra-”crunchy.” In order to determine whether I qualified for homebirth we went over together and in detail my medical history, my previous pregnancies, and other personal info that could affect pregnancy and birth. To claim that homebirth midwives offer a one size fits all model of care is laughable. It’s hospital regulations created as protection against possible litigation which ignore the needs of the particular patient. In contrast, homebirth midwives are usually highly attuned to the needs of the individual. Your criticisms cry of projection.

    • Amy Tuteur, MD

      Let me guess: you qualified!

  • Susan

    This post makes me think of when I first started to really rethink my notions about home birth. I had been a labor and delivery RN for maybe a year, maybe a little less, and definitely, I was doubting whether it could possibly be true that homebirth was “as safe or safer”. A friend and I went to a course in San Francisco put on by UCSF. It’s attended mostly by OBs, but also CNMs and RNs. I felt like the blinders came off. Because prior to being a nurse, I had been a Bradley instructor, I’d seen Tom Brewer lecture, I’d seen Suzanne Arms lecture, I’d seen Michel Odent lecture… all three were like “this is why THEY are bad… this is why WE are right. We have the secret magic to birth that if ONLY the other side knew”… Well, at this course, the OBs were all about self criticism, how can WE do better, let’s look at what WE do and see how we can serve our patients better. It’s the difference between cult and not a cult approach to birth.

  • TG

    I hated my ob/gyn, but since she was really only quarterbacking tests and stuff during my pregnancy and there was no talk of her being anywhere near my delivery, I didn’t really care. during L&D the only MDs I saw were 1- the anesthesiologist who did the epidural, 2- for some reason a doctor needed to do my stitches afterwards even though the midwives all knew how. the rest were CNMs. the doctor was supposedly at the front of the ward looking at the vitals of several labors at once and issuing orders. the midwives were really nice, but in Israel you need to come with a doula or someone else to hang out with and plead your case, because otherwise you’ll pretty much labor alone.

    • Isramommy

      At both of my children’s births in Israeli hospitals I was seen by an ob on arrival at L&D. I also had OBs popping in once or twice during the labor- I think that may have been because of issues showing up on the monitor. I also had an OB attend each delivery, although that was because the midwife called them in due to minor complications.

      The midwife did hold my hand for my epidural with my second. But on the whole, I didn’t expect them to hang out with me during my labor… our midwives are real medical professionals. They’re too busy and their time is too important for them to spend it on non-medical care related tasks. Regarding the suturing, you’re correct that the midwives are trained in it. The Ministry of Health is supposedly going to begin to allow midwives to handle repairs, pending the approval of the hospital and L&D directors in each hospital.

  • Adelaide GP

    I have often thought the same thing about chiropractors vs GPs. Chiros claim that doctors treat the symptoms not the cause – which they claim is spinal subluxation which only they can fix with crunching. They make this claim not only about back pain but extend it to asthma, non specific fatigue , bloating etc. I thought how could subluxations explain asthma or any other raft of symptoms they claim crunching fixes. Wheraeas when I get a patient in front of me presenting with eg fatigue , I take a thorough history ( it could be due to anything from anaemia to depression to sleep apnoea to cancer to too much Internet time at night time lol) and examination. The differential diagnosis is broad for back pain too , ditto for bloating or diarrhoea. I take time to understand the patient in front of me so I can manage it according to the specific cause found. Whereas Chiros say the same thing and offer same treatment regardless of who or what presents to them. And yet claim to be more “wholistic” in their approach than doctors!!!! Our local naturopath even has the cheek to send in patients with a list of irrelevant blood tests that they want done, with ” just get the lab form from your GP” , usually things like “hormones” or zinc levels. I don’t collaborate with them and never will because I think they’re full of bullshit and ripping my patients off ( I actually help them and I bulk bill, so make less money than the chiro/naturopath from the same problem). Very annoying problem. I can definitely see parallels with what Dr Amy is saying in this post. Couldn’t agree more.

    • DaisyGrrl

      It boils down to this: when all you have is a hammer, everything looks like a nail.

      Chiros/CPMs only have hammers. MDs have an entire toolbox plus will call others who have even more specialized toolboxes if they don’t have the right tool to fix the problem.

      • Coraline

        Great analogy!

      • http://www.prettythoughtsindeed.com Sally RNC-NIC

        Oh man, I’m stealing that saying like 1000 times.

    • Mishimoo

      “usually things like “hormones” or zinc levels.”
      Or blaming symptoms of ASD on copper imbalance, because “he can’t have Autism, he was never vaccinated!”

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

      My cousin is a chiro, and I love him, but he once suggested that chiropractic treatment would cure my suspected endometriosis. I just laughed, which I think offended him, but honestly. How the hell will cracking my spine stop uterine tissue from being places where it shouldn’t be?

      I also have a friend who was diagnosed with Hashimoto’s last year. She gave the medications about two weeks before she quit them and went to a naturopath who diagnosed her with adrenal fatigue and suggested that she eat all the gluten-free food and do all the nothing for three months to ‘recover’. As someone with a family riddled with autoimmune disease, one thing I know is that autoimmune protocols generally take time (it took a year before my mother’s anti-malarial routine for lupus kicked in and completely changed her life) to work.

      In both cases, the practitioners involved seem to think their approach is ‘holistic’ and more personalised, even though they do less for the patient than an investigative GP would.

    • Aussiedoc

      I’ve had people continue to suggest that osteopathy will help my son breastfeed. Because the nerves in the Fontanelles effect a suck. This will allegedly magically fix a tongue tie.

      The last (nurse mind you) who told me that got a withering stare and a ‘I have a degree in anatomy you know.’

      My favourite are the people who get sent in to be treated fir systemic candidiasis. Ok if you had that you’d be dead! No I’m not giving you a drug that might damage your liver (you know your REAL liver) for a made up illness!

      • LadyLuck777

        There are some fundamentalist osteopaths that believe once the body is in total alignment it will automatically heal itself. I am a DO, and many of us properly use osteopathic manipulative treatment as an adjunct to healing concurrently with modern medicine!

        • Sue

          Osteopaths in Australia are not trained like DOs in the US – they are really alt med practitioners who misapply manipulative therapy to systemic illness.

          Like many snake oil salespeople, the pseudoscience osteopaths and chiros tend to be excellent communicators and masters of spin who only have one diagnosis and treatment, whatever the presenting problem. As Adelaide GP says, it’s not very individualised!

    • Anne

      I always thought that was the accepted definition of a quack- applying the same treatment to all problems.

      • stenvenywrites

        That’s also the definition of my grandmother. Doc Tichenor’s and/or some cod liver oil was good for whatever ailed ya, from stepping on a rusty nail to constipation.

        • Anne

          Hehe- or maybe Windex?

    • anion

      No no, see, when you have a “sublaxation” it means the *energy* in your body isn’t *flowing* correctly, and THAT is what causes asthma/bloating/whatever! It makes total sense! It’s completely logical! Of course a slight nerve pinch can cause asthma! We’re lucky we have chiropractors, because our lives hang by a thread every second, and one wrong shake of the head or lift of the arm can cause all manner of deadly disease!
      /sarcasm

      What I find interesting is how many fans of woo believe both:

      *the female body is perfectly made to give birth with ease and little pain;
      *the human body is automatically out of whack from the moment one is born (or even from the womb) due to “sublaxations,” and only chiropractic “adjustments” can fix it.

      So…is the body automatically perfect, or is it all messed up?

      • Amy

        Oh, there’s an answer for that! The female body is perfectly made to give birth with ease and little pain IF the “mama” gets chiropractic adjustments during pregnancy! And if she doesn’t, well, that explains why so many “mamas” think they need pain relief in labor.

        • Bombshellrisa

          And her body will “bounce back” and her figure will also bounce back *if* she gets the prepaid package of adjustments specifically for new moms. Someone suggested this to me right after my son was born. Still unclear how my spine being adjusted will help me get in shape

          • Amy

            Are you sure that you’ve let go of all your fear surrounding your transition to “mamahood”? I’ve had crunchy acquaintances who insist that some women hold on to extra pounds because they’re holding on to negative feelings. Funny how that’s the exact same reason some women don’t have easy labors, huh?

          • Bombshellrisa

            Oh yes-negative feelings seem to be the reason for everything from baldness to cancer and also extra weight. In fact, someone went so far as to tell me that extra weight in my thighs was caused by my “anger at my father”. Of course, there is always some combination of over priced essential oil blend and a crystal to go with it that will cure me!

      • Medwife

        YES! I find myself talking to patients whose chiropractors or whatnot are telling to take herbs, homeopathics, get acupuncture, etc, for things that when they ask me, I tell them, Time. Lots of water, some rest, and time to let your body cure itself. And that is the mainstream medical opinion. Who’s the one who sees the body as intrinsically broken again??

        • The Bofa on the Sofa

          Moreover, you are advising them to “let the body heal itself.”

          My other favorite one is how they are so opposed to vaccination, which is based on the whole idea of using your body’s natural defenses to prevent problems.

          Meanwhile, homeopathy is based on the premise of like cures like, where “like” is determined by the symptoms exhibited.

          So who is trying to prevent disease and who is merely treating the symptoms again?

    • The Bofa on the Sofa

      https://screen.yahoo.com/medieval-barber-000000006.html

      “You’ll feel better after a good bleeding.”
      “But I’m already bleeding?”
      “Heh, heh, heh. Who’s the Barber here?”

  • thankfulmom

    Do those of you who had an OB’s deliver your baby find were they impersonal as the NCB crowd likes to paint doctors? I’ve found my OB’s to be friendly enough. My MFM was even better with the detailed explanations and a little bit of chit chat about our kids and such. It wasn’t all medically related, but it wasn’t overly personal either.

    • Young CC Prof

      My OB was definitely friendly. And delighted to see my healthy baby when I brought him to my 6-week checkup

      • Haelmoon

        I love seeing the baby pictures!! I don’t do primary care, so I rarely get to see moms after the fact. My partner and I love updates on the pregnancies, particularly the high risk babies. I have a large collection of photos, and its only been two years at this practice. However, I keep all the photos, some are only seen in my private space in the office, but these the trisomy babies, and other poor outcomes. They are still babies, and I still cared for the them and their moms. I tend to see these moms again in subsequent pregnancies (just starting to happen at year two), but they are happy to see that I kept their baby pictures too.

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

          That is beautiful

    • guesting

      Nope. I’ve been under the care of five OB’s and one Family Physician for three births so far. All of them were wonderful yet professional and the “old” OB that I initially perceived as gruff and impersonal turned out to be the sweetest man and pushed hard for my birthing preferences. I found that out after the fact, he certainly didn’t make a big deal of it publicly. The OBs that did an attempted external version and later one of my Csections were a father/daughter team, which was neat!

    • wookie130

      I would say that they were not IMPERSONAL, per se, but I would say that they were PROFESSIONAL. There is a fine line between being personable as a care provider, and trying to be a patient’s “buddy”. My OBs have always been friendly, and very willing to answer questions, address concerns, etc. I have found them to be excellent listeners when it came to me airing my anxieties during pregnancy. I don’t think I’d want to be that close-knit with someone who has to stick her/his fingers or a speculum in my holiest of holies. AWKWARD.

    • Carolyn the Red

      My OB and I had a collegial relationship, I would say. I had absolutely no desire to talk about my feelings.

    • OldTimeRN

      I had an OB for about 15 years who I adored. Old fashion,conservative with a bed side manner most docs would be envious about. Then he retired.:(
      I work with the OB/GYN and it was hard to pick a new doc. I would only need them for GYN as I was done having kids. I went with the doc I felt was the best fit for me as my needs as a woman, someone who I felt was the best doc as opposed to who I thought was the friendliest or who I was closest to. Luckily my new GYN is wonderfully friendly and a great doc. But for me the professional good doc was my main goal.

    • Julia

      Friendly and professional I would say. Conversation pretty much exclusively about medical stuff, but I felt listened to and my wishes were respected. For the touchy-feely part I went to a prenatal yoga class (sponsored by the medical center I went to).

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

      Mine is friendly but still professional. We have chatted about wedding photos and school districts in the area, and are newly married so have that in common, but when it comes down to nuts and bolts, she is professional.

      My only concern with her is that she said that she doesn’t automatically induce at 40w0d but that she will have me go to L&D every second day for monitoring and at 41w0d the decision should be made to induce. I am completely terrified of late-term stillbirth, though, so would happily spend from 38w+ on a fetal monitor because I am a Nervous Nell.

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

        I was nervous nell for this too – I ended up induced at 39+0, the second the doctor would do it. I begged. She was kind – I was sick, had GD and mild hypertension so she could “justify”. I personally still wish I’d even considered a scheduled CS (dunno if I could have even gotten it) . I was so scared something would go wrong, and my labor nurse was a Wooster who made me miserable. But my birth (cs!) was fine and my baby robustly healthy and now I can nervous nell about EVERY THING lol

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

          I am already the most anxious person ever, my husband plans to watch me like a hawk after she arrives, haha.

    • Amy M

      No, mine was great. Very friendly AND professional. She managed my identical twin pregnancy and I credit her (though maybe we were just lucky) with my boys gestating until 36w and not needing NICU. I still see her once/yr for gyn checkup and she tells me she misses seeing me now that I’m not pregnant anymore. She’ll discuss mental health, (tho I wish she’d been more on the ball when I had PPD) and books. I’ve mentioned this site to her and we briefly talked about how homebirth is a bad idea.

    • Bombshellrisa

      I had a wonderful OB, friendly and still professional. She is nothing like what the NCB types claim about OBs. Her manner is very much like the best CNMs I have known. My son was delivered by a hospitalist and that experience was actually wonderful, even if I had only met that doctor one time before when I checked into triage. He was not the typical “male doctor” as vilified by NCB types.

    • Aussiedoc

      Love my OB. She was all tearful when the little one was born. Took brilliant care of me. Two thumbs up!

    • guest

      Me too. Awesome doctor, and part of the reason I am so comfortable with her is because she is friendly and personable (though certainly not unprofessional). I am there for the medical expertise and resources, but the fact that she is very pleasant certainly makes me feel good too.

    • 2boyz

      I actually did have a nasty OB during my second birth (or rather, he was great during the pregnancy, and then treated me horribly during the birth). I’m not planning on running off to a homebirth midwife for next time, though. I plan to find a different OB, one who doesn’t lose his/her $hit when something unpredictable happens…

    • Jessica

      My OB was wonderful. Patient, kind, interested in making sure I was doing well during pregnancy, and always had time to answer my questions and concerns. I didn’t need to talk about my feelings the way I would with a therapist, but I never questioned whether he had my best interests in mind. He also knew how to address my husband’s concerns. (My husband thinks he’s an awesome doctor. Which is saying a lot, because unfortunately my husband has a low opinion of the medical profession. But he has said he thinks more doctors should be like my OB!)

      Honestly, I sort of missed seeing him after I gave birth! He is just a fantastic doctor. I ran into him at the mall a month ago with my son and we chatted for a few minutes and he admired how much the kid had grown. I have nothing but praise for him and the care he provided to me and my son during pregnancy and at birth.

    • yentavegan

      The ob who delivered my second and third child refused me as a client for my 4th pregnancy. He did not need nor want my friendship or my approval. The OB who delivered my 4th and 5th wasn’t out to make me her pal either. I think of them as being professionals, not unlike, say my dentist.

    • Maria

      I had never met the OBs that delivered both of my babies (hospital staffs the L & D floor with residents and a couple of attending OBs who only work in the hospital), but for both births (one VD and one CS) they were uniformly friendly, enthusiastic, and professional. The OBs I saw for my prenatal care were also professional and interested in me and my pregnancy, although some were warmer than others. I received excellent care from them all. Did I feel like I wanted to be friends with any of them? Probably not, but I enjoyed my appointments with them and liked them all.

    • Rochester mama

      I had an OB that took over for the CNM when I needed a vacume extraction after my son started having late decels when I finished dilating and started pushing. She was great, he was basically almost crowning so she had me do one contraction of pushing then explained the vacume procedure, I gave my consent, she numbed me up and he was out the next push, not even a bruise on his head. I ended up with 3b tears, she offered pain meds since I hadn’t had an epidural then I consented to be a teaching case and she walked though the repair with a new resident. That was cool cause I got to hear exactly how the repair was done. She came back to check on the repair the next day even though she wasn’t doing rounds.

    • sleuther

      My OB was quite lovely (she still is, she’s my gyno) and always and about kids, husband, etc. She has 3 kids herself. We didn’t sit and talk for hours (I wouldn’t want to!) but I never thought of her as impersonal.

      Her colleague who delivered my younger daughter by ERCS was actually a bit brusque. Not unkind though. And I unexpectedly went into labor at 3am and daughter was out before 7, so….. yeah. Maybe she’s not a morning person!

    • Coraline

      I love my OB practice. All of the docs there have been great; my third delivery will happen any day now, and I feel like I am in great hands with each of the OBs. They really do provide personalized care…I was just in L&D yesterday to be monitored for a strange higher-than-usual BP reading at my 38 week checkup, and the referring OB and OB at the hospital (both from my practice) were wonderful about it; not impersonal at all. I have always felt “listened to” and never “talked down to” by each of them, and they show a genuine concern for my well-being along with baby’s. They’ve always explained things well, and are always happy to answer questions. Actually, for delivery of #2, when I needed labor augmentation due to an amniotic fluid leak that had been going on unknowingly for a few days, the OB was happy to consider my opinion when I asked to be augmented with cytotec instead of pitocin (I was induced with #1 with cytotec and my body worked very well with it). I’m a simple layperson; she could have easily said, “No, I’m the professional, I know what’s best for you,” (like many CPMs seem to do!) and she would have been right; but she was happy to consider my request. Seriously, I don’t know where NCBers are finding these “evil OBs”; I’m sure they exist, but my experience has been the complete opposite of that.

    • KarenJJ

      Mine was a bit of an ass, but he still did a good job.

      • KarenJJ

        Actually I wasn’t al that keen on many of the midwives either.. I felt like a naughty preschooler when I “couldn’t” get the hang of breastfeeding… I did have a really lovely nurse the second time around doing my post-natal care..

        I’m a lot more fussier with medical professionals now and probably should have changed doctors.

    • Becky05

      I definitely preferred the care of my OB to the CPM I used for my home birth. He cared much more about me and my baby, and took plenty of time to take care of us.

    • Amy

      I went to a mixed practice for my first. Many of the OBs there were dinosaurs and very impersonal, but there were just as many who were sweet, friendly, warm, and caring during appointments while still keeping the focus where it belonged, on the medical issues. There were three CNMs and all three were the right balance of friendly and professional. I ended up needing a CS, and the on-call doctor at the hospital took the cake for being warm, friendly, and personalized. I was very pleased with the care I got.

      For my second, I went to an all-CNM practice overseen by a pair of MDs, and ended up with an emergency cesarean. I barely talked to the doctor, but the nurses and midwives who were there for my very long labor were amazing.

    • Lombardi

      It’s like any profession you find all types of people in OB.I found my OB very personable even had a long chat with her on the Saturday after the birth of my 2nd about education opportunities in our area. I found her “medwives”very personal, sympathetic, and above all professional! Now the other OB she practiced with lets just say I am glad he wasn’t on call when I went into labor. Well, he was for my first but no one could find him! He was one of those gruff types with little bed side manner but I am sure he knew his stuff. He also assumed that everyone in our rural area was uneducated. He would talk down to me and I am sure other clients. I always kinda got the impression that he was biding his time until he could get out of Hicksville. If he was my first and only experience with an OB or if he delivered my kids I think I would have been at risk of being sucked in by woooo. He was for all intensive purposes the most dickish medical provider I have ever meant. I later found out from a friend at the local hospital he had a bad reputation among the OB nurses. I think stories like that guy get repeated and blown out of proportion by the HB community.

    • Danielle

      My regular OB was very kind and approachable. I’d have settled for highly competent, but got more. The L&D nurses were kind and supportive as well. The NICU nurses, save 1, were wonderful beyond all measure. The OB who delivered my son later made the news for certain professional lapses–but I still remember that individual as the person who swept in, was calming in his no-nonsense let’s-do-this attitude, and got my baby out faster than I ever realized was possible. But he could still crack a joke afterward and insist I look at my placenta-from-hell… which in retrospect was pretty interesting.

      I also had a doula-in-training attend the birth, figuring she might be helpful. It was my first time, my parents far away, and all that. But in the end, I wasn’t really sure what to do with an extra support person. I didn’t really need anything the staff was not already providing. So I fear I was a boring client. But my labor was problematic and ended in a big emergency, so there was perhaps some schooling there. And when the delivery was immanent, she kindly ran to find my husband, who had just stepped out to call my parents, not guessing that just moments later my nurse would call whatever code it is that means, “We have a problem! Get the baby out now.”

  • Deena Chamlee

    One more thing. I deeply value MDs. Just had to get that on the record.

  • Guest

    This is a great post. This is a post every expectant parent should read. It’s really everything you need to know.

  • Bombshellrisa

    Love this post!
    What I value about the care I get from my OB/GYN is her ability to treat a variety of conditions, not just a woman “in the childbearing year”. She does LOVE babies and knew she wanted to deliver babies since she was a little girl-so she got the education and training that qualified her to be able to do that. She is also a very good listener and incredibly compassionate-although we don’t talk about my favorite colors and she doesn’t offer a variety of candles to choose from during my visits. When my blood pressure started creeping up during this past pregnancy, she didn’t suggest the Brewer diet and herbs, she had me visit triage regularly to be monitored and ordered blood work and let me know based on what the findings were how she wanted to treat me.

  • Certified Hamster Midwife

    OT but not really:

    Study: Nearly Half Of Americans Believe In Medical Conspiracies: http://washington.cbslocal.com/2014/03/19/study-nearly-50-percent-of-americans-believe-in-medical-conspiracies/

    Seems many Americans believe in medical conspiracies, reports Live Science. Researchers surveyed 1,300 Americans to find out their beliefs about 6 popular theories, including the discredited link between vaccines and autism or that water fluoridation is a cover-up that allows companies to dump dangerous chemicals into the water supply. Just under half agreed with at least one conspiracy theory. 18 percent agreed with three or more.

  • Irène Delse

    Great post! That’s really a very important distinction: what do people actually mean by “personalized care”? Alt-med advocates talk a lot about treating the whole person and not just one condition, but too often it ends up in reality as “taking a lot of time to chat about your favorite colors, high-school anecdotes and other personal quirks”. It may make a person feel good but doesn’t add any information relative to their care. Hence maybe the feeling that evidence-based healthcare professionals are “cold and impersonal”, they ask the questions needed to assess the medical situation, not the questions a patient may wish they had to answer.

  • Deena Chamlee

    One more thing how in the world are they still allowed to practice? How can anyone get alicense without moral or ethical codes as they blantantly state in their standards? Missy and others bragged about this by stating “licensure isnt going to make a difference in safety..” In your face blanantly bragging. But the most important question I have is..Why has ACNM GONE ALONG WITH THIS ABUSE FOR GREATER THAN 30 YEARS AND ALLOWED IT TO SPREAD LIKE A TUMOR NATIONALLY AND INYERNATIONALLY. I know the answer and all good people must stand togrther for change. Because statisticly speaking there is more of us than them.

  • Deena Chamlee

    They literally cannot accept the evidence that is right in front of their eyes, so they deny it (“some babies are just meant to die” sounds so much more soothing than “we tried so hard for a vaginal birth that we killed the baby”), or, in the case of homebirth midwifery leaders like Melissa Cheyney, they tell bald-faced lies about it, claiming that their own hideous death rates are “safe.”

    Sadly my colleagues who published this article in the our journal was also guilty of manipulating others reality of the truth. And continual denial works by making everyone else question the truth. Crazy making abusive dysfunction, harmful acts that involve others lives.
    They know it is a voluntary database, they know the data is entered retrospectively allowing for bias- enter the good data leave out the bad. Or maybe enter a few bad just to manipulate once again. I don’t think it is that they cannot accept the truth, because THEY KNOW THE TRUTH, They deliberately use semantics, language to confuse the public. Therefore, if MDs data say one thing and homebirth says the exact opposite it keeps everyone guessing, debating by pushing buttons, and the poor public gets the brunt of it all . Thus, in their reality therefore they have won because what is , is.
    All I can say is “what aint aint.”

    • Comrade X

      ” “Some babies are just meant to die” sounds so much more soothing than “We tried so hard for a vaginal birth that we killed the baby” ”

      I personally find that the opposite is true. Neither one is particularly soothing, and very little could be, given that someone has just been killed by medical neglect. But at least “We tried so hard for a vaginal birth that we killed the baby” takes SOME responsibility and ownership for causing a person’s death. “Some babies are just meant to die” is one of the most chilling, terrifying phrases that we hear in this whole NCB clusterfuck. It was nothing WE did, that person was MEANT to die. It’s even denying that the outcome was BAD. If something’s “meant” to happen, that kinda implies that it would be almost wrong to stop it from happening.

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

        That’t exactly it. That’s why it is ‘soothing’, because it absolves everyone involved (particularly the ‘practitioners’ involved) of any and all responsibility. It makes it into an act of God, or part of a ‘plan’ over which nobody had control. And you’re right, it’s chilling.

        • Comrade X

          But that’s insane!! I mean, what if I go out into the street and shoot some random passer-by in the face? Technically, if you believe in a pre-ordained plan by G-d, that poor person getting off the bus or carrying their shopping home was “just meant to die” and I was merely the means of it happening. That doesn’t stop me from being a FUCKING MURDERER. Also, I think if someone is really “meant to die”, in some deterministic philosophical sense, then they will die NO MATTER WHAT WE DO TO SAVE THEM. It still does not absolve us of ONE IOTA of responsibility for doing everything we can to save them. G-d, this makes me so fucking angry.

          • Amazed

            “God meant for them to die. If he hadn’t, my gun would have misfired.”

            Those are the words of a real serial killer. Currently bringing a lawsuit against us in ECHR because… I don’t know what the term is in English but it is a law where the imprisonment for life cannot be shortened by a guarantee or whatever the prisoner did to prove that he was now a better man… so this law passed quite shortly before his case was heard and he got sentenced to it. He feels cheated.

          • Young CC Prof

            Without parole?

            In that case, I’d say good.

          • Amazed

            Yes, I think that might be it.

          • yugaya

            In UK I think it is whole life order, with meaning of special court order that prohibits any parole to those sentenced to life imprisonment.

          • Amazed

            Ah, that sounds quite close.

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

            Oh, I agree with you, it is insane. In the worst possible way. Basically, these people are sociopaths with a society full of enablers. Same as fucking anti-vaxxers, as far as I am concerned.

    • OldTimeRN

      “Some babies are just meant to die”
      Anyone who has any experience with the newborn in the birth and delivery period would know that is a complete lie. Babies want to live.Babies want to breathe. They try very hard to help you. Sometimes they need a little help. Sometimes they need a lot of help. But, no some babies are not meant to die. Especially ones perfectly healthy who only die through negligent medical providers who ignore signs and symptoms of distress. But hey at least mom got to have the experience she’s dream about, right? /sarcasm

      • Karen in SC

        This sentence brought tears to my eyes: “Babies want to live.”

      • BeatlesFan

        “Some babies are just meant to die”

        My MIL had a stillborn daughter, exactly 53 weeks younger than my husband, who was dangerously premature and wasn’t expected to survive. The stillborn girl died in utero in the third trimester, so it was known before the birth. I believe to this day, my MIL has no idea why the baby died. She still talks about her. The baby was born on Valentine’s Day, and for years she would bake a heart-shaped cake that day, which my husband and his surviving sister thought was a V-Day cake and which my MIL made to be a birthday cake for her dead daughter.

        My MIL will never know why her second child died in the womb. There was no accident, to medical issues, nothing. Yet I can guarantee that anyone who tries to tell her “some babies are just meant to die/some babies just aren’t meant to live” is going to get their eyeballs gouged out with her fingernails, and they’ll be fortunate to escape with that.

  • Zornorph

    Yes, but homebirth midwives do offer a wide variety of scented candles. I kind of like the vanilla ones, myself.

    • stenvenywrites

      Heretic. Everyone knows the birthy-smell-scented candles are better for bonding, and cinnamon-scented candles prevent pph.

      • Mel

        We decreased PPH in cattle by burning straw-scented candles and the cracked corn variety dropped milk fever cases by 397%!!!

        (Actually, we changed the feed rations to decrease acidosis and prevent excess weight gain in late pregnancy cows. )

        Less woo, more common sense

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

      Heh, this made me think of you and our other resident dudes when I heard about it a few days ago. http://m.yankeecandle.com/mt/www.yankeecandle.com/yankee-candles/limited-editions/man-candles

      • Zornorph

        There are few smells I find as objectionable as cut grass, so ‘Riding Mower’ would not appeal to me. I suppose Movie Night smells like popcorn and Mmm, Bacon! is self explanatory. I’d be sort of worried to know what ‘Man Town’ and ‘First Down’ smell like, though.

        • Mer

          I love the smell of fresh cut grass, but I’m highly allergic so . . . I don’t even have a lawn.

      • Poogles

        Mmm, Bacon! ;-)

      • auntbea

        My husband is obsessed with smelly candles (and soap) and good gracious does he pick girly ones.

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

    Sadly, I must admit that the dogmatic belief in vaginal birth also infects many OB’s (perhaps more so in Canada than the US) – and there are women who want nothing more than personalized care who are being depersonalized by the care they are receiving. If I wasn’t witnessing it happening, I’d have a hard time believing it. It seems in Canada that many women with very, very good reasons for planned cesareans are being denied reasonable access. Women with twin pregnancies. Women with transverse lies and an objection to ECV. Women who know the risks and benefits of their options and would choose cesarean are being denied the choice. And unless something catastrophic happens – and they can demonstrate negligence – most will discover that they are without recourse.

    • Amy M

      How many deaths/disabled will it take to swing the pendulum back toward more caution?

      • Young CC Prof

        It’s not the number, it’s the interpretation and publicity.

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

        This isn’t about providers exercising “more caution” – this about allowing women to be able to declare they aren’t comfortable with certain risks and being able to choose for themselves care they are comfortable with. These women must ultimately live with the consequences – disasters may make women more cautious, but unless providers are willing to facilitate that it is meaningless.

        • Amy M

          Well, I was thinking in terms of how OBs in the US will often do Csections if there is any doubt at all because it is better to be cautious and have a live and uninjured baby and mother than take the risk. It seems to me (from reading here) that ECV on a transverse lying baby is more risky than simply doing a Csection at 39wk, which would be the more cautious way to handle the situation. Of course the woman in question should have a choice, if she wants to try the ECV and she should be aware of the risks and benefits of both options.

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

      This is happening in the UK and increasingly often in the Australian public system, too.

      It seems like there’s a twofold issue: doctors are being encouraged/pressured to reduce their cesarean rates and generally reduce costs to the state, and there is an increase in midwife-led care with younger nurses who are being taught this woo in universities (this I am basing mostly on anecdata, the midwivesI know between the ages of 25-35 and my family and friends experiences in the UK and AU public systems).

      • Aussiedoc

        I can confirm this in Australia at least.

        We ave a guideline ‘towards normal birth’ specifically aimed at reducing the Caesar rate. It is very difficult to get a maternal request Caesar in the public system (you need two consultant obstetricians to agree – so in places with no consultant obstetricians – not easy).

        And yes – increasingly woo infested midwives – the best example being the startling rise in the numbers of 3rd and 4th degree tears recently – due in part we think to this idea of ‘hands off birth’ being taught.

        • rh1985

          Australia does at least offer private options though, correct, unlike Canada? A woman on another message board I post on had an elective CS in Aus, but I think she used a private hospital.

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

            Yeah, that’s why I think a multipayer option is ideal, from a medical care perspective. The Australian healthcare system overall, in my experience and that of my friends and family, is excellent. In many cases you are better off in the public system but I don’t think that pregnancy and birth are one of those cases, simply because of the woo that’s emerged in recent years.

            It worries me that women who can’t afford private care are stuck at the mercy of a system that is cutting obstetricians out. Back in the day, some of the best obstetricians could be found in the public sector, but they seem to be getting edged out, sadly.

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

            You are correct.

          • Certified Hamster Midwife

            That’s the one thing that really doesn’t make sense to me about the Canadian system. I’m somewhere to the left of Bernie Sanders when it comes to health care, but taking away someone’s right to pay for whatever care they want if they have the money to spend on it seems very wrong.

          • AlisonCummins

            It’s viewed as jumping the queue.

            In my province we have free-standing radiology clinics. Doctors need to choose between only taking public insurance and never taking public insurance. While a private-pay-only maternity hospital would not be practical, it’s both straightforward and profitable for a radiologist to open a radiology clinic for private-pay only. The result is that people with cash or private insurance can get a fancy scan immediately or within weeks, whereas people who don’t have the resources for private-pay wait months for a scan in a hospital clinic. Sometimes many months.

            Many people conclude that if there were no private-pay clinics that everyone would be waiting many months for all their scans, but that’s not quite correct. Since people who can’t afford private-pay are less likely to vote, it’s easy for hospitals to cut costs by cutting their radiology services back severely

          • AlisonCummins

            … by cutting back their radiology services severely and letting outpatient radiology be handled by the private sector. If there were no freestanding, private-pay clinics then everyone would be waiting in the same queue and voters would grumble if the queue got too long. Something would be done.

            (Note that there is no apparent resource issue with inpatient radiology where there is no private queue. If you’re in an ER or on a ward and you need a scan, you get one. Period. As far as I can tell.)

            I empathize with the frustration of dealing with gatekeepers who seem to be serving an agenda other than the best interest of the patient, and wishing there were a way to do an end-run around them and find someone whose goals were aligned with mine. I’ve been there and I know. But this is the rationale.

          • DaisyGrrl

            Yup. The most recent campaign to reduce wait times in my province has focused on hip replacements. Meanwhile parents of children with ASD can’t get them into treatment without a 3-4 year wait. Gee, I wonder which group has a larger number of voters…

          • Aussiedoc

            That’s correct. Tellingly the Caesar rate is much higher in the private system ;). The midwives tell us this is a terrible thing. I wonder how much this is women exercising choice! (Granted its also older women as well).

            After all – I was offered an elective Caesar multiple times even during labour. At any stage all I had to do was say – nup I’m done and my OB would have arranged it. Because she knew I understood the risks. (NCB folk would probably think that was undermining. I personally found it empowering to know I had the option if I needed it on my terms).

            The issue is that private is very expensive ( American readers will no doubt laugh) and not available outside of the bigger cities. Interestingly as well – the care is not always as good. The nursing/midwifery staff are usually better in the public hospitals and if you have a high risk pregnancy needing potential NICU – you’re better off starting in public or else risk a transfer.

        • LMS1953

          Ain’t that the truth! Attitudinally, the only difference between a CPM and a CNM is the P=>N mutation on the X chromosome.

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

            I don’t think that’s at all fair. There are plenty of midwives, especially older ones, who are responsible and respect obstetricians. Many of the woowives I have encountered have been educated in the last 15 years or so.

          • SNM1

            Could you explain what you mean by this? I am about 6 months from being a CNM and I have very different views on birth than most CPMs. I have no opposition to the woman who wants pain relief during labor or to the woman who does not. To me those are personal choices for the woman to make and she knows best how she responds to pain then I ever would. Evidence based practice and informed consent are incredibly important to me as I think women need the information to make the decisions that, again, work best for them. Additionally, I may not have delivered thousands of babies like some CPMs can claim, but as a nurse I have been in emergency situations and I know how I respond when something goes wrong. I have many years of education and experience behind my practice and beliefs. And I know some CPMs that also take emergency preparedness very seriously as I have taken NRP and BEST training with them (not planning to do home births but figure that practicing simulations in shoulder dystocia and PPH among other emergencies can only be beneficial, even in a hospital setting). I have met some doctors/CNMs/CPMs that I wouldn’t wish on my worst enemies and I have met ones that I thought were great and really valued evidence and quality care. As was pointed out below, women and babies are not one size fits all… Neither are the providers, regardless of the credentials behind their names.

          • Deena Chamlee

            SNM what is your email address? I am a CNM who wrote a paper on Midwifery in the United States that was debated by the elders and would love to share. I think it may assist you with understanding.

          • SNM1
          • http://Www.awaitingjuno.blogspot.com/ Mrs. W

            But small mutations can have big, big differences.

          • Comrade X

            LMS – sorry, but a lot of us aren’t getting your joke/reference. Could you explain, please?

    • LMS1953

      Mrs. W, was the woman with a transverse lie able to decline to give informed consent to the ECV. How did that work out?

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

        LMS1953 – Here’s the problem – she declined consent, and in response the OB has now proposed that she either consent to an AROM/TOL with a transverse lie or wait for spontaneous labour with a transverse lie. A planned CS under a general has not been put on the table as an option. It’s a case of – “do it my way, or I’ll force you to do it the riskiest way possible.” She’s currently damned if she does and damned if she doesn’t.

        • Comrade X

          Fuck, that’s appalling.

        • Amy M

          Would this OB suffer any consequences if the baby is killed or injured? Or if the mother is?

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

            Then you are in the realm of medical malpractice law in Canada – doctors have the full backing of the Canadian Medical Protective Association and as a result have access to lawyers who are known to aggressively defend claims, even those with merit to the extent possible. Plaintiff’s fund their own litigation and will be on the hook for defendent’s costs should they lose at trial. Medical malpractice is an incredibly complicated area – and as a result unless the damages associated with the claim are very significant (dead babies actually don’t accrue a lot of damages…nor does psychological injury), few lawyers will take those cases on contingency. So unless the woman is independently wealthy, there are significant barriers to justice. She might be able to complain to the college of phsicians and surgeons…

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

            That is horrifying.

          • http://www.canadianliving.com/ Jennifer Gruden

            As someone who at first pursued and then dropped a case, I can confirm some of this. At that time (2004) the largest award ever in Ontario for a baby who died was $75k per parent, so $150k. At that rate even losing one baby a year wouldn’t cover the costs for extra doctors and nurses on each shift.

        • SNM1

          That is crazy and I can’t, for the life of me, figure out how that could be legal… This is my problem with going too far in either direction! Women should always have the final day! So what she didn’t want an ECV? I have heard they are quite painful (never had one so I have no personal experience here!)… An ECV was offered, she declined… To my understanding (just from what I have learned as an SNM) labor with a transverse lie is incredibly risky as there is a much higher risk of rupture and fetal compromise and I am also thinking prolapsed cord is a risk as well, but I would need to look that up to be sure .. I disagree fully with AROM/TOL in this case…

          • Medwife

            Definite increased risk of cord prolapse. This case is horrible.

          • SNM1

            Thanks! Been studying for finals so haven’t had a chance to look that up yet!! It is nice to see I haven’t forgotten all the information I have packed into my brain recently! :)

        • Karen in SC

          Any chance of going to the head of OB? or the head of the hospital? Or the hospital’s lawyer? Board of Directors? The plan as it stands is very risky and I can’t believe it would stand if she can go higher on the decision making tree.

        • DaisyGrrl

          Has she had any success in getting a second opinion? That’s nuts!

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

            Not as of yet, but has made it very clear she wants one.

        • The Computer Ate My Nym

          WHAT? That’s got to be reportable or lawsuit worthy malpractice. Transverse lie + labor = death for mother and baby.

        • toni

          What?! A transverse baby can’t be delivered vaginally, surely? What would be the point of labouring with an undeliverable baby?

        • Dr Kitty

          AROM with a transverse lie is against common practice and all good sense.

          If it was the UK I would suggest making a complaint to the GMC, the head of department and the hospital trust CEO, citing all relevant best practice guidelines…

          Of course, there is the option of going to the media, patient advocate organisations and politicians.
          But that is kind of nuclear.

          I like the NHS…you have a right to second opinions, have a right to fire your specialist, and the GMC will accept complaints from anyone.

          The management plan, as suggested, is malpractice.
          The SOGC guideline on IOL specifically states that transverse

          • Dr Kitty

            …lie is a contraindication to IOL.

            It is on page 4/18
            http://sogc.org/guidelines/induction-labour-replaces-107-aug-2001/

          • Dr Kitty

            There is the slightly less nuclear option too.

            A written letter to the CEO of the hospital, head of OB, her OB and a copy for inclusion into her medical notes.

            “I no longer have faith in the competence of Dr Y to manage my care. He is recommending a dangerous management strategy which is contraindicated by SOGC guidelines, and despite my request for a second opinion and transfer of care I remain his patient against my wishes. I am being co-erced into a course of action I believe to be dangerous, and any consent forms signed agreeing to AROM/IOL/TOL should be treated as invalid due to duress.”

          • FormerPhysicist

            Wow! It’s so horrible if that’s what it takes.

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

            I will point out the practice guideline – I think the OB may have been strong arming her to agree with the original plan (ECV then TOL) – it just seems so absurd .

    • LMS1953

      I think this attitude (decrease C-section rates without due regard for safety) was at play with the OB in Corpus Christi who did an “internal decapitation” of a baby girl he was trying to deliver with forceps back in December.

  • Mel

    YES!

    You crystallized another nagging feeling of mine based on my farm experiences – we don’t treat all cow labor and deliveries the same. Why would midwives insist on less thoughtful care than we do on our farm.

    – We watch first-calf heifers like a hawk – no idea what shape/size of the pelvis or calf she grows. If she has a bad calving, we will re-breed her since first births are often hard. I don’t know why midwives would accept homebirths for first time moms since you have no idea about the shape and size of the pelvis.

    - Second and third calf cows are in their prime and rarely need help. If they have a bad calving we look at causes. If she’s growing large calves from bulls that are known to produce small calves, we won’t breed her back. They are at higher risk for milk fever so the workers know to call us if the cow doesn’t get on her feet within 15 minutes after birth or is shaking so we can treat her. They are also at higher risk of uterine prolapse. I don’t know why midwives wouldn’t screen moms for dangerous situations like GD, pre-E ect since we track milk fever cases and don’t re-breed prolapses.

    -4th calves and up are much more likely to have a stalled labor and milk fever. We watch those older cows as tightly as we do the first calf heifers. Why midwives would accept human moms who are in similar situations are beyond me…..

    - Multiples and breeches are dangerous – both for mom and babies. We watch them like hawks and intervene fast since both have much higher stillbirth and dam deaths. Shoot, we’ve sold cows that dropped twins repeatedly – good cow, but once you’ve lost two calves and a cow on the same day, you never want to do that again. I can’t figure out why midwives think they can deal with situations as dangerous as twins and breeches at home. Hell, we can’t handle all breeches without multiple people and a vet – why would you want less for a human?

    • Karen in SC

      A friend planned her fifth baby at a birth center 2 hours away. The only plan the midwife had in place for a quick labor – If you need to pull over on the side of the highway, call me and I’ll drive up to meet you. I. kid. you. not.

      There are two hospitals here, one with a Level III NICU, the other has a more natural focused “birthing center” attached.

      • Amazed

        And your friend agreed? Oh my.

        • Karen in SC

          She agreed because she wanted the waterbirth offered at the center.

    • DaisyGrrl

      “Why would you want less for a human?”
      And that’s the part that baffles me. If you’re receiving care that would be considered abusive towards an animal, maybe you should re-think your plans.

      • Karen in SC

        Perhaps women planning a homebirth should have a large animal veterinarian on speed dial. /snark

        • Mel

          I’d be cool with that since the vet would have one response – “GO TO THE HOSPITAL!”

          • Comrade X

            Actually, I’d rather have a genuine vet attend me during birth than a fake midwife.

          • Young CC Prof

            Assuming I couldn’t get to actual medical care, I’d rather have any levelheaded person who’s seen it happen once or twice.

          • Trixie

            Absolutely 100% agree with this.

          • Medwife

            Vets are friggin smart. I’d take one over a CPM.

          • Stacy21629

            Thanks for the vote of confidence…but I’d still tell you “GO TO THE HOSPITAL!” :)

        • Trixie

          This thread is starting to remind me of Trailer Park Boys. Lol

  • Lisa

    This post is so true. I’m currently 22 weeks pregnant, and with every test my OB has recommended, she’s discussed the risks and benefits as they pertain to me.

  • OldTimeRN

    After attending 100′s if not heading into the 1000′s of birth over my career I often ask myself “What is a normal birth?”

    As the old saying goes “The best laid plans of mice and men often go astray”

    • stenvenywrites

      This is a great point. As a former homeschooler, I can attest that there really is no such thing as a first-grader (or a third grader or a ninth grader.) Many people who would have no problem with kids who are highly individualized, all over the map in terms of cognitive development, academic interests and creative talents, seem to believe that those same children, as infants, were one-size-fits-all. If there is no one “right way” to educate a child, why is there only one “right way” to feed, sleep, discipline, or locomote with his baby brother?

    • LMS1953

      I say it this way, “The earliest time you can make the diagnosis of “normal birth” is at the 6 week postpartum visit.”

  • Ra

    And another one: Pain is irrelevant. Regardless of the situation, history, or anatomy–you must not receive any pain medication.

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

      Sadly, this seems to be a common issue in midwife-led hospital care in the UK, too. There’s so much emphasis on the ‘productive pain’ dogma and despite the NHS saying they will never deny pain relief, they have arbitrary rules in place for when they will do it (i.e. not before 4cm) and will do their best to discourage a woman from getting it.

      This blog post from an anesthetist sums it up pretty well:

      http://theadequatemother.wordpress.com/2012/08/29/is-pain-relief-part-of-normal-birth-obstetricians-midwifes-and-birth-activists-in-the-uk-dont-think-so/

      How that is any better than offering pain relief to women in birth is beyond me.

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

        This is so different from the policy in place when I was in the UK. We could, and did, offer a variety of forms of analgesia, although, obviously, we couldn’t arrange for an epidural in the home.

        • Comrade X

          Yup, I’ve been watching “One Born Every Minute” recently, which is a “fly on the wall” type documentary filmed in a busy maternity unit in a town on the south coast of England – and while the midwives seem competent and committed to their jobs, monitoring seems reasonable, and serious problems do seem to be picked up and handed on to an obstetrician in a timely fashion, again and again and again we hear about how you can’t get an epidural until you’re at at least 4 or 5 centimetres. And would you like to try the gas-and-air. And there’s no point in screaming, it doesn’t help anything. And even, don’t put your energy into screaming, that’s wasting it, put your energy into pushing instead (during pushing stage).

          What is the rationale behind waiting until 4 or 5 centimetres before getting an epidural? And also, if there *is* a good reason to wait until 4 or 5 centimetres, that would surely mean that there’s usually plenty of time to get hold of the anaesthetist and let them know their services are going to be needed – so you don’t have to page them all over the damn hospital at the last minute – but that doesn’t seem to happen. It’s as if they’re sort of hoping that the lady WON’T want an epidural, that she might decide to “tough it out”, so they don’t make proper preparations ahead of time as a matter of course.

          I hope I don’t seem to be slagging off the midwives featured in this programme, as they mostly seem to be genuinely committed to their jobs and vocations, but this really does seem odd to me.

          • Aki Hinata

            “And there’s no point in screaming, it doesn’t help anything. And even,
            don’t put your energy into screaming, that’s wasting it, put your energy
            into pushing instead (during pushing stage).”

            The nurse I had with my first baby said this to me while I was pushing and she was darn lucky I wasn’t in a position to slap her! Let’s see how friggin’ quiet you are when you’re doing something painful.

          • Comrade X

            Lol! But is any of it even TRUE? IS THERE any reason to delay epidural to 4 or 5 cm? IS THERE any truth to the idea that you push better if you don’t scream? I have this horrible feeling that quite apart from not being a terribly helpful thing to hear at the time, it might all actually be platinum-plated BOLLOCKS.

          • Karen in SC

            According to this study, it is bollocks for the most part.
            http://theadequatemother.wordpress.com/2013/02/04/2-cm-810/

          • Medwife

            Well, if you’re screaming, you’re not holding your breath to push, is the logic. I have had births where the woman came in complete and baby at a low station and clearly no way to get an epidural in time. In those situations I’m careful to first acknowledge that this was NOT the plan, that yes it sure does hurt like hell, I wish she could get an epidural soon but at this point we just have to get through it as quickly as possible. I hate those situations. I will happily support a lady with a drug free birth plan but I am not in the business of tricking people into unmedicated birth, I think it’s very cruel and obviously unethical. I got a patient an epidural yesterday who was 10cm and low baby. She had it in place just before she had an irresistible pushing urge. It went just fine and it would have been a screaming, fighting-away-from-the-pain type scene otherwise because she had zero desire to give birth like an earth goddess.

          • BeatlesFan

            The same happened to me with my daughter’s birth- I showed up to the hospital at 8.5cm with my bag about to explode. When the CNM told me it was too late for an epidural, I nearly cried. She then followed up with, “So we’re going to push a bag of fluid into you as quickly as possible so you can get a spinal block instead.” I had my blessed pain relief within 20 minutes, and it lasted almost exactly long enough to get me through the birth without screaming the place down. I will always be grateful to the CNMs, OB, and anesthesiologist who went out of their way to quickly and efficiently get me the pain relief they knew was very important to me- and without the helping of condescension and guilt I received from the CNMs I had during my son’s birth.

          • SNM1

            Anecdotally, I have seen epidurals both speed up and slow down labor but I am not sure exactly what they base this rule on as I have not seen any research that supports that epidurals really slow down labor… Like my experience, most studies say that it varies… Maybe it is because it varies that many hospitals have this policy in place? Not really sure, but it would be interesting to seems study on the length of labors in women who had epidurals placed (including c/s rates and complications, etc.) compared to women who did not have them placed until after 4 cm and see if there is any science behind the policy…

          • Amy M

            I believe these studies have been done…see “The Adequate Mother” blog, link to the right.

          • C T

            Although the conversation here is clearly focused more on the first stage of labor, it’s relevant to not that there is a recent study (Cheng, 2014) showing that epidurals tend to increase the pushing stage by more than two hours. http://www.empr.com/study-quantifies-epidural-linked-increase-in-2nd-stage-of-labor/article/333152/ So, yes, they do slow down labor, at least the second stage.

          • Young CC Prof

            Actually, the 95th percentile was longer by 2 hours. Study is behind a payway, so I can’t see what the difference in 50th percentiles was.

            Also, it’s a retrospective study, so it suffers from the main confounder of all epidural studies: That women having longer and harder labors are more likely to ask for an epidural in the first place, and women who have easier labors are more likely to skip it.

            And finally, five and a half hours of pushing!? Whose idea was that? I think you’d die of stress if you tried to do that without an epidural! And I really really hope they were monitoring that fetus.

          • fiftyfifty1

            The second stage is from when a woman is 10cm (complete) until baby is out. It is informally called “the pushing stage”, but that doesn’t mean you have to be pushing during it. Instead you may chose to let the baby “labor down” without pushing. Obviously this happens way more often when a woman has an epidural in place. With the epidural in place there is no overwhelming urge to push, and because pain is controlled there is no rush unless baby is in trouble. Nurses may note someone is complete and at that point turn down the epidural to let it wear off a bit and encourage the person to wait to push. I wonder how much of the difference in second stage length is due to that rather than an actual increase in *pushing* time. Wish I could read the whole article.

          • Becky05

            “But is any of it even TRUE? IS THERE any reason to delay epidural to 4 or 5 cm? ”

            Nope. Absolutely not true. Actually some evidence that it may speed up labor to get an early epi.

            http://www.nejm.org/doi/full/10.1056/NEJMoa042573
            http://www.ajog.org/article/S0002-9378(05)02444-0/abstract
            http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2011.02906.x/full

          • Comrade X

            Then for the love of G-d, WHY???

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

            Because patriarchy.

            I always feel like they’re incredibly patronising to the laboring women, to be honest. I also hated the episode where they sent this poor girl home and she ended up nearly giving birth in her car.

          • Trixie

            It’s not like there’s even evidence for that. How many silent discus throwers have you ever seen?

          • wookie130

            Well, I’m not in the UK, as I’m in the states, but according to my Lamaze “instructor” (i.e. nurse turned woo-filled dipstick is a more accurate description of this person), that it’s “better” to get an epidural between 4 and 5 cm, as usually by then, a laboring woman will have a more established labor pattern, and at that point, having the epidural won’t slow the pattern down. I honestly can’t attest to the validity of that statement, but at the time, it sounded logical.

            Which is why I’m a special education teacher, and not a nurse or Lamaze instructor, but yeah.

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

            One Born Every Minute enrages me. If I had to hear ‘it’s productive pain’ one more time.

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

          I know that birthing shows are nothing more than anecdata, but watching ‘One Born Every Minute’ seems to demonstrate the current climate pretty clearly. The number of times you hear ‘productive pain’ on that show is startling, meanwhile the women asking for relief are patronised and essentially guilted into going without :(

  • Karen in SC

    Another part of the dogma: “Your baby knows when to be born.”

  • Rochester mama

    I love this post. I found this blog while I was pregnant and while I wasn’t actually considering homebirth I was consumed with reading sorts of pregnancy and birth information. There is SOOOO much crap out there and is post sums it up the differences well.

  • carovee

    Next time someone comes here complaining that Dr. Amy hasn’t practiced medicine in X years we can all point to this post (among others). She works amazingly hard at keeping up-to-date despite not currently practicing medicine. If I were “retired”, I wouldn’t be doing nearly as much to stay abreast of my field.

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

      Exactly what I was thinking. It is admirable and a point detractors seem to miss.

      They also seem to miss the irony of the fact that the midwives they trust aren’t bothering to keep up-to-date on, well, anything. Other than mantras that women’s bodies aren’t lemons.

      • Karen in SC

        Dr. Amy should compare the agenda of the OB conference with the Trust Birth “conference” being held in Pennsylvania.

        Add the CVs of the doctors, at least a shortened version, and in the “midwife” column, add known deaths and any pseudoscience articles.

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

          I think that’s a fantastic idea. It’s a shame we will just be accused of being ‘meen’.

          • Comrade X

            Well, if you’re going to be “meen” to anyone, a fucking murderer would be a good start.

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

            Couldn’t agree more. The shame lies with the fact that so many women aren’t interested in hearing facts and will just write us off as h8ers.

        • Young CC Prof

          So are we going to picket that conference? I’d totally do it.

          • Karen in SC
          • Young CC Prof

            It’s Friday April 25 through Sunday, with minor events on the Wednesday, Thursday and Monday. Which day would be best to protest? Saturday?

          • Amy Tuteur, MD

            The day that will be most convenient for the local TV stations to cover it.

          • Karen in SC

            I’d love to see a reporter corner Jan Tritten about Gavin Michael a la 60 Minutes style.

          • Deena Chamlee

            A channel 5 reporter in Atlanta is an aquantance of mine. He said we meaning as many as possible, should stand up and take this national. He suggested Dr. Phil because of the horrific widespread abuse.

          • Trixie

            I would suggest emailing the Harrisburg Patriot News. They broke the Sandusky scandal and do some pretty good reporting. They’ve given Diane Goslin a fair amount of coverage, and she’s a speaker at the conference, which may be surprising. I will also email them.

          • Trixie

            I’m local, but (ironically) throwing a baby shower that Saturday.

          • lawyer jane

            The agenda of the conference is terrifying. It includes sessions on twin and breech homebirths. http://www.midwiferytoday.com/conferences/Harrisburg2014/program.asp

          • Karen in SC

            Two poster suggestions:

            MANA stats — x out of XXX Breech babies died (not sure of exact numbers)

            List of second twins that have died at homebirth – with names and pictures if possible

          • The Bofa on the Sofa

            So the next time some midwife tries to brush off high risk homebirths as something that only fringe midwives do, we can point to this – this is FRIGGIN MAINSTREAM MIDWIFERY talking about doing crazy high risk births.

            This is not some “lunatic fringe.” This is a lunatic mainstream.

          • Trixie

            I tried to make that exact point on Orac’s post in the comments when he was criticizing Dr A for including high risk women. Look at what they’re teaching them!

          • Mel

            I hope the message is “DON’T” but I doubt it….

          • Medwife

            Short class!

          • Young CC Prof

            This is the difference between a baby’s head and its ass. If the baby has them mixed up and is trying to come out that way, call an ambulance.

            The end.

          • Amy M

            What are the emotional causes of shoulder dystocia, I wonder? Also, someone there thinks prematurity is often preventable. If only I’d known! I wish I could go to this thing…..

          • DaisyGrrl

            The speaker bios are nuts. At least three boast about teaching/attending VBACs, twins, and breach. Others boast of their human hesources or anthropology degrees. And there was a home-birthin’ anti-vaxxing chiropractor!
            There wasn’t a single one in the bunch that should be trusted within a mile of a pregnant woman.

          • Trixie

            You forgot the one who killed and maimed babies by not reporting the GBS test results to the mother or offering them antibiotics in labor. She’s teaching a class on herbal remedies.

          • DaisyGrrl

            Yeah, I was just going by their actual bios. I’m thinking of looking up their track records (that we know about) tonight when I get home. I’m sure it will be chilling reading.

          • Amy

            How about the facilitator who goes PROFESSIONALLY by “Sister Morning Star”? I made the mistake of visiting her website– the collective noun she uses for more than one adult female is “wimyn.” Yeah, that’s who I want delivering my baby.

          • DaisyGrrl

            Barf. Here’s a link to a news story on the grand jury report. It appears that after 6,000 births, Diane Goslin still doesn’t understand the dangers of GBS: http://lancasteronline.com/news/no-charges-will-be-filed-against-county-midwife-but-grand/article_e33f9252-3737-5de1-990c-02bbd9476998.html

            I’m going to email the reporter in the morning about this. Since he’s close to Harrisburg (and wrote a follow-up on that story recently) he might be interested in seeing just how prevalent the stupid is. For now, I’m off to bed. I’ve reached my limit of sickening idiocy for the day.

          • Trixie

            I’ve emailed that reporter as well. I recommend also emailing the reporter who covered Goslin in the Harrisburg Patriot News article about the grand jury report. Goslin’s assistant at some of the births, Heidi Yanello, appears to also do work for Midwifery Today.
            Goslin preys on recent immigrants with a poor understanding of English and Amish with virtually no science education. She is evil.

          • wookie130

            Bah. Nothin’ quite like having a friggin’ anthropologist deliver your baby.

            Sign me up for that.
            (Said no one ever.)

          • Haelmoon

            I have my undergraduate degree in antropology, but I also have my MD and perinatalogy certification. I would probably be ok :-)

          • Amazed

            Teaching breech. My god.

            “In the light of the latest MANA research, I can teach you how to give every 5 out of 222 breech babies a 100 % chance to die!”

            Barf.

          • yugaya

            I can only picket online, but give me a couple of hours and I can provide screenshots of NCB wisdom by the speakers from the Midwifery.com web pages.

          • Amy

            Well, that’s my quota of sickening for the day. Learn how to deal with a woman having a miscarriage without going to the hospital? (Who cares how much she’s bleeding, or about incomplete miscarriage?) Releasing your fears, especially helpful for midwives managing VBAC, twins, and breech? (Because the only pregnancy complication to fear is fear itself, right?) Intuition and Protocol, The Trouble With Transport, Income Issues in Midwifery…..these midwives must really hope their prospective patients are stupid enough to miss the huge ethical issues with this. Personally, I’m disgusted.

          • auntbea

            It’s relatively close to me, but I will be traveling a lot around then so I am not how my husband will feel about me going off another jaunt. Perhaps combining the trip with something fun for my daughter would work out.

          • Young CC Prof

            Hershey park? (depending on her age, and whether she likes chocolate and rides.)

          • Trixie

            The park won’t be open yet, but Chocolate World will be (pictures self accidentally trapped on Chocolate World ride with Ina May).

  • wookie130

    The points made within this blog post are quite accurate, I believe. I suppose there are women favoring the possibility of having a homebirth, because at home, they get to choose what scent of candles they have burning, what room they want to do most of their laboring in, and they get to eat whatever happens to be in their personal refrigerator at will, and this constitutes “individualized care.” What these women often fail to realize, is that they’re often not receiving ANY care while laboring at home, and no matter what issues have come up during their pregnancy, homebirth is often a one-size-fits-all situation. It isn’t right. Give me an OB and hospital birth any day, where care is provided based on what is happening with my baby, my body, and with a professional who knows what to do in the face of any number of gestational complications.