The Dr. Amy paradox

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I have a riddle for you.

What would I get if I added the following?

Nuance + Compassion + Dr. Amy =

Give up?

I would get IGNORED.

That’s the real answer to the riddle posed by Kristin of Birthing Beautiful Ideas. Kristen ponders:

That’s right. Sometimes, I agree with Dr. Amy.

But I rarely agree with her delivery. Sometimes it’s rife with logical fallacies*: straw man arguments, appeals to pity, appeals to authority, ad hominem attacks. It’s often mean-spirited and shrill and condescending…

And so after I read the piece from Feminist Midwife, I wondered: what might Dr. Amy’s blog posts look like if she injected nuance, compassion, a less dogmatic form of critical thinking, and some simmering-down-now (with a teensy bit of snark, just to let off some of her steam)?

At the end of her piece, Kristen highlights a previous encounter:

You’ve been here before, and you called me a “gullible, woefully undereducated women who’s likely never read a scientific study in its entirety.” It was fun(ny). In any case, I have read plenty of scientific studies in their entirety, though surely not as many as you have. Likewise, you may have read a bit of philosophy, but likely not as much as I have. Your training gives you the upper hand when it comes to expertise in practicing medicine. Mine gives me the upper hand when it comes to expertise in all things philosophical. These different trainings and types of expertise give us somewhat different approaches when it comes to reading said scientific studies: you will arrive from a clinical background based both on your medical education and your practice of medicine, and I will arrive from a philosophical background based on an in-depth examination of the philosophy of science and on a specialization in theories of autonomy…

Kristen is referring to this post, Newsflash: you did risk your baby’s life for your own experience. Not surprisingly, I stand by everything I wrote. I will add, though, that I have more training in philosophy than Kristen might imagine. I nearly completed a master’s degree in biomedical ethics with Dan Brock when he was still at Brown (everything but the thesis). Kristen would probably be surprised to know that my interest is also in theories of autonomy, especially as they relate to reproductive decisions. That’s why I disagree so vehemently with anyone who claims that homebirth ought to be made illegal; doing so is a violation of a mother’s right to medical autonomy.

Be that as it may, I believe that Kristen’s post deserves a reply.

In a way, Kristen, you have already answered your own question. You imagined what my blog might be like if I wrote in the same style as a midwife whom you admire. You didn’t ask what my blog might be like if I wrote in the style of Dani Repp at What Ifs and Fears are Welcome or Lisa Murakami of Married to Medicine or the many bloggers like them. Both Dani and Lisa are much nicer than me! They write about the same topic as I do with more nuance and more compassion, yet you didn’t mention them. Why? Either you’ve never heard of them or they made so little impression that you forgot them.

For better or for worse, nuance and compassion don’t attract readers. Years ago I briefly tried it and it nearly killed the blog. When I started the predecessor of this blog in 2006, I got about 550 visits a day, 500 of which I bought through Google Ad Words. I haven’t paid for advertising in years. Today this blog averages 6000 visits a day on weekdays, and often thousands more. For my most popular posts I’ve gotten 5,000 visits an hour. I’m sure that you’ve already guessed that the posts with the most traffic tend to be the snarkiest.

Simply put, snark is my schtick. Don’t get me wrong: my anger over the preventable deaths of babies and the misinformation spread by natural childbirth and homebirth advocates is real. I’m no different than the pediatricians who despair over the deaths of babies as a result of the anti-vax nonsense. But I’ve chosen to take a different approach. Recently a study was published that showed efforts to educate anti-vaccine parents about the benefits of vaccination have backfired. When public health officials have tried a respectful presentation of facts to educate parents about the benefits of vaccination, those same parents ignored the facts and figured that the public health officials had something to hide. In the best case scenario, they simply ignored the public health messages.

I take a very different approach because I attribute a very different cause to both anti-vax nonsense and natural childbirth/ homebirth. Both have nothing to do with medical facts and everything to do with the tendency of contemporary parents to judge themselves and others by their willingness to defy authority. Defiance and denial are at the heart of both movements: defiance of medical “authority” and denial that bad things can really happen to them and their children that no amount of good food or breastfeeding is going to prevent.

My approach can be summed up very simply. My snarky posts about parenting decisions tend to make the exact same statement:

You think that having an unmedicated birth, refusing interventions, giving birth at home, refusing vitamin K for your newborn, etc. etc. etc marks you out as an “educated” person and a superior parent. I’m here to tell you that it marks you as an uneducated, gullible fool.

Harsh, I know, but very effective at getting attention and causing people to question what they’ve been told.

And when I write about the luminaries of the natural childbirth/ homebirth world, I deliberate tweak the love of conspiracy theories that seem so prominent among advocates:

You think that Melissa Cheyney, Lisa Barrett, Lamaze International, the Childbirth Connection, etc. etc. etc. care more about whether your child lives or dies than her obstetrician or pediatrician? Haven’t you noticed that they have a greater financial interest in conning you to buy their services, books and products than either an obstetrician or pediatrician ever could?

Most natural childbirth/homebirth advocates lack the basic knowledge to understand a nuanced argument about childbirth, but no one lacks the basic knowledge to understand the desire to profit by convincing someone to buy what you are selling.

I have a goal that I am always working toward and that is the prevention of infant and maternal deaths. Although there are a few nitwits out there who like to put my title in quotes, I find that being retired offers a great advantage in gaining trust. Everyone knows, whether they agree with me or not, that I have no skin in the game. It makes no difference to my well being or the well being of my own children whether you listen to me or not. I write for YOUR children because I care about what happens to them.

If that isn’t nuanced and compassionate, I don’t know what is.

  • Anon

    Your tone is your right, and you may get ignored, but what is more relevant, and most important is by being such a heinous jerk are you really helping? Are you saving babies? Are you changing minds? I am sure there will be a slew of comments that say “Praise Dr. Amy! Thanks to her I came to my senses!” But I have a feeling the the homebirth friendly folks are only being pushed further and further away, making them even more prone to pushing the limits of safety, just to try to prove you wrong.

    I mean sure, fear tactics work to a degree, but usually education is the more sustainable way to create change.

    By citing that you would be ignored, you simply reveal you are more concerned about getting attention than about saving babies.

    • Amy Tuteur, MD

      Considering that I am only one person and that the homebirth midwifery community had about a decade head start on me, I think I have been remarkably effective.

      To a surprising extent, I singlehandledly shape the public conversation on homebirth. Consider the recent MANA study that claimed to show that homebirth is safe. I pushed the deeply flawed results into the mainstream and most of what was written subsequently to support MANA’s lies was directed in large part toward my arguments.

      I’ve worked with a variety of journalists and a variety of mainstream publications to counter the disinformation campaigns of natural childbirth and homebirth advocacy. Indeed many people now refer to homebirth supporters as homebirth advocates; that’s my terminology.

      The most compelling evidence of my effectiveness is that homebirth midwives and their organizations are petrified of me. I’ve made it impossible for MANA to spew their lies unanswered and frankly I’ve gone a long way toward discrediting MANA in the eyes of anyone but the true believers. I’ve basically shut down the Facebook pages of Jan Tritten and Midwifery Today because they understand that when they print nonsense (or worse) I will be shouting it from the hilltops.

      You may not like my tone, but my effectiveness indisputed.

      • Anon

        Wow, yet another steaming, self-inflating, while simultaneously defensive, pile of illusions of grandeur.

        For the record, I learned about this blog was educating myself on birth options. I couldn’t believe that someone who supposedly cares about women and children would behave this way, so I had to see for myself.

        • Karen in SC

          If you truly want to be educated on options, read the two posts linked above right under 2013 In Review.

          For a nicer tone, do read What Ifs & Fears, Safer Midwifery for Michigan, Married to Medicine. For specific info on epidurals, read The Adequate Mother. C-sections – Cesarian Debate. You may need to use the search function for specific topics.

          The latest post here (April 1st) is particularly enlightening, especially if you have formed a positive view of homebirths and CPMs using data from other countries where midwives are highly trained and integrated into the hospital system.

      • recovered NCB advocate

        I once was part of the “let’s hope Dr. Amy is a complete fraud” crew. But I think it was sort of stinging reality that helped me to confront the problems with this whole homebirth/CPM thing. I had been moderating my beliefs about it for years (especially since my own failed homebirth attempt when it was pretty obvious that “interventions” were not to blame and I would have had greater chance of avoiding c/s, let alone worse things, by planning a hospital birth). Then I started following the legal travails of my own former midwife and some other anonymous online commenter was pretty harsh (but not in some long rant) about the ignorance of my claims regarding the safety of some favorite NCB thing or other. I had that same desire to ignore him or her and not see that kind of comment directed at me again, but for some reason it stuck with me. I was already largely horrified by the goings-on with my former midwife but managed still to see her or what happened as anomalous. I think I started reading Dr. Amy with an open mind around the same time as she did at least refer to this case, or perhaps have a full post or two entirely based on it. So I think the “tone” may work with some people. But I really did have a sincere desire for the truth that was already becoming less and less muddied by my personal anxieties or desires.

    • Sue

      If people are risking the lives of their babies just to prove a person blogging on the internet wrong, you really need to question their ability to make rational decisions as parents.

      No, radical home-birthers are ”pushing the limits of safety” because they are competing for the most self-fulfilling and rebellious experience.

      On the other hand, some readers of this blog, previously in support of HB, understand the content and have enough insight and wisdom to change their stance, for the safety of future children.

    • The Bofa on the Sofa

      I mean sure, fear tactics work to a degree, but usually education is the more sustainable way to create change.

      Sounds nice, but I’d like to know what you have to support that claim.

      What kinds of “change” really come through education?

      Was the change in the attitude toward gay marriage in the US an issue of education? Or was it a result of courts imposing gay marriage into our society? Or TV shows like Ellen and Will & Grace forcing it out as an issue?

      Racial integration required forced busing and a civil rights act. Not education.

      I don’t know, has real change EVER come from “education”?

    • Ms. Pris

      I’ll tell you: Dr. Amy can come across as very rude, but yes, she has changed minds, including mine. Now that I know the real stats of homebirth, I am no longer considering one.

  • ngozi

    It is your blog, Dr. Amy. Your tone is your right. If I don’t like your tone or what you are saying, I don’t come back. It is different if you are threatening violence, or something like that.
    People (especially in the USA) are always saying that people have rights. People are free. People have the right to do what they want. I don’t always agree with what is said, but I respect that you have the right to say it.

  • DrDEG

    Two observations. One, I do think Dr. A’s tone can be harsh and that sometimes she could make her point better by being harsh and truthful without name-calling, but I am all-in for her cause. What irks me most, now that we’re criticizing the blog, are the relatively frequent grammatical and typographic errors–proofreading better would help. Just think it demeans the level of discussion. Second, regarding names, I feel ob/g is a very intimate sort of speciality, and call my patients by their first names, always (can get my mind around “Push, Mrs. Smith, push!”). I also introduce myself as Dr. Lastname. One reason is that in some contexts people don’t know who the doctor really is (especially when I was younger, and especially when you’re female) and also because I am the practicing professional in that interaction. If my patient is a judge and I’m in her court, she’s Judge Judy, but at her annual, she’s Judy. I cringe if I am the patient and someone calls me Dr. anything–I am a private person and patient there, not a doc. So, for me it reflects the role in the given interaction. Finally, there is the Miss/Mrs/Ms/Other Title issue–I don’t ever want to be called Mrs. Husband’s lastname, especially as I don’t use his name. Just my 2 cents. Occasionally kids I deliver are instructed to call me Dr. Firstname, and I am just fine with that.

    • Karen in SC

      I have been reading a long time and find very few grammar or spelling errors. If pointed out by an alert commenter, Dr. Amy fixes right away.
      Note that I found at least one error in your comment.

  • TheStirrings

    Hey Dr. Amy,
    I’m a doula and a skeptic by nature. I’m smart and educated, rail against anti-vaccers, and despise the term “natural birth” because it’s meaningless. I never give medical advice, but as a doula I do influence real women’s decisions about their pregnancies and births. I think I’m the kind of person you want to reach with your blog. But I never read your blog, precisely for the reasons Kristen outlined in her post. I read Married to Medicine, What Ifs and Fears are Welcome, and Birthing Beautiful Ideas regularly. I agree and disagree with all of them sometimes, but they have all made me think, and they have all helped me seek out sources that help me become better educated. You might want to think not just about how many people are reading your blog, but who those people are.

    • fiftyfifty1

      Sounds like you already have found your internet home then. Different strokes for different folks!

      • Sue

        But found her way here as well.

        I’ve never understood why anyone would chime into a discussion on a site they claim not to like just to express the fact that they don’t like it. So just don’t read. It’s not compulsory.

    • Jessica S.

      I guess it’s good there are all types of blogs out there for different approaches. Dr. Amy doesn’t and can’t reach everyone. It doesn’t make her wrong anymore than it makes the “nicer” blogs wrong for not being like Dr. Amy.

    • Something From Nothing

      What do you mean, “think about who those people are?”? So what if this blog isn’t for you? This isn’t about pleasing everyone. But what are you implying about those of us who find this blog refreshing, who value science, who can still hear a very important message, even if it is delivered with a harsh ‘tone’?

    • LibrarianSarah

      Uh..thanks? You know I don’t like the tone of a blog. I usually don’t read it instead of insulting all those who do. But I’m a skeptical OB reader and thus a terrible person so…

    • KarenJJ

      Who do you think we are? I, personally, have horns coming out of my head and eat puppies for breakfast, but I don’t believe that everyone here is like that.

      • Guest

        Yes on the horns. Sorry no puppies though. They were out at PetsMart so I went for kittens.

      • TheStirrings

        You’re right, I phrased that poorly. What I meant is, in reading the comments, it seems like most of the readers here are already completely on board with Dr. Amy’s point of view, or are not at all interested in science and evidence and their point of view being contradicted. I, on the other hand, am on the fence about certain things, including certain homebirth practices (I already have a reasonably narrow definition of what I consider a safe home birth, but I do think they can exist. I am, however, open to my mind being changed about anything.) I also have my concerns about various interventions, though I never ever try to convince a client to a refuse/not choose an intervention, as long as they are well-informed on the risks and benefits. So basically, I’m definitely not part of the “just trust birth” choir, but I’m also not part of the anti all home births choir. And I work with pregnant and birthing women. That’s why I think I’m the kind of audience Dr. Amy wants to reach. She just doesn’t reach me–not because she’s “rude” or “mean,” but because her writing is so damn reactionary and, yeah, completely without nuance, and I kind of automatically don’t trust reactionary.

        • KarenJJ

          I think you’ll find a pretty broad range of opinions on homebirth here if you keep reading. Where I live there is a government provided (ie free) homebirth programme without strict risk-out criteria (no twins. breech, vbac) and two university educated midwives and transfers with the main tertiary maternal health hospital here. For women that test as being low-risk then it’s probably as safe as homebirth gets. Not many women choose it, the rate of uptake is very low, but it’s there.

          Even Dr Amy has stated that she doesn’t believe homebirth should be illegal.

          Many of us are not so much anti-homebirth as we are anti-’poor quality care’ for women and babies. Many women here have had homebirths themselves. The fact that our arguments against homebirth are mischaracterised as being “want to make it illegal”, “shrill”, “rabid” and as being an “anti all homebirths chior” misses most of the nuance of what many of us actually believe.

          If you take the time to get to know Dr Amy and the readers here as we all stand, instead of through the lens of what has been interpreted by the NCB crowd you might come to think differently about us being an “anti-homebirth choir”.

        • Sue

          ”I already have a reasonably narrow definition of what I consider a safe home birth, ”

          ” I also have my concerns about various interventions”

          On what basis does a doula have a personal opinion in this area? One of the features of this blog, in contrast to most others, is that the discussion is based on what the evidence shows, not just on personal opinions.

          You may consider yourself ”smart and educated”, but have you ever taken responsibility for the course and outcome of an entire pregnancy and birth process? That’s when you really learn to apply evidence.

          • TheStirrings

            I didn’t say “I have my opinions” I said “I have my concerns.” It annoys me just as much as the next person when people think their opinions are just as valid as the evidence. But I don’t give medical advice at all. Because I’m a doula.

            But I probably wasn’t super clear with that statement. I’m not wholly against any single intervention and I don’t believe for a second that every woman should have a “natural” birth. My main concern is informed consent.

            Also, there is more than one school of thought in medicine, and trends change as new evidence emerges. Episiotomy used to be completely routine. Now it is not (in most hospitals).

    • Guest

      Welcome, Stirrings! I wanted a doula but never found one I would be a fit with. You sound like what I was looking for! I personally think Dr. Amy has the best readers on the Internet. Scroll down and read YoungCCProf’s bit on statistics and philosophy. Mind. Blown. Seriously. I’ll be thinking about that for a week.

      • TheStirrings

        Aw, thanks, I would definitely have been your doula! And it sucks that you couldn’t find one who fit with you. It does seem like there’s a shortage of rational doulas out there who don’t push particular agendas or have obvious religious overtones. And I hate to say that because I think it’s valuable work (I mean, I guess I would have to) and I definitely don’t think being a doula is antithetical to being science-minded. There are definitely others like me out there, though. This woman is my spirit animal: http://thejadeddoula.tumblr.com/

    • http://whatismyreferer.com/ MikoT

      a skeptic by nature. I’m smart and educated…
      I think I’m the kind of person you want to reach with your blog

      Not really. You’ve already demonstrated your ability to seek out proper information, and to filter out all the nonsense that abounds on the interwebs. You’ve already been reached.

      • TheStirrings

        I like to think so. But I’m open to my mind being changed as I learn, and I’m still learning. My response Karen JJ above clarifies my position a little better.

    • Amazed

      “You might want to think not just about how many people are reading your blog, but who those people are.”

      Yes. And one of them is Doula Dani, the one who writes What Ifs and Fears are Welcome. She openly admits that Dr Amy’s been a great influence on her. Like it or not, Dr Amy is an influence on you, too. Without Dr Amy, there might nor be a WIFAFAW blog. Think about it.

      And while the majority of us are indeed people who are already on board with Dr Amy, there is the other kind of readers, like PrecipMom, who were swayed into seeking information by reading this blog. And they are more than a few. Some of the commenters here tell us the story of how their lives or their babies’ lives were possibly saved by interventions they were completely against before Dr Amy gave them the other side. Others tell us their stories of how this blog helped them overcome the guilt NCB movement planted in them for failing to achieve the ideal of all natural. So, I’d say Dr Amy is meeting her goals. Even you are here and commenting.

  • LMS1953

    Dr. Amy: Do you “vehemently” contend that ALL homebirths should be legal? Or that NO homebirths should be illegal? Because if you do, your philosophical position could be torn to shreds. There are countries where homebirth is much more accepted in the medical community. They still have shitty results even though there are exclusionary restrictions (nulligravida, breech, >42 weeks, prior classical C/S to name a few) that seem to be well-received and obeyed (whereas they are the meat and potatoes of the variations of normal CPM practice in the US). Are these restrictions unethical?

    • The Bofa on the Sofa

      How can you make a homebirth illegal? The concept doesn’t even make sense.

      How can you make it illegal for a woman to go into labor and deliver quickly, before she gets out of the door, for example? How can it be illegal for someone to NOT go to the hospital?

      Now, whether someone masquerading as a “health care professional” can take a payment to help someone do that is a very different question.

      • birthbuddy

        What is a crime is effectively what the legislature (via voters) decides is a crime.
        Making homebirth illegal is possible, via legislation. This could occur by societal pressure based on the known risks.
        Whether that is right or not, is a different question.
        Most criminal acts have recognised defences e.g. self defence to murder. Not making it to the hospital would theoretically be a legitimate defence.

    • Amy Tuteur, MD

      Homebirth is always legal for the mother and never illegal.

    • Young CC Prof

      Home birth shouldn’t be illegal. Taking money to deliver someone’s baby at home, however, probably should be.

    • birthbuddy

      Waterbirth is arguably illegal. I note Dr Clay Jones refers to it as malpractice.

  • Squillo

    There’s a somewhat related post over at KevinMD: “New feminism is about women, work, and the will to be authentic”. The author’s points are more specifically about women of color, but are also broadly applicable, I think.

  • birthbuddy

    What exactly would the philosophical approach be to a p value?

    • AdelaideGP

      To “p” or not to “p” , that is the question. Oh hang on , that’s Shakespeare not philosophy lol.

    • fiftyfifty1

      Q: What exactly would the philosophical approach be to a p value?

      A: “It may be statistically significant but the absolute risk is still small. And people value other things besides a live baby”

      • Young CC Prof

        Right, there’s that too. Statistical significance is not practical significance, and determining which effects have practical significance may vary between individuals.

        For example, if a very expensive drug worked only a little better than a drug that costs next to nothing, a reasonable person might choose the cheaper one.

    • Young CC Prof

      Actually, there is a philosophical debate between frequentist and Baysian approaches, and which one more accurately conveys the true meaning of the data.

      Frequentist simply calculates the p-value and says, “This is the probability of getting this type of result through pure bad luck if (for example) water birth does not increase the risk of NICU admission.” It describes the probability of the data, not of a hypothesis.

      Baysian uses conditional probability and estimated prior plausibility to (sort of) make a statement about the likelihood of a particular hypothesis. It’s much easier to comprehend, but the formulas are harder, and you need to estimate prior probability, which is subject to nitpick. (It’s also good for putting a new study in the context of the established literature!)

      I don’t think that’s what was meant, however.

      • fiftyfifty1

        Wow CC Prof, that is so cool. Would love to have a second lifetime to learn about this to the point of being able to do what you do.

        • KarenJJ

          I know! It makes maths look so interesting. I actually went to an Open night at the local university thinking to do some refresher courses on undergrad maths (I might still do it but I also bumped into a previous engineering lecturer who also had other ideas for me which I will follow up on too).

      • birthbuddy

        You do realise that Kristen is going to say that this is what she meant. Excellent, eloquent answer.

  • brandonmenc

    Snark and science, entertaining and informative – that’s why this is one of my favorite blogs. Keep telling it like it is, doc.

  • Flora

    Anyone who uses the adjective “shrill” to characterize a woman who dares to complain loudly clearly knows very, very little about the history of feminism. Bonus points for the irony of “I want you to change because I don’t like the way you do things and demand you respect my autonomy if you don’t like the way I do things.”

    • Guestll

      YES! Goddammit, yes.

    • anion

      Yes!

      And does anyone else find it rather offensive/upsetting that there are women out there insisting that if you want to talk to a woman about facts, you must speak as kindly and gently as possible, because otherwise you’re just being mean? Way to encourage people to think of women as wilting flowers who’ll cry if you don’t couch your words in equivocations.

  • Amy

    I think what people don’t realize is that this is something worth getting “mean” over. And while obviously not as important as maternal and infant deaths, the utter lack of respect the crunchy crowd displays toward those who make different parenting choices is another thing that’s worth being mean over. These people don’t have trouble lobbing around terms like “sheeple,” “lazy,” and “too posh to push,” I don’t know why they get so angry about ignorant and uneducated.

    • realitycheque

      Ignorant and uneducated aren’t even necessarily insults. There are countless topics I am ignorant about and uneducated in. I wouldn’t know the first thing about law, engineering, business management and would never even dream of pitting my knowledge of medicine against that of an MD. If someone told me that I was uneducated in any of these fields, my response would probably be, “Yes, I am.”

      What is it with this day and age, where no one is willing to see the value in knowing what they don’t know? Where acknowledging your own ignorance in certain areas and valuing those who have dedicated years of their time, effort and money into becoming experts seems to fallen out of popularity, and is even looked down on by some. Google makes it so that everyone considers themselves an expert, and expect that they can pick a study at random about any subject they have a vague interest in and critique it with the same skill and understanding of someone with a PhD in the field. I honestly find it embarrassing to watch these Google Certified experts waltzing around with their inflated egos, misinterpreting studies and then talking with authority to anyone willing to listen.

  • Cold Steel

    I have occasionally wondered if diminishing the whole ‘cult of personality’ aspect to the blog would improve its message. Dr Tuteur made a great point several months ago that quacks tend to be known individually for good reason– the faceless masses are the ones who tend to be correct. There is no “Dr Tuteur believes in the germ theory of disease, versus Dr. Mercola who does not.” There’s just the germ theory of disease, versus outlier quacks.

    I’m not sure how to do it, but I do think the blog could be improved if it was less about the individual and more about the ideas. It would legitimize them, I think, to make Dr Tuteur into a mouthpiece of truth rather than the originator of that truth.

    Also I dislike calling her ‘Dr. Amy.’ Only women get called by their first name like this, and I find it kind of infantilizing. She’s Dr Tuteur. Not the folksy, we’re-all-really-on-the-same-level Amy.

    • Trixie

      If “Dr. Amy” bothered her, she probably wouldn’t have made it her email address.

      • Ob in OZ

        Tue. But there was a great book (forgot its title and author unfortunately) and the line was something like “A Rose is a Rose is a Rose…but call her Mrs Schwartz. I respect my patients and call them by their last name until they tell me something differently. Similarly I would not expect them to call me by my first name. Respect works both ways.

        • Trixie

          We aren’t her patients, though.

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

          I totally agree with this, although I respect Dr. Amy’s more “accessible” name. Its frustrating for me, having been raised with old school respect, to accept that friends’ kids never use “Mr/mrs/etc Lastname” so by default my kid does too. It’s a different, more casual culture we’re in now, so I just let it go, but I hear you.

          ETA oops, that was a reply to Cold Steel above

          • anion

            A girl at my daughter’s school recently was trying to ask me a question, and told me she was sorry, she didn’t know my name. I thought, well, you know my last name, don’t you? Did no one ever tell you how to call someone “Mrs. Lastname?”

          • Young CC Prof

            Parents and children don’t necessarily have the same last name, especially nowadays. Of course, if that’s the case, you shouldn’t be too surprised by someone who primarily knows your child calling you Mrs. (Your Child’s Last Name).

          • The Bofa on the Sofa

            At my kids’ preschool, I’m known as “Joe’s Daddy Joe’s Daddy! Look what I have!”

          • Anj Fabian

            That’s my title too.

          • The Bofa on the Sofa

            They call you Joe’s Daddy, too?

          • Anj Fabian

            _____’s Mom.

            It’s logical and accurate. I can’t fault them.

          • Siri

            My husband and I are both known as Theodore. 3-yr-olds and under like to keep things simple.

          • Irène Delse

            True! I have a 3 year old niece kindergarten. Her teachers is “Mrs. [Lastname]” and the kids refer to their group as “the [Lastname]s”. It’s cute to hear her tell proudly: “I’m a [Lastname]“, in answer to a question about school.

          • An Actual Attorney

            Why do you think she knew your last name? I wouldn’t assume a mom’s last name is the same as the kid’s.

        • realitycheque

          Not wanting to speak for Dr. Amy, but I believe I have seen her in the comments section of this blog clarifying that she doesn’t mind being referred to by her first name.

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

        I think “Dr. Amy” began because at one time, on her previous blog, there were a plethora of Amys, and it was a way to distinguish her. I agree that I am more comfortable with using her last name, but since we are all friends here [or most of us are, anyway...] a certain informality is OK.

        • Trixie

          My former 5th grade teacher and family friend makes fun of me because I can’t stop calling her Mrs. XXXX even though she’s been telling me not to for years. I just can’t make her first name come out of my mouth.

          • fiftyfifty1

            I have some of my former teachers from childhood as patients. We have agreed that we will continue in our old pattern: They are Mr. Smith, Mrs. Doe etc. while they call me by my first name.

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

            Here in Israel, teachers are routinely called by their first names [ the theory of socialist egalitarianism and all that] and when my daughter was in the class of an ex-American teacher for English who demanded to be called Mrs. Whatever, my daughter found it very hard to adjust to.

            I routinely call doctors that I work with by their given names, as they do me, in private conversations. In front of the patient, they call me by my first name, but I never do — so much for socialist egalitarianism in action.

          • Awesomemom

            When we lived in Kansas all the teachers were Mrs./Ms./Mr. Lastname. Here in California It is a crazy mixed bag. My son’s special ed teacher wants to be called her first name, some of the teachers go for Miss first name and other go for a Mrs. shortened last name. I would be so much easier if there was one common choice among them.

    • Gene

      I tend to agree with you on the name thing. I use my first name among my colleagues (I hate it when nurses insist on calling me Dr. XXX), but I always introduce myself to patients as Dr. XXX, not Dr. Gene. I know plenty of Pediatricians who go by their first name or by Dr. Firstname with their patients. I’m not one of them.

      • Siri

        We had a very useless registrar who insisted on being addressed as Dr X – that is, until he passed some exam and informed us we should hereafter call him Mr X, as he now had consultant status. We invariably called him Bob.

        • Gene

          People who INSIST upon their titles tend to be the ones who least deserve the respect associated with it.

          • ngozi

            AMEN!

      • Guest

        This brings up a very interesting dynamic for me. In the old days, no one used first names. It was title and last name. Now there is this cultural shift to first names … But not for MDs. So doctors get title and last name, but patients are first name. As a patient, I don’t like the implied imbalance. When a doctor introduces herself as “Dr Smith” I introduce myself as “Ms Jones.” I often get a laugh. Most often we just go to first names all around. If the doctor prefers “Dr Smith” I’m down with it and just ask her to call me “Ms Jones.” So far I am on a first name basis with three of our doctors, last names with one, and everyone is happy. I make my children call them by title and last name … But I make them do that with all adults. Because they are children. :)

        • Gene

          I BEG my nursing colleagues to call me by my first name. About half do. The BS about “you’ve earned your title” doesn’t fly with me. Nursing is another degree to be earned and no one call a nurse “Nurse XXX”. Same with techs and residents. At my old ED, a nurse calling me “Dr. XXX” was code for “drop everything and get your butt into the room NOW! EMERGENCY!!!” And I never call myself Dr. XXX out of the work environment.

          Most of my patients are kids, so get just first names (or “princess”, “cutie”, “angel”, etc). Parents are sir/ma’am. I also cannot assume that a parent has the same last name as their child (and in the ED, they aren’t always known to me).

          But I find that if I do not introduce myself as Dr. XXX, the patient/family assume I’m a nurse. We once had a patient complain that she never saw a doctor: female tech, female nurse, female physician’s assistant, female resident doctor, female attending doctor. Even after introducing myself as “Dr. XXX, I’m the supervising/attending doctor”, people will STILL ask later if the “real” doctor is coming. It’s bizarre.

          • AmyP

            How about Nurse Ratched?

          • Cartwheel

            This, exactly. I’m a vet; I don’t care what anyone calls me – or, to be more accurate, I dislike being called Dr Lastname but not enough to make a fuss about it and am pretty neutral about other polite forms of address. But when I meet a new client or when I’m making phone calls, I identify myself as Dr Firstname Lastname because I want to be clear.

            Usually people then call me by my first name – but I live in the informal Rocky Mountain west, and that’s how we do things here.

        • AmyP

          I’m thrilled to be addressed by any part of my name in a medical setting.

          I hate it when they call me “mom” when I’m not their mom.

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

            In nursing school, we were instructed to always call patients by last names with the appropriate designation [back then it was Mr., Miss, or Mrs. Ms. hadn't yet been invented] as a mark of respect.

            One day I was trying to deal with a difficult, rather senile old lady, who would not respond to anything I said to her until the patient in the next bed called out “Bubby!”
            [Grandma in Yiddish]. Then the old lady was perfectly compliant.

      • theadequatemother

        I’m Dr theadequatemorher in front of patients and their families and I address men as Mr and women as Ms until thy show a preference otherwise. If I’m dealing with a patient who is a physician dentist vet or professor I call them dr lastname. I’m teaching my two yr old to call my friends me and mrs so and so because I like a bit of formality.

        I think bc of what I do, which once the pt is out is highly paternalistic (there’s no shared decision making under anesthesia) it’s better to be more formal and be “Dr”. Plus if I went by my first name there would be confusion bc some Pts don’t know that anesthesiologists in Canada are actually doctors!

        When the pt is asleep or sedated we are all on a first name basis in the OR.

        • The Bofa on the Sofa

          I guess it’s probably not a good idea to be giving the patient the impression that you will be playing puppet show with them while they are unconscious.

          • Siri

            Ohhhh….that’s the only reason I went for surgery in the first place! That, and the stuffed gall bladder on my mantelpiece.

    • Trulyunbelievable2020

      “Only women get called by their first name like this, and I find it kind of infantilizing.”

      What about Dr. Phil? Granted, he does look kind of like a big mustachioed baby, but it seems to be a counterexample.

      • AmyP

        Yeah, it is common for celebrity doctors and psychologists to go by “Dr. Firstname.” In fact, it’s more the rule than the exception.

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

        I think Dr Oz would go by his first name if it were more mainstream.

    • fiftyfifty1

      Dr. Tuter, Dr. Teuter, Dr. Tutuer, Dr. Tueteur, Dr. Tueter. Dr. Teuteur.
      Screw it! Dr. Amy.

      • Young CC Prof

        Am I the only one who gets confused when spelling ordinary words that have adjacent vowels?

        • KarenJJ

          like cesaerean… I mean c-section.

      • Amy Tuteur, MD

        Exactly!!

    • Amazed

      We’re all on the same level here, though. It’s a blog. Sure, Dr Amy is the one with the knowledge, not me. But if I need my ovaries or something examined, I’ll certainly go to Dr Tuteur, not Dr Amy.

      I am not well versed in netiquette but it just looks obvious to me that when she’s writing on a blog, she can expect a slightly different treatment than when she’s giving a lecture or speaking to the ACOG, as evidenced by the fact that she was the one who introduced herself as Dr Amy.

    • Dinolindor

      The comment from a vet below reminded me – my dad, who is a vet, always called himself “Dr. Tom” when calling clients for updates. It may be in part because his last name is kind of tricky to pronounce and spell, but I don’t think only women get called Dr. FirstName.

    • ngozi

      But it is HER name. It is her right to be called Dr. Amy if she wants. It’s her right to be called Dr. Honey Boo Boo if that is what she likes (other than the people from the TV show or the network wouldn’t probably like it). How is it not her choice?

  • wookie130

    You know, perhaps this is a little wayward, but when I think of Dr. Amy’s writing style on this blog, I always think about the quote that states that “Well-behaved women seldom make history.” Likewise, the smooshy, touchy-feely, marshmallow approach would probably not make the right amount of impact on how women are viewing certain aspects of the state of midwifery in the U.S., homebirth, and woo-infested thinking. And in reality, I rarely think Dr. Amy is as callous or abrasive as the naysayers make her out to be…I think she’s honest, and straight-forward, and doesn’t beat-around-the-bush, and when it comes to the lives of babies and mothers, shouldn’t SOMEONE be throwing this information out there forcefully?

    • Rebecca

      Dr. Amy’s style isn’t that shocking to me, because I live in the real world. But it’s apparently like a bucket of ice water to women who live in the sickly sweet passive-aggressive world of NCB, where everyone expects to be validated by the echo chamber for making “educated” choices and everyone “feels sorry for” those outside the circle of wisdom.

  • Adelaide GP

    Being truthful is ultimately the most genuine kind of compassion. The hardcore NCB advocates might like to think they’re nice and warm and fuzzy but look at how nasty they turn when a home birth doesn’t go as planed, ending in death or disability. They trot out all the usual tropes like “it would have happened in the hospital too” or blame the mother directly , as demonstrated so glibly in that despicable email from Christie Collins recently. Cold comfort indeed for a grieving family. Ironically the hospital staff , even with all the imperfections inherent in an “impersonal” clinical environment, probably provide more genuine comfort and compassion to families affected by HB tragedies. It’s disingenuous for HB advocates to claim monopoly on “niceness” when the reality is often quite the opposite.

  • Dr Kitty

    Totally off topic. Sorry.
    How would you like or expect a 30 something female GP to dress at work?

    I’m usually in a shift dress or jersey wrap dress (sometime worn over a turtle neck in winter) opaque tights, flat boots or loafers and a cardigan. Alternatively a silk shirt over a camisole and trousers or a pencil skirt. No cleavage, no bare legs, no jeans, no high heels, bare below the elbows, hair tied back, minimal makeup.

    Would you consider that “trendy”, “overly sexual” or “unprofessional”?
    Because the only guidance I have about appropriate work wear says not to be any of the above.

    • Mishimoo

      Sounds like what our (female) GPs wear. They look both comfortable and professional, so I think that you would too.

      • Dr Kitty

        Thank you.

        I should say, no one has complained or anything, I’m just starting a new job and thought I should treat myself to a new outfit for work…and then started freaking out that maybe what I like to wear is inappropriate and everyone is being too polite to mention it to me.

        My hospital induction as an intern, we were told “girls, don’t look like you’re on your way to a nightclub, boys don’t look like you’re on your way home from one”. I kid you not. No ties, bare below the elbows, no white coats, no nightclub attire, don’t scare the elderly patients with your fashions, wear shoes you can run to a crash call in- that was pretty much it.

        • Mishimoo

          Congratulations on the new job!
          I can understand the slight freak out, but your clothes sound really nice. Definitely treat yourself to a new outfit.

        • AmyP

          My new Landsend catalog has some very pretty shift dresses that they pair with cardigans. Based on your previous posts, I think that might be not too far from your style.

          http://www.landsend.com/products/womens-sleeveless-pattern-ponte-welt-pocket-dress/id_257598?sku_0=::J7T

          Machine-washable knit!!!!

          A solid version of that might be more professional looking, but the pattern is really cute. Maybe you could get away with the blue with a dark cardigan?

          • Dr Kitty

            Yup that’s pretty much the kind of thing I wear, but I’m usually in grey/black/white/navy. I just find it easier if everything goes with everything else, and ideally doesn’t need ironed or dry cleaned.

            I wear dresses because I find it hard to get trousers to fit, and don’t mind if dresses are a little longer on me than the model (because I spend all day sitting, I like skirts that aren’t too short).

          • Siri

            AND they have a UK website! Mwah mwah! What a lovely girly chat we’re having about clothes….. :-b

        • fiftyfifty1

          The advice we got was “Look like you are here to cure disease, not spread it”.

          • Jessica S.

            Ha!

    • The Bofa on the Sofa

      Scrubs.

      Just like Dr Oz.

    • Jessica S.

      You’ve described basically the same thing my doctor wears – although I think she usually wears slacks, but that may just be her personal preference. I think it’s crazy to categorize what you wear as “overly sexual” or “unprofessional”. I don’t understand the “trendy” thing, unless the person(s) delivering the message meant it as “valuing style over professionalism”.

      • Haelmoon

        I work in a perinatology clinic. Patient’s are often not keen to be referred to me, and I don’t over dress, because I try to remove the formal-ness of the clinic. I often wear dressy jeans and a nice shirt and cardigan. Occasionally a pencil skirt, but I really am not keen on skirts. I don’t like dress pants either. I have a few pair of dark dressy jeans that work well. The other MFM is older, but wears slacks and short sleeve dress shirts. We try to be informal in our clinic – it seems to suit our patients well. Some days when I know I am dealing with a really difficult case I will wear scrubs to look more medical. My mother jokes that I became an OB so I could wear scrubs everyday! I hate dressing up.

        • Jessica S.

          “Some days when I know I am dealing with a really difficult case I will wear scrubs to look more medical.”

          I love it! :)

    • Guestll

      No, no, no. Sounds fine to me.

      My daughter’s ped, at her last check up, was wearing an Elmo tshirt, jeans, and Birks with socks. It really doesn’t matter. :)

      • toni

        Oh I wouldn’t like that at all! I’m all for formality. My pet hate is jeans in church

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

        I think a pediatrician OUGHT to wear something like an Elmo tee-shirt. I once took my granddaughter to my former clinic to say hello to my old co-workers and the minute she saw white jackets she began screaming.

    • Medwife

      That’s funny, I once googled that same question. It sounds like what I wear. One of my favorite things about hospital shifts is the hospital supplied scrubs. No fashion decisions!

      • Dr Kitty

        I loved scrubs too, but mine were always too big and had to be rolled, tucked and safety pinned.

        “Small” is designed to fit small men and average sized women, not small women…and apparently there weren’t enough small women for them to buy in that size.

        Unfortunately I can’t wear scrubs to work anymore.

        I could wear corporate work wear (suits) but a) I don’t want to and b) I think it would be a barrier for many of my clients if their GP was very smartly dressed.

        My male colleagues either wear suits with jackets off or chinos and shirts without ties.
        Some of the older male GPs do the whole tweed jackets with elbow patches thing…
        Being a girl is hard…too many choices!

        • Medwife

          I guess the fashion choice with scribe is, highwater pants or ballooning waist.

          Men have it SO much easier when it comes to office clothes.

        • RebeccainCanada

          I recently enjoyed Seattle Mama Doc’s seminar/convo with Seth Mnookin (Panic Virus) and she was wearing heels, I think a pencil skirt. She looked great anyway, professional and nice.

        • Mishimoo

          One of our GPs wears the tweed jacket and a knitted vest over a white shirt. The rest of the male doctors tend to do the shirt + chinos combination.

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

      I’m a terrible dresser (note an economist, so probably expected) – I could take style tips from you – sounds completely appropriate.

    • AmyP

      Sounds cute and professional.

    • theadequatemother

      That describes what I wear when in consultation clinic (if not scrubs). I try to stay away from dry clean only items both for the cost and because I would likely want to wear > 1 prior to cleaning and I think they might act as formites.

      • fiftyfifty1

        Oh I would love to wear scrubs to all my clinics. I get to wear them to just one of my clinics. They are the best. They are also really the safest option because you can wash them on HOT. Wear them whenever you can!

    • FormerPhysicist

      Sounds fine to me, and similar to what my internist wears.

    • Montserrat

      Working at the NHS I used pencil skirts with ballet flats, shirts and trousers that I bought at GAP with shirts also. During winter I sometimes used a cardigan or another knitted piece with short sleeves in order to be bare bellow the elbow. And Oxford style shoes. What you describe sounds great to me!

    • fiftyfifty1

      Yep, that sounds like “the uniform” to me.

    • toni

      I would expect pencil skirt + blouse with flats or low heels, maybe t-straps. Wrap dress is fine. I want my doctor to dress conservatively. I don’t like scrubs. One thing I preferred about the NHS was that you couldn’t mistake a doctor for a nurse, in US hospitals all the staff look the same a lot of the time.

    • Gene

      Sounds appropriate to me. Of course, one of the reasons I love the ED is because I get to wear pyjamas to work every day!

    • birthbuddy

      You really shouldn’t crowd source important medical decisions on the internet!

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

      No white coat? Are you sure you’re a Real Doctor, doctor? I mean, on TV doctors all wear white coats!

    • Ihateslugs

      I think it sounds very appropriate! No, medicine is definitely not like TV, where lady docs saunter around in sexy outfits and stripper heels. (I do, however, like to wear heels on occasion, just for clinic days usually or boots in the winter). As a pediatrician, I don’t wear a white coat, but can’t do the whole kiddy wardrobe. I find I get a lot more respect from parents when I’m dressed professionally, and believe it or not, fashion is often a great way to get adolescent females to actually open up and talk to you, building trust. And totally agree that dry clean only is usually out for me; I’ve been peed, pooped, barfed, and stickied on way too many times to wear something that I can’t wash myself!

    • anion

      Sounds perfectly appropriate to me.

      I assume minimal jewelry and no/very little light perfume, as well?

      • Dr Kitty

        Yup, exactly.

        • anion

          Yep, sounds perfectly appropriate (and actually really cute!) to me.

    • Adelaide GP

      Sounds good to me. OT on the OT: One funny aspect of not wearing white costs in GP land is the quips from patients when I tell them they have “white coat hypertension” . I get the old ” no it’s pink cardigan hypertension” or ” Green shirt hypertension” doc!! ( depending what I’m wearing that day) . Lol. Or they say, but I’m not even scared of you!! Blame it on the white coat!

      • Siri

        As long as you never wear migraine-inducing stripes! Those garments are the work of Satan.

        • KarenJJ

          Don’t try wearing high-vis with a headache…

    • SuperGDZ

      All the female GPs I know wear jeans when they’re not wearing scrubs, but I wouldn’t doubt their professionalism for a second.

  • Guestll

    What would Dr. Amy be like if she wrote more like a girl?

    Fuck that noise.

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

      I’ve unliked this multiple times because I keep trying to like it more.

    • Mariana Baca

      I wouldn’t describe the way someone writes as “writes like a girl”. Boht men and women can write in any style they like.

      • storge

        Don’t be disingenuous. It’s baldly obvious to anyone paying attention in our culture that women are “supposed” to write/speak in gentler, more persuasive, qualifier-filled language, and studies in fact show that women DO generally write that way because they are socialized to “soften” what they have to say. That is obviously what GuestII meant.

        • Mariana Baca

          Whatever women are “supposed” to do doesn’t mean we should equate a certain style of writing with “writing like a girl”. It is just as insulting as saying someone should “throw like a girl”.

          Plenty of women write in a straightforward manner and they aren’t “writing like men”. Why perpetuate bad societal stereotypes of what women are supposed to be like.

          Dr. Amy writes like a woman because she is a woman. And that doesn’t nor should it need to mean wishywashy, passive-agressive, concilatory, or anythng else. It should just mean “writing from a woman’s perspective”.

          • fiftyfifty1

            Here is an actual conversation that happened to me while playing catch at a company picnic with some guys from work I didn’t know well.

            GuyA: Wow fiftyfifty, you don’t throw like a girl.

            GuyB: You shouldn’t say that, it’s sexist and insulting.

            GuyA: What?! I said she DIDN’T throw like a girl!

          • The Bofa on the Sofa

            They could say, “Wow, you don’t look like you are throwing lefthanded!” (assuming you are righthanded that is)

            All indications are that throwing is about conditioning. What’s been found is that men and women throw the same when they try to throw with their weak hand.

        • Mariana Baca

          In other words — I’m not being disingenuous. I understood exactly what he said, and disagree with the perpetuation of the phrase “x like a girl” to mean something derogatory.

          • Siri

            I couldn’t agree more!! I’ve had to educate (sometimes forcibly) TWO husbands to stop using ‘girl’ in a derogatory way when talking to our sons. (I only had one husband at a time). Brits are particularly bad in this respect, or maybe it’s just that that’s where I’ve ended up having my kids…

          • anion

            No, it’s that Brits are indeed particularly bad in that respect. :-)

          • Siri

            Damn. I KNEW I should have stopped marrying them…. ;-)

  • Trulyunbelievable2020

    Amy,

    You’re a mean, salty bitch who reminds this nice Jewish boy of his mother.

    With love and respect,
    Trulyunbelievable2020

    • attitude devant

      I’m still giggling over snark being her schtick, as if she’s the tummler in the Catskill resort who gets the conversation going every night in the dining hall….which is not far from the truth, I guess.

  • Kristen the Woeful

    Hi Dr. Tuteur!

    That’s great that you’ve also had some philosophical training. I actually didn’t suggest that you hadn’t had *any* philosophical training, just to be clear.

    I don’t have time to respond to much of what you write here, but I do want to state for the record that my children have all three had Vitamin K injections after birth and that they are all fully vaccinated. I am also a doula who fully and wholeheartedly supports women who choose epidurals, inductions, and even (gasp!) elective cesareans. I have even been commended (even hugged!) by nurses and doctors for encouraging flexibility on the part of my clients when it comes to medically indicated and suggested interventions.

    I’d rather take the time to clear the air about those (baseless) accusations because they misrepresent my person and my personal beliefs and intellectual commitments more than some of your other characterizations of me here.

    • fiftyfifty1

      “I’d rather take the time to clear the air about those (baseless) accusations ”

      I’m confused. Dr. Amy never accused YOU of not vaccinating or not giving vita K. Those were just examples of other parenting decisions that she calls out (in addition to the decision to risk a baby’s life for a homebirth experience).

    • moto_librarian

      “I am also a doula who fully and wholeheartedly supports women who choose epidurals, inductions, and even (gasp!) elective cesareans.”

      So do you want a medal for adhering to the appropriate scope of practice for a doula? That is your job, right, to support the mother during labor and not get involved in medical decisions?

      Look, you have a strong background in philosophy, but your claim that this causes you to interpret the medical literature differently is horseshit. Intuition and “other ways of knowing” do not serve any of us well when it comes to medical decisions.

      • MLE

        The fact that she has been commended by doctors and nurses who went so far as to HUG her for being flexible shows how fractious these “birth professionals” typically are, and how disruptive and unhelpful NCB philosophy is. Pathetic.

        • fiftyfifty1

          Yep, this is like Bofa always says. When someone remarks “not all——— are bad”, you know the profession has a problem.

  • Deena Chamlee

    I am grinning. As a midwife it has been a difficult road to “own” our shortcomings. Breaking through the walls just about broke me. But I care about midwives and others must be awakened and believe it or not I care about babies and about mothers more than I care about midwifery. Hence, making the journey worth the turmoil.

    • SNM1

      My experience in school has been one where we are encouraged to try to break down as many walls as we can. While I believe that women should have choices and be informed about the risks and benefits of their options, I really don’t want to spend the next 30 years of my life breaking down walls. I went to school to be a CNM because I am passionate about caring for moms and babies. My dream would be to have a birth center and hospital privileges so that my moms really have a choice. If my moms want un-medicated, that is what we can aim for. If she wants an epidural, okay, I am fine with that as well… It annoys me to see all moms who don’t want an epidural placed in a pile with the hard core natural birthers. Some women have very logical reasons/concerns about having an epidural and don’t want one (and BTW, not every mom who chooses an un-medicated birth refuses vaccinations for her baby/children). And some women have very logical reasons for fearing the pain of childbirth. No position is completely right/completely wrong for ALL women. Because each mom is different, we can’t use a one-size fits all approach in midwifery/obstetrics. I have encountered so many students in the past few years that are very one sided in what they want to offer and, honestly, very judgmental about women who choose care that is not what they think is best. To me, that is in opposition to the cores of midwifery. For me, midwifery is about giving our moms the education they need to make the choices that work for them. I may not always agree with the decisions they make, but that doesn’t mean I can’t support them because, really, it isn’t about me or what I would want. It is about each individual mom and her baby and what they need to make it through healthy and whole. We really need to find a middle ground to make sure that all moms have the autonomy (educated choice) to make the decisions that work for them where they are and then as providers do all that we can (within reason and as long as it is safe for both mom and baby) to meet those desires/needs.

      • Deena Chamlee

        yes SNM. And hopefully YOU wont be breaking down the walls for the next thirty years. That is the point to the work that is occurring now and has just about broke me. Reality ,especially when it is not what you have always known as being truth, can be harsh.
        Hang in there things will change and Midwifery will become healthy despite us all.

      • fiftyfifty1

        “And some women have very logical reasons for fearing the pain of childbirth. ”

        And if their reasons weren’t “logical” what then?

        Widwifery, as a profession, doesn’t just have a problem with woo, it also has a problem with pain control. I don’t want to refer my patients to providers who have to spend time talking themselves through why it might be okay after all to have an epidural.

        Use pain control when you want to. Don’t when you don’t. The end.

        • moto_librarian

          I think that NOT fearing pain is illogical..,

          • SNM1

            And that is perfectly okay, but some women don’t view it that way and that doesn’t make them wrong anymore than your dislike of pain would make you… Every woman has her own threshold and level of tolerance and not wanting medication doesn’t necessarily mean that she is all about the “woo.” It just means that she doesn’t want pain meds. In contrast, the desire for pain meds doesn’t make a woman less a woman or a mom because she didn’t want to experience pain… In an “ideal” world women wouldn’t be criticized or judged for something so trivial as whether or not they wanted pain meds during labor…

          • moto_librarian

            My point is that I don’t think that anyone needs to have a “logical” reason for choosing (or not choosing) pain relief. And I have never said that a woman who doesn’t want pain medication is automatically into the “woo;” I just want women to be given the information to make informed decisions rather than fearing that they are going to screw up their bonding process with their baby over NCB misinformation.

          • Marie

            I can’t remember whether you have had children or not? The main beef I have with your comments is, hidden within the word choice (and, well, the fact that you bring up women who “fear” the pain of childbirth at all), is a fundamental misunderstanding of the PAIN OF CHILDBIRTH. I am a physician, not an OB, and have also had three children. In med school saw a 16 year old girl, with no prenatal care, no birthing classes, birth her first baby without a whimper..really, it seemed like just a little extra work in her day…and yet I helped another woman the same day in agony with her third. The difference? IT JUST DIDN’T HURT AS MUCH for the first woman. Something about her anatomy, the labor, etc. WAS DIFFERENT. The pain of childbirth is often life-altering; many women wish they could die or actually believe they are dying. And if they make it through, they are *exhausted* and traumatized and now have a tiny newborn to attachment parent thanks to NCB. Let’s stop saying that someone else is fundamentally different from us because they choose differently, and begin rather to say that since we are all more alike than different, that person’s *experience* must have been different than ours. Women fear childbirth pain because it is, for many women, worth fearing.

          • The Bofa on the Sofa

            Women fear childbirth pain because it is, for many women, worth fearing.

            I’m not a woman, so I don’t fear childbirth pain, but I have to say, anything that was recognized 3000 years ago as being so painful that it was considered punishment from God sounds “worth fearing” to me.

          • SNM1

            I was using pain as an example of an area where women have choice, not trying to have a fundamental debate about pain… It was mentioned above and someone had hinted at people who wanted an in medicated birth being about the “woo.” I have read the articles where physiologic birth is discussed and if that is important to the woman that is okay just as much as the mom who doesn’t care and just wants to make it through birth with as little pain as possible. I actually don’t really believe that women have to have a “physiologic birth” to bond as I have seen both types of birth and I have never seen an epidural interfere with a mom and baby bonding or establish breastfeeding… That is just my experience and personally I don’t think there is enough evidence to support the cascade of hormones that the NCB community claims is interfered with with epidurals because even the articles I have read have been based on supposition and educated guessing as many hormones can’t be measured during labor… I do think that we are all different psychologically and emotionally because we all have been through different experiences in our lives that shape our tolerance levels and how we cope. This is my problem with a one-size fits all approach because what is right for me may not be right for you… An example of this would be my adopted daughter who went through years of abuse. Her ability to cope is much different then mine. It isn’t wrong, it is just different. And because we are different we might come to completely different conclusions about something (pain meds in labor is an example) and neither of us be wrong. Because what is right for me wouldn’t meet her personal needs in the same exact situation.

          • fiftyfifty1

            Here’s a question for you. What if when you got into practice every one of your patients decided during her prenatal care that she wanted an early epidural? Would you be okay with that? Answer honestly. Or would you be disappointed?

          • SNM1

            I am perfectly okay with that. I promise I am being honest… It really doesn’t bother me! Honestly, I have no desire for a natural birth myself if I were to ever get pregnant… For me I have a very intense fear of having a needle placed in my back… Even though the risk of paralysis is incredibly low I still fear it! That being said, since I have never given birth, my dislike of labor pain might take over my fear and make me willing to risk it!, I really don’t know… I truly respect each woman’s right to choose these things for herself…

          • SuperGDZ

            In what possible scenario would it be illogical to fear pain?

          • fiftyfifty1

            “In what possible scenario would it be illogical to fear pain?”

            In NCB land.

        • SNM1

          I wasn’t judging the reasons, just pointing out that each person has logical reasons for their choice to medicate or not medicate… I meant no offense with the term logical… My bigger point was that neither point of view is wrong and is a matter of personal choice and that one choice isn’t right for all women and instead of trying to put all women into a one-size fits all category… A fact that you would have noticed if you hadn’t gotten hung up on one sentence and actually read my entire comment…

          • fiftyfifty1

            I read your entire comment. And noticed that in what was a very long comment a big proportion was spend stuck on the theme of pain control and why the fact that women can make choices surrounding it is acceptable. I’m glad that you have come to the conclusion that women should be supported in this. But I find it disturbing that this conclusion seems to require so much “talking out loud”. I notice that a lot with midwives. Even the ones who support a woman’s freedom in this spend an awful lot of time and words justifying this acceptance. That indicates to me that pain control is something that the widwifery profession as a whole has a problem with. I don’t hear OBs judging whether a woman’s choice for pain relief is “very logical” or not.

          • SNM1

            Really? Because I hear snarky cooks re from OBs and nurses all the time about the crazy in Room ____ who doesn’t want an epidural… And in my long comment only a couple of sentences was devoted to pain control as an example… Most of my comment was about education and choice. And my annoyance with some to try to place all women into one-size fits all. Pain relief was just an example. I didn’t go round and round. I said very clearly that I support either choice without any clarification needed… I also took some time to point out that I know fellow students and midwives who are very much on the “real women labor naturally” side of things and how much I dislike that stance because that is not a good option for all women… Do you attack all people who have opinions here or is it just because I will be a “midwife” that you automatically decided to find fault in my comment?

          • fiftyfifty1

            You’ll have to forgive me if I am reluctant to refer my patients to a type of care where apparently the “real women labor naturally” philosophy thrives. Where even the more liberal ones, like yourself, use loaded language like “very logical reasons for fearing the pain of childbirth”.

    • Siri

      I like you, Deena!

  • carovee

    These different trainings and types of expertise give us somewhat
    different approaches when it comes to reading said scientific studies:
    you will arrive from a clinical background based both on your medical
    education and your practice of medicine, and I will arrive from a
    philosophical background based on an in-depth examination of the
    philosophy of science and on a specialization in theories of autonomy…

    Wha?? Is this some kind of “different ways of knowing” argument? What on earth is she getting out of scientific studies on pregnancy and birth through the lens of her philosophical background that is any way comparable to what Dr. Amy is getting through her clinical background?

    • Amy Tuteur, MD

      Nothing except the ability to dismiss what the scientific evidence shows.

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

    This blog is exceedingly successful – and demonstrates the communicating “nicely” is not the same as communicating “effectively”. And at the end of the day, if the goal is to affect meaningful change, effective communication is needed. I applaud Dr. Amy’s strategic focus on her ultimate goal of protecting the health and well-being of women and their babies from a wholly inadequate standard of care. If this wasn’t a good reason to be angry, I don’t know what would be.

    • The Bofa on the Sofa

      If nothing else, the number of people who say, “I agree with your message but the way you say it makes me want to do a homebirth” tells you a lot about the people who are saying that. And it isn’t good.

  • theadequatemother

    OT: re canadian midwifery education

    I ran into a woman at a social event recently. A mutual friend happened to mention my baby was sick and had a fever. She asked how old. I said 4 mo. She said, “oh that’s outside my scope of practice. I only go to 6 weeks”

    I asked what she did (knowing the answer). The pride was palpable when she said she was in her last year of midwifery school. I did not mention my background/ training as its not really my habit unless directly asked.

    But I left that encounter wondering…how does she think medical care of infants < 6 weeks is within her scope of practice? The 6 week check is really maternal. Midwives have training in the newborn baby exam, can diagnose problems with breastfeeding, regaining birth weight and look for clinical signs of jaundice…but that's very different and very limited when compared with what a family doctor or pediatrician knows about babies < 6 weeks old. The more I come in contact with intermediate level practitioners (NP, CRNAs, and midwives) the more I am finding problems with their ability to set limits on their practice and understand the limits of their knowledge. And I find it very disturbing that intermediate practitioners are continuously pushing for wider scope. If you want wider scope, why not become a physician? It would be more appropriate.

    • Dr Kitty

      0-3 months and a fever of 38C or above is an ER visit.
      Three-six months and a fever >39C is an ER visit.

      If anyone with a nursing or medical background would like to brush up on their knowledge of paediatric signs of severe illness you can register for some online learning here:

      http://www.spottingthesickchild.com

      The NICE guidance on management of feverish illness in children is also pretty good.

      http://www.nice.org.uk/nicemedia/pdf/CG47QuickRefGuide.pdf

      • theadequatemother

        Thanks Dr Kitty we have a provincial algorithm for febrile illnesses in infants and I’ve also spent several months on pics rotations and in the pediatric ed. I’m not worried about my little guy as a physician. I’m worried about him as a parent…if that makes sense.

        What doesn’t make sense is that a midwifery student was giving every indication that she thought a febrile infant under 6 weeks was within her scope of practice.

        • Dr Kitty

          I wasn’t suggesting YOU weren’t on the ball with your wee one! Just that if anyone reading this was wondering what to do with a sick kiddie or what to watch for.

          I took my kiddo to the ER for Zofran when she was 2. Simple viral gastroenteritis, but LITERALLY every towel and piece of bed linen we owned had been puked or pooped on, and I was at my wits’ end. Sorted her right out thankfully.
          It is one of my triage questions for vomiting kids now “how many loads of laundry have you had to do?”.

          • Jessica S.

            “It is one of my triage questions for vomiting kids now “how many loads of laundry have you had to do?”.”

            Perfect way of putting it!

          • Siri

            In my mind’s eye I can see my son’s cuddly mouse, Speedy, pegged to the washing line by his ears. Meanwhile I was resorting to covering beds in old newspapers as no clean sheets or towels were to be had… aah, vomit… the bane of mothers everywhere.

          • Mishimoo

            The kids have 1 metre tall teddy bears, luckily they just fit into the washing machine.

          • Young CC Prof

            I was just at my friend’s baby shower, and she asked me about new motherhood. I said that it involved a lot of the three P’s.

            She’s a nurse, so she didn’t have to ask what those were.

          • The Bofa on the Sofa

            It is one of my triage questions for vomiting kids now “how many loads of laundry have you had to do?”.

            Ugh. Our last round of middle of the night pukeys involved I think 5 loads, at various levels. Always a sheet, usually the mattress cover, sometimes a blanket and/or pillowcase and/or a stuffed Elmo.

          • An Actual Attorney

            Pukeys (cat or kiddo) make me want to kiss the drop off laundry by the pound place.

        • Medwife

          Her scope would extend to identifying the fever. Then, direct to a pediatrician. End of scope. Personally in my job the baby is “mine” until the cord is cut, after that (unless something completely insane has happened and the nicu people are not there), she’s literally and figuratively out of my hands. I like it that way.

    • Zoey

      Not directly to your point on scope of practice, but the more I hear from the midwives in my part of Canada, the less impressed I am. For example, there’s one midwife (a licensed CNM) that posts in my local parenting group that is full on anti-vaccination, “prescribes” homeopathy to her patients, and tells everyone that she is obligated by Provincial standards to recommend the Vitamin K shot for newborns but advises parents to research on the internet before making a decision (and provides links to Mercola.com). I would definitely worry about someone like her having an increased scope of practice to include newborns with medical issues, or providing medical care to older children.

      • RebeccainCanada

        Are you in Essex Co. By any chance? That midwife sounds very familiar indeed.

        • Zoey

          No. Different province. But it’s scary to think there’s more than one of “her” type out there…

          • RebeccainCanada

            They are everywhere. I asked my Essex co. M/w if she was a CNM, and she said she doesn’t let her nursing training get in the way of her midwifery! Definite woo!

          • SNM1

            I don’t get that! I went to nursing school because I wanted to be a CNM… My nursing training and experience will only benefit me in being a safe practitioner. I have learned as an RN to trust my instincts when I just feel like there is something wrong with my patient, even when I can’t pinpoint what it is. I have also had to learn to handle emergencies as an RN and this will help me to keep my head when and if things go wrong. These experiences are incredibly valuable and will make me a better CNM… I can be “with woman” and not be so focused on an ideal that I miss the bigger picture all at the same time!! And seriously, why bother going to nursing school if you aren’t going to let your nursing training help make you a better CNM?

          • Siri

            She probably doesn’t let her brain get in the way of her midwifery either…

      • theadequatemother

        Zoey, if you know that individuals name I would recommend sending a complaint, along with screen shots, to the college of midwives.

    • Red

      As an anaesthetist, aren’t you essentially a MD with further specialist training? Which means you’re much better qualified and equipped to address issues with your baby..right?

      Sorry I’m confused now, Because in Australia, at least, you have to have a full medical degree before undergoing extra training etc…. (Just curious)

      • theadequatemother

        That’s right. I didn’t need nor was looking for help. It just came up in conversation and the midwifery student had no idea what I do for a living.

      • SNM1

        I don’t know much about Australia, but in the U.S. you can be an Advanced Practice Nurse with specialist training to be Nurse-Anesthetist. I don’t know the degree requirements or how long the program takes though.

        • theadequatemother

          in canada it takes min 3 yrs undergrad, 4 years med school, 5 yrs residency to be an anesthesiologist. We have no CRNAs up here. We have some GP anesthesiolgists. they have min 3 years undergrad, 4 years med school, 2 yrs residency and 1 yr extra training.

          • SNM1

            Thanks for the info! So I did some basic research since it isn’t an area I am too interested in and found that the Masters program for the CRNA takes about 2.5 to 3 years.

      • Siri

        No medical professional is equipped to deliver care to their own children… it’s a common misconception though, and other professionals often keep their distance because ‘she’s an OB, so she won’t want care and advice from a mere midwife’.

    • SNM1

      It is within the scope of practice for the CNM to care for the WELL newborn up to 28 days of life in the U.S. Most CNMs that do hospital or birth center deliveries only care for the newborn in the first few days of life. Because I will not be caring for babies outside of their first 28 days (unless I lose my mind and get my FNP certification as well), I do not plan to do any well baby care (outside of breastfeeding) past the first few days. I believe that time is better spent building a relationship with the pediatrician that will be following the baby’s care as it grows (this is just my personal opinion). And a midwife that would not refer an ill neonate to a pediatrician is practicing outside of their scope and should have their license revoked. We are simply not trained to care for anything but the care of the normal infant with no health concerns and babies that are ill should be cared for by the people who have the training and experience to treat them accordingly…

    • Mishimoo

      Slightly related – Took our eldest to the dentist yesterday and she ended up having a baby tooth extracted because avoiding a serious infection is more important to me than potentially avoiding braces. While discussing aftercare with the dentist, I was very happy with her response of: “Prescribing antibiotics is within my scope of practice, but I don’t have much experience with prescribing them to kids and I’d rather not risk underdosing or overdosing her. Your GP does this all day, every day, can you go and see them for a script?”

      (Also, things Dentists shouldn’t have to say: “Thank you! Some parents refuse to let us numb anything.”)

      • Trixie

        WTF who wouldn’t let a child be numbed for a tooth extraction?!?!

        • Mishimoo

          I know!! The other dentist thanked me for allowing anaesthetic when she had the original filling, and for asking the area to be numbed before the nerve block. Apparently, asking for local anaesthetic for kids is rare enough here that it is gratefully commented on. Which is truly awful!

      • fiftyfifty1

        ” I was very happy with her response of: “Prescribing antibiotics is within my scope of practice, but I don’t have much experience with prescribing them to kids and I’d rather not risk underdosing or overdosing her. Your GP does this all day, every day, can you go and see them for a script?””

        Sorry, I totally disagree. Prescribing antibiotics for mouth infections is within a dentists scope of practice AND within what should be their scope of EXPERTISE. There are only a couple of antibiotics that dentists need to be familiar with dosing and absolutely ANY dentistry training should have taught them how to prescribe these 2-3 antibiotics including both adult and pediatric dosing. If this dentist cannot comfortably prescribe what are absolutely standard dental medications to children she should not be seeing children. Very strange and disturbing.

        • Karen in SC

          Yeah, our family deductible is really high, so visiting our regular doctor just to get a script for dental work would be about $70 or more for the visit.

          • fiftyfifty1

            Yes it’s a huge waste of resources to have to cover for someone else’s inexplicable incompetence. But here’s what’s worse: As the child’s family doctor how am I supposed to know how serious the problem was? The tooth is gone so I can’t see it. I don’t have access to the dental x-rays. Is she concerned that there already is bone infection or is this more of a “preventive dosing”, so should I dose for 2 days or 10? Really I am flying blind here….

        • Mishimoo

          I can see your point, but I’m still glad that she admitted to being out of her comfort zone about prescribing for a kid that is underweight and so recommended seeing our usual doctor. There was the option to have another dentist double-check her prescription if I wanted, but I opted to see our GP.

          Since we live in Australia, we have the option of going to a bulk-billing practice that has a good working relationship with our dentist. The only cost was petrol and the price of the antibiotics. The GP we saw has experience with these things and tends to treat them fairly carefully, since he once dealt with the aftermath of a different dentist screwing up years ago. (Patient died while waiting for a transplant as a result of the dentist’s incompetence).

          • Siri

            The dentist needs to acquire that knowledge super quick; it’s neglectful to behave like that. Many GPs will baulk at requests for drugs the dentist should have prescribed; I had to beg ours (on a Saturday, so only a very limited number of appointments) for a script to treat my child’s dry socket. The alternative was waiting till the Monday with an ill child. I take it for granted that any dentist will be able and willing to prescribe WHATEVER drug is needed to treat the relevant condition; it’s also much safer to have whoever did the procedure, write the prescription. Delays cause pain and other complications. Your dentist sounds dodgy, sorry Mishimoo!

          • Mishimoo

            Ouch, your poor munchkin!
            She seemed embarrassed, so hopefully it is a learning experience. Still, I’d prefer honesty over winging it and hoping for the best.

            I was actually expecting to have to argue for antibiotics, thanks to my experiences as a kid and thanks to hearing on the schoolrun about the dentists that other families visit.

          • anion

            After my recent dental surgery disaster, I made an appointment with my local dentist in hopes of getting some painkillers (my impacted wisdom tooth started to break through within days of the surgery, which made the whole thing even worse!). My dentist told me he couldn’t do that and I should see my GP. So I did. My GP was super pissed that the dentist didn’t give me anything, and told me that technically she wasn’t supposed to prescribe for me for dental surgery, but thankfully she took pity on me and gave me some codeine.

            She also called my dentist to yell at them. :-)

        • GuestB

          As a dentist, I completely agree.
          I admit, I hate writing scripts for antibiotics for kids – it takes me 20 minutes because I check and recheck the calculations several times to be absolutely certain that I am giving the right dose. But guess what? That’s my job.
          I coouldn’t imagine telling a patient to go to their GP for meds. That just doesn’t make any sense to me.

        • Durango

          And what if the infection doesn’t resolve? Who does the pt go to–the MD or the dentist? I don’t think any doc should have to be writing scripts when another diagnosed the problem.

    • Ob in OZ

      “If you want wider scope, why not become a physician?”
      Amen

      • Deena Chamlee

        I actually agree

  • pburg

    “That’s right. Sometimes, I agree with Dr. Amy.But I rarely agree with her delivery. Sometimes it’s rife with logical fallacies*: straw man arguments, appeals to pity, appeals to authority, ad hominem attacks.”

    These accusations are addressing faulty arguments, which are only “delivery” issues in the extreme sense. Faulty arguments, oversimplifications and dogmatic thinking are, in part, what angers you (and me) regarding certain homebirth advocates. You justify your arguments by saying this is what reaches people. Is this what dialog has become in our age of unlimited media? You are contributing to polarization by appealing to the lowest common denominator.

    What Rush Limbaugh is to the left, you are to homebirthers. My hope is that people will get tired of this type of sensationalism and turn to a more socratic approach to discussion.

    • Karen in SC

      But that approach already exists on the two other blogs she mentioned, also Married to Medicine, Safer Midwifery for Michigan, and Exhomebirthers. People are not turning to those blogs. When I start to see comments from pburg on those blogs, I might give your argument some credence.

    • theadequatemother

      I missed the part of the post where Dr Amy acknowledges her arguments rest on straw men, appeals to pity, authority and ad hominems.

      But regardless, I think in using media to spread a message it is entirely appropriate to begin with those things to gather attention *as long as you have the ability to back it up with evidence and better arguments.* And Dr. Amy does have that ability and does do so. Whereas it seems to me that NCB and home birth advocates are more likely to stop the argument at ad hominems and straw men and never actually get around to presenting any compelling facts or evidence.

      • NoLongerCrunching

        I think many people don’t understand that just saying someone is foolish or narcissistic is not an ad hominem. Ad hominem means that you are equating the soundness of an argument with the soundness of a person’s character. So Dr Amy can say she thinks Melissa Cheney is a sociopath, but she shouldnt say that Cheyney is wrong about homebirth because she’s a sociopath.

    • Ennis Demeter

      Rush Limbaugh tells lies, heavily screens callers, and never debates anybody. Dr. Amy is nothing like that at all.

  • Irène Delse

    I find interesting that Kristen didn’t think Dr. Amy would have interest or training in philosophy. It’s the old trope about medical doctors being all cold and clinical, competent in the technical sense but with little or no interest for human experience… Again.

    • Young CC Prof

      You know, most doctors do have a liberal-arts undergraduate degree. Even if they majored in science (not all did) they took quite a few other courses.

      • Irène Delse

        Oh, I know. It’s Kristen from Birthing Beautiful Ideas who needs to hear this. ;-)

  • NoLongerCrunching

    I’ll admit I still clench my teeth when Dr Amy refers to the benefits of breastfeeding as “trivial” for full term healthy babies in the US. It’s hard to hear something you worked hard to do for your kids, and for me something I’ve devoted my career to helping other mothers do, described as “trivial.” But I’ll admit that in the current climate where moms who use formula are made to feel shame, it makes sense to push back hard against that.

    I’ve often wondered what I would do if I saw iron clad proof that there was absolutely no difference in health outcomes for babies and mothers. And I think I would still breastfeed and help other moms who want to, because I just feel like breastfeeding is special. (I’m sure every way of infant feeding is special in its own unique way; if I were a dad, I think I’d feel pretty delighted with bottlefeeding). So I’m thinking that it may be a religious belief system for us lactivists, even if we think we’re all about the science. And religion works best when you practice it yourself, be open to others practicing it, and respect people who choose not to practice it.

    • veggiegal

      Well, I am not aware of any studies that show that baking muffins with your toddler has any long term benefits whatsoever. Yet, I do it, even though it creates a huge mess. Why? Because it’s fun and we both enjoy it, and it’s worth a little trouble!!!! Substitute “bake muffins” with any of your favorite “fill in the blank”s, and it still works. I know many moms who truly enjoy BFing. That’s great. But it doesn’t make them, or their kids, superior. Just like whether or not a mom bakes muffins with your kids doesn’t make that mom or her kids superior. And, for the record, if baking muffins would be hellish and difficult to manage or I’d just hate it (or it would frustrate my kid), I would stop doing it, and find another activity that works better for us. And, that is the perspective I think is appropriate for BFing.

      • mamaellie

        I loved breastfeeding too, but I watched my sister and her baby struggle and it was an eye opening experience. We both remember when the baby had her first bottle after 6 weeks of nonstop breastfeeding and very little weight gain. Her tiny fists unclenched and her face relaxed. She slept peacefully for the rest of the afternoon. Their experience was far from enjoyable. There were so many tears and so much frustration and guilt. It didn’t have to be that way. A year later they are a very happy Mom and toddler. When it was all happening Dr. Amy did a couple of posts on breastfeeding that I shared with my sister. I think they helped a little.

        • Aki Hinata

          Exactly. I really, really wanted to breastfeed my first but his latch was awful and once both my nipples had split I had to stop. Incidentally, both he and I lack the patience for baking with children. I suppose our relationship is now forever damaged.

      • mom of 2

        What a great explanation! Perfect.

    • guest

      The medical benefits are small, yes. But there may be benefits beyond the medical ones. My breastfeeding experience was definitely special, and I am happy that I pushed through the difficulties to get to that point. (I am also happy that I was able to push through the difficulties; I know for some women no amount of brute strength is going to make it possible.) So, I don’t want to speak for Dr. Amy, but I think what she means is that the idea that feeding your baby formula is like giving them poison is complete and total bogus, and when it comes to nourishing your baby, the difference between breast milk and formula is very small. That said, I am so happy that I was able to breastfeed my son, not because of medical benefits but because of that special time we had together.

    • Jessica S.

      I have to say, I appreciate everything you’ve stated here. I didn’t breastfeed my first, am not planning on it with number two (currently “baking”). I fall into that heavily demonized category (in the militant lactivists’ world) of “WOULDN’T, not couldn’t”, the worst of the worst. :) But my decision isn’t based on thinking it has no benefit or that there is no specialness to be found. It’s just a personal decision I made, one that I feel fine about, and I’m very grateful there is a good substitute. I just wanted to say that I appreciate that in your dedication, you don’t demonize those who choose otherwise. :)

      • NoLongerCrunching

        I appreciate your appreciation LOL. It’s sad that you feel you have to thank someone for showing the basic human decency of not judging you for doing what’s right for your family. I really wish mothers would support each other more, because it’s so obvious that we are all doing the best we can. It’s funny to think that in a different era, our situations would be reversed; I would be seen as too cheap or low class to provide my child with the benefits of scientifically developed modern formula. We moms just can’t win sometimes.

        • Jessica S.

          It really is crazy that way, how things get totally reversed!

  • mamaellie

    I love this post. My kids are vaccinated because I came here. A good thing this week since we have been exposed to whooping cough.I admit now what I don’t know and I am grateful for the doctors in our lives who worry for us, so that I can worry a little less. Without the harsh tone I would have passed this blog over.

  • Coraline

    Very well said.

  • Jen

    That is a very interesting but unsurprising stat re: anti-vax. My husband is a pediatrician and obvs strong supporter of vaccines, but he laments that his respectful blogs, tweets, and facebook post seem to fall upon deaf ears. Now we know why.

    • Amy Tuteur, MD

      The public health campaign for vaccination ought to be based on the implication that only gullible fools refuse to vaccinate their children. We need to make it socially unacceptable everywhere, not a badge of honor as it currently is in some circles.

      I do think that part of the reason why this blog has changed many minds is that I hit people where they live; I tell them that not only do I not respect their “education,” I think they are gullible for thinking they can get educated by reading books and websites written for laypeople.

      • Ennis Demeter

        Another tactic: countering the (overblown, illogical) idea that the hospital is a scary, cold, rude place with the idea that a mother will put up with a rude doctor and a stainless steel table if she has to in order to keep her baby safe.

      • RebeccainCanada

        Bravo! And again, I want to thank you Dr. Amy, because of you, my children are now current, and I no longer have to worry each time the get sick, if it’s something really bad I could have easily prevented. Can’t seem to convince “friends” of ours and they can’t figure out why we don’t want our kids to play with their (Un-vaxed) kids anymore.

        • Trixie

          Lately I deal with any non-vaxxers I meet in real life by giving a look of sheer revulsion and horror while gathering my children and quickly backing away. While muttering about how my dad almost died of measles and my mom almost died of mumps.

          • Young CC Prof

            I think society as a whole is starting to take that tack. Instead of debating intellectually, it’s just, ew, get out of my country. Kind of like how you look at people who don’t wash their hands.

          • Trixie

            More like how I’d look at someone who took a dump on the Persian rug. In the middle of Thanksgiving dinner.

          • Bombshellrisa

            You have no idea how much I laughed reading that! My baby boy just went for his two month checkup last week and had three shots. Mentioning it to people got me everything from unsolicited advice from a chiropractor to being accused of being “overprotective”. I have seen post polio syndrome, I have heard the sound of a baby with pertussis-why the hell would I volunteer my child to be at a higher risk to get these things? I think your idea of the look of revulsion is perfect. I hate how I am made to feel like I am the one with something wrong with my thinking.

          • Trixie

            Yeah, I’m sort of over treating it like something to have a rational discussion about.

    • NursingRN

      I don’t understand how anti-vax parents can just turn a blind eye to the fact that creepy crawly buggies are coming back! Measles, Whooping Cough, all of it! I read a book in a store that catered to “natural parenting” types and it just went on and on about how measles and chickenpox were once “good old rites of passage!” Making light humor of it even and then making anyone representing conventional medicine- docs, NP’s PA’s into essentially unenlightened old school buffons. Again, heavy on the word “educate and empower”. So I hope it’s good for their natural souls and nurturing to them because the mom whose infant died from Pertussis isn’t feeling empowered, the little boy who is suffering from Orchitiis, secondary to mumps and may end up sterile some day isn’t feeling enlightened, the kid in the ICU with meningitis secondary to measles is SURELY having a party. I know *I* had a blast with my chickenpox “rite of passage” at age 5 (GRANTED that was 1985 prior to the vaccine). Wow! Pox in the throat, in the mouth, on my head and where the sun don’t shine- how empowering. It was great. No, really it was.

      • SNM1

        I agree wholeheartedly… I would not wish the chicken pox on someone I dislike let alone my own children! My experience was equally miserable (also, in 1985). My girls are both fully vaccinated and will remain so.

      • Jessica S.

        It’s mind boggling that people still throw “chickenpox parties”, when the vaccine is readily available. It seems so cruel! I remember a year or so back, a friend of a friend was invited to one such party. Turns out it wasn’t chicken pox, but hoof and mouth disease (or whatever that’s called.) It was a real eye-opener to me, b/c I had decided to keep my criticisms to myself, knowing that my son was fully vaccinated. Never did it occur to me that they could be transmitting some other disease. I mean, I know I can’t prevent him from ever getting sick, but I don’t mind taking reasonable precautions – like hand-washing, vaccines and keeping him away from the shedding recipients of infectious disease grab bags. :)

        • (No longer) Pregnant Guest

          ugh! I had hand foot and mouth disease while I was pregnant last year. I think it was the worst I’ve ever felt in my entire life. That’s a horrible story.

        • Trixie

          Not to mention, why would you want to purposely give the virus that causes shingles to your child? So they can remember 50 years later what an idiot you were?

  • KarenJJ

    I don’t see how you can be called “condescending” when you are treating women like grownups that have the ability to think and discuss and argue like rational people. I like it. I thrive under it.

    As a newly minted graduate engineer I worked under a senior engineer that kept me in the office doing office-based tasks instead of sending me out onto the plant. I was the first engineer to be treated this way and looking back I really feel it was because I was a young woman and he was trying to “protect” me. I hated feeling patronised and protected and pampered. I also found myself to be lacking in crucial site experience.

    My current manager has no such qualms about putting me out there and giving me site work. It’s awesome. He treats me like an engineer. I’ve worked with him for over a decade and we’ve had our ups and downs but I respect him a lot and I’ve learnt a lot under him.

    Women don’t need the sort of fake “empowerment” that feeds them ideal scenarios and can leave them far from medical help should they need it. They need to be empowered to speak as rational adults who can think and make requests and deal with someone telling them no and even that they are behaving like nitwits.

  • Gretta

    The. Truth. Hurts.

    But thank goodness there are folks brave enough to preach it.

  • jhr1212

    In addition to always admiring your vast professional knowledge, excellent writing skills, strong advocacy ability, I now add to that: intellectual and personal integrity.
    Fine work, Dr. Amy.

    • Guest

      And total accountability. I post here anonymously because I don’t want to take the heat Dr. Amy takes. I admire and respect that she signs her name to everything she says, she stands by what she says, she deletes nothing and bans no one. I know that’s a lot harder than she lets on, and I know some days it hurts, and I’m so grateful to her for doing it because I think it makes a huge difference.

      • Ob in OZ

        Ditto
        If I did not have to worry about how some of my comments here could affect my work environment, my name would follow. It will have to wait until retirement

        • Aussiedoc

          Exactly. The feminist breeder asked me why I was anonymous the other day. Because people like her could affect my work. Someday I’ll say my piece. But not today!

          • Young CC Prof

            Tenure is good. Of course, there are still other things that have happened to prominent female skeptics…

  • Guesteleh

    Defiance and denial are at the heart of both movements: defiance of
    medical “authority” and denial that bad things can really happen to them
    and their children that no amount of good food or breastfeeding is
    going to prevent.

    I also think it’s about demonstrating your class fitness. Good health, good pregnancy outcomes, and breastfeeding are all strongly correlated with socio-economic class. But if you are a success at “natural” childbirth, you can pretend that your good fortune is due to your innate fitness: I deserve good health and good outcomes because I am inherently worthy (not because I have a lot of money). Of course, the corollary is if you have bad outcomes you are inherently inferior/damaged/to blame, so the privileged few don’t have to worry about things like social equity, healthcare access, support for new mothers, etc.

    • The Bofa on the Sofa

      Yep.

      My kids aren’t vaccinated and are perfectly healthy – healthier, dare I say, than most vaccinated kids.

      Yep, and their farts don’t smell as bad, either, right?

      • Are you nuts

        Now THAT would be an anti-vax argument I could get behind!

      • mamaellie

        I had a conversation once with an aquaintance before I started vaccinating about how “pure” our babies were. Cringing.

    • stenvenywrites

      I think it’s reverse snobbery, actually, particularly anti- intellectual snobbery. These are the same “public health scholars” who fancy themselves smarter than medical school graduates and wish to bring homebirth and extended breastfeeding to the unwashed masses.

      • Amy M

        I agree with you, but I’d point out that snobbery is snobbery, regardless of which direction it is going in. No “reverse” necessary.

      • Guesteleh

        Actually, I’m not convinced they really want to bring it to the masses. They try to “educate” people and when the masses aren’t convinced, they can shake their heads sadly and bask in their superiority. If the masses actually bought in, they’d move on to some other way to prove they’re better than you.

  • Ash

    I have recently taken some screenshots of a CPM who had her license suspended after a breech homebirth death.

    http://i.imgur.com/aMr7nUO.jpg

    http://i.imgur.com/GqCooRO.jpg

    http://i.imgur.com/NdQtgYh.jpg

    Aspiring midwives wish to practice illegally:

    http://i.imgur.com/6LcnsKa.jpg

    • Karen in SC

      but she rated a 2 for punctuality!

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

      Reading that apologia pro vita sua written by Ms. Golliet, I now advise you, Dr. Amy, to send all your critics something made by hand, like a pie or something knitted. That would show how nice you really are.

      I’m sure the mother of the dead breech baby was thrilled to receive her handmade gift from Ms. Golliet. Oh wait, what she paid her was for “services” not a donation to the defense fund.

    • Trixie

      Really horrifying that she chose the word “undying” to express her gratitude.

    • Jessica S.

      Barf. On behalf of a Washington State resident, I absolutely hope any and all “midwives” of her ilk are run out of the state. I’d prefer they just stop practicing altogether. Sickening that she doesn’t even mention the death of one of her babies in her charge. I mean, that’s kind what your job performance should be based on, as a midwife, is preventing death the furthest possible degree. Determining breech presentation definitely falls in that range. Argh!

      • Bombshellrisa

        Double barf-another Washington resident agrees!

    • Jessica S.

      Oh, and the FB message and which states are the “best” to practice fly-by-night midwifery, where you’re least likely to be arrested? It’s like a drug dealer asking which state has the most lenient trafficking laws.

  • Monica

    I couldn’t get through Kristen’s rewritten posts of yours. As short as they were it was yawn inducing. I’ve never read her blog, but I’m going to assume that’s the case with much of her posts. The lack of comments on that particular post of hers suggests there’s nothing worth commenting on. Here, well completely different. A little nitwit here and a little nitwit there and I’m hooked ;).

    • The Bofa on the Sofa

      I left the old What to Expect monthly board because I got sick and tired of the stupid “be nice” crap. It got to the point where everyone was so busy “being civil” that they never said anything worthwhile, because if there was anything at all contentious, someone would be offended.

      Screw that. If you think about it, you realize that conflict is the key to interesting reading. Without some sort of conflict, it’s all really boring.

      One of my planned projects is to write a book (and turn it into a screenplay) based on Adam and Eve. But as I think about it, it’s really hard because what is there to write about in the days of the Garden of Eden? Everyone’s wandering around happy all the time. It’s very boring to read about. So I am having a good time getting started.

      Actually, the only thing that makes it at all interesting is that they are running around naked (and unashamed) all the time. The reason that is interesting is because, from a movie standpoint, if I want to be true to Genesis, it would involve a lot of nudity. And I’m not talking figleaves, that would represent modesty.

      Presumably, they are also having sex (although the question of whether Adam and Eve had sex before the fall is complex – if there is no death, then what happens when population gets very high?), so that would be included,*** but until the serpent rolls in, the life of Adam and Eve is pretty damn boring.

      ***Of course, the objective here is to test for cognitive dissonance. Lots of nudity and sex will cause a problem for many people BUT if it is a “true account” of the Garden of Eden, then why should it be a problem? I mean, the violence in The Passion was acceptable because it was a true account, so why shouldn’t nudity in the Garden of Eden?

      • Therese

        I would imagine a religious person who had problems with nudity might say that it was the Fall that made nudity unacceptable, so therefore, it is unacceptable even if it is shown in the context of a movie about a biblical story. I mean, your movie could also show Adam and Eve explicitly having sex (so in other words, the actors wouldn’t be pretending to have sex for the movie but actually engaging in it) and you could say, “What’s wrong with that? They’re a married couple and everyone believes marriage makes it okay to have sex” but that would be shocking to even non-religious people if you were to do that. (Unless you’re marketing it as porn.)

        • Therese

          Oh and to explain why the violence in the Passion was okay, it was fake violence, while nudity would be actual nudity.

          • The Bofa on the Sofa

            So fake sex would be ok? I could put it on Skinemax…

      • Trixie

        Have you read Awkward Moments Children’s Bible?

      • RebeccainCanada

        No the violence in The Passion was acceptable because the movie was about the Passion and Death of Christ. If you want to make a movie/book about Adam and Eve such as you describe, how about calling it the Marriage Bed of Adam and Eve, because that’s what it would be about. Nobody went to the movie The Passion, expecting a depiction of the early years of Christ’s life, or his neighbours’ lives, etc…. The Passion is referring to the Passion or Suffering of Christ. The Passion is a part of Christian worship and is considered sacred. Why would anyone expect to be going to that film to see otherwise?

        • The Bofa on the Sofa

          Well if you go to a movie about Adam and Even in the Garden of Eden, they are going to be naked.

          Why would you expect them to be otherwise?

          As I said, the whole figleaf version is completely contrary to the entire concept of the Garden of Eden before the fall, and the whole point of the Tree of Knowledge.

          Remember, Adam and Eve did not know they were naked before the fall. They didn’t even know the concept of being naked.

          • RebeccainCanada

            Dude fig leaves are for kids. The a Passion/Suffering and death of Christ is just that, violent. Just because they were naked doesn’t mean anybody wants to see them doing it. The point is (I know I’m fished in here) is that I am a fallen human, so nudity, is not something I want or chose to see in others, and I don’t walk around nude because I don’t want others to see me as a sex object. However, does just the theme of Adam and Eve mean sex? No, that’s a stretch.

            Hey how about you show up at work nude? Will everyone think sex? Unlikely. Will everyone think you nuts? Highly likely. There’s something sacred about the human body. Not all of us prefer to see others nude.

            Everyone who went to see the Passion were aware it was about the Passion!

          • The Bofa on the Sofa

            Dude fig leaves are for kids.

            There were plenty of people who let their kids to see the Passion because it was a true depiction.

          • RebeccainCanada

            Yeah, thanks for this discussion. Lots of parents do lots of things. Are you kidding? Bofa I normally love your perspective, you make me chuckle, but sometimes you seem a little jaded. And this is one of those times.

            As a Christian, I will apologise, on behalf of anyone who may have taken their kids to see The Passion. I did not, I saw it in theatre in Canada and saw no children there but a packed audience of adults. We own a copy even my 15yo has never seen. My children have a Nest Video, called “The Passion for Kids” and that is all they have seen.

            I can’t be responsible for what people do. I can only say that this discussion has gotten silly. Hope you have a nice day. I will continue to look forward to your comments on this blog in future. I think you really have a lot to share

          • The Bofa on the Sofa

            Yes, I am completely jaded.

            Most importantly, it shows how violence is so readily accepted, but dare suggest that we show a little nudity without shame, and suddenly it’s silly.

            See the comments defending all the violence in The Passion. However, throw some nudity in there, even thought it is completely biblical, and suddenly everyone frets.

            Would you keep a copy of a movie about Adam and Eve, true to the Genesis story, on your self, if it contained unashamed nudity? Regardless of whether you let your kids watch it. If Adam and Eve were walking around completely naked paying no attention to it?

            Do you think as many Christians would do that as would be having the Passion around? Or would the nudity be too much?

            That’s the issue at hand, and thanks to all participating to illustrate the point. Violence = ok. Nudity = bad. Even when it’s in the bible.

          • Aki Hinata

            Actually, I think more Christians that you might think are uncomfortable with biblical violence. For example, I have seen The Passion, but am not interested in owning the DVD and the church bodies I’ve been involved in have always de-emphasised the majority of the violence in the OT.

          • Anj Fabian

            The OT is chock full of a jealous and vengeful God who smites the heck out of his chosen people.

          • RebeccainCanada

            Nope. Nudity and violence for kids=bad.

            I have no problem seeing nudity in the sense of birth videos, my pregnancy books are full of nudity, showing the change in breasts and body during pregnancy. I have breastfeeding books with nudity. No worries there. They aren’t on my kids shelf.

            Now sex? No I don’t have pictures or videos of sex.

            We have watched The Passion video, usually on a Good Friday, to remind us what Christ experienced when he suffered and died. But I can count on one hand how many times.

            I do have Adam and Eve books but they are kids books. I don’t have any illustrated coffee table books of Adam and Eve. You are attributing vice where there is none.

            Now are you going to say I need to have porn around to be consistent? I won’t keep porn around. But I will recall the suffering and death of Christ because it’s part of my religious belief.

            And I am consistent in that my kids don’t see violence or nudity when I can help it.

          • RebeccainCanada

            Oh and you forgot to acknowledge my point about the Passion and I said nothing about Fig Leaves! I would assume them to be naked and ion that basis decide if I wanted to see the movie.

            You assume because I sound like a Christian I want to see fig leaves. I do want to see some fig leaves and well placed plant life in books for kids. Part of me being an individual with preferences. Nobody forced anybody to see The Passion.

      • Jessica S.

        Soooo…. I was just going to make a comment about the What to Expect books but now it seems out of place. Ha! Oh well, I’ll say it anyhow.

        I love the easy-to-skim format of the What to Expect books but the way they’re written makes me want to scratch my eyes out. Cliches and word-plays every other sentence. It’s so maddeningly predictable, yet I still reference them all the time. :)

        We were given a book just recently called Toddler 411 and it’s written a lot like the WTE books but not in the same irritating prose. I readily admit that this is a personal annoyance and can see how others might think I’m crazy. A lot of people do.

        Ok, back to religion and nudity.

    • theadequatemother

      I read her blog a little bit when I was pregnant with my first…because it was named one of Babble’s top 50 pregnancy blogs and her letters to her unborn were kind of sweet. However, it soon became apparent that she was IGNORANT. She links to studies but her interpretation of them seems to be based on how they are interpreted on blogs like science and sensibility and on several occasions she linked to studies to support assertions where the study doesn’t provide convincing evidence and where other contradictory studies were not mentioned or completely discounted.

      This happened on many posts that touched on epidurals. I’m a content expert in that area, well versed in the literature with respect to s/e and affects on labour. But I couldn’t touch her beliefs so I gave up on her blog and on her.

  • Guest

    I bet I can surprise you with another way your blog has done good in the world: I have a chronically sick kid and you’ve helped me be a better advocate for her. Because you are blunt where my kid’s doctors can’t be, I am much better able to understand the gap between what I know and what they know — and how they think and work as doctors. I get it now: why they were so angry at me for not giving her formula. They were still wrong, but I see now how scared they were for my baby, and all the ways I inadvertently made it worse. Because of your blog, I have never again permitted myself to get into an adversarial relationship with a doctor. I have learned when to accept and be grateful for how much more they know than I do — and when and how to dig in and claim my authority as the parent. You taught me how to do that, so thanks.

    • KarenJJ

      That’s a really good point. I’m in a similar situation and in the past my relationship with doctors was not great (nod, smile, ignore was the main tactic I had). Knowing more about doctors and about what they are trying to do means I am able to advocate much more effectively and without losing my temper.

    • Amy Tuteur, MD

      I’m so glad. I’m am very much aware that many doctors have obnoxious bedside manner, but even the most obnxious ones are deeply committed to their patients’ health and well being.

      The sad thing about most natural childbirth/homebirth professionals is that their primary product is “distrust.” Their income depends directly on causing women to distrust their own doctors and they’ve worked hard to create distrust not merely by peddling lies, but by convincing women by getting in their doctors’ faces and demanding absurd accommodations they’ve not merely created a self fulfilling prophecy (since the response to being lectured by someone who is repeating nonsense is not likely to be positive) but they caused doctors to distrust their own patients because of their bizarre, irrational demands..

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

    I think the ad hominem attacks and often vulgar, even obscene comments made by some of those who criticize Dr. Amy’s views are more objectionable than anything Dr. Amy writes. It’s not “snark” so much as the unvarnished truth, and frankly, I don’t want the truth either “varnished” or in any way obscured by double talk intended to deceive.

  • Ash

    Been thinking about this..the thing that bugs me about homebirth advocates is that there’s no effort to DO BETTER. When there is a ACOG meeting, does anyone sit around and say “our morbidity and mortality rates last year were pretty good. No need to research how to improve our practice. Everything is fine.” Yet there are no clinical practice guidelines for midwifery. “Yay, the MANA stats show that our ‘clients’ breastfeed and have vaginal deliveries. Good job!” That is not how professionals should act. You can call yourself a birth attendant, but don’t say you’re a professional midwife.

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

      There’s no impetus to improve outcomes when they’re already “experts at normal birth” and their “other ways of knowing” handed down through the ages. If the point is doing it the old way, anything new is BAD.

    • Melissa

      My cynical side thinks that MANA is practicing preventive midwifery by refusing to have any type of practice standards. It’s hard to be sued for malpractice for deviating from the standard of care when there is no standards.

      • Ash

        Exactly. If there’s no practice guidelines to say “we recommend vitamin K prophylaxis for all neonates”, no one can bust them when their members do not recommend Vit K.

  • Tamara

    THIS is a fantastic post! And I agree wholeheartedly.. the fact that you piss some people off is how I found you in the first place. You piss off the NCB folks, exposing them for the “uneducated, gullible fool”s that they are and they are going to TALK about it… lurkers, participants in the discussion, etc are gonna come check it out. People love drama on the internet and getting your message out to the masses is absolutely more important than being “nice.”

    Just imagine how many have learned that homebirth is NOT as safe or safer than a hospital birth purely from TFB alone ranting about you! I’d wager it’s a lot :)

    • veggiegal

      Just seconding – fantastic post :)

  • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

    There is no denying you are effective in getting traffic and getting your message across. When I first visited your blog, I did not like *what* you had to say…. but *how* you said it…. well, it wasn’t enough to scare me off. Granted, I thought you were awful and mean….. but it grabbed my attention. And I couldn’t deny what I was reading. I could tell the “mean” was coming from somewhere and the more I read, the more I could tell the anger was coming from seeing preventable deaths happen over and over and over again.

    I feel it, too. There are times now where I just want to scream I get so angry with MANA, with certain midwives (not just the obvious ones like Lisa Barrett and Gloria Lemay), etc… I get so angry with how they are trying so hard to dupe women. There whole stance is built on this notion of empowering women and informed consent… and that’s not at all what they stand for or what they want! It is infuriating. I understand why you are so angry.

    You’ve been at this the longest. You are the original advocate. You have given the voice to countless babies that have died preventable deaths. People who deny and dismiss you because you’re “so mean” just don’t see it… because they don’t *want* to see it.

  • Ague

    Dr. Amy, please do not change! Your snark is the reason I love your blog! There are other blogs which say similar things, but you are the only one who does not spend half her life apologizing to anyone who begs to differ, and who dares to tell it like it is. Everyone should have your attitude on this unscientific nonsense, and you are an inspiration to us all.

    • mamaellie

      Yes! There have been several occasions when I have been so offended by something Amy has written here that I declare myself “done with this blog!” But the heated discussion is what keeps it interesting. It is always amazing to me that she doesn’t back down even a little. No matter what Amy’s flaws she doesn’t compromise on her point of view in order to be better liked.

  • Mer

    Thank you Dr. Amy, I know sometimes I feel like you are being too harsh and then I remember why you’re doing all of this and how I feel just reading comments and how angry I get. I don’t know how you do it, because I couldn’t do it without losing my temper entirely.

  • anh

    This makes me think of this article http://krugman.blogs.nytimes.com/2013/06/06/bad-faith-and-civility-health-care-edition/?_php=true&_type=blogs&_r=0

    particularly this quote “Inevitably, there are some people trying to turn the conversation meta
    in a different direction, and make it all about civility. But bad-faith
    arguments don’t deserve a civil response, and if the attempt to be civil
    gets in the way of exposing the bad faith, civility itself becomes part
    of the problem.”

    If someone is saying something patently stupid or dangerous, why on earth do we owe them a civil response. It’s somewhat akin to my frustration with false balance in vaccine coverage in the media. No, presenting it as a debate makes it seem like there is something to question, to talk about. there isn’t.

    Why should you pretend there is a conversation to be had? There isn’t in many cases

    • stenvenywrites

      Or to paraphrase Sheldon Cooper, sure you catch more flies with honey than with vinegar; you catch even more with bull***t; what’s your point?

      • Jessica S.

        He is my favorite. Brilliant character!

    • Jessica S.

      Yes!! False balance lends false credibility – the exact opposite of how pseudoscience should be countered.

    • Melissa

      Gawker wrote a great article calling the movement against snark to be about Smarm. http://gawker.com/on-smarm-1476594977

  • Alannah

    The ‘Dr Amy is mean and rude’ argument is so sexist it makes me ragey. Just imagine if the author of this blog were male. There wouldn’t be nearly as much emphasis on his tone and certainly no-one would argue that it made his message invalid somehow.
    As a woman you are apparently under an obligation to be nice all the time.
    Guess what lady, there’s no obligation to be nice and cheerful to people who habitually kill off babies. It’s a spade and that’s what we’re going to call it. Keep up the good work dr Amy!

    • Amy M

      Dr. Amy–did you ever consider writing under a male pseudonym? Not that you should have to, but just to see how it would be received? Or maybe convince Dr. Grunebaum to do a blog, maybe he can net the ones who will only listen to a man. :)

      • Amy Tuteur, MD

        I would never do that.

        First, I’m used to the double standard. When I was a practicing physician I used to watch as nurses endured any amount of abuse from male physicians, but then turned around and condemned female physicians as “bitches.” One of the best things I heard about myself I’ve actually heard on multiple occasions: one nurse telling another that I’m a bitch unless my patients get the best possible nursing care. I took it as a compliment.

        Second, a good part of my credibility comes from being a woman and mother and also from my good luck in having easy vaginal births and breastfeeding my children without difficulty.

        I found Ananda Lowe’s letter to other doulas to be particularly enlightening in that it apparently never occurred to Ananda that I oppose a variety of NCB and homebirth practices because they kill infants and mothers. She was sure that my opposition came from my personal experiences since that’s where her need to believe false claims comes from.

        • Amy M

          That makes sense. I was thinking more of a social experiment. (what was that movie in the 80s? where the girl dressed as a boy to get on the school newspaper or something?) I hate that that sort of double standard still exists in 2014, but of course medicine is not the only arena where it still stands.

          • Young CC Prof

            Some folks did an experiment where they submitted the same paper to multiple journals under three different false names, one obviously male, one obviously female, and one with only first initial.

            Pretty significant differences in acceptance rate.

          • The Bofa on the Sofa

            “Just One of the Guys”
            http://www.imdb.com/title/tt0089393/

          • Amy M

            Thank you–(Terry’s such a stallion!)

        • fiftyfifty1

          ” When I was a practicing physician I used to watch as nurses endured any amount of abuse from male physicians, but then turned around and condemned female physicians as “bitches.”

          I think things have gotten a lot better. It’s no longer acceptable for physicians (of any gender) to abuse nurses. This has gone a long way toward improving doctor-nurse relations. The great majority of nurses I have worked with have been good and they were almost all incredibly supportive to me during training (once I proved to them that I wasn’t about to provide substandard care to OUR patients).

    • Zornorph

      Dr.Amy is bossy!