“Ways to Deal With Dr. Amy’s Negativity”

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Apparently waterbirth proponents can’t figure out how to deal with my “negativity” about waterbirth in the wake of the cautions issued by the American Academy of Pediatrics and the American College of Obstetrician Gynecologists.

It’s not as though any of them could mount a rebuttal to the paper. They haven’t read the literature, wouldn’t know how to understand it if they read it, and couldn’t care less what is says in any case.

So what if babies are injured and die unnecessarily at waterbirth from infections as a result of inhaling fecally contaminated water; umbilical cord avulsion and umbilical cord rupture leading to hemorrhage and shock; drowning or near drowning; and seizures and perinatal asphyxia?

Is that any reason to be so negative?

Ananda Lowe doesn’t thinks so. She is the co-author with Rachel Zimmerman of The Doula Guide to Birth; Secrets Every Pregnant Woman Should Know. Hmmm. Rachel Zimmerman; that name sounds familiar. Oh, I remember why; she’s the doula who authored the piece on waterbirth on WBUR, the Boston affiliate of NPR. Zimmerman revealed her bias by “balancing” the scientific evidence from the AAP and ACOG with the blithering of Barbara Harper, as if a nurse who just makes stuff up provides balance.

Lowe doesn’t like the comments I left on the piece. She wrote an email to her doula list about it and the email was posted on Facebook.

Hi all,

Thank you to those who responded to my previous email asking for your comments on the water birth article that my colleague wrote for the NPR Web site. You truly made a constructive contribution to the conversation.

If you looked at the article, you probably noticed the “flame wars” started in the comments section by Dr. Amy…

… Dr. Amy instigated perhaps the worst comment war I have ever seen her create. There were over 600 comments in just 2 days, many of which are posted by a small handful of people (Dr. Amy’s followers) repeating themselves many times and with extreme hostility. Dr. Amy had posted the very first comment to the article: “Would you completely immerse your head (eyes open, of course) in the fecally contaminated bloody water of a birth pool in the aftermath of a birth?” and the flame war took off from there.

I am curious what our community feels is the best way to handle her and others like her. She has an orchestrated way of disrupting the comments section of articles on a frequent basis. I wonder, should there be an orchestrated response to her, or should some other approach be taken? …

My feeling, and I have heard others speculate, is that she and her followers are acting out their pain over their own difficult births or difficult breastfeeding experiences and lack of support for mothers in our society, or other difficult experiences in their lives that somehow come out in their anger toward the natural childbirth community…

I myself do not have a lot of time to devote to a campaign to dealing with Dr. Amy. But she seems to be getting more and more wild, if that is possible, and I would be interested in hearing your ideas about relating to bullies in general, as well as those who inflame the childbirth wars and mommy wars in particular.

Ananda Lowe

How sad. I’m harshing the mellow of doulas and natural childbirth advocates everywhere and for the absolutely trivial reason that babies are being harmed by being delivered into the equivalent of toilet water.

Here’s a thought, Ananda:

Instead of reflexively opposing anything that calls your birth “knowledge” into question, maybe you ought to consider that the American Academy of Pediatrics Committee on the Fetus and Newborn knows much more about neonatal physiology than all the doulas in the country put together. They have no reason to claim that waterbirth injures and results in preventable deaths of babies unless it does. Y0u are wrong and babies are suffering because of your lack of knowledge, and the willingless of natural childbirth advocates to privilege process ove3r outcome.

We have a saying in medicine that doulas might want to take to heart: Primum non nocere. First, do no harm.

Waterbirth can and does harm some babies. That’s not negativity. That’s the truth.

Deal with it!

  • Gagarin

    If big medicine and all these OBGYNs were as cut throat as these Granolas claim, then you can BET water birth would be a great way to upsell. Deluxe private rooms? Warm-colors in the ward? Baby portraits? That’s passe… we’ve got WATER BIRTH! The AMA would stack the cards and lobby and do whatever it could to get BlueCross and other carriers to pay for this newer and safer and just magnificent and NEEDED option! Employees would raise a stink to their HR departments and the HR departments would demand that their insurance brokers get their providers to get that service covered! Think of the cashflow and increase in billings the doctors and hospitals would have! Think of the industry that would manufacture medical grade swimming pools or tubs! They might even offer underwater photography! They wouldn’t be letting these doolahs and hippies walk off with all that cash. Unless…. unless it wasn’t safe and was just totally ridiculous. ..

  • Emma J

    I have to agree with others who said it, it angers me that my support for Dr Amy is considered the result of my own difficult birth experience or bf issues. I was induced at 38 weeks and my daughter was delivered by a consultant obstetrician via forceps after a failed ventouse. I had an epidural, and I remember her birth as very pleasant indeed. I had two nurse midwives, two paediatricians, an anesthatist, the consultant and her SPR and my own husband, who is an ER doctor , in the room when she was born. I felt very safe and supported. As for bfn should we is still feeding at 16 months.

    • Emma J

      I apologise for spell correct there, she is still breastfeeding at 16 months.

  • birthdance

    Hello Dr. Tuteur,
    With sincerity, I would like to understand your positions. I have taken the time to try to do so at various points, and I have learned from you. Please understand, when someone like myself reads a person’s position that is delivered with great harshness (at me as an individual or at a community that I belong to), it takes a large amount of strength not to take it personally or immediately react with defensiveness, and to open our minds to absorbing new ideas and carrying them forward. We’re just human in that way. There are some gems of wisdom that have come out of these debates and discussions, in which a few people on differing sides have been able to see the possibility of bridging the divide, and working energetically together toward the common ground of making birth as safe as possible for babies and mothers. I am someone who read the position paper on waterbirth, and I am very open to hearing the discussions about any and all safety concerns and advocating for safety in whatever way I can, particularly as a public figure. I want to invite those with positions that differ from each other to remember that there truly is the possibility for us to learn from one another. My private comment that you saw on Facebook was not meant to speak to you directly Dr. Tuteur, but I would like to start over in making your acquaintance here, expressing my intention to learn from you in the future even if my feelings get hurt because I would prefer a less harsh tone, and extending the hope that common ground toward the utmost in safety for babies and mothers can continue to be found. I am certainly with you in that regard.
    Ananda Lowe

    • moto_librarian

      Ananda, I think that both ACOG and Dr. Amy have made it clear that laboring in water is not problematic, but delivering in the water can be. I think that the middle ground here is to labor in water if it provides you with enough pain relief, but get onto dry land before actually delivering the baby. That is the safest course of action.

      I will say that I personally grow tired of being told that the reason that I speak out against misinformation must be because I am “bitter” or “disappointed” about my birth experiences. I’m really not – after all, they resulted in my two beautiful sons! I will say that I felt let down by the natural childbirth movement after experiencing severe complications after my first unmedicated delivery. I felt like I had been lied to, and no one wanted to hear about how disempowering that experience had been for me. Becoming aware of your own mortality at the very moment that you have brought forth new life is an awfully humbling experience, and I didn’t feel like I had a lot of support in processing that experience until I got to know a lot of the regular commenters over here.

      • Young CC Prof

        Good point. Speaking against something because you tried it and didn’t like it, or because something bad happened to you as a result, doesn’t mean there’s something wrong with you! That’s a normal human thing to do, encouraging other people to learn from your experience.

        • http://momofmanyfeet.wordpress.com Bambi

          Unless it goes against what HB/NCB advocates think or feel.

      • birthdance

        OK, that makes a lot of sense. I would not have known that someone in your shoes would feel tired of being told that you are speaking out because you are bitter. It is really important for me to hear that. I am also extremely sorry to hear about Bambi’s loss. In my book, I wrote a 19-page chapter about unexpected outcomes experienced by mothers planning a natural childbirth, because I felt that the topic had been sorely under-addressed in other childbirth books. That was in the first edition which came out in 2009, and it was one of the first attempts to put something substantive about the topic into a mainstream book. (I am hopeful that you might like much of what I wrote in that chapter.) My wish is that we would have come further since then in terms of not idealizing one type of childbirth to the point that families would become so disempowered by that idealization, and some progress is being made in that department, but clearly not enough. I will continue to think about what you have shared with me, and again, I am grateful that you did.
        Ananda

        • Amy Tuteur, MD

          The bitter thing doesn’t bother me except for the fact that it is utterly untrue. Someone made it up and other people repeated it because it turns the attention from what I say to who I am.

          For the record, I had 4 easy, uncomplicated vaginal births, 2 with epidurals and 2 without. I breastfed all four of my children until they weaned themselves and I had no trouble doing so, even though I was still working part-time then.

          The only thing I’m bitter about is people lying about the risks of homebirth, waterbirth and refusing interventions. Lies about me are irrelevant. Lies about natural childbirth and homebirth kill babies.

          • Ashley L.

            Dr. Amy, do you think think it is possible that some doctors offer or push interventions that are not medically necessary? When you gave birth, did your doctor or nurse offer any of them? Were you connected to IV fluids the whole span of your labor? When you were practicing, did you feel comfortable letting women have physiologic labors if there were no known problems? I’ve always wanted to know the answers to these questions. This is the first time I’ve read anything about your own births. I also wonder if you have ever worked with an OB that, in your opinion, seemed to intervene when it was not necessary. Thanks.

          • Amy Tuteur, MD

            A patient who has an uncomplicated labor and an easy delivery is an obstetrician’s dream. That’s what you want for every patient. Unfortunately, babies are not always cooperative. They have a nasty habit of trying to die, sometimes totally unexpectedly. Once you’ve seen it happen a few times, you don’t let it catch you unawares if you can help it.

            I don’t see any particular value to “physiologic birth.” Birth is not a piece of performance art; it is a process and there’s nothing particularly valuable about it. The outcome is far, far more important.

            My philosophy of practice is that obstetrics is preventive care. Childbirth is inherently dangerous, and it is the obstetricians job to prevent, diagnose and manage complications. You cannot do that by pretending they won’t happen. You can only do that by taking all possible steps to prevent complications and being prepared in every way possible for when they unexpectedly occur.

          • attitude devant

            Yes, THIS! Thank you!

          • Jessica S.

            “Birth is not a piece of performance art; it is a process and there’s nothing particularly valuable about it. The outcome is far, far more important.”

            Yes, yes, yes! I know there are women who feel devalued by this, but I don’t know why – they don’t need to put value in it. We should value the outcome!

        • anion

          I really don’t mean to be rude, but I have to ask…you honestly didn’t think that someone in Bambi’s position wouldn’t appreciate having their feelings and experiences dismissed with “you’re just bitter?” It really never occurred to you that that’s an insulting and sexist thing to say?

          I’m genuinely curious how someone can say they care about women’s feelings and experiences and want to make women feel empowered, and that when it comes to birth the emotions of the mother are enormously important and should be protected, while at the same time dismissing women who don’t agree with them by saying, “they’re just saying that because they have negative feelings.” Thus dismissing their thoughts, emotions, and experiences–and them as people, as if they are not to be taken seriously because of their emotions, or as if the fact that they had negative experiences automatically means they’re unimportant.

          I’m not actually expecting an answer, and again I’m not trying to be argumentative; I just hope, as you seem honestly to want to make a connection and reach some kind of common ground, that you’ll think about the above.

          (FTR, two c-sections, both of which were great, breastfed my second for seventeen months, never wanted vaginal birth and was happy to avoid it in the end. No bitterness about my birth experiences, just anger at those who try to make me, and other women like me, feel bad or inferior because we didn’t make the choices they did. I’m not saying you’re necessarily one of those women, just explaining that any anger or “bitterness” I may have certainly doesn’t come from unhappiness with my babies’ births.)

          • birthdance

            Got it, thank you. I do feel bad that my private email got posted on Facebook without my permission. When I wrote that sentence about difficult births/breastfeeding/lack of support for mothers, I was picturing traumatic births but not those resulting in the death of a child. I, too, have friends whose babies have died during birth. So yes, I can completely see how someone in Bambi’s position would not appreciate having their feelings dismissed. (To clarify, I never said you’re just bitter, and I apologize if it seemed that that was what I meant–again, the email was never intended for public viewing.) Honestly, I was trying to understand, and I wanted to see if those in my circle had insights that had escaped my notice. I did hear from some colleagues of mine who expressed compassion for all concerned. To be sure, hearing directly from those of you on this forum is highly educational. My 3-year-old is getting overtired and I need to run and put her to bed so I’ll stop here, but thank you again for helping me to understand.
            Ananda

          • Trixie

            Thank you for being here and being willing to be engaged in this conversation. I said some snarky things about you down below, so I wanted you to know I’m glad you’re here discussing this.
            I’m not bitter about birth or breastfeeding either. I had a c/s and an all natural hospital VBAC, and nursed both of my kids well into toddlerhood. I was even an HMBANA milk bank donor. What I’m bitter about is a dangerous culture of home birth midwives who kill and harm babies and mothers and then lie about it.

          • anion

            No, I apologize; you specifically never said “They’re bitter,” but it is a phrase that’s been bandied about more than once as a reason to dismiss anyone who isn’t pro-NCB.

            Again, I really appreciate you commenting here, and don’t want you to feel attacked. I completely believe that you want to learn and understand. My question was more general, as in, “Comments like those are insulting and sexist, so when you see them, please consider what they’re *really* saying, and if people who say things like that are people you truly want to align yourself with.”

            FWIW, I completely agree that there is a lack of support for mothers–no matter what kind of birth they had or how they feed their babies or how old their children are–and that it’s shameful. Motherhood is devalued more and more, it seems, and I find that very distressing.

            Thanks again for joining the discussion.

            (Also FWIW, we share a publisher, though not an imprint.)

          • attitude devant

            Ananda, I really appreciate your posting here, but you can hardly expect us to take you seriously when you describe a post to a doula listserver as a ‘private email.” Don’t you think that’s disingenuous?

          • birthdance

            I accept the fact that it is now a public comment and any responsibility I have in that. I am doing my best here. Thank you for allowing me to participate in this discussion.

          • LibrarianSarah

            First of all, when you send an email to a listserv it is not “private.” It would be one thing to send an email directly to Amy and have her publish it without asking you first but you sent it to a listserv which is the email equivalent of a facebook group. I am a member of many listservs as a part of my profession and I wouldn’t say anything on them that I wouldn’t want written in the New York Times. It is misleading to refer to it as a “private email” as if you are trying to make it seem like Amy violated your privacy when she didn’t. You have as much of an expectation of privacy on a listserv as you do on Facebook.

            Secondly, “I’m sorry but I didn’t mean you to hear it” didn’t wash in middle school and it certainly won’t wash now. You were caught saying offensive things to what you thought were only an in group. The fact that you didn’t think you would get caught doesn’t make it better.

          • birthdance

            I get that now, which I didn’t before. Thank you.
            Ananda

          • NoLongerCrunching

            I’m another former NCB advocate who had beautiful all-natural births and breastfed my 3 kiddos for years. I came here originally to argue about why I was right and everyone here was wrong, but after reading for a while I learned a lot. It’s very eye-opening to listen to other points of view than what we get in our NCB bubbles.

    • http://momofmanyfeet.wordpress.com Bambi

      Perhaps you would not make blanket assumptions before judging people.

      This is what I think of your patronizing, dismissive, paternalistic remarks about us. http://momofmanyfeet.wordpress.com/2014/03/24/theyre-so-negative-omg/

      My daughter died a completely preventable death that has been dismissed by advocates like you.

      • Mishimoo

        Oh Bambi *hugs* she was so beautiful, I’m incredibly sorry.

        • anion

          I can’t say it better than Mishimoo did. Bambi, I am so sorry. What a beautiful baby. {{Hugs}}

    • Amy Tuteur, MD

      Hi, Ananda. First, please call me Amy; no need to be formal.

      One of the problems I find with discussing homebirth, waterbirth, etc. is that many people WANT to personalize it. They find it nearly impossible to think about anything that challenges their assumptions. I suspect that is at the heart of efforts to demonize me. You are hardly the first to ponder the “Dr. Amy problem.”

      Unfortunately, that’s the opposite of what we need to be doing, which is to consider the scientific evidence dispassionately. I’m always willing to participate in any conversations, but you need to ask yourself if you are really open to considering that what you believe might not be true. If there is no way that you would ever change your fundamental beliefs about birth, we won’t have much to discuss, because I will show you evidence and you will dismiss it.

      Homebirth advocates have a problem with scientific evidence. They were all for it when they thought they could claim that obstetricians ignore scientific evidence, but as the years go by it is becoming pretty clear to everyone that obstetricians are assiduous about following the evidence. That’s why we have journals that publish hundreds of papers each month concerned with every empirical aspect of childbirth. That’s very different from the publications of midwives, doulas, etc. who publish articles about the experiences of individual women or groups of women and their feelings about those experiences.

      Obstetricians do follow the scientific evidence and that’s how they know that homebirth is dangerous and that giving birth underwater can kill a baby. In the last couple of years, as it has become apparent too midwifery and natural childbirth theorists that the scientific evidence does NOT support most of natural childbirth philosophy, their attitude to the evidence has changed. You’ll notice midwives recommending “evidence informed” practice as opposed to “evidence based” practice. “Evidence informed” practice is basically a fancy way of saying that natural childbirth advocates plan to ignore any evidence that they don’t like.

      For people who provide real medical care to others, case reports on unanticipated dangers signal a need for further investigation. For faux providers like homebirth midwives, unanticipated dangers signal a need to demonize the messenger, criticize the message, and, above all, make no effort to determine if the message is true.

      Today I wrote about Melissa Cheyney of MANA who wrote a piece in Birth excoriating Drs. Grunebaum and Chervenak, as if that has anything to do with whether babies are dying preventable deaths at homebirth. There’s no question they are; Cheyney’s own data tells her so, but she simply refuses to acknowledge it because it costs her too much to recognize the truth.

      Multiple case reports have been published about unusual causes of death at waterbirth. For example, there have been reports of avulsion of the umbilical cord, with resulting neonatal hemorrhagic shock, that occured as the infants were being brought swiftly to the surface of the water.

      In the 30 years since I graduated from medical school, I have never even heard of a case of umblical cord avulsion, let alone seen one, so this is a complications directly attributable to waterbirth. And why were the midwives pulling the baby swiftly from the water? Because babies aren’t supposed to be born underwater; it can kill them if they aspirate the fecally contaminated contents of the birth pool. So why is anyone delivering babies underwater when it is 100% non-physiologic?

      Simply put, the deaths and injuries are iatrogenic complications of waterbirth. Midwives and doulas are encouraging a made up “treatment” for labor pain, a treatment that has killed babies and shows no benefits in large studies.

      It may be very difficult for you to understand my position or that of other obstetricians, because you’ve been fed a diet of lies about childbirth. Barbara Harper, the doyenne of American waterbirth, is an ignorant fool. I don’t mean that as an insult; I mean it as a statement of fact. Her “explanation” of why waterbirth is not dangerous is made up from whole clothe and is utterly nonsensical to anyone who knows anything about physiology, bacteriology, neonatology or even basic chemistry.

      Waterbirth is the equivalent of giving birth in a toilet. Again, that is not an insult; it’s a fact. I’ve seen and heard about plenty of accidental deliveries in toilets, and usually no one is the worse for wear, but I wouldn’t recommend delivering in a toilet.

      So the question is, are you willing to consider whether what you believe is untrue even if turns out that your cherished beliefs are untrue?

      • birthdance

        Hi Amy, thank you. I just replied to a comment from anion and need to run and put my 3-year-old to bed, but I wanted you to know I did read and appreciate your message above. The quick answer is yes, I am willing to consider whether what I believe is untrue. I am sorry to leave an incomplete answer here but participating in this diaolgue with you and others on your Web page has helped very much. I regularly read literature such as ACOG Practice Bulletins and AAP committee opinions word for word, and I followed the advice of those whose guidance led to the publication of my book to scour and reference the medical literature constantly in my book. I try my hardest to acknowledge best evidence, whether or not it favors my preferred worldview. Not always easy, but necessary. Thank you again and I wish you well!
        Ananda

    • DaisyGrrl

      I’m so glad you came and commented. I hope you stick around and share and learn new perspectives. The more the merrier!

      You’ve heard about the science and the umbrage at being called bitter (and frankly, I would be bitter and angry to learn that I had been lied to and those lies resulted in my child’s death). I don’t know much about you so I offer my perspective in the spirit of sharing and hopefully advancing the discussion.

      I am not a parent or a health care provider. I think of myself as a feminist and I view many of the issues discussed here through that lens. When I first started reading this blog, I didn’t have much of an opinion on natural childbirth one way or another, except to think that it was probably a good thing. My women’s studies professors had spoken of being poorly treated when giving birth in the ’70s and ’80s and that many aspects of midwifery and natural childbirth were a response to the patriarchal constructs of medicine. I learned how western medicine had failed women in other areas of health (such as cardiovascular health) and thought of pregnancy and birth as truly women’s issues.

      I still think that pregnancy and childbirth are at their very core women’s issues. Consequently, I get riled up when I see the narrative that a woman must have a natural physiologic birth in order to be a proper woman/mother. The idea that mother must have a midwife and reject interventions (unless medically necessary – which I read as “unless someone is at death’s door”) does a grave disservice to women.

      Informed consent means that a person must have all relevant information in order to make a decision and I don’t see that effort happening in natural birth circles. In terms of waterbirth, that means that a woman needs to know that while there doesn’t appear to be any harm in labouring in water, giving birth in water has resulted in very serious injuries and death to the baby. Just like a toy or crib can be recalled because of one death, waterbirth should be subject to the same level of scrutiny because of the serious nature of the injuries and deaths associated with the practice. Women should be made aware that these outcomes are possible, and that there isn’t enough data to say for sure how dangerous waterbirth can be.

      When I participate in these discussions on other forums, I don’t do it because it’s part of some coordinated campaign by Dr. Amy. She doesn’t tell me what to say or think. I do it because I think there needs to be a dissenting voice. The discourse around childbirth has in many ways been co-opted by the NCB movement and the counter-balance isn’t there. I don’t like being dismissed as a sycophant or follower or minion. I have my own ideas and my own opinions. I’ve had respectful comments deleted and been ridiculed by others for thinking that access to effective pain relief during labour should be a given in any developed country. This has happened on mainstream comment sites as well as NCB ones. I didn’t take part in the NPR comment thread (and didn’t bother reading it) but you are certainly not the first to mull over the “Dr. Amy problem.” She certainly has a way of bulldozing into a comment section and taking over the discussion (whether you agree with her style or not)!

      There are a huge variety of readers and commenters on this blog. There are parents, health-care professionals (including midwives and doulas!), and interested lay people. We all have different opinions and we all come from different places. When any of us take the time to comment on articles or blogs or whatever, we do it because we care about the issue, just like you.

  • anion

    Here’s my question, and forgive me if it’s a silly one or if I just haven’t seen/read enough waterbirth experiences, but I haven’t seen this in any of them (and there’s been quite a bit of discussion about armpit-length gloves etc.): If the water is so clean and lovely and all, why are the midwives not stripping down to a swimsuit and climbing into the pool to assist from there? Why lean over the side with long gloves on? Why aren’t they immersing themselves in it?

  • Isilzha

    I don’t have or want children; never been pregnant, never wanted to be.
    I’m here because I am interested in why people, especially women,
    reject evidence, facts and science.

  • mamaellie

    I had the picture perfect birth experience as far as the NCB crowd is concerned. It was a waterbirth, I was allowed to go overdue with zero pressure from my midwife to have an induction or even monitoring. I was counseled to refuse the diabetes test, vitamin K for my newborn and various other things. Baby’s heart tones were checked only a handful of times and my midwife had so little to do with the birth she may as well not have been there. I got to feel very smug when baby was healthy because of my clearly superior choices. I was utterly brainwashed. As it happens I am extremely upset about that birth experience now that I understand the extent of my midwives’ negligence and my own ignorance. By commenting here and elsewhere you are damn right I am acting out. Also, during my waterbirth I had diarrhea (in the toilet not the tub) and afterwards was encouraged to get right back in. My daughter was born into filthy water that I absolutely would not stick my face in.

    • Christina Channell

      I had a home labor (as opposed to home birth) in which I labored at home in a kiddie pool until I was ready to push. The hospital is one block from my house and we made the thirty-second drive during transition. All went according to plan and we gratefully avoided catastrophe during my completely unmonitored first stage of labor. A few days before labor began, my doula casually suggested that perhaps I should just “accidentally” give birth at home. I declined her offer out of fear of something going wrong. Only now as I have come out of the NCB fog do I realize just how deadly my doula’s suggestion really was. It would have essentially been an unassisted birth! I am thankful that the odds were in our favor that day.

      • CognitiveDissonaceHurts

        I did the same, in the shower at home. It’s a chilling feeling, isn’t it, to think of what might have gone wrong with our delusion.

      • lawyer jane

        I’ve been wondering about the advice to “labor at home as long as possible.” That is standard advice given by OBs as well as NCB proponents. But it seems like a lot of NCB proponents/doulas push it really far – like wait until transition. Is that safe? This is just an anecdote, but I have one friend who self-induced with castor oil and labored at home for a long time per the doula’s advice. Baby was delivered in the hospital but had some brain damage, thankfully has not produced any lasting symptoms.

        • Young CC Prof

          The OB/hospital version seems to be basically, “Even if you think you’re in labor, as long as your water hasn’t broken, it’s OK to stay home until things really start to get going.” Which means they have fewer women in the earliest stages cluttering up delivery rooms, and fewer women to examine and send back home for false labor.

          The NCB version is “Stay home until you think delivery is imminent, then lie about how long you’ve been in labor, to make sure they don’t do a c-section.” Which is dumb, especially the lying part.

          • Trixie

            Even if your water breaks, they often want you to hang out at home for at least a few hours if you aren’t in active labor.

          • Mac Sherbert

            May depend…I was told to come in right away when my water broke. They didn’t really ask about my labor symptoms the response from my OB was to go directly to the hospital. Of course, I was 38 weeks and was 3cm at my appt. the day before. Turns out it was the best advice as my baby had flipped to the breech position.

          • Box of Salt

            Broken water + GBS+ = come in immediately for antibiotics.

          • Trixie

            Both times my water broke before active labor and they told me to stay home for several hours to see if it got started, and I was GBS+. Two different providers. They told me to come in by X time, which was 3-4 hours in the future.

          • Mer

            I was told to come in right away when my water broke. I was GBS positive as well, and it turned out to be a good thing to go in right away as baby was delivered 2.5 hours later! But it was my third and previous labors hadn’t been longer than 11 hours and they knew I wanted an epidural, so that all probably factored in.

          • mamaellie

            The hospital bill for our false start with our last baby was bad, but the 40 minute car ride in transition with my second baby was worse. My OB took into consideration my previous precipitous labor and even urged me to be induced. Instead I was super anxious and made a couple of false starts. It turned out to be a pretty normal labor at 13 hours. I didn’t mind laboring in the hospital at all. I felt safe and supported. I could hear my guy’s little heart galloping away (I requested the monitor). The sandwiches weren’t bad either.

        • AmyP

          “I’ve been wondering about the advice to “labor at home as long as possible.””

          Yeah, me too. I almost missed out on an epidural because of that advice (I took a shower, had a snack, packed up in a leisurely manner, etc.) because it was only a 4-hour labor with my second and it took a while to get into triage and get a room. That HURT and they tried to place the epidural at least half a dozen times before succeeding, as I was thrashing around uncontrollably at that point. I almost had a totally unmedicated birth–the epidural only started working about when it was time to push. And I went in to that knowing 100% that I wanted an epidural.

          I would never give that advice to delay to anybody. It just guarantees that there will be unnecessary hassle, confusion and pain. Having done it several times, it’s so much better to check in in a leisurely manner, before you’re in awful pain.

          • Medwife

            I just don’t understand why someone they KNEW wanted an epidural would be told to “labor at home as long as possible”. Especially for a second baby! Getting triaged, admitted, labs drawn, fluid bolus administered., anesthesiologist arrival, it all takes time.

      • mamaellie

        That is incredible. So she was going to play midwife?

  • Sue

    Suggested approach for ACNM:

    ”We support the choices of women for pain-relief in labor, either through medication (including epidural) or through physical methods, such as positioning, movement, birth balls or warm tub water.”

    We also recognise the evidence that delivering through bath water, which is always potentially contaminated, can be harmful, and (rarely) even fatal to the newborn.

    Recognising that the health and safety of both mother and baby are priorities for every family, we therefore recommend that women laboring in water do not deliver in water, but leave the water when birth is imminent.”

    There – was that so hard?

    • The Bofa on the Sofa

      Isn’t that what the ACOG and AAP have said?

      So yeah, that would be hard for the ACNM…

    • fiftyfifty1

      “we therefore recommend that women laboring in water do not deliver in water, but leave the water when birth is imminent.”

      Hell, you don’t even need to go that far. They could just substitute the above line with:

      “we therefore recommend that waterbirths be considered experimental at this time and that a large scale study of their outcomes be undertaken”

      I have nothing against waterbirths. But opposing the call to formally study them (after multiple case reports of adverse outcomes such as drowning, bleed outs and sepsis that are directly related to the waterbirth method) is unethical.

  • RationalOB

    My first experience supervising a CNM performing a water birth convinced me babies were meant to be born on dry land. Mother covered with a light brown sheen of feces. Vagina a mess. Took me an hour or so to perform the repair. When looked at Internet sites talking about wonders of water births only talk about second deliveries which are almost always easier than the first. Never talk about the risks.

    • Rochester mama

      Were there any injuries to mother or baby from the water birth, or were you just grossed out? Was the mother happy with her decision afterwards? What kind of information does your hospital give to patients considering water birth?

      • RationalOB

        Was years ago. Took a lot of local anesthesia to repair lacerations. I no longer work at that hospital and do not know what info they give to patients. At my current hospital we offer laboring in the shower, tub, while walking, on a ball, epidurals. Most women choose some alternative but ultimately want the epidural. And why not? Queen Victoria was one of the first woman to use analgesia during childbirth. No one can accuse her of being a wimp!

        • LMS1953

          When I was a medical student, I did my OB rotation at a large county hospital in the South. Your competence was judged by when you decided to take mom back to the OR for delivery. No such things as LDRs back in 1978. If you took her back too soon, she would occupy too much staff time. One L&D nurse said, you need the “Big Mama Forceps”. I said, “No, I think the resident needs to apply forceps”. She gave a chuckle meant to subject me to ridicule and humiliation. Soon thereafter, in comes rumbling a 400 pound housekeeper. She fell atop the patient like a Word Federation Wrestler and I barely managed to catch the baby who shot out into my lap. The resulting appearance of the introitus could have been made by a hand grenade. Clusters of yellow fat emerged from immense jagged holes where vaginal sidewalks once were. Labia looked like crab bait. I was again subject to ridicule and humiliation since it took me an hour and a half to patch everything up as best I could as a third year medical student. Learned a lot about anatomy and surgery that rotation.

          • Mer

            That sounds utterly horrifying. That poor woman!

          • Certified Hamster Midwife

            …why did the housekeeper fall on the patient?

          • Anj Fabian

            I’m guessing that it was a flavor of abdominal pressure – apply external pressure to help ram the baby through the pelvis.

            It is still used in some parts of the world. It’s crude and risky.

          • birthbuddy

            Russia, apparently one example.

          • LMS1953

            To bring a rapid conclusion to the second stage. Fundal pressure is now considered malpractice especially if there are complications of shoulder dystocia.

          • Trixie

            I’m so confused. A housekeeper?

          • anion

            Jesus. That is one of the most horrifically evocative series of sentences I have ever read.

            And i read and write horror/urban fantasy.

      • LMS1953

        Yes there were injuries to the mother. A jagged, stellate vaginal/perineal laceration requiring one hour to repair in an “injury” by any definition of the term. I cannot see how the baby’s head can be well controlled on the perineum by the provider with perineal stretching that might have rendered the perineum intact. And, heaven forbid there be any consideration whatsoever to an episiotomy – oh horror of horrors.

  • Amy

    Pain from my own difficult birth or breastfeeding experiences?!?!? HAHAHAHAHAHAHA…..

    Oh my, that’s funny. Yes, both my children were born via cesarean, and I *was* upset by the first…..mainly because the crunchy brigade on the ICAN list and MDC were so hell-bent on persuading me how badly I’d damaged my child by not letting my obstructed labor continue another few days. My second was with a team of CNMs in a community hospital, and even the crunchiest woo proponent among them recommend a c-section after a stalled labor. I was supported and respected and treated like a rock star at that birth.

    My “difficult” breastfeeding experiences involved nursing each of my kids well past age three. I loved nursing my kids! I just try not to be an asshole about it to women who don’t nurse.

    • MaineJen

      Hear, hear. I don’t see where I’m bitter about my experiences, which were pretty darn good on both counts (easy births, good BFing experiences). I just can’t stand it when women are made to feel lesser or worse! that they actively harmed their kids by accepting pain relief (“caving” to the godsend epidural) or actually listening to their doctors, or feeding their kids formula for whatever reason they see fit. I disagree with the shaming tactics, the false “pity” that if only we were more educated, we would see things your way. Thanks, but no.

  • Jessica S.

    And seriously, WTF is up with her suspicion that it’s our bitterness over dead offspring or dead breastfeeding dreams that drives us to such radical lengths as informing people they may be putting themselves and their babies into harms way? How seriously f***ed up do you have to be to think that way? What a grade-A moron. Just the kind of person I’d trust with the health of my future children.

    • GranolaTastesLikeFrootLoops

      I suspect “dead baby” strikes a little too close for comfort, and if they really had to think about someone else’s dead baby they may have to start to challenge some of their beliefs. Therefore, it’s easier to say to a woman who has lost a child that her body is broken and she’s not meant to have children–and is therefore a stark raving lunatic. Which is more palatable than a woman who has suffered the loss of a child not wishing other women to needlessly go through the same terrible fate.

    • Trixie

      By “difficult birth experiencs” I think they mean, you know, lifesaving medical interventions inflicted on us by the patriarchy.

      • Mishimoo

        Something that I have wondered for a long time: How did they manage to escape the damaging influence of the patriarchy?
        How did they become such enlightened beings that they can criticise others, but not see the controlling aspects of the practices and beliefs that they espouse?

      • birthbuddy

        Penocracy! (LMS)

  • Jessica S.

    Her answer to this question: “I am curious what our community feels is the best way to handle her and others like her” can be found by answering this one (that set off the alleged “flame war”: “Would you completely immerse your head (eyes open, of course) in the fecally contaminated bloody water of a birth pool in the aftermath of a birth?”.

  • Zornorph

    It’s true that my failure to establish a breastfeeding relationship with my baby has enraged me towards those Earth Goddesses in the NCB movement.

    • prolifefeminist

      There’s still time to salvage that relationship – have you considered inducing lactation with domperidone and round the clock pumping? Don’t let anyone tell you that you have insufficient glandular tissue just because you’re a man!

      • Danielle

        Behold, Mr. Milker:

        “Fathers are quietly suffering the effects of not being able to breastfeed. It’s happening everywhere and fathers are not speaking out… but, maybe if they had a male breast feeding bra or vest they wouldn’t need to. Announcing Mr. Milker.”

        http://greatinventions.tv/home/product/mr-milker-male-breastfeeding/

        Zornorph, you can thank me later.

        • Zornorph

          The horror…the horror…

        • Siri

          Oh gawd, the comments make me die!!

      • Certified Hamster Midwife

        I have a MTF transgender acquaintance who didn’t have a child, but had always wanted to lactate. Once she had decent-sized breasts thanks to hormones, she bought something without a prescription online–domperidone, I’m guessing–and lactated.

        So, no excuses, Zornorph. Start by popping some estrogen!

    • The Bofa on the Sofa

  • stenvenywrites

    “she and her followers are acting out their pain over their own difficult births or difficult breastfeeding experiences and lack of support for mothers in our society, or other difficult experiences in their lives that somehow come out in their anger toward the natural childbirth community…” So emotional trauma is the only reason to reject a hypothesis — resolving feelings is part of the scientific method, now? If I’d known this, my dissertation defense would have gone so differently ….

    • Dr Kitty

      Isn’t that just a way of saying we’re all crazy/ butt hurt so feel free to ignore us?

      All those neonatologists must be acting out their pain over having to care for sick and dying babies…yup that’s it. Ignore them, they’re not thinking rationally.

      Nothing to see here, waterbirth is safe, move it along.

      • Squillo

        Ironically, it’s a classic dismissal of women’s concerns. She might as well have written, “It’s all in her head.”

        • prolifefeminist

          Exactly! So gross.

        • Young CC Prof

          Thank you. That’s it exactly.

          The final proof that you’ve failed to be a feminist: You are using the weapons of the patriarchy in a quest to silence other women who say things you don’t like.

          No oppressive regime has ever stood without the active cooperation of a substantial portion of the oppressed class.

          • Jessica S.

            “No oppressive regime has ever stood without the active cooperation of a substantial portion of the oppressed class.” Active cooperation fueled with propaganda, which is why our moaning and whining against the regime is so crucial. :)

        • anion

          Yep. There’s no way a woman can have an opinion based on facts or a genuine desire to see women and babies live, because we’re all just a bunch of sillykins who can’t think beyond emotions! Tee hee!

      • theadequatemother

        Well, a cs birth is much less likely to give you butt hurt…

    • prolifefeminist

      This is all part and parcel of the “mama wisdom” idea taken to the extreme. To me, and to any normal person, “mama wisdom” means knowing that the reason my sleepy teenager is late for school is probably because he stayed up too late texting his girlfriend, or that when my toddler is too quiet in the other room, he’s probably getting into something. In other words, “mama wisdom” is a judgement made based on past history and current facts.

      But to hardcore NCB advocates, “mama wisdom” means ignoring facts, ignoring history, and supplanting both with feelings – as if being female means prioritizing one’s feelings over rational thought. Even more revolting, this baloney is labeled as “feminist” when it is anything but.

  • Karen in SC

    Another case of “burying twice.” Ignoring that homebirth isn’t as safe as out of water birth, despite the evidence.

    The only problem is that hospitals and OBs have to follow evidenced based practices since no one has invented a crystal ball to know outcomes in advance. Even if the risk is low, it’s not zero!

    Recently, I commented about “unnecessary c-sections”, mentioning how OBs have to think of liability and careers. The NCBer I was replying to never responded to that comment, and others that were in agreement with me. I was reminded of that when I read this post on KevinMD:
    http://www.kevinmd.com/blog/2014/03/doctors-practice-cover-ass-medicine.html

    What defense would a hospital and an OB have if a malpractice suit was brought against them after a waterbirth tragedy? now that recommendations have been published against it? I’m not a lawyer, so I don’t know, but I wonder if changes will be forthcoming.

    • SuperGDZ

      I also had the thought that hospitals that currently offer waterbirth may (should!) now change their practice. In other words, potentially LESS revenue for hospitals, rather than more.

    • Young CC Prof

      I would imagine that, in hospitals across the country, that conversation is now happening between the maternity ward and the legal department.

  • Monica

    I think she has things a little backwards. The hostility in comments did not come from Dr. Amy or her “followers” it came from the supporters of water birth who seem to think Dr. Amy should be shot in the head. Lets remember Dr. Amy’s life was threatened in those comments and she was called a sadist. I saw no personal attacks made by Dr. Amy and even the email mentions no personal attacks. It was very on topic to the post it just so happened to be something these people disagreed with. That does not make one hostile, it makes one have a different opinion with evidence to back it up. So really the question she’s asking here is how can we make the evidence show something it does not.

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

      Are there caps of the threats? Those ought to be here…

      • Monica

        Oh yeah, I’m sure people have documented this.

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

          I hope someone posts. I can’t wade through what with the rage and all.

  • Ennis Demeter

    That Facebook comment section about water birth on the NPR page is very depressing. When we weren’t looking, the whole country went crazy on us and everyone hates modern medicine for women in childbirth. At least, it seems that way.

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

    The thing I don’t get – for a group that pretends to understand trauma, why on earth are they not aggressively trying to prevent women from having truly traumatic experiences?

    • The Bofa on the Sofa

      Oddly enough, they aren’t even denying that those experiences aren’t really traumatic. They just don’t give a shit.

      • Trixie

        Unless that shit is at the bottom of a birth pool.

    • christy

      Because from their point of view the only non-traumatic birth is one in which the mother trusts birth so completely she gives birth in the happy privacy of her home. And since birth is inherently as safe as life gets, the mom will make peace with whatever happens.

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

      I think they believe their own bullshit most of the time. Really. Its also very hard to realize you aren’t helping after you have done something wrong over and over.

    • http://momofmanyfeet.wordpress.com Bambi

      That’s what I wonder. It’s like “OMG, that episiotomy was so traumatic. What?? Your baby died preventably? Why is that a big deal?”

    • Mariana Baca

      Or why are they saying they using trauma as a debate stopper or saying traumatized women are too biased to have opinions.

  • Ennis Demeter

    I don’t get it. They always say that obstetrics can’t get the credit for lower death rates because that is due to germ theory and better hygiene, but a tub full of poo and blood is healthy.

    • Karen in SC

      Example of Midwifery Irony #458.

    • Tim

      That is par for the course for anyone making anti-medicine/anti-science arguments, they will always change up their stance depending on what they are discussing, just to make sure it fits their narrow world-view.
      There’s a wonderful example of this cognitive dissonance going on in the debate over a certain medical custody case that is being hotly debated in MA right now, with the same people saying both that the young lady in question should be home with her parents, while also simultaneously saying it’s unacceptable for the department of children and families to have her living in a low acuity facility vs in the actual hospital. They seem to see no problem with this stance, despite it clearly being in conflict with itself.

  • Christina Channell

    I just don’t get it. What in the damn hell is so difficult about altering your standards of practice in light of better information? Real healthcare providers do this constantly. It shouldn’t be such a blow to the ego to have to say “Huh. I guess that appears to be unsafe. Let’s stop this practice in favor of better ones.” Yes, sometimes this is disappointing, particularly when we’re making money off a service like waterbirth. But let babies die instead? Unconscionable.

    And I would know, by the way. I finished my DONA doula training and was set to attend births and rake in the dough. I had to turn away business within my first week of advertising my services because I had so much interest. Then I realized that homebirth was deadly and CPMs are underqualified, so I bailed on all homebirths. It hurt business. Oh well. I put on my big girl pants and you know, stopped encouraging deadly practices.

    The fact that most lay midwives are looking the other way on this speaks highly of their “profession,” and is the sole reason that they will never, ever be seen as real healthcare providers. The fact that nurse-midwives are advocating it is just confusing, however. Color me dumbfounded.

    • The Bofa on the Sofa

      It shouldn’t be such a blow to the ego to have to say “Huh. I guess that appears to be unsafe. Let’s stop this practice in favor of better ones.”

      I don’t know if I’d call it a “blow to the ego” but it would require that they rethink their entire premise as midwives.

      Because, you know, if they start actually paying attention to those things and revise their practices where it is unsafe, they will ultimately end up practicing like doctors. Imagine the disaster that would be?

      How can they sneer at medwives and proclaim how they are so much better if they actually follow those types of practices?

      • prolifefeminist

        There’s also the sheer financial survival element to it. I personally know four CPMs who are the sole or main breadwinners of their families. That’s a HUGE incentive to cling to your beliefs no matter what the evidence says. We can’t underestimate that.

        • The Bofa on the Sofa

          Well, that all gets to the point of why they need to be able to proclaim they are so much better than medwives in the first place.

          It’s hard to sell yourself as a less qualified practitioner trying to do what doctors do. “We do just what doctors do, but without actually having the training”

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

      I run an ex-home birthers blog. If you would ever like to guest post about your experiences please reply and I will give you my contact info.

    • Sue

      ”What in the damn hell is so difficult about altering your standards of practice in light of better information? Real healthcare providers do this constantly.”

      This is it!!!

      When I was an intern, we rarely wore gloves, we treated every overdose with gastric emptying and charcoal, we used lignocaine (Lidocaine) for arrhythmias, wrapped up screaming children to be stitched up, did skull XRays for head trauma (to name but a few). When evidence emerged of better, safer, more effective ways of managing, we changed.

      Like Christina says, that’s what real health care professionals do.

  • Allie

    Where did “Dr. Amy is meen” come from? I presume an actual post, and I’d like to read it. It’s disappointing her opponents can’t even identify her forms of argument and counter them rhetorically, even though they can’t counter them with facts. Life is interesting when you have a worthy adversary rather than one who just says “wah, I don’t like Dr. Amy playing in my sandbox.”

    • NoLongerCrunching

      It came from a post by Dr Amy about people complaining about her tone instead of discussing facts. It had a stock photo at the top that said YOUR MEEN. A lot of people found that funny because tone trolls often have terrible spelling and grammar.

  • Ash

    Anyone know if any USA states require that the state’s board of CPMs (if they have one) meet yearly to review adverse events from midwife attended homebirths?

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

      Utah has a peer review quarterly, but you are literally not allowed to ask hard questions. Protecting other midwive’s feelings is the main goal of their peer review standards.

      • prolifefeminist

        So basically, it’s a nice little pat-on-the-back session?

  • Rochester mama

    Here is the problem I have accepting that water birth is as bad as home birth. Good hospitals in a state known for great healthcare keep adding it.
    http://www.bizjournals.com/twincities/news/2014/01/02/methodist-hospital-investing-11m-in.html
    I’ve also found that some hospitals in the Twin Cities have been doing it for a decade and I haven’t been able to find any record of malpractice suits. I don’t get why there can’t be some analysis of all the water birth going on in the Twin Cities area.

    • Ash

      The hospital offering waterbirth labor&delivery here says they require women meet the eligibility requirements and the hospital will keep a registry of maternal&neonatal outcomes w/ data review at unknown timepoints. I can see no injuries being reported at this time; I don’t know howl long the hospital has been doing it, and how many women actually deliver in the water (as opposed to starting labor in the water and then transferring to a bed for delivery)

      • Young CC Prof

        That sounds legitimate to me.

        Right now, we don’t know how common bad outcomes from water birth are. We have case reports of a few incidents, but we don’t know whether this is the whole enchilada or the tip of the iceberg.

        So, the rational thing to do is to warn people that there appears to be some risk, and also start tracking outcomes in an organized manner. Then we can decide whether the risk is manageable or unacceptable.

        The irrational thing to do is to clap your hands over your ears and pretend that the case reports don’t exist, or, as one particularly shocking comment on the NPR article suggested, declare the practice safe until there is clear evidence that “thousands” of deaths have resulted.

        • Rochester mama

          I also don’t think you can slam the book shut on water birth as something only woo filled earth goddesses want. There are lots on non woo reasons not to want an epidural. The feeling I’ve often gotten the last few days is that we all should just get an epidural and shut up. I don’t react well with painkillers or anesthesia. I had 3b tears and never took more that Tylenol or Ibuprofen for the pain. There are also women who have had prior addiction issues and would rather avoid any painkiller for fear of triggering a relapse. We are outliers and I realize most women LOVE the epidural, but there needs to be research for the few of us that don’t.
          I suspect the procedure for water birth in a hospital differs greatly from what is done in home births.

          • Trixie

            The discussion about waterbirth safety has nothing to do with getting an epidural or not. Lots of commenters here have had drug-free childbirths on purpose, and even enjoyed them, myself included.

          • Young CC Prof

            Oh, there are definitely good reasons not to want an epidural, medical contraindications, personal reasons, whatever. And I don’t even care what your reasons are, if your choice was right for you, it’s none of my business.

            Having non-drug pain control techniques is a good thing. The only question is whether underwater deliveries present a significant safety hazard.

          • S

            Exactly! Well put.

        • GranolaTastesLikeFrootLoops

          Wouldn’t it be the same risk compelling OBs to strongly warn against taking a bath after pPROM? I understand there would be a shorter exposure period and birth afterward would be quicker than during expectant management of pPROM but women don’t always know they have a vaginal infection and sitting in water after ROM during labor could cause problems. To me, it’s a no-brainer to get out of the tub. Even the most crunchy of crunchies in the pPROM community would never think to sit in a bathtub, even during term labor, because of the risk of infection.

      • Ash

        Methinks it’s time for a multicenter trial assessing the safety of waterbirth in US hospitals. Anyone up for applying for a grant? :D

        • fiftyfifty1

          No! No! I oppose waterbirth being considered experimental! Those case reports of bad outcomes are nothing more than anecdotes! Women *love* giving birth in the water.

    • Irène Delse

      What I don’t get is the insistence on actually *delivering* the baby in the water. There’s no rationale for this, except the made-up stuff about humans being the “aquatic ape”, AFAIK. Laboring in a tub or in the shower (but getting out for the actual birth) does look great, and doesn’t seem to be associated with bad outcomes. The ACOG’s advice and Dr. A’s previous posts on the subject do make this distinction too. Do all those hospitals offering “waterbirth” really practice water delivery?

      • Trixie

        My guess is that most of them may put it in the marketing literature but not actually do it when the time comes.

        • Rochester mama

          I know a few women who have done water deliveries at Abbot Northwestern and within the Healtheast system in the Twin Cities.

          • Aki Hinata

            I also know a woman who has had a waterbirth in the Healtheast system. I had my last baby in that system and was taken aback by the promotion of water birth, i.e. “Are you sure you don’t want one?” I personally don’t find the tub all that soothing and don’t want to get in and be unable to get out.

        • Mariana Baca

          Or they use the “plausible deniability” version of waterbirth. “Oh, you labored in water and we can’t force you to get out! ::wink wink:: You technically can’t birth here but we won’t make you get out.”

  • Mel

    “My feeling, and I have heard others speculate, is that she and her followers are acting out their pain over their own difficult births or difficult breastfeeding experiences and lack of support for mothers in our society, or other difficult experiences in their lives that somehow come out in their anger toward the natural childbirth community…”

    Acting out over my own difficult birth/breastfeeding/lack of support for moms: I’ve never had a baby. I don’t remember my own birth – but I can tell you lots about life with a brain-injury that happened during or soon after birth if you want to hear. My life experiences have colored my views of NCB.

    Homebirthing isn’t brave – you’re risking your child’s life, brain and limbs for bragging points. Yes, I am VERY ANGRY that children suffer due to the stupidity of the leaders of NCB.

    Here’s what a MINOR brain injury looks like. Physical therapy starting as an infant. 4x a week until kindergarten. 3x a week in kindergarten. 2x a week 1st-4th grade. I grew up thinking that PT was a normal after-school activity. Before 3rd grade, my heels didn’t touch the ground when I walked. In 4th grade, I confused my teacher by naming ALL of the muscles in my legs. In the last 10 years, I’ve had 4 separate PT ‘readjustments’. On a good day, I can place my fingertips on the ground next to my feet. On a bad day, I can’t tie my shoes without putting my feet on a chair. I’ve chosen jobs based on health care plans that cover PT rather than any other basis.
    I grew up hating writing. I thought I was a bad writer. When I learned how to type in college, I had a break-through. My muscles in my hands cramp up when I write. When I type, I can write quickly and PAINLESSLY. A task I hated – absolutely HATED – became fun.

    I am one of the lucky ones. I can walk 5-7 miles at a time. I can talk.

    Guess what, Amanda Lowe? I WON’T STOP TALKING UNTIL YOU STOP MAIMING CHILDREN!

    • attitude devant

      Wow. Brava! Nicely said.

    • Christina Channell

      I’ve had three vaginal births in the hospital. The first two were drug-free. The third was a planned epidural. I still have nightmares from the first two births. The ghastly pain is something I wouldn’t inflict on my worst enemy. “Pain of my difficult births?” Yeah, definitely. The births that influence my outspokenness today are the ones I was led to believe should have been “empowering.” Fancy that.

      • Jocelyn

        My last birth was drug-free (unintentionally). The terrible pain was somewhat traumatizing. My memories of the actual birth fit the literal definition of tunnel vision – everything in the memory is blacked out except for a circle in the middle of my vision.

        • Mer

          Oh my yes! My last one was the same, planned for epidural but precipitous labor prevented that option. I had flashbacks for days every time I nursed and got afterpains. It was awful and the difference in bonding to my infant between the epi baby and the drug free baby was noticeable. I was so out of it from the pain that it was about 30 minutes before I held my brand new baby. With the epidural I was holding my baby immediately and didn’t let go for 30 minutes! Some people can handle a painful labor and be fine, I am not one of them!

        • theadequatemother

          I thought that by going in for an induction for my second, after my first had been pretty fast albeit not strictly precipitous, I would stack the deck so to speak and be able to get a second epidural. Whereas I felt letting labour start naturally would result in a birth on my kitchen floor or in a (dry) bathtub or rolling into LDR pushing.

          Best laid plans but no time for the epi.

          I don’t feel traumatized. I’m a little angry that no one took me seriously when I said I wanted one, but I recognize that is because I wanted special treatment…as an anesthesiologist I think I felt that I should be able to “order myself an epidural.” Since I wasn’t “vocalizing” with enough gusto no one else felt it was as urgent as I did.

          Husband is traumatized. He thought we were both dying during transition and the second stage and the neonatal resus for stunned baby.

          Luckily my OB empowered me by asking how I would feel about a pre-induction placement of an epidural catheter next time, should we decide to have a third.

          Funnily enough, there are NO services in my city (other than a family doc if you are lucky enough to have one) that look after paternal post-partum mental health. I’m not joking when I say my husband was traumatized. He was having flashbacks, nightmares. Thankfully its all settled down rather than developing into a case of actual PTSD but I was really worried there for a while.

    • The Bofa on the Sofa

      “My feeling, and I have heard others speculate, is that she and her followers are acting out their pain over their own difficult births or difficult breastfeeding experiences and lack of support for mothers in our society, or other difficult experiences in their lives that somehow come out in their anger toward the natural childbirth community…”

      Interestingly, my interpretation of this comment is more of, “You are just jealous of us”

      • Karen in SC

        Jealous? That’s totally laughable. Dr. Amy had natural births, and so did I! I even had a doula, and a birthing ball, and popsicles, and walked around. Yay, me!

        The difference, we accomplished that in the hospital.

        • The Bofa on the Sofa

          Doesn’t matter – your experience wasn’t near as awesome as theirs. We have “difficult experiences in our lives” and we take it out on them. Because they are the privileged ones.

        • moto_librarian

          I think that those of us who managed to have “natural” births in a hospital deserve a special gold star, since, you know, you have to fight to not be strapped down to a bed and given an epidural upon admission.

      • Dr Kitty

        My daughter’s birth was super easy (planned pre labour CS). I breast fed her until she was over a year (14 months, 16 months, something like that).
        No difficult experience here.
        Not jealous of the NCB experience.

        I like my baths HOT (so hot DH won’t share).
        The idea of lying in lukewarm water for hours….ew.
        The idea of lying in lukewarm, faecally contaminated water while in severe pain…ew ew ew.

      • Susan

        Seems to me there are a lot of women here like me who had great birth and breastfeeding experiences. I surely don’t fit into her mold having had three unmedicated births, one at home, and breastfed all my children till toddler years. Followed all the natural birth rules myself. I just don’t think that I am one iota of a better mother because I did so, and as great as my birth experience was with my daughter, I took unnecessary risk with her life believing what I was doing was as safe or safer…

        • The Bofa on the Sofa

          Seems to me there are a lot of women here like me who had great birth and breastfeeding experiences.

          Hey, I never said that they were RIGHT in their accusation that we are jealous. But that is what they are saying.

    • DaisyGrrl

      Thank you for sharing your experience. This was part of the reason I’ve stayed so interested in this topic. Aside from the whole paternalism that the NCB community seems blind to, there are REAL people who are killed or injured as a result of these practices. I’m not a parent and I haven’t had a difficult birth experience. But I care very much about this issue.

      As a teenager, I volunteered extensively with severely developmentally disabled peers and younger children. Many of them had problems that I suspect were caused by HIE. I saw first-hand what these injuries do to families. It takes so much time, energy, and money to have a child with a disability and if there was something that could reduce the risk of my child having severe problems by even 0.1% I would do it. Of course these children are loved by their families, but it’s not fair to expose them to these risks when they don’t have to be and don’t have a say themselves. I think parents have a responsibility to do what they can to minimize the risk of forseeable catastrophic outcomes (hence car seats, bike helmets, and hospital birth).

      I’ve read the heartbreaking stories of babies killed by homebirth and know that for each death there are probably many more close calls that result in permanent injury. If the NCB community would at least *acknowledge* that there are risks, I would be much more sympathetic to their cause. As it is, they hand-wave away the numbers and bury the dead twice. It disgusts me and I won’t shut up about it.

      • Christina Channell

        Car seats. Bike helmets. Hospital birth.

        Who wants to make the meme?

  • MLE

    Even if the attitudes here are the result of some kind of trauma (leaving aside the condescension of this comment), does that somehow make it ok to brush aside everyone’s concerns? Oh she had a bad birth so it’s not necessary to take her seriously. Isn’t that the opposite of what NCB has been saying all along?

    • Young CC Prof

      If you had a bad hospital birth, it’s because the hospital was mean and the doctors were ignorant, not because you went into it with wildly unrealistic expectations. (Not to belittle, yes, bad hospital births do occur, both impolite staff and occasionally genuine medical errors and bad outcomes.)

      But if you had a bad experience at home birth, it must be because you didn’t do enough kale and yoga while pregnant, or because you weren’t strong enough to face the pain.

      • attitude devant

        Oh, thanks, CC. My feeble ladybrain couldn’t understand that simple distinction.

      • auntbea

        For some reason I read “genuine medical errors” as “grammatical errors” and thought you were being a little harsh.

        • Young CC Prof

          Hey, grammar is important! (Especially in medical records.)

    • attitude devant

      It IS a really odd stance to take, since one of the more prevalent NCB tropes is the “My first birth in the hospital was traumatic, but I had a healing homebirth next.” Trauma is ok if it leads to NCB but not if it doesn’t ? Oh well, no one ever said these ladies were consistent.

    • http://momofmanyfeet.wordpress.com Bambi

      This is nothing more than their version of victim blaming, or what they call slut-shaming.

  • moto_librarian

    You know what would be great? If just once, lay midwives, doulas, and NCB cheerleaders would actually consider the evidence that leads to these opinions by groups like ACOG. It’s not like any of them are actually collecting meaningful data on outcomes. Over and over again, we see dangerous situations excused because someone shares an anecdote about how her patient/client had the same thing and everything turned out fine. Well guess what? It’s pretty clear that things don’t always turn out fine where waterbirth is concerned. My youngest went through a phase where he was pooping in the tub regularly. I didn’t just fish out the poop with a net and let him keep playing in it – I hauled his butt out of the tub and put him in the shower while I drained and bleached the tub! Would any NCB advocate let their own child play in a tub full of poopy water? If the answer is no, why on earth would you want to deliver your baby in one?

    • Trixie

      Whenever there’s poop in the bath tub I FREAK OUT. And I would add that most turds sink, and the water on top doesn’t immediately look poopy. I want to see a picture of the bottom of the tub, not the top 2″ of water.
      On second thought, maybe Ananda’s rght, and I’m acting out my deep trauma over bathtub turds.

      • Anj Fabian

        When I go to flush, the water often looks quite clean – but I wouldn’t bathe in it or drink it!

        No, I do not want to hang out in bacterially contaminated water for hours and hours.

        • Trixie

          You should take some arty B&W photos and make a montage with an Ani Difranco song in the background.

          • Bombshellrisa

            And make some vaginally knit or crocheted scarves! Hey, you could sell all that stuff at the farmers market-Turdy Tub Art and Yoni scarves!

          • Mishimoo

            Sales slogan: “Yoni Scarves – So you no longer freeze your yoni off!”
            Which begs the question, how does one wear a yoni scarf?

  • Young CC Prof

    You know, it’s not just whack jobs. It seems like an awful lot of essentially skeptical,
    pro-medicine people have difficulty seeing the harm of home birth. And
    last night, while climbing back into bed after the night feeding, I
    realized something interesting.

    Having a home birth is exactly as dangerous as measles.

    The probability that a home birth will kill your child is 1-2 per thousand. (Just like measles.)

    Risk
    of permanent brain damage from measles is also 1-2 per thousand. Risk
    from home birth is not well studied but may be in the same range.

    The
    probability that a home birth will involve urgent transfer to a
    hospital due to potentially fatal complications? 10%. Pretty close to
    the rate of hospitalizations from measles. (Of course, the
    hospitalization rate in modern outbreaks is sometimes higher, because so
    many of the victims are babies or adults.)

    Just as with measles,
    the total harm right now is small. The real danger is that it will
    spread if rejection of proper medical care grows more popular.

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

      The problem is that they use pro-choice rhetoric to explain their position.Its very effective, but completely dishonest.

      • Ennis Demeter

        That makes me so angry! It’s so illogical: “if you believe in choice, you have to support THIS choice!”. No, no, I don’t. And I don’t want to ban your stupid choice anyway, I just don’t want to refrain from pointing out how dumb it is!

        • The Bofa on the Sofa

          “Empowerment is manifested in the ability to choose, not in the choices we make…”

        • Danielle

          I just want them to say, “You have a right to a home birth, if you want one. You also need to know that a home birth increases the risk of injury or death in some cases. Good midwives do their best to reduce the risks. If you are a relatively low risk patient and feel home birth best reflects the values you hold or the experience you strive to have, or is a better choice for other personal reasons, this option may be right for you.” Just concede the point and let women puzzle over the legitimate tradeoffs.

          The result will be more women wanting natural births in hospitals. And that is OK. In fact, in the long run, this should be a good for midwives and doulas.

          • RebeccainCanada

            But if she then goes to the midwife to ask her opinion about home birth safety, she will hear the damned opposite! She will hear that anything going wrong at homebirth is such a small chance, but if something was to happen, “it’s like watching a train coming down a tunnel, and you don’t see it yet but you see the light and there’s time to react. And we are only five minutes from the hospital”. (This is one of the things my homebirth m/w told me). Birth choice is coached in lies, from NCB! Then they hint to you that you can’t trust Doctors and hospitals anyway. They exploit ignorance! This is not choice or informed consent!

      • Ennis Demeter

        Being pro-choice doesn’t mean I am pro-substandard health care for pregnant and laboring women. Supporting home birth is more like supporting back alley abortion. I want women to have SAFE healthcare delivered by professionals, be it to terminate pregnancy or bring one to term.

    • Amy Tuteur, MD

      It speaks to the success of the disinformation campaign run by natural childbirth organizations. It’s just like anti-vax was ten years ago. Salon recently published a piece excoriating those who don’t vax, but they were the ones publishing idiocy by anti-vaxxers back when such idiocy was fashionable.

      Just like it took years to counteract the disinformation of anti-vaxxers, it’s going to take years (and more deaths) to counteract the lies of the NCB lobby.

      • stenvenywrites

        Interesting you use the word “fashionable”. I’ve considered it a (deadly) fad. Not vaxing or giving birth at home proves how anti-establishment and supercool they are. When all the kids are doing it (or writing about it in Salon), it won’t be antiestablishment any more and they will have to prove their coolness by rejecting some other facet of common sense. Preferably something that does not kill babies or children.

      • Mishimoo

        Speaking of anti-vaxxers, I was not amused when I saw a tiny little girl coughing all over the bread at the store. Poor thing had the classic whooping cough sound with a bright red face, and parents that didn’t seem to care.

  • Amy Tuteur, MD

    She is an expert on ignorance after all … and making a fool of herself. Nobody does it better than the The Narcissist Breeder.

    She made the post free because otherwise no one would read it.

    http://thefeministbreeder.com/5-ignorant-arguments-water-birth/

    • Amy Tuteur, MD

      It is interesting as an example of what passes for “reasoning” among natural childbirth advocates.

      Gina knows that the most emotionally effective argument against waterbirth is that the pool is nothing more than toilet water. Therefore she solicited pictures of waterbirths from her readers, published the ones where there were no obvious feces in the water and then claims that is “proof” that waterbirth is not the same as toilet birth.

      • attitude devant

        Funny thing, there’s no obvious feces in my toilet right now either, but I still wouldn’t birth a baby in there.

        • stenvenywrites

          And I cringe when the DOG drinks out of the toilet.

      • Jocelyn

        Yeah, because we all know if water *looks* clean, it’s definitely safe to drink or immerse yourself in!

      • stenvenywrites

        Ah, but does she have any pictures of people who have just ingested substantial quantities of “perfectly clean” water into their lungs, smiling and dancing the macarena? Urine is sterile; that doesn’t mean you can’t drown in it.

    • christy

      I love how you can make bloody water look clean by turning the picture black and white and adjusting the lighting.

    • attitude devant

      The woman argues at a junior high level. That was painful to read. On the other hand it was giggle-worthy to be reminded that TFB hates me so much that she has blocked my IP address. (Sorry to tell you this Gina, but we have three computers here. I just used a different one.)

    • Young CC Prof

      Ah, take 5 incidental arguments, misstate them, and ignore the big glaring multiple case reports of serious illness or death as a direct result of it.

      When you have anecdotal reports of harm that are clearly related to a particular activity, you attempt to find the frequency with which harm is occurring. Common freaking sense.

    • Trixie

      Is it just me or do a lot of those pictures of clean water births actually seem to have pretty murky water?

      • Mariana Baca

        The water in my toilet bowl also looks clean, fwiw. Doesn’t mean it is.

    • http://whatismyreferer.com/ MikoT

      Might be an idea to switch this site and the Disqus comments over to https so TFB can’t block traffic from here by referrer.

    • attitude devant

      Hmmm. On second thought, I think the reason she posted it was that she got her posterior handed to her in the comments section on that article, so she wanted to re-play the whole thing in a venue where SHE controlled the comments.

      • S

        That part isn’t surprising. What blows my mind is that she actually typed those arguments out a _second_ time and still apparently hasn’t noticed that she makes no sense.

    • Amy

      You know, you really should start billing yourself as a “women’s health scholar.” She’d take you so much more seriously if you hadn’t finished med school.

  • attitude devant

    I know many bright and committed doulas, but good Lord! What in the world is wrong with QUESTIONING whether something is safe or not! If, just if, something that you do turns out to be unsafe, shouldn’t you STOP it?

    • Young CC Prof

      That would make you like the scientific medical establishment: admitting that past practices were imperfect and changing them as new evidence comes to light.

  • Trixie

    Yes, Amanda, my delicate lady brain is incapable of rational thought, and I’m just acting out my anger over that time my 8 month old bit my nipple.

  • moto_librarian

    Yes, I was traumatized by birth, but not in the way that Amanda assumes. You see, I bought into a significant amount of NCB dogma during my first pregnancy. I prepared for an unmedicated delivery (breathing exercises, meditation, made my husband learn some basic massage), and truly believed that it was better for my baby that I not receive pain medication. I arrived at the hospital dilated to 9 cm., and while in a lot of pain, felt confident that I could get through it because my childbirth teacher said that pushing would “feel good.” The next hour and a half was a blur of unimaginable pain and misery, followed by a pph caused by a cervical laceration. I still vividly remember waking up in the middle of the night and feeling like an idiot for believing that the “experience” would be empowering. It would have killed me had I not been in a hospital, and I was so ill that I didn’t even get to see my son until the next day.

    So yes, I speak out against the campaign of misinformation that is routinely spread by NCBers. I don’t care if a woman doesn’t want to use pain medication, but she shouldn’t choose not to based on outright lies, nor should she feel like less of a woman for accepting pain relief (something that feminists fought for was access to pain relief during labor).

    I will also say that I adore both of my sons, and that they were the end goal of pregnancy for me. While my younger son’s birth was a completely different (and positive) experience thanks to an epidural, the most important aspect of giving birth was meeting my children and getting to parent them each and every day after they were born. This should be the focus.

    • veggiegal

      Right there with you… Traumatized by my first birth (hospital birth) because I was trying to go natural, aided by the doula I brought to the hospital with me… After hours stuck at 9 cm (not to mention the hours and hours before then), probably because I was in too much pain (back labor) to release the muscles to push, I “gave in” and had the epidural. And fell asleep almost immediately. And woke up to push for 2.5 hours an hour later, and then my daughter had to be vacuumed out because her heart rate dropped, probably from the prolonged labor (9-10cm for maybe 7 hours not including the pushing?). She ended up having to spend the first 24 hours of her life in the NICU, and I never got to hear her cry when she came out, because they gave her oxygen as soon as they got the meconium off her face. Second birth – same hospital, no doula, epidural at 5cm – AMAZING experience! So yeah, traumatized all right, by the NCB attempt.

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

    They want to figure out how to quiet down the arguments because its threatening. I’m sure everyone will advise her to go heavy on the delete button.

  • no longer drinking the koolaid

    I have had 4 great births (3 hospital, 1 home). There is no pain or trauma involved only concern that women are not being fully informed. And thank you Ananda, for the patronizing attitude. I arrived at my concern through experience and reading the evidence, not by being a minion.

  • T.

    I never had a child. I don’t plan to have one, neither. I was a vaginal birth and brestfeed for a year. Still, since I don’t want babies or women to be hurt, I support this blog.
    The people that claims that anybody who doesn’t think like them must have some sort of trauma are terribly irksome. It is a lot like they are saying “You must be damanged, because otherwise you would think like ME, because I am perfect.”