When a homebirth midwife says “trust birth,” what she really means is “trust me.”

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American homebirth midwives, like all quacks, are incredibly paternalistic.

That’s because when a homebirth midwife admonishes a client to “trust birth,” what she is really means is “trust me.”

She’s decided to gamble with your baby’s life … literally. She bets that the odds of everything working out fine are high enough that she can put your baby’s life down as her marker and you will walk away with a live baby. She doesn’t plan to do a single thing to improve the odds, since she doesn’t know how to do anything to improve the odds, besides dial 911 and get real medical professionals involved.

She is no different from an gambler who asks to borrow $5000 to invest in a deal that “can’t go wrong.” You’re a fool if you hand over the money and you’re a fool if you hire a homebirth midwife.

I wrote earlier this week that homebirth midwives have a one size fits all approach to pregnancy and birth. That’s because they “know” that everything is going to work out fine. Obstetricians, on the other hand, despite their tremendous reserve of obstetric knowledge and experience, freely admit that they don’t know how your pregnancy and birth is going to turn out. And because they don’t know for sure that everything is going to be fine, they recommend everything that can raise the odds that your baby will be fine. That includes prenatal testing, ultrasounds, prophylactic treatments, fetal heart rate monitoring, and giving birth in a place that has the emergency equipment and personnel to handle just about any disaster, whether it was predicted in advance or not.

Although most of us find comfort in certainty, by the time we’ve become adults, we recognize that there is very little certainty in life. We buckle our seatbelts in the car, not because we think we are going to be in an accident; we don’t. We buckle them because we want to be prepared for the rare but life threatening possibility that we will be in a car accident. We try to eat healthy and exercise, not because we believe that we will definitely get ill otherwise, but because we want to decrease the odds of getting ill to as low as we possibly can. We seek shelter during a lightning storm, not because we are sure that we will be struck by lightning if we stand in the open, but because we want to minimize the chances that disaster will happen.

Homebirth midwives are masters at emotional manipulation and they recognized long ago that there was not going to be much profit in telling women “Trust me to be sure that everything is going to work out fine even though I am just a layperson with no idea how to prevent or treat disaster.” So instead they hit on the idea of telling women “trust birth.”

It sounds so much more transgressive and romantic, to trust birth than to trust obstetricians. The irony is that obstetricians aren’t asking you to trust them. They are admitting up front that they can’t guarantee your baby’s health (or your health), but they can do a wide variety of things (tests, treatments, etc.) to dramatically raise the odds that your baby will be fine. They have the track record to prove it. Over the past century, modern obstetrics (and pediatrics and anesthesiology) have dropped the neonatal mortality rate by 90%. And it didn’t drop because they trusted birth.

There’s also a quasi-religious element to trusting birth, as if Birth were a goddess that requires your praise and your sacrifice. The implication is that if you trust “her,” Birth won’t ever send complications your way. Homebirth midwives, in this scenario, are like those who practice religious snake handling:

… the religious ritual based on a Bible passage: People hold deadly snakes, believing that a poisonous snakebite won’t hurt anyone “anointed by God’s power.”

Similarly, homebirth midwives, the high priestesses of Birth, hold babies’ lives in their hands, believing that Birth won’t hurt anyone anointed by her power.

Inevitably, many of these snake handlers die, even the one who had his own reality TV show:

Tragedy struck [Pastor] Coots this past weekend when he died of a rattlesnake bite during a church service — following his wishes, his family reportedly refused medical help …

Inevitably, tragedy will strike homebirth advocates, too. Their babies will die at even higher rates than those who didn’t trust birth. The critical difference, though is that Pastor Coots chose to gamble with his own life. Homebirth midwives and advocates choose to gamble with a baby’s life, a baby who had no say in the matter, but surely wanted to live.

Homebirth midwives are gamblers and they their gambling has quasi-religious overtones. Just cede all control to them; your baby’s survival is a sure thing, so long as you trust them birth.

Make no mistake. Homebirth midwives, like all fundamentalists, are deeply paternalistic. They “know” what you should do. They “know” that everything will turn out fine. They “know” that if your baby dies it isn’t their fault; it’s your fault for not believing enough in birth.

Homebirth midwives are con artists whose only redeeming feature is that they actually believe their own con. But that’s not particularly surprising since they are too uneducated and untrained to believe otherwise.

So women who are contemplating homebirth need to ask themselves:

Do I want to bet my baby’s life that a layperson can predict the future?

Do I want to bet my baby’s life that Birth will protect my child if I just believe fervently enough?

Or am I mature enough to recognize that the world is full of uncertainty, no one knows what the future holds, and those who take precautions are more likely to survive than those who don’t?

The con artist knows that the con is always more comforting than reality. The real question for mothers contemplating homebirth is whether they prefer the paternalism of the con over the uncertainty of reality … and are they willing to risk their babies lives in exchange for the comfort of trusting birth?

  • Amy Tuteur, MD

    Check out the discussion in the comments:

    http://commonhealth.wbur.org/2014/03/childbirth-in-a-tub

    • S

      “They saw women flocking to the other hospitals that offered it, they saw that women had better experience and that babies had just as good of outcomes, and they realized that being against water birth makes about as much sense as being against a hot compress. If you have something that helps relieve pain, USE IT.”

      Direct quote from TFB. I laughed out loud. Yes, if you had a safe and effective method for relieving pain that didn’t compromise the baby, why _wouldn’t_ you use it?

      Also, nice anecdote: Her last birth was her easiest. Imagine that! Here’s my anecdote: My baby was eating my blood, in the birth canal, while i was in labor with him. Tell me again how babies don’t ingest the poopy water.

      • Trixie

        TFB: The Archimedes of bathtub turds.
        Her midwives knew *exactly* how much blood she lost because they were able to measure it so precisely in that warm toilet water her beloved HBAC baby was born into.

        • Karen in SC

          That was such a lie! 100cc = 0.100 Liters. Yes, that is one tenth of a liter! How many liters in a full waterbirth tub? 100 liters or more for large kiddie pool’s worth.

    • LMS1953

      I find it repulsive that an obstetrician could more easily attend to a water birth in a hospital L&D in the United States than a 38week 6 day “elective induction”.

  • Petanque

    She’s not doing nothing at all to improve the odds, she’s knitting in the corner holding the space, remember!

  • Jessica

    My somewhat OT anecdote for the day is thus: my SIL was 37w5d pregnant on Monday and went for an ultrasound because her OB thought she was measuring large. At the appointment her blood pressure was quite elevated and there was protein in her urine. She was sent straight to L&D for 24 hours of bedrest and urine catch. The next evening her protein levels were 380, and she had a C-section an hour later. My nephew was born weighing 8 pounds, 9.6 oz. They think she had also developed GD (though she’d passed the one hour test).

    I shudder to think what would have happened if she had not been in the care of an OB. As it is, my nephew developed pulmonary hypertension and has been in the NICU since birth; he’s currently on nitrous oxide and will likely spend another couple of weeks in the hospital, but has a good prognosis. Technology appears to have saved both of their lives, and I for one am very grateful.

    • Young CC Prof

      Whew! Glad to hear they are OK, and good job on her doctor’s part catching it!

    • Mishimoo

      So glad the doctor caught it! Hope he exceeds expectations and is safely home soon.

    • rh1985

      I am also so thankful for modern medicine and technology! I was so out of it at the time that I don’t know what my numbers were, but it was bad enough I was sent for a CS right away instead of waiting til the next day when I had a scheduled one and the doctor said she would have delivered me that day even if I was preterm – I went to L&D for what would probably just be an IV for hydration (I was throwing everything up due to what seemed to be very bad acid reflux), ended up with a pre-eclampsia diagnosis.

  • Captain Obvious

    Here’s a women declining 17-OHP because her midwife doesn’t believe in it and it “only” decreases PTB by 30%. Oh the stupidly. Some research is suggesting routine transvaginal cervical length screening at the 20 week sono to help identify women at risk for PTB. That researcher proposed that 22 neonatal deaths can be prevented and $19 million saved in NICU costs for every 100,000 cervical length screenings performed. I know, that is a lot, but for at risk women, IM or vaginal Progesterone decreases PTB by 30 frigg’n percent.

    “My midwife said the shots are far from proven to prevent pre-term birth, and it seems to cut down on the early birth chances by about 30%, which certainly isn’t a huge difference.”

    http://community.babycenter.com/post/a48491185/17_p_shot

    • Josephine

      Oh, 30%, is that all? Snort.

      • The Bofa on the Sofa

        That means that 1 out of 4 that used to have a problem does not have a problem.

        That’s a hefty improvement in my book.

        • Josephine

          I was being sarcastic. :) 30% is amazing!

          • The Bofa on the Sofa

            I know. I was just giving some perspective.

    • onandoff

      There is so much wrong with her post. She had the shot with her 4th, which went to term – but it wasn’t the shot. There were no side effects from the shot, her kids are fine. But 30% isn’t very much, so what’s the point.

    • LMS1953

      It is recommended to get a fetal anatomical survey at 18 to 20 weeks anyway. The cervical length measurement would be relatively negligible in additional time and cost. But don’t get me started on the price that the manufacturer attaches to Makena.

      • Captain Obvious

        The studies by Fonseca, O’Brien, Cetingoz, Hassan, and Romero ALL show vaginal progesterone shows the same benefit.

        • LMS1953

          Is the vaginal progesterone suppository compounded or is it a branded version like crinolone? I was able to get 17-P compounded for about $18.00 per dose, but Makena initially came out at $1800 per dose!!. I am sure you recall the hue and cry, and they brought it down but I think it is still about $800 per dose.

          • Karen in SC

            Wow, I had to have progesterone suppositories. At the time, they were compounded by only one or two pharmacies in my area. I can’t believe that marked up price!

          • LMS1953

            Sorry for the confusion. The 17-P is mixed in oil and injected IM weekly from 16 weeks to 36 weeks in women with a singleton pregnancy with a prior history of preterm delivery. I used to get it for about $80 per vial with 4 doses per vial. Medicaid did not cover it since it was not FDA approved. So I bought it and gave it essentially for free. Once it became FDA approved, it became known as Makena and Medicaid covered it at $1800 per dose. The typical Medicaid reimbursement for the OB fee for prenatal care and delivery is less than $1200.

          • AmyP

            “The typical Medicaid reimbursement for the OB fee for prenatal care and delivery is less than $1200.”

            That alone is a crime.

          • anne

            I believe that Medicaid pays for about half the births in the U.S.

          • Young CC Prof

            As I understand it, the FDA was concerned about inconsistent quality control at compounding pharmacies, which apparently is a legitimate problem. (See fungal infections in supposedly sterile injectibles, for example.) FDA wanted the progesterone injections made by a proper drug company in a proper factory, so they gave one a patent. Then the company took the patent to the bank in a truly abusive way.

          • LMS1953

            CC, you are correct. However, ALL of the research was done with the compounded version, much of it funded by taxpayers. It worked and there was not a word mentioned about contamination when it was saving thousands of lives.

          • Young CC Prof

            There are a lot of issues with the drug industry. Fundamentally the financial incentives are not in the right places, which leads to things like, say, insufficient research in new antibiotics. Or the inhaled corticosteroids (first approved in 1974!) all being name brand and super-expensive.

          • Captain Obvious

            Fonseca used micronized prog 200mg/day, O’Brien used crinone 90mg/day, Cetingoz used compounded prog supp 100mg/day, Hassan used crinone 90mg/day, and Romero had a meta-analysis, Rode used a prog pessary 200mg/day.

          • rh1985

            I used vaginal progesterone in my first trimester, Endometrin – my insurance covered it so I just had the copay. I think that particular progesterone was marketed more for IVF use since that was what the information inside referenced.

        • Haelmoon

          We don’t use the injection in our region – primarily for cost. However, I had them as a pregnant resident/fellow – they are very very uncomfortable (worse than morphine or steroids). Plus for women with hyperemesis or sensitivity to progesterone, it can make them worse for a couple of days. I like the vaginal route better – only limitation is most major brands are peanut oil based, but there is one brand in Canada that is not (forgot the name, but it is the brand we use in hospital).

      • Haelmoon

        But . . .the studies are based on transvaginal ultrasounds of cervical length. That adds 5-10 minutes to each anatomical scan, plus cleaning and sterilizing the probe. We can barely get out anatomical scans booked in the appropriate time frame, this would put our system over the top Patients can’t even get “routine” dating ultrasounds, they need a reason.

        The compromise may be to look at all cervices abdominally, acknowledging the limitations of this, and confirming any short cervices that look less than 2.5cm on abdominal scan. Its not perfect, it will still miss some. They need to empty their bladders for the cervical assessment, which still adds extra time. Its not quite to simple ti implement – we are trying to make it the standard in our region, but it is the logistics holding it up. We need a trial about screen with abdominal scans, confirmation with TV scans and the rate of preterm delivery, otherwise screening needs to be done transvaginally.

        • Elaine

          Would it even make sense to screen everybody? I’m G2P2 and delivered my two, medically uncomplicated pregnancies and spontaneous labors in both cases, at 40+4 and 40+2. If I have a third and it’s an uncomplicated pregnancy, I would imagine my risk of preterm labor would be pretty darn low, and so would it even be worth bothering with this screening? On the other hand, my friend who had her daughter at 26+6 would surely jump at the chance, if she decides to dare another pregnancy.

          • Haelmoon

            Actually, there is still a small risk. There is a subset of women who have a component cervix, but with each vaginal deliver (or attempt), there is a small amount of damage to the cervix. For most women, this is of little clinical consequence, but we see it as the multip who is already 4cm dilated at 37 weeks without contraction – painless cervical dilation, sub clinical incompetence of the cervix.

            For the subset of women though, the degree of incomplete progresses with each pregnancy. A clinical example who be a lady who deliveries her first at 41 weeks, second at 38 weeks, then an unexplained early delivery at 31 weeks. Next pregnancy, loss at 21 week, followed by another at 19 weeks. She failed an transvaginal cerclage and delivered at 22 week. Finally, she had an abdominal cerclage and delivered at 36 weeks. Not a classic history of cervical incompetence, but she did have a short cervix at her anatomy scan on pregnancy number 3 (2.0 cm), and each subsequent pregnancy.

            Mind you, this is uncommon, but not completely unknown. The other multifarious women I like to screen for cervical length are those that had prolonged second stages or stuck at 9cm with a thick lip. This may cause more cervical damage, and may actually increase the risk of cervical incompetence and preterm delivery in subsequent pregnancies.

            Of course, cervical length will only screen for a subset of preterm deliveries, which is why it won’t completely address then problem of preterm births.

          • Elaine

            Interesting! Thanks for commenting. I always enjoy your posts. Not often in the real world does one get to pick an obstetrician’s brain.

  • LMS1953

    There was also a rewrite of the Friedman Curve. It says that FTP should not be declared prior to 6 cm. A primip should be allowed to push for 3 hours, a multip 2 hours – and you add an hour to both if there is an epidural. I tried that a couple of months ago with a primip. (I imagine the guy in Corpus Christi who did an internal decapitation with forceps in December was trying to abide by these new “recommendations”. I made a half-hearted offer of a forceps/vacuum trial with the disclaimer that I would not consent to one if it were my daughter and grandchild. I had to use every trick in the book to dislodge one of the worst impacted fetal heads I have ever encountered – especially to avoid a vaginal extension laceration to the depths of nowhere and avulsing the uterine arteries. (Hint – push up gently on the anterior shoulder which will be at the level of the lower uterine segment transverse incision. Then use the opposite hand from the side of the table you are on to disimpact the head. This will require you to turn 90 degrees and face the feet). Anyway, these new guidelines will cause more operative blood loss for very little benefit. If a primip doesn’t deliver after 3 hours of pushing, she sure as heck won’t deliver with 4. She will be exhausted, the family will be pissed and the tissues will become progressively cyanotic/hypoxic and prone to infection. But the 39 week Nazi will now be given a stopwatch to be the 4 hour Nazi.

    • DaisyGrrl

      A serious question – if a primip declares herself done with pushing and starts requesting a c-section before the Friedman curve deadline (say it’s been 2.5 hours and she just can’t take any more), would you be able to so c-section if you agreed she wasn’t getting anywhere? Or would you have to wait the extra time before you can declare FTP?

      • LMS1953

        Best motto in obstetrics: “The only C-section you will ever regret is the one you did not do”.

        I can always find some segment of the tracing that is not “re-assuring”. I doubt any nurse would dare to countermand a C-section in this circumstance you describe, as they can for an “elective” delivery scheduled at less than 39 weeks 0 days. The OB has to put together a case list to present for review and defend before board examiners in person to become board certified. They can flunk you if you don’t do things “the right way” – even though the right way changes every decade or so. And goodness only knows if dictums will come down via ACA that may cause hospital employed OBs to not have their contract renewed because they did a C-section at 3.5 hours instead of 4.

        • DaisyGrrl

          Thanks for the answer. So I guess it’s a matter of hoping the OB can rustle up a good enough reason to go with the c-section from the charts and is willing to go along with the mother’s wishes. At least the nurses won’t get in the way like they are about the 39 week rule.
          The way this latest guidance has been treated in the media is so frustrating. It seems like everyone is all “aha! I knew they were too quick to cut! We’re all having unneccesarians!” whereas from what I’ve read here it’s actually more, “hey, if the mother/infant are tolerating labour and things are progressing, it’s not malpractice to wait a bit longer. Chill.” I’m not the best at interpreting doctor-ese, but that’s been my take on it.

        • Ash

          LMS, out of curiosity, what do your colleagues think of the “new” Friedman Curve? Do they feel it will negatively or positively influence their clinical practice?

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

        Women asking for c-sections should be given informed consent and allowed to make the decision – anything else should be considered a violation of that woman’s right.

        • DaisyGrrl

          I agree, but when the doctors are pushed up against the NCB nuts, it seems that the patient’s autonomy is the victim.

      • Haelmoon

        Its never just that simple. It depends on the entire clinical picture. If she has been pushing effectively with lots of caput and edema, and its going to be a long time before the baby gets out, even if I assist with forceps or a vacuum, absolutely, the sooner I do the c-section the easier. Prolonged second stages, with wedged heads, are very difficult sections, high risk for hemorrhage and complications.
        But, if she has no pain meds or a poor epirdural and she has not been pushing well, and the baby’s head is low in the pelvis, but without lots of caput or moulding, I would rather address the reason for failed pushing (but hopefully the nurses would have called me in before 2 1/2 hours). Sometimes a change in position, better analgesic or some pelvic floor pressure to direct her pushing may resulted in a baby much sooner. If the baby is OP and easily rotated, it should be done first too (put again, hopefully before 2.5 hours).
        Just asking for a c-section is not enough. There has to be a reason – I know some people will not like this response. I have more training that a pregnant woman, there are times when a c-section carries more risk. Its my job to understand what the patient is asking for, and help them achieve it. However, some women asking for a c-section are actually asking for something else and the c-section may be a surrogate. If a first time mom is pushing fr 2.5 hours and wants a c-section just because she is done, it may actually be safer and easier in some cases to still go ahead and deliver vaginally. Very few women in that situation are actually asking for c-section – they are asking to get the baby out quickly. My job is to assess the clinical situation and recommend the safest route and alternatives. I have refused to do c-sections on a mom who was pushing because of this reason – I knew her well enough that she wasn’t asking for a c-section, just a quicker delivery. With her consent, I rotated the head and she delivered <30 min later. She was happy in the end.

        Its all about communication. We have to talk to patients, but they also need to be willing to talk to us and share their positions.

        • Young CC Prof

          “Its never just that simple. It depends on the entire clinical picture.”

          Of course it depends on the whole picture! And yet the NCB nuts think that, just because the clinical guidelines include times, doctors are standing there with a stopwatch, going, “Your two hours of pushing are up! Baby’s crowning? Nope, push that fellow back in and do a c-section!”

        • DaisyGrrl

          Thanks for such a thorough answer. I just wanted to say I really enjoy your posts (especially the Canadian perspective). Thorough and educational – even if I have to look up some of the terms. And you’re right, if I’ve been pushing for 2.5 hours with nothing to show for it, I’d just want the baby out!

          I got the impression from LMS1953′s post that he felt these guidelines could fetter his judgement to the detriment of the patient. He’s pretty clear that’s how he feels about the 39 week “rule”.

          • Jessica S.

            I agree, I really enjoy her posts, too!

          • LMS1953

            I think the primip recommendations of a four hour second stage is complete and utter bullshit – basing this on 30+ years of experience. If mom has pushed for 3 hours and we’re trying to get baby out in the next hour, she is going to have agonizing pain. Do you know why? Because epidurals are notoriously poor at providing analgesia to the lower third of the vagina and the perineum. It will typically be a difficult operative delivery. I will have to endure the idiotic stares and scowls of episiotomy nazis who are so fncking smart that they “know” that episiotomies should NEVER be done. Difficult operative deliveries can result in the Corpus Christi decapitation tragedy at worst. Typically there are hideous stellate vaginal sidewall lacerations that can take an hour or more to repair. Another occurrence that sometimes happens is that you take a leap of faith and cut a generous episiotomy only to find that it would be dangerous to pursue the difficult forceps trial and you change to plan C. So mom gets to recover from both a vaginal “delivery” AND a C-section. I have done that but once in my career – I assure you the family members weren’t smiling very much at that point. The academic nitwits who promulgate these idiotic recommendations from their ivory towers are doing it to kiss political ass. They conveniently practice under an institutional malpractice umbrella that is not available in the “real world”. I have maintained a 20% to 25% C-section rate with this approach and liberal use of “medical intervention” and I’ll be damned if I am going to change now.

    • Trixie

      So, in my first labor, which ended after 20 hours in a c-section, where I had only dilated to 3 cm, and was stuck for hours and hours (OP asynclitic baby), that wouldn’t be failure to progress anymore?

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

      The pursuit of vaginal birth – it has to be the most vile thing I have seen…on so many levels.

      • rh1985

        I don’t get it. I had a CS, originally it was elective but it ended up being for medical reasons a day earlier and there was no discussion of doing anything else the day she was born. When my OB took my daughter out she commented that she would definitely not have come out any other way that day- too high up. A lot of women these days only want 1-2 children anyway and repeat CS risks do not go up until more than 2 CSs.

        My baby obviously didn’t know when to be born! (like the NCB people seem to think babies know…) Since she wasn’t trying to come out when it was no longer safe for either of us.

        • Young CC Prof

          The good news is, an awful lot of women don’t think that way. My friend had a baby last summer, and she ultimately wound up with an unmedicated vaginal birth like she originally wanted.

          However, her baby was breech until very close to delivery, so she and her doctor discussed the possibility of c-section. And, as she explained to me, she wasn’t stressed out about it either way, and definitely wasn’t wasting her time on SpinningBabies.

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

    Ignorance is the only reason any woman “trusts birth” – anyone who has spent any time actually around birth, or around birth statistics, or around those on the wrong side of those statistics does not “trust birth”. What about, Respect Birth – respect that it has the potential to wreak havoc, respect that there probably isn’t another time in a young woman’s life when her health is so vulnerable, nor is there a point in a child’s life as fraught with risk?

  • Zornorph

    I suppose it’s a mistake looking for logic in the woo but ‘Trust Birth’ has always struck me at the most illogical of all the HB beliefs. History proved that giving birth was the most risky thing for a woman back in the day – not to mention the risk to the baby. Any English Lit class is going to be full of stories where a woman and/or her baby died in childbirth. Not to mention queens and their offspring.
    I think that the Trust Birth people try to sell their victims on the idea that women are healthier now and we know about germs, but most of those women and babies didn’t die because they caught something from a germ, but because of something that went wrong at birth. Nature doesn’t care about everybody making it – just a high enough percentage for the species to continue.
    I certainly did not ‘trust birth’ and was on the edge of my seat until my LO was out and safe in my arms. I can’t imagine how much more nervous I would have been had I not had the comfort of all the monitors showing me that he was all right during the process.

    • Danielle

      Its the least logical and most religious aspect of the belief system. “Birth”, nor “Nature,” are benevolent. There may or may not be benevolent people, and there may or may not be a benevolent supernatural deity. But nature is a glorious brute that is beautiful and terrifying and indifferent. As a mechanism, evolution cannot be considered any more so. A self-knowing, rational beings first impulse is to cooperate with, fight, dominate, and eventually work in symbiosis with nature. But wait for nature to be benevolent? Sure, if you want your crops to die and your weak to get diseases.

    • Mariana Baca

      Except even if they think “germ theory” is the main cause for improvements in obstetrics, they still ignore gbs and antibiotics, or possible sepsis from meconium aspiration or waterbirth, or eye ointment for newborns.

  • LMS1953

    The March issue of Ob.Gyn. News came today. There was a good synopsis of the study presented by Dr. Grunebaum at the MFM meeting in New Orleans. The image is impressive for the startling bar graphs. It would make a good meme: Trust This?

    • Trixie

      Is it something we can see online?

    • The Bofa on the Sofa

      Catch this part:

      “In all probability, very few CNMs attended the home births in Dr. Grunebaum’s study, according to Jesse Bushman, ACNM’s director of advocacy and governmental affairs. The college’s own data indicate that 90% of deliveries by its members are in hospitals. Only 30% of home births recorded in the CDC data were performed by CNMs, he said.
      ‘That is one issue we have with Dr. Grunebaum’s results,’ Mr. Bushman said in an interveiw. ‘There are many people who could call themselves a midwife who may not have the the training or competencies that CNMs do. To lump them together is quite problematic.’”

      So stop doing it, then, ACNM!

      Amazingly, here the ACNM is trying to distance themselves from those other midwives who don’t have the training or competence of CNMs. Great. Now why don’t they do that all the time?

  • Are you nuts

    Somewhat OT but not… Woman performs c-section on dog and is arrested. Sad how a dog gets this reaction, but when a non-qualified human midwife kills a patient, they are somehow immune.
    For the record, I abhor what this woman did and think she should be prosecuted to the fullest extent of the law – just like negligent midwives should.

    http://tampa.cbslocal.com/2014/03/19/police-woman-performs-c-section-on-dog-uses-glue-to-close-incision/

    • Zornorph

      Well, a midwife would have never agreed to a C-section even on a dog. though. Poor doggie :(

      • DaisyGrrl

        A midwife wouldn’t believe that a dog could ever need a c-section to begin with.

        • Stacy21629

          Talking with an owner that wanted to breed her GSD “so her kids could see the birth” I told her she needed to be prepared that breeding her bitch was asking her to risk her life for their enjoyment. Her response? “Well that’s just your point of view.”
          Yea.

          • DaisyGrrl

            A great link for those types: http://www.woodhavenlabs.com/breeding/breeder2.html
            WARNING: THIS LINK CONTAINS VERY GRAPHIC TEXT ABOUT WHAT CAN GO WRONG IN DOG BREEDING/WHELPING (and thankfully, no pictures).

          • Melissa

            Why do the kids need to see a dog birth in person when so many women post their human births on youtube! That’ll teach the kids something.

    • Rochester mama

      This is the dark underside of dog breeding. When you buy a purebred that isn’t for show or from a show quality breeder this is what you are supporting.

      • Zornorph

        Um…I don’t see that. All the woman had to do was take the doggie to the vet. Some animals have trouble giving birth – happens all the time in the wild – but this one had a large number of pups and probably was just tired after having so many.

        • Stacy21629

          Unfortunately, she’s very right.
          This dog was a uterus with legs to these people. Competent breeders get pre-whelping xrays, know how long is “too long” between puppies and bring their animals in earlier.
          “Back-yard-breeders” rarely if ever do. They “just want her to have one litter” or “want their kids to see the miracle of birth” or “she just got out and got pregnant somehow”.
          Most of the time those dogs are ok. My first C-section ever I had recommended pre-whelping rads just the week before – last puppy was stuck, mom was 104.5F and going septic 48 hours after labor started before they brought her in. Before they managed to scrape together money for the surgery I was talking about euthanasia – better to euth the mom than let her die like that. They had declined the rads because they had no money and nearly let her die for lack of funds. All the owners (4+) were covered in tattoos and spent the surgery time outside smoking.
          They didn’t bring the dog in because they didn’t have any money. Sorry, but that’s what I see every single week.

          • auntbea

            If a dog gets stuck partway through labor, and you have to bring her in, will she resist? Do you have to bring the puppies with her so she won’t freak out?

        • Stacy21629

          I had another one recently (backyard breeder that is) bring in a 2 day -partum metritis that balked at the estimate because “my husband’s been out of work for 6 months”. Well the gestation on a dog is only 63 days (give or take) so you had PLENTY of time before that to decide “hey, we can’t afford this right now” and NOT breed her. But you did.
          I looked her straight in the eye and told her “Well, unfortunately breeding bitches can be expensive if there are complications.”
          The show breeders I have worked with have taken EXCELLENT care of their animals and I have never had issues with them. I’ve been more than happy to help them any step of the way in the reproductive process.

          • Trixie

            I’m so sorry you have to deal with that.

          • Stacy21629

            A very fitting quote I read on a veterinary board recently was “Veterinary medicine occupies the dangerous intersection of emotions and finances.”

          • Trixie

            It’s a tough profession for sure. We go to a really wonderful vet practice and I’m so grateful for them!

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

        But purebred dogs are their own horror, aren’t they? There are so many genetic problems associated with them and its because of rampant inbreeding that these problems exist in the first place. In some cases (like rhodesian ridgebacks) they simply “cull” the ones that don’t have the purebred appearance (like the dogs that just don’t have ridges). There is a damn lot of evil that seeps into any attempt to treat a living creature as a commodity.

        • Stacy21629

          Pluses and negatives to everything. Mixed dogs are a grab bag of unknowns…at least with a Golden I pretty much already KNOW what it’s issues are likely to be. :-P (I wouldn’t actually ever own a Golden, but that’s another way to look at it).
          I don’t think Rochester mama was advocating buying purebreds…just getting them from a good source if you do. If purebreds from a show line have genetic issues – those from a BYB are only magnified.

          • Rochester mama

            I’ve learned to separate out show breeders in my rants against breeding because inevitably someone will have a cousin, brother, friend that is a great breeder that has reservations for litters next year or only breeds dog for the blind etc… But those are NOT the breeders that put ads in the paper for three different kinds of dogs and have puppies year round.
            All of my animals are adopted and I do adoption and TNR volunteering.

          • DaisyGrrl

            It’s an important distinction. I find it especially useful for people who don’t want to adopt/rescue to explain the differences between good and bad breeding practices – at least they’re educated.
            I currently have a magical mystery mutt of unknown origins (brought into the pound as an adult stray). But I would not be adverse to one day purchasing a dog from a good breeder and try hard not to judge those who do. As for my cats – I’ve only formally adopted one. The others were strays that didn’t make it to the shelter (and yes, owners were searched for and not found). :)

          • Rochester mama

            My lab is a pure bred rehome. His first owner bought him for hunting then got cancer and while he kept his 3 other labs couldn’t keep up with the energy demands and training of a 10 month old puppy. I was lucky, he was crate and potty trained and had basic commands down. Just needed 2 hours a day of exercise. After living with him I think I’m a Lab girl for life. So I get why people want certain breeds. But you can often find a second hand purebred dog that needs a home.

          • Mishimoo

            My girl weimaraner is one of them! Her previous owner had bought her under breed-contract from a very reputable breeder and “didn’t have enough time for her”. In other words, she’d shown my dog until champion status, and wanted to breed from the daughter she had bought at 1/2 price, because that one had “not received genetic damage from vaccinations, so her offspring will be stronger”.
            I ended up paying a security deposit, taking over the contract, and having her neutered once she’d had the second litter. It worked out really well because I didn’t have to housetrain a puppy, and she didn’t end up having loads of litters. I think that her line was discontinued actually, because I pointed out to the reputable breeder that my bitch had problems with anxiety and that I was not comfortable breeding from her.

        • DaisyGrrl

          Yes, and you’ll see reputable breeders (those whose breeding stock is evaluated by outsiders for form and/or function) ensure that their dogs are as genetically sound as possible. In the breeds I am interested in, I would never purchase from a breeder who can’t provide proof that all recommended health tests have been performed on the parents. These breeders are interested in saving the breeds they love and improving them long term.

          It’s the breeders who breed for colour or personality that you really have to watch out for. They generally avoid the shows/trials and are only in it for the money.

          • Stacy21629

            “They…are only in it for the money.”
            And the best way to do that is to maximize income (sell pups for ridiculous prices) and minimize expenses (forgo veterinary care).

    • Stacy21629

      As an emergency vet this doesn’t surprise me at all. Dog “breeders”
      already do at-home ear crops with rubber bands and scissors, skip
      vaccinations so entire litters die of parvo and bring in a half-dead bitch
      with a puppy hanging out of her. In fact, that’s likely the only way
      this woman was able to do a “c-section” on this 100+ pound dog – she was
      probably already half dead from sepsis from being in labor with stuck
      puppies for 24-48 hours+. A simple pre-labor xray would have revealed
      how many pups there were and she could have sought care 24-48 hours
      prior when the last 2 didn’t come out.
      Interestingly enough, these
      type of folks always plan to sell the pups for $2000+, have a pack of
      cigarettes in their purse and an iPhone in their pocket…but no money
      for veterinary care. Priorities.

      • Siri

        ‘ A half-dead bitch with a puppy hanging out of her’ – that’s more or less how I felt when I requested transfer to hospital after a long labour at home…

      • Anj Fabian

        Certain breeds are at risk for birth complications – and mastiffs are one of them.

        My immediate reaction was “How do you do surgery on a mastiff and survive intact?”. My conclusion was the same as yours – the dog was in bad shape when it happened.

  • http://momofmanyfeet.wordpress.com Bambi

    You know, lately, I’ve been doing a lot of reflecting on everything. We’re told by our friend about how much they know and how they love and care for us and our families. And they have their kids become your kids friends. As they handle your care, you do, you trust them and you rely on them to be able to know when something is wrong. I remember that day having an option to transfer and her saying our baby was perfectly healthy, we didn’t need it. We believed her, she was the expert at all this. Right?? I remember afterwards her wanting us to talk to try to figure out why she died. Now I know why she wanted us to do this. My daughter’s death was suppose to be something that just happened. I wasn’t suppose to question HER. She was my friend who loved us who grieved for my daughter. She knew I was convinced that my body had given her some kind of genetic defect or made her sick. I was never going to have another child because of it. She saw me beating myself up. That was ok to her. Other midwives questioning and talking, OMG did she flip. They don’t give a crap what they do to us or our babies. They are the only ones that matter and they’ll do anything it takes to ensure this.

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

      I am so sorry for your loss.

    • Mel

      I am so sorry about your daughter’s death.

  • Amy Tuteur, MD

    OT:

    I hired a web designer to fix the problem with the black area at the bottom of long posts. She is working on it now, so you may notice some intermittent problems with the comments sections.

    • PrimaryCareDoc

      YAY!

    • Zornorph

      Glory, glory, hallelujah!
      But shouldn’t you just trust the internet?

    • Comrade X

      I think I’m the only one who likes the black bit. Much more restful on the eyes. :)