Jen Kamel, if you can’t acknowledge when you are mistaken, you aren’t doing science.

VBACFacts

Karma is a bitch.

Jen Kamel of the loosely named blog VBACFacts, a lay person with a very poor grasp of obstetrics, decided to do a hatchet job on a wonderful post by Doula Dani.

Danielle wrote about vaginal birth after cesarean (VBAC), Jen’s supposed area of “expertise.” Being the deeply conscientious person that she is , she gave Jen the opportunity to participate in the post. Jen turned her down, but when the post was published, she savaged it, first in private and then publicly by reprinting the private conversation without permission.

Jen titled her acid post The Dangers of Birth Blogs, and had this to say about Danielle:

Every practitioner and birth professional reading this has likely witnessed the problems that occur when lay people cross the line of giving information and feel competent to dispense actual medical advice despite the absence of any clinical training or education. (For specific examples of what this looks like, click on the third Facebook post above.) A doula is a childbirth support specialist, skilled at helping families navigate labor and birth in a way that fits each family’s needs, values and risk tolerance. A doula is not a medical expert, and medical advice is outside a doula’s area of practice.

Now I don’t name this doula or link to her blog because my objective is not to publicly shame her or to direct people to her blog. While I use my experience with this doula as a example, this is about the bigger picture.

My objective is to issue a warning: There are a lot of people out there who have no idea what they are talking about. And it is downright shocking to me how many parents and professionals are willing to just accept something as truth simply because they read about it on a blog … or writes about it on Facebook … A little bit of knowledge is not enough to understand any complex subject including post-cesarean birth options.

The irony, of course, is that Jen is describing herself. She is a lay person who “routinely crosses the live of giving information and feel competent to dispense actual medical advice despite the absence of any clinical training or education.” She has a little bit of knowledge about VBACs but “not enough to understand any complex subject including post-cesarean birth options.” And like Jen, I marvel at “how many parents and professionals are willing to just accept something as truth simply because they read about it on a blog” … like, say, VBACFacts.

Jen’s post is as clear as mud. It is extremely difficult to read and understand. But I did understand this, which Jen posted in the comments and on the associated Facebook post:

If there is something that I have said above that is inaccurate, please let me know.

So I let her know.

Jen criticized the use of the appalling MANA HBAC data to demonstrate that attempting a VBAC at home has a hideous death rate:

… You have to know that issues with the MANA mortality data. That collection of data is insufficient to accurately measure mortality. 1000 TOLACs [trial of labor after cesarean].

When Danielle points out that the data is not insufficient, Jen doubles down:

It is laughable that she makes this statement. Anyone who claims that 1000 labors is sufficient to measure maternal or neonatal mortality rates in America has no idea what they are talking about. It is simply too small of a sample size.

Jen is withering:

how much of my time should I give you to work on your piece?

2 hours?

3 hours?

7 hours?

I mean… I want to help you, but…

And I’ve already given you a line by line feedback.

And:

As someone with a website, you are under an obligation to be ethical, clear, and transparent. When you make conjectures like that, when you make leaps or tie two events together that have not been clearly connected per research, you are not being clear. It certainly makes for pretty dramatic reading but it’s not accurate.

So the question is: do you want to go for dramatic or do you want to go for factually accurate? Because sometimes factually accurate is a little bit more boring, frankly. All depends on what your objectives are. The truth? Or some other agenda?

And:

Is it good science to take an pretty solid figure (hospital mortality rates) and compare it to a figure found in a study that is not powered to measure mortality rates and then make a conclusion? Perhaps for someone reaching for an agenda, yes. But we have to be honest. And the honest answer is, the MANA data is not powered to measure mortality. They acknowledge that in the narrative. End of sentence. You cannot take this data and wave it around as a strong piece of evidence on the mortality rates of home VBAC.

Too bad Jen is completely, totally, utterly wrong.

I explained to Jen on her Facebook page why the MANA data is adequate to draw conclusions. I explained why you can’t just eyeball the data to determine if it is adequate (as she acknowledged that she did), and there is a statistical test for power. I explained that both sample size AND effect size determine power, meaning that a large effect requires a much smaller dataset to be adequately powered than a small effect and the difference between the HBAC death rate and the hospital death rate is quite large. She countered by claiming that MANA thinks the data is underpowered, as if that means anything.

But apparently, the more she thought about it, the more she realized she had made some serious errors. So she did what any natural childbirth blogger does when confronted with an error: she deleted the evidence. She deleted her blog post (the link above is the cached version) and she deleted the Facebook post where she is shown to be wrong, as well as multiple other Facebook posts that referred her withering hatchet job.

She forgot to take down one of her Facebook posts, the most ironic one of all.

image

The text on the illustration is cut off. It reads:

Science:
If you don’t make mistakes, you’re doing it wrong.
If you don’t correct those mistakes, you’re doing it really wrong.
If you can’t accept that you’re mistaken, you’re not doing it at all.

I propose that we add the following line just for Jen:

If you hide the evidence that you were mistaken, you are a very dangerous birth blogger.

And, Jen, one more thing:

If you don’t apologize publicly to Danielle for that underhanded, vicious, ignorant hatchet job, you are contemptible.

  • Brian C

    Snap! That is how you do it. Great post.

  • Mac Sherbert

    After I had my first baby via c-section for breech presentation, I contacted the local ICAN group. The lady that contacted me back. Told me all about her births. I can’t remember the details, but she had a failed VBAC that I think started as a home birth, but ended in a c-section. She complained about the mean woman OB at the Hospital and eventually had a VB with a midwife in a neighboring state not anywhere near a hospital. My response to that was say WOW you really are hardcore. When I say hardcore I mean you are so entrenched in what you believe you can’t think or do anything else. I thought she was nuts and never contacted the group again.

    Now to come full circle, if I had followed this woman I might have ended up trying to VBAC with 9 lb. plus baby with broad shoulders. Yeah, so happy I went with an OB that wanted to place a live baby in my arms.

    I’m so glad that there are those like Dr. Amy and Doula Dani that are willing to put the real facts out there and take the backlash that comes from it.

  • fiftyfifty1

    Nice work Doula Dani.

    What I like so much about your work is that you realize that SOMEBODY has to be the statistics.

    When many birth bloggers look at bad outcomes (if they look at them at all) they try to convince their followers that those bad outcomes don’t apply to them. You see that with Jen Kamel. Big babies? Less than 24 months between deliveries? Going over your due date? Well she has decided she doesn’t think those are real VBAC risks. Lack of continuous EFM? She has decided it’s not a problem. VBAC after multiple C-sections? Well nobody knows for sure how risky it is so carry on! Horrific MANA numbers? Well just like Jamie Bernstein said, she’s sure no conclusion can be drawn. Just avoid induction and you’ll be fine! She’s sure YOUR scar, is FAR less likely to rupture than the scar of those other, nasty, women who aren’t her followers. If you’ld like to know more, sign up for her special snowflake VBAC seminar $$$$$ !

    (And if you do have a full rupture at home, she’ll be sure not to tell you that she knew all along that there was NO CHANCE IN HELL that you would make it to the OR in time.)

  • mtbakergirl

    Great post Dani!

    I tried to wade through the screen caps and what stuck out to me (other than how incredibly rude she was/is) is that she is all for “facts” until they disagree with her pre-determined view (VBAC/HBAC is safe, la la la!) then she equivocates until the fact appears meaningless e.g., “this study demonstrated X rate of rupture, but don’t believe it because of inductions etc. etc. etc,

    Also, I work in healthcare and know that grade III evidence does not mean no evidence/ a lay person with a blog’s opinion is just as valid. The OBGYNs sitting in the ACOG meetings probably have 100s (if not 1000s) of years of collective experience in obstetrics, and that expert level of practice and education is hugely meaningful and cannot be discounted.

    • Young CC Prof

      There’s also the “err on the side of caution” principle.

      Let’s say you’re running a clinical trial of a new drug. You’ve got 200 participants, healthy volunteers, they’ve been taking it for a couple weeks, and then one of them suddenly falls ill, is transported to the hospital, and dies, all in the space of a few hours. You don’t yet know what this person died of.

      Do apparently healthy adults occasionally get sick and die? Unfortunately, yes. Could this be a coincidence? Statistics say yes.

      However, in 12 hours your 199 other volunteers are all scheduled to take another dose of this drug that MIGHT have killed 0.5% of your sample. Do you call them up and halt the trial until you figure out what happened, or do you seize on the fact that it might have been coincidence and declare that you need more data?

  • Jessica S.

    “the MANA data is not powered to measure mortality. They acknowledge that in the narrative. End of sentence. You cannot take this data and wave it around as a strong piece of evidence on the mortality rates of home VBAC.”

    Isn’t this so convenient for MANA and those of like minds? MANA releases data, this looking oh so transparent. But wait! It’s not good for anything. So don’t try to use it to make a point. Except, of course, about their being transparent.

    • Sue

      Which begs the question: does their ”study” have the power to make any conclusions?

      • Young CC Prof

        Obviously, that home birth reduces c-sections!

        Except that, as with everything else, MANA uses the wrong comparison group. They brag about their 5.2% c-section rate, then state that the US overall c-section rate was 1 in 3.

        Of course, given that the majority of their pool is multips with no history of c-section nor any major risk factors, this is absurd. I did a rough back-of-the envelope calculation, based on the risk factors of the various subgroups: If all those women had gone to the hospital, approximately 9.5% would have had a c-section.

        It also reduces epidurals. Not getting pain relief because you have no access to it is so empowering, right?

  • Trixie

    Here’s a post where she tries to use the car accident metaphor, rather badly. http://vbacfacts.com/2012/07/09/false-comparison-fatal-car-accidents-and-vbac/
    For a communications major, she really can’t write very well.

    • Anj Fabian

      “Now VBAC seems excessively risky and some loose confidence in their birth plans.”

      Go communications major, go!

      • MLE

        Hmm, excessive risk and loose confidence to boot.

        • Susan

          I my confidence in VBACs is sometimes loose too.

  • Guesteleh

    It just struck me that Kamel chose to attack a post where a loss mother very eloquently describes the devastation of a homebirth gone wrong. Have to drown out those inconvenient voices…

    • Amazed

      I labeled Kamel the bitch of bitches when she launched a veiled attack against a father who said, “It isn’t worth it. I have a child who was damaged by a VBAC and it isn’t worth it. Why invite the risk?” Granted, she tried to keep it sweeter there. Her worshippers must have convinced her that she was so powerful now that she could safely show her true colours.

      • anne

        I don’t know why I can still be surprised by this.

        • Amazed

          I tried to dig it out for you but our sweet expert seems to have deleted the post, although I can still access the site itself with her explaining how she’s all for science.

          • anne

            It’s funny how dead and injured babies and traumatized families don’t slow some people down but bad SEO does.

          • Young CC Prof

            What’s a SEO?

          • anne

            From Wiki because I can’t put it as well “Search engine optimization (SEO) is the process of affecting the visibility of a website or a web page in a search engine’s “natural” or un-paid (“organic”) search results.
            In general, the earlier (or higher ranked on the search results page),
            and more frequently a site appears in the search results list, the more
            visitors it will receive from the search engine’s users. SEO may target
            different kinds of search, including image search, local search, video search, academic search,[1] news search and industry-specific vertical search engines.”

            Jen Kamel is not going to be pleased because when someone googles her name the Skeptical OB, with screenshots and all, is going to pop up. If you have a business you want all the links/searches with your name to be flattering.

          • Young CC Prof

            Ah, yes. Didn’t recognize the acronym. Yes, that’s very important, and it is indeed very bad for your reputation when you have a little site, and then a bigger site writes a negative article about you.

          • http://kumquatwriter.wordpress.com/ Kq
    • Young CC Prof

      I’ve said it before, homebirth loss stories draw out the most vicious attacks. The pure-science posts are just ignored by comparison.

  • Meredith Watson

    I don’t know who Jen Kamel is, and as I was reading her cautionary statement about being careful who you go to for information, my first thought was that she must be an RN or Doc. Wow.

  • MLE

    Also, typo in your first line – change KaRMA to KaMEL and that will fix it right up. (Sorry, couldn’t help myself).

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

    I have said and still want to say that I wish I never would have written to her at all. But there’s a lesson in this somewhere. Even if it’s just that I need thicker skin and that I can’t allow people to walk all over me like that.

    My conversation with Jen was so, so humiliating. I was trying so hard to hear her out. The last thing I wanted/want to do is put up something that is not truthful. I was so confused because I had two experts review it. I made changes based on errors they pointed out before I published it. And I made changes based on things brought up by Jen as well. I didn’t want my post to blow any risks out of proportion, to make any one option look the “right way.” I can’t imagine the tough decision it would be deciding between TOLAC and RCS, it depends on so much for each person’s individual circumstance. And I can’t imagine not even having the option for TOLAC. But none of that means we excuse the risks of HBAC.

    Hospital TOLAC is LOWER RISK than low risk home birth (according to Guise, MANA and CPM2000) so of course home TOLAC is going to be even riskier. Just taking into account transfer time, how long it will take for a woman at home to have a c-section if she is one of the “unlucky ones” who has a UR, you know it is far riskier. It is a complete gamble of the baby’s life AND the mother’s life. There are too many HBAC’s gone wrong by now to know that it isn’t a gamble. Even with the most skilled provider, even with an ironclad trust in birth, UR happens.

    I let her walk all over me. I kept thinking “assume whoever you are talking to knows more than you” and also kept thinking “I’ll be damned if I pull a Jamie Bernstein.” So I wanted to hear her out. I was trying so hard but it was such a stressful conversation. At one point I was sitting in a doctor appointment – which I told her (which I believe is missing from the piece) – it’s when she says “I can PM til it dies” and I was trying to subtly say I couldn’t talk at the moment, I couldn’t do anything at the moment. I should not have been subtle and that’s my fault. I wanted to go over each point she made – and I did! I made changes based on some of her suggestions. I wish I just would have cut her off. I should have just said “Jen, I can’t talk right now. I will look over these points and get back to you.” That’s all I needed to say and I should have. Lesson learned. I just was so afraid that by ending it or ignoring her, it would make me look guilty, like I was trying to hide something, I was afraid she would think I cared only about telling the story the way I wanted to tell it and the truth be damned. And that’s not at ALL what I wanted b/c it’s not the reality of the situation. I was striving for and wanted a truthful, honest, accurate piece.

    Anyway. Ramble ramble. Thank you, Dr. Amy, for defending me. Although I don’t think it’s a matter of defending “me” it’s a matter of defending what is right. What Jen did was so, so cruel and I don’t understand why she did it. To take a private conversation like that, which was humiliating enough, then to add in all her little afterthoughts and digs and her just complete attempt to make me look horrible. It was a personal attack. She didn’t have to name me. She knew *I* would read it. That is a personal attack. And it was so, so easy for people to take 3-5 words from the post to do a Google search to find me. I just don’t get why she did it. But oh well. C’est la vie.

    • MLE

      This goes to show that whether you are aggressive/mean/Satan or approachable and respectful, it doesn’t matter. They will treat you the same because it’s the facts that threaten them. I think you are a very strong and compelling person Dani, and you should keep it up.

      • Karen in SC

        Excellent point that reveals the true colors of the “tone trolls.” Of course, what Dr. Amy has always said.

      • Susan

        Such a fabulous point MLE ….and I always think your name stands for midline episiotomy and then think nah :)

        • MLE

          Thank you Susan! Actually it stands for Emily…Em Ell Eee, get it? Haha. But knowing it could also be midline episiotomy makes me love the joke even more, since it has the potential to inflame the NCB!

          • Susan

            I suppose it could be mediolateral too but that’s how we used to abbreviate it in the log book.

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

      But it’s ok, b/c she is going to be kinder now. Either that or it’s her way of apologizing to me and saying “don’t become resentful b/c of what I did to you, let my cruelty make you kinder.”

      https://www.facebook.com/vbacfacts?fref=ts

      • Anj Fabian

        It’s a PWW. It doesn’t mean anything.

        What does mean something is her pulling her post. She was not willing to stand behind what she wrote, in her own words, on her own blog.

        I eagerly await her next blog post!

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

          I was just joking. It certainly wasn’t any type of apology to me! What is PWW?

          • Anj Fabian

            Picture with words. aka internet memes.

          • Karen in SC

            Some of her followers with more brains probably advised her to pull the post.

          • Amazed

            She has those? I don’t follow her but her sheeple on the NGM weren’t too impressive in brain department.

          • Jessica S.

            More brains, perhaps, but certainly not integrity. Not that Jen or anyone who would recommend disappearing a post has any acquaintance with integrity.

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

            Pictures with words are always true though. It’s a fact. The internet says so. Somewhere.

      • Tamara

        I suppose she thinks that we are the bitter ones.. but who’s laughing now ;)

    • Anj Fabian

      The final insult was not linking to your post so people could read it for themselves.

      When the discussion was going down at NGM, I considered posting the link to your blog. NGM certainly knew who and what Jen was talking about.

    • Guesteleh

      Dani, I have so much respect for you because you are blogging under your real name and taking the heat. You don’t have Dr. Amy’s personality, you don’t enjoy brawling and you always try your best to engage with people respectfully even when you disagree with them, yet you haven’t backed down even though you’ve gotten so much unfair and nasty crap thrown at you. You keep on going and never sling mud because you actually give a shit about keeping babies and mothers safe and because you have too much class and dignity to descend to their level. I know the area where you live and I have to say that makes you doubly brave in my book because it’s woo central and I’m sure you’ve upset people in your community. (braver than me since I only post here under a pseudonym). Just remember that a lot of people appreciate and admire what you’re doing.

    • Amazed

      Dani, your conversation with Jen was humiliating but not to you. It was humiliating for her because she spat at the chance to make her arguments heard and then revealed to the world what piece of intolerant, hypocritical, mean, and cowardly bully she is. You didn’t out her – she did so herself and in the process revealed herself as stupid beyond saving, dragging some of her cult members with her. I am talking of Philosophy Chick (I stole that one from Kory, by the way), as well as others, but mainly Miss Philosophy Chick Professor Jen Worshipper who faithfully exposed herself as stupid, intolerant and stubborn.

      You kept it classy when many women wouldn’t bother or succeed. Kudos to you.

      • Susan

        Yes, Dani, you have grace and class and that shined through.

    • Siri

      Don’t let it get to you, Dani! It’s better, ultimately, to be the softer one, even if that makes you vulnerable. You can toughen up, but she can’t grow a bigger heart… be proud of who you are and what you do; you have so many supporters, genuine ones, not sycophants. Your post is excellent, and your integrity is intact. You’ve got a lot of goodwill here, a good margin of slack, but you haven’t needed to draw on it yet! You stand on your own merit.

    • Meredith Watson

      I just wanted to say that I love your blog – don’t be upset by this incident because it doesn’t reflect poorly on you at all.

    • Susan

      Dani, I wish you could clone yourself and be a doula for all of the pregnant women who want one. Thank you for all the hard work you put in to getting the facts and advocating for safer birth.

    • Renee Martin

      Your mistake? EVER letting a totally ignorant, ideologically driven, laymen, review, or participate, in ANYTHING. Especially after you had actual experts review. The ONLY good reason to do this? Is to make a post that highlights their total ignorance compared to the experts.

      YOU are gracious, wonderful and caring. YOU are sweet and overly generous. It’s not your fault you tried to be as fair as possible.

    • Captain Obvious

      Keep up the great work Dani! Love your posts. I just read that VBAC post and have already referred it to someone needing to make that decision. I can’t believe Jen’s actions. What a low life. Alright, that was mean, what an ignoramus.

    • Trixie

      I, for one, am glad for the end result, which is that Jen Kamel’s dangerous bullshit has finally been exposed for what it is. I’m sorry that happened at your expense, however.

    • Dr Kitty

      Dani, you are a lady, and your writing is always full of integrity and honesty.
      You did nothing wrong, neither in what you wrote, nor in how you handled yourself.

    • Jessica S.

      This SO would not of helped the situation, but how great would it have been to, at the height of her bizarreness, say “I’m sorry, I didn’t realize I’d be dealing with crazy. I’m not interested in any, but thanks!”.

    • Jessica S.

      BTW, I’ll have to read your post. I’m due with #2 in July and not sure what the plan is for a RCS. That’s the route if like to take and I can’t see the OBs disagreeing (my regular physician handles my routine prenatal visits, she doesn’t do deliveries) but you never know. I’d like to have as much research read as possible before meeting with them!

    • Guest

      Here’s another reader who is glad of you, being gracious and understanding. Also glad you are a doula.

    • Rlbobg

      Some people are not worth your effort to try to be “fair”

    • Mac Sherbert

      Just another example of the “Professionalism” of these clowns..ummm midwives that is.

  • moto_librarian

    I have a question for Jen. I asked it on the FB post that she removed, so I’ll ask it here again where I know it won’t magically disappear.

    What are you doing to address the liability issues associated with VBAC? From reading various postings on your blog, you assert that VBAC bans are simply about enforcing policies and restricting women’s choices based on faulty information. But nowhere do you admit that the liability issue IS something that absolutely has to be considered by hospitals and HCPs. Have we seen a monetary judgement for an “unnecessary c-section” that resulted in a healthy baby and mom? No. But we have seen plenty of huge payouts when a baby dies or is damaged because a c-section wasn’t performed quickly enough. If you really want more access to VBACs, this is an issue that needs to be explored. The NCB community is silent on the matter, probably because lay midwives don’t typically carry malpractice insurance, and therefore have no financial stake when a HBAC goes wrong.

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

      Jen and Hush seem to have an awful lot in common.

      • moto_librarian

        I am now banned from commenting on her FB page. Keep it classy, Jen!

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

          Shhhhhh, no logic, lala lala no logic.

          • Hannah

            This is all I can think of when I see nonsense like Jen Kamel and co creating echo chambers.

      • MLE

        I’m not in favor of telling people to shut up, but I find it so hilarious that one of the most prolific commenters ever was named Hush.

    • The Bofa on the Sofa

      Exactly.

      The policies against VBACS in hospitals do not come out of nowhere. They come out of liability concerns as determined by the US court system. Hospitals that do VBACS without having proper response measures in order are liable for the outcome. The courts have established, for example, that a VBACS is not appropriate without proper anesthesiology available in a timely fashion.

      Hospital legal teams pay attention to this stuff. They watch to see what lawsuits are successful and which ones aren’t, and try to figure out the difference. When they do that, they tell you, “These are the things that others do that lead to losing lawsuits.”

      It’s a great thing that we have people paying attention to reality, instead of idiots asserting what they think it should be.

      • Anj Fabian

        If a hospital offered VBACs without following the ACOG recommendations, they’d be lawsuit bait. Offer a service without following best known practices and there’s an adverse outcome?

        It’s not going to end well.

        • The Bofa on the Sofa

          Offer a service without following best known practices and there’s an adverse outcome?

          It’s not going to end well.

          This is why, of course, MANA doesn’t actually have any policies regarding “best practices.” Because if you actually set standards, that means that people will get in trouble for not holding to them. And we couldn’t have that.

          • Anj Fabian

            That is so very true.

            Plus then there would pressure for MANA to actually do something to hold midwives to those standards. They can’t be having that!

  • moto_librarian

    I want to know just who is willing to give out CEUs to providers who attend VBAC facts workshops. Are nurses allowed to use this for CEUs, or does it only apply to CPMs and DEMs (we all know that their “educational” pathway is a joke anyway). I don’t want my HCPs receiving training on critical topics from a layperson. It is beyond inappropriate.

    • attitude devant

      Wonder no longer. It’s on her web page. It’s organizations like DONA, NARM, and Lamaze. Not exactly Harvard and Yale. Oh, and also the California Board of Nursing which makes me cock an eyebrow, but that’s definitely the only remotely professional one.

      • moto_librarian

        Further proof that Lamaze, NARM, and DOÑA don’t give a rat’s ass about expertise. Sigh.

    • Susan

      Sadly, there are CEU’s for all sorts of craziness. Many nurses see it as being open-minded. I am also beginning to associate the term “evidence based” with frustration because often people who use the term can’t cite the evidence. Brave New World stuff….

      • Jessica S.

        Evidence = “in my personal experience”, to those people.

  • Candi

    You know, Jen has a platform she could use to help woman have a safe birth but instead she advocates for home births after c-sections. Even in her VBAC “fact” closed group. I hope people read this and see that her birth blog is a danger and her information in the group have led to death of babies. Who knows how many other woman are out there suffering that trusted her when she says home birth is safe and they didn’t have a safe outcome.
    I would never pay 90-100 for a ticket to her workshop. It’s crazy how many people do. She’s not an expert and the information she gives is dangerous.

    • fiftyfifty1

      She’s making money off her advice??!! That’s so predicatable. Follow the $.

      • Trixie

        Oh, yeah. She gives VBAC workshops at ICAN chapters across the country. Also she compared her website to the Mayo Clinic’s as a source of information.

        • anne

          “Also she compared her website to the Mayo Clinic’s as a source of information.”

          I could really use a vomit spewing, head banging against the wall emoticon right now.

          • Guest

            Will this do?

          • anne

            Thank you.

          • Jessica S.

            Or

        • Young CC Prof

          Actually, comparing her website to the Mayo Clinic’s is a great idea. One is carefully vetted information reflecting the consensus of a group of relevant experts, the other is some random person expressing her opinion. It’s a perfect comparison of reliable vs unreliable health information online.

          • Trixie

            It was more like (paraphrasing), “be sure to consult websites with reputable, evidence-based information such as MayoClinic.com or VBACfacts.com.”

        • Jessica S.

          WTF? Wow, she mustn’t have a luck of self-awareness. How can she prattle on about how people shouldn’t listen to Dani b/c she’s not *really* an expert, etc – all the thing Dr. Amy highlighted in her post, but not think this applies to her, too? GAH! :/

  • Unbelievable

    The best part of this all is how much she was telling her own VBAC group about this blog coming, for about 2 days. We know it took Jen a lot of time and effort to put that up and to have to delete it after realizing she was wrong had to really hurt!
    I enjoy Dani’s blogs and I feel they are very informative.
    I hope Jen feels some remorse or something for Griffin and his mother.
    Thank you Jen for seeing you were wrong to post an entire private conversation and seeing your errors.
    Her own home birth story was also removed from her own blog. I wonder why Jen removed that? I’m sure it had something to do with how unsafe her home birth was.
    Dani please keep doing what you’re doing.

    • moto_librarian

      Oh really? That’s an interesting little nugget. This was all about shaming Doula Dani for pointing out that the data suggest that HBAC is a terrible idea. Of course Jen doesn’t want that fact publicized because she pushes HBAC as an option since she thinks that hospital VBAC bans have no basis. Of course, the studies that she claims to know so intimately demonstrate WHY ACOG has guidelines for whether or not a hospital can safely allow VBACs, but we wouldn’t want anyone pointing that out, now would we?

      • The Bofa on the Sofa

        To be fair, if you think HBACs are ok, then it makes sense that hospitals not doing VBACs have no basis.

        But it is all predicated on the claim that HBACs are ok

  • Trixie

    This is Jen Kamel’s account of her HBAC, which her midwife didn’t show up at until she was pushing. They never checked her dilation, just looked at the purple line on her butt. She hemorrhaged, but she’s okay, thanks to all the spirulina. Her midwife didnt forget to make placenta prints! https://web.archive.org/web/20140211021043/http://vbacfacts.com/about/hbacbirth/

    She took this down in the last day or so, probably when she realized Dr. Amy was going to write a post like the one above.

    • Trixie

      And this gem about her husband: “After M’s birth, T told me that unless I was dying, he wasn’t going to let me transfer to the hospital because he knew how much it meant to me to birth our child. ”

      • Young CC Prof

        Because being held prisoner while screaming in agony is so empowering…

    • Anj Fabian

      There are so many gems in this story. Jen being more concerned about her bleeding than the midwife was definitely ranks.

      Jen knowing all about hypnobabies and not much about how placentas work. (Hint: the maternal blood does not “flow through” the placenta.)

      And finally, at least half of the word count isn’t about her baby’s entrance into the world, or her baby. It’s her gushing about how great home births are, how terrible hospital births are and how she wished everyone could know how great birth could be.

      Yeah. The midwife who let her labor alone. The midwife who didn’t do any monitoring. The midwife who let her bleed. The midwife who couldn’t be arsed to make sure a laboring woman was supported and monitored, but had time to make placenta prints.

      • Trixie

        About how terrifying heplocks are.

        • Karen in SC

          I was able to get an anesthesiologist to give me a local before putting in my heplock and that was awesome. I’ve since learned there are creams that can be used and I plan to insist on getting that next time I have a procedure requiring an IV.

          • Durango

            Not every facility has the cream, so check before you go, or see if your pcp can prescribe some for you. And hope that the iv can be successfully placed where the cream was put! :)

          • Dr Kitty

            Emla cream is my go to for kids and needle phobics. Failing that you can use a fine mist of histofreeze (liquid nitrogen spray) to numb the skin.

            I got some lignocaine for the extremely large bore IV for my daughter’s birth (my anaesthetist friend wanted to get his numbers of wide bore lines up, so he put the biggest one (it was either 12G or 14G) he could find.

            I let medical students put 16G and 18G lines in me when I worked in the hospital. Rather they practised on me, an easy stick who can talk them through it and won’t get upset if they screw it up, than take 5 goes to get a line into a little old lady with paper thin skin and wriggly veins for their first real life attempt.

            Despite all the numerous sticks, I have big ropey veins that don’t roll. Last time I was in hospital I ended up with 3 lines in, because I had two bags of fluids and various IV antibiotics running simultaneously. It wasn’t

          • Dr Kitty

            It wasn’t anything more than a slight inconvenience (apart for the allergic reaction to an antibiotic, which was unpleasant).

            Get them to put the lines in your forearms or the backs of your hands, rather than elbows and wrists. They kink less and your movements are less restricted if you don’t have the line running over a joint.

          • Trixie

            Honestly, I really didn’t notice the heplock at all. The pain of contractions sort of overshadowed it. I remember a bit of stinging as they pumped the second bag of antibiotics in me. Oh, the trauma.

        • EastCoaster

          The last time I was in the hospital (for an idiopathic fever secondary to a serious illness), I had two heplocks. One on each arm. Sure it sucked but they really, really aren’t as bad as they are made out to be.

          When I wanted to shower the first morning, the nurses were great about taping me all up with plastic for waterproofing . . . so great, in fact, that I couldn’t bend either elbow (it made for an amusing shower). I decided to feel amused rather than annoyed. These histrionic crazies would probably claim brutality or something.

          • anne

            I spent a lot of time in the infusion clinic while pregnant sitting with cancer patients and patients with really bad infections. I had nice bruising from elbows to wrists from getting multiple IV’s each week (I’m not afraid of needles so I let the new nurses practice on me). At the end of the day it’s not a big deal.

            The IV that made me cry was the one in my son’s forehead after I gave birth. I wish that homebirth advocates were more aware of the fact that turning down interventions for yourself (heplock, hospital, etc) could mean that more interventions are done to your child after birth. A stay in the NICU is no picnic.

        • Young CC Prof

          Screw that. You know what’s terrifying? Watching someone start a line on a newborn with collapsed veins.

        • ModerneTheophanu

          Hep locks are fantastic. Being on continuous IV antibiotics for days, now that sucks. But after they stopped and I was just on a heplock? I could MOVE! And sleep in more positions! And my veins weren’t hurting! Hep locks are MAGIC.

      • Trixie

        Sorry to serial post, but also, she had an OB who was on board with her having a hospital VBAC, with only a heplock and EFM for 20 minutes an hour. So WTF is she complaining about?

        • Stacy21629

          Because her bracelet bothered her. How much more excruciatingly AWFUL a heplock would have been!

          • Siri

            Ah yes, the well-known phenomenon of jewellery trauma…lol.

        • fiftyfifty1

          “she had an OB who was on board with her having a hospital VBAC, with only a heplock and EFM for 20 minutes an hour”
          We get NCB types here all the time claiming OBs are driving women away from the hospital by being too inflexible and policy-driven. That if they would just give a little, women would choose to deliver in the hospital instead. This is a great example of how that’s not true. This OB obviously bent over backward to accomodate this nut and keep her in the hospital, to the point of being willing to promise that there would be no continuous EFM! Opening him/herself up to all sorts of legal trouble by being willing to waive normal standard of care to keep this woman in the hospital. But despite that, she chooses home. ‘Cause you don’t get bragging rights for a hospital birth.

          • Anj Fabian

            Could I start a career promoting hospital births? In general?

            Come to my hospital birth workshop!

          • Bombshellrisa

            Oh totally! That would actually be interesting, you could list the hospitals with jacuzzi tubs, free doulas, who offers water birth (since that seems to be such a selling point with NCB types), if candles are permitted.

          • Young CC Prof

            And the Cesarean rate specific to women like YOU, rather than the hospital or state’s overall rate.

        • moto_librarian

          Bitching about having a heplock makes me want to HULKSMASH! If I had had one during my first delivery, I wouldn’t have had to wait until well into my pph to get some pain medication. Let me tell you, Jen, a heplock is not painful compared to manual examination of your uterus and removal of clots without any anesthesia. Grow the fuck up!

          • The Bofa on the Sofa

            Someone the other day mentioned the possibility that all of this is based a fear of needles.

            This case is not evidence against that hypothesis.

      • Jessica Nye

        Um, WTF is a placenta print?

      • Young CC Prof

        You know what one advantage of birthing in the hospital is? If your provider has 3 women delivering on the same day, they are all on the same corridor and the midwife or OB can actually keep an eye on all of them at the same time. No need to wait half the day until the first one is entirely finished before you even get a look at the second one. (Now, if they all wind up delivering within a few minutes, that could get awkward, but hey, hospitals have more than one person working in them!)

        • LovleAnjel

          It does indeed get awkward. I was stuck pushing with just the labor nurse because three other of my OB’s patients were pushing at the same time. I was #2 in line. He took hours getting to me because, as my nurse said, the room for patient #1 was “in chaos”. But he was there all day to check on me otherwise and I had my labor nurse plus a series of shift nurses to check on me/refill my IV/ect. I can’t imagine being left alone with my husband at home during a time like that.

        • Busbus

          As a former homebirth mother, I can attest that this happens ALL.THE.TIME. In homebirth circles, this is often a “funny story” people tell afterwards, about how their midwife (almost) didn’t make it to the birth.

          • C T

            I had a doctor not make it to a birth (she was resting somewhere in the hospital and didn’t ever come see me while labor was progressing, then the pushing stage went very quickly). The nurses caught the baby and they grabbed a passing doctor whose name I never found out to pop in for a bit. Even when the OB care is less than optimal, hospitals win hands-down when it comes to numbers of birth specialists in attendance.

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

            My high school best friend had a baby our senior year. It was a tiny hospital with one OB on duty. Me and two other friends came to support her in labor. The doctor was washing his hands when my friends mom came sprinting out of the room yelling, “NOW NOW NOW!” And he dashed in after her, and *seconds* later we heard her daughter cry. Apparently she came out so fast she nearly caught air, the doctor barely could stick his still wet hands out to quite literally catch her.

          • Ainsley Nicholson

            With my twins, the doctor and nurses all missed the birth of the first one….the nurse checked me when I said I needed to push, and she found that I was at 5 cm still, so she left the room. Three contractions later, dispite my trying not to push, the baby was born. My sister caught him.

          • Young CC Prof

            Actually, I was almost born in a hospital bathroom after my mother demonstrated that, with the help of perhaps a bit more pitocin than was really needed, a FTM can go from early stages of induction straight through transition in about an hour without anyone noticing.

            See, these are funny. Needing urgent medical care and waiting hours because your provider can’t be bothered to show up OR hand you off to a colleague, not funny.

          • anne

            I have an acquaintance whose midwife didn’t make it to the last month of the pregnancy. Actually it was two midwives and they cancelled every single appointment after 36 weeks because they were too busy. She ended up with an emergency c-section at 42 weeks for low fluid after insisting on an ultrasound due to lack of movement.

          • Anj Fabian

            How very ethical of them!

          • anne

            Wasn’t it though? I was really feeling the intimate, one on one care that midwives love to provide.

          • Trixie

            Let me guess, she paid in full at 36 weeks.

          • Karen in SC

            Dr. Amy needs to write a post “How to issue a 1099-Misc to your homebirth midwife.” The IRS makes it very easy – you use a fill-able pdf form, print it out, mail one copy to the IRS and one copy to the midwife. You keep one and maybe you can deduct medical expenses on your taxes. Definitely, the IRS will be looking for a Schedule C for that individual.

          • AmyP

            That’s the midwife equivalent of those contractors who rip out your kitchen and then disappear with your money.

          • http://momofmanyfeet.wordpress.com Bambi

            My DR with my oldest was furious with his office staff because they had constantly rescheduled my appointments. I ended up having him at 36 weeks and he had undiagnosed CHD.

          • Young CC Prof

            Barely getting to the hospital with your third kid because he just came that fast is a funny story. Your midwife leaving you at home in full active labor with your first VB for many hours is negligence.

          • Trixie

            It’s a great strategy if you want to get paid without getting the blame should your client rupture. Wasn’t there, not my fault!

          • The Computer Ate My Nym

            But I thought having the midwife around all the time instead of the ob who comes in to catch the baby and then leaves was supposed to be one of the advantages of a home birth…

          • Trixie

            The midwife who delivered me barely made it to my birth…her car broke down. She walked up the driveway of the farm she was in front of, asked to borrow their truck, and they handed her the keys so she could be on her way. Different times!

    • Siri

      It was defo the spirulina that did the trick; nothing to do with the two shots of pitocin and the methergine tablet…..ok, the Hypnobabies could have helped too I guess.

    • Jessica S.

      Ok, I’m clueless as to what the “purple line” is? I really, really do not want to google it, either!

      • Trixie

        It’s a thing where supposedly you can judge how dilated a mother is by how long the purple line is in her butt crack during labor. So you don’t have to do unnatcherel cervical checks. According to NCB midwives, anyway.

        • Jessica S.

          I’m speechless. I’m also envisioning the “wetness indicator” strip on the front of diapers. :D

    • Captain Obvious

      So Jen Kamel’s midwife showed up at the last second, and TFB and Rixa’s midwife didn’t show up at all? Hmmm

  • Amazed

    I first saw this on NGM page. I found it hilarious how some of the commenters thought Jen’s degree in demographic made her an expert while conveniently overlooking the fact that Dani had a real, like life-real statistics professor on her side. Of course, that’s if Jen even bothered to mention this part. Her post was so horribly formatted that I got lost more than once.

    And the chick who boasted on being a philosophy professor made me laugh. That was why she wouldn’t read Dani’s original post – because she didn’t know how to evaluate it. Funny, she knew enough to know for sure that Jen was right and great.

    This chick reminded me of the time I graduated the Department of Philosophy (just the department, I am not a philosophy graduate). One of our professors told us that there are too many Philosophy students and professors today. And that hearing “What do you do for living” and answering “I think” is not a great reply. I quote here, “I wish that at least they did it as it should be done.” The lady was – you got it – a philosophy professor.

    Isn’t our chick a prime example…

    • Kory Oransky

      Jen’s degree isn’t in demographics, it’s in communications.

      I used to be a communications major (and almost married one of my classmates…..that was a lucky escape, trust me.) Guess how many statistics classes we had to take to graduate?

      None. All we needed was one math class, which could have been college level algebra. Any 100 level math class filled that requirement. I checked her school’s current requirements online, and they are the same as my school’s were.

      Now, maybe ol’ Jen took one stats class for her major. Possibly she took one at the community college for kicks.

      However, I’m willing to bet she’s self-taught on demographics (more like marketing research, really). She doesn’t know what she doesn’t know about stats, which is why she thought her “analysis” of Dani’s data was superior to an actual statistician’s.

      Maybe Philosophy Chick could explain the concept of hubris to Jen someday…..but I think she’s read too much Derrida to be useful in that regard.

      • Amazed

        Oh Kory, let’s be honest here… didn’t you enjoy her helpless cop out? It was so far-fetched that I chuckled… until I read the philosophy part, that’s it. Really? Philosophy Chick is a living proof for the accuracy of the anecdote we often repeated between outselves at the university… we were the students who needed less resources. Physics students? They needed paper, pens, money for experiments, erasers. Maths students? Paper, pens, erasers. We from Philosophy Department? We didn’t even need erasers.

        So many words to cover her retreat. And she got the audacity to call Dani “one poor woman who does not realize how little she understands”. Did she offer an excuse when Dani appeared in the comments section? No sir. More and more words.

        Oh Philosophy Chick, take a leaf out of Jen’s book and use an eraser.

        Dani,I admire your work and your self-restraint. I am not too aggressive – I think – but I could never keep it as classy as you did.

      • Amazed

        I still cannot get over the fact that she endorsed herself as the owner of all and any VBAC facts while making a small digs at the “statistician” who, just by chance, was a professor in statistics. Who cares! Jen knows more because she might have or not have taken a course in demographics.

        Earth to Philosophy Chick: if we go by Jen’s definition, you should not bother boasting your being professor. You’re just a philosopher. As my philosophy professor would have asked you, “What do you do for living? Thinking? You aren’t too good at it, dearest.”

    • Jessica S.

      Good god, that philosophy chick’s reasoning is nothing but a lazy excuse to not have to have her own beliefs challenged

      • Amazed

        Oh I think it was something more. She tried to both double up and impress the audience. In the beginning, she was all “I understand and Jen is right, and the poor doula is well-meaning but so stupid”. Now, it suddenly became “I don’t know, really, I just feel Jen is right but I don’t know enough… you’d understand my hesitation. I am a philosophy chick, after all, and my penchant for deep thinking won’t let me engage in such a primitive level debate…”

        All in all, a huge bucket of hogwash.

        • Jessica S.

          Barf. That’s all I can think of to say about it!

  • anh

    can someone translate this whole exchange for me? My feeble mind cannot parse this.

    • Stacy21629

      I think one needs a PhD in Stupid to translate this. Sorry. :-P

    • Anj Fabian

      The exchange, more or less.

      Dani: “Jen, let’s talk VBAC numbers. I’m doing this blog post and I want to get it right.”.

      Jen: “You’re wrong of course. HBAC is safe!”.
      Dani: [confused] “Are my numbers wrong? Science? What?”.
      Jen: “Any time that you imply HBAC is riskier than a hospital VBAC.”
      Dani: “If there are changes you think will make my post better, tell me.”
      Jen: “It’s rubbish, all of it!”
      Dani: “But I asked other people to critique it and none of them told me that.”.
      Jen: “You asked me. This is what I’m telling you. You’re a pathetic noob and I’m the expert.”.

      Jen’s blog post summed up:
      “The nerve of some people! They think that just anyone can blog about VBAC/HBAC without being immersed in the ICAN echo chamber for years. They think that just anyone can look up studies. Well, I’ve been looking up studies for longer AND I have my own business. Anyone that tells the public that taking on an HBAC with an American midwife is taking deadly risks is a threat to my ego and my income! But mostly my ego.”.

      • Trixie

        Excellent.

      • Guestll

        This should be the “featured comment”, forever and ever and ever.

  • realitycheque

    Talk about ego! Jen doesn’t have a leg to stand on. If Dani isn’t allowed to discuss birth safety without medical credentials (even though she had the humility to consult 2 experts to ensure nothing she posted was factually incorrect) then Jen had better shut down her own blog ASAP.

  • KarenJJ

    Trying to read blog post of Jen’s and I’m amazed by how nice and reasonable Dani was. I’d have gotten the irrits long before she did and told Jen to sod off.

  • Johntel

    Wonderful post. So confused my NgM and her waffling.

    • Therese

      It kind of seemed to me that NGM felt so important to be mentioned in Jen’s blog post that she didn’t even stop to think about the content of the post.

    • Anj Fabian

      NGM no longer confuses me. I thinks she’s much better at people than politics.

      I started with politics online. I don’t know if I’m any good at it, but I understand it.

      • NoLongerCrunching

        Well you summed up Jen’s post pretty well. Basically: I know Doula Dani. Doula Dani is a friend of mine. And Jen, let me tell you something: you’re no Doula Dani.

        • NoLongerCrunching

          Wait, please don’t tell me that NGM is the midwife that let her almost bleed to death.

          • Trixie

            No, I don’t think so. She gives her midwife’s initial as L.

    • Guestll

      I’m not. I like Barb but she’s been straddling the fence for far too long. HBAC is a bad idea.

  • Angela

    The arrogance in Jen’s replies to Dani is astounding! Another characteristic of a true expert is not just that they “know what they don’t know,” but that they’re also humble and polite enough to watch their words publicly in case someone with more expertise or newer evidence corrects them.

    I’m really disappointed in Jen. I had generally found her blog to be a decent source of balanced and accurate information. She really embarrasses herself here though.

  • violinwidow

    THANK YOU!!!!!! I hate what Jen did to Dani and that NgM endorsed it.

  • attitude devant

    Ahhh!! Sweet vindication! I think Dani is TERRIFIC!!! No one, NO ONE else was looking at the MANA data on HBAC. And the MANA data is TERRIBLE. It is SPINE-CHILLING. How anyone could look at that data and and contemplate an HBAC is beyond me. If you ask me, what pissed Ms VBACfacts off about Dani’s post was that she dared to take the MANA data and discuss it. Good on you, Dani! Brava!!!

    • KarenJJ

      I think Dani was onto something when she asked Jen if Jen was annoyed because Dani was tackling the topic of VBAC which is meant to be Jen’s turf. Turf war – not just between midwives and obgyns…

      • Stacy21629

        “Turf war – not just between midwives and obgyns”
        Except there’s not even a turf war OB –> MW. Just MW –> OBs. OBs want to deliver healthy babies to healthy moms. MWs are the ones competing for business.

        • KarenJJ

          I agree – it’s why I put the word ‘midwives’ first, but in my attempt at brevity I don’t think I made that point at all clear…

      • anne

        I view it as a turf war too but one over the internet. NCB advocates hate Dr. Amy and Dani for taking the fight to their turf – blogs, FB, message boards. It’s Dr. Amy who takes all the studies that have come out over the last few years and translates them from medical journal articles (which most people don’t have access to) to something that is easily searchable.

    • yugaya

      I think Birth Without Fear attempted to do some ‘looking’ at MANA stats and on the facebook page said sth like…” the mortality rate for breech birth in MANA study is omg too horrible, now guys, how do I publish that without publishing the actual number and saying that it is horrible or that breech birth at home is dangerous?”.

      • Anj Fabian

        There are ways of doing that. The most clever example I found was an NHS trust that said the risk to the baby of a VBAC was about the same as a woman giving birth to her first baby. No numbers. No other reference.

        So I hunted up a study (January 2014, Pakistan) that looked a primapara versus multipara births. First births tend to be more complicated and have higher maternal and fetal morbidity and mortality. IOW, VBACs are more risky.

  • Stacy21629

    Oh how I love Google cache and screen caps.

  • Hannah

    Bravo! I found Jen’s post extremely difficult to follow but after reading it three times, I was horrified at how hideous a hatchet job she had actually done to Dani’s wonderful post. Kudos to you for showing Jen for the piece of work she has shown herself to be. Hopefully some people might think twice before trusting Jen as a reputable source of information.

    • Stacy21629

      Honestly, I gave up. I got lost in her incoherence.

      • KarenJJ

        Yeah that was tough going. I was trying to see where Dani got it wrong and Jen had some interesting insight into VBAC but I got so hopelessly lost I didn’t see any. Her info on 43% of US hospitals having a VBAC ban was interesting but without context or reference to what other countries do it doesn’t make much sense on its own.

        • Young CC Prof

          Also, that 43% doesn’t tell us much about how many women are negatively affected by bans.

          If one hospital has a VBAC ban but a neighboring one is open to VBAC, it doesn’t make much difference for anyone. Or, let’s say the only hospital in your area has a ban, but your area is so sparsely populated that the hospital only delivers a couple babies a week. Then it does affect people, but not very many.

          On the other hand, if you’ve got a medium-sized city with four different hospitals and still no VBAC options, that’s a significant lack of options.

          The relevant question is not how many hospitals permit VBAC, but how many women want it, are suitable candidates, and cannot access it. I know there are some, but I have no idea how many.

          • OBPI Mama

            In the big city near us 1 hospital is highly equipped for vbacs and that is where everyone goes…. many of the other hospitals don’t offer vbacs because that hospital does. Makes sense to have at least one place be highly trained and all that.

          • Trixie

            In my moderately sized county, all 3 hospital systems offer VBAC, although not all OBs who practice at them do.

          • The Bofa on the Sofa

            But even if there are 4 hospitals and none offer VBACS, the solution is not to force them to do it. It is to better fund the hospitals so that they can safely offer VBACS.

            There are reasons that hospitals don’t do VBACS. Mainly because they can’t do it safely. You need to fix that FIRST before you insist they do them.

          • Trixie

            I know it’s a very complex subject, but I do wish that it weren’t so hard in some areas of the country for good candidates who desire VBAC to access hospital VBAC. It does have the effect of pushing some people down the woo rabbit hole.

          • Karen in SC

            But it’s more of a want than a need, isn’t it? I wish I lived in an area where we could have found a ranch house with a basement. I really want a basement, that is my dream. But they don’t exist where the land is at sea level. We can’t move easily so we manage with a lot of stuff piled in our garage.

            VBACs could be a need for a woman wanting a large family but there are commenters here and on Fed Up that have had 5+ c-sections. Note that I even typed “wanted a large family”. Not a need, and there are no guarantees.

            In fact, I had always dreamed of having seven children. When I didn’t get married until age 30, I knew seven wasn’t realistic. After struggling with fertility issues, I ended up very happy with two.

          • Trixie

            It’s still a phenomenon that happens. People HBAC because of it.
            Others, like Griffin’s mom or Jen Kamel or TFB, just HBAC out of hubris and stupidity.

          • The Bofa on the Sofa

            do wish that it weren’t so hard in some areas of the country for good candidates who desire VBAC to access hospital VBAC.

            You find someone to pay the salary of full time anesthesiologists, and there will be better access.

            Resources cost money.

          • Trixie

            Yeah, I completely understand what the issues are. Doesn’t mean I can’t wish it were otherwise.

          • The Bofa on the Sofa

            Sue, we can all wish for an unlimited amount of money.

            But since there isn’t, and we have to make choices, I admit, I don’t see this as a high priority. There are a lot better uses for a quarter million dollars a year at most hospitals.

        • Stacy21629

          Where did she get the 43% number? Did she list a source?

          If I was an OB in a little community hospital that couldn’t guarantee decision to incision in <15 min for a ruptured VBAC I wouldn't feel comfortable presiding over a VBAC either. It's 100% responsible not to be party to setting up a situation where you cannot treat a predictable emergency. Crises in non-VBACs can't be predicted, but in a higher risk patient, why would you purposefully handicap yourself that way? Especially when it's YOUR name on the lawsuit afterward…

          • KarenJJ

            Where I live not all hospitals even do maternity health. So they might have even listed a hospital as “don’t do VBACs” whereas they don’t do any form of maternity care AT ALL. So yeah – what does 43% actually mean in the real world?

          • Young CC Prof

            Good point. Some Children’s Hospitals deliver babies, but only babies who are badly premature or prenatally diagnosed with serious problems. So no VBACs there.

          • Stacy21629

            And NCB folks would probably decry their >50% (higher??) C-section rate too. @@

          • KarenJJ

            Did I once read of some NCB people picketing a hospital with a 98% C-section rate which was a children’s hospital that took on very serious cases of ill neonates? That sounds ridiculous when I type that so hopefully my memory does not serve me well and nobody is that idiotic…

          • Stacy21629

            After reading about Griffin’s death, I am certain that, yes, there are people out there that are that idiotic.

          • Stacy21629

            You don’t even have to look at just Children’s Hospitals. A dinky little community hospital with a level I NICU is going to do far fewer C-sections (percentage) than the hospital in the largest city in the state with a level III NICU. Period. But NCB types can’t see that. All they see is “50% C-section rate – gah!” and their head spins around. Never mind that every high risk mother in the state will be referred to the level III hospital in order to save the lives of their babies.

          • Young CC Prof

            I think I read CH Philadelphia had a c-section rate over 80%, although that was a few years ago. But yeah, there are NO normal deliveries at a Children’s Hospital, it’s just not what they do.

          • Anj Fabian

            If you are at a Children’s Hospital delivering a baby there are two possible scenarios:
            The baby is very medically fragile.
            or
            Someone showed up in the ER and you couldn’t get them transferred fast enough.

          • FormerPhysicist

            So, 20% VB is really high there. Statistics.

          • Amazed

            I cannot help but wonder what would Jen do if she wants to have extensions added to her hair. I’ll bet that 53 of regular hairdressers don’t offer this service. I don’t know why but I really have the feeling that she’d go to someone who does without whining about rights and bulling.

          • fiftyfifty1

            “Crises in non-VBACs can’t be predicted, but in a higher risk patient, why would you purposefully handicap yourself that way? ”

            Exactly! Why would you want to take a situation that can already throw a rare unpredictable emergency at you (cord prolapse etc) and ADD to that a predictable need for a crash c-section 1 out of 200 births due to rupture?

        • Joy

          Even comparing it to other countries probably won’t help much. I had a choice of two hospitals to give birth to in the UK. I picked the awesome amazing one, but even if I had picked the other it is a 20 minute drive or faster life flight away. The hospital where I went to Uni in US was in the middle of nowhere. There are a lot more places in the middle of nowhere in the US than most other developed countries. I often get into this discussion when it comes to new arrived expats lamenting public services in the US. In fact, once about how there were no homebirth midwives in Northern North Dakota, compared to all the midwives in the UK. Well the UK has 650 people per square mile and North Dakota has four. And that ND reference includes Fargo, so I am sure her tiny ass village had fewer. How are they supposed to earn a living with four people per square mile unless all those people are pregnant women using their services?

          • anne

            I had a client who’s son died after a freak accident in his rural home. A stupid fall off a ladder and he bled to death before emergency services arrived 40 minutes later. Thinking of each country in Western Europe as being the size of one U.S. state kind of helps give an idea of scale.

        • AmyP

          I bet 43% of US hospitals (or close to that) are in hick towns.

          (I’m from a hick town, so I can say that.)

    • Brooke Orosz

      Yeah, I couldn’t read it either. I did see the words “The statistician” a few times, and mention of a doula discussing the MANA VBAC data, so I assumed she was talking about me and Doula Dani, but most of the post was dialogue without dialogue tags, and multiple subjects addressed without background information or transitions. Essentially unreadable.

      • Hannah

        Yeah. I still did not fully understand her point other than her desire to be an ass but I had the context of the FB post from Dani to help a little in defining what she was talking about. It made Jen look insane, honestly.

  • Amanda

    Oh! I just love how you seamlessly and eloquently handed her ass to her!

  • Rachele Willoughby

    Aww… This post gave me feels.

  • mostlyclueless

    Um I would be happy to do a formal power analysis for Jen if it’s too hard for her to google.

    • attitude devant

      no need, mostly. She’ll be happy to tell you the data is under-powered because MANA said so.

      • Young CC Prof

        It is rather weird that the authors of a paper are claiming that their data are not statistically significant and the paper’s critics are the ones claiming it is. Normally it’s the other way around.

        • Anne

          Real studies have interim safety monitoring to allow the investigators to pull the pin if significant trends become clear prior to the completion of the study (Women’s Health Initiative; Term Breech anyone?)

          However, this inadequate data collection (MANA stats) is not a scientific study, so they just go on dredging the data of their faux birth “care”, hoping that they can pull the wool over the eyes of the gullible public- “ooh, look- 97% breast feeding rates”- while bleating about lack of statistical power in things which really matter- dead and damaged babies.

    • Brooke Orosz

      Yeah, I explained it to her in the comments section of the post she took down. No, a sample size of 1000 with 5 deaths is not large enough to precisely determine the death rate, but it is large enough to see that the death rate is TOO HIGH.

      In the USA, a sample of 1000 SHOULD be far too small to say anything about neonatal or intrapartum mortality among term babies. The fact that it isn’t says a whole lot all by itself.

      • attitude devant

        Brooke, thank you sooo much for speaking out on the MANA data. It was truly brave and principled. One for truth!

      • Trixie

        Math, Y U so hard?