Vicki Markham Williams, the doula who recommends VBAC after uterine rupture

WTF. Internet Concept.

Taking obstetric advice from a doula is like taking architecture advice from a cleaning woman.

Sure, a cleaning woman cares for a home, business facility or skyscraper, but she knows nothing about how to build any of those things, and only a fool would think otherwise.

Sure, a doula knows how to care for women in labor (rub her back, get her ice chips, encourage her), but only a fool thinks she knows anything about obstetrics.

Case in point: Vicki Markam Williams, the woman who runs the Facebook group Pregnancy and Birth after Uterine Rupture with the aim of encouraging women who didn’t die at their first VBAC [vaginal birth after Cesarean) attempt (although many of their babies did die) to take on the much higher risk of killing their babies and themselves at another VBAC attempt.

Her website explains her philosophy:

Care providers are so filled with fear, and that fear is affecting the women they care for, in attitude and in denial of choice. A section rate of one in three is indefensible, and at that rate is causing MUCH more harm than good.

I think that the risks of VBAC and PAR [pregnancy after rupture] are actually MUCH lower than women are being told. If women are really re-rupturing at the rates given above then their ruptures are not being repaired properly. There is good research to say that tears heal better than cuts ( and so a repaired simple rupture (no healed edges to the hole, no placenta involved) should be stronger than a second planned section scar from an incision by knife. This is clearly being taken on board, because many surgeons are now using ‘blunt extension’ techniques, which in effect means separating the uterine muscle by tearing it along its natural planes, which leads to a stronger repair and less trauma to the tissue.

Williams is referring to a 1999 paper on the Misgav-Ladach method of C-section. First, there is no evidence that the method of tearing the uterus instead of cutting leads to a stronger repair. Second, the Misgav-Ladach technique involves a one layer closure of the uterus instead of the traditional two layer closure. One layer closures have been shown to be associated with an INCREASED risk of rupture in a subsequent pregnancy, not a decreased risk. Third, very few women undergo a Misgav-Ladach C-section, so it is irrelevant to counseling most women about the risk of rupture in a future pregnancy.

Williams continues:

I’m expecting that most of the re-ruptures are women who have had windows and scars that have opened during the trauma of a repeat section. We don’t worry about any other scar or injury to the same extent. I think that the ‘dead baby card‘ is just out-and-out blackmail. So few women carry a PAR (because most get a hysterectomy and the rest are told not to try again, of which a significant majority will heed that advice) that we will never have big enough studies to know what the numbers really look like.

I have been told repeatedly that no one has a baby after a rupture, well clearly I did, and I know others who have.

Markham had a spontaneous uterine rupture at 33 weeks* (fortunately the baby survived) and her response was to attempt a VBAC? Even though she knew that a future uterine rupture could kill her baby??!!

Her musing on the risk of future rupture is probably less valuable than the cleaning lady’s musing on what holds up a building. The cleaning lady’s architecture advice is more likely to be correct since she is living in the real world while Williams is clearly just making stuff up to support her ignorance and wishful thinking.

The idea that she was told that no one has a baby after a rupture is bizarre. The issue has been studied. Indeed there is a paper in this month’s edition of Obstetrics and Gynecology on this exact topic, Pregnancy Outcomes in Patients With Prior Uterine Rupture or Dehiscence.

I know you will be shocked, shocked to learn that Williams is spectacularly wrong.

What did the authors find?

Fourteen women (20 pregnancies) had prior uterine rupture and 30 women (40 pregnancies) had prior uterine dehiscence. In these 60 pregnancies, there was 0% severe morbidity noted (95% confidence interval [CI] 0.0–6.0%). Overall, 6.7% of patients had a uterine dehiscence seen at the time of delivery (95% CI 2.6–15.9%). Among women with prior uterine rupture, the rate was 5.0% (95% CI 0.9–23.6%), whereas among women with prior uterine dehiscence, the rate was 7.5% (95% CI 2.6–19.9%).

So, in contrast to the typical risk of rupture at VBAC of less than 1%, these women had a dramatically increased risk of rupture. And that was in patients who were NOT allowed to labor! I shudder to think what the risk is in women who actually attempt VBAC.

Williams, of course, believes that the fact that she didn’t kill her baby and herself in a subsequent pregnancy indicates that VBAC after rupture is safe. Of course, if your definition of safe is that you are not 100% guaranteed to die, even Russian roulette is “safe.”

Williams concludes her piece with this:

It is so wrong to tell women that if their babies die it will be their fault and that surgery will save everyone, because it doesn’t and it won’t

Kind of like your cleaning lady telling you that is “wrong” to tell people that violating building codes leads to unsafe buildings. The claim is untrue, and there’s no reason why anyone should listen to her in any case.

Williams is criminally ignorant. She shouldn’t be allowed to care for a houseplant, let alone a pregnant woman.


*Williams’ rupture was not associated with an induction for stillbirth as originally reported.

257 Responses to “Vicki Markham Williams, the doula who recommends VBAC after uterine rupture”

  1. Laura
    May 2, 2014 at 10:32 am #

    Vicki you giving out and promoting a dangerous situation. How are you going to feel when one of your followers and their baby dies due to you trying to play Dr? I will be honest I ran an ICAN chapter for a bit, I never promoted homebirth I started every meeting with this is a stepping stone in pursuing a VBAC you need to work with your healthcare provider to make a safe medical decision. I shut down the chapter because it became about promoting homebirth, every time I posted in the leader forum I was told to advise a women to have a homebirth, that message went against that I wanted to promote.

  2. Renee Martin
    April 11, 2014 at 12:59 am #

    You are seriously dangerous. Please stop passing out such deadly info. There are lives at risk, real people.
    NO VB is worth death. And a VBAR is really asking for it.
    If you honestly believe what you are telling people, you are so seriously misinformed. Please, I beg you, stop with the push for VBAR. Please.

  3. Deena Chamlee
    April 10, 2014 at 5:39 pm #

    One more OT:

    • Young CC Prof
      April 10, 2014 at 5:51 pm #

      Yeah, I saw that one. I especially love how they talk about the low “risk profile” of out-of-hospital births, without ever discussing OUTCOMES.

      • Deena Chamlee
        April 10, 2014 at 6:12 pm #

        I know they do, I look forward to the day when we all can become honest and open. Thereby, making the patient the center of care and not the center of confusion.

  4. Deena Chamlee
    April 10, 2014 at 5:24 pm #
    OT: But interesting none the less…..

  5. Vicki Williams
    April 10, 2014 at 2:44 pm #

    Dr Amy, you wonderfully, bile filled, spouter of hatred… I am soooo pleased that you were at my birth and have thoroughly explored my medical notes, and are therefore qualified to state what did and did not happen to me, and please forgive me if I occasionally do not write the whole story blow by blow, for your clarity. Following my whole medical history is clearly important to you.
    To be fair to your own particular brand of poison, I am utterly delighted that you feel threatened enough by what I have written to seek to discredit it.
    P.S. you spelled my name wrong.
    P.P.S. doulas don’t give advice.

    • attitude devant
      April 10, 2014 at 2:57 pm #

      Hey, Vicki, nice to meet you. Could you do me one favor? Could you stop telling women that VBAR is safe? Because it isn’t. And by telling them it is, YOU are acting outside the scope of your certification, training, and knowledge, not to mention encouraging women to purse a reckless and dangerous course of behavior.

      OK? Thanks!

      • Vicki Williams
        April 10, 2014 at 3:09 pm #

        Post with your name on and your experiences and I might take you seriously 😉 xxxx

        • The Bofa on the Sofa
          April 10, 2014 at 3:18 pm #

          Aside from the fact that the commentor IS medically qualifed with experiences well-beyond yours, so what? That doesn’t make any difference as to whether VBAR is safe, or to the fact that you running around telling people it IS safe is outside the scope of your certification.

          • sdsures
            April 11, 2014 at 10:11 am #

            Points all taken. I did say “some people”.

        • attitude devant
          April 10, 2014 at 3:19 pm #

          Nope dear. Not gonna give my name for reasons unrelated to you. Having said that, I’ve been a practicing OB for 27 years had my most recent successful VBAC client, ummmm, yesterday. So I know what I’m talking about.

          • sdsures
            April 10, 2014 at 3:45 pm #

            attitude devant: 1
            Vicki Williams: 0

            Ms Williams, are you aware that some people prefer to use pseudonyms on the Internet for security reasons? It’s not a personality defect.

          • The Bofa on the Sofa
            April 10, 2014 at 3:50 pm #

            I always use my real name.

          • attitude devant
            April 10, 2014 at 4:02 pm #

            So Pablo isn’t your real name?

          • The Bofa on the Sofa
            April 10, 2014 at 4:43 pm #

            Never heard of him.

          • attitude devant
            April 10, 2014 at 4:49 pm #

            Or Lebowski, for that matter.

          • The Bofa on the Sofa
            April 10, 2014 at 4:58 pm #

            Him either, at least not on Disqus.

          • The Younger Miss Buchwald
            April 11, 2014 at 3:27 am #

            Agent Buchwald is my father.

          • Siri
            April 11, 2014 at 3:23 am #

            My mother’s name was Bofa.

          • Renee Martin
            April 11, 2014 at 12:52 am #

            Yep, she was my OB and is wonderfulSaved my babies life. Oh, I had a VBAC too. IN the hospital.

        • Karen in SC
          April 10, 2014 at 4:48 pm #

          Why? Amy is using her real name, and you didn’t take what she said seriously. You know, by discussing your point of view with actual facts about birth safety and complications.

        • Stacy21629
          April 11, 2014 at 1:08 am #

          How about, post with your CREDENTIALS? Those are actually a bit more influential than “experiences”.

        • Amazed
          April 11, 2014 at 5:52 am #

          Vicki dear,
          So nice of you to post with your name on. We like to know who people provoking self-harm are. In other words, it’s nice to have a name and face attached to your amazing lunacy and monstrous advices.

    • Dr Kitty
      April 10, 2014 at 3:32 pm #

      What exactly is the difference between advice and counsel?
      Doulas obviously CAN advise…they’re just not supposed to.

      How do you draw that line in what you write as a doula?
      How do you, personally, ensure that nothing you write can be construed as medical advice?

    • attitude devant
      April 10, 2014 at 4:48 pm #

      Dr. Tuteur, please do make sure that her name is spelled correctly so anyone looking for her comes across this blog post, ok?

    • Captain Obvious
      April 10, 2014 at 5:56 pm #

      Leave Vicki alone. I love her site. I had a uterine rupture during my healing birth and am pregnant again with twins at age 42. She has motivated me to deliver these babies vaginally. And if noone will care for me, I am just going to do it myself at home :-/

    • anion
      April 10, 2014 at 6:24 pm #

      So, you have plenty to say about one throwaway sentence in this post, but nothing to say about your egregiously irresponsible behavior in giving out dangerous medical advice you are unqualified to give? (And yes, you most certainly are.)

      Nobody cares why you ruptured, or really that you ruptured. What we care about is that having effectively played Russian Roulette and lived, you’re now running around waving a gun in the air and urging other women to play, too, because it’s so totally safe!

      P.S. Your response here is so utterly childish it makes me sad.

    • Jessica S.
      April 10, 2014 at 8:42 pm #

      “P.P.S. doulas don’t give advice.” So you’re not a doula, then? Probably best for everyone.

    • KarenJJ
      April 11, 2014 at 6:36 am #

      “I am utterly delighted that you feel threatened enough by what I have written to seek to discredit it.”

      And she did discredit your advice. So your reply to the information posted by Dr Amy above is to call names. You got anything better than that? More information that might help counter Dr Amy’s info above?

      • Squillo
        April 11, 2014 at 10:22 am #

        And she’s got it wrong. It isn’t Amy who’s threatened, it’s the women and babies who follow her “not-advice.”

    • birthbuddy
      April 11, 2014 at 7:30 am #

      So, doulally Vicki, how many baby deaths are you directly, or indirectly responsible for?

  6. LadyLuck777
    April 10, 2014 at 12:02 pm #

    I thought the tearing method was used to minimize the amount of time the scalpel was in the vicinity of the baby?

  7. Amy Tuteur, MD
    April 9, 2014 at 10:50 pm #

    Here’s an article in which Williams in which she describes her freebirth HBAC and details her complex obstetric history. Apparently her rupture occurred not in association with her induction for a stillbirth, but in the next pregnancy when she had a spontaneous rupture at 33 weeks. The baby survived.

    • lawyer jane
      April 10, 2014 at 10:27 am #

      Wow. It is just totally bizarre to me that a mother with many children, who almost lost one baby already, would put herself and her baby at such risk, and risk leaving her other kids motherless as well. When I was pregnant with my baby everything was so theoretical so I focused more than I should have on things like “the birth experience.” But now that he’s here, and I would literally throw myself in front of a train to protect him, I can’t fathom doing anything that creates unwarranted risk. There is truly some kind of mental disconnect here, and I don’t understand it at all.

      • Young CC Prof
        April 10, 2014 at 10:34 am #

        Exactly. It’s impossible to create a child without taking some risk, but now that I have one child, I canNOT see deliberately taking large risk to myself to create another one. My son needs me more than he needs a sibling, and if there was a significant chance that getting pregnant again would kill me, no way nohow.

        Heck, I actually know two women who stopped at one solely because they had suffered dangerous complications the first time decided another pregnancy wasn’t worth the risk. (One had DVT after her first birth, was diagnosed with hereditary clotting disorder and remains on blood thinners. The other developed HELLP at 33 weeks.)

  8. Jessica S.
    April 9, 2014 at 8:17 pm #

    “A section rate of one in three is indefensible”. No, Vicki. What’s indefensible are the statistics involving lives disabled or lost thanks to the ridiculous hubris you peddle. THAT is indefensible.

    • April 10, 2014 at 7:59 am #

      TheActual percentage of Caesarean births is irrelevant as long as the sort of patients delivering by C/S is unknown. This simple fact seems beyond the understanding of the NCB crowd. I certainly wouldn’t have had a second and third C/S if I had been denied my first one because I’d be dead, and the statistics, except for maternal and fetal mortality would have looked a lot nicer to those who decry the high rate of C/S.

      • Young CC Prof
        April 10, 2014 at 11:20 am #

        Yes, that’s why home birth doesn’t prevent nearly as many c-sections as its supporters claim. The majority of women who birth at home (and the only ones who have outcomes that are only moderately worse than hospital birth rather than hideously worse) are multiparous women with no prior history of c-section and no major pregnancy complications or preexisting health problems.

        Let’s see. A woman has had at least one uncomplicated vaginal birth already, carrying a single head-down fetus at term. Do you really think you’ve got a 1 in 3 chance of c-section in the hospital? Of course not! (Then again, many of them do think that the 1 in 3 really applies to every woman who walks through the door.)

        • Captain Obvious
          April 10, 2014 at 5:42 pm #

          It seems that one size fits all logic in thinking transcends all NUCB arguements.

      • Jessica S.
        April 10, 2014 at 8:32 pm #

        Perfectly stated!

    • Renee Martin
      April 11, 2014 at 12:54 am #

      1 in 3? For whom? First time CS is more like 12%. Once you add in all the repeats by CHOICE, and by request, you get a higher number. But so what?

  9. Stacey
    April 9, 2014 at 7:07 pm #

    Her VBAC after uterine rupture was UNASSISTED. She was attended by her husband and 12 year old daughter.

    • Lombardi
      April 9, 2014 at 7:55 pm #

      What are blessingway and pantomime?

      • toni
        April 9, 2014 at 8:31 pm #

        Pantomime is a stage production based on a fairy tale they put on at Christmastime. Silliness and cross-dressing are usually involved. Plenty of audience participation.. ‘Boo! Hiss!’, ‘he’s behind you!’ etc. Low culture but lots of fun! Blessingway is some kind of spiritual baby shower I think. Google it?

        • Lombardi
          April 9, 2014 at 8:42 pm #

          You forced me to get over my lazy and your right. “Birth is a key life passage for women. But modern culture has become preoccupied with the arrival of the baby-to-be and has lost touch with birth’s profound impact on the expectant mother.”
          So if your a yuppy and natural mom you can now have 3 to 4 parties before your kid comes: pregnancy announcement, gender reveal, shower for baby, and blessingway for you. Also, your mate must now present you with a “surprise” push present. American princess syndrome.

          • Elizabeth A
            April 9, 2014 at 9:44 pm #

            It’s easy to crap all over these things – gender reveals are pretty dang mockable – but it always seems to come out misogynist.

            I have absolutely nothing against anyone who wants to throwing all the parties they like. It’s tacky to throw yourself a shower, as that looks like a grab for gifts. But there is absolutely no rule that says you can’t throw open your doors and serve cake on any pretext you can invent. I was very happy to be pregnant, and often, when my family is very happy about things, we throw parties. The seven months between us reaching a comfort level with announcing the news and us feeling up to throwing a fiesta for the baby would have been a long party-free spell for us. I don’t recall what excuse we used for the middle party, but we definitely threw one.

            I think getting the woman who just gave birth to your child a present is a nice gesture. It’s a sweet way to acknowledge her importance in your life, and her hard work. If you’d really appreciate that kind of gesture, you should let your partner know. It’s not a crazy thing to want.

          • toni
            April 9, 2014 at 10:22 pm #

            Yes that’s definitely not a new thing where I’m from. My mother and grandmother received gifts for each child they had, jewellery, pieces of art etc. my dad gave mummy some mediaeval musical instrument for my birth which I like to point out to my sibs was by far the dearest of all of them hehe. Got sod all from my (American) husband.

            ‘They throw too many parties’ is not a criticism you will ever hear me utter about a friend lol

          • Lombardi
            April 10, 2014 at 7:12 am #

            I am sorry I didn’t mean to insult. My negative view is likely a cultural thing as my family background is old school Puritan from way back. I never absorbed the religious stuff but I defiantly picked up on the austerity view of the world. Also, the only gender reveals I have been to were for two of the worst bridezillas I have ever known. Needless to say they wedding attitude has carried over into they baby/kid events. I shutter to think what their blessingway would be like since that is an all about the mom event. So those negative expectancies may be clouding my judgement.

          • BroccoliSoupTown
            April 10, 2014 at 10:27 am #

            My friends and family get annoyed when people hold off on announcing the gender so they can plan an elaborate, cutesy announcement event. We’re too get-to-the-point for that and we just don’t have a lot of patience for unnecessary delays and ceremonies. I come from a long line of people who skip their own graduation ceremonies and elope to avoid weddings, though. What can I say, we’re party poopers.

          • anion
            April 10, 2014 at 11:10 am #

            I don’t understand the whole gender-announcement thing, or rather, I don’t understand the idea of planning some big elaborate ceremony. Sure, have everyone over for dinner and announce what the baby is–celebrate whatever you want–but man, nobody but you and possibly your parents *really* cares so much that you need to treat it like the unveiling of a cure for cancer. If Apple released the iPad with less ceremony than you’re planning to tell people if it’s a boy or a girl, you’re maybe going a tad overboard.

            (But then, we never did any of that sort of thing. The closest we came was with our second, when we decided that having everyone know the gender and name of our first before she was born had been a bit anticlimactic. And our second was a planned c-section, so even her date of birth wasn’t going to be a surprise. So we let everyone know we were having another girl, but didn’t tell anyone what her name would be until she was actually born. That was fun. But even that wasn’t a big ceremony, it was just a series of texts/emails/conversations where we said, “The baby is here! Firstname Middlename, 7 lb. 13 oz.”)

          • Young CC Prof
            April 10, 2014 at 1:25 pm #

            We shared the gender but not the name, partly out of fear of, well, you know. When I heard him crying, THAT is when I said his name aloud.

          • anion
            April 10, 2014 at 6:32 pm #

            It was fun, wasn’t it, having a secret? 🙂 It made it feel like those births in old movies, where the baby pops out and the doctor shouts, “It’s a boy/girl!” and then everyone in the waiting room cheers.

            I mean, I get the superstition aspect, too–we did not bring a single item of baby furniture into our home until after our first was safely born–but it was more fun than I’d expected it to be, having a piece of new information to give when the baby came.

          • Mer
            April 10, 2014 at 9:02 pm #

            That’s what my husband and I did, kept the name back so we could announce something. It was fun, but it also got annoying when everybody kept asking what baby’s name was before he was born

          • Bombshellrisa
            April 10, 2014 at 9:18 pm #

            We just went through that-since my parents and siblings announced to everyone I was pregnant and when I had the baby before I got a chance, I refused to tell anyone his name until after we got home from the hospital.

          • toni
            April 11, 2014 at 1:31 am #

            Grr, my family in India found out our baby’s name on Facebook before I got the chance to call them. It took us a day or two to decide. I know my MiL was excited to tell all her friends but I was livid that they found out like that

          • Bombshellrisa
            April 11, 2014 at 1:43 am #

            This is what happened to me. I had asked my husband to call my parents only AFTER the baby was born and then they immediately called my brother, who posted it on Facebook. The baby had arrived a month early and I had really wanted to announce his birth myself. My mother actually walked out of my hospital room and didn’t talk to me for almost a week after I told her that I was upset that she had called and texted family and MY friends to tell them that baby had arrived. So his name was MY announcement.

          • The Bofa on the Sofa
            April 10, 2014 at 3:34 pm #

            nobody but you and possibly your parents *really* cares so much that you need to treat it like the unveiling of a cure for cancer.

            And I don’t even think your parents caring is all that common. Do grandparents really have their heart set on a granddaughter or grandson? That just seems weird.

            Whatever it is, I’m happy for you, I really am, but honestly, I really don’t care whether you are having a boy or girl. And I can’t imagine why anyone would care whether YOUR child is a boy or girl, unless you are talking about the succession of the line of royalty, why do you think it would matter.

            Do you really think that some of the guests are going to be disappointed if you announce you are having a girl?

            Now if you could announce you were having an alien, that would be cool.

          • toni
            April 10, 2014 at 4:19 pm #

            My in laws already had two granddaughters and were hoping we’d have a boy. I thought it very bad manners how they, esp. MiL, would go on about it. I felt like Ann Boleyn at times. My parents didn’t mind but they did care if that makes sense. First thing they wanted to know when he was born. It’s one of the most exciting things about having a baby when you find out the sex even if you have no preference

          • prolifefeminist
            April 12, 2014 at 1:32 pm #

            My MIL once patted my belly (after baby wouldn’t uncross her legs during the ultrasound) and said reassuringly, “you have nothing to worry about – I’m sure it’s a boy.” Like, seriously?!? WTF. Of course, it was a girl, and she’s just the best thing ever.

          • Hannah
            April 10, 2014 at 11:54 am #

            Yeah. If I tried that, my family would side-eye the crap out of me. My extended family is way too enormous for people to have to go to three events for every baby. It’s all you’d do.

          • The Bofa on the Sofa
            April 10, 2014 at 12:14 pm #

            With our first, we didn’t tell anyone it was a boy, particularly because we didn’t want a bunch of blue stuff.

            With our second, we didn’t even find out ourselves. Therefore, with both of them, the “big announcement event” was the message that said, “We have a new baby boy. His name is…”

            Actually, from my perspective, the “big announcement event” with the second was in the OR, where I got to tell my wife. The OB never said anything, just, “OK, dad, take a look.” I looked up, took a second hard look to make sure I had it right, and then looked in my wife’s eyes, tears streaming down my face, and told her “It’s a boy”

            You can take all your fancy parties and sex announcing events, that moment was and will probably be the best single moment of my life.

          • Jessica S.
            April 10, 2014 at 8:57 pm #

            *sniff* Wonderful!

          • April 11, 2014 at 11:53 am #

            I teared up too!

          • prolifefeminist
            April 12, 2014 at 1:26 pm #

            We didn’t find out the sex of our last baby during the U/S, and my husband was the one to stand up and look and tell me that it was (another!) boy (I had a c-section). Awesome, awesome moment – I will never forget the excitement in his voice.

          • toni
            April 10, 2014 at 2:01 pm #

            I do think it is tacky to expect lots of presents and throw multiple parties in order to get them. Baby showers were not something I grew up aware of, I think they are strictly an American phenomenon, but I’ve never been to one where the parents were demanding. I don’t doubt there are grasping, overindulged people out there but I think mostly it’s just a nice excuse for a get-together.

          • The Bofa on the Sofa
            April 10, 2014 at 3:28 pm #

            Baby showers were not something I grew up aware of, I think they are strictly an American phenomenon, but I’ve never been to one where the parents were demanding.

            The concept of a baby shower is great – provide expectant parents with things they will need with a new baby. I like that, it’s a good way to support new parents.

            And in this way, it should be initiated and hosted by friends. The parents themselves are guests of honor.

            And it really should be just for the first (unless there are extenuating circumstances, like how your first was 15 years ago and then you got remarried and now you are having another)

          • Jocelyn
            April 10, 2014 at 10:48 pm #

            “And it really should be just for the first.”

            Yeah, I agree. When I was pregnant with my second last year, people (friends/family) kept asking me if I wanted a baby shower (implying they’d help throw one if I wanted). It made me very uncomfortable. I told them we already had everything we needed, especially since we were having another girl – we didn’t even need any new clothes.

            If people want to have a baby shower for each baby, okay. I can especially get it if it’s a different gender. But the thought made me very uncomfortable and I didn’t want it at all.

          • Medwife
            April 11, 2014 at 1:19 am #

            I’ve heard of “sprinkles” being held for subsequent babies. They’re not for presents, just basically to get together and celebrate a new life coming. Any excuse to eat cake is ok with me!

          • Hannah
            April 10, 2014 at 11:53 am #

            I think there’s a big difference between throwing a party and expecting others to throw party after party after party for you, with everyone footing the bill on the big items for your baby, which is not uncommon.

            I also don’t have an issue with giving presents, I love doing it. As does my husband (incidentally the only person I can’t buy gifts for because he buys anything he wants himself). But expecting a $2000 bag or a new diamond ring is not at all uncommon either and it can’t be explained by anything other than entitlement or Princess Syndrome.

          • attitude devant
            April 10, 2014 at 3:49 pm #

            Oh, gender reveal parties? Puh-leeze. I may be pleased for my friends that they are having a baby, but I could not care less what gender that child is.

          • Hannah
            April 10, 2014 at 11:50 am #

            That’s assuming you only have one shower. It seems that it’s common to have one for each side of the family, plus friends.

            I don’t have enough friends in the US to justify a shower and in Australia they’re just an excuse to eat scones and drink tea and nobody I know expected thousands of dollars worth of presents. Princess Syndrome, indeed.

          • Renee Martin
            April 11, 2014 at 1:06 am #

            So what? I love parties and presents. You don’t have to be a “princess” to want a gift for having a baby. I don’t need a reason to want a gift!

            Pregnancy can be awful, uncomfortable, and labor and delivery can be downright traumatic. Why not get a gift for this? And yes, the baby is the reason you get pregnant,and the ultimate gift, but why can’t you have another gift too?

            I will take as many parties as I can manage and people want to attend. Life is short!

        • Medwife
          April 9, 2014 at 9:52 pm #

          A true blessing way is a Navajo ceremony. I don’t know much about it except it’s been ripped off and muddled by the hippies.

        • madwife
          April 10, 2014 at 7:29 am #

          My kids often perform in the local pantomimes.. its just like a big game of dress ups. And a little like a comedy show. . And always exaggerated and over the top…
          A little like Doulas really. .

        • sdsures
          April 10, 2014 at 3:47 pm #

          Please remind me how a Christmas pantomime relates to this article? Thanks. (I missed last year’s one.)

      • Amy
        April 9, 2014 at 10:26 pm #

        Blessingways in the crunchy community make me pretty angry. They’ve taken a religious Navajo ceremony and ripped it off, exploiting the “noble savage” trope to get another notch in their anti-establishment belts.

        If you’re in the running for crunchiest mama in your due-date club on MDC, you lose untold points for having a traditional shower. Good crunchy mamas have blessingways instead, where the focus is shifted from gifts for the baby to use, to giving the mama-to-be blessings and affirmations to help her trust birth, let go of her fears, and welcome the baby earthside. Because as we all know, a mama who’s holding onto fear has only herself to blame if she ends up not having a beautiful unmedicated vaginal birth. (Also, if the baby dies and the mama DID do everything right, the blame is shifted to the baby, who maybe just didn’t want to come earthside or wasn’t meant to live.)

        • Vicki Williams
          April 10, 2014 at 3:05 pm #

          Where my friends knitted me birkenstocks and tended my yoghurt trees…

          • Amy
            April 10, 2014 at 4:37 pm #

            Oh, did I hit a nerve?

          • Vicki Williams
            April 10, 2014 at 7:05 pm #

            Dr Amy, you get on an awful lot of nerves. However, my gel nails are not currently stuck in your back, unlike those of some of your other victims. How dare you blast my blessingway as crunchy, as you were not invited, since you are not my friend and you are not supportive, you have no right to comment because you have simply no idea what form it took. Truth is, it was a day filled with love and good food.
            You spout so much tripe, so much judgement, so much hate, your sole purpose seems to be to upset and disempower. I don’t buy into your philosophy and quite honestly I think you are a thorn in the side of women supporting other women. Still, my opinion will not rate with you because, amongst my other sins, I indulged in a little ceremonial pampering.
            The old adage “If you have nothing nice to say, say nothing” was lost on you.
            You come across as a very nasty and bitter person, which is a shame, because I’m sure if you reached out with love your message would have much more power.
            Still, there is no such thing as bad publicity, and thanks to your advertising my site I have had three enquiries this evening from women who seem to disagree with you…

          • Amy Tuteur, MD
            April 10, 2014 at 7:15 pm #

            The person to whom you’ve been posting back and forth is not me. It’s someone else whose name is Amy.

          • Trulyunbelievable2020
            April 10, 2014 at 7:20 pm #

            Is there such a thing as a non-crunchy blessingway?

          • Vicki Williams
            April 10, 2014 at 7:45 pm #

            Errrrrrr…… Yes…………………. Just like there is more than one way to have a baby shower or a hen party…

          • Amy
            April 10, 2014 at 10:25 pm #

            I suppose you could serve McDonald’s food at it.

          • April 11, 2014 at 11:50 am #

            Yes. I had the least crunchy one (because in Eugene Oregon, it’s blessing way or the highway). We eschewed the “birth altar” and I requested not to have guests bring beads for a “birthing necklace” but did do the “blessing ceremony.” That part was lovely – a ball of yarn passed from guest to guest and wrapped once around a wrist as they said a wish or blessing or something loving about the family and new baby coming. At the end, the yarn was cut and guests tied their piece into a bracelet to wear until baby was born as a reminder to think of/pray for/Maybe make a casserole for the new family. I liked that my husband was part of it and it was NOT all about me or only women. Emphasis was on our new family as a whole.

            Don’t get me wrong, it still is white privilege cultural appropriation, and I wish it was just called something else. And we had a friend crochet the remaining yarn into a hat for the baby, so, you know we screwed up the whole thing anyway 😉

          • Deena Chamlee
            April 10, 2014 at 7:34 pm #

            Vicki, I feel for you. And I understand why this seems harsh and hateful. Maybe, don’t react and listen to what is said. And move on without debate. Let it go.

          • Vicki Williams
            April 10, 2014 at 7:47 pm #

            Yes. Slightly hard when you are subjected to such hatred, but you are right. This is not a debate to be had, because ultimately it is about women having enough choice to make the one that sits right with their conscience and beliefs, and to hear good stories as well as bad ones.

          • attitude devant
            April 10, 2014 at 7:59 pm #

            That’s disingenuous of you to say, Vicki. Yes, women ultimately get to choose, but risk of rupture has nothing to do with belief, as you seem to think, and everything to do with facts. You make up those facts to support your belief that that risk is small. And you don’t allow negative stories on your little board, because reality would just scare women into making more sensible choices for themselves. Do you KNOW anyone who lost a baby at rupture? I do. Have you been present at a rupture? I have been present at three (and no, these weren’t inductions). You don’t know what you are talking about, and you are encouraging women to take deadly risks.

          • Amy Tuteur, MD
            April 10, 2014 at 8:51 pm #

            No, it isn’t. Your clients aren’t given the option for informed choice because you are grossly misinformed. You actually seem to think your personal opinion is the equivalent of scientific evidence. It isn’t. You are dangerous and you should lose your certification for negligent behavior.

          • UK Doula
            April 11, 2014 at 4:25 am #

            That’s an interesting statement, Amy, given that your personal opinions on this blog are clearly not following scientific evidence in so many ways! Now, regarding informed choice, one thing I think you need to understand is that doulas are there to support women in making an informed choice. So, let’s say that a woman is told by an OB that there is a “high risk” of uterine rupture in a VBAC (to pick an example), a doula’s role might be to ask the OB to quantify that risk, so that the mother can make an informed choice as to which option she wishes to consider. If the mother is not satisifed with the answer (meaning that she feels she’s not getting a straight answer, which is certainly common in my experience) then the doula can help the mother to research further, perhaps by getting her in touch with another OB, or with a consultant midwife, who is more willing to to share information with that woman. It is not a doula’s role to give medical advice. But, if we have evidence based information to share then we are quite able to share that. So, if Vicki has sound figures on, say, uterine rupture, there’s no reason why she can’t share that. But she cannot do what the OBs do which is to say, “well, you could do X but we wouldn’t recommend it. We’d suggest you do Y”. Hope that clears up the confusion.

          • Amazed
            April 11, 2014 at 6:09 am #

            And how is Vicki trained to know that the figures are sound? Right, she isn’t.

            For that matter, how are you trained to know whether a MD is following scientific evidence? Right, you aren’t. It simply isn’t part of your curriculum.

            Once upon a time, there were some very sound figures showing that homebirth was as safe as hospital birth for low-risk pregnancies. Well-meaning people shared them with love. A mother believed them. A baby died.

            The mother had a name. Bambi. The baby also had one. Mary. The sound figures sold as Johnson and Daviss’ study turned out to be manipulation. A lie. All because well-meaning people shared what they believed was sound figures without being trained to analyze them.

            Be careful of what you defend, UK Doula. You’re getting dangerously close to the boundary of overreaching and overestimating your own capacity and Vicki’s capacity to classify scientific evidence as sound and unsound.

          • Captain Obvious
            April 11, 2014 at 7:54 am #

            Uh, wrong. What statistics classes do doulas take to interpret and analyze studies? Not all studies are unbiased.

          • Durango
            April 11, 2014 at 9:04 am #

            UK Doula, you say that if a woman is not satisfied with the answer that her OB gives her, then the doula can help her research? The doula does not know how to do research, and lacks the training to interpret the research. Vicki does not have sound figures on uterine rupture success–she can’t even respond to the commenters here on the most basic facts of her recommendations, so she’s arguing about everything else (“you spelled my name wrong!” “you haven’t read my medical record!” “you have no idea what my 12-yr-old thinks!”).

            Also, for your example, there are lots of things doctors tell patients that patients are unhappy with. Doesn’t make it wrong.

          • Amazed
            April 11, 2014 at 9:07 am #

            Actually, I read her post as advertising doctor-shopping. Not liking what your OB told you? No problem, I’ll get you in touch with someone else who, from my past experience, is more likely to tell you what you want to hear.

            Homebirth doulas and midwives keep touch with a certain kind of OBs (when they keep one at all).

          • birthbuddy
            April 11, 2014 at 9:16 pm #

            Hi, arrogant UK doula. Thank you for coming along and putting us all in our place and ‘clearing up the confusion’.
            Please tell us your credentials so that we can put your wise comments in context..

          • KarenJJ
            April 11, 2014 at 10:30 am #

            Is it “hatred” when you are telling someone they are wrong? Do the police “hate you” if you are caught speeding? Did you maths teacher “hate you” when you got an answer wrong? When you tell your toddler not to run onto the road because it can be dangerous, do you “hate her”?

          • Amy
            April 11, 2014 at 2:55 pm #

            I don’t know if you’re familiar with the old Deep Thoughts feature on Saturday Night Live, but one of them was: “I think instead of answers in math class, we should have impressions, and if you get a different impression than the teacher, so what, can’t we all be brothers?”

          • Poogles
            April 10, 2014 at 7:47 pm #

            “I’m sure if you reached out with love your message would have much more power.”

            Funny, Dr. Amy is very well known in NCB and Homebirth circles, yet other bloggers who do as you suggest are all but un-heard of in those same circles(unfortunately), such as:




            So, do you really think her message isn’t already powerful, indeed would most likely be made LESS powerful, not more, by using a tone similiar to the blogs I just linked to?

          • Jessica S.
            April 10, 2014 at 8:52 pm #

            That’s not Dr. Amy. It’s another commenter.

          • anion
            April 10, 2014 at 9:44 pm #

            Really? Do the lurkers support you in email? :rolleyes

            And you have a pretty funny idea of what “reaching out with love” and “being supportive” are.

          • Amy
            April 10, 2014 at 10:14 pm #

            Um…..I’m not Dr. Amy. It’s not exactly an uncommon first name. I’m not even a doctor; I’m a mathematician.

            I’m a fairly crunchy mom myself, one who saw CNMs for prenatal care with my children and continued gyn care now, one who nursed both children well into toddlerhood, one who practices many tenets of attachment parenting and natural living myself. But the MDC crowd would shun me as much as they would any “mainstream” mother because my both my children were delivered via cesarean.

            Dr. Amy IS supportive of women who make some “natural mama” approved choices, such as breastfeeding and giving birth without pain medication…..IF THAT IS WHAT THE WOMAN HERSELF WANTS. She is MORE supportive than natural-birth advocates who insist that unmedicated home birth is the only right way to give birth, more supportive than lactivists who shame women who don’t exclusively breastfeed.

            And white women having blessingways does make me angry. It is cultural appropriation. Many Navajo women have called for white women to stop calling their earthy-crunchy alternative baby showers blessingways and come up with a new name.

          • Beth
            April 10, 2014 at 10:21 pm #

            I agree, cultural appropriation is not ok. Also, this “earthside” business really irritates me. The baby is in the mother’s uterus, not on another planet.

          • The Bofa on the Sofa
            April 11, 2014 at 9:41 am #

            Also, this “earthside” business really irritates me. The baby is in the mother’s uterus, not on another planet.

            Interesting. I always interpret that comment as implying that the baby is in the earth’s interior.

          • Young CC Prof
            April 11, 2014 at 10:12 am #

            Does that mean they really do pop out under cabbage leaves?

          • April 11, 2014 at 11:02 am #

            Only if you’re gestating Mole People. All hail Ishtar!

          • Renee Martin
            April 11, 2014 at 1:02 am #

            WHY do you only comment about the stuff that doesn’t really matter?
            Why not talk more about how VBAR is a great idea? Defend your page? Not fight over stilly stuff that doesn’t endanger people, like your misinformation does.

          • KarenJJ
            April 11, 2014 at 10:24 am #

            I agree, she’s defending the wrong stuff. I don’t care what she called her party. I suspect she’s only answering the questions she can actually defend. A politician’s response.

          • Bombshellrisa
            April 11, 2014 at 1:38 am #

            All OB/GYNs? Or just three uneducated lay persons who watched BoBB and read some books?

          • Amazed
            April 11, 2014 at 5:58 am #

            Look, Vicki, you seem to think people here are so focused on you and your experience.

            Don’t flatter yourself, dear. No one gives a shit about your blessingway, your birth and so on.

            I know it’s hard for you to fathom but you aren’t the only person on God’s earth and you certainly aren’t the most important one.

            We only care about the dangerous lies you’re spreading, encouraging other women to risk their lives and their children’s lives. Your personal story might keep us entertained but it isn’t half as important.

            A tough pill to take, I know.

          • The Bofa on the Sofa
            April 11, 2014 at 9:43 am #

            I’m sure if you reached out with love your message would have much more power

            Maybe if she were to put “xxx” at the end of each post? Then she could claim it came “with love” no matter what she said.

          • wookie130
            April 10, 2014 at 9:28 pm #

            Well, at least you’ll admit that much.

    • CanDoc
      April 9, 2014 at 10:59 pm #

      Okay, I reviewed her story. She did NOT have a uterine rupture. She had some variety of placenta accreta/percreta. Given that she didn’t end up with a hysterectomy, I don’t think it’s as bad as any of the ones I’ve seen (“skill of the surgeon” or not, with the bad ones there’s NO front wall of the uterus to put back together.) So she can’t even really say that she’s had a vaginal delivery after a rupture because she didn’t. She had a regular old HBAC, so I guess she’s not such a special snowflake after all. Just sayin’.

      • Vicki Williams
        April 10, 2014 at 3:02 pm #

        Of course, please feel free to come and review the lies my surgeon has written in my medical notes. Really, come and have a cup of tea with me, I don’t bite.

        • attitude devant
          April 10, 2014 at 3:29 pm #

          CanDoc, of course her surgeon lied in his operative note! Of course he did! Because Vicki herself looked at her uterus while it was open and she knows (never mind that she couldn’t really see it and that she’s not trained to evaluate it). She KNOWS, and you don’t.

          • Karen in SC
            April 10, 2014 at 5:23 pm #

            Here’s some photos of a uterine rupture occurring at a homebirth after a “traditional Indian quack treatment” – abdominal massage. The hospital in India was able to do emergency surgery to save the mother’s life. Graphic pictures, but maybe Ms. Williams will see what a UR looks like.


            Quote from the blog author: “A grim reminder of how archaic obstetric care remains for quite a lot of our fellow citizens . . .”

            (PS. Do US birth attendants use this technique? is that what Nirvana meant by using the Rebozo? I hope not!)

          • Bombshellrisa
            April 10, 2014 at 7:02 pm #

            They actually sell DVDs and have handouts (“18 positions to use a rebozo in!”) that you can buy, but since I don’t want to fund the woo, here is the free explanation of rebozo

          • Vicki Williams
            April 10, 2014 at 5:59 pm #

            Sigh… My surgeon has written great detail of the old hole, and the new one, complete with pretty pictures, and came to give me a thorough explanation of how she saw the situation, but that will never, ever, be good enough for the supporters of this blog. The comment about ‘lies’ was tongue in cheek, that maybe my surgeon lied about the hole in my uterus for her own amusement or to scare me out of having more babies…
            Perhaps I don’t have any kids at all, maybe I made the whole lot up, just to raise your blood pressure…
            At what point were any of you there, able to see more than me, or reading my medical notes over the surgeon’s shoulder? I can feel your hate and your ignorance, it doesn’t make you more clever than me, it does make you appear judgemental and spiteful, and not at all supportive of a woman’s right to decide, to hear positive stories or to have any kind of bodily autonomy. Perhaps you don’t see that as important?
            Please tell me that you have never seen a uterine rupture after an induction of labour, or any other catastrophic event that could have been prevented by not intervening, or that you have never had a poor outcome that you didn’t see coming, because I so would like to put your practice on a pedestal of perfection.
            Of course, my story is completely invalid because you can misread it and pick holes in it forever and a day. So what if my damage wasn’t as bad as some you have seen, really, does that make every shred of it wrong?
            I wouldn’t care two hoots, except that feel you have a right to bully another woman, one you do not even know, on the basis that you think you have more right to her body than she does…
            You are perfectly entitled to your opinions, it does not necessarily make them fact, nor me wrong, and this blog does not seem to attract the kind nor the supportive.
            I am not a ‘special snowflake’, I AM a woman who had a good birth and I can not imagine why any provider or supporter of women would see that as a bad thing.
            I’m sure you could find much more constructive outlets for your anger………

          • attitude devant
            April 10, 2014 at 6:27 pm #

            Hey Vicki, YOU are the one making things up. You say on your own website that you think (based on what, I don’t know—messages from the planet Krypton, maybe?) “that the risks of VBAC and PAR are much lower than women are being told.” And you “expect” that ruptures are caused by “the trauma of a repeat c-section.” (!!!) Here’s the thing: there is no evidentiary basis for EITHER of these claims. And both of them fly against what we KNOW about the physiology of labor and birth.

            Which of course brings me to the ultimate point: You have NO training or background or standing to make these claims. And yet you DO make them, and you DO encourage women to thereby risk their lives and the lives of their children in VBAR and unassisted VBAC. How crazy, stupid, and criminal is THAT?!?!?!?

          • birthbuddy
            April 11, 2014 at 7:41 am #

            No hate, no anger, just disgust.
            You have been outed as a liar and your advice to others can potentially cause significant harm, or even death. Wake up to yourself.

          • Bombshellrisa
            April 11, 2014 at 1:36 am #

            It’s a variation of special snowflake syndrome. Every woman is capable of unmediated vaginal birth and everything is a variation of normal according to whatever channel you get your birth woo from. until you have to get care from a real healthcare professional when that variation of normal turns out to be a real emergency and then they couldn’t possibly be right in what they have charted because they are impersonal/don’t practice evidence based medicine/just want to cut you.

        • wookie130
          April 10, 2014 at 9:24 pm #

          What is WITH you people??? Why the hell would the surgeon lie about your uterus? How does that benefit her/him even slightly? Why must all medical professionals be conspiring against you? Look, she/he gets paid either way…no more, no less.

          • April 11, 2014 at 10:54 am #

            Well, midwives lie in notes all the time; I daresay they just assume real medical professionals do too…

    • rh1985
      April 9, 2014 at 11:57 pm #

      Imagine how the 12 year old would have felt if something had gone horrifically wrong. 🙁

      • Busbus
        April 10, 2014 at 9:48 am #

        Whatever happened or didn’t happen in this case, I always think about the kids when I hear about unassisted births with children present. What a terrible, horrible thing it would be for them if something went wrong.

        In fact, I even think about it now in relation to homebirth with a midwife. When I planned my homebirth, with a CPM, I (at least consciously) didn’t even consider that things could possibly go wrong. But now I seriously question the wisdom of having my then-three year old in the house while it was happening. Luckily, everything went fine in my case. But if I gave birth again – in the hospital – I would think much more about protecting my kids from possible fright or trauma should any difficulties arise.

      • Young CC Prof
        April 10, 2014 at 11:10 am #

        Imagine how the 12 year old would feel even if everything goes fine! Little girls do NOT need to see that.

        Serve her right if that daughter has a nice calm MRCS fifteen years from now.

        • anion
          April 10, 2014 at 11:12 am #

          My BFF went to school with a girl whose mother was big into homebirth, and she was forced to witness the birth of her younger siblings. She’s in her thirties now, childless by choice and determined to stay that way. It seriously traumatized her.

          I would never want to see my mother give birth, and I’d never want my daughters to see me do it, either.

          • CognitiveDissonaceHurts
            April 10, 2014 at 9:17 pm #

            Back in my time in crunchyland, I had my children with me when I homebirthed. It seemed like a good idea at the time, and they had support people to care for them and take them in and out of the room as needed/desired. I don’t think any of them were traumatized. We had a book from the midwife that we used to prepare them for what they might see, and they seemed pretty excited to see the new baby. It was a family-centred event.

            Of course, I was trusting that all would go well. And it did. If it hadn’t, that would be a different story, I’m sure.

          • anion
            April 10, 2014 at 9:40 pm #

            The problem is, though, that there’s no real way of knowing beforehand how it might affect each child, or if they would actually confide that trauma to you, or if it might affect them later. If you were my mom, I certainly wouldn’t tell you how much it upset me or freaked me out or traumatized me to watch you give birth*, or what sorts of issues I might still be dealing with about it years later. My BFF’s friend’s mom thought her kids would be overjoyed and awed by the Miracle Of Birth.

            *I’m not saying your kids absolutely were traumatized or whatever, just that if they were they very well might never tell you. There are quite a few things that I’ve never breathed a word of to my parents but that haunt me to this day and have caused me some real problems in life. Again, not saying this is the case here, just that it’s a possibility in any situation like this. I totally do not mean to imply that you’re a bad mother and your kids hate you or anything and I hope you don’t feel attacked by my comment(s).

          • CognitiveDissonaceHurts
            April 10, 2014 at 10:38 pm #

            I do not feel attacked, lol, and welcome discussion on this topic. I made sure that there was an adult caregiver who would take them away from the situation if any child was distressed. However, I also found that I was very mindful of when the children were present, and that I laboured almost silently as a result, not wanting to scare them. They were mostly playing or sleepling elsewhere and just came in for the actual delivery. They were excited to see the baby crowning, but I do remember them being grossed out by the placenta as they got older. I will have to ask them if they remember the births, and any negatives surrounding it. We have a close relationship and I know they would be honest with me. They are now all adults and planning on having (or have already had) children of their own.

            That’s not to say that other children might respond differently or if the mother wasn’t as careful, that it couldn’t be a negative thing for them.

            I see that the newest post is on this very topic, so I look forward to reading the responses there.

          • The Bofa on the Sofa
            April 11, 2014 at 9:25 am #

            However, I also found that I was very mindful of when the children were present, and that I laboured almost silently as a result, not wanting to scare them.

            Interesting. One could almost say then that, with your children present, you did not labour naturally or as you wanted.

            Funny, we hear complaints about the hospital all the time like how having monitoring prevents you from moving around the way you want, but I don’t think I’ve ever heard an NCBer complain that having children present prevents you from screaming as you want.

            Thanks for the story, it’s a great lesson.

        • Vicki Williams
          April 10, 2014 at 3:00 pm #

          Of course my daughter could never have asked to watch her brother be born, because that would be, what, weird? Still, I’m sure that before judging her decision, or mine to say it was OK, you have asked her what she wanted, or even what she thinks now…

          • Captain Obvious
            April 10, 2014 at 5:43 pm #

            Did you just like your own comment?

          • wookie130
            April 10, 2014 at 9:19 pm #

            Vicki, may I ask why you seem to be fixated on all things irrelevant to the main issue stated in Amy’s blog post? Your name being spelled wrong, what a doula does (or doesn’t do), whether your daughter wanted to witness a birth, etc… Those are all bullet-dodging tactics, if you ask me.

            Please tell me how the above statement you made in Amy’s post could not be construed as “advice” to a pregnant woman, and how do you take responsibility for such reckless statements?

          • The Bofa on the Sofa
            April 11, 2014 at 9:20 am #

            Vicki, may I ask why you seem to be fixated on all things irrelevant to the main issue stated in Amy’s blog post?

            You will find Vicki’s picture in the dictionary for the definition of “non sequitor”

          • Renee Martin
            April 11, 2014 at 3:49 pm #

            Of course she can ask and be interested.
            That doesn’t mean it wouldn’t have been traumatic for her if you had died in front of her.
            Or that its a good idea to let her.
            Or do you let your 12 yr old do anything she asks?

          • The Bofa on the Sofa
            April 11, 2014 at 3:56 pm #

            When we went to the beach last summer, my 5 yo cried because we made him wear a life jacket. “I can too swim!” he insisted.

            Aside from the fact that he can’t swim in the least. But hey, he wanted to, so we should have let him, right?


            Maybe, as parents, we should not base our judgement of what is appropriate for our kids on what they want, but on what we think, given our experience and knowledge, is appropriate for them?

            Nah, he wanted to swim without a life jacket. Who are we to object?

  10. April 9, 2014 at 3:06 pm #

    OT- an update for those here on the mom in Ontario who was wanting the section (the one where the baby was transverse, but got into position but the mom had an issue with pushing and anesthesia). The baby (boy, 7lbs 10 oz) arrived late last night after a failed induced TOL – 41 weeks, 5 days gestation. The care team agreed to let mom have a section over a week ago, but then the hospital did not book a time/date.
    The mother wishes to thank everyone here for their helpful suggestions.

    • Amy M
      April 9, 2014 at 3:09 pm #

      (the like is that he is here, not for the craptastic treatment of the mother.)

    • Medwife
      April 9, 2014 at 3:13 pm #

      Those assholes! So she got a c/s but only after a failed TOL, the scenario with statistically the worst outcomes.

      • Young CC Prof
        April 9, 2014 at 3:36 pm #

        Failed induction at almost 42 weeks. Nope, no unnecessary risks for the sake of a “natural birth” here, none at all.

        But at least they are both safe.

      • Dr Jay
        April 10, 2014 at 10:56 pm #

        Here in NSW (Australia) there are several hospitals that put tremendous pressure on women to TOLAC…and a couple that are refusing repeat CS for previous (if that is the only indication), stating that a 1% risk of rupture/loss is not high enough to justify surgery. O.o

        • Young CC Prof
          April 10, 2014 at 11:53 pm #

          How can that possibly be cost effective, even? Unless they’re doing those TOLACs in a really unsafe manner. Isn’t it easier for the hospital to just have RCS scheduled weeks in advance? Now, if a woman is medically declared a good candidate and wants TOLAC, she should totally be able to do it. But why on Earth are they forcing women towards the dangerous and more expensive choice?

          • Dr Jay
            April 11, 2014 at 6:56 pm #

            We are part of the public system; in 2010 a policy directive called “Toward Normal Birth” was implemented. Honestly, when I read it, I get the feeling the first draft was probably written in green crayon, it’s that fluffy. However, one of the key points is that we are to create NBAC clinics to counsel (read: push) TOLAC. They justify it by using stats that show that vaginal birth is cheaper than CS. They tend to ignore the ITT principle when calculating the same. And of course they NEVER consider the costs of pelvic floor trauma/levator avulsion/OASIS. They tend to use the Landon paper for success/rupture rates. However, while Landon quotes 74% success rate, I can’t thin of a single hospital in Sydney that’s getting more than around a 30% success rate. It’s highly political. The main KPI for obstetrics is the CS rate. It’s gotten so bad that we recently released a clinical guideline that has stated that all trainees should be skilled at the use of forceps before they can use a vacuum. So, in an effort to get a roughly static CS rate of 30% down! we are now going to convert all vacuums to forceps, in effect practicing on women without their consent.

          • Stacy21629
            April 11, 2014 at 7:10 pm #

            I think if I had a prior CS and was forced into a TOLAC when I wanted a RCS…from the moment I walked in the door in labor I’d be telling EVERYONE from the janitor to the receptionist to the nurses to the OB at every possible moment “I want a C-section”. Document THAT. So if something went wrong it would be on a whole lot of peoples’ heads that they ignored me. That makes me furious.

          • KarenJJ
            April 11, 2014 at 7:27 pm #

            I think that was written by Hannah Dahlen (she’s been discussed on here before). I gave birth in NSW in the private system so didn’t encounter this initiative (quite a few people were in the private system because they wanted a c/section or epidural and were worried they wouldn’t get it in the public system).

            It’s annoying that the main KPI is c/s rate – not health outcomes and patient satisfaction.

          • Young CC Prof
            April 11, 2014 at 7:30 pm #

            Saving money my ass, pardon my language. Didn’t Mrs. W. (in Canada) calculate that planned c-section cost only $400 more than planned vaginal birth when emergency c-s and complications were factored in? Granted it’s a different system, but costs can’t be that different.

            With VBAC, lower success rate, higher complication rate, it must be MORE expensive than c-sections. Planned, during day shift, back to back to fill the OR and maximize staffing efficiency!

            Logic, people. If you’re using more finite medical resources, getting worse outcomes AND making patients unhappy, what exactly are you accomplishing?

          • KarenJJ
            April 11, 2014 at 7:42 pm #

            It was written by Hannah Dahlen (a midwife). Unfortunately it gets taken seriously by NSW Health for some reason – due to the “cost-cutting” reasons I imagine – and cultural reasons whereby women need to be told to how to give birth in a certain way or they’re not “real women”.

            I gave birth in NSW in 2011 (three years ago today actually) but I was in the private system and at my first appointment with my obgyn was “I want a repeat C/S” and then we picked dates. No counselling and I wouldn’t have accepted it unless my obgyn had some really good medical reasons for it.

        • araikwao
          April 11, 2014 at 2:56 am #

          Wow, you NSWers are craaaazy!(with love from a fellow Aussie from a more awesome state 😉
          more seriously, I thought my hospital was fairly strongly suggesting VBACs, especially compared to the one I’ve just done my O&G rotation at, but that is super-paternalistic..

    • Awesomemom
      April 9, 2014 at 4:04 pm #

      I am glad the baby is here, she must have been so sick of being pregnant and worried about how the birth would go. I am sad they didn’t respect her wishes and book the csection.

    • DaisyGrrl
      April 9, 2014 at 5:28 pm #

      I’m glad the baby arrived safely. I’m furious at the hospital though. I hope she’s able to put in a complaint when she’s recovered and feeling up to it.

    • CanDoc
      April 9, 2014 at 10:34 pm #

      So much about this scenario makes no sense. Either terrible care, terrible communication, or some features in the story that have not be conveyed as intended. Regardless, to prevent recurrences of the (alleged) mismanagement, she needs to be in contact with the Patient Advocate at her local hospital, who will provide an objective review based on current best obstetrical practices (which do not include forcing a TOL at 41+5.) Best of luck, and congratulations.

      • April 9, 2014 at 11:23 pm #

        She plans on going through a formal complaint process – and I agree that there isn’t a whole lot about this particular situation that makes much sense…for the love of god if I never hear a similar story it wouldn’t be soon enough.

    • Hannah
      April 10, 2014 at 11:57 am #

      This is just appalling.

  11. Comrade X
    April 9, 2014 at 2:11 pm #

    Question to any UK-based doulas on here: is there anywhere in the UK to train as a doula that isn’t completely full of guanopsychotic woo nacheral-worshipping nonsense? I would be genuinely interested in potentially becoming a doula, like a proper one who doesn’t feed people made-up bullshit that I know nothing about for a living.

    • Maria
      April 9, 2014 at 7:05 pm #

      I actually had a friend tell me I should be a doula and I told her I would end up being the “un-doula” because I have no patience for the NCB hoo-ha. She said there is probably a market for that!

      • anion
        April 9, 2014 at 7:33 pm #

        I think there would actually be quite a market for that. I know of a few women who specifically didn’t consider having a doula because they were afraid they’d be judged for wanting an epidural (and/or drugs) asap, but would have liked the additional support.

        Personally? I think a doula who proudly and loudly offered support for mothers who want interventions (whatever they may be) would be in fairly high demand.

        • Comrade X
          April 10, 2014 at 2:28 pm #

          Thank you all so much for the feedback. I might genuinely look into this.

      • Young CC Prof
        April 9, 2014 at 8:36 pm #

        I think there would be a market. Especially if you don’t have a family member to support you during labor, someone with a sane, science based mindset to just plain help would be really useful.

      • Elizabeth A
        April 9, 2014 at 9:50 pm #

        There is a market for that.

        My husband is terrible with medical stuff. He almost passed out while I was in labor with our son. He’s a good man and a great dad, but there are some things he just can’t do. A labor support person who could do the things he couldn’t would have been wonderful for both of us.

      • Hannah
        April 10, 2014 at 11:59 am #

        There is absolutely a market for that. If my husband wasn’t the person he is, and I thought I would need someone to support and advocate for me, I’d totally hire an ‘undoula’ as I wouldn’t want said ‘replacement’ to be a close friend and I wouldn’t want a NCB fanatic.

      • Amy
        April 10, 2014 at 4:21 pm #

        Adding to the chorus that there would be a market for that. The doula I used for both kids was pretty crunchy, BUT actually talked me down from my at-the-time MDC-induced woo love, telling me I’d have more satisfaction if I didn’t go in with too many expectations about how it was supposed to go.

        My husband had the flu during my second labor and was pretty much useless. I was super-grateful for someone giving me massages and getting me ice chips.

      • Renee Martin
        April 11, 2014 at 1:11 am #

        There IS a market for this. With my first I looked around, but couldn’t find anyone that would take a mom that didn’t want to BF. No, Really.

        In OR, they are going to be covered by insurance, but you have to work with OB/hospital CNMs and follow a bunch of rules. So no woo allowed. A nice, evidence based doula would do well here.

    • toni
      April 9, 2014 at 8:46 pm #

      If you have the time go for it. You’re obviously a compassionate person. I couldn’t do it. I almost have a nervous breakdown whenever I watched OBEM and the baby got stuck or wasn’t crying. Also almost every midwife aggravated me

    • Christina Maxwell
      April 9, 2014 at 9:50 pm #

      I’d like to do that too.

      • Karen in SC
        April 9, 2014 at 9:52 pm #

        Start up your own business! The Un-Doula’s.

        • Christina Maxwell
          April 9, 2014 at 9:53 pm #

          Hmmm, I wonder how one would go about it? Comrade X, am I right in thinking that you too are in Scotland?

          • Karen in SC
            April 9, 2014 at 10:07 pm #

            Can you just IMAGINE your website full of links to evidenced based practices? You’d be so different, you would need a different name. Is there a Scottish word for “helper” or “smart cookie?”

            You both could even write a book! Hey if Margulis and others can do it, I know you guys can.

          • Comrade X
            April 10, 2014 at 2:20 pm #

            I’m in Gateshead at the moment, although I spent all of my later childhood in Scotland and am half-Scottish. Hoping and praying that I can move back there at some point with my big Geordie love-squirrel.

        • April 10, 2014 at 11:14 am #

          Heh, you could use the old 7up slogan, slightly modified: “Un-doula It”

          (There must be other old farts who remember 7up was The UnCola)

    • LadyLuck777
      April 10, 2014 at 12:07 pm #

      Guanopsychotic is my new favorite word.

    • Renee Martin
      April 11, 2014 at 1:08 am #

      I think this is something you could learn on your own. So much of the info out there is garbage anyway.

  12. Trixie
    April 9, 2014 at 2:06 pm #

    Wow, just when I thought the corners of the internet couldn’t hold any more stupidity. Just, wow.

  13. anion
    April 9, 2014 at 2:00 pm #

    I know I shouldn’t be, but I’m always shocked when I see people deriding doctors for “fear.” Yes, the doctor is afraid. S/he is afraid that you will die. Is that really something we should pooh-pooh? Would you be happy with a doctor who responded to your worries about shooting left-arm-and-chest pain with, “Nah, you’re probably fine, stop being silly!” Would you feel that’s quality care? What about if you slice an artery, do you want a doctor to say, “It’ll probably heal on its own at some point, quit being such a fraidy-cat!”

    We PAY doctors to be afraid for us. We PAY them to know all of the potential disasters that could happen, and to do whatever is necessary to prevent them.

    • Comrade X
      April 9, 2014 at 2:03 pm #

      ^^^ What she said ^^^

    • Guest
      April 9, 2014 at 2:05 pm #

      Maybe they’re afraid because they actually know what they’re doing. Or something nutters like that.

    • Dr Kitty
      April 9, 2014 at 2:22 pm #

      Also, the buck literally stops with your doctor.
      They will watch you bleed out. They will try to save you. They will have your blood on their boots and clothing and hands. They will have to break the news to your loved ones if you don’t make it.
      They will have to relive it all in the hospital M&M and the coroner’s inquest.
      They may be sued, and have to relive it again in court, where everyone will ask if they couldn’t have tried just a bit harder to change your mind.

      It is your choice, but your doctor will deal with the fall out if it goes pear shaped.

      NO ONE could deal with a rupture in a patient who was high risk for rupture and hellbent on VBAC against advice and walk away emotionally unscathed. You just couldn’t.

      • anion
        April 9, 2014 at 7:49 pm #

        Well…except for CPMs, it seems, who’ll merrily allow numerous women to die of the same thing and then continue to insist it’s perfectly safe.

        • Dr Kitty
          April 10, 2014 at 3:16 am #

          Yeah but they’re not actually facing consequences in quite the same way, are they?

          They’re not in the OR or the M&M, and they get a nice sympathetic peer review when they get told that nothing they did was at fault…and no one sues, because there is no point.

    • Are you nuts
      April 9, 2014 at 3:05 pm #

      And… fear is a biological response to something that is scary. Like rattlesnakes or burning buildings or body parts ripping open. Nothing unnatural about fear.

      • anion
        April 9, 2014 at 7:47 pm #


        What gets me, too, is that you don’t see these people complaining about fear when it comes to things like smoking or drug use. I don’t see a lot of NCB folk looking down their noses at legislators who propose anti-smoking laws, and dismissing them with, “They’re just skeert.”

        I mean, fear is a big part of a ton of public health campaigns (and other sorts of campaigns). When we tell kids not to shoot up heroin because they could die, are the NCB crowd standing behind us, rolling their eyes, shaking their heads, and smirking? Should we be encouraging our children to go ahead and try jumping into the hotel pool from the tenth-floor balcony because, man, what else are they gonna do, go downstairs and use the diving board like some kind of chicken?

        For people who are terrified that merely being inside a hospital will cause labor to stop, or are so afraid of being touched by a doctor that the mere thought sends them into hysterics, they’re awfully dismissive of the idea of “fear” as a basis for decision-making.

        Without fear, the human race–and every other species on the planet, pretty much–would have died out long ago.

        • The Bofa on the Sofa
          April 9, 2014 at 8:19 pm #

          Anti-drunk driving campaigns? Fearmongering…

        • Young CC Prof
          April 9, 2014 at 8:34 pm #

          Super-careful about carseats, too, although statistically driving around with a baby on someone’s lap for several years is safer for the baby than one home birth.

          • Trixie
            April 9, 2014 at 9:38 pm #

            Yes, I remember that time on a car seat forum when a woman was trying to talk her husband into a new car seat to continue to rear face her 4 year old while simultaneously planning her HBAC and declining ultrasounds. Good times.

          • Jessica S.
            April 9, 2014 at 10:22 pm #

            Cognitive dissonance in the extreme.

    • Aki Hinata
      April 9, 2014 at 4:34 pm #

      And that is EXACTLY why I left the group of CNM’s I had been seeing and went to an OB. I have a SCH and the CNM’s were just sooo casual about my bleeding saying things like, “Well, I guess you could rest but really either you’ll miscarry or you wont.” Or after every visit, “Well, everything looks fine…” While I understand there is very little to be done about the situation, you could at least act like it’s a real threat.

      • April 9, 2014 at 4:53 pm #

        Sickening. That is what my mother was told in 1975 when she ultimately miscarried my brother. You’d think there’d be progress – and there is, in real medicine.

        • SNM1
          April 10, 2014 at 1:39 am #

          I worked phone triage in an OB office and that is what we were told to tell the patients… There really is not anything we can do to prevent a miscarriage… That being said, we can run some labs and possibly do an U/S to see if there is another cause of bleeding and no one should be treated like what they are going through doesn’t matter. Sorry to hear that any provider would treat the situation callously.

      • Ceridwen
        April 9, 2014 at 5:44 pm #

        Unfortunately bedrest has little evidence to support it and does carry risks. That said, my doctor and discussed it (including that most evidence says it doesn’t help) and opted for me to do rest for a limited time period since I was bleeding and cramping more when active. And I had increased monitoring (with frequent ultrasound) so we could keep an eye on the situation so I wasn’t so anxious all the time. Which is how we knew at 14 weeks that my SCH had been well on the way to resolving and we should look for another cause to my suddenly increased bleeding. Turned out my placenta was too low and we needed to keep an eye on that as well until it moved up. If they hadn’t been keeping a close eye on things they would likely have just shrugged it off as more SCH-related bleeding.

        Additionally, my doctors were very aware of the increased risks of later complications I was at because of my early bleeding and took that very seriously.

        So yeah, while there may not be a ton that affects your risk of miscarriage, at least in the early stages, it doesn’t mean you should just pretend like there’s nothing abnormal going on. I’m glad you were able to switch to someone who took the SCH more seriously.

        • AmyP
          April 9, 2014 at 5:46 pm #

          You had both the SCH and a previa? Holy Cow!

          • Ceridwen
            April 10, 2014 at 1:10 am #

            Yep! Fun times for me! Thankfully the previa was not complete, and did move up well before it was time for the baby to come. The first half of my pregnancy was not a fun time. SCH from 5 weeks, previa, borderline HG. But by 24 weeks or so most of the bad stuff had subsided and I had a pretty easy time and my daughter was born healthy at 40w2d.

        • R T
          April 10, 2014 at 6:26 am #

          All I know is I had no idea I had a SCH until it turned into a partial abruption at 20 weeks and the first MFM told me bed rest was useless and I would lose the baby. I had been bleeding off and on since 12 weeks and told it was normal. Well, after the partial abruption I just kept bleeding and bleeding until I changed doctors and was put on strict hospital bedrest! Within a few weeks of bedrest the bleeding stopped! I spent four month on strict, complete bedrest and I believe it’s why I delivered a healthy baby at 38 weeks! There are so few studies on SCH and bedrest in particular, but I belonged to a SCH support board with a few thousands members. We realized we were probably the largest (informal) study every done about it and overwhelmingly the results for those of us put on bedrest were better than the women who had doctors who didn’t “believe” in bedrest!

    • Anne
      April 9, 2014 at 4:44 pm #

      “if you can keep your head when all about you
      Are losing theirs- chances are you haven’t quite grasped the situation”
      With apologies to Rudyard Kipling.

      • Anne
        April 9, 2014 at 5:32 pm #

        Att. Russ Tyson- I couldn’t recall his name earler

    • LadyLuck777
      April 10, 2014 at 12:08 pm #

      You should just trust your heart! It knows what to do!

  14. Charlotte
    April 9, 2014 at 1:57 pm #

    I had a friend rupture her uterus at 34 weeks last month. Thank God she happened to be in the ER for a completely unrelated reason at the time and they were able to save her and her baby with an emergency c-section. Her first baby was a an emergrncy c-section at 29 weeks for PPROM (the unbilical cord slipped out 10 minutes after her water broke) and she got pregnant just 5 months later when the pill failed, so it’s not surprising that she ruptured. But even with all that, she still had people encouraging her to have a 3rd. It’s a true miracle she and her two kids are even alive.

    • Young CC Prof
      April 9, 2014 at 2:19 pm #

      Wow! She was amazingly lucky twice! (And now has a former-preemie young toddler and a mildly premature infant, which must keep her plenty busy.)

  15. drmoss
    April 9, 2014 at 1:31 pm #

    I have even seen a spontaneous rupture of a lower segment (not classical) C-section scar prior to labour. It was just that thin that it gave way even before being stretched by contractions. Emergency repeat section and all well.

  16. April 9, 2014 at 1:30 pm #

    The “Misgav Ladach” C/S is actually a misnomer. The chief of obstetrics was looking to make a name for himself, in hopes that the very small, private hospital would get more patients, and he would become famous. When the doctor in NYC (IIRC, Dr. Joel Cohen) who developed the one-layer closure technique found out that Dr. Michael Stark was publicizing it as his own idea, he threatened legal action. Practically none of the other doctors on staff liked the technique or used it.

    I was a staff midwife at Misgav Ladach from 1989 to its closure in 2001 after it went bankrupt.

    • S
      April 9, 2014 at 3:23 pm #

      So that method really does use fingers to enlarge the opening? Why would anyone want to study that? Why would anyone sign up for that study? Wouldn’t the tissue end up bruised from being stretched? Or does uterine tissue behave differently from skin?

      • April 9, 2014 at 3:45 pm #

        I saw the technique of barely nicking the uterus with a scissors [NOT a scalpel] and then opening the uterus [gently] by separating the muscle fibers with fingers as long ago as 1976 at the Columbia Hospital for Women in Washington, DC, so I am surprised at that being thought “revolutionary”. Dr. Stark did make a big thing of single layer closure, though [most of the other doctors worried about adhesions, btw, not rupture].

        Remember that the “bikini” incision on the skin does not reflect how the various layers are opened internally. While a C/S isn’t [usually] complicated surgery, it isn’t a matter of just making a single slice right down to the baby, either.

        • S
          April 9, 2014 at 3:51 pm #

          Thanks! Obviously i’ve never seen any kind of smooth muscle, just diagrams (and Google Images isn’t helping me too much either). It sounds like the composition of the tissue is very different from what i was thinking.

      • CanDoc
        April 9, 2014 at 10:42 pm #

        That’s actually the current standard cesarean section in may places. Small incision to enter the cavity/membranes, then stretch the myometrium (uterine muscle). It doesn’t bruise. Because the stretch is in the same direction as the muscle fibres run, the incision just extends and stretches easily, it’s a beautiful technique. When I trained 14 years ago, only one staff OB used the bandage scissors to “cut” the incision open, everyone else was already using a blunt technique. It works very nicely, but mostly because you get a little less bleeding, it’s a little faster, and a little less cumbersome than trying to put a blade of the scissors inside the uterus without catching anything (eg cord/etc). (However, I do a 2-layer closure for any woman who I think may consider a VBAC in future pregnancies, not the Joel-Cohen 1-layer.)

        • Ob in OZ
          April 9, 2014 at 11:33 pm #


        • S
          April 10, 2014 at 3:55 am #

          Interesting, thanks! Even without knowing about the smooth muscle fibers, her explanation didn’t make a lot of sense, since i thought in general cutting along anatomical planes was just the way things are always done (I never transcribed surgery, just things like simple skin excisions).

      • R T
        April 9, 2014 at 11:29 pm #

        Yes, I ended up horribly bruised on one side of my incisions because of this! It really hurt too! My son got stuck and they ended up tearing one side of my incisions with their hands to get him out quickly! It did not heal nearly as well as the side that was cut open! Of course, this was not planned in my case and was done quickly and forcefully!

    • Isramommy
      April 9, 2014 at 3:27 pm #

      Anigonos- I used to live in Old Katamon (until we got priced out of the whole area), right down the street from Misgav Ladach. Can I ask you why did it go bankrupt? I’ve heard many rumors… some good, some very bad, and some veritable conspiracy theories on how the evil ob establishment wanted it shut down for being too pro-natural childbirth.

      It seems like it should have been financially sound, with bituach leumi paying for every delivery and the very high birth rate in the area. I mean, Sharei Tzedeck alone has what, almost 12,000 births a year? Ein Kerem has over 6,000… were the major hospitals actually pulling away too many births for Misgav Ladach to continue?

      • April 9, 2014 at 3:41 pm #

        The short answer is that the people who ran the hospital stole huge sums of money — but of course it is much more complicated than that. Actually, Israeli hospitals are ALL in debt chronically. Look at what is happening to Hadassah now. Since this is extremely OT, drop me a line at meir dot cnm at gmail dot com and I’ll be happy to further enlighten you.

        BTW, the figures for ST and Ein Karem, for the year 2001, are wrong. Hadassah Mt. Scopus and Ein Karem EACH did about 3500 deliveries per year, and ST did about 6000. ML did about the same as each of the two Hadassah hospitals.

  17. DoulaGuest
    April 9, 2014 at 12:54 pm #

    Note the scope of practice of her certifying body, Doula UK. I already sent a complain. Like the issues we see in midwifery, if doulas (myself included) do not hold each other accountable then this will continue to happen and potentially harm mothers and babies.

  18. April 9, 2014 at 12:42 pm #

    There’s a saying – you don’t get to pick your parents….but you can pick your doula and for the sake of your health and well-being and that of your child, you’d best pick a different doula than this woman. Anybody who can’t think beyond their own personal experience really should not dispense advice.

  19. attitude devant
    April 9, 2014 at 12:37 pm #

    OK, for the record, if anyone comes to me seeking a trial of labor after prior rupture, I am saying no. Not even discussing it. You want to kill yourself and your baby? Fine. I want no part of it.

    • Young CC Prof
      April 9, 2014 at 1:21 pm #

      Yeah, prior rupture = scheduled c-section at like 36 weeks, IF nothing goes wrong earlier. Common sense, people!!

      • attitude devant
        April 9, 2014 at 1:32 pm #

        The last time I had one of these prior rupture moms we did an amnio for lung maturity and delivered her at 37 weeks on the nose. I opened the abdominal wall, opened the peritoneum, and there was the amniotic sac with baby visible through it. No uterine wall at all visible. Scariest thing ever.

        • April 9, 2014 at 1:42 pm #

          I just choked on my coffee. How horrifying! !

        • April 9, 2014 at 3:17 pm #

          My best friend had that happen when she had her 5th C/S. No indication at all that anything was amiss prior to the surgery [elective, of course]. Outcome was good for both mom and baby, but she decided 5 kids were enough after that.

        • Karma Kidney Stone
          April 9, 2014 at 6:19 pm #

          Just out of curiosity, why did you do the amnio for lung maturity? They wanted to do one for my last baby when we were inducing at 36 weeks for ICP and isoimmunity (plus I have lupus), and I asked them if they were going to do anything differently depending on the results. They said they wouldn’t change a thing. I was already delivering in a hospital with the highest level NICU, and a NICU team was at the delivery, so we opted out given that amnios have risks.

        • R T
          April 9, 2014 at 11:23 pm #

          I joined the VBAC support board to check it out since I’m hoping to have a VBAC if I have another child. One of the mothers on the board decided to ditch her VBAC plans and go for the RCS. Here’s a picture of what they found when they opened her up! Terrifying!

          • CognitiveDissonaceHurts
            April 10, 2014 at 8:30 pm #

            The photo is gone. Anyone have another?

          • R T
            April 11, 2014 at 2:31 am #

            I can still see it, weird…

          • CognitiveDissonaceHurts
            April 11, 2014 at 6:01 pm #

            Now I can see it too. Is that the amniotic sac bulging through the uterine wall?

          • Stacy21629
            April 11, 2014 at 6:19 pm #

            That is utterly terrifying.

          • Dr Kitty
            April 11, 2014 at 6:43 pm #

            The little yellow bubble sitting on the womb is amnion and amniotic fluid herniating through the previous scar.
            Not good.
            Really not good.

            As always Jeevan has great pictures of uterine windows (the second one about to become a dehiscence).


            I’ve been at a CS where we could tell the baby’s hair colour through the uterine window. Which is really more information than is a good idea.

          • Dr Kitty
            April 11, 2014 at 6:49 pm #

            If I google “uterine window babycenter” it is the first pic.

            It is a surgery picture with a yellow bubble on a uterus and four gloved hands.

          • Renee Martin
            April 11, 2014 at 1:23 am #

            WOAH, WTH is that? The sac? Jeeeeeezzzz

          • R T
            April 11, 2014 at 2:30 am #

            Yes, the sac was outside of the uterus being held in by the abdominal wall. The uterus had slightly ruptured at some point in the pregnancy or maybe never healed closed all the way to begin with. Everyone in the ER was shocked and its very lucky she didn’t go threw with the VBAC!

        • Renee Martin
          April 11, 2014 at 1:22 am #

          HOLY CRAP. I wish you had pics of that.

    • Lee
      April 9, 2014 at 6:47 pm #

      Where did this trial of labor bullshit even come from? I don’t remember any of this when I was growing up. At least half of the women in my family and neighborhood had c-sections and no one felt bad about it. All anyone cared about was that everyone made it home from the hospital okay. This was especially true if the mom’s prior pregnancies or deliveries had been difficult or dangerous. When did it become all about mommy and her little cult of woo friends playing Birthin’ Princess rather than whether or not the she and the baby made it out safely?

      • Christina Maxwell
        April 9, 2014 at 9:45 pm #

        It’s not necessarily a recent thing, my ma-in-law went through obstetric hell in the 1950s, in Scotland. She had an emergency section with her first baby in 1954, then TOLAC in 1955 ending in another cs, then TOLAC again in 1957 followed by another cs. Finally in 1958 she was ‘granted’ an elective cs when my husband was born. Just as well as he was 12lb. Ma-in-law is tiny, with narrow hips. She says that 4th section was pure, unadulterated bliss by comparison. I don’t know how she, or the babies, survived.

      • CanDoc
        April 9, 2014 at 10:48 pm #

        “Trial of labour bullshit” isn’t bullshit at all. Most low-risk women will have a vaginal delivery after a cesarean section, depending on circumstances, with a very low risk (approx 1/200, depending on which numbers you use) of uterine rupture. With rupture, 25% chance major morbidity for baby, 15% major morbidity for mother. So, trial of labour is a little safer for mom, but a small bit more dangerous for baby. But for women who are planning 4 or more pregnancies, that’s 4th or 5th cesarean section can be technically difficult with increased risk of placental catastrophes (see below – uterine window), placenta accreta (placenta grows through uterine wall, occasionally into the bladder or other structures), internal injuries (bladder especially), and hysterectomy.
        So, enough evidence to support it being a personal decision with good evidence on either side.

        • Renee Martin
          April 11, 2014 at 1:21 am #

          I think she meant TOL pushed on people, and why its seen as the only way. It is a comment on how people now are looking at the process more than the outcome.

    • CognitiveDissonaceHurts
      April 10, 2014 at 8:28 pm #

      Would it make a difference if it was a dehiscence? I’ve been led to believe by those in crunchy land that that is not a big deal and that is what most ruptures actually are. ie. therefore, the risk is overblown and doctors are just scare-mongering.

      • attitude devant
        April 11, 2014 at 12:10 am #

        No. They both show that the muscle is weakened beyond what will stand up to labor

    • Renee Martin
      April 11, 2014 at 1:20 am #

      If AD won’t do it, that means it shouldn’t be done. Full stop.
      This is an OB that truly respects women and will let them make choices that are unpopular, so long as they are medically sane. She will take the heat in order to support a woman, and she will give you true informed consent.

  20. Renee Martin
    April 9, 2014 at 12:33 pm #

    Criminally stupid.
    What a shock!

  21. Zornorph
    April 9, 2014 at 12:21 pm #

    So Williams thinks the ‘dead baby card’ is ‘out-and-out blackmail’ but women like her have no problem using their own emotional manipulation to get their ‘patients’ to give birth the way that THEY feel is right. I think doctors should play the dead baby card – let mums know just what they are risking and let them think if their ‘birth experience’ is worth their baby’s life.

    • Young CC Prof
      April 9, 2014 at 12:26 pm #

      How about the unbonded baby card, as in, “Oh no, if you accept labor interventions you will never properly bond to your baby!”

      Which is not only insulting to mothers, telling them their love for their children is no better than the chemical attachment of a duckling, but equally insulting to fathers, non-biological parents, and other relatives.

      • KarenJJ
        April 9, 2014 at 9:35 pm #

        It’s like the hokey-pokey of bonding. You take your baby’s hat off, you put your left breast in, you co-sleep all night and then you shake it all about..

        • Jessica S.
          April 9, 2014 at 10:24 pm #

          Oh lordie, I’m dying – that’s good stuff!! LOL!

    • Medwife
      April 9, 2014 at 3:01 pm #

      They say “dead baby card”, I say “informed consent”.

  22. mollyb
    April 9, 2014 at 12:14 pm #

    OT: I just had my first anti-vaccine bomb on my facebook page! I’m not even sure how to respond (a former coworker I’m friendly with). It name drops Monstanto about a dozen times, references someone she knows (‘not wel”) who had to quit her job at a pharmaceutical company because they were making her lie about the safety of vaccines and the fact that the number of autism cases has risen. I don’t even know what to say beyond “I’m sorry you believe in so many conspiracy theories that are impossible to disprove because any proof is also tainted by your conspiracy theory”.

    • DaisyGrrl
      April 9, 2014 at 12:23 pm #

      I’d probably say: “okay, well I like not having to worry about smallpox.” and leave it at that. Clearly she’s been brought over to the dark side, and there’s not much you can do about that.

    • Renee Martin
      April 9, 2014 at 12:32 pm #

      She is an idiot. Delete her and forget her.

    • Dr Kitty
      April 9, 2014 at 1:07 pm #

      “I do not find you evidence as convincing as the convential research on this topic. I will not be changing my plan to vaccinate, and I am not open to reading more anti-vaccination material. Kindly consider this a topic I no longer wish to discuss with you, in the interest of preserving our friendship.”

    • Squillo
      April 9, 2014 at 3:27 pm #

      Hmm. Vast majority of scientists, pediatricians, and epidemiologists vs. “some guy/gal I kinda know”. Who to believe?

    • Lena
      April 9, 2014 at 8:03 pm #

      That “someone she knows” who quit her pharmaceutical job is either a member of some anti-vax message board or a random commenter at a blog she reads. I’ll bet my house on it.

      • The Bofa on the Sofa
        April 9, 2014 at 8:23 pm #

        Monstanto (sic) doesn’t make vaccines, of course.

        • Trixie
          April 9, 2014 at 9:44 pm #

          But Monsatan uses genetic engineering and some vaccines are starting to use it too. Therefore, by the transitive property, Monsatan = vaccines.

      • Dr Kitty
        April 11, 2014 at 3:09 pm #

        She knows Sideshow Bob?

    • Lombardi
      April 9, 2014 at 8:10 pm #

      I typically respond by making a donation to A Shot at Life. I then take a screen shot and post that in my reply.

    • LadyLuck777
      April 10, 2014 at 4:59 pm #

      Here is a letter (complete with copious citations) to your former coworker.

  23. DoulaGuest
    April 9, 2014 at 12:01 pm #

    Please know that there are *many* of us who do not practice doula work like this. In fact, it was my time as a doula working with wonderful CNMs and OBs that convinced me to become a CNM, and not a CPM (unfortunately as many doulas go on to do). I wanted to be able to better understand birth, and eventually provide medical advice and clinical care (just as many CNAs, EMTs, MAs go on wishing to do more) Anecdotally, I think that many aspiring CPMs begin as doulas and then move to apprenticeship, and the culture around those circles is what leads them to believe that making statements like the ones above. She could easily be reported to her certifying body for dispensing advice like this because it is so out of her scope. The doula organizations I know (CAPPA in particular) take this *very* seriously.

    • Box of Salt
      April 9, 2014 at 12:35 pm #

      DoulaGuest “She could easily be reported to her certifying body for dispensing advice like this because it is so out of her scope.”

      If you are familiar with the reporting procedures, why don’t you report her?

      • DoulaGuest
        April 9, 2014 at 12:50 pm #

        Done and done. She is a UK doula, and I pointed out that she has neither medical training, or the training to interpret the data on this issue. I also pointed out that it reflects poorly on their organization if she is dispensing this advice, rather than having mothers discuss with providers or research on their own. I will let you know what they say!

        • Dr Kitty
          April 9, 2014 at 1:21 pm #

          She is a recognised doula with Doula UK.
          Their code of conduct SPECIFICALLY says that a doula may offer support and counsel, but not advice.
          That a doula may not diagnose medical conditions nor give medical advice even if trained as a medical profession prior to becoming a doula, unless making it clear that this is NOT done in her doula role.

          Doula UK, btw, accept complaints from anyone via email.

          I think any disciplinary action will be largely toothless and without consequence, but at least if someone dies as a result of her advice Doula UK can’t claim they weren’t aware of her actions.

          • DoulaGuest
            April 9, 2014 at 1:39 pm #

            I have seen doulas loose certification around this, or at the very least have it suspended. I hope that they take it seriously.

          • Dr Kitty
            April 9, 2014 at 2:00 pm #

            Not holding my breath, but yep, I emailed them too.

Leave a Reply

You must be logged in to post a comment.