Get government out of birth!

hands off my birth

Over the past few days, in the wake of the UK decision to promote homebirth, I’ve looked at several reasons why the effort to promote homebirth over hospital birth is unethical.

First, in a system struggling with staff shortages, lack of supervision of midwives, poor outcomes, and exorbitant insurance expenditures, it is defies logic to promote type of birth that will only exacerbate staff shortages, further limit supervision of midwives, and increase the risk of poor outcomes and additional insurance expenditures.

Second, it is nothing short of cruel to force women to choose between personalized care and pain relief in labor.

Today, I’d like to address the third reason why promotion of homebirth is unethical: a national government has no business encouraging ANY form of birth over another. In doing so, it restricts women’s reproductive autonomy.

Imagine, if you will, that the UK government had decided to encourage “natural family planning” (NFP) over other forms of contraception, claiming that NFP is the most “natural” method and the way that women have controlled their fertility for most of human existence, and that it costs the government far less in contraceptive funds than the birth control pill or IUDs.

Women’s rights groups would, quite appropriately, decry such a plan. They would be angry because NFP is not as effective as other forms of birth control, it is far more onerous to use than other forms of birth control, and the government is overstepping its bounds by involving itself in the highly personal decision of fertility control.

They would not be mollified by government claims that the ideal effectiveness rate of NFP is high. They would likely point out that the real world effectiveness of NFP is rather low, and that is the rate that counts.

They would likely point out that women should not be “encouraged” to sacrifice convenience of a birth control method to save money for the government. The greatest portion of the burden of contraceptive failure falls on the individual woman and therefore, she is the one, and the ONLY one, who should choose among safe, effective methods of birth control.

They would almost certainly point out that choice of fertility control is a personal decision in which the government ought to have no role. Women are not truly free to control their own bodies when the government is “encouraging” a less effective, less convenient method of contraception over others.

Women’s groups would be correct on all three counts.

Let’s take another example:

How about if a government decided to promote induction of labor over conventional surgical pregnancy termination? For most first trimester and early second trimester terminations, minor surgery is used to evacuate the uterus, thereby ending the pregnancy. Surgical termination is a safe method, takes only a short time, and involves a relatively easy physical recovery.

But imagine instead that a government decided to “encourage” medical abortion, using various types of medication that induce uterine contractions to force out the products of conception, reasoning that it is the most “natural” method, one that women have used to end pregnancies for hundreds of thousands of years, and costs the government less than surgical terminations. The government might point out that pharmaceutical manufacturers have been recommending medical termination over surgical termination for years.

Women’s rights groups would, quite appropriately, decry such a plan. They would be angry because medical termination is far more painful, more onerous, and takes longer than a surgical termination. They would point out that government is overstepping its bounds by involving itself in the highly personal decision of which method of termination to use. That is both a medical decision and a personal decision and there is simply no justification for government involvement.

They would not be mollified by government claims that medical termination is cheaper and they would likely point out that women should not be “encouraged” to endure the hours of pain of a medical termination to save money for the government. The greatest portion of the burden of the procedure falls on the individual woman and therefore, she is the one, and the ONLY one, who should choose among safe, effective methods of pregnancy termination.

They would almost certainly point out that pregnancy termination is a personal decision in which the government ought to have no role. Women are not truly free to control their own bodies when the government is “encouraging” a more painful, less convenient method of pregnancy termination over others.

Women’s groups would be correct on all three counts.

The government in the UK does not privilege one form of birth control over another, and does not privilege one form pregnancy termination over another, but it has decided to encourage one form of birth over another.

The government has decided to promote homebirth reasoning that it is more “natural”: it’s the way women have given birth for millions of years; and it costs less than hospital birth. The government notes that midwives have been recommending homebirth for years.

Women’s rights group, indeed anyone concerned with medical ethics, should decry such a plan.

They should not be mollified by government claims that homebirth is relatively safe for some women under ideal conditions (i.e. The Birthplace Study). No one has bothered to look at the safety of homebirth in the UK under real world conditions, and that is the only standard of safety that counts.

They should highlight the fact that women should not be “encouraged” to sacrifice safe, effective pain relief for the agonizing pain of childbirth to save money for the government. The burden of childbirth (pain, risk of death, risk of the baby’s death) falls on the individual woman and therefore, she is the one, and the ONLY one, who should choose among safe places to give birth.

They should emphasize that place of birth is a personal decision in which the government ought to have no role. Women are not truly free to control their own bodies when the government is “encouraging” a more painful, arguably less safe place of birth over others.

The decision by the UK government to “encourage” homebirth is fundamentally unethical. It interferes with a woman’s right to control her reproductive decisions. It makes no sense from a healthcare perspective. It represents political pandering to midwives and a vain hope that reducing upfront costs for childbirth won’t be totally obliterated by massive downstream costs for care of children injured at birth and lawsuit payouts for infants who died.

It’s not healthcare; it’s politics. And, above all, it’s unethical.

236 Responses to “Get government out of birth!”

  1. Jude
    June 24, 2014 at 4:19 am #

    I think the fact the UK Government has encouraged home birth is indeed wrong in our country. Midwives in UK have rigorous supervision, every year. I think it is unfounded to say women are at risk from midwives in the UK. What women are at risk from is midwife shortages.

    ‘Agonising birth’ – what sort of statement is that?
    Birth can be painful in circumstances where it has deviated from normal. It is not always agonising. Why do health professionals always seek to destroy a woman’s confidence in their ability to birth a baby. I am a strong advocate of hypnotherapy in birth and a practitioner of hypnotherapy. It is a powerful tool, along with self management during antenatal care and the birthing process.

    Women have never been free to determined their own birthing process, the medical models have all too often interfered. What we need is to get the medical model of care to concentrate on women who have special needs, and to leave normal women with no medical or obstetrical issues alone. Now that would be a novelty in all countries not just the UK.

    In the UK there is an issue with the fact a midwife is the woman’s advocate, even if she has handed the care of the woman to an obstetric team. The midwife can still be held accountable for a woman’s care despite the fact an obstetric team (is in theory) caring for the woman. Now it is hardly fair for midwives to be held accountable for poor obstetric care.

    Political pandering to midwives, well that made me laugh! Midwives have always been the obstetricians handmaiden! I know because I have been in the UK practising midwifery for years. I am now retired, early due to the fact I could not continue to burn the candle at both ends, working day and night was slowly undermining my health.

    I have a lot of experience of home birth. It is perfectly safe if the woman is carefully screened and is low risk, realistic, its her choice and she is happy birth at home. I am also not sure we have enough midwives in the UK who are experience in home birth and who are happy to be on call at night to cover home births, after working all day. Most midwives now want a home life balance. One should not forget since the 60’s when it was decreed that hospital was the safest place to birth the majority of women have birthed in a hospital. This is where a large percentage of midwives are used to working.

    I think the article above is a rather narrow view and tempered by the fact the poster is a medical practitioner, whose view is affected by obstetric practices. Birthing is a normal physiological function, midwifes support women in this process and notify deviations of normality to a medical practitioner who then takes over the care of the woman. Most women will and do birth ‘normally’, whether that is in hospital or at home. Women can free birth legally in the UK. A woman’s choice is of paramount importance in the birthing process.

    I do agree however, that the UK Government have an alternative agenda in the UK, and prescribe home birth as a way of saving money. It was the same with breech births too. Dodgy research ended vaginal breech birth in the UK along with NICE guidance. Now we have few obstetricians in the UK who actually know how to facilitate or assist a woman in birthing a breech baby, yet suddenly the tide turned, in the realisation the research was poorly done, UK Government decided in their wisdom that vaginal breech birth is now safe for women. Alas but after ten-twelve years of C/S for breech births, we have no practitioners who can facilitate this practice or who can recognise the deviations of normal breech birth, so how safe is it in reality.

  2. Mattie
    May 28, 2014 at 5:24 am #

    I totally agree that the government should not have said what they did about homebrith, but only because sadly for many people their local maternity services do not cover it adequately and it means increased risk for women and babies.

    I take issue with your claim that midwives are not supervised? Would you care to elaborate on that statement because in itself it isn’t true.

  3. Guestll
    May 21, 2014 at 1:10 am #

    Now don’t you be maligning NFP!

    My smart Catholic mother taught NFP at the Catholic hospital where she worked as an L+D nurse. My parents used NFP and withdrawal to space their first three children, exactly how they wanted them spaced, and then they were done like a dinner.

    #4 was me, 9 years later. So much for NFP + withdrawal!

    I am very grateful for NFP. 🙂

    • Steph858
      January 13, 2015 at 5:26 pm #

      I thought the Catholic church were opposed to the withdrawal method too. Sin of Onan and all that …

  4. Phipps
    May 20, 2014 at 10:35 am #

    Live perspective from the UK: Having three excellent hospital facilities within 20 minutes of my home (inc. 2 maternity units recently CQC inspected) that could be accessed with ease, in addition to a supportive team of community midwives attached to one of those hospitals, enabled me to make the decision to have a home birth. Were it a difficult pregnancy this option wouldn’t have been available to me. Should risk become a considerable factor, the local infrastructure supports immediate step up care. I agree with Young CC Prof that this has an immediate cost implication not factored into the maths. Unlike other countries, this system is free at the point of access.

    I am thankful to have been given the choice which was never as simple as stay home or go to hospital. I have been supported by a team of community midwives to think through the entire journey which now starts in my bedroom as opposed to the hospital door. Once again, this will have had a cost. They have supported me to identify key decision making points and given the evidence (back to NICE) to preempt and shape my views, noting that they could change on the day and I could go straight to hospital. This has included decisions that may need to be made in hospital should care be stepped up. I have no doubt that this has improved my psychological state in preparation for birth.

    Why write at all? Because this is a very high level article that however passionate and well intentioned, will inevitably be read by UK mothers. It references losing choice linked to costs and my experience has been quite to the contrary. It is also not what NICE recommended, they advocated choice across the four settings. This is only one of a number of maternity commissioning challenges to improve standards across the board. I do agree resourcing will be difficult but not impossible.

    • fiftyfifty1
      May 20, 2014 at 11:11 am #

      It’s great to have a live perspective from the UK, I’ve been wanting that for awhile. I’ve been wondering how real life counseling has changed since the BIrthPlace study. In your experience, did the midwives review the study explicitly? In particular I have wondered how they are counseling first time mothers (who were shown to have substantially increased perinatal mortality at home). Are they trying to discourage them from giving birth at home? At first I heard they were going to, but then I heard they were not. Also I wonder if they explain that the inclusion criteria for the BirthPlace study were more strict than what the midwives actually accept as homebirth candidates (absolutely no problems with this or any other pregnancy and living very close to the hospital). Do they sit a woman down and tell her “This study does apply to you” or “You wouldn’t quite have qualified for the study because of factor x, so this study does not apply to you”? I am envious that the UK has this study. The United States has nothing approaching it.

      • Irène Delse
        May 20, 2014 at 11:47 am #

        That would be interesting to know. There’s also the issue of possible geographical discrepancies. The UK is not as big as the USA of course but being in a large city with several hospitals can play a part.

  5. drmoss
    May 19, 2014 at 2:51 pm #

    This is all financial. No government has ever, in my experience, tried to control costs without actually screwing up. Twenty years ago we went in my home province from volunteer community hospital boards to paid administrators who “would cut the waste”. We have gone from four administrators in our regional hospital to 74, whilst beds have been cut from 150 to 70. I think you can see the problem.

  6. Mama
    May 17, 2014 at 6:43 am #

    Dr. Amy needs to understand how the UK NHS functions otherwise she risks thinking midwives have some great influence over women’s birth choices. The decision and indeed all health care decisions is about what costs the least.

    • Young CC Prof
      May 17, 2014 at 10:34 am #

      I just don’t believe that, though. I’ve been looking for the math to support the claim that home birth is cheaper, and I can’t find it. Doing it right, with proper provisions for emergency transfer? I just don’t believe that’s really as cheap as they claim.

  7. auntbea
    May 16, 2014 at 9:14 am #

    Government pays for healthcare, therefore it is inevitably “in it.” There is no decision the government can make in terms of what it will fund that does not inherently encourage some sort of medical care over another. We can debate over what those decisions should be — and it is entirely fair to suggest that this decision is shortsighted at best — but to get the government out of healthcare would mean both lack of regulation and lack of access to anyone but the well-off.

  8. Anna T
    May 16, 2014 at 5:07 am #

    ” a national government has no business encouraging ANY form of birth over another”

    I’m not so sure about this one. I think the government should be encouraging, and funding, the SAFEST way of birth, regardless of how much it costs. Lives of mothers and babies are just not the thing where they should be cutting expenses.

    In Israel, all hospitals are entirely government-funded. This means that any woman can go into any hospital to have her baby, and have all the health care services – however simple or complicated – for free, without having to worry about the hospital bill. If she needs an epidural or a C-section, or her baby needs the NICU, she won’t pay more than if she had a natural birth with just some monitoring and midwife assistance.

    There are of course hospitals who offer extras (for extra pay) such as a “natural delivery-oriented” room with fancy accessories, doula services, hospital-attached mini-hotels for mothers and new babies, but overall there isn’t such a thing as free hospitals for poor people and expensive hospitals for rich people, and I think that’s a good thing. Our hospitals all have a relatively uniform level, and all are good. I’d feel equally safe giving birth in any of them.

    Home birth with a private midwife, on the other hand, costs quite a bit of money, and if a birth isn’t registered at the hospital, the mother won’t receive her “maternity allowance”. Thanks to these simple measures, home birth remains a marginal choice for rich hippies. It will always, ALWAYS cost much more than a hospital birth, even if there are no complications.

    • May 16, 2014 at 5:37 am #

      A small correction: not all hospitals are ” government-funded” . However, all costs connected with birth are covered by government via the National Insurance, except for “extras” as noted. In fact, all the hospitals in Jerusalem are privately-owned.

      • Anna T
        May 16, 2014 at 9:06 am #

        Thanks for the correction. Still, I maintain my point: no woman in Israel will be tempted to choose home birth because it’s cheaper. On the contrary, many women (like myself) would have considered home birth but discarded that option because they just didn’t have the money to shell out for it. Basically I was financially pressured into choosing the safer (though I wasn’t aware of it at the time) option, for which I am now very grateful.

        Make hospital births free and government-funded, and make sure home births have to be covered privately, so that the option of home birth is always, always more expensive than a hospital birth. I’m sure this will discourage most women from choosing home births.

        • pettelly
          May 16, 2014 at 10:33 am #

          I was looking at the forums on the other day and the bonkers ‘unassisted childbirth’ forum. There was a woman there who couldn’t afford a midwife and home birth as it wasn’t covered by her insurance. She was so fearful of hospitals that she had decided to have an unassisted birth.

          I think that the place of birth shouldn’t be determined by cost. Every woman should have the right to choose where to give birth, whether at home, in a birth center or in hospital. No one should be pushed into a decision because of cost.

          Personally, I wouldn’t choose a home birth. But I’m fortunate enough to be in a situation where cost isn’t a factor in my decision and every woman should be granted the same privilege.

          • Young CC Prof
            May 16, 2014 at 11:17 am #

            I disagree. Other people should not have to pay for you to make a decision that society has decided is unwise.

          • pettelly
            May 16, 2014 at 12:15 pm #

            Yes, but society HASN’T decided it’s unwise to have a home birth, at least not in countries where home births are properly integrated into the medical system with fully trained and competent medical attendants.

            And you DO pay for people’s unwise decisions…all the time.

          • MLE
            May 16, 2014 at 1:42 pm #

            So, because we pay for some unwise choices, we should pay for more?

          • pettelly
            May 16, 2014 at 3:42 pm #

            Given the NICE guidelines, it is clear that the evidence in the UK is that home birth, done properly and for low risk women, is safe and certainly not an unwise choice.

            Home birth is not something I’d chose for myself but I have a lot of respect for NICE and how they reach their decisions.

          • Stacy21629
            May 16, 2014 at 9:47 pm #

            98% of pregnant women and their partners have decided it’s unwise to have a home birth. That’s pretty much “society”.

          • Siri
            May 18, 2014 at 12:36 pm #

            That’s why smokers, drinkers, helmet-less cyclists, bad drivers, careless pedestrians, equestrians, motorcyclists and community mental health nurses are exempt from free healthcare in all right-thinking countries.

          • Young CC Prof
            May 18, 2014 at 2:58 pm #

            There’s a difference between paying for the potential consequences of dumb choices, which is an inevitable consequence of freedom, and literally paying for you to do something stupid.

            If you crash your motorcycle, fine, you can use my tax dollars for your treatment. But I don’t want my tax dollars used to buy the motorcycle in the first place.

          • Siri
            May 19, 2014 at 4:15 pm #

            That’s an absurd argument. What about smokers then? You’re happy to pay for their health care as long as you don’t have to buy them cigs? Happy to pay for wingsuiters to be rescued if they buy their own chutes? What about gastric bands vs food bills?

        • May 16, 2014 at 1:33 pm #

          It is my impression that very, very few of US mothers who homebirth do so for financial reasons — it’s much more likely to be ideological reasons, however erroneous. In Israel [and I know a good many of the CNMs who do homebirths in Israel], the NCB crowd and the woo-lovers are very few in number [a lot of them ex-Americans, btw] because there is much less distrust of established medicine. During my last job, with the Meuchedet health fund’s Women’s Clinic, I spent far more time dissuading women from UNnecessary tests, and explaining that more technology was not always desirable. Not infrequently I’d hear from some woman, whose pre-natal check left her disappointed that “neighbor’s doctor did an ultrasound at every visit”, assuming this was a necessary routine exam. Ditto NSTs for perfectly normal pregnancies.

        • May 16, 2014 at 9:31 pm #

          Are the hospitals mostly non profit or for profit?

    • pettelly
      May 16, 2014 at 10:24 am #

      I got totally sub-standard care when I gave birth in Israel (albeit more than a decade ago). My husband got sub-standard nursing care on a ridiculously over-crowded ward when he had an operation in Israel about 15 years ago. Unless standards have substantially improved, I wouldn’t say that all hospitals are good. I would say that they’re pretty good for the amount of money which is spent on them (less than the UK and far far less than the US) but they’re not good.

      Why shouldn’t Israeli women be offered the choice of homebirth? NICE says it’s just as safe for multi-parous low risk women. Why are only rich women being offered a choice?

      • Anna T
        May 18, 2014 at 1:16 am #

        It wasn’t all sunshine and roses for me in the hospital where I gave birth, either. When I said that the hospitals are good, I didn’t say there is plenty of room or that every patient is getting loving and personalized care, or that the food is very good… what I meant to say is that there is a *relatively* uniform level of medical equipment and competent doctors in all L&D and maternity wards. The hospitals may not be pleasant, but they are SAFE.

        The nurses were pesky. The doctors were overworked. The nursery was dreadful (which was why I immediately requested, and got my wish of, keeping my babies with me). The administration staff was dumb. I couldn’t wait to go home… but all of this is nothing compared to risks of having your baby without the right equipment for emergencies near you.

        There is basically 3 ways a birth can go:

        1) All is good, you don’t need much medical assistance.
        2) Tragedy that cannot be remedied by being in hospital (sadly, it does happen).
        3) Life-saving interventions are needed.

        In the case of number 3, where would you rather be – at home or in a hospital? To me, the answer is obvious. There are of course mollifying arguments such as “low risk women”, but can you guarantee nothing that requires intervention will happen?

        If you can’t, it’s a gamble. Perhaps it’s a gamble with very good odds that everything will go well, but very good odds just don’t cut it, because we are talking about lives of babies. If even one baby a year dies because of home birth, it’s not worth it.

        And so I believe government shouldn’t fund it, ever.

        • pettelly
          May 20, 2014 at 8:34 am #

          I wouldn’t choose homebirth myself, despite having had a bad experience in hospital (and I don’t think Israeli hospitals are all that safe – corner cutting extends to medical procedures as well).. But I do think that where it is set up correctly, with the appropriate criteria for low risk and integrated into the infrastructure, the risks of a disaster which cannot be identified earlier or managed at home are very small – clearly not enough to have any statistical significance even in decently powered studies (although I do believe that they exist). In this case, I think it’s a fair decision to take a very small risk and birth at home. I got in my car this weekend with my kids and drove to the beach. It would have been a bit safer to have stayed at home. We drove to the beach for the experience. I don’t think I’m a bad mum for not having taken the absolute safest option. Again, I wouldn’t choose a homebirth. The experience of birth isn’t all that important to me (personally) but I accept it is for others, even those who don’t subscribe to! As long as the risks involved are small and minimised (ie well trained personnel, low risk pregnancy, ability to transfer quickly into an integrated system) then I do think it’s a valid choice and not one that should women should be denied.

  9. prolifefeminist
    May 16, 2014 at 12:13 am #

    Completely OT, but did you guys see this?

    (If, God forbid, this woman’s cancer returns, I’ll be waiting for the anti-vaxxers to claim that it came back because of all the “zomg toxins!” in the vaccine…;).

    • May 16, 2014 at 1:08 am #

      That is very cool.

      But I bet they missed the whole part of “lab-engineered measles virus” so that they wouldn’t actually get the measles, and the patients still got very sick- the video mentioned one hospitalization, one headache so bad the patient required morphine, and 104F+ fevers and vomiting in all patients. Still very cool, but not a reason to go out and get the measles just because you have cancer.

      • Young CC Prof
        May 16, 2014 at 9:48 am #

        Also the doses were enormous, much larger that the viral load of a person suffering a “normal” measles infection. I think that was the key: Enormous quantities of weakened live virus.

    • UsernameError
      May 16, 2014 at 12:16 pm #

      It’s on the MDC anti vax forum. They’re all “its well known that fevers cure cancer. Duh.” Bogus cancer cures really set me off. My father passed from cancer, and at the end he had what they called the cancer fever. They’re not sure why, but people in the last stages of cancer run a fever. It didn’t cure him, he died about a month later.

  10. Beth S
    May 15, 2014 at 9:21 pm #

    In all honesty I’d really rather keep the government out of my delivery room. For me it’s the same underlying reason that even though I support early abortions for those who want them I couldn’t do it myself. I also don’t confuse the issue with late term abortions which I only support in the case of either saving the life of the mother, or in which the child has conditions incompatible with life. I’d much rather my doctor and nurses make the decisions about my care rather than some nameless faceless senator in DC somewhere.
    The only time the government had a say in my standard of care was with my older daughter, and that was just that the EMT’s couldn’t give me pain meds due to the law, and I understood that. With this one I couldn’t eat because hello surgery, but DH did make sure to have a box of chewy lemonheads waiting for me in my room.

    • pj
      May 15, 2014 at 9:35 pm #

      I don’t think you understand how public healthcare works. Politicians don’t make clinical decisions.

      • Beth S
        May 15, 2014 at 9:41 pm #

        I don’t know how public healthcare works? Public healthcare paid for my ODD to be born. What I’m trying to say is I don’t want the government in my hospital room, I’d much prefer to see standards set by those who know what they’re talking about and what they’re doing then some paper pusher up the line. I like the fact that if my doctor thinks I’m making decisions that he can’t support he can fire me as a patient, for some it could be the wake up call they need to stop doing stupid stuff like homebirthing with women who barely have a high school education.

        • pj
          May 15, 2014 at 9:48 pm #

          What system are you talking about where clinical standards are set by laypeople?

          • Beth S
            May 15, 2014 at 9:51 pm #

            I’m thinking more about the US in the early nineties when things got so weirdly out of hand with HMOs insurance companies were shipping mothers out of hospitals the same day they came in. Things have changed now with changes in laws and more options, but it got bad there for a while. It’s not so much I think the UK system is bad, I just don’t know if the universal model would work here in the US. I wish there were a happy medium between it and the cluster that has become the ACA.

          • pj
            May 15, 2014 at 10:12 pm #

            Clinical standards in countries with public healthcare systems aren’t set by politicians; they are set by independent medical councils (in my experience, anyway). Not sure what you mean by the US situation in the early 90s–how is it an example of a public healthcare system?

          • anh
            May 16, 2014 at 3:11 am #

            look at the case of mandatory ultrasound laws for women seeking early abortions. That is legislation being passed which makes certain medical procedures the legal obligation of the doctor, which are set by politicians without medical knowledge. it happens.

          • auntbea
            May 16, 2014 at 9:22 am #

            Requiring women to undergo a procedure (and doctors to perform them) no matter who is paying for it is a different thing entirely from making a decision about what types of healthcare will be funded by the government — under this policy, women are not being banned from (or forced into) getting pain relief. They are simply told that the state will not pay for it.

            This doesn’t mean I support that decision. I think it is scientifically unsound and clearly gendered. But it is not the same thing as politicians making medical decisions.

          • pj
            May 19, 2014 at 10:59 am #

            That’s not an example of a public healthcare system. It’s an example of totally inappropriate government interference in a country with a private healthcare system.

        • May 16, 2014 at 9:36 pm #

          I fully support techocratic public healthcare.

    • KarenJJ
      May 16, 2014 at 7:39 am #

      And yet insurance companies have a huge say in health care and they can’t get voted in or out and people’s workplaces have a say over what insurance cover they get for their workers.

      I really have to say I prefer having the government supplied option and a private health insurance option that I get to choose myself and doesn’t change when I swap companies or end if I’m not at work. The government health care in Australia is pretty good – I can’t fault either of the public hospital emergency wards that I’ve been to in the past fortnight. The waiting wasn’t too bad, on call specialists were able to consult with the emergency ward doctors and we even attracted an entire team of paediatricians at one stage, just because they were interested. They even brought a plate of sandwiches 🙂

      In some ways there are less options. Hospital budgets means specialists prefer the cheaper version of a drug over the three-times expensive one even though the cheaper one is off-label – patients in the US seem to get the more expensive one because insurance companies prefer to use that over one that is off-label.

      But most people here at least get ready access to these drugs, unlike the arguments in the US. Plus nobody is getting bankrupted in Australia for their kids having the rare disease my kid has – whereas three families are going through bankruptcy in the US and one has been surviving by renting but they don’t feel like they are getting ahead.

  11. Cold Steel
    May 15, 2014 at 7:09 pm #

    I too disagree substantively with the premise underlying this article. Government has a very real interest in regulating health care decision making, both in terms of cost and in terms of safety/efficacy. It is the reason the licensing and credentialing process is monitored by the government, the reason that outcomes are monitored by the government, and the reason that the government funds a great deal of the education, training, research and reimbursement of physicians.

    In addition there is a much broader argument regarding “autonomy.” Autonomy does not mean you can do whatever you want with no consequences. “Reproductive autonomy” in the US does not allow the voluntary termination of a healthy 37wk fetus, for example, no matter how much the mother desires it. You do not have the “autonomy” to take up a knife and stab another person to death, no matter how much you desire it. I as a surgeon do not have the “autonomy” to perform at-home amputations of limbs, despite the existence of fringe fetishists who desire me to do so. And based on the excellent data and arguments found in this blog, I feel midwives do not have the “autonomy” to practice medicine without a license, and subject non-consenting babies to dramatically increased risks of death and lifelong profound disability, simply because their mother desires it.

    • May 16, 2014 at 9:38 pm #

      Comparing abortion to stabbing someone. Wow.

      • Stacy21629
        May 16, 2014 at 9:46 pm #

        I don’t read it that way at all. Was he also comparing at-home amputation to stabbing someone?

        • May 16, 2014 at 9:53 pm #

          In making his examples of how “autonomy” can go out of hand and lead to bad healthcare for birthing mothers, he uses ridiculous examples such as at home limb amputation and stabbing someone to death, while also using late term abortion as if it were barbaric and of no medical value, which is not true.

          • hr
            May 16, 2014 at 11:39 pm #

            Late term abortion most certainly is barbaric. There is no difference whatsoever between it and stabbing someone to death. That baby is a person, a human, just the same as you and I.

          • Cold Steel
            May 19, 2014 at 8:28 pm #

            I have no desire for my comment to be drowned in the abortion debate. @Wharves, your reading comprehension is poor: I said quite explicitly that VOLUNTARY termination of a term fetus is not permitted in the US. Medically-indicated therapeutic abortions are rare as hen’s teeth but they are in fact legal. This was meant to be an example of my central premise: “autonomy” does not mean you get to do whatever you want with your body. Hence the other examples of using one’s body to commit a crime, etc.

            And for such a self-described feminist, I found it *extremely* amusing that you immediately assumed, presumably from my occupation, that I am a man.

          • May 17, 2014 at 8:37 pm #

            The same people who call themselves “pro-life” don’t support social programs for poor children.

          • hr
            May 18, 2014 at 2:01 pm #

            So you’re saying that children up to 2-3 yrs aren’t really people? Aren’t human? What was your point in saying that? That infanticide should be legal too? You cannot say that a young child who doesn’t remember things yet isn’t a human, and you also cannot say that an unborn baby isn’t a human. You may say otherwise, but if your conscience wasn’t so seared and you were honest you would have to admit that isn’t true. Those pictures of aborted babies are real. You don’t think that’s what abortion really looks like? You are shutting your eyes to the truth. It is bloody, it is violent, and a human being dies. You can talk about women’s rights and the inappropriate responses & reactions of some pro life people(your example of the college campus fight) but that in no way changes the fact that abortion is murder, nor does it excuse it.

            I debated whether I should even comment in the first place, because it’s rare that someone online changes their mind and usually saying something is fruitless. But I had to, it would have been wrong not to say anything. The rights of human babies are being trampled on and their murders are being treated as a wonderful thing, as progress. I’m pretty sure that Nazi Germany was convinced that murdering millions of Jews was progress too. People, more people, need to stand up for them and defend them. I will not be ashamed to say that abortion is wrong, it is evil. One day God IS going to judge the world in righteousness, and he is not going show mercy to those who have murdered innocent lives.

          • May 18, 2014 at 4:39 pm #

            I’m not debating this. If you believe in putting the unborn over the autonomy of grown women, you are lacking in basic ethics. It’s easy to say you care about the unborn, but much harder to fight for an equitable society which brings abortion rates down.

          • hr
            May 19, 2014 at 10:20 am #

            My replies keep disappearing; I think if they’re being removed I should at least be told why.

          • hr
            May 19, 2014 at 2:30 pm #

            Basic ethics is valuing a human life over a more convenient lifestyle. To say that I wasn’t prepared for you, I don’t want you ruining my self centered life, so I am going to kill you-that is unethical. A grown woman has the autonomy to choose from the wide variety of birth control methods available, or not have sex. She has no one to blame but herself if she gets pregnant, and it is unethical for her to require someone else(her baby) to suffer a violent death because of her lack of responsibility. The life of one person should not be snuffed out just so another person can take it easy. Autonomy over life is not basic ethics, it is disgusting selfishness.

          • hr
            May 19, 2014 at 2:56 pm #

            You don’t put more value on your own convenience than on someone else’s life.

          • AllieFoyle
            May 19, 2014 at 3:01 pm #

            She has no one to blame but herself if she gets pregnant,

            Yeah, totally. Except if she’s raped, or her birth control fails, or she hasn’t been taught about contraception, or she doesn’t have the means to access it. Oh yeah, and maybe the father of the baby.

            and it is unethical for her to require someone else(her baby) to suffer a violent death because of her lack of responsibility

            There’s nothing inherently violent or unethical about an early abortion. A cluster of cells that has the potential to become a human being, but is not yet one, is removed from her body. Nothing more, nothing less.

            Having respect for human life means respecting people’s rights to determine what happens to their own bodies, including deciding to continue or terminate a pregnancy before viability. It means not shaming women for having sex and bearing the biological burden of its consequences. It means not dismissing the life and health-altering effect that any pregnancy, wanted or not, can have on a woman’s life with insulting terms like “lifestyle choices”.

          • hr
            May 19, 2014 at 3:50 pm #

            Less than one percent of abortions take place because of rape. Most people know that birth control can fail and have sex anyway knowing that there is a slight chance they could still conceive. The means to access it? A generic form of the combined pill costs $8 per month, that is hardly a prohibitive cost, not to mention obamacare which requires everyone to be insured and insurance companies to provide it for free. These are all excuses.

            Abortion is always inherently violent and unethical because it is the murder of a human being made the image of God. Just because that person can’t speak up and defend themselves doesn’t make them less of a person, or make it ok to murder them. A beating heart is not just a clump of cells.

            In no other situation does a person have the right to kill someone that they don’t want in their life, whether it be an annoying co worker that they don’t want to deal with, an elderly parent that they don’t want to take care of, or child that they don’t want to pay child support for. Respect for human life is just that-respect for life even when it inconveniences you.

          • AllieFoyle
            May 19, 2014 at 4:13 pm #

            No, but literally, it is a clump of cells. It’s not murder to remove a clump of cells that can’t sustain itself independently from someone’s body. But you know what, there are actual people out there, well beyond the clump stage, capable of feeling and thought, unlike an embryo, who are in desperate need of help. Why you concern yourself with what other women do with their bodies when there are real tragedies happening in the world is beyond me. No, actually, its not. I think you’re just sort of limited and like to blame and condemn people because it makes you feel good about yourselves.

          • hr
            May 19, 2014 at 4:37 pm #

            Why do I concern myself with what other women do with their bodies? Because of just that-it’s not their body that they are destroying, it’s someone else’s body. When a “clump of cells” has fingers and toes and brainwaves and a heartbeat, it is a person. You are deceived if you think otherwise. A nursing baby also can’t sustain itself independently from its mother’s body, but thankfully our nation isn’t so depraved yet as to legalize infanticide.

          • AllieFoyle
            May 19, 2014 at 7:10 pm #

            Nonsense. You really can’t tell the difference between a 6 wk old embryo and a breastfeeding infant? Hint: one is a fully formed human being, capable of thought and feeling. The other has the potential to become that, but isn’t. Do you make any distinction between a miscarriage and the death of a child? Of course you do. Instinctively you know that there is a difference, you just refuse to acknowledge it.

            Having a baby is not an “inconvenience”. It is an all-encompassing, life-altering decision. It can harm or kill the mother. It can keep her from pursuing education or a career. It can plunge her into poverty, as well as any children she already has. And if you think that everyone knows about and can afford birth control, and then you live a privileged life. It’s not your place to judge.

          • hr
            May 20, 2014 at 12:55 am #

            The difference between a 6 week old embryo and a breastfeeding infant is age, nothing more. Both are humans. Abortion is just one little step away from infanticide and euthanasia; it is a very slippery slope. And yes, a miscarriage is the death of a child-I know that instinctively, just as you do if you would be honest for a moment and stop trying to suppress the truth.

            In most cases, thanks to modern medicine, pregnancy does not harm or kill the mother. Abortion is not primarily for the sake of the mother’s life. I agree, having a baby is not a small thing. It is life changing, it takes sacrifice. Doing the right thing usually does take sacrifice, but that doesn’t give a person license to murder. A difficult, hard situation does not give the right to kill another human, no matter how small. I have never heard of a mother choosing to give life to her child and regretting that decision, but many regret choosing abortion. Where are all the stories of women saying “I sure wish I’d had an abortion while I had the chance”? There are people who will help, pregnancy centers that will help, and many couples who would love to have a baby of their own but can’t and want to adopt. There are always options that don’t include death for the baby.

            The whole idea of an unborn baby merely having the potential to become a human is yet another sad-and sinful-suppression of the truth. If I have a pregnant horse, I do not have a horse that is carrying around a potential horse, I have a horse that is carrying a baby horse inside of it. No one disputes that. If she has a miscarriage, what am I going to find out in the field? ….a dead baby horse. But when it comes to people, suddenly it’s not the same. Suddenly women are carrying around weird little non things that don’t become anything until they’re born…or until the mother decides she wants to keep it. Then, if she’s murdered, her murderer is charged with two murders because, get this, two people were killed. Not one, two.

            Sin is supposed to be called out for what it is. It is not judgemental to point out when something is morally wrong.

          • Stephanie
            May 20, 2014 at 1:24 am #

            The difference between the fetus and the baby is that one can survive if the woman decides to give it up. When you figure out a way to reimplant a fetus into someone else’s womb, let me know.

          • May 20, 2014 at 3:25 am #

            My cousin regrets ever joining the military. Many people who join the military are full of regrets about doing so. Of course, the experience is really beneficial for a lot of people too.

            Should we make it illegal to join the military?

          • AllieFoyle
            May 20, 2014 at 7:31 am #

            Again, nonsense. Learn some biology, preferably not from your bible-study group. A horse zygote or blastocyst or embryo or fetus early in development is no more a “baby horse” than the human version is a “baby human”. You are right that time is the important element–an embryo or early stage fetus may develop over time into an actual baby, BUT IT IS NOT ONE YET. A walnut may develop into a tree over many years, but it is not a “baby tree”; it’s a completely distinct entity. $500 may become $1,000 if invested with wisdom and luck, but we don’t consider it “essentially $1,000” because it is not that yet and may never become it.

            You probably don’t hear many stories of maternal regret because you hang out with regressive religious types who reinforce your anti-abortion views. You also probably don’t hear it a lot because abortion is legal and accessible and women who choose to terminate a pregnancy are able to do so. I assure you though, there are plenty of women who harbor secret regrets about having had a baby and the consequences thereof, which you conveniently gloss over and minimize.

            Say what you will about sin–I can’t argue logic with someone whose beliefs are anti-logical. I will say that your god seems extremely petty and punitive. I can’t really imagine or embrace the concept of a higher being who is motivated by base human habits like shaming, judgement, nosiness, insularity, and close-mindedness.

          • hr
            May 20, 2014 at 8:31 am #

            Biology says that human life begins at conception. Simple as that. Of course, our society does it’s best to deny that and to try to convince people that it’s not really a life yet(your comments are perfect examples) so therefore it’s ok to kill it and women should feel no shame or guilt or regret. But women who get abortions will always have guilt and regret because they know instinctively that what they did was morally wrong. It’s inescapable, because each and every person has a conscience, though it is usually very hardened.

            Someday you are going to see the truth of my words. You are going to see that there is a God; a just, holy, and righteous God who hates sin, who must punish sin to be true to his righteous character, just as an uncorrupted judge in our country must punish those who commit crimes. And he is not going to overlook the millions of babies that have been killed by abortion. Their murders are not going to go unpunished. I hope your eyes are opened to the truth before you die. He exists whether you want to believe it or not. You are one day going to bow your knee to him and confess that he is God.

          • AllieFoyle
            May 20, 2014 at 9:33 am #

            More nonsense. I know a number of women who’ve had abortions and have no particular regret, just gratitude for having been able to make an intelligent and autonomous choice instead of having biology or some weird imaginary deity dictate the terms of their lives.

            The idea that there is a god who cares deeply about fetuses and punishing people for enjoying their sexuality and will someday emerge to punish people who have abortions and other things he dislikes, yet is also somehow powerless to stop them and actually must be responsible for the whole set up, as well as every other form of human suffering on the planet… it’s laughable. If you want to live an existence based on nonsensical bigotry and fear and judgement, be my guest. I won’t be joining you.

          • Young CC Prof
            May 20, 2014 at 9:55 am #

            You really can’t come up with a moral argument more compelling than “God says so?”

          • hr
            May 20, 2014 at 11:09 am #

            I have given other moral arguments as well, if you read through them. We know, from science no less, that life begins at conception. Denying that an unborn baby is in fact a baby and a human being is foolishness and willful blindness. Our society rejects the idea of absolute morals because of pride and arrogance and selfishness. But absolute morals exist, and ultimately, whether you reject God or not, he is going to judge you by them.

            I’m not going to repeat my other comments; you know where they are. You can find arguments from other people who do a much better job than I do at defending the unborn. But none of them will make a difference to you as long as you’re blinded by sin and selfishness and your heart hardened to truth.

          • Irène Delse
            May 20, 2014 at 11:38 am #

            At conception, that life is is a cell. It’s no more sacred than scraps from your skin. The developing embryo basically functions like a parasite: a biological organism that attaches to the woman’s body and pumps oxygen and nutrients from it. It’s perfectly sensible to say that it’s up to the woman herself to accept to lend her body, her energy, her time to let that organism grow into a complete human being. So, 1) your knowledge of science is deficient. And 2) you take yourself much too seriusly for someone trying to give moral advice to others. If you’re a Christian, that should give you pause: overreliance on your intellect may well be called pride, and you know where that leads.

          • AllieFoyle
            May 20, 2014 at 11:53 am #

            You can find arguments from other people who do a much better job than I do at defending the unborn.

            Not really. They’re all pretty much at the same level of intellectual rigor.

          • Spamamander
            May 21, 2014 at 1:05 am #

            I’m an atheist. And I’ve had an abortion. I have no regrets about either of those facts, and am not concerned about what anyone else’s superstitions have to say about them.

          • May 21, 2014 at 1:44 am #

            That tired old bullshit?

            Oh hey look, badly thought out theology combined with lies and ignorance. That’s surely going to convince someone … but not here. We do try to be educated and knowledgeable here. 180movie debunked.

            As for the autonomy argument- do you, or do you not, think that the government should force men to ‘donate’ their organs if the life of another depends upon said donation? Liver lobes, bone marrow, blood- those all even come back, so it’s not permanent. What say you? Can the state impose a regime upon men such that their health must be regulated because they may one day be called upon to donate organs? May it kidnap men to hospitals, anesthetize them, and surgically remove organs without permission, all to save another person’s life? May it do so regardless of the state of the man’s finances, whether he is capable of keeping his job after the surgery, his financial obligations to family, and his own personal health status? May it charge the cost of his care to him for the “privilege” of being forced to give up his bodily autonomy?

          • hr
            May 21, 2014 at 8:41 am #

            I stand by all that I’ve said. Your example doesn’t work because in it no one is brutally murdered. If you don’t want to risk the possibility of a baby, don’t do the one thing that will result in a baby. And if you have a surprise pregnancy and can’t afford to keep it, give it up for adoption. That is the only morally right choice to make.

          • Mishimoo
            May 21, 2014 at 9:19 am #

            So people can choose to not be raped?

          • hr
            May 21, 2014 at 10:06 am #

            Less than 1% of abortions are a result of rape. The child doesn’t deserve to die because of his father’s sins. Two wrongs never make a right.

            Find the stories of women who were raped and yet chose life for their child. They are out there, and they are beautiful examples of selflessness and love.

          • Mishimoo
            May 21, 2014 at 6:38 pm #

            1 – I question that number due to the stigma surrounding rape. It is plausible to me that some women would be hesitant to say they had been raped, especially if (like most rape cases) they did not report it to the police.

            2 – You’re implying that only men can rape. I am the result of marital rape, specifically “You exist because your father was too tired to say no.”

            3 – Why should the woman be punished for someone else’s sin?

          • Alcharisi
            May 21, 2014 at 12:28 pm #

            Define “brutally” and “murdered.” If, say, I deliberately withhold insulin from someone who is diabetic such that they die, I have definitely murdered them in a pretty brutal fashion. If someone is in end-stage organ failure, depriving them of an organ is roughly equivalent for the purposes of this argument to depriving a diabetic of insulin. End-stage liver failure is a horrible way to die. (I have, unfortunately, some intimate second-hand experience of this.)

            I think all of us here get that it is different for me to deprive someone of ANY insulin than it is for me to deprive them of half of MY liver (even assuming, for the sake of argument, that I’m the only available match), and that is because a resource, even a desperately needed one, takes on a different moral cast when it is also an integral part of someone else’s body.

            However, hr, if we follow your logic there SHOULDN’T be any significant difference between the insulin and the liver. If a person has a right to life, then I shouldn’t withhold any resource necessary for them to have a shot, even if that resource is part of my own body. Right?

            Following it a step further–say I’m the only match, and I choose not to donate for whatever reason. It’s one thing for you to find that action MORALLY reprehensible. (Frankly, I’d be morally queasy about it too.) But would you want to LEGALLY compel me to donate half my liver, by whatever means necessary?

          • AllieFoyle
            May 21, 2014 at 12:48 pm #

            Further, something is brutal insomuch as it induces suffering. Expelling an embryo that is not developed enough to have any capacity for consciousness or cognition is not brutal, nor is it murder. On the contrary, it can be considered a compassionate act, if you are someone who believes that the life of the fully formed human in the scenario is meaningful.

          • May 21, 2014 at 3:47 pm #

            You’ve never seen anyone dying of liver or kidney failure, have you? It’s brutal, painful, and unnecessary when we have a pool of men who could totally be forced to give organs. If brutality is your concern, then you’ll also be happy to know that 88% of abortions occur by medical or vacuum means, which removes the embryo/fetus intact, and that 99.5% (or more) of abortions take place before a fetus can even feel pain at 24 weeks, assuming the natural anesthesia of hypoxia doesn’t prevent pain responses until birth which is likely. The ones that occur after that point are done for medical reasons only, and do involve anesthesia if warranted.

            By your logic, choosing not to donate organs is brutal murder. So every man in the US is a brutal murderer of people who die of kidney or liver failure. How does it feel, to know you’re an evil murderer?

            Torture and slavery are immoral. Being forced to be pregnant is torture and slavery. You’re allowed to kill slavers and torturers in self defense. You can do that even if they don’t know what they’re doing- a sleepwalking rapist is still committing rape and may still be killed in self defense. A mentally ill torturer is still torturing and may be killed in self defense. An insensate fetus is still doing both and may be killed in self defense. Adoption is the solution to not wanting to be a parent. Abortion is the solution to not wanting to be pregnant.

            You never did answer my questions above. May the state forcibly remove organs from men in order to save the lives of others?

          • AllieFoyle
            May 20, 2014 at 11:49 am #

            Biology doesn’t “say” anything. It’s not a religion and it doesn’t make simplistic philosophical or ethical declarations about complex issues.

            Someday you are going to see the truth of my words. You are going to see that there is a God; a just, holy, and righteous God who hates sin, who must punish sin to be true to his righteous character

            Why is your god so judgmental and punitive? Doesn’t seem very god-like to me. If I have to meet a god someday and account for the terrible sin of believing that women deserve the right to determine what happens to their bodies, I hope it’s one of the other ones, maybe one that leans more toward love, wisdom, humility, and compassion.

          • hr
            May 20, 2014 at 1:10 pm #

            You have a very low view of the one to whom you owe every breath you take and every beat of your heart. Of course, you will deny that too…

            God is actually quite merciful. If he gave each of us what we deserve, we wouldn’t be alive right now; though I’m sure you don’t believe you’ve done anything worthy of punishment. Every hateful thought, every lie, every selfish desire(and acting on that selfish desire) is direct rebellion against the God who made you, shaking your fist in his face in defiance, and is deserving of death. It’s not just murder that’s deserving of punishment. He cares about the heart too, not just outward actions. He would be neither good, nor righteous, nor just if he were to let sin slide and not punish it, just like a judge would not be a good judge if he let murderers go unpunished. He would be corrupt. The Lord will punish every evildoer one day. Yet here you and I are, still alive, given opportunity after opportunity to repent and humbly turn to Him. He was compassionate enough to send his sinless perfect son to this earth to die in our place, to take the wrath of God against sin on himself and pay the penalty for every wicked thought, desire, and action so that we wouldn’t have to. How is that not loving, kind, merciful, and compassionate?

          • AllieFoyle
            May 20, 2014 at 1:48 pm #

            He was compassionate enough to send his sinless perfect son to this earth to die in our place, to take the wrath of God against sin on himself and pay the penalty for every wicked thought, desire, and action so that we wouldn’t have to. How is that not loving, kind, merciful, and compassionate?

            It sounds hopeless convoluted, nonsensical, and not particularly kind, loving, merciful, or compassionate to me.

          • hr
            May 20, 2014 at 4:14 pm #

            It’s very simple. When the law is broken, someone has to pay. If you break the law, you have to pay unless someone offers to pay for you. God provided a way for you to not have to pay for your own sins by taking it on himself. It takes humility to admit that you have broken God’s law and sinned against him and are in need of his mercy. Pride keeps people from turning to him, and pride will result in you paying for your own transgressions.

          • LibrarianSarah
            May 20, 2014 at 4:29 pm #

            So if you got a speeding ticket, and the judge sentenced you to being tortured forever but offered to have someone beat the crap out and brutally kill his son in order for him to forgive you your speeding ticket, you would be okay with that and think that judge is a great and just man?

          • hr
            May 20, 2014 at 6:13 pm #

            You have no concept of the wickedness of sin. The bible says we are born in sin and that every inclination of our hearts is toward evil. There are none righteous, none who seek after God on their own. That is vastly different than a speeding ticket. Eternal punishment is just because sin is, first and foremost, an act of direct rebellion against an infinitely righteous and glorious Lord. People trivialize sin, particularly their own sin, but it is in no way trivial to God.

          • AllieFoyle
            May 20, 2014 at 6:59 pm #

            It’s slightly less simple from the point of view of the billions of other people in the world who don’t believe exactly the same thing you do. Or even the many other christians who aren’t exclusively fixated on wrath, judgement, fear, self-righteousness, fetuses, and an obsessive need to control and shame women. The bible is full of wisdom and lessons about love, kindness, humility, charity, patience, and duty–I suggest you direct your attention there.

            What’s the point of a supreme deity constructing a world designed around judging endless human transgressions and enacting punishment? It’s the sort of system humans might come up with, but an all-powerful, loving deity? I think he or she could (and possibly did) do better.

          • hr
            May 20, 2014 at 10:39 pm #

            Any true Christian is going to believe in all the aspects of God’s character-his love and mercy and compassion and wisdom as well as his righteousness and wrath and justice because that is what the bible, his word, teaches. Not every one who claims to be a christian or goes to church is one, and the evidence that they are is that they are going to follow God’s word over the politically correct views of society and they are not going to be swayed. They will follow Jesus til death even when it means that they are mocked and hated and killed.

            God’s mercy and love cannot be separated from his wrath and justice. A person cannot brush off murder and say that it’s ok and still be a decent person. To look approvingly on murder is corrupt and evil. Love of what’s good and righteous must result in hatred of evil. If a person loves the Jews he must hate the holocaust. A god who overlooks sin is not a god at all but rather a corrupt being himself.

            The things I am saying are found in the bible. It is indeed full of wisdom and love and kindness and patience. And if you knew any true Christians you would see these things portrayed in their life; Christians are far from perfect but they are continually growing more holy and righteous and humble and hating and repenting of the sin that they find in their own lives more and more. But this is not separated from other truths found in the bible; that God is righteous and just, that he hates sin and will punish it, that he cannot even look upon it. Sin is vile and filthy. If he overlooked it he would be no better, and certainly wouldn’t be worth worshiping.

            Talking about God’s wrath, righteousness, and judgement against sin is not being exclusively fixated on it; it is accepting that those things are an equal part of his character as is his love and kindness, and not discarding what the bible says about it in order to fit in with our degenerate society that says there are no absolute morals, and therefore no sin to be punished. It is not judgemental to point out when something is sinful. Regardless of what culture says.

            Love and kindness? Tell me, when you see someone headed towards disaster and severe consequences, what is more kind and loving? To warn them and explain to them what is going to happen- even though you know they aren’t going to believe you because they can’t see the situation clearly, and they are going to mock you and hate you for interfering in their life- in hopes that they might listen and be spared? Or to watch from a distance and never say anything? The bible teaches me to love others more than myself. Believe me, it is far easier to stay silent on controversial issues(abortion, God’s wrath against sin) than to speak up, when I know that doing so will result in multiple people trying to make me look like a fool and mock me, when I know that in most cases what I say will be completely rejected. I have not said any of this for myself.

          • Mishimoo
            May 20, 2014 at 10:45 pm #

            Every single time people try the ‘True Scotsman’ ploy in regard to Christianity, and follow up by expressing just how righteous they are and how they only want to help those they are lecturing; it makes me think of Matthew 6:1 and Matthew 7:16..

          • hr
            May 20, 2014 at 11:57 pm #

            I’m not expressing how “righteous” I am, simply pointing out that my comments are not self motivated. I do not enjoy arguments, as Allie seems to think. I am, however, trying to obey the command to “open your mouth, judge righteously, defend the rights of the poor and needy” proverbs 31:9. The unborn certainly fit the description of poor and needy as our society refuses to acknowledge their lives as valuable and precious and murders them without hesitation.

            And um, Matthew 7:16, really? I think you must have accidentally mistyped the reference. 😉 Cuz what Matthew 7:16(15-20) is saying is that you will know true Christians by their fruits. A true Christian-healthy tree; a non Christian(whether they are church goers or not-v.15 implies that they are, hence the “false prophets” wolves in sheep’s clothing descriptions) is described as a diseased tree. true Christians are going to be growing in grace and knowledge of God, becoming more humble, more meek, more christlike, because their foundation is in Christ and his word- they are bearing good fruit. A diseased tree cannot bear good fruit(v.17). That passage is saying that there is a difference between a true Christian and a false Christian, and that that difference can be seen in lifestyle and behavior.

            If you care to read v.15-20 in context, you will find in the few verses before and the few verses after that Jesus is talking about the fact that the gate is wide and the way easy that leads to destruction, and those that enter by it are many, but the gate is narrow and the way hard that leads to life, and those that find it are few; and that not everyone who says to him Lord, Lord will enter the kingdom, but only those that do the will of the Father. He makes it very clear that there are true Christians, and false Christians; we can and will see the difference “thus you will recognize them by their fruits” v.20.

          • Mishimoo
            May 21, 2014 at 12:01 am #

            Which is exactly the point I was making, it was a mild rebuke. You come here and choose to grandstand about your religious superiority and then have the gall to claim you are being meek? That you are humble and Christ-like? That you are a true Christian and everyone who disagrees with you is going to hell? Thanks for reminding me just how loving and kind ‘true’ Christians are.

            Edited to add: If you’re not being righteous, why did you turn around and quote a verse about being righteous?

          • hr
            May 21, 2014 at 12:42 am #

            I quoted that verse because it is saying to not silently stand by and watch injustice. It’s saying to speak up in defense of those who can’t defend themselves.

            It doesn’t matter if anyone disagrees with me; what matters is if they disagree with what God says in his word.

          • Mishimoo
            May 21, 2014 at 12:37 am #

            Also, since you’re quoting the Old Testament as grounds for your pro-life argument, how do you justify Numbers 5:5-31, which clearly depicts a forced miscarriage?

          • hr
            May 21, 2014 at 12:51 am #

            No where in those verses is a pregnancy or miscarriage mentioned or even hinted at. I don’t need to justify it at all.

          • Mishimoo
            May 21, 2014 at 12:55 am #

            Perhaps you need to read your Bible?

            “11 Then the Lord said to Moses, 12 “Speak to the Israelites and say to them: ‘If a man’s wife goes astray and is unfaithful to him 13 so that another man has sexual relations with her, and this is hidden from her husband and her impurity is undetected (since there is no witness against her and she has not been caught in the act), 14 and if feelings of jealousy come over her husband and he suspects his wife and she is impure—or if he is jealous and suspects her even though she is not impure— 15 then he is to take his wife to the priest. He must also take an offering of a tenth of an ephah[b] of barley flour on her behalf. He must not pour olive oil on it or put incense on it, because it is a grain offering for jealousy, a reminder-offering to draw attention to wrongdoing.

            16 “‘The priest shall bring her and have her stand before the Lord. 17 Then he shall take some holy water in a clay jar and put some dust from the tabernacle floor into the water. 18 After the priest has had the woman stand before the Lord, he shall loosen her hair and place in her hands the reminder-offering, the grain offering for jealousy, while he himself holds the bitter water that brings a curse.19 Then the priest shall put the woman under oath and say to her, “If no other man has had sexual relations with you and you have not gone astray and become impure while married to your husband, may this bitter water that brings a curse not harm you. 20 But if you have gone astray while married to your husband and you have made yourself impure by having sexual relations with a man other than your husband”— 21 here the priest is to put the woman under this curse—“may the Lord cause you to become a curse[c] among your people when he makes your womb miscarry and your abdomen swell.22 May this water that brings a curse enter your body so that your abdomen swells or your womb miscarries.”

            “‘Then the woman is to say, “Amen. So be it.”

            23 “‘The priest is to write these curses on a scroll and then wash them off into the bitter water. 24 He shall make the woman drink the bitter water that brings a curse, and this water that brings a curse and causes bitter suffering will enter her. 25 The priest is to take from her hands the grain offering for jealousy, wave it before the Lord and bring it to the altar. 26 The priest is then to take a handful of the grain offering as a memorial[d] offering and burn it on the altar; after that, he is to have the woman drink the water. 27 If she has made herself impure and been unfaithful to her husband, this will be the result: When she is made to drink the water that brings a curse and causes bitter suffering, it will enter her, her abdomen will swell and her womb will miscarry, and she will become a curse. 28 If, however, the woman has not made herself impure, but is clean, she will be cleared of guilt and will be able to have children.

            29 “‘This, then, is the law of jealousy when a woman goes astray and makes herself impure while married to her husband, 30 or when feelings of jealousy come over a man because he suspects his wife. The priest is to have her stand before the Lord and is to apply this entire law to her. 31 The husband will be innocent of any wrongdoing, but the woman will bear the consequences of her sin.’”

          • hr
            May 21, 2014 at 9:45 am #

            Most other translations, and far more literal ones, refer to a wasting of the thigh and swelling of the belly. If ‘miscarry’ in whatever translation you found (neb, maybe?) meant to literally miscarry a baby, the other 9+ translations would have conveyed that meaning as well.

            When you read the bible, or any book for that matter, try to figure out what the author is really trying to say. And when there’s multiple translations, check how all the others translate a particular verse.

          • Alcharisi
            May 21, 2014 at 11:31 am #

            Or perhaps learn to read it in the original Hebrew if you’re going to try to argue fine points of translation and meaning?

            I do feel compelled to note, pace Mishimoo, that “induced miscarriage” is probably not the best interpretation of the result of the Sotah ritual in Num. 5. Biblical scholars (of whom I am not one) find “v’tzabetah bitnah v’naflah y’rekah” –“her belly shall distend and her [genitals] shall sag” (JPS, except for “genitals” for “y’rekah” in which case I follow Tikva Frymer-Kensky 1984)– to be some of the trickier language in the Hebrew Bible. In any case, verse 28 indicates that the innocent woman will be able to become pregnant in the aftermath of her ordeal, from which we infer that she is not pregnant during it.

            But all of that is to say, so what? Exodus 21:22 tells us that in the case of a fight where a woman intervenes and miscarries as a result of her injuries, the injurer is liable for the miscarriage under the rubric of property damage rather than of “a life for a life.” That doesn’t prove that the Bible is pro-abortion any more than your favored citations prove it’s anti-abortion. It proves that the cases mentioned in the legal and moral writings of the Hebrew Bible are context-specific and don’t make sense for contemporary ethical guidance when unmediated by an interpretive tradition.

            TL;DR–simple prooftexting from the Hebrew Bible (or any other religious text) is a terrible way to make arguments, religiously informed or otherwise, about contemporary issues in ethics. You want to make a religiously grounded argument against abortion? Great. Go for it. I may disagree with you strenuously, but I can understand where you’re coming from. But don’t do it by fishing for prooftexts and assuming that anyone who doesn’t immediately see them as clear and unambiguous precepts of unmediated pure reason is spiritually fogged or ethically bankrupt.

            Oh, and hr? Speaking as a practicing Jew–please quit appropriating the Shoah for your own ideological purposes.

          • Mishimoo
            May 21, 2014 at 9:37 pm #

            Interesting, do you apply that rule to yourself or only to people that you seem to view as inferior?

          • Guest
            May 21, 2014 at 1:00 am #

            Christ, meek? What was so meek about throwing out the money changers and merchants?
            Matthew 21:12-13
            New International Version – UK (NIVUK)

            Re. diseased tree, fruits – dunno about your experience, but my parents gets some good apples from the seed I planted decades ago. The original apple was a genetic hybrid so the current crop of fruit have reverted to the original types; meaning some are good to eat straight off the tree and some need stewing to be edible.

            May I remind you about sawdust, and wooden planks?
            Matthew 7:3-5
            New International Version – UK (NIVUK)
            We are individuals, with different priorities.

          • hr
            May 21, 2014 at 9:49 am #

            Meekness does not mean weakness, nor does it mean standing helplessly by while you watch wrongdoing.

            The bible says to love God first and foremost in your life. He is to be your number one priority. If he’s not, you should be very concerned for the state of your soul.

          • hr
            May 20, 2014 at 11:09 pm #

            The last couple of days discussing this has shown me something that I’ve never seen near as clearly before: that abortion isn’t really about “women’s rights”. Abortion is purely about selfishness. It’s all about me, and my happiness, and the fact that I don’t want to sacrifice anything for any other person.

            Two Sundays ago one of my pastors preached a sermon on meekness. One of the things he said was that meekness is the opposite of selfishness. Meekness is so absorbed in helping and doing and sacrificing for others that it forgets about itself, whereas selfishness is constantly worried about itself so much that it is always unhappy. A self centered life is, at it’s core, a deeply miserable life.

          • Kupo
            May 21, 2014 at 3:43 am #

            “Abortion is purely about selfishness. It’s all about me, and my happiness, and the fact that I don’t want to sacrifice anything for any other person.”

            Yes, it is all about you. It is your focus on your reasons for choosing abortion. It takes lots of arrogance to presume to be the voice for every one.

          • Guest
            May 21, 2014 at 1:03 am #

            If a person loves Judaism, must they also love the oppression and segregation of Palestinians?

            Note: I have no answers to the Israel-Palestine problem, as I am not a Nobel Peace prize winner. I do know there are very few things in life which is black and white all the way through.

          • Kupo
            May 21, 2014 at 1:06 am #

            “God provided a way for you to not have to pay for your own sins by taking it on himself. It takes humility to admit that you have broken God’s law and sinned against him and are in need of his mercy. Pride keeps people from turning to him, and pride will result in you paying for your own transgressions.”

            So here you are writing against taking personal responsibility?

          • hr
            May 21, 2014 at 10:02 am #

            Repenting and turning to Christ is taking personal responsibility. It is admitting that ‘I’ have sinned, ‘I’ am deserving of God’s wrath and judgement, and I need help. I cannot help myself. I need a Savior.

            You can’t say that, can you? You still think you’re a pretty good person, despite the bible saying that theres no one good, no one righteous, no one who seeks after God on his own. Humans need help, we need a savior. But in order to get the help we need we have to humble ourselves before the Lord.

          • Kupo
            May 21, 2014 at 1:10 am #

            “He was compassionate enough to send his sinless perfect son to this earth to die in our place, to take the wrath of God against sin on himself and pay the penalty for every wicked thought, desire, and action so that we wouldn’t have to. How is that not loving, kind, merciful, and compassionate?”

            Is this love Agape? In which case I accept the gift in the spirit it was given.

            Is this love manipulative like Highsmith’s Tom Ripley? In which case, no thanks.

          • May 21, 2014 at 1:38 am #

            How is that compassionate? That’s freaking immoral and wicked! Human sacrifice to force his all-powerful self to forgive humanity for being the way he made us and breaking the rules he himself had made? That’s just … ewww.

            Besides, I don’t want someone to die or suffer in my place. That’s immoral. I’m a better person than that. If I do something wrong, then I and only I should pay the penalty for doing so. It would be immoral for my sister to offer to take my place in prison if I committed a crime, and it would be immoral for me to accept her offer.

          • hr
            May 21, 2014 at 9:55 am #

            “I am a better person that that.” No, I’m sorry, but you have no idea of the wickedness in your heart, in every person’s heart. Judge yourself by the standards found in the bible, not by how much better than other people you think you are. Do you love God with all your heart, soul, mind, and strength? Do you love your neighbor as yourself? With every lie, every hateful thought, every lustful desire you have broken his law and sinned against him. The bible says if you are not a Christian then the wrath of God abides on you.

          • Irène Delse
            May 21, 2014 at 10:10 am #

            Oh, but I think we have a very good idea of the wickedness in your heart: from your very own words, you prove to be arrogant, judgmental, close-minded and lacking in compassion. I will charitably assume that you are that way because you’re just a terrible person, and not because of your religion, because not all Christians are like that. But you definitely showed that religion is no gauge of character. Well done.

          • hr
            May 21, 2014 at 12:38 pm #

            I’m amused that you make judgments about me in order to condemn me for being arrogant, judgmental, and close minded…anyone who disagrees with you-you’re judgmental and have no compassion!

            No, sorry, but it is not judgmental or arrogant to call moral wrong what it is. We live in a society that glorifies all kinds of sin, and excuses it at the very least. As I’ve said before, it is morally corrupt to affirm as good or even as ok/acceptable what is evil. “Woe to those that call evil good and good evil, who put darkness for light and light for darkness, who put bitter for sweet and sweet for bitter!”-Is.5:20; “Seek good, and not evil, that you may live, and so the LORD, the God of hosts, will be with you…Hate evil, and love good, and establish justice in the gate;” Am.5:14-15; “Let love be geniune. Abhor what is evil; hold fast to what is good.” Romans 12:9.

          • May 21, 2014 at 3:53 pm #

            The Bible condones and orders slavery, genocide, rape, and murder. It says eternal torture is just fine. I’m better than the Bible, too. I’m more moral than your god.

            I also don’t judge people based on thought-crimes. I don’t condemn people to be tortured or killed based on differing beliefs to me, because people have a right to their own thoughts. Your god is Orwell’s nightmare- he watches everything, he knows everything, he condemns our thoughts and not our actions, he makes the very act of being human a crime.

            So no, I don’t love a deity with all my heart, mind, and soul, especially not yours (you stole that from Judaism, btw, that’s part of the Sh’ma so obviously it doesn’t apply to you anymore right?). I don’t think one exists, but even if I did, I wouldn’t worship such a monster as your god is. I do love my neighbors, I try not to lie, I try not to hate, and I don’t see anything wrong with lust. By your own admission, your god will torture me (immoral!) forever (even more immoral!) for daring to think differently than he ordered. I’m going to be damned for thought-crimes. And you’re okay with this? You claim the moral high ground for this?

            The entire basis of Christianity is the immoral, unethical, and frankly vile idea of substitutionary atonement. I and I alone am responsible for my actions, and I refuse to let someone else take punishment on my behalf. I won’t accept even a willing offer, because then what type of cowardly, unethical person am I?

          • The Computer Ate My Nym
            May 21, 2014 at 4:20 pm #

            The Bible also says look to the beam in your eye before worrying about the mote in your neighbor’s eye. May I suggest you take its advice?

          • Kupo
            May 21, 2014 at 1:12 am #

            “Biology says that human life begins at conception.”

            How much of human biology have you studied?

          • Wren
            May 21, 2014 at 2:36 am #

            Biology says life has not come from non-life since well before the arise of humans. Egg cells and sperm at alive. Skin cells are alive. None of those are considered separate human beings.

            If the bible is your guide, don’t claim biology is. Also,I must have missed “thou shalt not have an abortion” in the 10 commandments and everywhere else in the bible. Numbers 5 has an interesting take on abortion.

          • Stacy21629
            May 21, 2014 at 3:18 am #

            Sounds like you believe in a works based salvation. Praise God for salvation by grace through faith in Jesus Christ.

            Abortion and gay marriage may be the religious neocon hobby horses but they are not the bar by which salvation is determined.

            Jesus had a heart of love and compassion for the poor and lowly that may have made awful decisions in their lives. He had nothing but disdain for the religious that looked down on and condemned those same people. WWJD?

          • The Computer Ate My Nym
            May 21, 2014 at 4:18 pm #

            Biology says that human life begins at conception.

            Wrong, wrong, wrong. “Biology” (actually, biologists) says (say) that life began in the precambrian. All life has come from other life since then.

          • Kupo
            May 21, 2014 at 1:14 am #

            “$500 may become $1,000 if invested with wisdom and luck, but we don’t consider it “essentially $1,000″ because it is not that yet and may never become it.”

            Uggreb. There goes my chance of winning the lottery.

          • Alcharisi
            May 21, 2014 at 11:48 am #

            “A nursing baby also can’t sustain itself independently from its mother’s body.”
            Sure it can. It’s called formula.

          • hr
            May 21, 2014 at 12:40 pm #

            Still requires another person’s effort and time.

          • Alcharisi
            May 21, 2014 at 12:44 pm #

            Yeah, another person that could conceivably be anyone. That’s not the same thing as depending on one specific person’s body as a total life support system.

          • hr
            May 21, 2014 at 1:15 pm #

            Again, it comes down to a self centered attitude. There is a living human being inside of me, and I am going to murder him/her because I don’t want the inconvenience of pregnancy. That’s morally corrupt. The baby had no part in being conceived, did not choose you, and did nothing wrong, but he or she is the one being forced to bear the consequences of his or her parents.

            If you don’t like the way that pregnancy works, complain to the One who made it that way. And then do the morally right thing anyway, knowing that His wisdom is infinitely greater than yours(that’s why you’re not god, after all) and he had a reason for creating women’s bodies the way they are.

          • Alcharisi
            May 21, 2014 at 2:05 pm #

            Yes, I get that you think that. However, the point under dispute in this subthread, if I understand it, was whether or not the state of total dependence on another body for life support during pregnancy is at all comparable to any state in a human organism’s life cycle post-birth. You argued that for all significant purposes a nursing baby has the same degree of dependence on the body of its biological mother as does a six-week fetus, thereby implying that birth was not a significant dividing line in the life cycle of a human organism. I demonstrated to you that the premise for your implication was incorrect.

            You fairly consistently mix apologia into your arguments here. Presumably you recognize that for someone who doesn’t come from your specific religious tradition (which I gather from the theological statements you’ve made thus far to be some sort of conservative Protestantism, and I think I’m detecting a Holiness flavor, but I could be wrong about that–care to enlighten me?) will find neither your theological premises nor your Biblical hermeneutic convincing. And your non-religious arguments have consistently been proven wrong, or at least very far from self-evident.

            Am I thus to understand that prior to convincing us that your position on abortion is correct, you mean to convince us that your overall religious convictions are correct? If so, I have to tell you that this blog is unlikely to be fertile ground for evangelism of the kind you’re attempting. If you want to make any sort of headway, in any case, you’re going to have to do much better than the circular theological arguments you’re currently making.

            If, on the other hand, your mission here is NOT primarily a soul-winning one–what’s your point?

          • Young CC Prof
            May 21, 2014 at 2:30 pm #

            You know, I would really like to read a pure ethical argument against abortion, one not driven by either religion or sexual morality. I’m not sure I’ve ever come across one.

          • Irène Delse
            May 21, 2014 at 3:00 pm #

            Neither did I. Interestingly, I learned from history books that in ancient Rome, abortion was legal but providers were often targeted for legal prosecution because men didn’t like the idea that their wife could have the means to stop giving them heirs (children were the property of their father) or, worse from the husband’s point of view, to get rid of a pregnancy that would betray the fact she had had a lover. But the Roman men, who were also the ones making the laws, wanted to be able to provide abortions to their mistresses, and to female slaves that became pregnant when that was inconvenient (prostitutes for instance), so abortion stayed legal, though sometimes iffy. Not a jot of what we would now call ethical concerns in their considerations.

          • FormerPhysicist
            May 21, 2014 at 3:07 pm #

            Very interesting!

          • Alcharisi
            May 21, 2014 at 3:09 pm #

            I could imagine one based in a certain sort of virtue ethic (“we don’t want to be the sort of people who treat even potential human life as disposable,”) or in some kind of nontheological deontologism whose premise is that we have a duty to preserve life (either human life or all life) when at all possible.

            Now that I think about it, I believe Rosalind Hursthouse argues in “Virtue Theory and Abortion” that while there may be particular circumstances in which a virtuous agent would find abortion the most justifiable path, in all cases the act calls for remorse and guilt.

            That being said, I actually don’t think there’s such a thing as a “pure” ethical argument that’s free of religious influence. There’s almost always some religious background contributing to the history and foundation of even the most secular arguments. (Which, note, is not a “should” claim so much as it is an observation about how deeply religiosity has been and continues to be intertwined with all human thought.)

          • Alcharisi
            May 21, 2014 at 3:50 pm #

            FWIW, my own argument in favor of abortion (which all told I find almost always justifiable, and the almost is in there only because I don’t like making absolute statements) rests on three prongs, each of which I find necessary but not sufficient for the overall moral question.

            First, I think that prima facie, no one person gets to occupy another person’s body without that person’s consent. I believe that the direct use of one’s body is a kind of aid that is different from other kinds of aid that one person MAY, under certain circumstances, compel another to give. I also think that this argument alone is sufficient legally speaking.
            However, I don’t think that argument is morally sufficient, since even though I can’t compel someone to lend their body to someone who will die without its use, I believe that in general we actually do have positive duties of care and responsibility towards others, especially vulnerable others, when we have things we can spare and they can’t.

            Second, I think that a fetus is not a person, and in any case does not have a moral status equal to a human after birth. On one level, this is straightforwardly Benthamite– “the question is…can it suffer?” Being a potential person doesn’t cut it either; my duties are greater to someone who is a person NOW than to someone who may become a person at some point in the future.
            This isn’t morally sufficient on its own either, though. First off, I’m nervous about making a judgment that a being isn’t morally significant based on my assessment that it can’t suffer. There’s a chance I’m wrong (and this holds true more so for later-term abortion than for first trimester), and in any case I’m not crazy about the precedent that might set for, say, someone who is severely mentally disabled, or for various animals. (I’m pretty confident an oyster can’t suffer, but I’m pretty confident a chicken CAN–and I eat chicken, albeit rarely.) I also think in general it’s best to err on the side of less suffering than more. Second, I DO believe there are ways in which we have positive duties to potential persons–for example, I think we have an urgent duty to any humans now in utero, or yet to be conceived, to take immediate and drastic action re: climate change. Or more immediately, since this is a blog about birthing practices, I think a pregnant person who intends to carry the pregnancy to term has, all other things being equal, a duty to that potential person to choose the birth setting and attendants that give the baby the greatest chance of surviving the birth neurologically intact.

            Finally, something that gets left out of the abortion debate shockingly often is that pregnancy is LABOR–potentially dangerous or deadly, and often at least temporarily disabling labor at that. Under most circumstances, I consider forced labor morally wrong.
            That being said, I also think that there are times when one does have a moral duty to do dangerous labor one would prefer not to do.

            However, taken together? When an organism of doubtful personhood occupies a person’s body without their consent, subjecting them to potentially dangerous labor? That, to me, is pretty damn clear.

          • hr
            May 21, 2014 at 4:03 pm #

            Birth is not a dividing line in human-ness. You don’t magically become a human at the moment of birth. Out of sight, out of mind appears to be pro-abortionist logic. If it can’t be seen or touched, it’s not a person. There really is no arguing with someone who refuses to acknowledge personhood before birth when we know that life begins at conception. Yes, you all know it too. It is the reason why a woman who plans for and tries to conceive a baby is devastated when she miscarries, and grieves for her dead child. Your position-that humanness doesn’t begin until after birth- is nonsensical, but it is the only thing that allows you to defend the murder of unborn babies and still tell yourself that you’ve done nothing wrong.

            As I believe that the Lord is the author and giver of life, it is impossible to leave him out of the issue of abortion. It really doesn’t matter that you don’t believe in him-either in his existence or in what the bible reveals about him-saying, or believing really hard that something isn’t true doesn’t make it untrue. I can say all I want to that gravity doesn’t exist(can’t see it, you know), but I will still die as a result of it when I jump out of a plane without a parachute.

            As a Christian, I am to take every thought captive to obey Christ. My entire worldview is shaped by the truth of God’s existence and the truth of his word, including what it says about sin. Therefore, there is no topic that doesn’t ultimately come back to him. Everyone’s worldview is shaped by their presuppositions about God and sin.

            And lastly, why have I done this? Why have I said what I’ve said? Not really for you. You are hardened in your rebellion against the Lord, and I didn’t expect you to change your mind on anything. But because I know that there are many people who read comments but don’t comment, and I pray that God might use something to reach even one. He can do that you know. Use the imperfect efforts of an imperfect person to reach another for Christ and ultimately bring himself glory. I pray that just one woman would see the pictures of dismembered, burned, murdered babies and realize that what she’s carrying inside of her is a precious baby- and be moved to choose life for her child. That even one person would realize that despite their best efforts they can never be perfect enough to satisfy the demands of God’s law. No matter how hard they try, no matter what laws they keep, no matter how outwardly good they are, their heart is still dirty and sinful and they can never be clean enough to merit heaven on their own. They need to be humble enough to cast themselves on Christ’s mercy and grace and be covered by his righteousness alone. God doesn’t need the world’s wisdom to change a person’s heart.

          • Alcharisi
            May 21, 2014 at 5:02 pm #

            This conversation has, I believe, reached the end of its usefulness. However, I wish for the record to clarify a few points.

            First, I characterized birth as a potential dividing line for PERSONHOOD, not HUMANNESS. It isn’t self-evident from either side that the two are the same. My tooth is human–you can tell by analyzing its DNA–but it isn’t a person. Conversely, there are some species of animal that demonstrate a high enough level of consciousness that I might err on the side of calling them persons. Personhood, on my view, has less to do with particulars of species and more to do with consciousness and ability to suffer. Furthermore, it’s already been explained to you that we’re all aware that life AS SUCH begins at (actually, before) conception, but that that statement has no moral force in itself unless it is further defined.

            Second, I’ve actually spelled out in GREAT detail below that the question of personhood is NOT the only argument on which my pro-abortion argument is based. My position also factors in whether any one PERSON may nonconsensually occupy another’s body, and whether any person may force another person to engage in potentially dangerous or disabling labor.

            Third, my logic about personhood has nothing to do with whether or not something is visible. That shows me you didn’t actually comprehend what I wrote. You don’t think pro-abortion folks are aware of ultrasounds?

            Fourth, I wasn’t asking you to leave the Holy One, blessed be they, out of the discussion. I was asking you to consider that for someone who doesn’t hold your particular theology, the rest of your arguments would not be convincing. Further (and I say this as someone who is a theist)–gravity and God are not comparable. I believe in God, but I can reliably and repeatably test gravity’s existence in ways I can’t test God’s.

            Fifth, I’m actually acutely aware of my own sinfulness and rebellion against the Holy One. When I walk past someone on the street, and don’t give them the five bucks I can easily spare so that they can eat that day? When I use energy I don’t need? When I see oppression anywhere and don’t speak up because it’s easier for me not to? Or when I speak up because I’m feeling terribly clever and in so doing drown out voices who can shout at the top of their lungs without being heard? Ashamnu. I have sinned. We have sinned. We must do better.

            I honestly do get where you’re coming from. I simply do not see abortion as a form of oppression in itself, and I guarantee you I’ve thought about it deeply, and prayed about it as well. If I had the belief you do, I might be doing what you’re doing now. But I don’t. In fact, I believe that depriving women of the ability to control their own reproduction in the absence of compelling reasons to the contrary is oppressive an yes, sinful. So here I am.

          • The Computer Ate My Nym
            May 21, 2014 at 4:17 pm #

            Actually, there isn’t a lot of evidence for brain function, certainly not cortical function, until late in pregnancy. At best. Most abortions occur in the first 8 weeks of pregnancy when there are literally no stationary and connected neurons. No neurons=no brain waves.

          • Alcharisi
            May 21, 2014 at 11:46 am #

            That a being is “in your life” does not necessarily mean that said being is “in your body.” There’s a substantial difference there.

            Also, since a “beating heart,” “brainwaves,” and the presence of identifiable extremities seem to be major criteria for whether or not a being can justifiably be killed for the convenience of another, I have to ask–do you eat meat? (For the record, I do.)

          • hr
            May 21, 2014 at 1:03 pm #

            Oh, did I forget to add that a baby has a soul? That a human has value because he/she is unique/ set apart from all other forms of life in that he/she is made in the image of God?

          • Alcharisi
            May 21, 2014 at 1:18 pm #

            So argue THAT. Recognize, by the way that that argument has no LEGAL merit.* But if you are making a moral, religiously grounded argument, stick to that. And be prepared to give supporting evidence BESIDES Gen. 1:26-28–especially given that a number of Scripturally serious traditions have NOT interpreted those verses to mean that a human fetus is ensouled at the very point that sperm meets egg.

            *in a secular and/or religiously pluralist legal system such as most commenters here live under.

          • May 21, 2014 at 4:08 pm #

            Uh huh. Sure. Then God is the greatest abortionist of them all, because 50-80% of blastocysts fail to implant and are washed out before a woman even becomes pregnant. So if your god has no issues with abortion, why should you?

          • The Computer Ate My Nym
            May 21, 2014 at 4:15 pm #

            Oh, did I forget to add that a baby has a soul?

            What’s your evidence for that?

          • hr
            May 18, 2014 at 2:20 pm #

            Another couple things: first, the issue of poor children does not excuse abortion. Two wrongs never make a right. Second, how are pictures of aborted babies “fear and intimidation”? All they do is show the simple truth of what happens during an abortion. Of course pro-abortionists protest the pictures, it’s pretty hard to convince women that it’s “just a clump of cells” when they can clearly see fingers and toes and dismembered limbs and the truth that it’s actually a baby.

          • hr
            May 18, 2014 at 5:50 pm #

            Why were my two replies here removed?

          • hr
            May 16, 2014 at 11:56 pm #

   scroll down to the end of this post and look at the pictures. Tell me that’s not barbaric.

          • May 17, 2014 at 8:34 pm #

            Fear and intimidation have historically been some of the most powerful tools to push an agenda. When people are unlikely to hop on board with a cause, it’s time to find some way to manipulate the masses. Fear is a great way to do so. This fear is reinforced through the “pro-life” movement’s violence and threats to eliminate life-saving health care services for women. It makes pro-choicers in targeted communities scared to go to work, scared to do their job, scared to help women. Intimidation is used every time they march onto a college campus with their enormous fake photos of dead bloody fetuses screaming that “abortion is murder”.

            I remember in college, one of these groups came to my school with 8 foot tall posters, screaming and hollering, setting up thousands of white crosses on the lawn to signify the “dead” unborn. Women on campus who had had an abortion (1/3 of women will in their lifetime) spoke up angrily and vocally. The scene was brutal. Within the first hour, 2 fist fights had broken out and the police were summoned. How can a cause claim to be pure of heart when it channels an undercurrent of emotional and physical violence everywhere it goes?

      • Guest
        May 17, 2014 at 1:59 am #

        Didn’t read his comparison that way at all. And, um, abortion happens to be a whole lot worse (at least for the baby) than being stabbed. Most stabbing victims survive, and well, 99.9% of aborted babies do not. And dismemberment is a pretty horrific way to go… Also, for the record, only 21 states have restrictions on abortion after viability; depending on geography, a 37 week baby could be electively “terminated.” Think on that for a little while…

        • May 17, 2014 at 8:32 pm #

          They aren’t babies they are fetuses.

          • anonymity@@
            May 18, 2014 at 6:17 pm #

            So, we suddenly care deeply 30 seconds after birth but don’t give a damn 30 seconds before?

  12. Hannah
    May 15, 2014 at 6:53 pm #

    The “government” in the UK is irrevocably in the medical aspects of birth, as it is in any other aspect of healthcare. NICE is strictly independent of the government, now, and was never really under political control, but leaving that quibble aside it produces guidance on all aspects of you healthcare from how you should have your blood pressure managed to what cancer treatments you can access. It does indeed also issue guidance on contraception (although not recommending afp, you’ll be happy to learn) and early miscarriage (recommending expectant management):!topicsummary

  13. pettelly
    May 15, 2014 at 3:29 pm #

    First, this is NOT a govt decision but draft guidelines developed by NICE, an independent organization. Second, the idea is to INCREASE choice not to interfere with an individual woman’s decision. The LACK of involvement of the US government in health is fundamentally unethical, not guidelines being made by a public independent body – after all, women are pushed into hospital births in the US as they may not be able to afford a home birth which may not be covered by insurance. Or, if in hospital, they may not be able to afford the co-pays involved in an epidural. Increasing choice is a good thing. You just don’t like what they said about home births. If they’d had said that home births should be discouraged, you’d be cheering them on.

    • pj
      May 15, 2014 at 5:19 pm #

      I usually like Dr Amy’s writing a lot, but in this case I think she is dead wrong–factually and philosophically.

      • NoLongerCrunching
        May 15, 2014 at 6:46 pm #

        How so? I thought these were brilliant analogies.

        • pj
          May 15, 2014 at 8:43 pm #

          First, she is claiming recommendations made by NICE (a body independent of government) are a reflection of government policy. Second (as I explain in the comment directly below this one) I don’t believe there is anything inherently wrong with government encouraging women to choose certain healthcare choices (which is not to say all choices are appropriate for the government to encourage).

          • pj
            May 15, 2014 at 9:02 pm #

            Wait–the NICE guidelines have not even reached the level of “recommendations” yet.

          • Sue
            May 16, 2014 at 2:38 am #

            There is definitely scope for COIs in medical guidelines that are philosophical rather than financial – people at the end of their careers often join guidelines-writing groups because they have the time. There are certainly guidelines in both cardiology and acute stroke that do not reflect the current evidence objectively.

            Certainly the NHS is often admired externally by its ability to contain costs. It’s hard to know whether the UK HB system reflects cost-cutting or local tradition – or perhaps both.

            If they are using evidence from the UK Birthplace study, they will need to take no first-timers and have a really tight risk-out and high transfer rate.

          • pettelly
            May 16, 2014 at 10:28 am #

            That’s exactly what the NICE guidelines say. That homebirth is as safe as hospital birth for low risk multiparous women. Not for first births and that women should be counselled regarding the risks. You also need the whole service to be fully integrated with the hospitals to allow efficient and fast transfers. Home birth isn’t my thing personally but I can see how this could be a safe option.

          • Amy Tuteur, MD
            May 15, 2014 at 9:53 pm #

            I am aware of the difference between NICE and the government, but in this case I believe they are working hand in glove to promote homebirth because they think it will save money and because it is easier to pander to midwives by offering them homebirth than to pay to hire more midwives.

          • Beth S
            May 15, 2014 at 9:57 pm #

            I understood that to be what you were saying. I wish there was a way to kind of form a hybrid of our current system and the UKs system.
            Oh and this is OT but thank you so much for your blog, you and the moms and dads and friends here made me feel so much better about the choices I made for my birth and recovery. When one of the ladies in my birth club makes someone feel guilty about their choices I send them here.

          • pj
            May 15, 2014 at 10:20 pm #

            Wait, you are accusing NICE and the British government of corruption?!

          • Pettelly
            May 15, 2014 at 11:08 pm #

            Do you have any evidence of this apparent abuse of power other than you don’t like the NICE guidelines and can’t accept that they may reach different conclusions to you? You wouldn’t be making such ridiculous claims if you happened to agree with them. This reminds me of the anti-vaxers claiming that the CDC is in cahoots with big pharma because they don’t like what they say about vaccines being safe.

    • Guesteleh
      May 15, 2014 at 5:19 pm #

      Or, if in hospital, they may not be able to afford the co-pays involved in an epidural.

      Actually, pretty much any woman in the U.S. who wants an epidural will get one. The Emergency Medical Treatment & Labor Act (EMTALA) mandates that any woman in labor who shows up at the hospital must be treated and that would include appropriate pain meds.

      Also wanted to point out that the US government is heavily involved in healthcare, as a regulator, as a provider (via Medicaid, Medicare and the VA system) and as a funder of research. It’s not the same model as socialized medicine in other nations but it’s not true that the U.S. government isn’t involved at all.

      • Guesteleh
        May 15, 2014 at 5:26 pm #

        Having said that, this post unfortunately reminds me of this sign:

        • Young CC Prof
          May 15, 2014 at 5:35 pm #

          I was also thinking of that famous line. Yes, the question is not whether government should be involved in medicine, but HOW.

          • Jessica S.
            May 15, 2014 at 10:58 pm #

            During the ramp up to the ACA, I read a blog that talked about the difference between covert and overt rationing, the point being that health care is already rationed, but covertly and not equally. So it’s not a matter of whether or not, but in which manner.

        • Jessica S.
          May 15, 2014 at 10:55 pm #

          That sign is troubling, both for logic and spelling fails. :/

      • pettelly
        May 15, 2014 at 5:38 pm #

        I have a friend who is a graduate student in the US. She is insured but has a high deductible and co-pays. She did not get an epidural during her birth because she was worried about the cost. It’s not the uninsured or indigent. It’s the under-insured and those with some assets but not enough. Cost IS a factor in many American women’s healthcare decisions unless you’re so poor that you’ve got nothing or you’re wealthy enough that it doesn’t matter. Not great choice.

        Of course the US govt is involved. It picks up a lot of the tab (public spending on health is actually MORE than in the UK, same % of GDP) but doesn’t really get to say what it spends it on and how cost-effective those spending decisions are. The system is bonkers!

        • Young CC Prof
          May 15, 2014 at 5:46 pm #

          Remember when Congress voted to deny Medicare the right to negotiate drug costs? The US lost so much that day!

          You know, what if we gathered up all the healthcare transaction cost money in the USA (Insurance companies, billers and coders, advertising, gatekeeping, processing, etc) and eliminated most of it through a more unified system. Then, what if we actually started considering cost effectiveness, just a little, and negotiated at a national level the prices of drugs and devices? Then, what if we turned around and poured all that saving back into actual health care?

          With those two things, I think we could give everyone in the country the level of care currently enjoyed by citizens with reasonably good private insurance.

          • bunny323
            May 15, 2014 at 9:07 pm #

            You would have a nationalized health care system/rationing as a means to control cost. See the USSR, Venezuela (price controls on everything), and Cuba for what would happen. Only Elites/connected would have decent care. Industry/innovation would grind to a halt – companies aren’t in business to provide a free service. For an example closer to home, see the current VA scandal where people were denied appointments. Plus, you would no longer be treated as an individual but a statistic. (see women in their 40s that get breast cancer). And yes, epidurals would be a thing of the past. They cost too much.

          • DaisyGrrl
            May 15, 2014 at 9:14 pm #

            Or, you would have a nationalized health care system like Canada, the UK, Australia, etc. where we have much lower administrative costs relative to the total cost of delivering health care. Women in these countries can still generally access epidurals (inability to access an epidural usually has more to do with staffing/location than a specific gov’t decision to limit epidurals).

          • Beth S
            May 15, 2014 at 9:25 pm #

            But we get epidurals here whether we have insurance or not. The only reason I’ve heard of someone who wanted an epidural here and not getting one was me, and that was because I was in an ambulance, so it was understandable (first pregnancy).
            Even if you don’t have insurance hospitals have to take you, there’s no way for them not to, they may stabilize you and transfer out, but in my city there are four hospitals that deliver babies, the others don’t.
            Not to mention around here most pregnant women get health care through Medicaid. The income brackets are much different than for normal Medicaid even in states that didn’t expand it.

          • Young CC Prof
            May 15, 2014 at 9:31 pm #

            I’m pretty much picturing a national health system WITH that much money poured into it, which wouldn’t eliminate all rationing, but would allow pretty generous care for everyone.

          • pj
            May 15, 2014 at 9:44 pm #

            I understand Cuba actually has an excellent healthcare system–no doubt not comparable to a first world country, but remarkable given its poverty and isolation. Not sure why you think third-world countries are a useful analogue here anyway.

          • Jessica S.
            May 15, 2014 at 10:51 pm #

            You’re absolutely correct. Especially if you take into considers risk what our embargo does to their economy, it’s even more impressive what Cuba has accomplished. But every government needs a boogeyman.

          • Trixie
            May 15, 2014 at 11:10 pm #

            My friend who risked his life to escape from Cuba would disagree about the quality and availability of medical care to the non-elite. In his words, it’s easy to give people free health care when there’s no health care to give. His mom gave birth to twins and what happened to her was apparently barbaric.

          • prolifefeminist
            May 15, 2014 at 11:56 pm #

            I’ve heard the same thing from my Cuban friends. If you’re not one of the elite, forget about getting anything that approaches modern care.

          • Sue
            May 16, 2014 at 2:32 am #

            Colleagues of mine who recently went to a medical conference in Cuba say the same – whatever glories the Cuban health system may have had,t hey don;t appear to be there now, and they seem to be very evasive about showing any outsiders the facilities.

          • Trixie
            May 16, 2014 at 9:50 am #

            Yeah. They show the foreigners like the one hospital in Havana where things are semi-functional and that nobody who is nobody is allowed to go to.

          • AmyP
            May 15, 2014 at 11:28 pm #

            Eh–they’re Soviet-trained.

            Anybody here want to be treated in a Russian hospital?

            (To give them their due, Fyodorov did some amazing pioneering stuff with eye surgery.)


          • Kory Oransky
            May 16, 2014 at 7:41 pm #

            Cuba’s health care system sucks.

            Fidel Castro and Hugo Chavez both got cancer. Fidel went to Spain to get treated. Hugo went to Cuba, for what was a very treatable cancer (Brazil’s president begged him not to go to Havana, and offered to arrange treatment in Sao Paulo.)

            Guess who’s still alive.

          • auntbea
            May 16, 2014 at 9:41 am #

            1) The USSR does not exist anymore. 2) The examples you are giving are of three notoriously dysfunctional states. There are plenty of well-governed, wealthy countries with nationalized healthcare (and plenty of poorly governed states without). Implementing a single-payer system is not going to suddenly erase 100 years of economic growth and install a shiny new autocratic leader.

          • prolifefeminist
            May 15, 2014 at 11:52 pm #

            “You know, what if we gathered up all the healthcare transaction cost money in the USA (Insurance companies, billers and coders, advertising, gatekeeping, processing, etc) and eliminated most of it through a more unified system.”

            ^^ This, x10000

            Insurance companies (and all the hangers-on that come with them) add NO VALUE to the healthcare system. They exist only to make money and to risk people out, so they can keep on making money.

            It’s a tremendous waste. Like it or not, health care is a finite resource, and every dollar given to health care bureaucracies is one less dollar that’s spent on actual health care. US insurance companies ration care just as much as socialized systems do, except instead of rationing it to everyone across the board, they ration care based on how much money you have. More money = better insurance = more services made available to you. I fail to see the justice in that.

        • AmyP
          May 15, 2014 at 9:37 pm #

          It’s odd she wasn’t on Medicaid.

          Was her income too high?

          • Pettelly
            May 15, 2014 at 10:59 pm #

            Yes. The income level for Medicaid is very low. This was an insured person who was on a budget and didn’t want to have to beg the hospital for charity.

        • Beth S
          May 15, 2014 at 9:47 pm #

          I wish underinsured women would ask hospitals about the programs they have to help those who can’t pay their full bill. It’s a tax write off for them and most hospitals will try to work with you to get you the care you need, even if it’s just setting up payment plans. I agree the system is bonkers, especially wasteful spending and medical malpractice laws. There is a need for a huge overhaul of the system, I just don’t know personally if a single payer system is right for us either. I wish there were a happy medium that wasn’t the absolute cluster of the ACA.

          • AmyP
            May 15, 2014 at 11:23 pm #

            Hospital billing offices can be surprisingly helpful and compassionate if you go to them, explain your situation, and do the appropriate paperwork.

            A Type 1 diabetic friend of mine had a $10k hospital bill forgiven by a US hospital after she went into ketoacidosis and had an ER visit and a short intensive care stay. They saved her life. (She was an Eastern European visiting the US for medical treatment about 8 years ago.)

            Thank you, Georgetown University Hospital!

          • Beth S
            May 16, 2014 at 12:09 am #

            Yeah, when I had the car wreck that ended up with me having hardware in some of my bones my bill was huge, something like 100k when all was said and done. But that included surgery, intensive care, meds, a three week hospital stay, and initial hospital PT, the billing office ladies I dealt with were some of the sweetest women in the world, and between the aid programs, the write off, and payment plans I was able to pay the bill off within five years or so. All thanks to the University of Louisville hospital.

        • auntbea
          May 16, 2014 at 9:32 am #

          Sure it does. There are plenty of things that Medicare won’t fund, and plenty of things it won’t pay more than X dollars for. If a hospital performs those procedures on an uninsured patient, they eat the cost.

    • auntbea
      May 16, 2014 at 9:29 am #

      Government is not in the business of increasing choice. It is in the business of maximizing public welfare, while (hopefully) not infringing on choice too much. The statement that increasing choice is a good thing is silly on its face — the government should not be increasing choice as to whether people pay taxes, or stop at stop signs, or dump their medical waste in the local estuary. Encouraging homebirth is bad governance because it trades short-term savings for long-term welfare losses — in other words, it does the opposite of what government policy should do.

  14. pj
    May 15, 2014 at 1:58 pm #

    I actually disagree with much of the underlying premise of this article. Governments regulate the kinds of healthcare choices that are available all the time. It would be impossible to have an effective healthcare system if they didn’t. Personally, I’d have no problem with a government discouraging (although not banning) women from homebirthing if the practice was compromising the safety of women and babies. I’d have no problem with it discouraging unassisted childbirth for the same reason. The problem with governments encouraging homebirth (and it’s debatable whether that’s even happening here) is that it is rooted in a prevailing attitude that pain in childbirth is somehow less deserving of proper management than other pain, plus there are safety issues.

    • GuestS
      May 15, 2014 at 3:02 pm #

      I think this is one of those cases of over stating the argument. Totally agree with your statement that this belies an attitude where childbirth isn’t taken seriously as it’s a women’s issue, but the rest of the underlying premise is pretty hyperbolic. Especially given that it’s only based on NICE recommendatations and nobody in government (although, actually, it’s local healthcare authorities who would be the key players) have made any sort of statement about it…yet.

      • pettelly
        May 15, 2014 at 3:53 pm #

        And they’re actually only draft recommendations so could still be changed after stakeholder input

    • pettelly
      May 15, 2014 at 3:54 pm #

      If you read the report, you’ll see that it’s based on reported patient satisfaction. There may be cultural reasons why women report satisfaction with unmedicated births (presumably by choice, I don’t think satisafaction is derived from being denied requested pain relief) but that’s what’s been reported.

  15. Sarah
    May 15, 2014 at 1:52 pm #

    I think your opposition to government control of birth is overstated. In my state, CPMs are not allowed to practice, and only CNMs are allowed to attend births. This is an example of a government regulation, based in evidence that does indeed limit women’s autonomy for the purposes of public health.

    The issue is not government regulation, but what kind of regulation and whether it is based in evidence or woo.

  16. May 15, 2014 at 1:44 pm #

    I am going to further grumble at this: On a government website – declaring “increased rates of homebirth could save the health care system a great deal of money”… or a few disasters and those increased rates could cost the system a great deal of money indeed.

  17. mollyb
    May 15, 2014 at 1:38 pm #

    Or, as I always say, I love NFP. I wouldn’t have my beautiful Irish twins if it wasn’t for NFP. 😉

    • Young CC Prof
      May 15, 2014 at 1:43 pm #

      I’ve always thought that NFP works better when used as an aid to conception than as a way of avoiding it.

      • Trixie
        May 15, 2014 at 2:39 pm #

        If you’re very regular, and extremely good at abstaining at the time when sex is most pleasurable, it can work. Big ifs, though. And, if your cycles are like mine, short, about 24 days, and you ovulate around day 10, assuming you don’t want to have sex during your 5 day period, NFP leaves you with about a 12-13 day stretch of abstinence every cycle, or about half of your life. Vs. an IUD that shortens or eliminates your period entirely, and lets you have sex whenever, and is more effective at preventing pregnancy.

      • Beth S
        May 15, 2014 at 9:54 pm #

        I was always taught that too. However when I chose my birth control this time I went for the permanent sort a tubal. I’ve had problems with most hormonal birth controls, I’m allergic to most brands of condoms because of the latex, and my IUD fell out leading to this pregnancy so for me, especially since I was open on the table, I just said end it, now.

    • attitude devant
      May 15, 2014 at 1:48 pm #

      I had a lovely patient whose name if I repeated it here would instantly identify her as Irish Catholic. The archdiocese where we both lived was famously conservative and contraception was loudly decried by the Church, even more loudly than in some other regions. Anyway, this lovely lady had very irregular cycles and therefor NFP was not a great choice for her, but she gamely tried it. And promptly got pregnant. Twice.

      Being a good Catholic lady she cheerfully bore both children, and indeed she was and is an excellent wife and mother, but at her second post-partum visit broke down in tears: how was she going to prevent a third pregnancy, and how did all the other women in her parish limit their children to the one or two she saw them bringing to Mass every Sunday? Well, I broke the news to her, that all those other women were probably using contraception. She was irate; felt she’d been sold a bill of goods. I put her in touch with a family friend, an ex-priest who carefully outlined a more liberal theological attitude for her.

      And she started on Ortho-Novum 7/7/7 and that was how she stopped at two.

    • The Computer Ate My Nym
      May 15, 2014 at 2:16 pm #

      Heh. My (Catholic) grandmother had Irish twins (my father and aunt) within two years of her marriage. Two babies in diapers in the depression was enough to convince her that if birth control was a sin it was a minor one compared to bearing children you couldn’t feed. Her third and final child came some 8 years later. A good 60 years later, she was still irate at any priest who preached against birth control in her hearing. I have a certain suspicion she and her sisters were the reason that her parish priest was always a liberal…

    • Ellen Mary
      May 15, 2014 at 3:53 pm #

      I use a form of NFP that is *highly* scientific and very effective, Marquette. It is 92% effective in typical use. It does require using a Clear Blue Easy Fertility Monitor, which is $155 retail. It provides nearly real time access to an OB/Gyn who developed the method.

      NFP can be very effective, however many women do not use it correctly, do not understand the method, are not in relationships where they have 100% control over the timing of intercourse, etc. I am also often frustrated in my NFP support groups when women insist that mucus only methods are as effective as mucus plus hard data methods and then, quite predictably, wind up pregnant.

      But NFP is NOT the rhythm method anymore. I agree with Dr. Amy’s point in this article, that there is a large gulf between perfect use and typical use with NFP, however comments like ‘NFP only works to achieve pregnancy’ or ‘NFP only works if you are not fertile’ are not accurate.

      Another interesting thing about NFP, is that the women who are the best at rigorously collecting & interpreting data on their cycle are the least likely to procreate when they don’t want to . . .

      • Trixie
        May 15, 2014 at 11:12 pm #

        92% is a pretty crappy level of effectiveness, unless you’re in a relationship where you don’t really care if you have more kids.

        • Hannah
          May 16, 2014 at 2:10 pm #

          As a typical use effectiveness rate it compares favourably with both the pill and condoms alone, though:

        • Ellen Mary
          May 16, 2014 at 3:31 pm #

          Well then a LOT of women have to switch to an IUD or Implant from Combined Oral Contraceptives . . .

          • fiftyfifty1
            May 17, 2014 at 9:43 am #

            Exactly, and a lot of them do just that (or sterilization) when they want or need a better success rate.

      • anh
        May 16, 2014 at 3:25 am #

        92% is nowhere near highly effective. I am married and want more children, but even I’d be terrified by that failure rate. (shudders)

        • Ellen Mary
          May 16, 2014 at 3:29 pm #

          If you want a better typical use effectiveness than 92% you would basically need to choose an IUD, an implant, or Sterilization. Even Depo Provera injections only have a 94% typical use effectiveness. You can quibble with whether you think the sample size of Marquette studies was sufficiently large to determine typical use of 92% but if your are terrified of 92% effectiveness, you might be overestimating the typical use effectiveness of most FDA approved methods.

          I really need to space my next child at least 9 months from my Cesarean, beyond that, I am not terrified of conception in general . . . Especially since via this blog, I have freed myself to seek the absolute best OB care accessible to me. I took a class through Cousera/UCSF School of Nursing on Contraception and they talked about combining methods for increased effectiveness. In my case, I am combining LAM (as my cycles have not returned PP) and Marquette to achieve greater than 92% . . . This post was all about having choices, I can CHOOSE to trade convenience and a higher effectiveness of an IUD/S for freedom from risks associated with an IUD/S.

          I wouldn’t want anyone to overestimate the typical use effectiveness of their method though. I have heard on here that the Combined Oral Contraceptive Pill is 99% effective and that is quite far from the truth.

          I consulted with my OB/GYN on my choice of method, we discussed how it had a similar typical use effectiveness as the Pill and she agreed it was a reasonable choice for me . . .

          • anh
            May 16, 2014 at 3:55 pm #

            I really hope I didn’t come across as judgmental. If NFP works for you, that’s great! I just think for most people a 92% rate would be really frightening.

            I opted for a copper IUD because my career couldn’t handle an unexpected pregnancy (nor could I)

            However, I there are many birth control methods that are much more effective than 92%. Nuva ring (which is really hard to screw up) is more than 99% effective.

            even withdrawal has been shown to be around 97% effective.

          • Ellen Mary
            May 16, 2014 at 8:40 pm #

            According to the CDC chart I posted, Nuva Ring is 91% effective in typical use. Withdrawl is 78% effective, not that different than condoms, but a little bit . . .

            I definitely understand not being able to tolerate an effectiveness rate under 99% though, I got VERY scared of accidental pregnancy after my Cesarean, and briefly considered each of the IUDs . . . But adding the monitor to NFP increased my confidence substantially.

          • anh
            May 17, 2014 at 4:58 am #

            I’m not seeing a CDC chart you posted?

          • anh
            May 17, 2014 at 5:06 am #

            if you’re citing the “effectiveness of family planning methods graphic” then sure, nuvaring is 88-94% effective with typical use and withdrawal is still 78% effectice WITH TYPICAL USE.
            most people I know who care about family planning use their methods with ideal use.
            you seem to be comparing ideal use of NFP with sloppy typical use of other methods to deduce your method is superior. but that’s shoddy logic.

          • fiftyfifty1
            May 17, 2014 at 10:03 am #

            “you seem to be comparing ideal use of NFP with sloppy typical use of other methods to deduce your method is superior. but that’s shoddy logic.”

            Exactly! That has been the problem with much of NFP research. Women who plan to use NFP but then have sex during their fertile days and fall pregnant are sometimes thrown out of NFP studies with the argument that “well if they had sex on their fertile days then they weren’t really using NFP”. But that is completely unfair because no other method does this. For example when typical use rates were determined for Depo Provera, they kept ALL the women who started Depo in the study. Even if a woman decided not to continue Depo and never got another shot and went on to have unprotected sex for the rest of the year she was still counted as “being on Depo” even when she wasn’t.

            What Ellen Mary doesn’t seem to understand (although it has been explained to her more than once) is that typical failure rates are only an average. Just because the average score on a chemistry test is 94% doesn’t mean your personal score will be 94%. If you are highly motivated and able and don’t have any complicating medical factors, what you should look at is the ideal rate.

          • Young CC Prof
            May 17, 2014 at 10:46 am #


            The drastic fall in teen pregnancies over the last 2 decades (50% drop, down to record lows) seems to be driven by three different but related factors. One, young people actually appear to be waiting a bit longer on average to become sexually active. Two, more sexually active teens are using contraception, and three, more of them are using contraception exactly as it was meant to be used (and some are using barrier and hormonal methods simultaneously).

          • fiftyfifty1
            May 17, 2014 at 12:52 pm #

            That and the arrival of 2 highly effective, reversible, long lasting contraception methods that do not rely at all on user motivation once they are in place: Nexplanon and the progestin-releasing IUDs (Mirena and Skylar). These have been wonderful for my patients in their teens and 20s. In our state there is a program that allows access to free family-planning services for almost everyone. You can sign up under what is known as “presumptive eligibility”. You sign up the day you arrive in clinic and the doctor or nurse practitioner can provide you with any birth control method you want for free for the next 60 days. You don’t have to show proof of income or even legal residency status. Even though Nexplanon and Mirena are expensive up front, they are still covered. There are so effective and last longer, so it is cost-effective in the end.

          • fiftyfifty1
            May 17, 2014 at 9:48 am #

            No one on here has claimed that the typical use effectiveness of the OCP is 99%. But that is indeed the perfect use rate. Some women are capable of perfect use or near perfect use, wouldn’t you say? If you didn’t believe your own rate of NFP was better than the typical 92% rate, I doubt you would be using in.

    • Jessica S.
      May 15, 2014 at 11:03 pm #

      Same with my husband and his younger sister! (And ONLY sibling, largely for that reason. ;))

  18. May 15, 2014 at 1:37 pm #

    It’s no different than when the then Minister of Health for British Columbia encouraged more homebirth in 2012. It was wrong then, it is wrong now. Equally abhorrent are policies designed to discourage patient choice cesareans. Women needgood quality information on the risks and benefits of their options and need to be facilitated to choose the best option for themselves in their particular circumstances. The last thing they need are barriers to exercising an informed and free choice.

    • Young CC Prof
      May 15, 2014 at 1:56 pm #

      There’s also the “twitch” theory:

      People make a lot of decisions in their lives, like a LOT of decisions. No one has enough time or mental energy to optimize all of them, so some of them are made off-the-cuff, or on the basis of simple heuristics like copying a friend’s choice. Again, this isn’t because people are stupid, it’s because there are too many choices and not enough time.

      Often, it doesn’t matter. Whether you buy the strawberry jelly or the grape isn’t going to affect anyone’s life much. However, other choices affect not just you but, in aggregate, society at large, like whether to vaccinate or how much to save for retirement.

      Governments and other groups worry a lot about how to change people’s minds. It’s near-impossible to get everyone to make the “right” choice, and you don’t want to remove too much freedom most of the time. However, you can influence a surprisingly large percentage of people just by making the “right” choice the default or slightly easier one, because not everyone cares all that much.

      Opt-out pension plans have considerably higher participation rates than opt-in ones, for example. Why would anyone not think about their pension? Because she just started a new job, and is thinking about the health insurance and tax paperwork, and the new-job responsibilities, and setting up childcare, and moving house, and six thousand other details.

      And when it comes to medical care, a large percentage of people will just do whatever the provider recommends, even if the recommendation is one valid choice among several.

      So, should home birth be the default choice? Or should we twitch women away from it, and leave it for the true believers only?

  19. pj
    May 15, 2014 at 12:49 pm #

    Are we talking about a “UK government decision to promote homebirth” or the NICE recommendations? They are not the same thing.

  20. Therese
    May 15, 2014 at 12:47 pm #

    I would hope nobody would actually claim that people have been using NFP for most of human history since the knowledge needed to successfully implement NFP was only discovered in the last century.

    • fiftyfifty1
      May 15, 2014 at 2:45 pm #

      You are right, withdrawl would have been a better example.

  21. T.
    May 15, 2014 at 12:02 pm #

    I have a question: what is the reason of the current UK baby boom?

  22. Zornorph
    May 15, 2014 at 11:48 am #

    I’m suddenly reminded of the Spoonerism that James Naughtie used to describe Jeremy Hunt (who is now the Heath Secretary).

    • Hannah
      May 15, 2014 at 1:23 pm #

      Now, I have a great many complaints with Jeremy Hunt, but this actually has nothing to do with him, as NICE is independent of the Department of Health:

      • Zornorph
        May 15, 2014 at 1:27 pm #

        Ah, I did not know that. So what minister has that portfolio?

        • pj
          May 15, 2014 at 1:46 pm #

          NICE is independent of the government.

          • attitude devant
            May 15, 2014 at 1:58 pm #

            So I went to the NICE website and read up, and now I’m REALLY confused. This is government funded but ‘independent’ and yet directs public health policy.

            And yet we have this NICE stance which seems to be based on…what, exactly? Because it’s BAD public health policy, at the very least.

          • pj
            May 15, 2014 at 2:02 pm #

            I think this is pretty normal under Westminster system governments.

          • attitude devant
            May 15, 2014 at 2:40 pm #

            “pretty normal under Westminster system governments.” Would you care to translate for an American audience?

          • DaisyGrrl
            May 15, 2014 at 9:10 pm #

            A not-so-brief primer on how it would work: in the Westminster system, the legislative and executive branches are much more closely linked. Our parliament is composed of members of parliament (MPs) who belong to various political parties. The party with the most seats forms the government, and the party leader is the prime minister. S/he appoints Ministers from among the party’s MPs who are responsible for different portfolios (kind of like your various Secretaries). The various government departments take policy direction from their Minister, who is accountable to parliament for the actions of the department.

            Arms-length government organizations like NICE do not take instructions directly from a Minister. They are often governed by a board of directors who are appointed by the Minister for a fixed term and the head of such an organization reports to the board. Policy direction is determined within the organization without any direct input from the Minister. Basically, the Minister’s role is limited to making sure the money needed to run the organization is in place, periodically appointing board members, and ensuring that reporting requirements are met. A Minister giving policy direction to such an organization is Not Done. In theory, if such a thing were found to be happening there would be resignations all round.

            So, money comes from parliament, but any position taken by an organization like NICE is not necessarily reflective of the priorities of the government of the day.

          • attitude devant
            May 15, 2014 at 2:43 pm #

            Still puzzling. Stateside, when we talk about a government agency, we mean any agency wholly funded by the government. Am I to take you to say that this is (by that American parlance) a government agency, but non-partisan, meaning not under the purview of elected officials? So NICE is like our CDC or FDA?

          • pj
            May 15, 2014 at 3:01 pm #

            Well, I am not British, but I simply understand it to be an independent agency (so no, not a government agency) that is funded by the government. I don’t see an inherent problem with an independent agency being funded by government. It’s what I’m used to and in my experience it works, although I can understand your suspicion. I guess it is a cultural difference, in the same way that it might seem odd to an American that public servants in a Westminster system are expected to leave behind their personal political views and be apolitical in their professional life as government advisors.

          • pj
            May 15, 2014 at 3:18 pm #

            Sorry, I don’t know enough about how the CDC or FDA work to know if they are the same, but from the little I know they are comparable.

          • Hannah
            May 15, 2014 at 3:10 pm #

            It’s role was set by statute but it was cut loose from government control in 2013 due to health care reforms. I believe it’s broadly government funded but also contracts work to businesses and foreign governments.

            See this article in the New York Times from 2008, for more on NICE and it’s history:


          • auntbea
            May 16, 2014 at 10:04 am #

            It just means that the head of the agency can’t be easily dismissed by the president. They then aren’t (as) beholden to satisfying public opinion and/or currying favor in order to keep their jobs. The CDC and FDA are NOT independent agencies, as they operate under the purview of the Department of Health and Human services, whose head is a member of the president’s cabinet and can be fired at will. Examples of independent agencies include the postal service, the Fed, and the EPA.

          • AmyP
            May 15, 2014 at 5:14 pm #

            I guess it’s like the Federal Reserve? Kinda public, kinda private?

        • Hannah
          May 15, 2014 at 2:33 pm #

          None. NICE is a non-departmental body, as of 2013 (and even before then ministers would have had little to no input into its day to day operational decisions), so there is no minister in charge:

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