Homebirth advocates, here’s your chance to prove me wrong!

Don't miss your chance

Homebirth kills babies.

Homebirth advocates are well aware of this, and they have a convenient fiction at the ready to combat it. It goes something like this:

Sure babies (and mothers) die at homebirth who could have been saved in the hospital, but that’s dwarfed by the number of babies (and mothers) who die because of hospital interventions and would be alive today if they had simply had an unhindered birth at home.

Therefore, I think it is only fair to allow homebirth advocates to list those who died of interventions as a counterpoint to my many posts about the babies and mothers who died because they were far from the hospital.

There must be an extraordinary number of them if the death rate from childbirth interventions exceeds the death rate at homebirth. Homebirth represents less than 1% of US births, so if the death rate in the hospital were higher, there would need to be nearly 100 intervention related deaths for every homebirth death.

If homebirth advocates are correct, we can expect hundreds of comments about thousands of intervention related deaths. That could be humiliating for me.

Of course if they are wrong, that could be humiliating for them.

So have at it homebirth advocates. Here’s your big chance. Let the world know about all those babies and women who die because of childbirth interventions. Tell their stories. Prove your point…

… if you can.

  • Lioness

    you can google hospital disasters as well as the next one. clearly your post is not actually looking for an answer. A very quick google search brought me lists of disasters that occured in hospitals. checking more specifically under various interventions, starting with vacuum delivery I found a 4-6 per thousand neonatal mortality rate from use fo vaccuum. the maternal mortality statistics you yourself posted indicated approximately 19 anesthesia- related maternal deaths a year. haven’t yet looked for mortality rates for other interventions. but then again, you aren’t really asking a question. i suppose i’m looking this up for myself then, not you. Congratulations, you have made me friendlier to homebirth.

    • Stacy48918

      Come on, just one? One specific example of a preventable death due to a hospital intervention. Should be easy if you got lists and lists.

      So the death rate with vacuum delivery is high – if the birth is obstructed already who says it was the vacuum that killed the baby? So you clearly support more C-sections, right? Because that’s the alternative to vacuum deliveries.

      19 anesthesia related maternal deaths. And these would be 100% preventable at home? How would a midwife prevent an amniotic fluid embolism in a woman having a C-section for complete placenta previa? (actual case in MA this year)

      Please, enlighten us. Since you clearly state that you can.

      • Lionesss

        agreed; AFE is unpreventable. As for those anesthesia related deaths, we dont have more data as to what type of anesthesia or what the surgical procedure was, or what the indications were. But we do know that they were listed separately from the underlying medical conditions, it is entirely possible that anesthesia alone was the culprit. i myself know someone who died in a dental office chair from anesthesia. (although thats not a maternity case. )As for vacuum, vacuum is routinely performed not only when the fetus is in distress. your response sounds very similar to homebirth denialists- “how do you know the same thing woudn’t have happened in a hospital?”

        • same guest

          Please, just one clear example.

          • Lioness

            oh, you mean you want an eyewitness story complete with all the gory details? no, since I wasn’t there, I can’t provide that. but that is hardly a scientific approach.

          • sameguest

            You said you had a list. Please share one example of a death directly caused by a childbirth intervention.

          • Lioness

            I just shared with you an entire study; what would one case prove? your approach is hardly scientific. but since you are so insistent here’s one: http://nypost.com/2013/02/10/bronx-woman-died-after-childbirth-due-to-botched-placenta-removal-lawsuit/

          • Young CC Prof

            That’s definitely hospital incompetence, but it looks more like failure to rescue than hospital actually killing her. In other words, her placenta fell apart. She would still have died without care.

          • Stacy48918

            Yea, no.

            Retained placenta cannot be prevented at homebirth and midwives cannot manage them at home either. This woman would have needed hospital care anyway. This is possible malpractice just a if a sponge was left behind after appendectomy. The intervention was necessary.

            Thanks for playing.

          • sameguest

            Thank you, come again.

          • Stacy48918

            Right, because the science clearly shows that low risk babies are much more likely to die at homebirth. Dr. Amy was just giving NCB folks like you a chance at providing some anecdata to “bolster” your argument. And you can’t even do that.

        • Expat

          The vacuum is used when the baby is stuck in the birth canal. That is pretty distressing. They don’t use it just for fun. Mine was stuck for a long time and eventually twisted and came out vaginally, but he was the worse for wear. A cesarean would’ve been better for him.

          • Lioness

            Sometimes a vaccuum is the only solution but very often a vaccuum is used merely because labor is taking longer than expected- whatever expected happens to mean. My Dr. wanted to do a vaccuum on me, but the nurse convinced her (and me) to wait just a bit longer.

    • Beth S

      I’ve worked in two of the four hospitals that deliver babies in my hometown, as well as kept up with news about the other two when I was trying to decide where I was going to have my third child. In those four hospitals in the last ten years I’ve heard of one disaster a baby being decapitated because they forgot to remove a cerclage. This happened at the crunchiest, NCB friendly hospital in the city. However there was also a systemic change within that system where women with higher risk pregnancies were delivered at the hospital downtown where there is a NICU, not to mention the hospital is physically connected to the local children’s hospital.
      Show me in the homebirth movement where there are reviews and systemic changes in response to preventable disasters? Oh that’s right you can’t because homebirth midwives would rather bury these stories and the preventable deaths and injuries caused by their own incompetence. #notburiedtwice

  • RNMomma

    I’m not against hospital care or interventions, but I heard a crazy story today. A friend of a friend gave birth two weeks ago. She was dilated 6cm when they attempted several times to get an epidural placed. They thought they had it in the right spot and pushed the meds. She then coded because it was in her CSF! They had to use the defibrillator twice, but she was out for about two minutes and then they were able to successfully revive her. Crazy part is they were still expecting her to deliver vaginally after all that!!! FHTs took a dip a little later so they did a section. Can you imagine though? Who wants to bet mom is either adopting or going for a natural VBAC after that.

    Not a death of either (baby so far seems healthy), thank goodness, but definitely came close.

    • theadequatemother

      And that is why when you place an epidural catheter you need to aspirate, give a test dose and then load it incrementally with care. Glad she and baby are alright.

      • RNMomma

        I know they did a test dose… She felt her legs go a little numb. I’m glad everything ended up alright too!

    • Anna T

      I’ve actually heard plenty of personal accounts of epidural horrors. Not anything as insane as what you described, but stories of badly placed epidurals, ineffective epidurals, epidurals which caused debilitating back pains and headaches. Not something anyone would die from, but it just figures that, as epidurals are placed by human beings, there is some margin of error. So in my eyes, there is nothing crazy about wanting to avoid one.

      • Expat

        It is crazy if you are shrieking in pain at 4 cm and doing it because you want an NCB medal.

        • RNMomma

          Yeah, I’m not for experiencing torturous pain just so I can prove something (my birth attendant told me she’s seen women crying in the fetal position on the floor from the pain… She would assume they were close to transition, but they would only be at a 4 or 5), That’s why I don’t run marathons with my husband. He loves them though. Weirdo.

          Anyway, I’d want to avoid an epidural for my next one if I felt like I was in a good place (if it’s crazy back labor like this first one, count me in). But that’s me. Everyone handles labor differently. So long as you aren’t going med free because you’d feel guilty if you didn’t.

    • Susan

      That’s scary. I haven’t heard of one that bad and I have seen a lot. I know it’s theoretically possible and part of the informed consent. I have had leaks where we needed some O2 and to turn it off. And I heard of one where the mom needed to be bagged. I guess too much Marcaine could cause an arrhythmia but wouldn’t that be if it were in the bloodstream? I’d like to hear what Adequate Mother has to say about it. Usually they do a test dose, and the test dose is supposed to rule out being in the bloodstream or inadvertent spinal. All invasive procedures do have risks, and I think that’s a valid reason for a patient to decide to go med free, if the very small, but real, risks are not worth it to her. I know that’s how I felt, I had nothing against epidurals but I really didn’t want all the paraphernalia and monitoring that goes with one. Didn’t want the IV, sat monitor, foley, frequent BPs, and it is nice the way mom’s without an epidural tend to have an easier recovery in terms of getting up a little quicker. None of those are reasons for every person, and to me, agonizing pain with no end in sight would have been a good reason to get one. But, I am not hard core either way, whatever’s right for the individual.

      • RNMomma

        Yeah, super scary, but thankfully rare. I was told they did do a test dose that indicated things were good, but they also had previously done multiple attempts before they got that one (hubby passed out watching). Not sure what went wrong exactly.

  • C T

    Hi, I just had a successful induction 11 days ago and have a healthy little–OK, nearly nine pounds so not that little–girl. She’s wonderful, and I’ll be taking a break from reading this blog for a while to take care of her.

    While nearly everything about the induction was fine or even awesome (the efficacy of peanut-shaped birth balls was proven to me when the labor nurse used one to help my baby rotate so that she finally went from -2 to being born in three contractions, and I’m now a big fan of Fentanyl :) ), there was one thing that was done wrong.

    When they inserted the IUPC (intrauterine pressure catheter) after doing an amniotomy, either the doctor or the nurse forgot to remove the insertion sleeve. I had a semi-rigid plastic stick poking up into my cervix for nearly two hours. Luckily, since I did not have an epidural, I could feel that something was “in there” and avoided ignorantly injuring myself or my baby by sitting on the IUPC insertion sleeve wrong. My OB did not have a happy look on her face when she saw that insertion sleeve in my vagina during a check.

    I looked up IUPCs on the internet afterward and found out that IUPC placement has caused at least one documented perinatal fetal demise. http://www.ncbi.nlm.nih.gov/pubmed/18989829 While I’m certainly not a homebirth advocate, I wanted to mention this case as it appears to fit the above request for reports about babies lost due to a hospital intervention.

    • Ash

      I would followup with that OB to ensure the issue (leaving the sleeve inside) was thorough discussed at a later meeting to discuss how this can be prevented in the future.

  • Jude

    Hospital births kill too!

    One can argue both points, it could be argued if you are not in hospital you cannot be interfered with and so your chances of staying alive are greater. Your chances of getting a hospital acquired bacteria are less too.

    • Young CC Prof

      As this post says, please provide an example of a woman who died in childbirth or lost her baby because she went to the hospital. A news article will do, along with a reason why you think staying home would have worked out better.

      Note that about 10% of home births end in transfer to the hospital, more in first time mothers.

    • Guest

      “It could be argued if you are not in hospital you cannot be interfered with and so your chances of staying alive are greater…”

      Of course, if you are not “interferred with” during a dangerous medical event, you could also die.

      “Your chances of getting a hospital acquired bacteria are less too.”

      Yes, but there are also bacteria all over your house.

    • The Computer Ate My Nym

      Hospital births kill too!

      As this blog points out, repeatedly, a baby born in the hospital has about a three fold better chance of survival than one born at home, all else being equal.

      it could be argued if you are not in hospital you cannot be interfered with and so your chances of staying alive are greater.

      That’s the question under discussion: Can you come up with a case or series of cases where the patient was “interfered with” and that interference caused a death or other poor outcome? We’ve come up with a small series, but nothing very impressive.

      Your chances of getting a hospital acquired bacteria are less too.

      Kind of by definition. Your chances of dying in a plane crash are lower if you drive from point A to point B too, but that doesn’t mean that your chances of dying in a transportation accident are lower. Most deaths due to infection are due to infection with the patient’s own normal flora going to the wrong place (i.e. skin or vaginal flora infecting the uterus). Being outside the hospital makes it harder to treat those infections. See, for example, Wren’s story.

    • LibrarianSarah

      Hospital births kill too!

      And people die in car accidents while wearing seat belts. Does this mean that it just as safe to drive without one?

      One can argue both points, it could be argued if you are not in hospital you cannot be interfered with and so your chances of staying alive are greater.

      One could make that argument but they would be wrong. You are 3 times more likely to lose a child in outside the hospital than you are inside the hospital. That is because babies and mothers die precisely because they are not being “interfered with.” That’s the thing about arguments, they have to be based in reality or else they are worthless.

      Your chances of getting a hospital acquired bacteria are less too.

      If you are not in a hospital your chance of getting a hospital acquired infections should be pretty close to zero assuming you and those close to you don’t work in a hospital. However, in order to accurately calculate the risk you have to know how many newborns and new mothers die of hospital acquired infections.

      Otherwise, it’s like saying “I’ll spray this chemical on your house, it increases the rate of SIDS 400% but your risk of malaria will be pretty much 0.” That would be a good idea if I have no children and live in the Congo but not so much if I have two infants and live in New England.

      • Sue

        Actually, very few women having babies acquire hospital-borne infections. Labor and maternity wards have dedicated staff who don;t work with the elderly or on general surgical wards, and the patients are all under 50 years of age and almost all healthy.

        Post-natal sepsis and wound sepsis are not from hospital organisms.

        • Durango

          I thought the leading cause of neonatal fever was bacteria picked up from vaginal birth? (Don’t remember virtually anything else except that one little factoid, and I don’t even remember where I heard it: an emergency medicine podcast maybe?) In any event, if my little factoid is true, it would be irrespective of place of birth.

        • LibrarianSarah

          Just as very few people in New England get malaria. My point is without the numbers you can’t say “home birth is just as safe because you can’t get hospital acquired infections there.” So we are in agreement and I don’t understand why you replied to me.

        • pinkyrn

          One of the hospitals I have worked for in the past kept track of post-op C-section wounds. They would keep track of all personnel responsible for keeping a sterile field.

        • Lioness

          Really now. Why, the nurses don’t even have to wash their hands between patients…

          My friend who is a ordinarily a very healthy women, jokes about her post c/s that she liked the staph so much, she took them home with her. Went on to have a vba2c

          • Beth S

            Actually anyone working in a hospital is drilled daily on the gel in gel out procedure when entering a hospital room, you are also required to change gloves between patients and wash your hands between every three.
            In maternity even the housekeepers are required to change from their normal uniform into surgical scrubs (believe me I have about a hundred different sets of these from working hospitals) wear the little booties over their shoes at all times, and the men and women who work in these departments are dedicated workers which means they can’t be pulled to any other department period.
            I know I used to work in LD before I had kids.

  • Taylor
    • Young CC Prof

      In summary, maternal mortality is caused by:

      1) More accurate reporting and broadening of the definition of maternal mortality. (Note that deaths from “classic” causes like hemorrhage, preeclampsia and infection have stayed the same or slightly decreased over the past few decades.)

      2) More women with preexisting risk factors becoming pregnant

      3) Lack of access to care before the pregnancy, during the entire pregnancy and after the pregnancy. Women without health insurance are several times more likely to die than women with health insurance.

    • InfiniteSovereign

      Oh God! That is so terribly sad!

  • OBPI Mama

    I do remember the story of 2 women from the same hospital in Ohio contracting bacterial meningitis and at least 1 of them dying (I think both ended up passing away, but can’t remember for sure). The common factor was spinal anesthesia. So heartbreaking. I wonder what became of the investigation… http://www.10tv.com/content/stories/2009/05/26/story_meningitis.html

    Does anyone know?

  • CV

    Completely OT: My mom had twins in 1980 and the history I was told (she is dead now, so no way to discuss the subject) is that after my first sister was born labor stopped and after some time the doctor inserted his hand inside her and pulled the second twin by her feet. I have absolutely no medical knowledge and I am just curious about this story. As there are lots of people with medical knowledge here I ask you: is this story plausible or was she just delusional?

    • MacArthur Obgyn

      That’s called a breech extraction. It’s an option for delivery of the second twin if it’s not head down

      • sdsures

        It sounds more dangerous than a CS. Is this something that’s done for a multiples birth if CS is no longer an option?

        • Therese

          No. Breech extraction would be attempted first, before resorting to a c-section.

          • sdsures

            The head doesn’t get stuck?

    • Paloma

      It is absolutely possible. Usually in a twin birth where the second twin isn’t head down a internal version is performed and the second twin is born breech. Since they tend to be smaller babies and the doctor positions them perfectly for the birth, it is quite common. Actually, this is what my hospital does for twin births ;)

  • sdsures

    Is anyone else still hearing cricket chirps to Dr Amy’s challenge?

  • disqus_ealSxkOnJn

    Or, rather than attacking homebirth, you could be working to make it safer.

    You realize that if you made it illegal for a healthcare provider to attend homebirth, that many would choose to just do an unassisted birth (some do anyways)? Attacking homebirth means that you don’t actually give a damn about the safety of babies OR gestational parents, it means all you care about is proving a point and feeling smug. Good for you. This is akin to the abortion debate- because it’s about peoples’ bodies and their right to choose what to do with those bodies. If you make it illegal to have an abortion safely, people will instead do them illegally and unsafely- so why not make it as safe as possible? And part of that is changing the way hospital birth works so that pregnant people know they’ll be treated with dignity and respect while at their most vulnerable rather than being driven to homebirth out of fear. I’ve seen a number of medical professionals who work in maternity wards say that they chose to do a homebirth specifically because of what they see every day- that shouldn’t happen. I don’t care if they’re a teeny tiny, insignificant proportion- it shouldn’t happen at all.

    Now, that’s something the homebirth advocates need to do as well- which I don’t see happening. Which is a big damn problem. Homebirth advocates shouldn’t obfuscate the facts, pretend it’s safer than it is. Homebirth advocates shouldn’t protect midwives who do harm and try to silence those who speak out against dangerous practices. Homebirth advocates shouldn’t decry ultrasounds as evil without actual damn proof. Homebirth advocates shouldn’t insist that people ignore risk factors that make it dangerous to do a homebirth. Right now, the way homebirth is done in the US is downright stupid. In a lot of states, there’s virtually no medical requirement for midwives. If homebirth advocates actually worked to make homebirth safer- we don’t know what the statistics would look like, but it’s not reasonable to assume they’d be identical to now.

    • Karen in SC

      Have you even read anything here? We are fighting to make homebirth safer than it is currently. First, abolish the CPM credential.

      People who work in maternity wards and decide to homebirth don’t know what they don’t know. Doctors work from years of experience – maybe they could communicate better – but that experience and evidenced based practices mean hospitals are the best place for birth.

    • wookie130

      While I agree with some of the points you’re making, I guess I still feel that it boils down to informed consent. Women are being fed a bunch of fallacy and lies related to home birth, and are unable to really sift through what is good information, and what is poor info. I blame NCB and home birth advocates for this. There are ways to make home birth safer, yes…having midwifery stringently regulated in the U.S. would be a nice beginning to this. However, no matter what way you slice it, you can’t bring the operating room home with you…nor can we teleport hospitals closer to home birth sites when they become a necessity within a very short timeframe. Wouldn’t it be better if the NCB and home birth community stopped lying, and attempting to instill fear of hospital birth in mothers? Perhaps women would feel less inclined to birth on their own (or with midwives, which can sadly be about the same as birthing on their own), and realize that the safest place to have a baby IS actually in the hospital, if the wrong information could be prevented from infiltrating every corner of the web, and media.

    • Jenny_from_da_Bloc

      You are missing the point, the people who attend home births are not healthcare professionals. They are lay people and should not be practicing midwifery. Most are not licensed and the most education they have is a H.S diploma and correspondence courses from an uncertified “school” run by other unqualified wannabe midwives. There are no standards of care or education and let alone responsibilty for theor actions when a mother is injured and a baby dies. When something goes wrong 99% of these so-called midwives do not take responsibility for their actions and can’t be held accountable because they are unlicensed and uninsured. It is unacceptable for these midwives to run around lying about their credentials, like saying they are certified in neonatal resuscitation when they can’t be, lying to pregnant women about the safety of home birth, lying about the so called cascade of interventions and most of all lying about the skills and education they possess. If any other medical professional ran around uninsured and unlicensed claiming to be something they are not and were hurting.innocent people they would be in jail. Because these women claim to be midwives justifying their practice on pseudoscience and preying on uninformed or misinformed women in the name of the natural vaginal birth experience. Moat of these midwives have no scruples and do not practiced evidence based care, do not have the skills to know when something going wrong and they attend births that should never happen at home, like VBACs or a diabetic mothers birth. Dr. Amy is informing and educating the public about the dangers of home birth and unlicensed midwives. There is no need to sugar coat or work to make something safe that is inherently dangerous and can never really be safe.

    • meg

      This blog isn’t about making homebirth illegal. It’s about making homebirth accountable.

      • Amy Tuteur, MD

        Yes!!!

    • areawomanpdx

      No one here is suggesting that homebirth be illegal or that it should be illegal for *real* healthcare providers. The problem most of us have is ill-trained ideologues masquarading as health care providers and pretending that taking an online course (or a course at a not-accredited-by-any-legitimate-accrediting-board “college” that believes that “Birth Stories” and “Homeopathy” are appropriate required courses for midwives) and apprenticing with one or two equally ill-trained midwives constitutes appropriate midwifery training. It does not. I am all for making it easier for CNMs and CMs to attend homebirths if that is what women want, but the CPM is a complete sham and is endangering the lives of babies and women. Not only that, but women are being LIED TO about the risks they are taking when choosing homebirth.

      Additionally, hospital births *are* changing. No one gets shaved anymore. Episiotomies are no longer standard practice. VBACs are practically being forced down women’s throats where I work. Many hospitals have started offering delayed cord clamping and water births in response to requests from consumers and evidence on the cord-clamping front. Real medical care providers change in response to new evidence, and that is what is happening. Yes, the medical establishment is a slow-moving entity. But saying “Nah nah nah nah hospital births,” is a way to deflect attention from the very real problem of homebirth in the United States. There are plenty of people caterwauling about the supposed horrors of giving birth in the hospital and no one is trying to shut them up.

      • EmbraceYourInnerCrone

        Hospitals have been changing for a long time though.
        My daughter will be 20 years old in a couple months. I gave birth in an inner city, Catholic hospital. They did not shave me, they offered my an epidural but would not do it until I was at least 4 centimeters dilated, they asked weeks before I delivered, when they filled out my “plan” if we want to delay the silver nitrate drops until after we held her and if we wanted skin to skin right after birth. Yes, they did a heplock as a matter of routine, and in my birthing class they asked us not to eat anything once we started labor (wish I’d listened. barfing during transition sucks)
        I had external and later (due to mec & fetal distress) internal monitoring, but they asked or explained before they did anything. No one restrained me and I could change positions if I wanted, they just asked me to let them know so they could adjust the monitors. I was lucky, and I realize that but, according to my friends and coworkers at the time my experience was not that unusul, heck the hospital even had a part time lactation consultant and rooming in was standard(every one had their own room and bathroom on the maternity wing.

    • Bombshellrisa

      There is no medical requirement for being a CPM. I believe CNMs are recognized in every state and that they have uniform educational requirements for becoming licensed.
      Making homebirth safer is something that cannot happen unless all midwives are of the CNM variety and have back up OBs. Even then, there needs to be a strict criteria for risking out and a clear transfer plan. Most midwives who do home births end up calling the local hospitals to see who has staff and a bed ready for a transfer, as the large majority don’t have hospital privileges (because what hospital would let a CPM take over care once the transfer is complete? They can’t prescribe meds and don’t have medical or nursing training). Having uniform charting systems, transfer plans and malpractice insurance would be a start to making homebirth safer. But you don’t see the majority of CNMs willing to rock the boat and demand that the only midwives who should be called midwives be CNMs.

      • Medwife

        I used to want to attend homebirths, before I finished my training and began practicing. Now I don’t think I could do that, with awareness of what it means to have an OR and major assistance half an hour away, in the vey best of circumstances. Say I auscultated late decels during second stage, that means transferring with a woman with a strong, no-epidural urge to push? The pushing is where you see a baby with little reserve run out of that reserve. Just one of the many scenarios that keep me from trying to establish a homebirth practice.

        Besides, I’d be too conservative for most people who want homebirths anyway. Everybody’s all about safety until it’s them with the problem.

        • Bombshellrisa

          I admire you knowing your limits and NOT trusting birth. Someone who is spouting the usual “I am trained in infant resuscitation and the hospital is down the street and don’t worry I carry oxygen” is NOT conservative no matter what they claim and cannot be trusted to transfer at the first sign of trouble.

          • Medwife

            They forgot to give me a Wonder Woman cape at graduation.

          • Stacy48918

            Does that come with the crystal ball and magic wand I seem to be missing so often? :-P

          • Bombshellrisa

            Maybe those only come with the “other ways of knowing” crown that so many midwives claim to have

          • Tim

            Don’t you get a cape with your master’s degree? Just put a WW logo on it!

        • Stacy48918

          Knowing your limits is a very important part of being a good medical provider.

    • Guest

      Here’s the thing: OBs are not under any obligation to compromise the standard of care just to accommodate the whims of a select group of individuals. Homebirth will NEVER be as safe as a hospital birth, and as such, physicians don’t have to “make it safer.”

    • Stacy48918

      “rather than attacking homebirth, you could be working to make it safer.”
      By “attacking homebirth” we ARE working to make it safer.

      And we’re not “attacking homebirth”. We’re attacking poorly trained “midwives” (CPMs and other lay midwives) that, through their lack of education, kill a much larger proportion of babies than CNMs. Wherever has Dr. Amy or anyone here said they want to make it “illegal for a healthcare provider to attend homebirth”? Quote please?
      I’d like to make it illegal for an UNQUALIFIED “healthcare provider” to attend homebirth.

      Abolishing CPMs would be the single greatest thing that could happen to improve the safety of homebirth.

      If mothers choose to go unassisted instead, I can’t stop that. But don’t you think mothers and babies have a right to qualified care providers?

    • KarenJJ

      I have homebirth provided for free where I live for low-risk women that live within 30 minutes of the back-up hospital. Two midwives (registered and university educated) are provided and are backed up by the main maternity hospital. There isn’t a huge take-up but neither is there a heap of women that are risked out that are free-birthing everywhere.

      So yes – something that midwifery in the US could aim for:
      1. Ban CPMs
      2. Force the midwives to be integrated into the health care where their registration and their job depends on their ability to practise within guidelines and with hospital staff including obgyns/hospital based midwives.
      3. Guidelines must be adhered to – screening must be done (no dodging scans or diabetes testing). Women that are found to be a higher risk must be referred on to the hospital.
      4. Reporting is mandatory and will be collated by the government and published on their website.
      5. If you fail to practise within hospital directed guidelines you will be sacked and/or de-registered.

      Is this attacking midwifery, or saving it from being hijacked from a bunch of negligent, ideological wannabes?

      • Bombshellrisa

        What I like about that system is that even if a woman is risked out of homebirth, she can still be attended by her midwife in the hospital (I assume these midwives also are able to care for women in the hospital).

        • KarenJJ

          I’m not sure how the transfer works between the “community midwives” and the “hospital midwives”, but I think some homebirth programs in Australia allow this – it’s up to the hospitals how they do things here – and I imagine the scope of the midwife would be pretty limited or they would need to be continuous training in the hospital protocols and other skills to prevent de-skilling.

          • MJ

            In the state I live in there is at least one hospital run homebirth program delivered by hospital employed midwives who stay with the woman if her care is transferred to hospital. More info:
            http://www.westernhealth.org.au/Services/Womens_and_Children/MaternityServices/Pages/Homebirth.aspx

          • True Believer

            Why don’t you ask Western Health about their home birth death or transfer rate? I can tell you that the midwives that stay with the patient during transfer are very quick to “pass the buck” when things go awry or the reputation of their precious program (which is obviously far more important than caring the Mothers, Babies & Families in the aftermath of their program) is questioned…

          • MJ

            “Why don’t you ask Western Health about their home birth death or transfer rate?”

            Because I was simply providing factual information in response to Karen’s post above and I think it’s interesting for the people fighting for midwifery regulation in the United States to have an idea about what forms greater regulation can take (even if they are less than perfect).

      • Sue

        Yep – this is about as good as HB gets, but still carries excess neonatal mortality and unmeasured morbidity.

        The Catling-Paull review (MJA 2013) of Aus publicly-funded HB services found 2.2 per 1000 births v 0.4 per 1000 for low-risk hospital births.

        Also, as we have discussed previously, free-birthing and calling the ambulance when worried seems to be safer than having an unqualified or renegade HBMW.

  • Amy M

    So what’s the tally so far? And am I interpreting correctly that Dr. Amy was looking for deaths caused by hospital intervention/error, where a woman basically otherwise would have had a straightforward VB, and therefore would have been better off at home, because she would have avoided the intervention/error that caused harm?

    • Amy Tuteur, MD

      The tally is:

      Not a single one of the many, many homebirth advocates who routinely decry the deaths “from interventions” has parachuted in to tell us of any. Looks like they’re just making stuff up again.

      • Karen in SC

        Yes, very telling that regular commenters were the only ones posting possible tragedies.

        The only thing interventions “kill” is a perceived perfect birth experience.

        • Amy M

          Ok, so what about the ones submitted by the regulars? 2? 3?

          • meg

            The bedrest one (maybe?) and the epidural-instead-of-penicillin one, by my count. So two?

          • Medwife

            Mag to woman for preterm contractions at 35 weeks, overdose, maternal death, compromised neonate. Three.

          • The Computer Ate My Nym

            It’s interesting that we also have two cases of dads dying unnecessarily during a birth: one death in an MVA on way home to pick up clothes prior to c-section and one fainting and subdural after seeing too much of an epidural. So we’re really getting into the freak accident category of problems.

          • Medwife

            That’s true. I mean, look up magnesium sulfate and errors and you’ll find that it’s the second most common error in maternity care. But permanent injury or death is rare to the point of freakishness because it’s a drug with a known narrow therapeutic range. There are protocols to recognize and treat mag toxicity very quickly.

          • meg

            I stand corrected.

        • The Computer Ate My Nym

          I know of one other event that led not to a death but to PVS in the mother, though I don’t know all the details.

          Young woman comes in in labor, routine pregnancy, progressing normally, wants an epidural for pain control. She suffers severe hypotension in reaction to the epidural and has brain hypoxia for some time and ends up in PVS. I suppose she eventually died of it. This all occurred in the early 1990s, so probably no epi at bedside or other precautions that would be routine now. But arguably a fourth case.

          • guest13

            But shouldn’t we be looking year to year or even decade to decade?

          • MaineJen

            I can tell you of a more recent one in my state…almost identical to the case above, rxn to epidural leads to hypoxia leads to brain death, baby is delivered by crash section and survives. I don’t have a lot of details because obviously it’s still under investigation. Because when someone dies in childbirth in the hospital, there is an investigation and a FULL accounting.

        • SF Mom & Psychologist

          I know two women who died from meningitis in the hospital following normal VBs. Both had epidurals, which was blamed for the infection. These deaths both occurred in the late 90s – one in SF and one in the DC area.
          My mom was a practicing anesthesiologist for ~35 years and said she had never even heard of, let along seen, a maternal post-partum death from meningitis. If I didn’t actually know both women, I would doubt it.
          Is it possible that the meningitis was contracted some other way, and the timing was just hideously bad?

        • Medwife

          The regulars are concerned about optimal outcomes in maternity care. It doesn’t stop when we enter the hospital. Just like at an M&M, looking at anything we do wrong or could do better gets discussed.

          A lot of the parachuters probably don’t know much about the reality of the hospital and know bullshit stories will be called out. They may have a healthy fear of looking stupid.

          • Young CC Prof

            And that is the difference between real science and fake science. Real science strives for continuous improvement.

      • sdsures

        *cricket chirps*

        As suspected, eh?

  • Tabitha Ziegler Yaffe

    Slightly OT: My friend gave birth to a healthy 33 weeker this morning via emergency c-section because of a placental abruption. Said friend was strongly considering unassisted childbirth because there are no homebirth midwives available in our corner of Germany who will attend births for Americans on the military posts. She has a challenging obstetric history (lengthy difficult labors, one stillbirth at 28 weeks, SIDS baby, hospitalizations for dehydration related to HG with at least two pregnancies etc.), yet the desire to have a “healing birth at home” was overwhelming for this mom. Thank the Lord that she listened to all of her friends (NCB types included) when we insisted that she go to the hospital yesterday. She’d been complaining of severe abdominal pain and nausea/vomiting for over 24 hours. This mom & her baby could’ve easily died had they decided to stay home and attempt to birth there when labor started. There is no way to transfer fast enough with an abruption. Homebirth advocates.. explain to me how this mom would be better off at home??

    • doctorex

      Home’s probably the most comfortable place to get hospice care… Is that what confuses the NCBers?

      • Ellen Mary

        My mom was a hospice nurse most of my childhood & a home IV nurse before that, so yes, I think that is part of what initially led me to seek out home birth care. However since I was also aware that BSNs worked out of homes I never sought a care provider without any nursing education whatsoever, my first birth had a CNM & RN attending (before transfer) . . .

      • sdsures

        Could be. Except that a hospice patient is expected to die. Babies are not.

    • The Computer Ate My Nym

      I don’t understand this “healing birth at home” thing. I can see* the argument for home birth if you’re deathly afraid of hospitals or find being at home more comfortable or really want to be able to stage manage every aspect of the birth or have very fast labor and fear giving birth in the taxi, but what about a home birth is “healing”? Is it the “my body is not a lemon” thing? Are women being convinced that they must give birth vaginally or they are less than good women and mothers if they have a C-section?
      *I don’t agree that any of these are good reasons, but can see why people would want to do so.

      • Tabitha Ziegler Yaffe

        I think the “my body’s not a lemon” ideology is very strong for some moms who aspire to high crunchiness in their child-raising practices, but feel that they’ve fallen short of the ideal (NCB) because of pregnancy or birthing complications. I have a lot of empathy for these women because they are holding themselves to a dangerously unattainable standard.

        • Allie P

          I don’t want to “like” that comment, but I agree that this is the motivation for a lot of women. I don’t understand it, but a lot of women, especially ones who are really interested in healthy living are trying to prove that they can overcome their body. A friend of mine was very into eating whole foods, running triathalons and marathons, etc., and her Bradley birth plan was thwarted by an unripened cervix and she wound up with a c-section. When later she ended up doing IVF to get pregnant again, she was ADAMANT about having a home birth, which baffled me, given how high risk she was (failed labor, previous CS, fertility problems, advanced maternal age). But just as she wanted to “prove” what her body was capable of by running triathalons, she wanted to “prove” that her body was capable of giving birth naturally. But she isn’t risking anyone’s life by running.

          • Elizabeth A

            If you want to prove points about the excellence of your body, I am all in favor of triathlons. They have a lot to offer – physical challenge, which you can practice for, from which you can drop out at any time (aside from in the water – try to get out of the water), and the only person at risk is yourself.

            Aside from “physical challenge”, those selling points do not apply to birth.

          • Amy

            You know, rereading this comment, it struck me that the drive to “overcome the body” is often associated with religious practice. The whole “spirit is willing but the flesh is weak” thing. And in religion, overcoming your body is therefore associated with virtue– you’re a BETTER PERSON if you don’t use the epidural, if you reject medical aid, if you eschew that brownie for a kale and kombucha smoothie. It’s not so much about what’s healthier as it is about avoiding the “sin” of modern medicine.

        • Amy

          For the very short time I bought into the woo, that was absolutely it for me. For political and economic reasons primarily, we try to stick to locally sourced and sustainably raised food and other products, and we engage in a lot of crunchy off-the-grid-type activities. But my first daughter was asynclitic and two weeks post-dates, and came out via cesarean after not one but two failed inductions. Then, we had difficulty establishing breastfeeding, and although I pumped exclusively for my baby, which was a way more work than nursing or formula would have been, the crunchy crowd shunned me like Hester Prynne for not meeting their standards. Fantasizing about a hospital or even home VBAC with my next baby was entirely about righting that portion of my earthy-crunchy resume. Thank goodness I got over it before doing anything really stupid in my next pregnancy.

          • RNMomma

            This is what I don’t understand. Why do some of them get so wound up when medical intervention IS necessary?

            My baby was posterior and asynclitic. I’m sure there are some who would judge me for my tiny little dose of Nubain that I got midway through. It was exactly what my body needed though to relax from that back labor and dilate more. Things really picked up after that. As it was, if I had to do that EXACT labor again, I would march myself right to the hospital and get an epidural.

          • Tabitha Ziegler Yaffe

            I know what you mean. Pain relief can sometimes be the difference between a successful vaginal birth and an emergency c/s. I ended up with an epidural after 17 hours of difficult labor (four hours in transition) with my 5th child. The two hours of rest I got after the epidural took effect were just what I needed for a quick and effective second stage of labor. As it was, baby had a nuchal cord that was keeping him from descending properly, and my tired uterus had stopped working effectively at around hour 16 (which was about 5 am, so I’d been up almost 24 hours at that point, and 12 + hours with no food). I credit that epidural with keeping me out of the OR.

          • Karen in SC

            EXACTLY, most interventions (really they are just procedures) are performed with the goal of preserving a vaginal birth!!!

          • Tabitha Ziegler Yaffe

            Geez.. Exclusive pumping is such a commitment. To think that the crunchy crowd was judgmental of your willingness to sacrifice so much of yourself in order to give your child breastmilk says a lot about the intolerant nature of such people. I’m sorry you had to deal with that BS.

        • meg

          It’s this devastating binary of EITHER pregnancy is an illness and your body is a useless lemon OR birth is as safe as life gets/babies know how to be born/your body is a perfect gift from Gaia/etc that is so very damaging. I empathize with women who don’t want to feel like they’re faulty, but in truth, nothing is perfect. You can be an excellent mother /despite/ whatever limitations you have – whether it’s PPD that makes bonding with your infant a difficult uphill slog, an upbringing without appropriate parental behavior modeling that makes being patient with your toddler a daily struggle, or the need for a c-section due to placenta previa. Interventions don’t make you weak, powerless, or a failure. Engaging in the process is itself a show of strength, and accepting medical help as necessary shows a selflessness of character in your willingness to do what’s best for your child even if it isn’t what you’d ordinarily prefer.

          • Siri

            Brilliantly put, meg. OT, is your username Meg as in the girl’s name, or Norwegian for ‘me’?

          • meg

            Meg as in short for Meghann :-)

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

            Were you by chance named for Meggie from The Thorn Birds
            ?

          • meg

            Officially, I’m named for a distant relation of some kind. However, The Thorn Birds IS my mother’s favorite miniseries (she had/has a huge crush on Richard Chamberlain) and the timing works well, so it’s impossible to say ;-)

        • Ellen Mary

          Some women are *gasp* actually subjected to over interventive care & react in a reactionary way in their next pregnancy.

          • Tabitha Ziegler Yaffe

            Of course! There are certainly good reasons to choose a more natural birth setting, especially if you are low risk and intend to have a med-free delivery. I’m speaking more of the moms who have a legitimate need to be in a more medicalized setting (i.e. gestational diabetes, VBAC etc.), yet seem to believe that they need to prove their body’s worth by choosing homebirth even with serious risk factors.

          • Jenny_from_da_Bloc

            Usually.interventions during birth are performed to continue the vaginal.birth or preserve the life of the baby. I don’t understand how interventions that save lives are deemed unnecessary or unneeded when a doctor or CNM clearly see the indication for the intervention. In my experience working in hospital most doctors and nurses do not perform unnecessary procedures because it takes time away from more critical patients or patients requiring urgent care. This whole over-intervening in birth thing is stupid, if you don’t want the interventions suggested then deny it (because that is your right to autonomy) go against medical advice and take the risk associated with declining interventions deemed necessary by a doctor. It is clearly quite simple, if you don’t want an intervention go against medical advice, but you can’t claim all or any interventions are unnecessary.

          • RNMomma

            But from working in a hospital, you should also know that sometimes providers do things because that’s the way they do things. Practice is slow to change in hospitals even when evidence based. For example, in my hospital is was fairly common for patients to be deep suctioned when we could tell the were super congested and working a little to breathe (no drops in stats). However, it wasn’t until a hospital guideline policy came out saying not to do this for bronchiolitis patients under 2 that the practice stopped. Was it unnecessary to deep suction? Yes. When we were doing this “intervention” we had reasoning for it though and felt it was necessary.

          • Jenny_from_da_Bloc

            Well yeah of course, but we don’t do things against patients wishes or to purposely hurt or traumatize the patient. I’m an RT and sometimes I do exactly what you just described because I want to help the patient even though its probably better they bring it up themselves, but I don’t keep doing it if the patient says no or if they are getting it up without difficulty. These women who want healing births are acting like the doctor was just using the vacuum, pit or c-section so they could make the doctors life easier or the old”he had golf game or plane to catch” excuse and there was no medical indication that what the doctor was needing to do was in the baby and moms best interest. I feel bad for these women who claim they need a vag birth to “heal” something.in them and put their baby and their lives at risk. 5 years ago we never heard about this stuff at work and now we hear about women denying necessary, life saving measures in the name of their birth experience. I’m on RRT and we get paged at least once a week because of situations like this and it’s so horrible and sad that something as simple as pit, epidural or vacuum extraction could have saved the baby from the real unnesscessary cascade of interventions all in the name of unmedicated, natural vaginal childbirth.

          • Guest

            I think we are on the same page. It just easy to see how patients can feel things were unnecessary when care providers approach the situation saying “we are doing this.” Granted, there will always be patients who wouldn’t see the necessity of an intervention or procedure even when fully explained, but a lot of people are much more reasonable when the right approach is taken.

            For instance, I wrote earlier about this mom who I was giving asthma education too. The night shift doc got her all stirred up because he was harsh in his approach. The report that I got in the morning was that mom did give her kid asthma meds because she liked natural remedies. Terrifying, no? Turns out that she does give the kid his meds when he needs them (kid was at dad’s at the time of the asthma attack). She was much more reasonable to talk with when the day shift doc and I incorporated her desires into the treatment plan or explained when we couldn’t rather than just saying “no, do it this way.”

          • RNMomma

            I think we are on the same page. It just easy to see how patients can feel things were unnecessary when care providers approach the situation saying “we are doing this.” Granted, there will always be patients who wouldn’t see the necessity of an intervention or procedure even when fully explained, but a lot of people are much more reasonable when the right approach is taken.

          • Anna T

            Also, how one provider does things is not how another does them. There can be different approaches to the same case.

            When I showed up in very early labor for the first time, the doctor would rather give me pitocin than send me home to wait.

            But when I showed up in early labor with my second child two years later – at a different hospital – I was told, “it’s really a little too early to admit you. So if you aren’t in a lot of pain, it would be better if you go home for a while (if you live near enough). We expect we’ll be seeing you in a few hours again, anyway.”

            So… essentially the same situation, different approaches. Because I wanted a natural birth, I was of course happy with case number 2.

            But if I had planned on an epidural, and if my early contractions were more painful, very likely I would have been happier with case number 1, and frustrated if I had been told to go home and wait.

            So if there is room for variety, I believe the patient’s wishes should be considered.

          • AllieFoyle

            But who decides that the care was “over-interventive”? It may appear that way to the woman, but perhaps there were medical justifications she didn’t know about. Perhaps those interventions would have been welcomed by other women. Maybe the care that you would have preferred would have been considered “under-interventive” by someone else. I think you have to be careful not to decide that something was poor care if you aren’t really sure, and you also have to remember that individuals will have different preferences.

            I think you and I are completely opposite in preferences, but I can understand and respect that your c-section was unwanted and traumatic for you, even though it’s the exact thing that I wanted and found traumatic not to get. It’s hard for me to picture having three children at 36 (did I get that right?) and being concerned about a c-section limiting my future fertility, but I accept that you feel that way. I just wish you (and folks like you, who favor less intervention and prefer vaginal births) would not label things as “over-interventive” in general or bemoan c-section rates because you’re only speaking for you.

          • Ellen Mary

            Do you really think there are no doctors that push interventions in excess of indication? Perhaps it is a smaller percentage than bad midwives, but I assure you they exist, just like doctors who straight won’t attend VBACs. Where I live now, a doctor would be embarrassed to admit they don’t attend VBACs, but where I moved from, it was VERY rare to find a doctor that would & very likely his whole practice would not be on board. And it was a major US city with ample facilities to permit VBAC.

          • Stacy48918

            “Do you really think there are no doctors that push interventions in excess of indication?”
            Again, examples please. Define “interventions in excess of indication”. You are using this terminology. Define it.

            “Perhaps it is a smaller percentage than bad midwives, but I assure you they exist,”

            And the negative outcomes of each group (interventive docs vs bad midwives) are what exactly? Are you really comparing the use of pitocin or an “unnecessary” C-section or episiotomy to a dead baby? Because they’re not the same. Not even close.

          • Ellen Mary

            A dead baby is not even close to an unnecessary episiotomy but they are both wrong. If I rear end your car, can I say, well I didn’t kill anyone in your vehicle like a drunk driver so lay off?

            A L&D RN locally informed me that a certain OB on her floor places an internal monitor in every one of his patients. That is an example. Doctors who strip membranes without consent is another great example.

            Again: no, these don’t kill anyone. But they could drive a woman into the care of someone who could negligently allow their baby to die. And we aren’t allowed to just do things that are wrong & that harm people because no one dies. A woman that theoretically wants a big family & has a cesarean that could have been avoided (and really only the provider & his/her hospital know if it could have but it does happen, it is ridiculous to say 100% of OBs act with good faith in this area) leads to an infection & loses fertility thereby *has been harmed* even if she has not been devastated by a perinatal loss.

          • Stacy48918

            “& that harm people”
            Placing an internal monitor is not “harm”.
            Stripping membranes without consent is a breach of autonomy but does not “harm people”.

            But of course if a subsequent baby dies at homebirth at the hands of a negligent provider it’s the DOCTOR’S fault!

          • Anna T

            Example of pushing unnecessary interventions:

            A healthy 23-year-old woman arrives at the hospital too soon because it’s her first, so she panicked and rushed to the L&D at the first contraction. She’s full-term and 1 cm dilated.

            Instead of sending her home, the doctor suggests a long walk. After several hours, she is only 3 cm dilated.

            The woman is feeling fine, monitor shows the baby is feeling fine, and very importantly, amniotic fluid is intact. But the contractions have stopped and she’s still at only 3 cm.

            The doctor admits her to the L&D and matter-of-factly says, “we are going to augment you”. Please note he uses the Latin word “augmentation”, while the conversation is held in *Hebrew*, and most Hebrew-speakers do NOT know what “augmentation” is.

            (Perhaps the doctor doesn’t know that??)

            The woman, whose language skills are not that poor, asks “do you mean pitocin?”

            The doctor (reluctantly): “yes.”

            The woman: “I’d rather wait.”

            The doctor (annoyed): “You can’t occupy an L&D room forever!” (Exact. Quote. No. Mistake.)

            The woman: “Then I’d rather go home and wait.”

            The doctor (incredulous): “You want to go HOME?”

            Woman gets up from the bed, changes into her own clothes, husband picks up the bag, and they leave to home (which is located 5 minutes from the nearest hospital) to wait things out. Baby is born safely and naturally in *another* hospital 24 hours later, without ANY interventions or pain meds.

            That was me.

            Do you think I should have agreed to an induction? I don’t. I could have, and it probably wouldn’t have damaged me, but I didn’t want one and didn’t need one.

          • Stacy48918

            “Do you think I should have agreed to an induction?”
            That’s not an induction – starting labor. It’s augmentation of an already established labor. You were in labor. You were in the hospital to have a baby. The doctor is wrong for wanting to help you do that by coordinating your spaced out contractions?

            They don’t give doctors crystal balls at graduation. You might have known you didn’t “need” the augmentation, but there is no way for the doctor to know that.

            Sounds like you had a very typical first labor. Doing it without interventions or pain medications doesn’t make it any more noble than the woman who says “yes” to augmentation.

          • Anna T

            Sorry, you’re right, I should have been more accurate. The doctor didn’t mean to induce, he wanted to augment. Either way, he meant to give me pitocin.

            Indeed, I had a very typical first labor with a long early stage. However, this didn’t cause me discomfort. My husband and I browsed shops and went for a plate of pasta (our last outing as a couple with no children!), so as you can understand I was not in excessive pain. The baby was not in distress either.

            The doctor was not “wrong” for wanting to speed things up. I was not “wrong” for wanting to wait. My point here is: the clash was not between the baby’s safety and my wishes, but between my wishes and the doctor’s.

            Oh yes, the doctor knew very well I didn’t really NEED the pitocin (as much as it is possible to know anything for sure). He didn’t say, “it is better for the baby to come out early”. He didn’t say, “you are putting yourself at risk.”

            His argument was, “if you can have this baby sooner, WHY NOT?”

            My argument was, “If we can wait and do this naturally, WHY NOT?”

            And that was about it. The question of safety or health didn’t even come up, because there wasn’t any. Either way I was doing fine.

            So, because there was no medical reason NOT to wait, I waited.

            I never said I was more noble or superior to women who did it without interventions. I am not a masochist – when I’m in a lot of pain, I take pain meds. But I was not in a lot of pain, not in any danger, and I wanted a natural birth.

            So was it wrong to say no to interventions?

          • Amazed

            I must have missed the part where the doctor threw himself at you and held you bodily while you were screaming and begging him not to, like Rinat Dray (my opinion of her is not stelar but she was mistreated) had to suffer. It was just the way he talked. You were free to go home which you did and most likely, you wouldn’t have been turned down if you decided to come back later.

            It was a recommendation and the fact that you did have a voice is evidenced by the fact that you packed off and left. He consulted you. His bedside manner might let something to be desired but you were not a victim of trying to push interventions with no reason at all.

          • RNMomma

            Whether he was “pushing unnecessary intervention” on her is open to interpretation, but from what I read, I wouldn’t agree that he consulted her. The big push these days is for family/patient centered care. I’ve had this problem with docs in my own hospital. They make changes to the antibiotic regimen (for cystic fibrosis patients) but don’t talk to the families about the plan. Just saying “we are going to do this, just so you know” isn’t involving the patient and isn’t consulting, it’s telling. Very rarely do patients know that they can disagree with the doctors. Trust me, I’ve had to pull doctors back into the room later after a patient has expressed to me that they aren’t okay with the treatment plan.

          • Amazed

            I thought healthy patients by definition don’t have an antibiotic regimen to be changed. Whether patients are consulted or not is not the matter here. You are talking about cases when interventions are clearly needed. Whether the patient agreed with them or not is a different matter altogether. They went to their doctor because they had a problem that presumably needed interventions.

          • RNMomma

            I was talking about patient involvement and it is a part of this situation that shouldn’t be left out. Yes, cystic fibrosis patients need intervention. Many families though are particular about what antibiotics their kids are placed on (or simply prefer to have a conversation rather than be told what is going to be done to their child). In the event of an emergency, sure, discussions can happen later. I was just disagreeing with the point you made about the doctor making a “recommendation” or consulting Anna T. From the sounds of it, that’s not what he did.

            The way a doctor talks to a patient in a non emergent situation can make a big difference when it comes to compliance of care. It is incredibly important.

          • Amazed

            Oh yes, I do agree that a physician’s method of communication is incredibly important. But having a bad bedside manner isn’t the same as “pushing” unnecessary interventions. He probably thought the intervention was necessary, didn’t do it just to spoil Anna T’s planned birth. He might have phrased his recommendation poorly but nothing in the way she tells her story suggests that he actually tried to push anything on her. He didn’t even use the dead baby card to make his evil fun!

            I don’t believe Anna T is objective when it comes to pushing interventions. She’d be only too happy to push psychiatric consultations on trauma survivors who just don’t want to visit the place they survived ever again, when they might be perfect candidates for MRCS because such a trifle should not be an obstacle on the way of the superior vaginal birth.

          • RNMomma

            Yes, unfortunately many people perceive persecution or even harsh bedside manner when there is none. And unfortunately for care providers they have to become more and more careful to accommodate for this.

            I’ve only been reading Dr. Amy’s blog for a few months and obviously have just started commenting. I’m sure I don’t pick up on where different people are coming from very well just yet. Thanks for the discourse.

          • Anna T

            I never claimed I was abused or anything of the sort. Of course nobody held me by force. BUT, I had a choice because I *knew* I had a choice… not because the doctor gave me one.

            He did not give me a “recommendation”. He didn’t say “I recommend pitocin”. He told the nurse to prepare the i.v. and matter-of-factly said, “we are going to augment you”. “Going to” is not a recommendation, it is a statement.

            Basically, he used his authority to promote something he knew I did not want, and something he knew I could probably avoid.

            I most certainly was not a victim and never liked to think of myself as one. I realize the doctor did not mean to pursue any sinister goal. We merely did not see eye to eye.

            He wanted to do things efficiently. I wanted to take things slowly.

            Sure, the baby is more important than the “experience” (it seems like almost an indecent word here on this blog…). But once we’ve ensured everyone is safe and doing well, the mother’s wishes, comfort, and yes, “experience”, do count.

          • Amazed

            “But once we’ve ensured everyone is safe and doing well, the mother’s wishes, comfort, and yes, “experience”, do count.”

            They do count and I agree. I remember you don’t, though. Not when it came to elective c-sections. You claimed that women like me who might have some reason other than purely medical to desire to avoid vaginal birth, should be interrogated by their doctors despite being given an informed consent. That such women should be given counseling and whatnot, just so they achieve the aim YOU set for them – a vaginal birth.

            So, what? Women like you should not be pushed into “unnecessary interventions” but women like me should be pushed into those because YOU don’t count pushing counseling on us as one.

            Which way is it? Do the mother’s wishes, comfort, and yes, “experience”, count or do they count only when you, out of care for the large family this mother is probably not planning because she’s fully informed, insist on vaginal birth on all costs when the mother is physically able to and is likely to end with a healthy baby and a physically healthy self, despite the emotional cost to herself?

          • Anna T

            I never said anyone should be interrogated.

            I merely said I believe it is a doctor’s duty not to take a careless approach to a medically unnecessary surgical procedure.

            I do not think women should be “forbidden” from making the choice of an elective C-section.

            I do believe, however, that the choice must be *fully* informed, and that all possible risks must be taken into account.

            When I was in university, during one lecture on anatomy which discussed the process of giving birth, one girl said, “this is so scary. If I ever give birth, it will ONLY be by C-section!”

            Our professor asked her, “Why?”

            “Well,” she said, “because a C-section seems so much safer, more controlled, more predictable. More… civilized. Much better than to just wait until the baby decides to pop out in whatever way.”

            The professor said, “it may *seem* this way, but read the statistics. C-sections are less safe than vaginal births.” [normal vaginal births, of course]

            So this girl read the statistics. And she realized that, even though vaginal birth seemed “scarier” to her intuitively, and sounded very unappealing, it was actually – statistically – safer.

            And then she wasn’t so keen on having a C-section anymore.

            This is what I mean by making an informed choice.

            Perhaps a woman is motivated to choose a C-section by a very specific fear which can be addressed easily enough. I believe such fears should be addressed. I believe in choice, but I also believe vaginal birth should be the “default option”.

          • AllieFoyle

            What a lovely anecdote.

            Except that it’s complete bullish*t. C-sections are SAFER for the baby, and each delivery mode has a distinct but comparable set of risks for the mother that will vary with individual characteristics.

            A hundred bucks says your classmate was never informed about third or fourth degree tears, forceps, episiotomies, shoulder dystocia, hypoxic brain damage, urinary and fecal incontinence, prolapse, or future pelvic surgeries during this little educational episode.

          • Anna T

            We actually *did* have a discussion about possible risks and side effects of vaginal birth.

            However…

            If it is true C-sections are so safe, if they are actually safer for the baby, why aren’t they recommended to more women?

            Why isn’t every expectant mother asked, “how would you like to deliver? Vaginal birth or C-section? The latter is safer for your baby, you know.”

            Why do doctors object to the increasing rate of C-sections? Shouldn’t we be happy about every C-section *for a first-time mom*, because it is supposedly the safer option?

          • AllieFoyle

            Your question implies that they aren’t offered or recommended, when they actually are by some doctors in some locations. C-section rates have risen as the techniques and overall safety have improved. I responded to you a few days go with a quote from a prominent Ob/Gyn who said that c-sections are safer for babies and there are risk tradeoffs for mothers, but ultimately the risks are essentially equivalent.

            There is a lot of gnashing of teeth over the c-section rate, but is that concern totally legitimate? C-sections definitely come with risks, some quite serious, but those risks must be weighed against the risks of vaginal delivery, which are not insubstantial. Further, each woman will have different characteristics that influence her personal level of various risks. There is an enormous difference in the risk/benefit picture between a twenty year old woman planning a large family for religious reasons and a 35 year old athletically active woman with severe childbirth anxiety planning only one child. A primary c-section is probably not the best possible outcome for the first woman, but it absolutely may be for the second.

            Why do people oppose c-sections? Sometimes out of concern for the genuine risks, which are real and should always be considered, especially for subsequent pregnancies. Sometimes out of ignorance, believing that they are more dangerous than they are or being unaware of the risks of vaginal birth, which are little studied and rarely acknowledged. Sometimes out of backward or misogynist beliefs that women should suffer to become mothers and c-sections are selfish or a cop-out. Some believe c-sections cost too much, though long-term comparisons with planned vaginal birth show little difference. And then there are the people who believe that natural childbirth is a good in and of itself and should be preserved, protected, and apparently forced on women who would choose otherwise.

            Change takes time. It made sense that vaginal birth was the default when there were no other safe options, but now that the risks of VB and C-section are approaching equivalence, this need no longer be the case.

          • Amazed

            Ah, so pushing counseling is not pushing interventions because…

            Another little anecdote: a healthy young woman of 29 with one vaginal birth you would count as successful (the father wasn’t singing praises to the natural childbirth when he had to rise at night to bring the baby to mom because she was too weak from the vaginal birth and that went on for quite a few months) went to have a straight vaginal delivery with no interventions of a second, bigger baby, a PPH that almost killed her, and the following dialogue with the doctor at the followup. He: one day, you’ll sneeze and you’ll pee your pants. She: this day has already come. What a lovely realization for a 29 year old.

            My mom still has troubles with urinary and fecal incontinence, although, thank God, they aren’t as serious as those same problems in other women. It just means that whenever she needs a loo, she needs one FAST. You can bet your ass she would have loved to be giving birth now when C-sections are much safer and at least be suggested the option to think, “Damn it, it’ll be an annoying 5 minutes until I get home”, instead of, “Can I keep it in, or should I make a run for that bush?”

            Perhaps you should save your double standards for yourself. Perhaps a woman should be entitled not to relive her past, just so she can get the option YOU consider default.

            And perhaps you should tell psychiatrists who work with trauma survivors that they aren’t real doctors. After all, the only truly “medical” reason is the one happening within the flesh, right?

          • Stacy48918

            “So was it wrong to say no to interventions?”
            No. But to imply that doctors that suggest augmentation are “pushing unnecessary interventions” is foolish. Argue for better communication. All doctors should communicate their decisions to their patients, but suggesting augmentation for your labor would not have been unindicated or unnecessary.

          • AllieFoyle

            ^This. If we’re going to find fault with the doctor, it’s for his style of communication and not including Anna T in the decision-making. Augmentation in that scenario is only “over-interventive” if “avoiding interventions” is your goal, which, it’s worth mentioning again, is not necessarily what every woman wants.

          • Anna T

            Exactly!! It was not what EVERY woman would want, but it was what *I* wanted.

            This doctor read my birth plan. He knew I wanted to avoid interventions. It wouldn’t have cost him anything to say, “there are two possible courses of action here. I personally would choose augmentation if I were you, but you could also go home and wait for things to pick up.”

            You know what? He should probably have told me this as soon as I arrived. It was obvious I came too early.

          • anon

            Well, you showed him didn’t you. I bet he never even gave it a second thought.

          • Anna T

            No, I did not “show him”. I never saw this doctor again in my life and I don’t care what he thought of me.

            My point in relating this personal anecdote was to demonstrate that not all doctors have a minimal interventions policy; to answer the question, “why/how/when would a doctor even want to do something that is not absolutely medically necessary?

          • AllieFoyle

            Why should all doctors have a minimal intervention policy?

          • Anna T

            They shouldn’t.

            However, a policy I believe ALL doctors should have is “we will do our best to accommodate our patients’ preferences unless it is clearly unfeasible or associated with significant increased risk.”

            This doesn’t only regard interventions, by the way, but also other things such as privacy during labor&birth attendance (or other treatment). For instance, in the case I already discussed ad nauseum in other comments, there was another tweak: I let the doctor know I have a strong wish for privacy, that is, that no unnecessary people be present in the room – no students, specifically. I felt it to be a reasonable request founded on a basic human right.

            What did he say to that? He shrugged and commented, “well, we have a POLICY of allowing students in the room.”

            Interestingly, this clashed with what *I* was taught by my supervisors during my hospital internship (I’m a dietitian). We were told, “you can’t be present for an interview or a procedure without asking the patient’s consent” (if the patient is conscious). And many said “no”. They were just in no mood to see some more strangers hovering around them. And that was their right.

          • Stacy48918

            “However, a policy I believe ALL doctors should have is “we will do our
            best to accommodate our patients’ preferences unless it is clearly
            unfeasible or associated with significant increased risk.””
            Even elective C-sections for first-time mothers? You would support that? After all, shouldn’t doctors ask “What kind of birth do you want? Vaginal or C-section?”

          • Anna T

            My “support” means very little as I’m basically a nobody. I’m not a doctor and/or public figure.

            I do believe mothers have the right to request Cesareans, just as mother have the right to request natural birth.

            The doctors have the obligation to explain all associated risks. (“If we perform a C-section, you will be at higher risk of placenta previa/accerta the second time around. You say you don’t want another baby now, but it can change, you are still young.”/ “I know you said you wanted to have a natural birth, but this fetal monitor isn’t looking too good. It may be a false alarm, but to be on the safe side we must make sure the baby comes out soon”).

          • Gene

            If you don’t want students/learners, don’t go to a teaching hospital. Period. I preferred not to see medical students during my actual delivery as I was their supervisor and graded them (conflict of interest), though had little problem with them at ultrasounds, etc. ANYONE (residents, students, etc) who wanted ultrasound practice in the ED when I was pregnant was free to have a go (abdominal, not trans-vag). The students tended to avoid my room anyway (OMG, it’s Dr. Gene? What if she sees me screw up! What if she grades me bad eval later?) However, I had a second year anesthesiology resident place both of my epidurals and a third year (last year of training) OB resident deliver my first baby. The latter was WONDERFUL. And she is a credit to OBs everywhere. I wish that she would have joined the staff because I would have gone back to her in a heartbeat.

            I have zero problems though with student nurses, new technicians, new phlebotomists, etc. Everyone has to learn. EMTs I’d say no to because I work with them closely in the ED (again, it’s a working relationship issue).

            My issue was more that I had the potential to supervise and grade some of the medical students and residents on their ER/Peds rotations. But everyone also knew that if there was an emergency, I didn’t give one god-damn who was in the room. When #1 arrived, there were about 20 people there (including some Peds residents) because we lost her heartbeat briefly. And I didn’t give one shit. For #2, we knew in advance that there might be some issues and the NICU sent down the nurse practitioner team instead of the residents. And I am incredibly grateful for their presence.

            FWIW, ANYONE in the medical field (from lowly student to lofty attending) is there to provide care. And we learn our entire career.

          • Anna T

            Gene, I had no problem with student/intern acting in the place of a caregiver, that is, if they are competent. Sometimes students are even more careful/attentive/polite. I know we tried our best when we were interns.

            What I HAD a problem with was a doctor coming in to do something WITH a bunch of students who would just hang around and watch. I didn’t want a crowd around me, so I stated it in my birthing plan.

            Imagine that happening while I was, for instance, getting stitched up for my tears after birth… just lying there on the bed with my legs spread… it would have been horrible. My request was – someone comes to do something, OK, please nobody else to come in with them just to “watch” or to “study a case”. I wanted a minimum of people in the room with me, and it was important. It was also my right.

            I never thought to ask beforehand whether the hospital was a teaching hospital. Luckily, the hospital I ended up in allowed a great degree of privacy.

          • Gene

            Those students standing around and watching, do you think MAYBE they were learning about vaginal repairs? Just maybe? Or would you prefer they not see one before they do their first repair? That is what medicine is: you WATCH, you STUDY CASES. There is an adage: See one, Do one, Teach one. You CANNOT learn medicine from a book or a TV screen. And the person doing your repair, HOW DO YOU THINK S/HE LEARNED?

            I learned how to do vaginal tear repairs from pictures in a book, then by practicing on a piece of foam, then by watching my teachers perform them, AND ONLY THEN was I allowed to touch a patient myself.

            I’ll ask again: if not you, WHO exactly should we learn from?

            Again, it is your right to have a “minimum” of people in the room. And if you don’t want students, GO TO ANOTHER HOSPITAL! I have a friend who drove an hour away (and we live in a place with a world renowned hospital on every corner) because she wanted to deliver in a place that guaranteed only female providers in the room AT ALL TIMES. She found one that offered that guarantee and drove there for all her care. I’ve had patients (or parents) request: no blacks, no jews, no muslims, no asians, no middle-easterners (in whatever colorful language you can imagine), no men, no women, no students, no whatever. In the ED, my response is, “You may leave at any time and find another ED because XXX is who is on staff and s/he is an excellent provider”.

          • Anna T

            Rationally I agree with you on the importance of learning for students – surely they must learn from somebody, as we did during our internship – but as a private person in the emotionally vulnerable place of a woman in labor, I couldn’t think of “the greater good”. All I could concentrate on was how to make myself tolerably comfortable, and I doubt anyone can call me selfish or unreasonable for not wanting any extra people in the room while my legs were spread and I was still in the bed where I gave birth…

            (I mean, it’s really great if you have a cheerful attitude and say, “sure, guys, anyone who wants a look can come in – you need to learn!” – but you can’t expect this kind of rationalization from all patients.)

            By the way, I eventually had my babies in a hospital that turned out not to be a teaching hospital. But I didn’t know it beforehand.

            However, I disagree that by going to a teaching hospital, one loses the right to say “no students” or “no more people in the room than necessary”. Theoretically you’re right that if privacy is an issue, don’t go to a teaching hospital, but there are emergencies or “perceived emergencies”, such as when the patient is just anxious to get to the nearest hospital and doesn’t bother to check whether it’s a teaching hospital or not.

          • Gene

            A woman in labor is more emotionally vulnerable than someone going into emergency surgery? Or headed to the ICU on a ventilator?

            In an emergency, you chose your battles. You can always decline to consent to care (and leave AMA).

          • AllieFoyle

            Who should they have learned from? Someone who gave consent for them to be there!

          • Gene

            Yep. WELCOME TO A TEACHING HOSPITAL. Don’t want students, GO SOMEWHERE ELSE. How is this difficult for you?

          • AllieFoyle

            What’s difficult for me is that you are apparently a doctor and you seem to have a shocking level of respect for the rights of your patients to privacy and dignity. Not everyone can GO SOMEWHERE ELSE, though I imagine a lot of them might choose to if they knew you had that kind of attitude.

          • The Bofa, Being of the Sofa

            Define privacy in a non-tautological way.

          • Gene

            Agreed. The rich will continue to buy better care and the poor are left with what is closest and available.

            But you seem to think that medical personnel seem to arrive fully formed in their education. Either that, or that they can learn from “SOMEONE ELSE”, cause I’m a speshul snowflake and I deserve BETTER than a student. I’m still waiting to hear your suggestions on WHO exactly is deserving of 100% private personalized care and who isn’t quite good enough and deserves student care.

            There is a huge difference between respect/privacy which is offered to ALL patients and demanding special care because YOU are somehow different/better and shouldn’t have to be a “specimen”.

          • The Bofa, Being of the Sofa

            Does the patient have to consent to everyone participating, or only specific ones?

            Can the patient insist that they don’t want a pediatrician in the room, for example? (Not that I know why they would, but if they did; maybe because it’s a guy)

            Or can they say, “no more than 3 nurses in the room ever”?

            Actually, my male pediatrician is a good example. What if she INSISTS that there cannot be any men in the room, but he is the staff pediatrician. Would you defend her insisting that he has to leave, despite being needed in her case?

          • AllieFoyle

            If you don’t want students/learners, don’t go to a teaching hospital. Period.

            No, no, a thousand times, no. People do not give up their right to privacy and dignity when they go to a teaching hospital. Not everyone has a choice of hospitals, and many people simply do not know that it’s something they have to be concerned about.

            A group of students was ushered in to watch the end of my first delivery without my prior knowledge or consent. It was humiliating.

          • Gene

            Given a choice between a teaching hospital and a non-teaching hospital, I pick the former. In my experience, the quality of medical care is vastly superior. However, you cannot go to a hospital and then refuse all student care. The students are there to LEARN. You can’t have your cake and eat it, too. A group of students trouping in without permission isn’t done (usually) anymore. But if the med student and resident are part of the team, THEY ARE PART OF THE TEAM. You want the attending (boss)? You get his/her students as well. That is the POINT of a teaching hospital. I TEACH future healthcare providers (nurses, doctors, technicians) in my ED. And some of my former students are pretty badass in their fields now. I was a student once, too (and, as far as I’m concerned, I will be a student forever since I’m always learning).

            Or do you expect your future doctors (and nurses and midwives) to learn on “someone else” (aka some poor person). I actually once had a wealthy woman tell me that students need to learn on Medicaid patients (“the poor”) since that was their penance for “leeching from society”.

            Seriously, WHO exactly do you want students to learn from? And saying “someone else” doesn’t cut it. You think Ben Carson, Oliver Sacks, Alfred Blalock, Atul Gawande, and Abraham Verghese (that’s way too many men – ugh) weren’t students at some point? Respect is one thing (and the students shouldn’t have trouped in en mass), but refusing any student care? Seriously, you don’t want students? Then go to a NON-teaching hospital. Me, I want the students.

          • Anna T

            Interesting, I thought I had commented on just this topic, but it seems to have gone into Cyber-nothingness… my personal issue was not that I thought student care was incompetent care. What bothered me was the number of people attending me at every given time. That is, I was OK with being attended by a student, but I was not OK with being attended by a doctor/midwife and a group of students hovering in the background and watching.

            I mean, imagine the doctor placing stitches on a vaginal tear and a bunch of totally unrelated people just standing there watching me as a specimen… I had an issue with that, and I don’t think I was unreasonable.

            But, indeed, not everyone has a choice of hospitals. What if the only hospital at a reasonable distance is a teaching hospital and you feel very strongly about your privacy?

          • Gene

            What if you are a racist, homophobic, antisemite misogynist who needs a specific surgery and the only game in town is an incredibly talented black, lesbian, jewish woman? Deal with it or find another place.

            Seriously, anyone in medicine is held to national patient privacy laws. But if you feel strongly about exactly who is in the room, do as above.

          • Anna T

            I believe you are taking this a little too far… surely if you want special and very specific accommodations, that’s one thing. But I didn’t require any. I merely said, “no spectators”. It’s not like the hospital needs to go an extra mile to comply with such a request.

          • Gene

            Not really. They are both unreasonable requests. Don’t want students? Go to a non-teaching hospital. Don’t want blacks. Find some place staffed by the KKK.

          • Anna T

            There is a difference between asking the hospital to jump through hoops because of one’s prejudices (“get me a different nurse, this one is Muslim” – I’m not making this up), and merely asking that something should NOT be done when such a request can be easily accommodated. It doesn’t take any special effort on the hospital’s part NOT to let a group of students into a room if the patient is feeling uncomfortable at being observed by several people at once.

          • Gene

            But Anna T, it DOES. Part of the mission of a teaching hospital is indeed that: TEACHING.

            Have you ever seen teaching rounds? An entire group of doctors (and depending on the hospital, nurses and pharmacists, sometimes social workers and case managers) walk from room to room, discussing the patient and his/her care for that day. It is when we learn about the patient, the medical reason they are there, and the plan for treatment. You can’t do that one on one.

            Again, I’m not saying that you have to consent to students. But if you do not, then you can choose to go to a hospital that does not teach them.

          • Anna T

            Yes, I’ve seen teaching rounds. I’ve participated in them, too. I realize there are things that can’t be done one on one.

            What I talked about are things that are normally done one on one (such as a doctor stitching a patient up). Once we were supposed to be present for an interview of a patient with our supervisor, and eventually the patient said he doesn’t want us sitting in the background; he said it annoys him. So we had to leave, and though we were a little disappointed, we were also understanding.

            I realize this is different because I’m a dietitian, not a doctor or nurse, but we have to learn too. And sometimes we had to take a “no” from patients.

          • The Bofa, Being of the Sofa

            But I didn’t require any. I merely said, “no spectators”

            But they are not mere “spectators” there to watch. They are students there to watch and learn.

            And yes, the hospital WOULD be put out complying to that type of request, because it would be hindering there educational efforts.

          • AllieFoyle

            I’m going to leave this conversation now because I’m finding your unfeeling, blithe replies to something that was deeply humiliating to me really upsetting.

            I’m a human being. I went to the hospital to have my baby. I had no idea about teaching hospitals (I don’t even think this one was one). I didn’t make any outrageous requests. My previous life experiences involved sexual violence, and being forced to have an experience like that was just not acceptable. I can’t wrap my head around the idea that you’re more concerned with hindering the hospital’s educational efforts than violating a patient’s humanity.

          • Gene

            By all means, FLOUNCE away.

            And when you calm down, I want you to THINK about why YOU are more special than someone else. YOUR sexual violence makes you more special than the 20% of other women who have also experienced sexual assault? Or the 1-2% of men (this is likely much higher as it is WOEFULLY under-reported)? What makes YOUR sexual violence experience different than them? EVERYONE deserves respectful care. But in medicine, learning is part of the game. And unless you want your doctors and nurses and techs to learn only from computers and books before being considered competent, or to learn on the mythological SOMEONE ELSE, you will have no care at all.

          • Anna T

            As a rational being sitting right now in front of the computer screen, and as someone who had done a hospital internship, I agree with you that students need to learn.

            But while I was in labor, and shortly after I’ve had my baby, my knee-jerk emotional response was, “I want as much privacy as possible.” It’s unrealistic to expect an emotionally and physically vulnerable person to be concerned about the students in the hospital missing on an interesting case study.

          • Gene

            You are correct. Most people do NOT care who medical personnel learn from as long as it is not them.

            And I’ll ask again, as you are a rational being in front of a computer screen: if you want your medical personnel highly educated and competent, have experience with those 1/10,000 emergencies (not just from a book), and know exactly what to do because they have seen it countless times before, WHO should they learn from.

          • Anna T

            At the moment, I’ll probably say “me”.

            But knowing myself, I’ll bet that once I’m in labor again, I will feel very different…

            You are right. If everyone refused to be treated/watched by students, nobody would learn. However, I don’t think it’s ethical to force people to become “case studies” for a group setting. Instead, one has to take care to request this in the nicest, pleasantest manner possible. Rather than say, “it’s our policy to allow students in, so you get no say in the matter” (which practically asks for a knee-jerk negative response), one can say, “these are students X, Y and Z (say their names). Would you mind if they stay to observe us? It would be ever so helpful if you agree, and they will be as unobtrusive as possible. Thank you very much, it means a lot to us.” Let the patient feel they are doing you a favor. It’s much more diplomatic and doesn’t cost anything.

          • Gene

            What makes you think I don’t do that? When I have an “interesting case” (say, mumps, which I see about 1-2 times a year), I ask the patient/family if my other students can come in and see to learn. But the student is often the first person in the room (I’m in an ED). If the student is kicked out because the patient/family “wants only the attending”, they get the gentle “teaching hospital” talk. If they still say no, they get maps to another hospital.

          • AllieFoyle

            That was exceptionally cruel.

            I have just read the list of patient rights and responsibilities at several teaching hospitals. They clearly spell out the right to respectful care, the right to privacy, the right to know the name and role of each person involved in your care and to have any observer not related to your care leave.

          • Gene

            Cruel because I pointed out that there are MANY MANY MANY women and men who have experienced sexual violence (much to our society’s shame)? And that they, like you, deserve respectful care?

            All hospitals publicize a list of patient rights and responsibilities. The right to respectful care. Check. The right to privacy. Check. The right to know the name and role (ie: “This is Ms. Kathryn Smith and Mr. Jason Jones, they are your 3rd year med students. This is Dr. John Carpenter. He’s your intern. This is Dr. Mena Rao. She is your resident. I am Dr. Gene and I’ll be the supervising doctor”). Check. …observer… “This is Mr. Gil Schwartz who is thinking about becoming a med student”. “I prefer not to have the observer” “That is fine.” Check.

            My OB/Gyn rotation was three med students, two interns, one senior resident, and one attending. During my 6-7 weeks on L&D, I think I delivered maybe 20 babies.

          • AllieFoyle

            I did not receive respectful care, by your own definition. I was treated like garbage, just as you are treating me like garbage. I hope you rot in hell.

          • Gene

            Because I am calling you out on your prejudices?

          • AllieFoyle

            You are a disgusting human being. The only prejudices I expressed were that people be treated with respect and their privacy and dignity be respected, which apparently means nothing to you.

          • Gene

            No, I would be a disgusting human being if I treated some people better than others based on their own perceived inadequacies. You deserve the SAME treatment as everyone else. Or did you miss that particular lesson in kindergarten?

          • AllieFoyle

            You belong face-down in a trash can, you piece of human filth.

          • Gene

            This is quite telling, Allie. I’ve stated my point several times that EVERYONE (even you) deserve respectful care. And your response is to tell me to “rot in hell”, call me “a disgusting human being” and “piece of human filth”, and tell me I “belong face-down in a trash can.” How sweet of you. Reminds me of the drug seekers and drunks I deal with all day long at work. You know, the ones I treat with kindness and respect no matter what insults they hurl my way.

          • AllieFoyle

            Kindness and respect? Those are human beings, not “drug seekers” and “drunks” and “female sexual assaults”, just as I’m a human being who you mocked for being raped and wanting to be treated with dignity. Fuck you.

          • Amy Tuteur, MD

            Stop with the “fuck you.”

            She obviously hit a nerve and instead of blaming her for hitting it, you should be investigating why it stings so much.

            As an outside observer, it seems that what bothers you most is that Gene pointed out that, contrary to what you have been telling yourself, you are not entitled to shift the burden of students off yourself and onto others. I have yet to see you explain why poor women and women of color should have students present while you can merely benefit from being in a teaching hospital without teaching.

            If you have specific circumstances that warrant special treatment, by all means share them with your providers and ask for accommodations. But don’t imagine that your circumstances mean that others must bear the burden for you.

            The right to privacy means that you have a right to keep your medical information private. It does not mean that you have a right to hand select your care team while everyone else takes what you didn’t want.

          • AllieFoyle

            I know why it hit a nerve. It will always hit a nerve, no matter how long I live, how many therapists I see, how many antidepressants I take. I have never said anything at all about hand-selecting my care team or making specific requests or asking anyone to bear any burdens. I said that people deserve to be treated with respect and dignity in the hospital and, as a human being, the way that I was treated humiliated me.

          • Gene

            Yes, I treat human beings. I am not a vet. And some of those human beings are incredibly abusive to me and my coworkers. And we treat them the same way we treat any patient. With kindness and respect. Alcoholism is a disease. Drug addiction is a disease. I will not treat a drug addict coming to my ED seeking a fix any differently than an asthmatic with a flare or a broken arm or a psychotic break.

            And I didn’t mention female sexual assaults in my above comment. I never specify gender because males are sexually assaulted as well. And they often don’t come forward because of prejudicial attitudes that only women can be raped. The last male assault victim I saw was the subject of disparaging comments by the police as well as a seasoned ED nurse. And I read the riot act to both of them regarding their comments because ALL PATIENTS DESERVE RESPECTFUL TREATMENT, including those who abuse us, swear at us, or threaten us. Even you.

          • Amy Tuteur, MD

            It seems like you have assumed that excluding students harms no one since they are there simply to be entertained. The reality is that excluding students harms the students and places a burden on the other patients.

            The irony is that in many cases, the most excited, caring and emotionally involved person in the room besides the parents is the student. When I was a student, I felt privileged to attend a birth. It was still a miracle to me. More than 30 years later I still remember the name of the first baby whose birth I witnessed. It was a special moment in my life.

          • Anna T

            Situation A: student is assigned by the hospital to act as caregiver. Thus, the student actually does something for the patient and the patient benefits from the student’s efforts.

            Situation B: a doctor goes in to see a patient and motions a group of students to join: “I want you to see an interesting case”. The patient is emotionally overwhelmed and doesn’t feel comfortable with having any extra people around.

            I believe in situation B it’s a lot more reasonable, from a patient’s point of view, to refuse having the students. Because the students aren’t actually doing anything for the patient, they are just there to watch. Which is acceptable, as long as it’s done respectfully; but it’s also acceptable to refuse.

            I’ve been on both sides, as a student in a hospital and as a patient. Sometimes, patients said “no” to having us around just to watch; they didn’t feel comfortable with our presence, and it was OK. There were still enough patients to go around.

          • Gene

            Situation B: someone is here with a rare presentation of X. This is something that maybe is seen once a year and if the student does not see it, s/he may not recognize it later and the patient may suffer because of it (see CPMs who are “experts”). Come back later is fine. But “go see someone else” is not.

            It’s a bit like vaccine refusal. I don’t want any of the risk of the vaccine, but I’ll benefit from all you sheeple who consent to them for society’s greater good.

          • Anna T

            Question: even if you think the patient in this particular case is being unreasonable and selfish, do you believe it is ethical to force the presence of students on them?And, if the patient specifically requested that the students leave, can you ethically and legally say, “no, they will stay?”

            What does the law have to say about this?

          • Gene

            I tell them that we are a teaching hospital and the students are a valuable part of my medical team. If they prefer to have their care performed by another practitioner, I can give them names and locations of other, non-teaching hospitals in the area (few and far between). My ED does not teach medical students. We have residents (graduated from med school, getting training in their specialty) and PA students. We also have brand new fresh nurses who are still learning on the job and need to work with a more senior nurse. I will sometimes take a patient myself without the resident (usually an experienced male resident when a female sexual assault comes in). But ALL physicians who work in an ED must know how to treat a sexual assault, take a history, and collect forensic evidence, male and female.

            If you want an experienced medical team, they MUST learn. And learn from patients.

          • Amazed

            Is it ethical of the patient to know that it is a teaching hospital, go there for the care and refuse to do their part?

            It might be legal. But not ethical.

          • AllieFoyle

            But who defines what any ethical obligation actually consists of? No one in this conversation has said they don’t favor students learning or participating in care. But some of you seem to feel that there are no limits to a patient’s obligation to foster learning, to the extent that this vague notion of obligation justifies superseding a patient’s rights, as well as the provider’s obligation to the patient to provide respectful care that honors a person’s dignity and privacy.

          • Amazed

            I am not an ethicist. But I think that once a patient had knowingly chosen to go to a teaching hospital to receive the care provided there, there are indeed very few limits to their obligation to foster learning. The limits should be: let the students who have direct interest in being there be there. Introduce them. Don’t leave the patient feel like a freak show but a participant in a teaching process. Even if someone is late and comes bursting in, explain why they are there. But yes, once a patient chose to go to a teaching hospital, they buy the whole ticket, not only the part they like.

          • AllieFoyle

            But there have to be some limits. My experience was more than ten years ago, and I think there has been a real change in attitudes toward patient rights and autonomy since then. Rightfully so, in my opinion. I don’t see any reason you can’t balance educational needs and a respect for patient rights and dignity. I’m surprised to see such vehement resistance against the desire for sensitivity in labor and delivery. Isn’t it the health care provider’s obligation to ensure that the patient’s experience isn’t unnecessarily humiliating or dehumanizing? First do no harm.

          • Amazed

            I do think there have to be some limits. Like, having teaching hospitals reserved for people who wouldn’t feel humiliated or dehumanized by having students present.

            Someone who is too sensitive for that doesn’t belong in a teaching hospital when it can be avoided. An emergency doesn’t fall into this category. But a patient doesn’t get the right to demand consideration of her special sensitive needs by a teaching hospital when there are others, non-teaching, and they are accessible.

            Do no harm includes getting knowledge first. I cannot waltz in a place where knowledge is gathered and demand the perks but leave the burden to someone else.

          • AllieFoyle

            I really don’t understand the distinction. Patients who go to any hospital are patients, with associated rights that health care providers have an obligation to respect. Those rights don’t go out the window because a hospital has a certain designation. Maybe you are all coming at this from the angle of people in large cities, with many hospitals to choose from. My experiences have mostly been in college towns in rural states. There is one hospital in town. Why would you think of going anywhere else? Why would you have to?

            And sensitivity to privacy and dignity in childbirth is a “special sensitive need”? I’d consider it common human decency.

          • Amazed

            I repeatedly said in every post that I was talking about situations where people have choice. This is the last time I am saying it: I AM TALKING ABOUT SITUATIONS WHERE PEOPLE HAVE CHOICE.

            Yes, I live in a big city. And I speak as someone who dislikes people squirming from responsibility while retaining the good things. There are hospitals to choose from and I find it problematic when people go to the one that teaches with the specific purpose to to gain the professors and everything but refuse to comply with their moral obligation to contribute.

            And yes, sensitivity to privacy and dignity in childbirth is a “special sensitive need” when you go to a hospital that doesn’t offer them WHEN YOU HAVE CHOICE!

          • Meerkat

            I am sorry, but in a real world very few people truly have a choice. I live in a big city with lots of hospitals, but that doesn’t mean that even I had a choice of all of them. I had to find an OB-GYN that took new patients AND my insurance, AND was reasonably close to my house, AND worked in a hospital that was also reasonably close to my house. It was harder than I thought. I called about 20 practices before finding 2-3 that even took new patients, and only 1 of them accepted my insurance. Majority of people are tied to the hospital that their doctor is affiliated with, whether it is a regular practitioner or a specialist. I am not even talking about an area where physically getting to a non-teaching hospital is impossible.

          • Amazed

            I am talking about sitiations where people have choice, though.

          • Meerkat

            Right, and I am saying that in reality, with our current healthcare and insurance systems, there are very few situations and people who truly have that choice.

          • Amazed

            Your healthcare system isn’t the same as mine. My grievances with mine are quite great. But I really don’t think I’ll feel justified to bitch about the doctor who mismanaged my care 15 years ago and I still feel the consequences if I refuse to contribute to students learning.

          • AllieFoyle

            I don’t think we actually have a huge disagreement. If you specifically choose a teaching hospital for the access to expert care, then you should also expect some level of student learning being involved in your care. But I don’t know that everyone who goes to a teaching hospital will have that level of motivation or understanding or choice though. I did not know teaching hospital from non-teaching hospital, and I imagine a lot of other people don’t either. I also don’t think that accepting student care in general means submitting to every opportunity for student learning, or that hospital staff in a teaching hospital don’t have the same requirement to respect a patient’s dignity and privacy that staff in any other hospital do.

          • anion

            Allie, while I don’t necessarily agree with your whole take on the situation, I absolutely I agree that you should have at least been informed before students were brought in–perhaps not at that moment, but during one of your maternity appts. your OB could have said, “Hey, that’s a teaching hospital so FYI you’ll probably have some students popping in to learn stuff.” Your history should have been addressed, and you should (if at all possible) have been given the opportunity to–even if you couldn’t outright refuse–meet the students or greet them while you were covered so you would have felt at least a bit more comfortable.

          • Amazed

            Actually, I might be even sterner on patient’s privacy than you are. You don’t get to enter the room when I am having my care and stand to watch. How am I to know that you’re a student and not, say, a hidden… how was the word? Someone who likes to stare. I’ve had those in other public institutions and I am not going to tolerate them in a hospital. You are introduced to me, so I know that you belong there.

            But utilizing the resources of a teaching hospital specifically for the care is something that I am watching right now, with dentists. A few people advise each other of how to go to the faculty and receive care at symbolic price. But here is the perk: they only want to go there when they know they’ll be attended by certain students supervised by certain professors. Those are people I know in person and I know they aren’t experiencing any financial difficulties. If I, who am not poor but not anywhere near them where money is concerned,can go to a very qualified dentist and leave there quite the nice sum to get her expertise without getting bancrupt (although I do feel the need to go to shopping therapy as a small act of revenge, not that she cares), then to hell, so can they! If they want to get the care of the best dentists of the future supervised by the best dentists of the now for no money at all, then I am having a problem with that. There are enough poor people who don’t know the tricks to get that.

          • Gene

            Allie, I think you are confused about the meaning of PRIVACY in healthcare. Anyone seen in a healthcare setting in the US (and most other places) is subject to rules guaranteeing that the providers cannot break confidentiality. Exceptions are in place when a patient wantś to hurt himself/herself or others or if the patient is a protected class (minor, elderly) and someone I’d hurting them. Those things must be reported. I can’t disclose ANYTHING else to ANYONE else. I can’t bitch to my spouse, brag on Facebook, post online, write in a newsletter, anything. I could lose my job. I see someone famous? I see someone newsworthy? I see a friend/colleague? My lips are sealed. I can’t even access their records without written permission.

            All medical personnel are held to the same rules. Those nursing students who watched you a decade ago, assuming they were in the US, we’re not violating your privacy. We can discuss patient care freely among the team without violating of privacy. Your medical care is protected within the team. So your statement that your PRIVACY was violated I’d incorrect. If one of those students (or even the doctor) posted a pic on FB, yes, patient privacy has been violated. But a team member’s presence in the room is not, by definition, a violation of your privacy.

          • AllieFoyle

            I don’t think I’m confused. Privacy is not limited to confidentiality.

            From Patient Rights and Responsibilities at Beth Israel Deaconess:

            Your individuality – including your cultural and personal values, beliefs and preferences, and your educational background – will be respected.

            When you are examined, you are entitled to privacy – to have the curtains drawn, to know what role any observer may have in your care, and to have any observer unrelated to your care leave if you so request.

            You have a right to know the identity and the role of individuals involved in your care. Because this is a major teaching hospital, there are many members of the health care team participating in your care and treatment. You may request that an individual not be assigned to your care and may expect that this request will be honored whenever this is possible without jeopardizing access to medical or psychiatric attention.

          • Gene

            You may request and whenever this is possible is not always going to happen. No blacks or Jews or Muslims or women? Hurray for segregation! I

            I recommend you be seen only by medical providers who meet your strict rules: nurses who have never seen a vaginal delivery. Or ones who have never a sexual violence victim have a delivery. Oh wait, you want experienced providers? By all means, let SOMEONE ELSE be the specimen.

            Do you actually hear yourself and how selfish you sound?

          • AllieFoyle

            Have you actually read anything I wrote? There are four nurses out there who got their training from me. I didn’t refuse them. I didn’t have the chance. But sure, let’s pretend that the only way to train health care providers is to do it against a patient’s will, in large groups and without the patient’s prior knowledge or consent, and with no sensitivity or consideration for the feelings of the patient.

          • AllieFoyle

            Also, comparing my humiliation at having my private parts viewed at a sensitive time by several people without my consent to a bigot making racist demands is the height of insensitivity.

          • The Bofa, Being of the Sofa

            You may request and whenever this is possible is not always going to
            happen. No blacks or Jews or Muslims or women? Hurray for segregation!
            I

            I’d haven’t seen this addressed yet (except maybe Anna dismissed it)

            If a patient is uncomfortable with a black person in the room, will you insist that the hospital “respect” that request? Or is it ok to disrespect racist patients?

          • AllieFoyle

            Because a woman wanting sensitive care is equivalent in some way with someone making racist demands?

          • Meerkat

            Ha, that would do wonders for that hospital’s public relations! I can just imagine a following conversation: “Mrs. Doe, I see you came in for a procedure ordered by your doctor. Before we proceed please note that this is a teaching hospital and you would have to consent to being observed by medical students during your procedure.” Mrs. Doe is an older woman with a gynecological condition, and she is very embarrassed. She says she doesn’t want to be observed by students and the hospital sends her away. Mrs. Doe is pissed off. If Mrs. Doe is feisty enough she will call local newspaper who will raise a s…storm, or sue. A less feisty Mrs. Doe will just complain to her doctor, who will also be pissed off because the hospital is making his and the lives of his patients more difficult.

            So, instead of being flexible, the hospital would get a huge problem on their hands. This is probably why hospitals are embracing more and more patient friendly policies. Patients are just happier that way, and a less stressed patient will be more likely to comply with their treatment and hospital policies.

          • http://www.antigonos.blogspot.com/ Antigonos CNM

            I have repeatedly been treated at Israel’s flagship teaching hospital. Whenever a nursing or medcal instructor wanted students to observe, I was asked whether I minded being observed or used as a teaching model. I’m naughty enough to try and make the experience ” interesting” for them, most of the time. (The instructors usually caught on pretty quick). But occasionally I’ve been unwell enough to request not to be bothered, and they would all go away to find another “victim”). I’ve never experienced having the enclosing curtain roughly pulled abck without warning and having a horde of strangers begin poking at me.

          • Gene

            Me, either. And I’ve been both patient and worker (from med student to resident to fellow to attending) at mültiple US hospitals in multiple states starting in the mid 1990s. From “the number one” hospital to smaller community. I’ve never seen it. And we were taught from the very beginning to always introduce ourselves and treat patients and their families as politely and respectfully as possible, even if they are abusive to us.

            To me, a child needing surgery for an appendectomy can be just as scared and deserves as much compassion as a laboring woman.

          • Amazed

            “To me, a child needing surgery for an appendectomy can be just as scared and deserves as much compassion as a laboring woman.”

            I didn’t see that before writing a post about this very matter.

            Gene, if you have a woman whose labour is progressing so finely that she feels she can argue with her doctor that everything is totally fine, on the one hand, and a child with acute pancreatic condition that is still undiagnosed who knows doctors cannot figure out the thing he owes that pain making him want to die to, on the other, which one would you think is more scared?

          • Meerkat

            little did you know, but on those occasions when you didn’t want to be bothered, you were shirking your responsibility as a patient and hindered teaching process:)

          • Amazed

            When she felt unwell enough. Or did you miss that part?

          • http://www.antigonos.blogspot.com/ Antigonos CNM

            Oh, I knew it, all right. But I reserve the right to be grumpy when feeling crummy…

          • Meerkat

            Well, cut it out! Just close your eyes and think of Israel! Your country will thank you in the future, which will be teaming with great doctors, all because of your selflessness!
            (A little joke, but I gotta go hide now, I fear Gene will crawl out of the computer screen and bite my nose off!)

          • Amazed

            Don’t worry, Gene is just a mean old doctor. She can’t do much anyway. Hide from my mom instead. As someone who had to sit and wait for her child to die (thank God, they got THAT wrong, too) after the team of clueless doctors misgiagnosed him, delaying precious care for his rare condition, she feels quite strongly about doctors actually knowing what they are doing. And she recognizes that teaching hospitals are a vital part of it.

            But by any means, enjoy your little joke. Just don’t expect those who needed their doctors to be able to tell this from that and normal from abnormal join in your fun.

          • Meerkat

            Oh, please! This is internet, and Gene and Allie’s pissing contest was getting ridiculous. We agree here, so no need to shame me for not taking this discussion with the grave seriousness it deserves. The discussion was getting personal and silly, with both sides accusing each other of crazy shit and getting nowhere.
            I understand that you are passionate about this issue because of your personal tragedy. Gene is passionate about it, too. Just remember that despite all the personal insults all discussion participants agreed that in great majority of cases, when asked respectfully, all of us were absolutely fine with student doctors either observing or treating us.

          • Amazed

            No tragedy, or did you miss that? He’s FINE now. The serious question was, the one who got the diagnosis was the one who had seen it all. And let’s not forget the pharmacist. Pitiful that a pharmacist had to intervene and say what the diagnosis wasn’t while a whole team of doctors couldn’t say what it was.

            I am not forgetting it. I just take issue with statements like “Other patients are not my responsibility.” And you might have seen that I didn’t have nearly as much of an issue with Allie’s legitimate trauma and mismanaged teaching case as I did with Anna T’s insistence that she was totally entitled to privacy and a teaching hospital should have hounoured her birth plan excluding students because it was so easy to accommodate. I don’t know how she failed to notice it was a teaching hospital. Maybe in Israel it’s all different but where I am, the words UNIVERSITY Hospital are written in huge letters as a part of the name, just above the door.

            I also happened to notice that your little jokes were all in Gene’s field.

          • Meerkat

            My “little jokes” were in Gene’s field because instead of passionate she started sounding belligerent and paranoid. Some of her posts and personal stories are great and would make her argument much more compelling, but only if she forced herself to stop bickering with Allie.

          • AllieFoyle

            Or perhaps teaching hospitals should consider amending their promotional materials to make it clear that they don’t care for “special sensitive” patients.

            “…committed to providing the highest quality women’s healthcare in a compassionate and supportive environment.”

            “We understand that each patient has personal and unique concerns. This is why we encourage our patients – and those close to them – to be active participants in care, and we work with each family to meet their needs.”

            “A comfortable, patient-centered atmosphere with a caring medical staff”

            “A welcoming, safe and intimate place to experience childbirth”

          • Gene

            That’s because we treat ALL patients the same. Or would you prefer we go back to whites only hospitals? Do you really want us to treat certain patients differently than others? Really?

          • Amazed

            Yes, because Mrs Doe cannot enter her car and cross – oh my God! – the entire city to go to the hospital that would accommodate her.

            My grandmother can so relate to the fact that a whole city is a really great distance that makes reaching a non-teaching hospital physically impossible. She can reminiscence about the good old days when she could climb into the donkey cart and head for the only hospital in the region to give her body at least a fighting chance to stay pregnant (it only worked once). Ah poor Mrs Doe, indeed!

            Don’t forget, in each of my posts I include the premise that there is accessible non-teaching hospital nearby. I certainly won’t stand for forcing anything to anybody.

          • Medwife

            Patients very rarely refuse the presence or participation of a student or students when asked respectfully, and they should always be asked respectfully. Part of training is learning how to treat patients with compassion and respect. I remember feeling such gratitude towards people who permitted me to observe their care or examine them, when I was a student. A situation where a student is shoved at an unwilling patient isn’t good for either education or patient care.

          • Meerkat

            Precisely! Handling a situation diplomatically vs. forcing a patient to comply will have very different results.

          • Meerkat

            I, for example, didn’t have a choice. When I got pregnant none of the doctors in a non-teaching hospital were taking new patients. I had no choice but to find a doctor affiliated with a teaching hospital and deliver there.

          • Amazed

            Not having a choice isn’t as choosing a hospital for the perks and refusing to take the negatives.

            I, for one, chose to go to the ER doctor who put me in plasters to remove them. My reasoning? He would do it for free because he was obliged to. Nowhere in his obligations was it written that he’d do it when I find it convenient. He told me an hour where the ER usually wasn’t busy. I went there ang guess what? There was an emergency. I sat and waited it out for over an hour. A woman who was told to come half an hour after me because it wasn’t a busy hour for the ER usually raised a hell. They were ruining her daily schedule, she was a patient and had rights… Bullshit. She didn’t want to pay, she waited until she could be fit into the schedule of the doctor who could take her in for free. And I told her so because frankly, it was innerving to sit in the ER with all those people who needed urgent medical attention and listen to someone whining that they weren’t getting their plasters removed for free because they didn’t get to bump the emergency that sent everyone running for the antishock, or whatever it was, hall.

          • Anna T

            You see, when my first baby was born, the memories of my own hospital internship were still fresh. We were students, and before we were allowed to do things on our own, sometimes patients would say “no” to having a few extra people in the room, just because it annoyed them. None of us even thought of doing anything but respecting those patients’ wishes. No one muttered and called the patients “selfish” or “ungrateful” either.

            We realized that people who are hospitalized, and who are in a sensitive situation, can be set off by any little thing. We realized they can be moody, irritable, and perhaps sometimes unreasonable. Non-cooperation was an important part of our hospital experience, too.

            We realized that patients don’t come to the hospital to “do their part”. It’s perfectly normal if people in the midst of pain and uncertainty can’t care less about the hospital’s educational goals and just want to be as comfortable as possible. They come to be treated. And if they say, “caregiver only please, this is not a show”, then it is their basic right.

            Of course there’s the “if everyone refuses…” argument. But in practice, there was never a shortage of patients who said “yes” (and even, I think, saw us as a little diversion). It just didn’t make any sense to foist ourselves on people who said “no”.

            So, since I had heard my share of “no” from patients as a student and never had a problem with it, it just never occurred to me that, once the coin flips, I can’t say “no” to students as a patient.

            (And please note that I’m only speaking of observers, not caregivers. Saying “no observers” in an intimate situation is not like saying “I want a different caregiver”).

          • Amazed

            I can see what you mean. On the other hand, I wonder what would happen if my mother had said. “caregiver only please, this is not a show”, when she got asked to have doctors who were not caregivers to watch my brother being treated. At the time, he was the only child in our city who got an “elderly” diagnose. No abundance of patients willing to say “yes” would have changed the fact that she was the only one who could give them an “interesting teaching case”.

            I wish more people say yes, so no other family would almost lose their child because a whole team of doctors had never seen such symptoms presenting in a child this young.

          • Gene

            That is why I am so passionate about this. I want to make sure that the residents I teach know what they are doing. It’s why I volunteer myself as a subject, my family volunteers, we are organ donors, everything. When it is you or your loved one out there, do you want someone experienced? Then BE A TEACHER. Let them learn from you.

            NIMBYism at its finest…

          • Amazed

            We were incredibly lucky. A farmacist friend of my mom’s – yes, farmacist – told her that she didn’t know what her child’s problem was but it was most certainly not appendicitus and not to let them do the surgery. My mom didn’t. A national consultation was held and the man who got the right diagnosis was guess what? An elderly professor. Someone who had seen it all.

            When you almost fall on the short side of statistics because of a rarity few have seen, you tend to see the insistence of privacy from those who learn because well, there are always others who won’t care in a slightly different light.

            As to those who think that a woman in normal labour is the most vulnerable patient who should be treated with the utmost importance given to her because of it, I’d like to introduce them to a seven year old in excruciating pain being examined by his third of fourth doctor already feeling that this one can’t say what his problem is, either.

          • Amazed

            But you did. You went to a teaching hospital and demanded something that defied their very aim – to TEACH.

            If a patient isn’t aware that it is a teaching hospital before going there, that’s one thing. They will be made aware of it. If a patient goes there in emergency without knowing, it’s still one thing.

            But making a lovely birth plan with “no spectators”, aka students, and bringing it to a teaching hospital so that they can benefit from the best care but without shouldering any part of the burden is NOT OK.

          • Meerkat

            Nope, a hospital’s first aim (teaching or otherwise) is to treat patients.

          • Amazed

            And patient with “spectators” present still get treated.

          • Meerkat

            Well, yes, but what happens to the patient who refuses “spectators”?
            I doubt that you will find any teaching hospital whose mission is to teach future doctors first, and then treat patients. Treating patients always comes first, even if those patients are difficult and don’t always comply.

          • Amazed

            I thought it was obvious what happens to that patient. Either they get spectators anyway and are pissed off, or at future point they encounter a doctor who is less than stellar and patient whines “Doctors don’t know anything!” while a sympathetic chorus pats them on the head, busy writing plans of care that don’t include “spectators” and discussing how lowly medicine has fallen.

          • Gene

            Very succinct.

          • Meerkat

            This was more or less a rhetorical question. And let’s leave musings of the hypothetical future aside for a minute. Antigonos just described her experience at a large teaching hospital in Israel, which, I think, is a typical situation in the US as well. She accepted student observers in most cases, but declined in some. When she asked not to be bothered, she was left alone.
            Perhaps Gene can tell us what happens in her particular hospital when a patient refuses to be observed by a group of 7 student doctors in her rotation. I believe she previously mentioned that she does some insisting, and if a patient still refuses, she basically tells them to go to another hospital? Did I understand correctly?

          • Gene

            I’m only been attending at smaller teaching hospitals. I’ll have maybe two residents with me at a time. When I get a “no residents” patient (not uncommon as we have some uber privileged people in the area, I explain that we are a teaching hospital and Dr X is a fantastic doctor. Still say no, I give them the address of two local hospitals that are not teaching. My same response to no Jews or no blacks.

            When I’ve been the student in the larger group, my attendings tended to do the same thing. Sometimes the cross covering residents /students would śtay outside. But the team directly involved in care always consisted of a student, an intern, a resident, and attending at minimum. A “no students” case did not exist.

          • Amazed

            Gene, what would you do if, for some reason, going to another hospital wasn’t an option? I cannot really imagine forcing the patient to have students present.

          • Gene

            Well, it’s an ED. If it is truly a life and death emergency, I STILL can’t treat with consent (meaning a sexist guy screaming that no wimmin can touch him) might get a call to the adult ED to see if a male attending is around. But if we have an all female crew, he’ll get the “it’s us or you die” line. I’ll often do a lac repair in lieu of my resident if it’s uber complex, but they will be in the room with me to learn how to do it. And for sexual assaults, I usually do them myself (legal reasons), though if a man was requested, we’d try to oblige. If I have a shadow (college student, wants to be MD) asked to leave, it’s fine. It honestly doesn’t happen that often. I get way more sexist, racist, homophobic, xenophobic, anti-whatever-religion people than people who refuse resident care.

          • Amazed

            I got the rhetorical part. I just chose to answer because I believe that in long-term plan, that’s what happens. Of course, I am aware that there are mistakes who somehow found their way to the medical school. But I also believe that experience and expertise come with practice. I’d prefer to be a student’s practice than a doctor’s mistake.

          • Susan

            “What if you are a racist, homophobic, antisemite misogynist who needs a specific surgery and the only game in town is an incredibly talented black, lesbian, jewish woman? ”
            Wasn’t there a Twilight Zone or Marcus Welby or some medical show with this premise? Rings a drama bell. I knew someone who pretty much fit this bill, sadly, and when he was hospitalized as most people do was grateful from the diverse cast of characters who gave it.

          • Gene

            I see it a lot. I’ve had people refuse my care because of my gender (apparently, my breasts and uterus suck up all medical knowledge and make me a dumb female). I’ve seen people refuse care based on religion, country of origin, sexual orientation, accent, and race. Even subtle discrimination (“He’s good, right, not affirmative action good?” “Did he go to med school in the US?” “Does she go to church?”). It’s not uncommon.

          • Anna T

            I’ve seen this too. Patients refusing the care of someone because they are Muslim, or have a specific accent (“I don’t trust Russian doctors”). It’s unreasonable. But still a little different from saying, “please allow me as much privacy as possible, it’s so very important to me at the moment.”

          • Gene

            In a teaching hospital, you are refusing care because of someone’s educational background. And PRIVACY is paramount in medicine. What you are talking about is foisting “education” on someone else (as long as it is not you). And education is part of medical care at a teaching hospital.

          • Anna T

            I don’t think asking for no observers is the same as refusing care from someone specific because you think this someone is incompetent. To me the difference is obvious.

            Also, labor and birth – especially unmedicated – is a little different since it isn’t surgery or a clinical procedure. It’s a physiological process that is actually affected by the patient’s emotional comfort. I can tell from personal experience that I felt the pain of contractions more intensely while I was being interviewed by a doctor (during active labor) than when I was let alone and free to move around, stand on all fours, get into the shower, etc. Obviously the interview was a necessary part of my care and could not be skipped. But if someone ushered a group of students in and said, “look, here is a woman who is laboring without an epidural, hang around for a while and watch”, that’s not an essential part of hospital care.

            Of course in my case it’s hardly relevant because I don’t plan to go to a teaching hospital anyway.

          • Gene

            “But if someone ushered a group of students in and said, “look, here is a woman who is laboring without an epidural, hang around for a while and watch”, that’s not an essential part of hospital care.”

            But it is. Or are you going to start talking about how OBs know nothing about unmedicated vaginal deliveries. Labor and birth are things that medical personnel learn. And learning the NORMAL is just as important as learning the ABNORMAL.

          • Anna T

            Allow me to rephrase what I said: that’s not an essential part of MY hospital care.

            It might sound terribly selfish, but while I was in labor, every little thing that caused me discomfort counted. And if having extra people around would make me experience labor in a less comfortable way, I think it’s in my best interests NOT to have those extra people around.

          • Gene

            Then I recommend a non-teaching hospital.

          • Irène Delse

            “What if the only hospital at a reasonable distance is a teaching hospital and you feel very strongly about your privacy?”

            Ask beforehand to be informed of who is going to be present during a procedure and talk about your concerns if they tell you “a group of students”. Most hospitals try to make things reasonably comfortable for everybody, patient included.

            I never gave birth, but I do go to a teaching hospital several times a year for a chronic issue, and quite often the doctor who sees me is one of the professors. Each time, she asks me if it’s ok for one of the students to be there and take notes, or do the examination under the prof’s supervision. Never once has someone just assumed that I would be ok with it. (I generally say yes, even though we cover a lot of private stuff in these visits. But once, I declined to have the student do the examination and administer the questionnaire because they often take longer, and I wasn’t feeling up to it. It wasn’t a problem.)

          • Gene

            I’ve always been find with any learner involved in my care, my kids’ care, any of my family’s care. Every hospital visit is to a teaching hospital (better care overall). I preferred no med students or Peds/ED residents during the actual delivery (since I GRADE AND SUPERVISE THEM and they might be more uncomfortable than I was), but everyone knew I didn’t care otherwise. And no issues with nursing students (one started my IV for one delivery). Though during both deliveries, Peds residents were involved in my kids care when things went south. AND I DO NOT CARE. The more hands around, the better!

            Since I teach others every day, I feel strongly that I should myself be a subject of study. I think my son got ultrasounded at least twice a week when I was pregnant. More if the ED residents were having an learning session. I want future medical providers to be competent in their care. And if I have to be a subject, so be it.

          • Irène Delse

            I can see why residents would be relieved to not have to care for their own supervisor… ;-)

          • Gene

            Agreed. In an emergency, no one cares. But even as laid back as I (normally) am, most med students and/or residents would be uncomfortable taking care of me (or ANY attending) when I was swearing and naked. Most medical personnel compartmentalize well, but it’s tough line to walk. I was fine with the OB and anesthesia residents, though. I don’t grade/supervise them.

          • theadequatemother

            I have the same rule. If the learner is junior enough that I may have to precept them in the future, I prefer them not to be involved.

          • AllieFoyle

            I’m not a doctor. I had no idea about teaching hospitals or non-teaching hospitals. I went to the one hospital in town. No one ever told me it was a teaching hospital (I don’t think that it specifically is, actually) or warned me that there would be students involved in my care. After ignoring my pleas for an epidural for many hours, a group of nursing students was brought in to watch the delivery–basically to stare at my private parts while I screamed, pissed and shit myself, had my vagina tear and be cut–without even mentioning to me in advance that this was a possibility, let alone asking if I was ok with it. It made a difficult experience that much more humiliating.

            This was more than a decade ago. I’ve always been asked if students can participate in my care in other situations, and I’ve always agreed to it, because I think that it’s important for students to learn, just not unnecessarily at the expense of people’s privacy and dignity. Maybe I would have agreed to have those students present had I been asked beforehand, but I never had the choice. Doctors have a duty to teach and learn, but they also have a duty not to harm their patients and to treat them with respect. Most people are eager to help students learn; you don’t have to dehumanize them to make that possible.

          • Anj Fabian

            I went for orthopedic care and had a Ortho specialist and resident. I learned a lot by getting examined twice and listening to the senior explain things to the junior.

          • Meerkat

            I will probably get torn to shreds here, but I think you are being too harsh.
            I did give birth at a large teaching hospital, and was OK with receiving care from students. I am pretty sure that half of the doctors at my emergency C-Section were students. I was very happy with the way hospital set up the training—the care was personal, and there were never more then 2 doctors at a time. I did have some anxiety that they were making mistakes, but their work was always checked by the supervising doctor. Interesting to note that the student who did my ultrasound when I was being admitted, made no mention that all my amniotic fluid was completely gone. I am not sure if she even made a mistake, but isn’t it something you would look for on the ultrasound? My doctor was very surprised.
            With this system of teaching I felt both respected and cared for, and was ok with going. Through several examinations instead of one.

          • Gene

            I’m not going to tear you to shreds. It was a reasonable comment. Regarding the fluid, sometimes students (med students or young residents) are hesitant to make an official diagnosis without being checked by their superior.

            My argument with Allie is that she seems to believe that some people (like herself) deserve different/better care.

          • AllieFoyle

            Show me the spot where I said that I deserve something better than other people. Show me where I said students shouldn’t learn. Please, point out a place where I said anything other than that patients have a right to privacy and dignity.

          • Amy Tuteur, MD

            You didn’t say it explicitly, but it is the inevitable result of what you did say. If students can’t learn by observing you, they will need to learn by observing everyone else. Therefore, everyone else will be getting the care that you disdain.

          • AllieFoyle

            Where did I say that students can’t learn by observing me? If you read what I actually wrote, I said that I have always allowed students to participate when asked. I don’t understand how you can go from people have a right to dignity and privacy to students can’t ever learn. Is there a limit? Four nursing students can watch my delivery without my permission; how about ten? Why not televise it for the whole class to see. It’s educational, right? What does a right to respect, privacy, and dignity even mean if hospitals can do anything they want?

          • Gene

            Please see your post above where you said you were leaving and because you experienced sexual violence, students in the room weren’t acceptable.

            “My previous life experiences involved sexual violence, and being forced to have an experience like that was just not acceptable. I can’t wrap my head around the idea that you’re more concerned with hindering the hospital’s educational efforts than violating a patient’s humanity.”

            I replied that 20% of women in the US have been raped (likely more) and challenged you to think about why YOU deserve a different standard of care than them (or anyone else). And then you started hurling some quite nasty insults my way.

          • AllieFoyle

            I don’t think ANYONE deserves to have four people stare at their genitals without their permission, if for no other reason than that many will have a history that makes it especially traumatizing. You have the sensitivity of a rock.

          • Gene

            So the mythological “someone else” rears their head yet again. You can’t have it both ways. Either your medical providers learn from a human being (just not you, because you are speshul/different/sensitive) or they get all of their knowledge from artificial sources (books, computer sim, lectures) and are then magically competent regarding how to provide care in the real world.

            If you don’t want students, I will reiterate, don’t go to a teaching hospital. Just remember to thank all the men and women who did allow others to learn from them so that you get competent care from your medical providers.

            And I’ve had pissed off drug seekers who were less abusive to me and my staff than you are. You should be proud of yourself.

          • AllieFoyle

            Less abusive to you? You eviscerated me for thinking that all people deserve respect, dignity, and privacy, no matter what hospital they go to. You’re cruelly mocking me for something that was not my fault, that has affected my entire life. If you really believe that it’s essential to nursing education to allow unwanted spectators to watch a woman’s delivery without her permission, then you are just as unethical as you are insensitive.

          • Gene

            If you’d rather have uneducated people who have no proper education, by all means there are plenty of CPMs you could see.

            Yes, nurses learn about deliveries by watching them. They are not spectators there to gawk at you, but to LEARN.

            And how do you think your medical providers that deal with sexual violence learned? Yep, from patients.

          • AllieFoyle

            You know, a student practiced placing my IV (someone else had to eventually do it) and assisted during my D&C. It was also a vulnerable and difficult time, but it was absolutely fine with me. The difference? He was introduced to me and I was treated like I was an actual human being. What is wrong with you? People don’t deserve care unless they let every asshole doctor like you do whatever they want to them? I don’t deserve care unless I let everyone in the hospital witness my delivery? What are the limits? You don’t seem to have any.

          • The Bofa, Being of the Sofa

            How about 3? Why 4? Is 2 ok?

            How did you determine how many people are allowed to stare at someone’s genitals? And does everyone have to ask? Does every nurse have to ask whether they can watch?

          • AllieFoyle

            This isn’t a logic problem; it’s an issue of treating patients in a way that maintains their dignity as human beings. Do you have any feelings for other people at all?

          • The Bofa, Being of the Sofa

            I’m just trying to figure out the line of what is acceptable or not.

            You need to explain how 4 students in the room does not maintain their dignity, but 3 does? Or whatever the number is?

            It’s begging the question. If the answer is, “Whatever makes her uncomfortable is too many” than the question is, does that apply to a racist patient, too, in the room with a black nurse? Or do you deny her (racist) feelings?

            I asked below, does she have to have expressed consent for everyone in the room? Or is it ok for some people to be there without asking her? And if the latter, where do you draw the line?

          • AllieFoyle

            I understand your line of reasoning, but you could just as easily come at it from the other end. You’re all defending four students, but seriously, why not eight or ten? Why not broadcast it live to an entire class? They need to learn, right? Why bother with those pesky lists of patients rights and responsibilities? Why worry about treating people respectfully at all? Dignity is an intangible; why bother with it at all?

          • The Bofa, Being of the Sofa

            you could just as easily come at it from the other end. You’re all defending four students, but seriously, why not eight or ten?

            Yes, why not?

            You are completely begging the question still. What about having 8 students observing a procedure makes it disrespectful? Because whatever answer you give, I can demonstrate how it leads to unresolvable issues. As I said, if it is just about “what makes someone uncomfortable” then where do you draw that line. If it is about “what is necessary” you have to define what is considered “necessary”. Gene contends that education is necessary, so in a teaching hospital, having students present is as necessary as having a L&D nurse.

            Yes, you can say “You can come at it from the other end.” And that is EXACTLY what I’m telling you. Looking at it from the other end, no, it’s not so simple. Yes, you want to treat people with respect and dignity. We all agree. The question is, where is the line between respectful and disrespectful? Sure, it is completely subjective, but it’s obviously not absolute. We can’t and don’t want to accommodate everyone’s prejudices in this regard. There are absolutely things that are necessary, even if it makes someone uncomfortable. Where is the line? I don’t presume to know, but I am sure that it is not near as obvious so to insult anyone who questions your placement of it.

          • AllieFoyle

            It comes down to the fact that you are treating human beings, Bofa. If your treatment of a patient humiliates them unnecessarily, then I think you have failed as a health care provider and as a human being. If you want me to acknowledge that the line between respectful and disrespectful is fuzzy and arbitrary, no problem. We all know on some level that respect and dignity are important and that some treatment situations would be unacceptable because they violate those. We won’t always agree where to draw the line, but we can hopefully agree that a line must be drawn, and safely on the side of preserving a patient’s rights. People differ; it is the duty of the health care provider and hospital to take people as they are and provide them the best possible care they can. Wanting to preserve your dignity is not a prejudice.

          • The Bofa, Being of the Sofa

            If your treatment of a patient humiliates them unnecessarily,

            Begs the question. How are student observers unnecessary?

            Gene tells you that observation by students is absolutely necessary for proper teaching of new doctors. You disagree?

          • AllieFoyle

            I believe that their educational needs must be balanced with patient rights and dignity. You cannot supersede the rights of the patient because it is convenient educationally. There are numerous respectful and practical ways to do this.

          • The Bofa, Being of the Sofa

            I believe that their educational needs must be balanced with patient rights and dignity.

            Yes.

            And that is the nature of the discussion. Where is that line of balance?

            You cannot supersede the rights of the patient because it is convenient educationally.

            Gene would contend that education is not merely “convenience”, it is a responsibility of the hospital. So we have to balance rights of the patient and responsibilities of the hospital. We agree.

            I don’t know how that makes “4 people staring at your genitals” a problem.

          • AllieFoyle

            If you think that situation is perfectly acceptable, then I invite you to volunteer yourself.

          • Gene

            I HAVE! To help educate the medical professional who care for people like you who reap the benefits of the system while moaning and groaning about having to contribute.

            ETA: I think about 300 anesthesiologists saw my ass when I was a med student. A friends father needed volunteers to demonstrate how to do various nerve blocks. I got the short straw: sub gluteal. Oh well. I had a great ass when I was 22.

          • AllieFoyle

            I really resent that characterization. Every other time I have been asked to allow student participation I have. Without “moaning and groaning” — which to you, seems to mean having any sensitivity about your body or expectation of dignity whatsoever.

            I commend you on volunteering. I suggest though that you consider the amount of control you had over the situation compared to your average hospital patient. I suggest you also revisit the notion that your lack of medical anxiety and sensitivity somehow makes you a better person.

          • Gene

            I gave you ONE example. I’ve given birth at teaching hospitals, had a d&c at a teaching hospital, had my family members treated at teaching hospitals. Both of my births were “oh shit” moments and there were 20+ people in the room each time! including students.

            I don’t just talk the talk.

          • Amazed

            Name one. They all include someone else do what you don’t want to.

            I doubt there is someone who likes being observed this way. At the end, it all comes down to the fact that many others have to be the ones observed.

          • AllieFoyle

            Well in this situation I was the one who was observed. You and Bofa and Gene are free to offer yourselves up for unlimited spectators during sensitive procedures. I will happily volunteer to do anything that I don’t think will cause me psychological harm. Ftr, that might have included having a student present if he or she had been introduced to me beforehand and I’d had the choice to decline.

          • Amazed

            What situation? I believe you mentioned you weren’t sure it was even a teaching hospital?

            Have no care about me. Usually, I am quite agreeable to contribute when I receive. When I demand something that defies the very foundation of a certain instutution, I usually find a way to avoid utilizing it. Or have you forgotten that I answered you I was talking about situations where people have choice?

            I blame my dad. Imagine, he was stupid enough to cross half the country because an acquaintance of ours might need it during a surgery. It happened during a period when out financial situation wasn’t the best and still, he didn’t even demand to have his expenses for the journey covered. I wish culture of donationg blood was better here but alas.

          • AllieFoyle

            You’re talking about people wanting to reap benefits of a teaching hospital without contributing. I get it. My only point re:teaching hospitals is that people there still deserve to have their rights and dignity preserved and that there have to be limits on what is expected of them. I don’t know why that’s so contentious. I doubt my experience would even happen today, with all the focus on patient experience and patient-centered care, but Gene and Bofa seem to think it’s defensible.

          • Gene

            Because YOU think YOU are somehow excused from being a teaching case (because of your history of sexual violence). If you don’t want to be a teaching case, fine. Do NOT go to a teaching hospital And please remember to thank those who are willing to teach others.

          • Amazed

            In all fairness, her experience sounds like a mismanaged teaching case. You don’t just open my bedroom door, especially when I’m standing naked, and stare; you don’t do that in a hospital either. Letting the patient know that those are students who are here to learn is the least the team can do.

          • Gene

            Agreed. And if it truly happened, it shouldn’t have. But to demonize students and the comments about learning from someone else reveal her attitudes. That and the swearing and threats.

          • AllieFoyle

            But to demonize students and the comments about learning from someone else reveal her attitudes.

            I never did either of those things, and I didn’t threaten you either.

            You, on the other hand, mocked me for having been raped, for being a human being with sensitivities and pain.

          • Gene

            Let’s see, I believe you said something about me rotting in hell, being garbage, saying fuck you, etc. you also said, when I ask if not you then who, “someone who gave consent”. Aka the “someone else”.

            And if learning the number of sexual assault victims somehow mocks you (your rape was different/worse than theirs?) it insults every victim of sexual violence in this world.

          • AllieFoyle

            Do you think you’re educating me about the prevalence of sexual assault? You are not. Subjecting people to the treatment I received, and which you want to defend, is unacceptable–for all people.

            Mocking someone for wanting to be treated with dignity, for having pain related to something that was done to them against their will, calling them “speshul” and overly sensitive and selfish, referring to their need for sensitive care as “perceived inadequacies”? Implying that people who are have any sensitivities shouldn’t expect respectful, compassionate care at a teaching hospital? You are an exceptionally cruel, insensitive person.

          • Gene

            Yeah! More personal insults!!

            You said that your sexual assault made you different than other people, that YOU should be treated differently because of it. It appears that you truly believe that. The problem is that every person out there has a reason to be treated with dignity and respect, not just you. Part of respectful care is competent care. I’m still waiting for you to tell me how we should teach students to perform the above skills. You know, so people like you who think you deserve extra special care GET such care.

            How should someone learn to examine a sexual assault victim? Repair a vaginal tear? Give bad news? Do a genital exam? So far, you are either silent, making direct personal insults, or saying “someone else” (aka “I’m speshul”).

            (Crickets)

          • AllieFoyle

            You said that your sexual assault made you different than other people, that YOU should be treated differently because of it.

            No I didn’t. And you know it.

          • Gene

            “My previous life experiences involved sexual violence, and being forced to have an experience like that was just not acceptable.”

            Aka: I was raped and shouldn’t be expected to have students at my delivery.

          • AllieFoyle

            Repeating that over and over does not make it true. But if it makes you feel good to continue to belittle me for it, be my guest.

          • Gene

            I’m happy to continue to quote your own words to you at your request. Maybe at some point, you will see how you sound to others.

          • AllieFoyle

            You keep repeating it because you hope it will hurt and shame me, not because it means what you want it to. I never said any of what you’re attributing to me (except the insults, and I stand by those), and you know it.

          • MaineJen

            Wow. That got nasty. Gotta go with Allie on this one…”teaching hospital” should not translate into “free reign to any and all students who wish to view my nether regions.” The patient has the final say as to who will examine her, full stop. I gave birth at a teaching hospital, and before any student came in the room or examined me, my permission was obtained. And after a particularly painful dilation check, I was able to tell them “no more students, please,” with no hard feelings anywhere. And I didn’t have to justify myself; they simply honored my request. Sensitivity: try it.

          • Amazed

            No hard feelings? Nice.

            My mom certainly harboured some very hard feelings against the damned idiots who should have never graduated and who were the idiots who gave them their diplomas anyway? Of course, those same idiots later got to view the same child they had misdiagnosed being treated for the life-threatening condition (with prognosis of almost certain death) that they had missed thanks to the fact that they had never seen it in a child. And it wasn’t even a teaching hospital.

            It’s easy to think of dignity when it’s only your dignity that is affronted. When it’s your very life or your loved ones’ lives threatened, it quickly becomes, “Why didn’t they know what it was?” There is only way they can get to know.

            I don’t find anything this special that you were asked for permission to have students present. No one can force a student on a patient. Anyway, when someone knowingly choose a teaching hospital when an alternative is available, it’s not OK for them to go in with the intention to refuse having students. Changing your mind during examination is OK – you thought you could deal with it, found out you couldn’t, no big deal. But going to a teaching hospital when a non-teaching is accessible intending not to give the students chance to LEARN is not acceptable to me.

            Rights? Sounds great. Having someone mismanage your care because five others with this exact rare complication defended their rights? Not so great.

          • MaineJen

            Okay, a) The average person is not going to know which hospital is a teaching hospital and which isn’t (they don’t all have “University” in their names). Sometimes you don’t have much choice where you go. In my city the major hospital is also a teaching hospital, and that’s where you go if something’s really wrong. No choice in the matter. So it’s not as easy as saying “Just don’t go to a teaching hospital.”

            And b) I’m very, very disturbed by Allie’s sexual assault being totally discounted as a reason that she *might* not want a bunch of strangers ogling her during one of the most vulnerable moments of her life. I see her being told essentially “Yeah, you and 20% of the population. Get over yourself.” And I can’t believe my eyes. Is this, or is this not, the same blog/comments section on which I’ve repeatedly seen argued that prior sexual abuse is a valid reason for someone to request a c section over a vaginal birth? What the hell happened to bodily autonomy, guys?

          • Amazed

            A) What happens when you go somewhere because something is really wrong and the doctors cannot recognize what’s wrong because the people who went to the teaching hospital to have the best care available were jealously guarding their privacy from those who hold the care of the future patients in their hands? I know: let’s someone else be the observed guinea pig. Just not me.

            In my opinion, those who go to a teaching hospital for the care and refuse to give the students chance to observe them are morally forfeiting their right to whine that an ignorant doctor got their care wrong. Of course, I know that everyone is different and everyone thinks they are the most innocent of all and couldn’t those students found someone else to learn on?

            B) I cannot claim to speak for Gene. I can only say that in my opinion, Allie’s case was mismanaged and I stated so.

          • Gene

            Yes, I think it is shameful that you believe that someone else should be the ones to teach others while still wanting to reap the benefits. I quote your own words back to you even you ask for clarification, yet you respond with childish insults and continue to ignore pointed questions like how we teach others. NIMBY and not my job.

          • AllieFoyle

            Never said those things. Don’t believe them.

            I’ve already answered your question, but I’ll answer it again:

            How should students learn? With the consent of the patient and respect for his or her privacy and dignity as a human being.

          • AllieFoyle

            How? One on one, with the consent of the patient, who you treat like a human being. Or do you think medical education can only be done if it’s forced on people without their consent?

          • Gene

            Teaching isn’t one on one. At minimum, it is two people: student and teacher. And you yourself implied there was no difference between one observer and a TV broadcast. See your exchange with Bofa previously.

          • AllieFoyle

            One on one in the sense of making a personal connection, being introduced to everyone involved in your care.

            And I implied the opposite: the more public you make someone’s private medical event, the more obvious it becomes that you are at risk of violating their privacy and dignity. The line must be drawn somewhere, and the patient should have a have the ultimate say in where that line falls for them.

          • Gene

            And you seem to not get it. If you don’t want students, go to a non teaching hospital. Just thank those more selfless than you (or maybe they are selfish, since they want to guarantee they get good medical care in the future).

          • AllieFoyle

            Yes, I think students should not observe someone in L&D without their consent. Not just me, anyone. Do you?

            Will you please stop goading me about *my rape*? It’s unnecessary and beyond cruel.

          • Gene

            Aka: “someone else”. Ie: the poorz, the sluts, the exhibitionists, the illegals, the baby factories, just not me

            You were the one who brought up your sexual assault as the reason why you didn’t want nursing students there.

          • AllieFoyle

            So, by saying that my experience was humiliating and that people deserve to be treated with dignity, I’ve now insulted every victim of sexual violence in the world, have demonized students, have insulted every medical care provider, am comparable to a racist, am selfish, and think that medical education ought to be foisted onto someone else? Do I have that right? Is there anything else?

          • Gene

            No, I said there were many many many men and women who have experienced sexual violence and all deserve respectful care. But respectful care can and should include students at a teaching hospital.

          • AllieFoyle

            I never said or implied that students couldn’t be involved. Ever. Anywhere.

          • Gene

            Just not with you during your perceived sensitive times. That’s when the magical “someone else” steps in.

          • AllieFoyle

            That magical person can be and has been me on numerous occasions, though I believe it is still my right, and every other patient’s, to be treated with respect for my privacy and dignity. But please, insult me for having been raped again.

          • AllieFoyle

            On re-reading, I noticed this gem:

            I preferred no med students or Peds/ED residents during the actual delivery (since I GRADE AND SUPERVISE THEM and they might be more uncomfortable than I was), but everyone knew I didn’t care otherwise.

            So you in fact used your own privileged position to dictate no students or residents for your own delivery.

          • Meerkat

            Gene, methinks you are trolling Allie here, aren’t you? She is not demonizing students, she just doesn’t want a crowd of them barging into her room and staring at her vagina as she is pushing our her baby and possibly some poop. I get it.
            Also, in the spirit of being fair, why don’t you lecture Antigonos, who said that she also declined students when she felt especially crappy?

          • Lioness

            no one said anything bad about the students. presumably the students didn’t know there presence was unwelcome and the patient hadn’t been consulted. That was the instructors responsibility, not each individual student. and your insistence that the patient was in thte wrong makes me certain taht incident is highly plausible and not only did it happen, but happens relatively often in institutions with people like you.

          • sameguest

            So, have you found an example yet?

          • AllieFoyle

            WTF are you even talking about? I ALWAYS participate when asked. In that situation, I didn’t get to choose whether or not to be a teaching case, or have a say in any aspect of the students presence. It was humiliating and I don’t think it’s an acceptable way to treat anyone. I went to the only hospital in town. But by all means, continue to make fun of the fact that I was raped.

          • Gene

            You brought up sexual violence. Pointing out that one in five women have been raped (and 1-2% of men, both of which are likely under reported) is making fun of you? No, I’m saying that MANY MANY MANY people have experienced sexual violence. Just because you are one of them does not mean that you deserve special treatment.

          • Lioness

            if you threaten people that they can not get care at your hospital because they do not want students observing, you could have a serious lawsuit against you. not jusst allie. EVERYONE.

          • Gene

            How should a medical provider learn to PERFORM the following procedures? Meaning how to do them on a real person competently.

            1. Repair of a vaginal tear post delivery
            2. Perform a genital exam and collect evidence for a rape kit after sexual assault
            3. Give a family member bad news (death of patient, fatal diagnosis, etc)
            4. Run a code on a newborn baby
            5. Rectal and genital exam on a teenage boy
            6. Pelvic exam on a teen girl
            7. Trans vaginal ultrasound

            This is not knowledge and skill that magically appears, but must be learned by repeated observation and practice.

          • Irène Delse

            I bet the ways to mitigate this really depend a lot on the individual. Personally, I found that it’s easier for me to have observers in the room if I don’t have to look at them. Earlier this year I had surgery on a breast w/ local anesthesia. Normally I’m very self-conscious, but I found that because I was only able to see the ceiling above and the anesthesiologist by my head, I didn’t care how many people were in the room and saw my naked chest.

          • Dr Kitty

            Number one of which is the patient saying “I’m not comfortable with all of these people, please get them out”.

            Whenever I trained it was always made clear to the patient who was the trainee, and that it was OK to ask them to leave.

            I occasionally have med students sit in with me to learn (one at a time, not crowds). The patients are told when they book the appointment there will be a student, when they arrive on the day that there is a student.

            When I walk them to my consulting room from the waiting room I tell them there is a student, ask if it is OK if the student sits in, and that they can ask him or her to leave at any point.

          • Lioness

            yes, they do have to ask.

          • Lioness

            Gene, YOU are the one who considers this “special care,” not Allie. This is supposed to be the standard of care for everyone. IF you missed that, that is a serious problem that doesn’t speak well of you or your institution. As for the sexual assault issue, I respect Allie for honestly and bravely trying to share why she found this issue particularly traumatic. I would have never dared in such antagonistic company.
            Last but not least, Allie, many many women includeing myself, who have not experienced sexual assault, would have still found the experience you describe to be very degrading. its not just you! I personally would agree to have one student, if she was courteous and respsectful, but def not a whole passel.

          • Meerkat

            I don’t think she was making that argument at all. I think she was reliving her humiliating experience and regretting she didn’t at least say something. She feels used and humiliated.
            I guess this is an interesting argument as see from the sides of the doctors and patients.
            I am a patient, and even though I am a pretty “patient” patient even I have my limits.People, all people, are selfish. When I go to a hospital I am generally not well, so other patients’ rights or well being or discrimination don’t even enter my mind. And why should they? Other patients are not my responsibility. The argument of “if not you, who else?” doesn’t work here, I am sorry. This is one “should” that I don’t feel obligated to do. I pay taxes, donate to charities, vaccinate, serve on jury duty, vote, recycle, try to limit my carbon footprint. By the end of my pregnancy I barely tolerated even my doctor by my private parts, let alone a gaggle of students. If I were put in the same situation as Allie, I would be very upset. I guess its a question of what the priorities in the hospital are.
            The hospital would either make their patients deal, or structure their teaching environment in a way that wouldn’t make patients want to jump out of their skin.

          • Gene

            If you don’t want students, go to a non teaching hospital. But even then you benefit from the selflessness of others.

            Everyone benefits from teaching hospitals. The same way everyone benefits when we vaccinate. If you want the benefits, you need to contribute.

          • Meerkat

            You are absolutely right, of course, but I see being a subject for students more of a courtesy than an obligation. If the hospital and the doctors give me the courtesy of respectful treatment (which they do at my hospital), I give them the courtesy of answering the same questions over and over again and suffering through 2 hour long appointments with a restless toddler, just for the sake of learning. I do wonder if you and Dr. Tateur would have attacked Allie in quite the same way if she said that she refused medical students because of her religious convictions. Dollars to donuts there would be no discussion. You were chastising Allie because asking for special treatment was unfair to other patients. I am curious how is this different from the special treatment that hospitals routinely give to their religious patients? My hospital had a special Saturday elevator and Kosher food. I don’t know for sure, but it is possible that ultra orthodox Jewish moms had special modesty considerations as well. It is interesting that my desire for modesty or increased privacy might be treated as a whim or a privileged white woman’s snobbishness, while the same request made for religious reasons would be respected.

          • An Actual Attorney

            Gene, that doesn’t exactly make sense. If everyone needs/is obligated to contribute, there shouldn’t be non teaching hospitals.

          • fiftyfifty1

            My opinion as a doctor is somewhat less strong than Gene’s and Dr. Amy’s. I am glad that there are LEGAL protections in place for patients to refuse students (and there are) but I do think that it is totally selfish from an ETHICAL standpoint for patients to adopt the “anyone else but me” attitude. You like privacy around your genitals? And black women don’t, huh?

            I have difficult veins. I also have something of a needle phobia. Students get to place my IV anyway. I think for an instant about refusing and then I say to myself “suck it up, baby” and stick my arm out.

          • AllieFoyle

            This conversation has gotten ridiculous. I shared a specific experience that was upsetting to me, and said simply that people have the right to be treated with respect and dignity at any hospital–ALL PEOPLE. I never said “everyone else but me” should shoulder some kind of burden (and I refuse to believe that medical education is impossible if you don’t allow groups of students into a patient’s L&D room without consent), and absolutely nothing about preferential treatment because of race or SES was ever said or implied in anything I wrote. I didn’t refuse student care in the situation under discussion or in any other subsequent situation.

          • fiftyfifty1

            My reply was to Actual Attorney who expressed surprise about Dr. Amy and Gene’s opinion, not in response to you or your specific case. As I said, I take a less hard line approach than the opinion expressed by Gene. I am glad patients have the legal right to opt out of seeing students, and I personally ALWAYS ask permission before bringing in a student and never try to pressure a patient if they say no, and do not suggest they seek care elsewhere. The reason is that I do feel people *ought* to be willing to see students if they can but I don’t want them to put themselves in any psychological danger to do so. I leave that assessment of risk up to the patient where it legally and ethically belongs. Medical education can do just fine with a small % of opt outs. Those who seek out a teaching hospital but them opt out for no good reas

          • fiftyfifty1

            Those who seek out a teaching hospital but then opt out for no reason except for a general desire for “privacy” without any particular extenuating circumstances are lame in my opinion, but that doesn’t sound like your case.

          • AllieFoyle

            That sounds very reasonable. Thanks for explaining.

          • Lioness

            i don’t know why everyone is bringing race into it. indeed i don’t know on what basis yall assume you know allie’s race or ethnicity. for all we know allie is black but doesn’t want to give away identifying info. so what? it makes no different if she is black or white.

          • Lioness

            and if she would be black, would you be more sympathetic? don’t get why some of you have a problem with a white woman asserting her legally protected rights. no black woman is harmed by this.

          • fiftyfifty1

            I made no assuptions about Allie’s race and was not commenting to her or about her (see my other response). My reply was in response to Actual Attorney. Race and class ARE an issue in the whole opt-out debate. When a priviledged patient opts out for no good reason beyond “wanting privacy during this private time” (and they are the ones who typically do) the burden of being the example patient falls on others: typically non-white patients on public assistance.

          • fiftyfifty1

            Actual Attorney, does the same thing happen with lawyers ever? For instance do high status clients ask that the head lawyer be the only one to know the facts of the case (out of a sense of privacy), or that more junior lawyers not be allowed to do the research for the case or write things up (out of concern that they won’t do it as skillfully)?

          • An Actual Attorney

            Apologies in advance. I’m on my phone not a real keyboard.

            It is a little hard to make a direct comparison because there’s no such thing as a teaching law firm. The closest analogy might be a law school clinic, but that’s really not the same at all.

            But yes, in firms it is common for clients to refuse to have junior associates work on a case because they think it is not a good financial deal. Junior attorneys charge less per hour, but they take longer. But that’s different as the client is buying a service.

            I guess the closest might be when I have interns at the ngo I work at. It has never happened, but if a client didn’t want to talk to an intern, I wouldn’t have one in the interview. But I try to be proactive and think about that when discussing sensitive issues.

            I was thinking more about the way the docs seem to be analyzing the question as compared to how I would as a lawyer. I’d start by listing all the possible applicable laws, like the ada, rehab act, local human rights laws, emtla, that apply to the patient, and laws that apply to the students, like title is, and see if that gave me an answer. Then I’d look at common law. Then professional ethics.

            In my classes, I have a whole lesson devoted to figuring out what to do when these give opposing answers (like a rape survivor who didn’t want a man to be her lawyer) so I was especially interested in the different “habits of mind”

          • fiftyfifty1

            “Everyone benefits from teaching hospitals. The same way everyone benefits when we vaccinate. If you want the benefits, you need to contribute.”

            This is generally true. People who choose not to vaccinate their children because they don’t want them to be exposed to any of the risks while still wanting them to benefit from herd immunity are unethical. But it’s not universally true. Sometimes a patient is “given a pass” not to have a vaccination when the risk of harm to them as individuals is deemed too high. Examples include certain previous reactions to a vaccine, pregnancy for live virus vaccines, certain active cancers, certain immune conditions, history of allergies to certain components, Guillain -Barre etc.

            It certainly is unethical when a high-status patient chooses a University hospital to benefit from the expertise but refuses learners for no better reason than “I deserve my privacy!”. But really there needs to be some flexibility. If a woman tells me that she still has active flashbacks to her gang rape, isn’t it reasonable to provide her with a birthing room which contains the smallest number of needed participants if that is what she tells us will help?

          • Meerkat

            Yes, the student didn’t say anything to anyone, and this was the only time that I recall when a senior doctor didn’t confirm the diagnosis.I am not sure it would have made any difference, because I had to get an emergency C-section a short while later because my son was in distress. I do think the level of fluid would have been important information, because my doctor was very surprised there was no fluid at all. He kept asking me when my water broke and was very incredulous when I told him I had no idea!

          • Anna T

            What was done to you was precisely what I feared would happen to me. That’s why I specified it in my birth plan. And the doctor dismissed it. I’m so glad I switched hospitals in the end.

          • Amy Tuteur, MD

            I strongly agree with Gene.

            It is not a matter of the right to privacy. It is a matter of fair exchange. If you want to benefit from a teaching hospital, you are ethically obligated to contribute to a teaching hospital.

            The alternative is that poor people and people of color can be forced to contribute to teaching hospitals by allowing students and house staff to learn from them and that well off Western, white women can take all the benefits and leave the burdens to everyone else.

          • AllieFoyle

            Do you think that isn’t already the case? I think that western, well-off, white people are the least likely to accept this kind of care. Like Anna T, they are most likely to advocate for themselves and thereby maintain their dignity and privacy, while less privileged people are less likely to question the status quo. They are precisely the people who make it imperative for health care professionals to treat people with respect and dignity as a rule.

          • Gene

            Yep, the poorz don’t know no better, so we can treat them like the teat sucking leeches they are. Them rich deserve BETTER care.

            You just insulted every person who cares equally for people regardless of their socioeconomic status. I’ve treated royalty and the homeless. And the day I stop treating EVERYONE as if they deserve the same respect and care is the day I will quit medicine.

          • Lioness

            you mean the same respect or the same disrespect for all? cuz “find yourelf another hospital” isn’t very respectful.

          • Lioness

            No one is ethically obliged to do anything they find humiliating and degrading. White women are under no special obligation. What’s unethical is forcing them or pressuring them to do it.

          • Bombshellrisa

            That is awful.
            I didn’t know this could happen until I read the admission form and consent to care forms. There is something about students in one of the bullet points. I encourage everyone to read these forms if they are admitted to a hospital AND circle that sentence and make sure that it is known that you don’t consent to that part. Make sure whoever may have power of attorney for health care for you and signs any consent forms know it too so they can advocate for you.

          • Gene

            BSR, that is something listed in every general consent form at every teaching hospital. That is an integral part of the mission of a teaching hospital. The vast majority of the top hospitals in the US are teaching hospitals. And if you do not want to utilize a teaching hospital because you don’t want students, you are welcome to go elsewhere.

          • Bombshellrisa

            I don’t think a lot of people know that it’s part of a consent form. If someone has parts of their care that they do not want to have students be a part of, then they should be able to make that wish known. All of the hospitals in my area are teaching hospitals, I work at one of them and have gotten care at a few. I believe that it’s important for students to learn, so there are parts of my care that I consent to have students be a part of. I have terrible veins, so I often encourage whoever needs to learn to start an IV or draw blood feel free to try on me. I do not want five different people giving me a pelvic exam due to some history I have with abuse. I don’t think that I should have to travel far away and out of my insurance network to have that wish accommodated, and I don’t think it’s an unreasonable request if one of my patients makes it.

          • Lioness

            That is incorrect. A teaching hospital may not turn a patient away for refusing to be observed by students.

          • http://www.antigonos.blogspot.com/ Antigonos CNM

            All doctors, as well as nurses and CNMs and other health care providers, should have a SENSIBLE intervention policy, customizing care to the needs and desires of the patient (to the extent this is medically feasible)

          • Stacy48918

            “No, I did not “show him”. I never saw this doctor again in my life and I don’t care what he thought of me.”

            Except for:
            “Baby is born safely and naturally in *another* hospital 24 hours later, without ANY interventions or pain meds. So THERE”
            I added that last bit. But certainly seems that is your thought process.
            If you didn’t care what he thought of you…why did you go to another hospital? Afraid you’d get him again if you went back there?

          • Anna T

            “why did you go to another hospital? Afraid you’d get him again if you went back there?”

            First, yes. I didn’t want to see that doctor again. He had an appalling bedside manner, showed very little regard for my dignity as a patient (he refused my wish to have no students present to “watch”), and I wanted to avoid him if I could.

            Second, I was disappointed in the hospital, which advertised itself as very pro-natural birth in the hospital tour conducted for expectant mothers. I felt duped (because the hospital staff *itself* had set my expectations so high).

            Third, the second hospital was nearer to my in-laws, where I was staying in between. Since it was the middle of the night, and my water had broken, we preferred the nearest hospital.

            (In Israel, you don’t “sign up” with a hospital beforehand, you can just show up wherever you want during labor, so I could switch with no problems).

            I assure you the last thing I was thinking at the moment was, “ohh, I’m going to have a natural birth and it will be so cool, and I’m going to post it on Facebook tomorrow

          • Lioness

            sounds like a good choice. clearly she was trying to go to another hospital with the hope of getting more appropriate care. had she wanted to show anything to the same dr she would have gone back to him. Great anecdote, Anna.

          • jenny

            Yes, it was inappropriate for him to just tell you what he was going to do to you because it is your choice. That’s neither here nor there with the necessity of interventions though. Two separate issues. Or possibly three.

          • expat

            Hindsight is 2020. Speeding up labor sometimes prevents exhaustion, so that was probably the basis of the doc’s recommendation. You may not have needed induction, but it might’ve lowered your risk of a labor which could wear you and the baby out. You should’ve been given the full picture. The doc saying that heshe didn’t want you tying up an L and D room for 24 hours doesn’t sound unreasonable but a more nuanced explanation might’ve caused you to make a different decision.

          • expat

            Also, 3 cm isn’t something to mess with if you are contracting regularly. I went from 3 to full in a few hours with contractions that were only difficult to talk through during the last hour. If you aren’t contracting at all, then resting makes sense. It is just the hours of ineffective contractions which are bad news/exhausting. The former would be a reason to go home, while the latter would be a reason to stay and induce. Maybe your doc thought you were in the latter category.

          • Anna T

            Expat, I was definitely in the former category. Stuck at 3 cm and no contractions for hours. I was feeling fine, the baby was doing fine… I just had no contractions. I told him so. He didn’t want to send me home. Perhaps he thought I would be happy to just have the baby out as soon as possible.

            Here I say the woman’s wishes come into account. One will want the baby out, NOW; the other will want to wait. If both courses of action are safe, why not let the mother decide?

            I was not exhausted, was able to eat, sleep and rest once I left the hospital, and it took about 18 hours until my contractions picked up and my water broke, which was when I went to another hospital.

            How much was I dilated? 5 cm.

            Yep… from 3 cm to 5 cm in 18 hours.

            It was not exhausting. It was not excruciating. It was not dangerous. It was just SLOW. I didn’t need pitocin; I only needed time.

            Once the water broke, by the way, things picked up and the baby was out in 6 hours. So that’s 6 hours from 5 cm and until the baby was in my arms – not bad for a first time.

          • Amy Tuteur, MD

            No, you didn’t “need” time; you risked your baby’s life and brain function for no better reason that to boast that you didn’t have pit. Just because it worked out fine does NOT mean that you didn’t take a risk.

          • Anna T

            I risked my baby’s life? How interesting.

            Because that is NOT what the doctor in attendance told me.

            He said nothing about risks. If there were any, shouldn’t he have enlightened me?

            Wasn’t he supposed to say, “if you don’t agree to what I suggest, you are risking your baby’s life and brain function”?

            You know what, I may be wrong, but I think that if he could in any measure of honesty pull out that card, he would. He was a very conservative old-school doctor, and I don’t think he would have let me walk out so easily if he thought there was any risk.

            Did he say I was at risk? No.
            If he had said so, I would have listened.
            He only said, “you can’t occupy the room forever.”

            It’s also very interesting that you understand my underlying motives of over 5 years ago (“to boast that you didn’t have pit”). I assure you that at the moment, I couldn’t care less about what anyone may or may not think about my birth.

            Please explain why a long early labor (as someone said here, a typical first-time labor), with *mild* contractions that may stop for hours, with the amniotic fluid intact and a good fetal heart rate is harmful for the baby.

            I’m not talking of a prolonged time of very intense contractions (which I know can cause fetal distress), or of a long pushing stage. But of long *early* labor, which is typical for first-time mothers.

            Would you argue that every first-time mother needs pitocin?

          • Stacy48918

            “not bad for a first time.”
            And that’s brag-worthy, why?

          • Anna T

            I don’t see where I’m bragging. I merely pointed out that once things picked up, they picked up. It’s not like the labor remained slow forever.

          • Karen in SC

            Another point: there are probably several ways Anna T’s labor could have gone from the point of the doctor’s decision to augment. That it ended the way she envisioned doesn’t negate those possibilities.

          • Guestll

            Woman gets up from the bed, changes into her own clothes, husband picks up the bag, and they leave to home (which is located 5 minutes from the nearest hospital) to wait things out. Baby is born safely via section in *another* hospital 24 hours later, after experiencing distress when labour failed to progress.

            With the benefit of hindsight, it’s easy to say you didn’t need an induction. Your doctor wasn’t psychic, he didn’t know how the dice would land. He could have chosen a consultative approach and suggested augmentation, but he would not have been wrong.

          • pinkyrn

            Early rupture of membranes. Rupturing membranes when the patient is a primip at 2cm and ballotable.

          • AllieFoyle

            But what you consider “pushing interventions” I might consider erring on the side of safety or conscientious management. I can understand some women want as few interventions as possible, but why does that have to be the standard for everyone? Personally, I would be much more comfortable with a doctor who was proactive and offered interventions early and liberally, rather than someone whose main concern was preserving the natural process (when that’s not something I value) or who waited until the last minute to intervene.

            If I’ve learned anything from visiting this site, it’s that providers vary, and if you want a specific type of care it’s worthwhile (and sometimes necessary) to look around and find a provider with a practice style that suits your preferences. Some doctors don’t do VBACs; others do. VBACs carry a significant amount of risk; to the baby and mother but also to the doctor in terms of professional responsibility and liability. Do you think doctors should be forced to attend VBACs if they would prefer not to?

          • Anna T

            Perhaps I should explain a little about how things are done in Israel. You don’t need to “sign up” with a hospital in advance, you just show up when you are in labor at any hospital, and you don’t know which doctor or midwife will be attending you, so it is in a large part a matter of luck. Of course hospitals have policies, but there can be variation within the staff.

            It just so happens that I went on a “birthing tour” for expectant parents which was conducted at the hospital of my first choice (the one in which I was offered augmentation). In that tour, they talked a lot about natural birth and made clear that they are very much in favor of it, try to do it whenever it is at all possible, have their own team of doulas, all the fancy equipment for NCB, etc. So I said, “I wanna go there!”

            I wrote a birth plan which was very much inspired by that hospital tour. Really, there were things I would never have written if they didn’t speak so much in favor of them. But the specific doctor who attended me obviously wasn’t on board.

            Take 2, switch to hospital number 2. I went on a tour there as well; they didn’t speak very much in favor of natural birth, or so it seemed to me. They sounded much graver and talked a lot about possible interventions. So I thought I probably don’t want to go there. I decided to try, though, after things didn’t work out in the first hospital.

            And guess what? It was there that I had two unmedicated natural births conducted entirely by crunchy midwives who helped me birth in an upright position, who offered me to touch the baby’s head during crowning; who were really, genuinely excited to attend a natural birth.

            So I’m just saying… this choice of a provider can be sometimes unpredictable and tricky, at least here.

            I’m all for choices (within safety limits). For patients AND doctors. I don’t think a specific doctor should attend VBACs if they feel it is unsafe. I don’t think a specific doctor should perform elective C-sections if they feel it is a wrong choice, medically.

          • Lioness

            Terrible system. Israeli women are oft heard to say that the type of birth you have depends on the luck of the draw.

          • Anna T

            Exactly. However, that’s what we currently have, so that’s what I expect to face again in January. I intend to go, once more, to the hospital where I had my first two, partially because things were good there and partially because it’s close to my in-laws so my husband and children can stay within walking distance.

          • Mandi Foster Davis

            I think part of it goes back to the underlying mentality that “if you didn’t push that baby out in a rice paddy while your friends chanted and passed hibiscus tea around you FAILED at childbirth.” I don’t understand the need to glorify the natural process. I guarantee that if 250 years ago someone could have offered a woman the perinatal mortality rates we have in the developed world today as a result of OB education and best practices (yes, BEST. I said it. Your OB’s advice is the BEST advice you get on how to get your baby out as safely as possible for you and your child) then they would have jumped at the chance to have Pitocin, fetal monitoring, c-sections with a near zero mortality rate (vs a near 100% mortality rate). Yes, the baby comes out either way. I think these women are spoiled by the realities of what modern medicine has done for the human lifespan. We don’t expect to die from childbirth because it’s not the norm. So they had glommed onto that and decided it’s because women’s bodies are some sort of perfect machine for extracting offspring- they’re not. If they were, then women wouldn’t have died from giving birth for all of recorded human history. Interventions are what have made dying from childbirth an anomaly instead of a commonality.

          • Irène Delse

            If doctors heeded the NCB advocates and started *not* offering interventions until it’s a matter of imminent life or death, for fear of being accused of “pushing” interventions on women, I bet we would see an uptick in perinatal deaths, maternal deaths, birth injuries and traumatic births. There’s a reason doctors tend to suggest interventions earlier rather than at the last moment.

          • anon

            What possible incentive is there for a doctor to push interventions?

          • pinkyrn

            Speed up the birth. I once had a doctor scream at me for shutting off the Pitocin while the patient was getting an epidural placed. His great displeasure was that I “Unnecessarily delayed this birth!”

            I shut off Pitocin during epidural placement if I cannot effectively monitor the baby with electronic fetal monitoring. During epidural placement the woman is usually in a sitting position and if she is fluffy, it is difficult if not impossible to keep the baby on the monitor. Shutting off pitocin can piss off some OBs and/or midwives, especially if they can leave the hospital once the baby is out.

          • Stacy48918

            Define “over-interventive”, please.
            Some women have unrealistic, pie-in-the-sky expectations and when their body or their baby doesn’t cooperate and the doctor steps in to facilitate a safe labor and delivery they blame the *doctor* for the loss of their “birth experience”.
            I am a big believer in setting expectations LOW. That way, if things turn out well – hooray! Set your expectations on a “dream or healing birth” and end up with a few interventions and you’ll have “PTSD”. Which I doubt any psychologist has actually diagnosed but it sounds good on the birth boards and blogs.

          • meg

            I read a case study of birth-related PTSD once, years ago. Wish I could remember more about it … but the mom had PTSD from violently hemorrhaging and very nearly dying while everyone around her freaked out, not from the doctor asking if she wanted pain medication. Better alive and traumatized than, well, dead from blood loss, I suppose.

          • Stacy48918

            I don’t doubt that a scenario like that could induce true psychological distress and PTSD. So many NCBers run around wailing “I had to have a heplock and the doctor broke my water and I had to push laying on my back. Now I have PTSD! WAAAAA!” Gag me. No you don’t. You’re a whiny child that didn’t get just EXACTLY what you wanted so now you’re stamping your feet and sulking in the corner.

          • Mishimoo

            That really bugs me. My dad has been diagnosed with PTSD (among other things) and his mental health really impacted on my upbringing. It feels like they’re making light of a serious disorder or using it to excuse their bad behaviour and that is just not cool.

          • Stacy48918

            I agree completely. Claiming they have “PTSD” after their “birth rape”…it’s like, OK, how many more truly harmed people groups can you offend in your self-entitled ridiculousness? I guess we can add the millions affected by the Holocaust after the recent post.

          • Lioness

            No, there are actual studies, albeit small scale, and the criteria for PTSD were chosen by the researchers, not the patients.

          • Mishimoo

            My reply, in context, is in regard to the situation presented by Stacey48918 of homebirthers blaming hospitals for a serious illness that they may not have been diagnosed with, and endangering their child for the ‘healing’ experience of homebirth. I am well aware of the risk of PTSD after childbirth – I was screened for it a few times after my last baby as he was a difficult delivery (according to my CNM with ~20 years of experience) even though I didn’t find it traumatic.

      • Ellen Mary

        My second birth was intervention free & I did experience it as healing. I am allowed to do that. It *was* traumatic for me to have my first vacuum extracted even though I was intellectually grateful for it. Getting right up, without a scratch from childbirth does feel amazing, and that is okay.

        And I legitimately grieved my section because my future fertility & childbirth & family planning were now going to be more complicated & I am going to be at increased risk for infertility, Accreta & previa (because @ 36 I was also AMA, which compounds these risks). I was again, intellectually grateful for the Cesarean, but I also had to spend time wondering if it was strictly necessary because it was the first time I had accepted Membrane Stripping, Pit & Epi. Logically I do not believe these things caused it (except maybe the membrane stripping), but emotionally I wondered. Women are allowed to not want surgery. Women are allowed to be traumatized by surgery. It is a mistake to say that every woman who need to recover from surgery emotionally or doesn’t particularly want a RCS is under the spell of Birth Woo.

        • Guest

          It’s not your baby’s job to “heal you” under any circumstances. THAT is the problem with the notion of a “healing birth.” You bring a child into the world because you want a child, regardless of how they are born, not to fix yourself.

          • Ellen Mary

            I didn’t say the baby healed me?!? I do have a problem with the phrase ‘I did it’ regarding childbirth because, no, really your body did. However, I do believe we do women a disservice when we pretend there are ZERO consequences to a Cesarean. I *only* want a RCS for clear & definitive indication, and if you think that is the only reason women have RCS in the US (for indication or if they definitely, unequivocally want one), you’d be fooling yourself.

            I feel sometimes like Dr. Amy is the only commenter on here that can accept that uncomplicated vaginal birth can be a benefit to the mother. It really is okay to have one. It is even okay to want one. It isn’t okay or even beneficial to sacrifice your child’s health for one.

            The other thing that I find bothersome is ‘if that’s what’s best for mama & baby’. Sometimes, often, what is best for my baby is not what is best for me. Then I *choose* to do what is best for my baby instead of what is best for me. Of course a healthy baby IS what is best for me psychologically. But it isn’t what is best for my body, so let’s no pretend that it is. Mother & baby are not the same thing & statistics show cases where both would have died are less common than people act like they are. The only thing worse is when people refer to us as one entity ‘mamababy’, that does get the award for absolute worst.

          • Young CC Prof

            Assuming you want more children, there is nothing wrong with trying VBAC, unless there is a medical reason not to. If successful, you’d have an easier recovery.

            However, what’s weird is the women who claim you are incomplete if you didn’t have a vaginal birth.

            It’s a subtle distinction, but it’s important. It’s the difference between “I want another child, and I’d prefer to avoid another c-section if possible,” and “I want a vaginal birth to make up for the fact that I needed a c-section before.” In the first one, the child is the important thing, in the second, the birth is.

          • Ellen Mary

            Right. I won’t intentionally conceive unless I am sure we want another child.(although theologically I plan to have generously spaced children unless there is a compelling reason not to, where compelling reason can be maternal health, finances, family issues, defined liberally). Do I want to have a hospital VBAC for VBAC’s sake? Sorta. I would love to. But conceiving with that plan in mind would quite obviously be a mistake, because there is nothing guaranteed about pregnancy & birth & I could quite possibly have a RCS for a million different indications. VBAC also forces you into a little bit of a pickle because now the risks to your baby are higher than in a normal vaginal birth, from my reading, nearly the same as the difference between a low risk vaginal birth at home vs. the same birth in a hospital . . .

          • Jessica S.

            You probably have read it but the ACOG has a practice bulletin on their site about VBACs that I found interesting. Long, but interesting. :)

          • Amy Tuteur, MD

            What does it mean to be “healed” by a birth? What was psychological disordered or broken that was healed?

          • Jenny_from_da_Bloc

            I’m not understanding your statement about RCS? Nobody here has a problem with vaginal birth if the patient’s medical history indicates it is a safe and reasonable option. Nobody has a problem with VBACs either, again as long as it is medically safe for the mother and baby. People here have a problem with mother’s taking unnecessary risks so they can have healing natural birth when the evidence indicates a c-section or induction is the safest route. It is unfair for people to claim that vaginal birth is best in all or most cases when it is clearly not.
            Women should be given the option to have a vaginal birth, maternal request c-sections, RCS, induction or medications during labor as long as the safety of mother and child are at the center of the birth. The outcome of birth should be a living, healthy baby and a healthy, living mother. Yes, there are risk to having a c/s, but there are also risks to having a vaginal birth and a VBAC as well. I’m 25 weeks pregnant and will have a RCS because a RCS is the best option medically. I don’t feel the need to be healed by my births because my son was born safely and my new son will be born safely. I just want to know why it is so important to have a vaginal birth or VBAC if it puts the baby at risk?

          • AllieFoyle

            Who pretends there are zero consequences to cesareans? Aside from this site, it seems the opposite to me. Look for info anywhere on the internet and you’ll hear all about the horrors of cesareans but little about the consequences of vaginal birth.

            You personally want to avoid a c-section, so long as it’s safe. Fine! No one thinks that’s a problem. But you think it’s a problem that other people are having RCS instead of the VBACs when neither choice is perfect. Why?

          • Ellen Mary

            No I think it is a problem when women are having RCS who *sincerely want a VBAC* AND are good candidates for VBAC, because they lack resources to get to a safe setting or awareness of their options or their providers are not following ACOG’s guidelines or they just are pressured by family & social group who perceive Cesareans as safer.

            I just don’t want us to pretend that doesn’t happen, because it totally does. Even Dr. Amy has stated that many more women could VBAC than currently are VBAC’ing & that is only okay if it was all maternal choice or clear health indication, which it totally isn’t.

            I am 1000% for RCS if a woman opts for one after reviewing solid fact based info, in fact I am 1000% for primary ECS if this happens. What I am against is economic, social & medical pressure into RCS.

          • Bombshellrisa

            But how can you have a healing birth without birthing a baby?

          • Jessica S.

            I totally agree with your last paragraph, which is precisely the logic I use for having a repeat CS, even though I *could* try for a VBAC. (I’m not the optimal candidate but I’m also in no way precluded by serious conditions or what not.) So I guess that’s the great thing about options in childbirth.

        • Jenny_from_da_Bloc

          I think it would have been more traumatic if your babies had been injured or died. I’m sure it did feel great to get up and feel good after an intervention free birth, but the whole “my body was meant to give birth and is not a lemon” is dangerous to women who prescribe to the whole NCB movement regardless of any complications or their medical history. I don’t understand not wanting a RCS if it is what is best for the mother or baby? I don’ t understand wanting a birth to be healing if it puts your life and baby’s life at risk? It is a dangerous concept that puts doctors in a bad position and mothers/babies in danger. It doesn’t make sense in a world of modern medicine where women don’t have to die giving birth and babies don’t have to be brain damaged or injured at birth.

        • The Computer Ate My Nym

          You’re allowed to feel anything you like about any subject at all. I’m also allowed to not understand it.

          I can certainly understand wanting an intervention free birth. and not wanting a c-section. If I could go back in time and make my labor go perfectly I’d do it, as long as I was guaranteed that things would go well and that I’d get a healthy baby at the end.

          But having a “healing home birth” goes beyond all that. If you have a home birth knowing that you’re high risk, i.e. if it’s a VBAC or you had complications with your first pregnancy, even if those complications didn’t end in a c-section, you’re taking a risk with your own and your baby’s life. How is winning that unnecessary gamble healing? Why is it the only thing that can be healing?

          • Ellen Mary

            Well the irony is that there is nothing healing about perinatal loss whatsoever. However I don’t know the answer: I know there are mothers in groups I am in planning ridiculous Homebirths like VBA3+C & it seems impossible to try to talk them out of it . . .

        • AllieFoyle

          I think people can feel lots of different ways about the same things and their feelings can be completely legitimate. The desire to re-experience something that was upsetting or traumatic but have a different outcome — the one you wanted or expected the first time — is understandable. It’s not a sign that someone is crazy or stupid. Emotion and memory and cognition are all interconnected. If you experience birth negatively, for whatever reason, those emotions and memories can continue to affect the way you feel about the subject and its associations indefinitely. The draw of the “healing experience” is that you get to replace some of those negative, painful associations with positive ones, so that each time you mentally revisit the subject you have positive feelings instead of anguish.

          Of course sometimes it’s not possible or desirable to do that. If you were planning another child anyway, why not do everything possible to try and get a positive experience, safety permitting? But bringing a child into the world for the sole purpose of having a healing experience is obviously not a good idea for a number of reasons, least of all that there is no guarantee that the experience will actually be healing. Thankfully there are other ways to address those emotions: talking with someone, coming to an intellectual understanding of what happened and why, reaching out to others, pursuing justice if a wrong was committed, medications, etc.

        • Jessica S.

          C-sections increase the risks of infertility? I didn’t know that.

    • disqus_ealSxkOnJn

      I’m a homebirth adovcate, and 100%- she wouldn’t have. In most places I know of (at least in the US), it’s illegal for a midwife to attend a birth before 37 weeks because premature births SERIOUSLY need to happen in the hospital.

      There’s a difference between saying “home birth should be an option and we should make it as safe as possible” and saying “people should only ever do home birth and it never goes wrong”. I know that there are homebirth advocates who say the latter, who would rather take huge risks with their own and their baby’s well-being rather than risk being told that they’re too high-risk to give birth at home, but not all do.

      • Karen in SC

        So what are YOU doing to change the status quo?

        One thing you could do is share the Not Buried Twice video.

      • Tabitha Ziegler Yaffe

        If you’ll re-read what I wrote, this mom didn’t have a homebirth midwife. Because of liability insurance laws here in Germany, homebirth midwifery is on it’s way to being illegal. So.. her options were hospital or unassisted. I don’t know that she would’ve gone the unassisted route if labor had started on it’s own prior to 37 weeks. As it was, she had symptoms of an abruption without labor, and she was convinced to go to the hospital by well meaning friends. I’m so thankful that she did.

      • Jenny_from_da_Bloc

        Yet “midwives” like Vickie Sorenson and unlicensed and uninsured midwife tried to deliver premature twins at 33 wks at her birthing center instead of sending the mother to the hospital. The first twin died and Vickie lied to the parents so she could attend this birth and killed a baby. Unlicensed, uncertified and unqualified midwives don’t care about legalities as proven by Vickie, Darby Partner and countless other “midwives.”

      • Stacy48918

        Wren was delivered at 36 weeks by a homebirth midwife. He’s dead now.
        Homebirth midwives flaunt the “rules” often. With their limited “education” they think they know better and endanger women and babies in their hubris. Until proper education and licensing and oversight is required more babies will continue to die.

  • ChoiceRocks

    ok, so i get that you all are for a medicated hospital birth. good for you. but why are you so damn angry at people that choose a different way of birthing? i’ve read a few of your blogs, and to me, while lightly laced with good intentions, seem incredibly emotionally charged, accusatory, and frankly, a bit snotty. almost as if you take it personally. (that rip off a nazi written poem was a bit messed up, though.) the way i see it, a woman should be able to choose how she gives birth- whether at a hospital, a freestanding birth center, or at home- without the fear of being persecuted or judged by anyone. i myself am choosing a birth center attended by a midwife, because that is what appeals most to me, and fortunately, i am able to because i am low risk. at the same time, i am grateful that a hospital is nearby in case-god forbid- an emergency arises. i also must note that i don’t care, nor get upset by someone choosing a different route than i, and what i don’t understand is how someone can get so angry if someone wants a different thing than they do. being militant about something only turns people off.

    • Guest

      The issue is more the lies, manipulation and false information midwives tell those choosing a different route of birth. Have you really investigated this birth center? Many in my area spew on how they have such a low transfer rate, yet there are many a brain damaged baby due to that policy.

    • Karen in SC

      Because the untrained birth attendants have no accountability and are judgement proof. And they sweep the dead babies under the rug.

      #notburiedtwice

    • meg

      I’m not an obstetric provider, but as an educated person who has worked in public health, I’m not worried about the “fear of being judged.” If you choose to maintain a Real World Las Vegas lifestyle of heavy drinking and illegal substance dabbling during pregnancy, or refuse evidence-based preventative measures like ultrasounds and vaccinations because of some non-factual crunchy hysteria, I will judge you. The same is if you (case in point) eschew prenatal care and/or engage in a home “stunt birth” and/or take the advice of a murderwife over actual medical professionals. I’ll judge you then, too. If you’re such a sensitive snowflake that you perceive this as a threat (as opposed to the GENUINE threat of your behavior), you have a lot of growing up to do.

      • ChoiceRocks

        Duuuuuuuude, you are such an angry person, aren’t you? Where did you get any of your statements from my comment? I don’t drink or do drugs. Ever. I just had my 20 week antenatal scan. I also have amazing prenatal care from highly skilled CNMs in a state licenced birth center. And what the hell is a stunt birth? Do people give birth while skydiving or something? And you can keep on judging, but remember “judge not, lest ye be judged”. Crunchy hysteria? You sound pretty hysterical yourself.

        • GiddyUpGo123

          Duuuuuuuude she never said you drink or do drugs. She was using that as an example to clarify her point. Some people *should* be judged and no one can argue that a person who drinks heavily during pregnancy is one of them. Before you jump to hammering out a response you should make sure you understand the thing you’re responding to.

          • ChoiceRocks

            “if you choose to maintain a real world Las Vegas lifestyle and drink or do drugs” sounds like she’s saying I’m drinking or using drugs. Or has the definition of you changed? And if she was merely using that as an example the proper phrase would have been to say for example, not the personalizing ‘you’.

          • AllieFoyle

            Give birth wherever you want. It’s your body, your baby, your choice.

            A word of warning about the birth center though: it’s good that your providers are educated and trained, however, you should understand that you are giving up some safety in having your baby outside the hospital, where emergency surgery and neonatal care is available. Yes, you can transfer, but there are situations in which any delay can make a significant difference in outcome.

            You should also think over the pain control issue. There’s no way to predict in advance how painful your experience will be, but it’s worth considering the scenario of having horrible, unrelenting pain and not being able to access an epidural if it turns out that you want one.

            I hope things go well for you.

          • Alcharisi

            Are you not familiar with the concept of analogy?

          • wookie130

            This is really just typical of people who parachute on in here…they get hung up on some extraneous irrelevant thing that was said, and miss the larger picture entirely.

        • The Computer Ate My Nym

          I don’t drink or do drugs.

          But you’d be ok with meg judging you if you did? Because that’s what it sounds like: you’re judging women who drink or do drugs. If it’s ok to judge women who put their fetuses at risk by drinking too much, why is it not ok to judge women who put their fetuses at risk with an out of hospital birth?

          • ChoiceRocks

            Well, she did say”if you choose to drink or do drugs”. And I was clarifying that I do not.

          • The Computer Ate My Nym

            So then you wouldn’t judge a woman who chose to start or continue drinking heavily or using other drugs during pregnancy? I’m trying to sort out what you mean and not misrepresent you.

          • meg

            I’m not saying you do. But you seem to think all pregnancy and birth choices are equally valid, which they very much are not. You’re “afraid of being judged,” when what you should REALLY be afraid of is a brain-damaged or dead baby. If you choose to ignore evidence-based medicine in favor of some hare-brained naturalistic assumption about the safety of birth because you “trust your own body,” you’re putting yourself and your child (who has no say in the matter) at real risk for no long-term gain. (Except “an experience,” sorry, my bad, that’s totally legit.)

            My points, therefore, are: a) not all pregnancy and birth choices are equally valid, nor should they be free of criticism – if you’re putting your child as risk for a fleeting moment of relaxation (whether it’s tequila shots or giving birth in a kiddie pool at some “birth center” not attached to a hospital because you’re oh-so-education), I reserve the right to judge your decisions as bad ones. and b) Judgment isn’t what you should be afraid of. Hemorrhage, hypoxia, and shoulder dystocia should be much higher on that list than “someone might judge me for my crunchy woo choices.”

          • KarenJJ

            “You’re “afraid of being judged,” when what you should REALLY be afraid of is a brain-damaged or dead baby.”

            This. There is a lot worse in life then something thinking you’re behaving like a moron.

          • Amy

            It was an example, not directed at you.

          • Jessica S.

            She wasn’t insinuating that you do. You read it wrong.

        • Karen in SC

          Did you watch the Not Buried Twice video? Those mothers thought their birth attendants were well trained. They were told homebirth was safe or safer than the hospital and if there was an emergency they could transfer. Who knows, a few of them might have read medical texts and books, same as you. They only have a picture of their baby now.

          That is why we are angry – at the homebirth “industry” that purports to be all about the mother & baby but in many cases it is really all about the birth attendant.

        • wookie130

          For someone who has read so much, you either have skimmed the information, or have very poor reading comprehension skills. And the very arrogance you flaunt by equating your “book smarts” and “education” with those who have gone through medical school and practiced in the field over the years…well, that is also very telling. You could not possibly know what you’re talking about, and it’s very evident that you don’t.

          You have yet to prove to anyone in all of your “research” how out-of-hospital birth is safer than hospital birth. All you’ve done is regurgitate every tired argument of the NCB community, and argue with the regulars here, who actually KNOW how to rebuttal your baseless claims with actual facts, and SENSE.

    • Houston Mom

      Please do check out the midwives running the birth center. Are there sanctions against them at the state board of nursing/midwifery? Are there suits against them in your local court? In my area, the Bay Area Birth Center has a good reputation on the surface, but if you go to the Texas Board of Nursing and look up the record for Jacquelyn Griggs, the owner, you get a different story. Injured moms and babies, high risk pregnancies, at least one death, suspended license, failure to abide by sanctions, letting birth center license lapse, failing to work without board ordered supervision.

    • Amy Tuteur, MD

      How can you make an informed choice if you believe the lies propagated by homebirth advocates? They are no more honest about birth than the anti-vax folks are honest about vaccines.

      • Guest

        Oh but she’s low risk, and there’s a hospital right up the road. NONE of the bad outcomes here ever have those 2 factors.

      • ChoiceRocks

        I can make an informed choice because I do alot of reading. Medical guides, college textbooks, manuals written by healthcare professionals, and medical journals. I have also talked with many doctors and midwives alike over the years long before I even got married. Just because i am not a care provider does not mean that I am not educated. Please don’t assume I decided to have midwifery care on some whim or because I listen to some militant homebirth advocate. Most HBs are a bit too pushy with thier beliefs for my taste. Kinda like the newly vegan. Passionate, but too angry. My choices are incredibly informed, not just about my healthcare, but about many other things.

        • Sue

          “ChoiceRocks” – I am also a smart person who does a lot of reading, but I could not possibly understand specialised material outside my profession because I have not been trained in all the underlying theory, and I have never made critical decisions based on that knowledge.

          COuld you fly a plane by reading all the manuals?

        • Amazed

          Bullshit. And even if YOU are so very informed (I don’t believe you are but keep worshipping your hubris), don’t forget that most women don’t read medical textbooks for years just for fun before even getting pregnant. So, according to you, they cannot make a truly informed choice. So, they have no business defining low risk and so on.
          I have encountered people like you in my own field (completely unrelated to medicine). They read a lot and they think that makes them as informed and skilled as me.

          You must be a patient who is a joy to be around.

          Don’t you dare to be sad for the millions of normal women who don’t obsess over obstetrical textbooks for years before they were pregnant, Queen of Sanctimony. You must be surprised but the vast majority of them get just as good results as you,

        • Trixie

          People who are informed don’t make statements like, “I won’t accept any medication ever.” Really? No antibiotics if you’re group b strep positive? No insulin if you’re diabetic? No pitocin if you start to hemorrhage? No lidocaine while they sew up your tear?

          • RNMomma

            Oh but “natural” treatments are okay. To which I ask, what about aspirin or digoxin or morphine?

          • KarenJJ

            Well, as long as you don’t inhale…

            It is the sort of luxury someone who has been largely healthy will say. My child had scarlet fever earlier this year and I’m very very thankful for modern day anti-biotics.

          • Karen in SC

            Perhaps her research didn’t include looking up the fact that epidurals in the year 2014 do not reach the baby. The anesthetic is released into the dura and doesn’t cross into the bloodstream.

          • pinkyrn

            I am not sure that is entirely true.

          • Karen in SC

            You are not sure that the medication doesn’t cross over to the baby or you’re not sure her research included that.

            I’m not a doctor nor a CNM so I would refer you to The Adequate Mother’s blog. She is an anesthetist and wrote some posts about epidurals with links to her source information.

          • pinkyrn

            I am not sure that none of the medication gets to the fetus. I vaguely remember one of the anesthesia Doctors or Nurse anesthetists saying it does. I would have to look it up. I am under the impression a lot less of it gets to the fetus.

          • meg

            “I vaguely remember something” > “Read this resource that has links to studies”?

          • pinkyrn

            I don’t recall ChoiceRocks saying she would never accept medications ever. Now I think you are putting words in her mouth.

        • pinkyrn

          A lot is two words not one. A lot not alot. Just saying.

        • Prudentplanner

          You and I sound very much alike. I read the OB textbooks, Midwifery manuals (including the gruesome stuf), birth stories, and Best practice recommendations. I used to visit this page to disagree with Dr. Amy; ‘she clearly doesn’t understand natural childbirth’. But eventually dr Amy’s statistics won me over. But you can’t be truly “educated” until you understand and accept that choosing home birth will result in the death of 2/1000 (1/500) babies which would have survived in a hospital. Being really educated

          When I became pregnant, I started with a home-birth CNM. When I really got down to the wire (34 weeks), I switched to an in hospital Obgyn/CNM practice. I realised I had to do everything humanly possible to keep my baby alive.

          The hospital was great

          • PrudentPlanner

            Sorry, ipad fail.
            Being really educated means being open to new information and continuously reassessing your understanding of new facts. If you claim to be educated, you must also be willing to change your mind when presented with new information.

            Please don’t be afraid to rethink your choices. It can be hard to change providers, but so worth it. The hospital was great. the staff was respectful and open to NUCB/hypnobabies, I recommend hospital birth to everyone.

            At the very least a hospital birth can be an act of defiance, “you can show them a beautiful natural birth”. You can go unmedicated but in the hospital, your baby will be in the safest possible environment.

          • Karen in SC

            Prudent, I had two of those births in the hospital and many others here have done the same. I applaud you for being open to new information and learning.

    • Young CC Prof

      Want an unmedicated birth? Wonderful. Go for it. Make sure your midwives are giving all the appropriate prenatal care. Make sure they’ve checked the position of the baby’s head, we’ve heard quite a few tales of undiagnosed breech, often with catastrophic results. What kind of relationship does the birthing center have with the hospital? Can you register in advance at the hospital, in case transfer is needed? What’s so awful about that hospital that you don’t want to give birth there?

      And if people saying mean things about your choices on the Internet is “persecution,” may I suggest you lack perspective?

    • wookie130

      I’ll tell you what makes me so “damn angry” about the state of home birth in the U.S…
      *It is often presided over by laypeople who may or may not have even graduated from high school, posing as “midwives”, who are basically just untrained birth junkies who teach expectant mothers to value process over outcome…a vaginal birth is often worth more than the baby’s (and mother’s) life.
      *Why WOULDN’T this topic make people emotionally charged? Do you realize that there are loss moms who post regularly on this very blog…mothers who lost their precious babies to home births gone wrong? You’re expecting them to silence their pain, and not try to use their first-hand experience to prevent others from experiencing that emotional agony?
      *The talk of “persecution”…ugh – PUH-LEEZE quit with that nonsense. Who are the real victims here? The midwives who are lying to women, those that support the NCB movement, MANA (who lies about A LOT of things, if you’d stop and read a while longer)? Or perhaps it is the women who have bought into the lies, and have died in the name of having the “perfect birth”, or have cost their babies their lives? These women who chose home birth under these falsehoods were not provided with informed consent…they were duped.
      *Look at the real stats on home birth safety, and the actual RATES of death that we’re talking about, vs. hospital birth. I will choose to deliver in a hospital, because not only do value myself, but I value the life of my child.
      *Dr. Amy believes that women have the right to choose home birth, but in doing so, they should be told the TRUTH, so that their decision is based on REALITY and FACTS.

      You’ve said you’ve stuck around and read some of the blog entries on here. Stick around, and keep reading.

    • Trixie

      You’d be surprised how many commenters here have had unmedicated births. Even Dr. Amy has had unmedicated births.

      Is your birth center accredited? Do they employ CNM or CPM midwives? Do they carry liability insurance? Have hospital privileges and written backup agreements with the hospital? If your baby needs resuscitation, does the hospital send a team over in an ambulance? Or will you be driving your blue baby there in the back of your car?

      Unless you can answer all of those questions, maybe you should rethink the birth center.

      No judgment or persecution, just facts.

    • KarenJJ

      “that rip off a nazi written poem was a bit messed up, though”

      Yep. And once you start to see it, you start to see a whole lot more that is messed up.

      Keep reading. Keep getting tested to make sure you actually are “low risk” and it’s not just wishful thinking – and if you do decide to stay with those midwives then keep your fingers crossed!

    • Jessica S.

      *sigh* If you would read just a little more, you’d see that Dr. Amy is all about choice, informed choice. What she’s attacking is MISinformation by homebirth and natural child birth advocates. That’s it. Nothing more behind the curtain.

    • Sue

      “ChoiceRocks” – I am guessing that you are not, and have never been, a health care provider. Am I right?

      Dr Amy has provided specialist care as an OB, and has been in the role of being held to account for her advice to patients and decisions she made. Many people who comment here are also responsible for the safety – and lives – of people under their care. Can you see that this might give a different perspective to yours?

      Also, do you think that an individual’s choice is a valid one if they haven’t been appraised of the real risk/benefit information for all choices?

    • Jacob Wrestled (Danielle G.)

      Of course you should have the right to choose. However, that doesn’t make all choices equally safe or appropriate for a patient. Just make sure you are getting what you signed up for.

      I was low risk too. Until I wasn’t.

    • ChoiceRocks

      wow, are some of you masters of assumption!!! Of course I looked into my birth center and midwives. Because I’m not an idiot. Not only are the midwives CNMs, they all work as RNs on the labor and delivery ward at the hospital. The head midwife has a PHD in nursing, and has been a midwife since the early 90′s. The midwife I see went to UC Berkeley followed by Columbia university. They have admitting priveleges to the hospital. My prenatal care is top notch, and they offer all testing that is done at an OBs office. I choose midwifery care because I prefer the more personal nature of care, a more woman centered environment, the midwives at my center are highly skilled in what they do, and really the fact that I am treated like a human, not some ignoramus or just another patient. Plus, they appreciate the fact that I have educated myself fully about pregnancy, labor and delivery. I choose midwifery care because i don’t want interventions unless it is a life or death situation, and believe in my bodies’ ability to birth a baby without interference. I also trust and know my body enough to listen to it-and my midwives- if a transfer is necessary. Also, to give birth with no drugs is my informed, personal preference, as i do not take any medication whatsoever.

      • KarenJj

        Sounds great. Sounds like midwifery care where I live (not the US) which also reports good outcomes.

        ” i don’t want interventions unless it is a life or death situation”

        On this though – would you want interventions if say, your baby had a chance of ending up brain damaged (hypoxia)? Or your chance of faecal incontinence? Or if it improved your chance of a vaginal birth?

        • ChoiceRocks

          I think brain damage or any other such emergency would be lumped with life or death. Because quality of life is very important as well. And thank you for being respectful with your response.

          • Mishimoo

            I would expect that too, the problem is: How can you be sure that they will prioritise those things over their transfer rate?

          • pinkyrn

            Because the transfer rate won’t wake you up in the middle of the night. The baby that you think your decision may have hurt will.

          • Karen in SC

            You sound like an ethical provider. Unfortunately, we know of too many instances where the midwife didn’t transfer in time. Sometimes ignoring the mother’s pleas to go to the hospital.

          • pinkyrn

            Were the midwives who refused to transfer CNMs?

          • Karen in SC

            Yes in at least one instance. Magnus Snyder was breech and estimated to be a large baby. The midwife was a CNM at a freestanding birth center.

          • Stacy48918

            Griffin’s CNM advised the mother to stay home while her uterus ruptured. She couldn’t even be bothered to show up at the start of labor for a HBA2C but was managing things by phone.

          • pinkyrn

            The CNM agreed to do a HBA2C? That is stupid. What state was she in? I cannot see that holding up in court.

          • Mishimoo

            My best friend was in a hospital-based birth centre and the CNM attending her tried to block her transfer to the L&D ward for an epidural for 5 hours. Long story short, bub was delivered by vacuum extraction, had shoulder dystocia and a suspected OBPI, and needed help breathing. The father thought he’d lost a baby and was about to lose his wife. I hope that CNM has learnt, but I doubt it.

          • pinkyrn

            Not only is that illegal, since keeping someone against their will is not justifiable of legal, it is unethical.

          • Mishimoo

            Which would be the point lots of people here are trying to make. This happens even with CNMs who should know better, who should be putting health and safety ahead of their numbers/profits, and it needs to stop.

          • Amazed

            More respectful than you deserve, with the way you reacted to the tragedy of a mother who didn’t fit your nice little world. Oh, a mother cannot know what her baby’s developmental delays are due to. It sucks for the mother but ChoiceRocks knows best!

            You people are so callous that I can just break a piece of what passes for your hearts.

          • Guestll

            +1

          • KarenJJ

            There’s a huge spectrum of potential issues. I did a hypnobirthing course prior to my first child being born and the best thing the midwife said was to trust my medical providers. I needed to hear that. Health care providers who are skilled, professional and great at what they do will have you and your baby’s health and well being at the centre of their thoughts.

            I didn’t understand that myself until my baby was born, but I’m glad I trusted what the midwife said and I’m glad I trusted my obgyn. But I should also note that I live in an area where midwives are much much more heavily regulated than the US.

          • Amy

            I took a hypnobirthing class also, and my teacher (a doula wiho also owns a natural parenting lifestyle store $$$) said that everything your OB tells you is based on how many malpractice lawsuits they’ve experienced.

          • Amy

            The idea that preventative medicine has no place in obstetrics is fucking bananas. WHY would anyone want to wait until you get to the EDGE of life or death to do anything….You would never wait until the very last minute to step in if someone you love was in danger…as long as they were already born, that is.

      • UsernameError

        Wow. Homebirth bingo. (I’m educated, I trust my body and so on). Do you have so little respect for people who spend 12+ years getting experience and education (ie., doctors) that you think you can educate yourself with a Google search? That’s some hubris right there. Why do doctors even go to medical school? Anyone can be educated with out it, after all.

        Well, good luck with that. I had a non-medicated birth with midwives, and it sucked. And my son has severe developmental delays. But I hope you’re one of the lucky ones.

        • ChoiceRocks

          Did you even read my comment? And who said anything about home birth? If you had bothered to even read what I posted you would know that the head midwife has a PHD in nursing, and that all the other midwives are RNs on the labor and delivery ward at the hospital. They are all CNMs. Also, don’t assume I educated myself on the internet. I read those things called books. Lots of them. Medical guides, textbooks, books written by healthcare professionals, and medical journals among others. I have also talked with doctors and midwives alike over the years before I even got married. And yes, it sucks for you that you had a bad experience with a midwife. But I doubt you sons developmental delays are due to that- unless there was an emergency and she was unskilled in say, recucitation or some such thing. No one really knows what causes things like autism spectrum. But simply choosing a midwife is not it.

          • Stacy48918

            ALL midwives – CNMs included – are “unskilled in recucitation (sic)”. It is not possible to appropriately give neonatal resuscitation outside of a hospital. Period. See the recent guest post about this.

            If YOUR baby comes out blue and floppy YOUR midwives will not be able to adequately treat him because you chose to be out of a hospital and far from true resuscitative care.

          • pinkyrn

            Now that is a sweeping generalization. I am a CNM student and I have taught NRP for the last 7 years. I can do it in my sleep. If her CNMs are labor nurses who have worked in a high census hospital, they have probably done a lot of NRP. Especially if they are old, like me.

          • Ash

            I think the point is that no one can follow NRP algorithm in a low resource setting like a home. So no matter how much a HB attendant says they are skilled at NRP, they simply don’t have the resources at home.

          • pinkyrn

            This particular lady is not planning a home birth. She is planning a birth center birth with what appears to be trained attendants.

          • Ash

            By “freestanding birth center”, I assume this is a birth center staffed by midwives that is not affiliated with a hospital. I have a hard time believing that a birth center birth attended by perhaps only a CNM and a doula, or even if it was two CNMs, would be skilled at neonatal intubation and umbilical access. I haven’t investigated every birth center out there, of course, but I certainly haven’t found any websites that indicate the staff intubates or has a CPAP.

            A freestanding, non-hospital affiliated birthing center in the USA is pretty much someone else’s home.

          • pinkyrn

            The two birth centers in my neck of the woods are affiliated with hospitals.

          • Karen in SC

            I wish more states required homebirth midwives to carry malpractice insurance.

          • Trixie

            Accredited CNM birth centers do have better outcomes than home birth.

          • Medwife

            If they don’t have a peds response team- more RNs, respiratory, people who can intubate, along with enough staff to manage maternal complications- it’s just not enough. It’s basically equivalent to a homebirth. CNMs are not all-powerful any more than OBs are.

          • pinkyrn

            I never said that OBs or CNMs are all powerful. My assertion is that a birthcenter birth is preferable to a homebirth because there are professional birth attendants who are accountable for the decisions they make. It is my understanding that a CNM would not decide to take for example, a VBAC for a birthcenter patient whereas a laymidwife may.

          • pinkyrn

            And small community hospitals that provide maternity care often do not have a pedi response team. They may have an on-call pedi or anesthesia may be the person to intubate the newborn. Most pregnant women do not know to inquire on how each place responds to an emergency.

          • Medwife

            Yes, but at the least they have more L&D nurses on hand who can assist in resuscitation and a simultaneous maternal emergency.

          • ihateslugs

            Oh, if only a good pedigree and an Ivy League education were enough to save babies! A PhD cannot save a dying baby without the proper equipment and most importantly, a well-trained team of physicians, (or NNPs), nurses, and respiratory therapists. It’s all good…until it’s not. Then, that five or ten minute transfer (which is loftily optimistic, given that even the best transfers are typically in the thirty minute range), is suddenly the difference between life or death, or a functioning brain or life with incapacitating cerebral palsy. I suggest that you do a little “education” on something called hypoxic ischemic encephalopathy or HIE. Especially before you casually dismiss another mother’s claims that her child’s delays are related to birth.

          • Kupo

            Hi ChoiceRocks, informed choice is empowering.

            If I had to describe an allegory, it could be akin to being an educated first-time parent who has read all the books about newborns: sure *you’ve* read all the books and research — but your baby hasn’t, and will do what it darned well has to do!

            As an educated pregnant lady, you will be aware that first-time (aka ‘trailblazer’) childbirth is one of the most riskiest times for the baby and mom. I’m not fear-mongering, just sharing my concern as a person who also desired a non-intervention first-birth.

            My second birth was much easier as her big bro had ‘made the trail’ for her to follow.

            Good luck.

          • Amazed

            Oh, so we’re playing the autism card here? Nice try, oh Informed One. The poster wrote about developmental delays, not autism. Oxygen deprivation tends to do such things and even the most skilled midwife can’t make a stat C-section. And an unskilled one can fail a baby’s brain by grossly mismanaging a neoresusitation. Informed choice: Darby Partner’s past and Shahzad Sheikh.

            But let’s make it all about autism. Never mind that this mother didn’t mention it at all.

            It’s sad when one wastes years of their life reading medical textbooks, only to reveal that they cannot differentiate between autism and developmental delays. Comes to prove that reading isn’t enough, understanding is needed, as well.

          • Stacy48918

            She also seems to be playing the “Some babies aren’t meant to live” card, cleverly reimagined as “Some babies arent meant to have their brain function” card. It couldn’t POSSIBLY be due to having a lesser educated care provider at the birth or being outside of a hospital and far from expert resuscitation. Nah, couldn’t be.

          • Amazed

            Oh absolutely. And she’s appalingly dismissive of the poster’s tragedy. It sucks for you, that’s all.

            Disgusting.

          • KarenJJ

            Not cool, ChoiceRocks. Keep reading. You know nothing of her experience and yet you make a pronouncement as though she hasn’t done exactly the same research that you’re doing and hasn’t walked down the exact same path that you’re about to tread and hasn’t then experiences the “rare” events that you are now hoping fervently won’t happen to your baby (and it’s true – it’s rare – there’s only a very small chance of your baby being brain damaged by your choice of removing yourself further from the option of a quick c-section).

          • Trixie

            Out of hospital birth is not really that different — home or birth center. Accredited birth centers do have slightly better numbers, but I don’t think anyone’s studied the rate of brain injury at accredited birth centers.
            It all comes down to how long your baby can hold its breath until you get to the hospital. Minutes of time = brain function.
            In your research, have you read the study out of Weill Cornell (NY State and surrounding areas mostly has CNM-led home birth) that showed an 18x increased risk of brain injury with home birth? http://www.skepticalob.com/2014/01/risk-of-anoxic-brain-injury-is-more-than-18-times-higher-at-homebirth.html

          • Guestll

            Autism isn’t a developmental delay, genius. Better crack those heavy books again.

            People like you just piss me off.

          • Anj Fabian

            I dunno.
            Apparently enrolling in kindergarten now involves giving some details about the child’s birth, including the place of birth.

            If only some credible academic could access that data to see if place of birth has any correlation to academic success, or qualifying for special education services.

          • ali connelly

            Frankly, A phd in Nursing is great, but will it actually improve any outcomes in birth? I think you are a troll

      • sapphiremind

        Do they staff a neo response team 24/7? If they don’t, you being “near a hospital” won’t do you a lot of good. You may be low risk, but your baby might have other ideas.

      • Stacy48918

        “I believe in my bodies’ (sic) ability to birth a baby without interference” and “I’m highly educated about birth” are mutually exclusive statements. It illustrates how little you know about birth.

        Does this birth center have a neonatal resuscitation team available? Like within 30 seconds of birth? Can you transfer that fast? Or better – can you hold your breath for the 5-30 min it would take you to transfer?

        The midwifery model is great. Choose to be outside of a hospital – fine. Your choice. But you are not truly “informed” or “educated” if you cannot recognize and admit that in a true emergency your baby could die simply because you are not IN the hospital WHEN the emergency develops. Transferring “quickly” AFTER the emergency has happened is too late.

      • ihateslugs

        Ha! Your “I trust my body” and “I’ll know if I need to transfer” statements are, at best, laughable, but could be potentially statements you’ll regret. I hope not. But know this, coming from a woman who has delivered two children naturally and believed in all the woo, (Ina May, Birthing From Within, the works): your mind plays wild tricks on you in labor. You may be rational at times, and at other moments, bat shit crazy. You absolutely need sound, experienced, competent birth attendants in whom you can trust to help make those decisions. I truly hope that is what you have found, (though it still doesn’t change the fact that a birth center cannot offer the same degree of neonatal resuscitation).

        • Karen in SC

          Even if you have the best midwives and a well equipped facility (for a birthing center), ChoiceRocks needs to remember that low risk =/= no risk and the consequences are high. Sounds like she is comfortable and confident with that equation, even if her glasses are slightly rose-colored.

        • Jenny_from_da_Bloc

          If they are as educated as they claim they would know that they could have their self-centered, natural birth in a hospital where the equipment for life saving measures is available and ready just in case all that trust they have in their body goes out the window due to no fault of their own. God forbid the unexpected happens and she needs those awful medications to save her life or her baby’s. Woe is me that I am treated like a *gasp* patient under the care of a competent doctor in a safe and fully staffed hospital!

          • Amy M

            This is an excellent point Jenny—we should use this idea more often with the “I trust my body” crowd. Just like you said: Well go ahead and trust your body in a hospital—no reason it should let you down there any more than it would at home, right? If that holds true, they’ve sure shown their doctors! And if it doesn’t, well then maybe no one gets hurt.

          • Jenny_from_da_Bloc

            A little OT: A friend of mine forwarded me an episode of A BAby Story and the parents had like a 32 hour natural labor in a hospital and denied every suggestion made to them.by the doc and nurses to augment her very painful labor. The parents even had sex in the bathroom to get things moving faster (I’m pretty sure that’s what they were doing! At least it was definitely implied.) Nobody forced them to do anything, the staff only made suggestions. Finally, when the mom couldn’t take it anymore she requested her water be broken and an epidural (the crunchy father was aghast that mom wanted meds and interventions after the baby was showing signs of distress) and shortly after the very large baby was born. The mothers exact words were: “good thing I got that epidural and I wish I would have done it sooner.” The dad was a weirdo, but it proves you can have a natural birth in a hospital and nobody is going to make you do anything you don’t want to do and if something goes wrong you have help a few steps down the hall, not 20 minutes away if traffic isn’t backed up.

      • Stacy48918

        A CNM killed baby Griffin at a homebirth in January.

        • Karen in SC

          Also one of Magnus’ midwives was a CNM.

          • PrecipMom

            My midwife is a CNM. Two deaths and one near miss in the last four years… that we know about.

        • guest

          My midwives were willing to let me go home after my almost 40 weeker had several decels on the monitor. Thankfully, I declined. We think it was to preserve their low induction stats. Kind of scary.

          • guest

            CNM midwives, that is.

      • RNMomma

        I gave birth at a free standing birth clinic and had terrible back labor. I’ll tell you that as a FTM I had no idea the pain would be so intense. Looking back, I’m thankful nothing went wrong, because it was my first rodeo I wouldn’t have known the difference in “good” pain and “bad” pain. I had well educated and experienced CNMs who made great decisions and managed my labor in such a way as to prevent complications before they arose. However, knowing what I know now (i.e. There is no way I’d be able to get to the 8 minute away hospital in less than 20-30 minutes while in the throws of labor) I’m likely to do a NCB in a hospital setting next time around. I don’t ever want to gamble with my child’s life or health.

      • Hooligan

        this is so ignorant. You can’t have educated yourself “fully”. no one can, in 7 to 8 months. Thats why med school lasts much, much longer than 9 months. Christ on a cracker… the amount of smug self-satisfaction you have, when you know so so little about what you’re writing. ‘i do not take any medication whatsoever” – this is white american priviledge to the extreme. ‘lookee mee, im so natcheral…” I daresay you DO take meds, and you would, if your life depended on it. Those women who do not have ready access to modern medical care will walk miles, wait hours, just to get medications. The same ones you poo-poo because theyre not nacheral and its just Big Pharma trying to make money from you. Have you ever considered that in addition to making a profit, yes, big pharma is a business, that they work really hard to save lives??? tens of thousands of people are alive today, and sustained by medicines. stop being such a smug bitch. you have your head up your own ass and you’d run to the nearest ER or call 911 if YOUR life were in danger. as a paramedic student, i can tell you, brace yourself, we use MEDS (gasp!) every day to save lives. Suck up your sanctimony. go have the birth you choose. but KNOW that the reason we’re so “bothered” is that mothers are still lied to every day, by lay midwives, telling them to trust birth, and babies are DYING. Hundreds of preventable deaths because untrained lay persons tell mothers lies, about their education, training and abilities. Telling women who have risk factors that need monitoring by a hospital, that they can handle those things at home should be criminal.

        • pinkyrn

          Wow, you are really angry. And I don’t mean to piss you off further, however historically medications have been given to women in the USA that have had really bad repercussions. For example, my own dear mother took DES while pregnant with my sister. You may know that DES has a horrible side effect of screwing up the fetuses reproductive organs. Well now my mother must live with the fact that she took a medication that has negatively altered my sisters life. After an experience like this, folks may be hesitant to take meds. Just saying.

          • meg

            Some people took medications with side effects = all medications are bad. That’s really reasonable logic, and I 100% agree with you. Which is why, after I had an allergic reaction to shrimp, I stopped eating all food forever. So far so good.

          • pinkyrn

            Jeez, I am sorry to hear that. However the weight loss must be amazing! That must beat the shit out of Atkins!

          • jhr

            DES was prescribed during the 1950s for women who had repeated spontaneous abortions or miscarriages. Your mother likely believed that she would not be able to carry her pregnancy to term had she not taken DES. In the 3 cases of which I am aware, women who were previously unable to carry to term had healthy babies. I know that there have been correlations between DES use and congenital reproductive anomalies but there is no 1-to-1 correlation/causation that has been proven.

          • pinkyrn

            Where are you getting your information?
            http://www.cancer.gov/cancertopics/factsheet/Risk/DES

          • Jessica S.

            Or, you could consult with an OB that specializes in maternal fetal medicine and weigh the risks/benefits of each medication you take. Things have changed a lot over the last several decades and it’s no longer a complete guessing game. If it were, I wouldn’t have had kids at all.

            That is awful about your sister and your mother. I wish it weren’t the case. I hope that we get even better at deciphering the risks/benefits of medications in pregnancy.

          • pinkyrn

            I guess the point I am trying to make, albeit unsuccessfully, is that medications are not completely harmless to everyone. And a cost benefit analysis should be made on each medication a person takes. And some people have had terrible experiences with medications and do not wish to experience that again.

        • Medwife

          Your grammar, inconsistent capitalization and use of the term “smug bitch” makes you look like an internet crazy person.

      • Life Tip

        Well, I say this with all sincerity, good luck. Because that’s what you will be relying on.

      • ali connelly

        I am very skeptical about what you have written. I am an Rn and have not seen our CNMs working as RNs on the floor. There is a fundamental distinction in the two roles as well in the pay grade. A CNM is AN Rn with further training and an Masters degree. Perhaps you are confused about the difference between the two roles

    • The Computer Ate My Nym

      a woman should be able to choose how she gives birth- whether at a hospital, a freestanding birth center, or at home- without the fear of being persecuted or judged by anyone.
      I agree that women should be able to make their own choice. However, women should also have the right to accurate information. They should have the right to know, for example, that if they give birth at home they are increasing the risk of their baby dying at birth by three fold or so. They should have the right to know exactly what skills and training their attendant, if any, has. They should have the right to know their attendant’s record with respect to prior losses, lawsuits, etc. They should have the right to sue their attendant for malpractice if things go wrong.
      And no one has the right to lie to women and tell them that, for example, breech is a variant of normal with no increased risk. Or that delivering twins at home is no problem. Or that gestational diabetes will stay away if you just don’t test for it. Or that vitamin K causes cancer (it doesn’t).
      It’s your choice. If you want to give birth at home or in a birth center or on the beach or in the Oval Office, I have nothing against any of those decisions as long as you’re making them with the knowledge that you are taking a risk. If you decide that the risk of being outside the hospital is outweighed by the comfort or nice view or historic location, that’s your decision. But no one should have the right to lie to you and say that you’re not taking a risk when you are.

      • ChoiceRocks

        Sadly, misinformation occurs on both sides. And it is even sadder when a woman blindly listens to any medical advice whether from a doc or midwife without looking for more information on her own. Or if she only does ‘research’ on the internet.

        • The Computer Ate My Nym

          zB? What misinformation is routinely provided by hospitals or OBs?

          • pinkyrn

            I don’t think it is misinformation as much as each doctor or practice has their own take on the subject. For example, one practice I used to work with would offer elective primary c-sections whereas other practices disagree with this practice.

          • The Computer Ate My Nym

            Yes, but ChoiceRocks said that there was “misinformation on both sides”, i.e. the NCB and OBs. This strikes me as looking at two people, one of whom is saying the earth goes around the sun and the other that the sun goes around the earth and concluding that they’re both wrong because the earth and the sun actually both orbit a gravitational average point (or something like that–I may be misdescribing it–not a physicist): that’s technically true, but the person describing the earth going around the sun is much closer than the one describing it as the other way around.

          • pinkyrn

            ChoiceRocks is not comparing NCB loonies to medical doctors, she is comparing CNMs to MDs. I have worked with both CNMs and MDs and I don’t think the main difference is that CNMs are less informed or accurate.

          • The Computer Ate My Nym

            Hmmm…I read “on both sides” as meaning OBs or NCB and homebirth midwives. I agree that CNMs are not, in general, less informed or accurate. (Though some, like some doctors, have bought the woo.)

        • KarenJJ

          Plenty of women research the internet as well as ask their obgyns or doctors. They just come to a different conclusion then you did. It doesn’t make them “blind”.

          • Stacy48918

            Exactly. I’ve “done my research” about pain control. Even had 2 unmedicated births so I do actually know what it’s like unlike this first timer OP. I want an epidural this time TYVM.

            I was BLIND when I thought I was doing the “right” thing by suffering, screaming through labor unmedicated. That it made me a “warrior mama”. No. It made me excruciatingly painful and that’s it and I don’t plan on doing it again.

        • Stacy48918

          Right. Because your “research” – books, Internet, the lot – is CLEARLY more reliable than years of education, training, actual research and clinical practice. The hubris.

          What “misinformation” are OBs peddling? Can’t be worse than “trust your body”.

          You know, it was a CNM that oversaw the death of baby Griffin at an HBA2C in January. His mother “trusted” her body and “knew” she could have a vaginal birth this time. Laying on her living room floor as her abdomen filled with blood from a uterine rupture proves “trusting your body’s ability to birth” is a worthless and deadly LIE of the natural childbirth movement and out of hospital birth.

        • Amazed

          And what qualifies as research in your book? Funny, I think myself your average Jane, not a goddess who can cram all the years at the medical school in 8 months (1 month before I know I am pregnant) and become an expert.

          But I bow to your extraordinariness anyway.

          • The Computer Ate My Nym

            Medical school is the least of it. What about the 4 years of OB/GYN training and the N years of specialist training in the relevant subfield (i.e. maternal fetal medicine)?

          • Amazed

            Now, now. Don’t go into details. I am sure ChoiceRocks has crammed those into another few years of reading big books. And actual clinical practice is sooo overrated.

          • Bombshellrisa

            Not to mention presenting at Grand Rounds or at least attending one. I have even watched Grand Rounds on University of Washington TV, which is on public access (a great way to pass the time when I am on standby until 3am, beats reruns).

        • Montserrat Blanco

          I am a physician myself. I specialized in another branch of medicine though. When I first attended my OB to get care for my pregnancy I listened to his advice. I am an expert in something but I do trust my colleagues to be experts in their field. I have studied OB for one year at university and had practical training for months during my training years. Even with that I do not consider myself capable of making better decissions regarding my care than my OB. Google “research” is literally of no value and mostly even dangerous. At least it is in my field of expertise. I do not want to get care from someone that gets his or her knowledge from Google university and I expect to do not get that kind of care from my providers, nor that I would offer that to my own patients. I might Google the best anti strecht marks creams but that is pretty much everything. To manage my blood pressure, blood sugar and make sure the baby is healthy, please, I want a real professional. When my OB suggested an extra O’Sullivan test I did it as soon as they would book it. I did not complain and said that my online forum friends said it was unnecessary (something I read a lot of times in online forums).

        • Trixie

          Could you be more specific about the misinformation that occurs on the OB side?

          • Jenny_from_da_Bloc

            She can’t be more specific because an OB isn’t going to misinform a patient because they have nothing to gain by doing so, unlike a lay midwife who wants the patients money regardless of medical history or safety. An OB has nothing to gain and too much to lose by lying to a patient, unlike a midwife or birth center who doesn’t accept insurance or is unlicensed. I honestly didn’t know unlicensed midwives existed until I was pregnant with my son and was straight lied to by one who was obviously motivated by financial gain and not patient safety or the best interest if the patient and neonate.

        • pinkyrn

          Where else would the average woman or man do research other than the internet? The hospital where I work has an excellent library with an engaging, happy to help librarian, however it is hidden in the bowels of the campus and it is not open to the public. One of the reasons it is hidden in the bowels of the campus is to ensure the public won’t stumble upon it. My point being, much of the most accurate and up to date information is not available to the general public and even if it was, the jargon would deter the most hearty soul.

        • PrecipMom

          And what about when you go to multiple midwives giving them your history and no one bats an eye taking you as a candidate? How is the lay person supposed to know that even if a midwife is NRP certified that they can’t actually perform full resus in the home setting?

        • Jenny_from_da_Bloc

          IWith my first pregnancy I saw a midwife who was recommended to me by a friend who just had her second baby. I did not realize she was a lay midwife until after my first appointment when she told me that my fused pelvis would.not impede my natural birth. I was extremely confused and skeptical because all she talked about was avoiding a c-section. Luckily, I went to an OB who told me the truth and said a vaginal birth was most likely impossible. He told me the truth, not what he wanted to be the truth and it saved my son’s life and brain function.

        • Anj Fabian

          Why should I have to double check everything my doctor or midwife tells me?

    • OBPI Mama

      I felt judged by some when I decided to have a homebirth with my first baby. It hurt and I got defensive. “Every choice is valid!” I’d say (along with quite a few lies and misinformation I was fed and consumed).

      But you know what hurt MORE… way more… than being judged?

      The guilt I felt when my baby was born during a severe shoulder dystocia… with no one “really” trained and practiced in neonatal resc. when it really counted, with no doctor there thoroughly trained, practiced, and drilled in these emergencies, with not enough people there to split the focus between me and baby…

      The guilt I felt as I watched my precious little baby struggle to live, then struggle for these long 6 years with his birth injury (a severe brachial plexus injury)… with his surgeries, with countless and various therapy sessions, with his anxiety as he tried new things like tball or mentally worked through his injury when he can’t do things other kids can, with his limited range of motion not allowing him to wear “big boy pants” (the kind with zippers and buttons) or “papa” shirts (button ups) or even being able to pull both sides of his pants up right so he doesn’t look silly… even as a 6 year old, they don’t want to appear silly. The guilt when he says, “Mama, my Lefty feels like it can’t stretch out, but it wants to stretch. Look, it hurts.” The guilt that came with his dev. delays because of his oxygen deprivation and his body going through so much, it didn’t have the energy to focus on eating real food, talking, and other “back burner” things… The guilt with how much he’s had to overcome and his newer obstacles.

      The guilt that comes with knowing that his story didn’t have to be his story… that is much stronger than the hurt of judgement.

      Not all choices are valid, they aren’t all equal. There are real… so real consequences to not being in a hospital. Preventable consequences. Heartbreaking consequences. Life-altering consequences.

      Just because I’ve made the best of where our lives are at, with what has happened, doesn’t mean I wouldn’t take it back in an instant. Good things have come from bad because we’ve chosen to look at that. But you can bet, I was in a hospital with my next 3 births because once you’ve had an unhealthy baby, you realize just how precious/how fragile/how much of a blessing it is to have a healthy one.

    • PrecipMom

      I am not angry at people who give birth differently. I had three children at home. I am angry that I was lied to by the natural birth industry, because with hard facts I would never have chosen to give birth at home. My daughter could have died because of the choice that I made, and the choice I made was based on the information given to me by my midwives and the home birth community at large.

      Yes, I have a right to be angry that I could have a dead child because I trusted that no home birth midwife would ever participate in a home birth that was not at least as safe as a birth in the hospital. Yes, we have a right to be angry on behalf of the people who are lied to and whose children pay the price for that lie.

    • sdsures

      What choice does the baby have?

    • Guest

      Most women over-focus on the birth. It is not that important. For most of us, birth is a crappy way to spend a day. Some people are lucky and it’s not that bad. But it’s a question of luck, and anyway, it is only one day. Get the kid here in the safest way for both of you and get on with your life.

      The rest of your life begins on Day Two. Your baby needs you focused on Day Two.

      • RNMomma

        I agree. It’s like the people who get super focused on having the perfect wedding. Sure, it’s a very special occasion and you want it to go well, but really it’s just one day. Focusing on your marriage is far more important. (Except of course, your wedding day typically isn’t a life threatening event.)

      • Montserrat Blanco

        I completely agree.

    • LibrarianSarah

      First off, there is a shift key on either side of your keyboard. Feel free to hit one of those whenever you begin a sentence or use the letter “i” when indicating yourself. It is not nice to force people to read that wall of text with not a capital letter in sight. Some of us have bad eyes. We can move on to the enter key later.

      Secondly, just because you can do something doesn’t mean you should or that I am required to pretend that it is a good idea. Being able to make choices means that you sometimes face criticism for them. There is plenty of evidence that giving birth outside of a hospital with a CPM is far more dangerous than giving birth in a hospital with an OB or CNM. This fact leads to people criticizing you for needlessly putting yourself and your offspring in danger.

      Thirdly, Dr Amy does take this personally because she takes the health of women and babies personally. She is pissed off that these rip off artists convince women that one type of birth is better than another and that they will be better mothers if they risk the lives of themselves and their children by giving birth outside of the hospital.

      • Trixie

        What do you mean, bad eyes? Don’t you trust your eyes to see perfectly? Have you been falling for the lies of your optometrist again?

  • Forgetful Guest

    I have an auntie who died in the hospital after giving birth to my cousin. But I’m sure the hospital had nothing to do with it. It was a ruptured brain aneurysm noboy knew about. My cousin was fine.

    I also have a cousin who died during an accidental, unplanned homebirth, because there was no one around to catch her and she fell on her head and suffered fatal injuries, or so the story goes. Can’t verify details as her mum (a different auntie of mine) has since died too, but it sounds like being born in the hospital might have saved that child, which would have been the plan if she hadn’t arrived so suddenly. I wonder what the homebirth crowd would make of it…

    So, no – I’m not a homebirth advocate, and I’ve got nothing, except for a strange family history.

    • Thankfulmom

      I remember a mom dying on our postpartum from a brain aneurysm! It was many years ago, at least 14. It was such a tragedy, it happened on the day she was supposed to be discharged. I wasn’t working that day, but I heard about it from my co-workers. My condolences on your family’s loss.

  • Bomb

    OT found this gem today. Not ‘interventions!’

    “We recently admitted a patient for an acute MI (heart attack). The patient refused all intervention, despite the fact that she was initially unstable. Her kidneys took a bit of a hit when her blood pressure dropped down, but other than IV fluids and some aspirin she her family refused everything. I spent about twenty minutes on the day of discharge answering their questions and explaining why she did not need to be in the hospital, since they were refusing everything we offered. I then went outside the room and wrote the orders for discharge.

    I happened to be in the lobby when they were wheeling her to the car and I overheard her daughter say, “We’ll take you to a good hospital next time, mom. This place didn’t do anything to help you.””

    If there is a next time.

    • Anj Fabian

      Take her to the chiro next time. It will be cheaper, less stressful and they’ll be able to give her aspirin.

      • Trixie

        Naturopath!

        • Mishimoo

          Homoeopathic digitalis will fix it right up and it’s natural!

          • Amy

            They could take her to the homeopathic ER:

      • The Computer Ate My Nym

        Hey, don’t dis aspirin. It’s a good drug for someone having an MI. It’s just not as good as streptokinase or a cath and revascularization.

    • Ob in OZ

      I am becoming cynical in my old age as I found this very funny

    • Sue

      Sometimes this calls for a subtle question like “What was it you were hoping we could do for you today?”

    • RNMomma

      I did asthma education once with a mom who would give her kid rescue albuterol when needed but just didn’t like the idea of him having to be on medication for the rest of his life (which I get). At one point she though she expressed that it just didn’t seem natural and asked what would happen if he was out in nature and didn’t have these meds with him. My response, “Well, he’d either recovered from the attack very slowly. Or he’d die.”

      I don’t know anyone who actually enjoys having the need to take medicine, but if you need it you need it.

  • Medwife

    With the caveat that I am not a homebirth advocate and don’t agree that medical interventions kill as many moms/babies as homebirth- I still take medical errors seriously and acknowledge that they DO happen.

    http://www.sptimes.com/2006/06/08/Tampabay/Hospital_says_error_k.shtml

    Now, this is particularly bad because the patient was given mag to stop preterm contractions, and mag sucks at that. I don’t know if they had tried turb or procardia first. But the mom and baby would almost certainly have been better off, at 35 weeks, if they had done nothing at all.

    • the wingless one

      So awful :( My OB made it sound as though it was standard not to offer interventions to stop labor after 34w.

      • Amy M

        I don’t know about standard, but often they don’t….I kept having pre-term labor episodes, and my OB told me that if I went into labor again at 34wk or beyond, even still pre-term, they wouldn’t try to stop it any more. Luckily, my babies held out to 36wk at that point. I know a number of people (many, but not all, with multiples) who went into labor between 34 and 36 week and there was no attempt to stop it. With the current state of technology, the vast majority of 34wkers do very well, even if they need a bit of NICU time. The ones that don’t usually have some other issue besides “just” prematurity going on (IUGR, mom has pre-eclampsia/eclampsia/HELLP, some kind of congenital defect).

        • the wingless one

          This was it exactly for my son, he was born at 34w5d (via c/s though it had been discovered I had a dynamic cervix a few weeks earlier which is what prompted that remark from my OB). He had no issues from his prematurity, lungs were developed and he was regulating his own temp fine. It wasn’t until a few days later that he developed serious complications stemming from maternal lupus antibodies that crossed the placenta during pregnancy.

    • sapphiremind

      They absolutely do happen, and huge consequences happen after them, both financially and practice-wise. That’s the difference between the errors at hospitals and lay midwives.

    • The Computer Ate My Nym

      I agree that medical errors are a serious problem. Hospitals agree too and I don’t know of any hospital that doesn’t have procedures in place to reduce errors and active programs to try to find ways to reduce errors further. Same with hospital acquired infections. This, IMHO, is the basic difference between real medicine and woo (be it naturopathy, NCB, chiropractors, etc): In real, science based medicine, if a problem is found a search is made for a solution. If a new way that is better than the older way is discovered, it is used. In woo, if a problem is found it is denied and evidence ignored. If a new way is discovered, it is ignored or ridiculed–only “ancient ways” are good.
      Ironically, it’s this very strength of medicine that lay people often hold against it. “Last year they said butter was bad for you, this year margarine’s worse. Clearly they don’t know anything at all!” and that kind of statement. So maybe one reason that people like woo is that it provides a comforting certainty–even when that certainty is dead wrong.

      • Sue

        Well said, Nym. I don’t get how people can see that advances in science have brought them smart phones and blogging but they think that health care knowledge should be fixed in the nineteenth century.

        • Stacy48918

          Ever read or watched Call the Midwife? There’s a chapter/episode about Magn’Mave – identical twins married to 1 man in London in the 1950s. One gets pregnant and the other takes over her prenatal care by acquiring and consulting “medical texts” about birth from the Middle Ages or so. Spouts on about herbs and “old knowledge” and decries the modern medicine practiced by the midwives. So many parallels to the modern homebirth movement.

          In the end she is AMA, primip, carrying undiagnosed twins and has a placental abrupt ion at birth and her sister is quite glad of the midwives that save her sister and 2 nieces.

          • Karen in SC

            And the midwives appropriately called the doctor!

      • Medwife

        Absolutely. There is a system in place to learn from mistakes so that they’re not repeated.

  • Deborah

    There was a father who died in a Kaiser hospital in California in the early 2000′s from fainting while watching his wife get an epidural (hit his head and had a bad bleed.)

    • Young CC Prof

      Hmm, maybe that’s why the hospital where my son was born had a policy of kicking visitors out during the epidural placement.

      • Maria

        I never thought about it, but my husband was escorted in after the epidural and I was all prepped for the c-section. It was at Kaiser too!

        • Lion

          My husband watched in sick fascination. Afterwards, he couldn’t stop talking about the size of the needle. I’m not sure what went wrong at the first epidural attempt but blood spurted out, he still talks about the fountain of blood. It was quickly stopped and the blissful epidural was put in place. That was my first birth, the second one was unmedicated, not by choice, by bad hospital midwife refusing to call an anaesthetist, but I’d just really asked early and was coping so just got through it. Still a bit cross, but what is done is done.

    • Anj Fabian

      During the RCS my husband was escorted to his seat next to my head. I’ll have to ask if there was someone stationed near him.

      • Medwife

        It’s good to have strategic chairs around even at a simple, uncomplicated vaginal birth. Haven’t had any “support people” hit the deck yet, but a few have sat down rather heavily. :)

  • Karen in SC

    Here’s an excellent blog post in rebuttal to an Australian homebirth advocate decrying the maternal death rate there. Takes a different approach but you can see how few of those deaths can be correlated to the hospital.

    http://landlockedseaotter.com/2014/06/16/doreyhomebirth/

  • Renee Martin

    What are we at, like 5-6?

  • manabanana

    http://www.ksl.com/?sid=25091500

    6th c-section. Placenta previa, accreta and hemorrhage.

    • Amy Tuteur, MD

      How would that have been managed at home?

      • Renee Martin

        It wouldn’t have. This one does not count.

      • Deborah

        The idea that if the first cesarean had been avoided, then so would have all the others, the accreta and the death. Someone really should do the math: an x reduction in primary cesareans results in so much of an increase in intrapartum deaths/HIE, but prevents so many previas/accretas —- is that tradeoff worth it?

        • Amazed

          Yeah, let’s avoid the first cesarean for all those footling breeches, transverse babies, and stubborn placentas previas. Sure, we’ll have a death at the first try but at least mom will be able to keep having more children. If she survives herself, that’s it.

          You know why they did the first section, don’t you? Do share.

          • The Computer Ate My Nym

            A transverse lie is pretty much death for mother and baby without a C-section, unless you’re proposing using a “partial abortion” technique to deliver the baby–in pieces, but at least with a living mother. I’m not sure how this is better than a C-section in any place that has a sterile OR though.

        • Anj Fabian

          Save the baby in front of you but risk the babies that might be conceived in the future?

          • Amazed

            Basically, this. Plus, if you want a large family, starting off without your first child dying a preventable death or sustaining a preventable injury isn’t exactly the greatest beginning.

            I cannot believe no one told this mother that a seventh pregnancy wouldn’t be recommended, in her case.

        • Guest

          I know! I know!

      • Certified Hamster Midwife

        Ooh, I know!

    • Amazed

      High risk pregnancy that DEMANDED interventions? Not the common profile of a low risk woman with a perfect low risk pregnancy from the start.

    • Captain Obvious

      And she would have done better at home how?

  • manabanana
    • Amy Tuteur, MD

      How do you manage that without interventions?

      • Renee Martin

        Again, she would NOT have survived at home.
        FAIL

      • Guest

        I know!

    • Rabbit

      According to that article, she bled to death, at a hospital other than the one where she delivered her baby. She didn’t die from too much intervention, she died because there weren’t enough interventions done. The challenge was to find deaths attributable to unnecessary interventions. This poor woman died due to lack of intervention, not too much intervention.

    • Captain Obvious

      Come on your posting anecdotes that couldn’t possibly of done better off at home. You may as well post a hospital death from a Homebirth transfer and “prove” it’s a hospital intervention death.

    • meg

      Dr. Amy is collecting stories of women who died BECAUSE of their hospitalizations, not just women who died during childbirth. Unless you’re going to argue that women who birth in their jacuzzis at home magically never hemorrhage?

  • manabanana
    • Amy Tuteur, MD

      Can’t say whether this wouldn’t have happened at home, too.

    • Captain Obvious

      Doesn’t clearly state what she died of. If hospital workers failed to listen to her complaints , and she died on day 6 post partum, she easily could have died at home too because Homebirth midwives don’t stay 6 days. Just another maternal death anecdote, doesn’t prove she died because of hospital interventions.

  • manabanana

    http://www.startribune.com/lifestyle/18224714.html
    Bedrest for preterm labor. C/S. Pulmonary embolism.

    Preventable or unpreventable maternal death?

    • Amy Tuteur, MD

      Preventable.

    • Karen in SC

      Was the intervention in this case bedrest?

      These are all such sad cases and I’m very glad my childbearing years are behind me.

      It really is difficult to determine if an intervention led to the fatal complication in most of these situations.

    • The Computer Ate My Nym

      Preventable. Does bed rest even work? Why are we doing it? More to the point, why are we doing it without DVT prophylaxis in a patient with a known hypercoaguable state (pregnancy)?

  • manabanana

    2006: inadvertent IV administration of epidural anesthetic kills patient.
    http://host.madison.com/news/nurse-is-charged-in-death-of-patient-legal-action-upsets/article_1e495798-ed4f-5f8d-971d-3eb3effdd43d.html

    The major difference between hospital errors and CPM errors is that there is a system of recourse – the RN who made this error no longer has a license – and hospital practices changed to help this error from happening ever again. Also, many hospitals implemented new safety guidelines for epidural medication management after this happened.

    What happens after a CPM causes the death of a client?

    ???

    • Renee Martin

      Thats 2

    • Captain Obvious

      Agree.

  • Student

    What about the 2 maternal deaths at South Shore Hospital within 1 month of each other? One mother had a amniotic fluid embolism (unpreventable) but the other, because of complications from a c-section.

    http://abcnews.go.com/Health/childbirth-related-deaths-mass-hospital-spark-state-investigation/story?id=21621446

    • Amy Tuteur, MD

      It’s hard to know exactly what happened until we see the results of the state mandated investigation. In Massachusetts, every maternal death must be fully investigated.

      • Renee Martin

        WHY did she have the CS?

        • Stacy48918

          Complete placenta previa I believe.

          • Jessica S.

            Which is like, one of the 100% necessary reasons for a CS, correct? So the CS was not reasonably avoidable, but something that occurred during it could have been atypical and thus preventable? (Working it through in my head.)

  • meg

    I know a woman who was laboring just fine at home, naturally, not too much pain, very little blood loss, very calm and soothing, lots of resting, nature takings its course in its own time. Then her husband put his foot down and made her go to the hospital, and the next thing you know, she’s near death and has two lifeless twins born by c-section. Everything would’ve been fine if she’d just stayed home instead of letting that monstrous doctor rip her open. The c-section nearly killed the mom, and DID kill the children.

    (At least, that’s how the midwife told me the story. She left out the part where the mother had labored for THREE DAYS and was going in and out of consciousness when her husband demanded transfer; she barely survived, and couldn’t get out of bed for almost a month to care for her EXISTING children. Also the part where the midwife didn’t know the mother was pregnant with twins, let alone that the first one was transverse. But to hear the midwife tell the story, it’s the doctor who caused all that mess, not her.)

    (For the record, this was not in the United States. But still.)

    • Renee Martin

      She would have died at home, and her care at home was totally negligent.

      • meg

        I don’t doubt it. The mother was extremely hesitant to tell anyone this when people started hearing the story, because she didn’t want to shame or alienate the woman who had delivered her other (healthy, uncomplicated-birth) children. So the only story most people heard was the midwife’s. I can only imagine the amount of damaging gossip the midwife could have started about the mom if the mom had questioned her.

  • Lion

    A colleague of mine (she was a cleaner in a remote branch of our company) died in hospital after a vaginal delivery. I don’t think this one counts for these purposes though as it was In a rural government hospital and the level of care is probably so bad that home or the dirt patch outside the hospital may have been safer (too few doctors and nurses, facilities not clean never mind sterile) I don’t actually know the details of what happened. Her husband informed us he had found a lawyer and they were going to take legal action against the department of health for the negligence. The wheels of justice turn slowly here, so unlikely i will ever hear the outcome. I she’d tears for her for weeks, going somewhere she thought she could trust for good care and that happening. This type of thing doesn’t just happen with birth here, or probably in other developing countries. A different colleague at a company I worked at previously died after an emergency c-section done for pre eclampsia. It was the eclampsia that killed her. She was a close friend of mine so it was a very sad loss, I had had my first child a few months earlier, we had been pregnant in the office together. I don’t think this counts for these purposes either as it wasn’t the fault of the hospital that she died, it was despite being there that she died. She was Ina private hospital, our private hospitals offer world class care, at the very steep costs of our medical aid premiums. Just thought some might be interested I reading this. I don’t know what Caesarian rates are in this country, it is rumored (by our rather militant NCB types) that private hospitals rates are around 70%). I doubt this, but we do have OBs here who won’t do vaginal births at all and make it clear at the first appointment that they do planned c sections only, so whatever our rates are, I can believe they’re quite high. The government hospital situation is the opposite, there are women who can’t have a needed c section because there is no operating theatre or the one that there is is busy. Planned c sections are ok because the women are transferred to better equipped hospitals early on, it is the emergency ones that are a problem. However, it also depends on the hospital, some government hospitals offer excellent care, and if you are zoned in an area with a good hospital, you might not get a TV in your room, but you don’t need to be afraid of being there or of nurses slapping you for screaming in labour, which does happen.

    • Lion

      My apologies for the appalling typing, I just can’t get used to the autocorrect on this device, and I can’t edit my post, and even when I spot an error before posting, i can’t tap the right spot, the word copy appears and that is that. :(

      • RNMomma

        What country is this?

        • Lion

          South Africa. I’m not in teh health care field, so I don’t have any actual figures. Our private sector record keepign is pretty good and I could probably phone and get figures (they’re not published on web sites) but our state sector records won’t be available for public scrutiny (in theory they are – we have laws on transparency, but in practice you can’t get the information you ask for becdause of red tape)

      • Jessica S.

        I thought it was perfectly clear! :)

    • meg

      I am so sorry about your friend. What a terrible thing.

    • Jessica S.

      So sorry for your losses, Lion. That’s terrible.

      This is interesting to me: “we do have OBs here who won’t do vaginal births at all and make it clear at the first appointment that they do planned c sections only, so whatever our rates are, I can believe they’re quite high.” Why do they insist on a planned CS from the start? This is intriguing.

      • Lion

        Thanks to all of you for your kind words about my colleagues and friends. Both happened a long time ago, so I’m over the deep sadness from the time.
        It is quite intruiging. I’ve never actually asked. It is interesting though that at all mommy groups as everyone discusses who their doctor was (we call an OB a gynae, even though it is the obstetrical care we’re talking about) and people ask “oh, does he or she do natural births or only c-secions?”.
        Basically here in the private sector, you have to search for a doctor willing to do a vaginal birth or at least let you try. It isn’t so much that pressure is put on you, you’re told straight out.
        I had my son a decade ago and my GP recommended a gynae willing to do vaginal births. I had my son on a Friday. I was the only woman in the maternity ward (two six bed wards and 4 private rooms), I asked why and the nurse said it was because births are only done on Monday to Wednesday, except your doctor who has some natural births. My friend and I were at the same hospital, so that added to the sadness with losing her, knowing she was where I had been just a few months earlier.
        I had my daughter 3 years ago in a different city and it was a bit different, I did chuckle at one point when I went into theatre the week my baby was due as my son was having grommets (here we are allowed to hold our child’s hand until the anaesthetic has taken effect and then we wait outside till called into the recovery room, the porters / orderlies give the children face masks and booties and so on to take for show and tell, the effort people go to to make our children feel comfortable is really amazing), and one of the theatre nurses noticed I was heavily pregnant and said “how soon will we be seeing you again”, so I said I was due in a few days, she asked who my doctor was and then replied ” well then we won’t see you unless there is an emergency during the birth, I hope we don’t see you, no offence”. My sister wanted an elective c-section, but because of all the pressure you get (despite how almost everyone you know has had a c-section, everyone tells you you must have a natural birth and not have an epidural), she was embarassed to say so, she eventually told my mom and I how relieved she was when at the dating scan, the gynae said he would chat to her about the c-section date in the second trimester and she needn’t worry now (she hadn’t asked), I’ve had similar stories told to me by many friends.

  • Therese

    Here’s a woman that died from her epidural: http://www.nbcnews.com/id/9818616/ns/dateline_nbc/t/routine-epidural-turns-deadly/#.U6HmgpRX-uY

    Also, looking from that story I found where there are 3.8 deaths from regional anesthesia per 1 million c-sections. So 4 millions births in the U.S., I would think more than 1 million would be c-sections, so it would be safe to say 4 women die every year from complications of anesthesia. Not sure you are going to find 4 maternal deaths from homebirth a year. http://www.parentdish.com/2010/12/27/epidural-related-deaths-in-childbirth-on-the-rise/

    Of course, we don’t know if any of those women would have died without a c-section.

    • The Computer Ate My Nym

      I doubt we have 1 million home births in the US in a year so saying that you don’t have 4 home birth maternal deaths is not particularly meaningful given the difference in the denominator.

      The average mortality from pregnancy in the US is about 14 per 100,000. In other words, 140 per million or 35 times greater than the risk from epidural anesthesia. Sure, epidurals have risks, but they’re relatively low compared to the overall risk of pregnancy.

    • RNMomma

      Right, home births only accounted for 1.36% of births in 2012. So that’s roughly (rounded down) 54,000 homebirths. Someone else can help me with the math, but that is definitely less than one mom who would have to die due to a home birth to equal the death rate from regional anesthesia during sections.

      • RNMomma

        Rather, OOH births. Sorry.

    • Amy Tuteur, MD

      We’d need to find 400 maternal deaths in the hospital for every maternal death at home in order for the hospital death rate to be higher than the homebirth death rate.

      • KarenJJ

        Wouldn’t we be looking at low-risk women at the hospital to compare to the women at homebirth?

        • Young CC Prof

          There’s something like 500 maternal deaths each year altogether in the entire country, many of them NOT due to any sort of delivery complications.

    • Captain Obvious

      Rate, not absolute numbers

  • DoulaGuest

    I personally know of one maternal infection from CS that led to sepsis and death, and one cytotec induction that resulted in death in the 90s (I’ll have to post full story later). I’ve seen some crazy things like ignored decels and variables, and a VBAC mom pushing for 6hrs. So ya….people drop the ball in the hospital too. But I have to say, it’s kind of besides the point when you look at why women and babies die at home: a complete lack of skill and knowledge. So yes, there is bad care in the hospital but it is quite different from that of CPMs at home (I refuse to use midwives as a general term bc of the great CNMs and CMs).

    • Amy Tuteur, MD

      I don’t doubt that there are babies and mothers who have died as the result of interventions. And I don’t doubt that there are babies and mothers who have died of malpractice. Yet the rate of these preventable deaths is far lower than the rate of preventable homebirth deaths.

      • Renee Martin

        Isn’t malpractice considered preventable?

        • Karen in SC

          Yes, but I think Dr. Amy is looking for deaths specifically caused by interventions like epidurals or pitocin or IV saline. However one could argue even having an OB is an intervention.

          • Young CC Prof

            Specifically, I think we’re looking for women or babies who died in the hospital but most likely would have survived at home.

        • Poogles

          I believe when she said “Yet the rate of these preventable deaths” was in reference to the aforementioned deaths due to interventions and malpractice – so yes malpractice is considered preventable.

      • DoulaGuest

        Isn’t that what I said;)

  • Mac Sherbert

    There’s this story, but I think the Mom would have died without the surgery anyway??….http://www.newser.com/story/185456/pregnant-woman-died-after-wrong-organ-removed.html

    • doctorex

      In that case, again, the issue was the wrong intervention. If they had actually not acted completely negligently and removed the appendix instead of the ovary in the first place mom and baby would have probably been fine. It’s not a birth intervention death, and certainly treating the appendicitis with something other than surgery in a hospital would have meant the same result.

      • Dr Kitty

        I no longer have an appendix, even though my ACTUAL issue was a right sided ovarian cyst.

        There is something to be said for the old-fashioned idea that anyone with RIF pain who gets as far as the operating table gets their appendix out, even if it looks normal.

        They’re already in there, you have scars that might cause confusion in future if you have another episode of pain in that site, and you don’t need your appendix.

        I knew when I went under that when I woke up I would no longer have an appendix, whatever they found when they had a look.

        If I have pain there again, at least I know one thing it can’t be.

        • doctorex

          Exactly. This is why it is so completely baffling to me that the resident in question could not identify the appendix. I can do that, and I am not a medical doctor.

    • The Computer Ate My Nym

      Yeah, given that she died because she didn’t have an appendectomy, I think it’s safe to say that her staying home and not having an intervention wouldn’t have been the right move. I wonder why this error wasn’t found on frozen path, though, or at the very least a couple of days later when the final path came in. Did no one check it? Didn’t anyone notice that the woman was still having pain, fever, and leukocytosis? Bad hospital medicine certainly can kill.

      • doctorex

        Yeah. In the health services research world in the US, one of my first questions here would be if this happened in August or early September. The worst time to get seriously sick if you get care at a teaching hospital is when the old residents are either moved on or about to be and the new or rising ones have no idea how to perform their new responsibilities but are slipping through the cracks because the preceptors are more concerned about the malpractice waiting to happen by people newer than them. I’m always telling my family members not to get really sick in August or September. I don’t know how the UK schedule works.

  • theadequatemother

    All of the intrapartum or early neonatal deaths I’ve seen I hospital have been the result of optimism bias (2 midwife Pts where bad strips were not acted on for hours) or transfers from home…except there was one where chorio was ignored for a long time and the uterus was so irritable at the time of cs that the time between uterine incision and birth was long….incision had to be extended, tocolytics given. That baby was probably already compromised via sepsis and I doubt that the period of hypoxia during delivery really contributes much but I’m not sure. That mom was super sick too for weeks. A cs done something like 6 or more hours earlier probably would have made a difference. That was also a midwife pt where the combo of fever, maternal tachy and fetal tachy with poor variability was downplayed for hours before consultation with OB was requested.

  • SJR

    If the baby is still alive but brain-damaged, does that count? I personally know a woman who had an epidural during a completely normal labor up to that point that caused maternal hypotension that resulted in hypoxic ischemic encephalopathy in her child. (BTW, this is what her OB told her, so not made up by the mother). Today, that child has severe cerebral palsy and will likely never live independently. I’m sure this is rare and there was likely some medical mismanagement, but I can’t imagine how this specific chain of events could have occurred at home. Any thoughts? I’m a med student interested in OB, so I’ve always been curious about what happened.

    • Renee Martin

      That would count! If it was epidural caused, then it would have been avoidable if she went unmediated or stayed home. Sad as hell

      Poor mom, poor baby, that sounds horrible.

    • AmyP

      Where was the fetal monitoring?

      Did they sue and win?

      • SJR

        There was CEFM, although mom wasn’t told if that showed anything. (Mom also lost consciousness, which hopefully tipped them off that something was wrong.) I guess that they just didn’t raise her bp/get the baby out in time. Mom is not a medical professional, so she’s a bit fuzzy on those specific details. They didn’t sue, although she says she probably should have, given how much it has cost to take of her. Maternal hypotension is a well known side effect of epidurals that is listed on informed consent, and acute maternal hypotension is a known cause of HIE, so would there have been a legit lawsuit there?

    • Captain Obvious

      Could be related, but then again, we see many cases of maternal hypotension after epidurals and need for fluids and ephedrine and the babies don’t have CP or HIE. So many studies say CP is an ante partum event and not an intrapartum event. So how can you know for sure if the two are related?

      • SJR

        Honestly, I don’t know if it was an intrapartum vs antepartum event. All we have is what her OB told her when her baby was in the NICU. It had been a completely normal full-term pregnancy with standard prenatal care (including normal ultrasounds), and her labor had progressed normally until the epidural. This is why I find this case so interesting.

    • pinkyrn

      I think this story is missing a lot of information. Patients often do not get the story straight because a lot of the information is very specialized. I don’t see how one episode of hypotension in the mother that is caused by epidural placement would cause HIE. If the fetus was completely uncompromised at the time the epidural was put in, the fetus should be able to handle a little decreased oxygen episode. Also we expect the hypotension, it is not a surprise so we are ready to deal with it when it happens.

      • SJR

        So then I guess my question is, how long would the fetus need to have decreased oxygen supply to be compromised? I thought one of the arguments against homebirth was that, in situations like this, every minute counts. (And no, I’m not an NCB advocate, just someone who likes to try to see an issue from both sides.) And my experience is that, unfortunately, just because the medical staff expect something and are ready to deal with it doesn’t mean that the situation will always be resolved in time with favorable results.

        • pinkyrn

          I agree that if you do not know both sides of the argument, you really do not know the argument. How much hypoxia is too much hypoxia? Good question. I do not have a really specific answer. If you look at David Miller MD and Lisa Miller CNM & attorney, they have reasonable answers to those questions.

        • Renee Martin

          Only a few minutes before they have effects from brain damage.

          • pinkyrn

            seriously? Babies have 2-3 minute decels all the time and do not come out with brain damage. If every time a 2-3 minute decal caused brain damage, we would be c-sectioning 70 percent of the patients. Babies live in a low o2 sat environment (compared to adults) with a high fetal hgb level so they are built for some of these interruptions in oxygen.

          • Medwife

            These stories are why it is so important to send placentas if there’s any doubt.

    • CanDoc

      I think it very conveniently absolves the OB of possible responsibility when the OB claims “The epidural did it”. Maybe the epidural DID do it, setting off hypotension and prolonged fetal bradycardia with fetal compromise… but that’s pretty unusual. Most CP is in fact not related at all to intrapartum events, but instead to antepartum events.

  • Scott Dave

    Nice discussion, Really because I was looking for one case that I remembered & I found this other one.

    Physician
    Practices

    • LibrarianSarah

      Out, damn’d bot! out, I say!

      • http://whatismyreferer.com/ MikoT

        Scott Dave
        Now there’s a natural sounding name.

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

          He misspelled SteveDave (“Tell ‘em, SteveDave!”)

        • MLE

          My husband has a first name for his last name. Maybe there is a career for him in spamming.

  • Young CC Prof

    Reasons I would definitely accept as hospital-caused deaths:

    Deaths in transit to and from the hospital, including death of father driving back and forth during hospital stay. (I’m sure it’s happened at least once!)

    Infections that were hospital-acquired, NOT from garden-variety germs carried in or on the mother’s body, in a birth that did not require a c-section.

    Maternal deaths from c-section complications, when the reason for the c-section did not in itself pose a serious risk to the mother’s life.

    Iatrogenic prematurity when the reason for c-section or induction was not threat to the life of mother or baby.

    • The Bofa, Being of the Sofa

      Infections that were hospital-acquired, NOT from garden-variety germs
      carried in or on the mother’s body, in a birth that did not require a
      c-section.

      I know that hospital-acquired MRSA is the most commonly invoked reason for wanting to avoid a hospital (of the actual reasons, as opposed to strawmen). However, no one has ever provided a single example of someone (baby or mother) who ever got it, much less died from it.

      And it’s not like we haven’t looked.

      (YCCP knows this all, btw, since she and I have tried to look into this)

      • Ellen Mary

        Really because I was looking for one case that I remembered & I found this other one . . . http://www.dailymail.co.uk/news/article-2149411/Quadruple-amputee-flesh-eating-bacteria-childbirth-receive-U-S-double-arm-transplant.html

        Excuse the source but women very occasionally do acquire bacterial infections . . .

      • Karen in SC

        This case of necrotizing faciitis struck a mother a few days after giving birth to twins. However, skimming a few articles I could not see a link to the birth, or even if she had a c-section.

        This from one news site; “Kuykendall, a paramedic, went to the hospital after noticing a rapidly expanding bruise on her leg, her husband, a firefighter, said last month. A variety of the bacteria, which are common in the environment but rarely cause serious infections, can cause the disease.”

        • The Bofa, Being of the Sofa

          The only person I know who got MRSA got it at the gym.

          Community acquired MRSA is very common

        • areawomanpdx

          Well, there was a case in Oregon where a homebirth midwife didn’t wear gloves and gave the mother a raging case of necrotizing fasciitis. That is not the purview of hospitals only!

      • expat

        When I checked in for each of my labors, they swabbed my nether regions for bacteria and put it in a petri dish, I assume. It is a good way to prove to a mom that any infection which occured came from the mom, not the hospital.

        • Dr Kitty

          My trust does nasal and axillary and perineal swabs for MRSA.
          I was pleasantly surprised that, despite working in hospitals until 6 days before my CS, I tested negative for MRSA.

          Still negative when they checked me during the recent ovarian cyst debacle.

          So…IME actually possible not to get colonised with MRSA, despite treating people with MRSA all the time.

      • ModerneTheophanu

        What is the difference between community acquired MRSA and hospital acquired MRSA? Are the bacteria different, or is it just about where the infection was acquired?

        • Amy Tuteur, MD

          They are different. Hospital acquired MRSA is multidrug resistant organism that is particularly common among those in chronic medical or nursing home care.

          Community acquired MRSA is an organism that makes a substance toxic to white blood cells, rendering the body unable to defend itself. This is the more common type of MRSA.

          • doctorex

            And, of course, there are a hundred other multidrug resistant bugs, many of which can be acquired in the community. I’m recovering now from a surgery to correct an abscess where somehow a multidrug resistant periodontal bacteria appears to have gotten into a migraine injection site while I also had skin colonization of MRSA. In my case, multiple cultures gave different results.

      • Mac Sherbert

        Well, now that you mention it. My SIL just told me about a woman they go to church with that got MRSA after her C-section. She didn’t die, but they did have to go back in and clean it out (I’m not sure the technical terms for that). So, a very nasty recovery for sure on that one. However, I’m also pretty sure that it wasn’t an optional C-section…I just can’t remember the details right now.

        • Captain Obvious

          It’s very possible she already was colonized with MRSA, or a family member was colonized with MRSA. And when she had a CS, the bacteria got into the wound and caused an infection. MRSA in the hospital still comes from people. I do not believe it is on the floor or doors per se, at least not long.

          • Mac Sherbert

            Which I imagine is why before I had my c-section I was given antibacterial wipes with specific instructions on how to wipe down. I’m sure they also disinfect the site before the procedure in the OR. I didn’t really ask or want to know what went on after they put the curtain up. I assumed in a good hospital (or any hospital) avoiding infections is high priority.

            And I do know someone that had MRSA and never been the hospital! Their experience definitely made me very particular in following the hospital’s instructions!

      • RNMomma

        A lot of people would swab positive for MRSA, especially anyone who has worked in the medical field. We used to joke about it all the time at the hospital where I worked. “Make sure to gown up for this one. They are on precautions for MRSA. Wouldn’t want to get that. Hahaha.” Like E. Coli or any other bacteria… It’s when it gets in the wrong place or starts to overgrow that you get an infection.

      • Sullivan ThePoop

        MSRA is not usually hospital acquired. It is community acquired.

      • doctorex

        And at this point most of the “hospital-acquired” antibiotic resistant bugs occur either equally or more often in the community. We all have MRSA in our houses. I’d venture to guess it’s in some of those birth tubs, too.

    • TheGiantPeach

      My husband went to high school with a man who died going home from the hospital to get clothes prior to his wife’s c-section.

      http://www.wsaz.com/news/headlines/79581972.html

      • Lion

        That is really sad.

    • The Computer Ate My Nym

      How about garden variety medical error: The patient (mother or baby) is given the wrong drug and dies of complications, that sort of thing.

      Or cray cray malpractice, i.e. the OB who carved his initials into a woman’s uterus (or was it her skin?) during a c-section. (That didn’t result in death, but a surgeon that crazy might also do other things that would lead to unnecessary deaths.)

      • doctorex

        link? That sounds like something that would happen in an episode of Criminal Minds. Or in a natural birthing cult.

  • Ellen Mary

    I don’t actually think you are wrong about HomeBirth v. Hospital birth in terms of mortality, however a mother in my community died of AFE during a routine C. I was unaware that I accepted procedures that increased my chances of AFE (amnioinfusion) because it was never mentioned to me . . . I am grateful for my hospital birth but there were several times in which informed consent was lacking IMO.

    • Karen in SC

      There are many things that have been associated with increased risk of AFE, c-section is one of many including induction, rupture, advanced maternal age, eclampsia, fetal distress, and others. Some of those can occur at homebirth so in the case you mention, it’s not possible to say she wouldn’t have had an AFE at a homebirth.

      • Ellen Mary

        Sure but isn’t that like saying: you don’t KNOW the baby would have survived in a hospital? Many things CAN cause AFE but this mother DID have an AFE during a section. I think you can make your case without discounting all the hospital adverse events as probably just coincidences.

        • Young CC Prof

          Perhaps we can count that as a fraction, IF the c-section was done for a reason that was not in and of itself associated with maternal death. (If it was for fetal distress, it might count, if it was for arrested labor, it doesn’t.)

        • Karen in SC

          What are the AFE survival rates in the hospital? Pretty low, it’s life-threatening. At home, the survival rate is zero.

          When saying we don’t know the baby would have lived in the hospital, we are usually talking about things like breech, second twin, GBS, and other situations that have very high survivable rate in the hospital.

          I agree that cases of AFE during a c-section are worth a mention but doesn’t negate those babies that probably, most likely, survived in the hospital.

    • Amy Tuteur, MD

      Would the mother and baby have survived without the C-section?

      • Ellen Mary

        It was scheduled vs. emergent, that is the extent of my knowledge of the case. I believe it was an ERCS but I couldn’t possibly know if there were indications for the RCS, beyond the primary . . . Could have been. The baby survived.

      • Mel

        I say we give the point to Ellen Mary. So far, we’ve found 1 death due to forceps usage (maybe) and 1 mother whose amnioinfusion and/or CS may have lead to a AFE death (although the baby survived).

        How many babies died last year in home births that occur in less than 1% of total deliveries? If we’ve got 2 (perhaps) deaths in the hospital category, we still need to find hundreds more to even out our known home birth deaths.

        Really, we’d need about 600 more since I doubt we hear about all of the home birth deaths of infants and women so I’m willing to spot the NCB side 2 deaths.

    • CanDoc

      AFE stands for “Amniotic fluid embolism”, not “Amnioinfusion”. It is an extremely rare complication of delivery (1/20,000 births), and only slightly more common with cesarean section than vaginal delivery. It is not part of routine consent for cesarean section due to its rareness (necrotizing faciitis and motor vehicle accident fatalities would be more common, for example.). Consent requires disclosure of all common, and severe “rare” risks, generally interpreted as a risk >1/2000.
      It’s an interesting point. Yes, possibly slightly more women who delivery in hospital will have an AFE vs women who deliver at home, due to increased cesearean section rate. But women are much more likely to survive an AFE in hospital. And women who have had long labours at home before transferring to hospital and ending up with cesarean section likely have the highest AFE rate overall.

      • Ellen Mary

        Um Duh! But amnioinfusion is a risk factor for AFE. Which I was not told before I accepted it. If you read what I wrote I stated that pretty clearly, sorry you got confused.

        • Ellen Mary

          I would also think Pitocin/Misporostol would be the greatest cause of an increase in AFE over home birth . . . Again, I accepted Pitocin turned WAY up after my Cesarean, I didn’t really even think about the implications but I did glance at the numbers & they were very high. Maybe they had to be?

          However I did not know that there was a threshold numerically for if risks have to be disclosed or not, so it is interesting that there is one.

          • Dr Kitty

            If you’re still on a pit infusion after a CS you were bleeding, and it is turned as high as it has to be so you stop.

            Most women don’t get ongoing pit post op.

          • Ellen Mary

            I most definitely was not bleeding, I would have been told, I was awake, aware & asking questions the whole time. The Pit drip was routine.

          • pinkyrn

            In my neck of the woods we used to give Pitocin to every mother post C-section for 12 hours. That has changed in the last ~ 4 years I think.

          • Dr Kitty

            Never wrote it up or saw it given post op except for bleeding, and I did OBGYN in 2007.
            Regional variation I guess.

            Live and learn.

          • Medwife

            All women in my facility get IV pit for 12 hrs after a c/s.

          • Trixie

            It’s not like a restaurant where you order up whatever helpin’ of pitocin you think is best…they give you the dose you need.

  • Are you nuts

    This is the only one I can think of that I’ve read about in the news recently: http://www.examiner.com/article/baby-olivia-parents-of-infant-internally-decapitated-at-birth-work-to-pass-law
    The baby was killed by a foreceps delivery, but had the doctor performed a c-section instead, everyone would be fine. From reading the mother’s comments, no way was this baby coming out vaginaly.

    • Amy Tuteur, MD

      It is my understanding that the baby had major congenital anomalies including an abdomen swollen from intra-abdominal fluid. Although the doctor definitely made a mistake, it’s not clear that the baby would have lived in any case.

      • Medwife

        Not crushing his skull would have been a start for him.

    • The Bofa, Being of the Sofa

      And, of course, the failure of the doctor in this case was not that he did “too many interventions” it’s that he should have done a c-section. It’s not clear the baby would have lived anyway, but it’s really hard to claim this as being a problem resulting from birth being too medicalized.

      He was trying to be too non-medicalized about it.

      • Are you nuts

        Agreed. But technically we’ll probably never know if the baby would have lived or not so for me this counts. Of course, no one is raising money for the doctor’s defense (nor should they) and the parents will have the ability to sue the pants off the doctor if they so choose. Very different from what happens in a homebirth death.

        • The Bofa, Being of the Sofa

          In fact, when we have discussions about the “provide three examples of babies who died in a hospital that would have not died at home” I actually give them this one. It’s like, “And I’ll even give you that doctor in Texas who did a bad forceps delivery”

          No actually commenter presented with that challenge has been able to meet it.

          • AmyP

            That’s very sporting of you, Bofa.

            I’m not sure she would have delivered that baby at home though, ever.

    • CanDoc

      Wow, a chilling account. Sounds like a physician who was attempting a difficult rotational forceps delivery. Awful.
      (Having said that, I feel that a move to ban forceps would be extreme and dangerous, leading to a) more cesarean sections, including difficult ones with hemorrhage where a vaginal delivery would have be easily achieved with forceps, and b) more inappropriate vacuum-assisted deliveries.)

      • Young CC Prof

        As I understand it, instrumental vaginal delivery is a good idea if the baby is “close” and gets stuck, but the really tricky moves like high forceps and rotational forceps don’t make much sense if if immediate safe c-section is an option.

        • Lion

          I had a forceps delivery with my son. I didn’t even know there were risks, I was just exhausted, and the doctor said he would use them but I still had to push with All I had. My. Hilda head wasn’t even bruised, as I believe many are, and although I had an episiotomy, I have thankfully had no serious damage. From reading what you have written, it sounds like my son was “right there”. I had specifically looked for a doctor who only did c sections in emergencies. I was terrified of the recovery time and pain. I have learnt so much on this blog. Wish I had found it while pregnant with my first and not after I finished having kids.

    • Susan

      It sort of makes me crazy when I see this campaign to ban forceps because I have seen them used well so many times. I have seen far more serious injuries from vacuum extractions in my career. I can understand someone preferring a C/S over an operative vaginal delivery in most cases but there are situations in which either tool is lifesaving or the best choice for that patient’s individual situations. Banning something on the basis of an extraordinary awful misuse of a tool ( especially if the parents it sounds like aren’t telling the whole story ) … just seems wrong to me.

      • Are you nuts

        I should have chosen another article to post.. I didn’t mean to start a debate about foreceps delivery! It seems clear this was a single very bad judgment call.

      • The Bofa, Being of the Sofa

        I’ve never seen a campaign to “ban forceps.” I know I’ve seen a campaign from NCB folks to get doctors to do more forceps, but the objections to that are not the same as trying to ban forceps.

        • PrimaryCareDoc

          There is a change.org petition floating around to ban forceps as a result of this case.

          • Ash

            Since we all know how effective change.org petitions are…

          • Renee Martin

            Don’t knock it. Sometimes just getting that many people together has value. It’s a great tool. Just because you cannot change the worlds intractable problems with them doesn’t mean it is not worth the bother.
            I do agree that if someone thinks merely signing a petition is political action, there is a serious flaw.

      • areawomanpdx

        Having seen several forceps deliveries, I would never, EVER choose that over cesarean for myself. And all of those had good outcomes for the baby and…the mother lived and was healthy. Not so sure about the vaginas, though. But I agree, they shouldn’t be banned. It’s a useful tool under certain circumstances, and almost all of the situations in which I’ve seen them used, the mother has had her heart set on NOT A CESAREAN.

        • Amy

          Yes, this was me. I wanted to avoid a CS. I did NOT know the risks of forceps. My baby was perfect, luckily, but I suffered a 4th degree tear and it was f’ing horrible. If I had known the risks and what would happen to my ability to control my bladder and rectum I would have gone with a c-section. I’m AMA and was terrified of trying to recover from abdominal surgery with a newborn. I was really uneducated.

          • Renee Martin

            I’m sorry, that really sucks. Too often, women are very under informed and uneducated about the actual risks of VB- instrumental delivery, or not.

          • AmyP

            That’s terrible.

            The sad thing is, a few hundred dollars in babysitting costs and you would have sailed right through your recovery.

            You probably spend that much on adult diapers every year.

            I’m so sorry.

        • Renee Martin

          I cannot imagine forceps and what you had to do to the v to use them, is at all better than a CS.

          • Sullivan ThePoop

            Forceps were a miracle in obstetrics and saved many lives, but it takes more than knowledge to use them correctly and there are so many different techniques to learn. The amount of babies born these days you are only going to a portion of OBs that are good with forceps and when it goes wrong it can go so wrong. CS is definitely more reliably safe.

        • Medwife

          Never, ever, ever would I have forceps used to deliver my baby. If it’s emergent and the baby’s low, vacuum. Otherwise, c/s. We know now what they do to the pelvic floor. Nope!

    • Guest
  • Anj Fabian

    Prematurity would be a tricky issue.

    • Guest

      But it’s unlikely that premature babies that died in the hospital would have lived at home.

      • Elaine

        I think the idea (held by some) is that if an iatrogenic prematurity is caused and the baby dies, they would not have been induced/sectioned at home and therefore the baby would have been a-ok.

        Leaving aside the fact that EVEN IF a doc induces at 37 weeks and EVEN IF it’s for no good reason and EVEN IF the due date is wrong and the baby is really 35 or even 34 weeks and EVEN IF said baby would have been totally fine and gone to term without the induction, a 34- or 35-weeker is hardly under threat of death or serious injury with modern technology. At most they’ll spend a bit of time in the NICU and need a bit more medical attention than the average kid for a little while.

        • Sullivan ThePoop

          I had a 35-weeker who spent no time in the NICU.

        • Guest

          I’ve just given birth to a 36 weaker and baby didn’t need any extra care or nicu. And I was induced due to prom.

    • areawomanpdx

      Prematurity is rarely caused by intervention! Especially in the era of banning “social” inductions prior to 39 weeks.

      • He

        What’s a social induction? Lol

        • Young CC Prof

          Don’t laugh, it’s an induction done for convenience with no medical indication.

        • EmbraceYourInnerCrone

          Social induction is basically trying to time your delivery so you can control some of the factors around the birth. Example: Lets say you are active duty military, pregnant several monthss and your husband(also military/US Navy) goes on Westpac. A Westpac deployment is normally 6 months. Lets say your mom can take 2 weeks vacation and come stay with you and help after the birth BUT she has to schedule her time off in advance. So you want to be induced on a certain date so you can tell her when to take her vacation.
          Or maybe your husband is going to be deployed on the 1st of October and you are due on the 13th of October. Perhaps you want to be induced at 38/39 weeks so your husband can meet his baby before he has to deploy for six months to the Persion Gulf.
          As long as your OB feels there is no danger to the baby, why is it anyone elses business if you want to deliver on a certain date? It certainly makes trying to get someone to come out and help you or arranging childcare simpler.