Can’t rebut the facts about homebirth deaths? Smear the messenger.

image

Some days it’s harder than others to get out the message that homebirth kills babies who didn’t have to die. And some days, like today, it’s so easy that it’s like a battle of wits against unarmed opponents.

Consider this gem found on Jan Tritten’s Facebook page:

image

You remember Jan, don’t you? She’s the Editor of Midwifery Today and she crowd sourced a life or death decision for a 42+ week baby with no amniotic fluid on ultrasound while the baby died.

She republished the post from Elizabeth Wyson Camp Smith above after it was submitted to her wall.

The money quotes?

I am wondering if anyone has thought of defending ourselves against a ‘certain’ blogging OB’s attacks with strategies I learned in Jr. High School Chess Club? “Never retreat when you can counter attack.”

And:

I am not usually in favor of attacking another human being, but isn’t anyone who steps on a political platform kind of asking for it?

I’m going to go out on a limb here and guess that Elizabeth’s chess career ended in junior high school, since she obviously did not understand what she was told. Let me explain it to Elizabeth in small words that she can understand:

Elizabeth, when they told you to counterattack they meant with chess moves, not by smearing the other little chess player. That’s because to win a chess game, you have to actually play chess. You don’t win if you make up lies about the other players.

Now, Elizabeth let’s extrapolate (sorry, that’s a big word) figure out what that means in this situation. It means that if you want to defend yourself against my claims that homebirth kills babies who didn’t have to die, and that homebirth midwives are dangerous laypeople who made up a pretend “midwifery” credential and awarded it to themselves, you need to rebut (sorry, another big word) show that those claims are untrue.

It does not mean, as you apparently think it does, that you should smear me. When you do that, it’s like you are smearing the other chess player and you can never win that way. In fact, you would probably be disqualified (oh, dear, another big word) lose and maybe even get thrown out of the match.

It’s hard for me to figure out who is the bigger dope here, Elizabeth, who doesn’t appear to have the reasoning capacity to care for a house plant, or Jan Tritten, who just keeps making a bigger fool of herself as time goes by.

The bottom line, though, is easy to figure out. Neither Elizabeth nor Jan can summon any evidence that homebirth is safe, and any evidence that homebirth midwives are anything other than ignorant and dangerous. They no longer even try. They have reached the point of desperation where it seems easier to them to try to discredit me than to discredit my factual claims.

  • itry2brational

    Can’t rebut the fact of increased risk with obesity in pregnancy? Can’t rebut ACOG’s position statement on obesity and pregnancy? Smear the messenger.

    • Stacy48918

      itry2brational – Try harder. Your post doesn’t make sense. What is your point, exactly?

      • Bombshellrisa

        There is never a point with this person, they are hung up on on obesity and think Dr Amy is somehow promoting it.

        • itry2brational

          “Can’t rebut ACOG’s position statement on obesity and pregnancy? Smear the messenger.”

          • The Bofa, Being of the Sofa

            Um, that’s not a case of “can’t rebut” but a case of “can’t comprehend the messenger’s point, then smear the messenger.”

            Which is not only not a fallacy, but is pretty much right on the mark.

  • Shella Morris

    I Never believed i was ever going to be HIV Negative again,Dr Molemen has given me reasons to be happy, i was HIV positive for 2years and all the means i tried for treatment was not helpful to me, but when i came on the Internet i saw great testimony about Dr on how he was able to cure someone from HIV, this person said great things about this man, and advice we contact him for any Disease problem that Dr Molemen can be of help, well i decided to give him a try, he requested for my information which i sent to him, and he told me he was going to prepare for me a healing portion, which he wanted me to take for days, and after which i should go back to the hospital for check up, well after taking all the treatment sent to me by Dr Molemen, i went back to the Hospital for check up, and now i have been confirmed HIV Negative, friends you can reach Dr Molemen on any treatment for any Disease he is the one only i can show you all up to, reach him on (drmolemenspiritualtemple@gmail.com) or call him on +2347036013351 ..

  • Dr. Thomas

    Oh, yet another blog post where Dr. A posts a screenshot and then mocks people? Let me express my opinion in small words you can understand… *yawn*. I think we all know who the bigger dope really is here.

    • MLE

      Are you the same person that just said laughing is not classy on the Jen Kamel post? If not, what’s up with the anti laughing at screenshots brigade?

  • D/

    Another example from yesterday

    Witnessed a heated little back-and-forth on a different fb group with an L&D nurse calling into “question” the disastrous nature of neonatal resuscitation in the home setting and other birth ‘professionals’ chiming in with this response from a doula first coming to the defense of a CPM (and then shaming the RN to another doula):

    “You do realize that she is a nationally known and revered midwife who has likely been practicing medicine and midwifery since before you were born, correct? (… it seems J is trying to “school” one of the most experienced midwives and midwifery educators in the US about something that is her speciality.)”

    Hell, all you docs on here must just be gluttons for punishment with all your “schooling”. Didn’t you realize a high school diploma and some experience is the qualification to practice medicine?

    • The Bofa, Being of the Sofa

      Since when is neonatal resuscitation a midwife’s “specialty”

      I thought midwives were “experts in normal birth”?

      • sdsures

        Maybe not breathing is a variation of normal?

        • Bombshellrisa

          To be fair, they actually believe as long as the cord isn’t clamped and the baby is below the placenta that they are doing things right

          • sdsures

            Well, I can believe that the sun is going to turn into a bran muffin on Tuesday. Doesn’t make it correct.

          • D/

            I’ve been waiting all day for the sun to turn into a bran muffin today (read it on the internet) … Doesn’t seem to be correct though … Unless it’s next Tuesday?

          • sdsures

            The sun didn’t turn into a bran muffin. WAAAAAAAAAAH!!!!! I’M BEING OPPRESSED!!!

          • sdsures

            We can always hope it will be “next Tuesday”, right?

      • D/

        Perhaps it only goes along with being nationally known? … That, or maybe with being revered?

      • Guest

        Filing a rebuttal after four days in the middle of this “conversation” during which I developed this nearly constant “tic-ish” response any time I’d let it come to mind (slow head wag with deep cleansing breath/ deep exfoliating forehead rub) and am going to need an uber-experienced Shaman to help me retrieve the piece of my soul I’ve lost during the process. http://www.theanimalsiview.com/human-services

        Here goes:
        I’m now leaning toward neonatal resuscitation as a MW speciality being a very multi-faceted arrangement. Given the fact that any concerns about parents making decisions with fully disclosed risks and understanding the consequences of those risks are just a ploy to create distraction from the actual issues of rigid laws forcing families into UC and to give birth underground, the qualifiers go something like this …

        Known risks of interventions are weighed against all variations of normal leading those Googling/ facebooking their local options and research studies to conclude that any intervention must be avoided; (I got a little confused at this part) but even though a hospital isn’t a home nor a home a hospital, the outcome for babies is shown to be better at home as long as there is nothing more than emergency assistance available. For the healthy babies nothing is needed other than a few secretive puffs by mouth. For the damaged babies their reality is hard, happened before they could get themselves out of the womb, and the choices their parents have to live with are invariably unavoidable since they didn’t respond quickly to simple measures.

        Since I lack the deeper ways of midwife knowing that makes all this easier to understand, I’ll need to diagram this mess out in flow chart form at some point to work my mind around the home birth NRP protocols.

        Good news report: I won’t have to see a shaman after all, my kid fixed me right up with a fb message to “cleanse my palate”after all that m2m biz and this
        http://news.distractify.com/fun/fails/baby-shower-fails/?v=1

        disclaimer: I don’t know anything about the shaman link, other than it ranked high in my “research”.

        Finding this site has been absolutely therapeutic for me. My thanks to you, Dr Tuteur and every regular SOB commenter!

        Excerpted posts from “one of the most experienced midwives and midwifery educators in the US” that lead me to the if anybody cares to read them.
        ————————–
        As I said, I do not know of anyone who makes this decision lightly. they carefully weigh their options. It is rigid laws against midwifery which are forcing so many to give birth without assistance and which is now forcing birth to go underground.
        …..
        “A hospital is not a home. a home is not a hospital. There are benefits and risks. Some families will weigh the known risk of intervention in their local hospital against the very low risk of complications in a fullterm spontaneous labor and conclude they are safer at home. They may investigate and find their local hospital has a 20% cesarean rate for multips (yes there are some that high) and decide they will avoid that known risk and stay home. Even without midwifery care. This is a very personal decision — made according to local conditions — and it is the parents who have to live with those choices.”
        …..
        There are now several large studies comparing ‘place of birth’ and showing essentially the same outcome for babies and much better outcome for mothers. Some families will interpret this as home being an appropriate choice in their particular situation even if there is nothing more than emergency assistance.
        …..
        By far the vast majority of fullterm babies born after a spontaneous normal labor are healthy. If they have experienced distress it is generally short-term and they recover very well with minimal support — IE ventilations with air done by mouth-to-mouth. Often babies are given a quick and gentle few puffs if needed without any fuss and bother… And the parents seem almost unaware.
        …..
        A baby who requires more than this for recovery, or for support while awaiting transport, has likely already suffered severe damage before he exits the womb. Otherwise he would respond quickly to simple measures. That is the hard reality.
        …..

      • D/

        snark disclaimer: No parent reading this should interpret any of my sarcasm to mean disrespect toward them. It’s my primary coping mechanism in the face of ignorance.

        Filing a rebuttal after four days in the middle of this “conversation” during which I developed this nearly constant “tic-ish” response any time I’d let it come to mind (slow head wag with deep cleansing breath/ deep exfoliating forehead rub) and am going to need an uber-experienced Shaman to help me retrieve the piece of my soul I’ve lost during the process. http://www.theanimalsiview.com/human-services

        Here goes:
        I’m now leaning toward neonatal resuscitation as a MW speciality being a very multi-faceted arrangement. Given the fact that any concerns about parents making decisions with fully disclosed risks and understanding the consequences of those risks are just a ploy to create distraction from the actual issues of rigid laws forcing families into UC and to give birth underground, the qualifiers go something like this …

        Known risks of interventions are weighed against all variations of normal leading those Googling/ facebooking their local options and research studies to conclude that any intervention must be avoided; (I got a little confused at this part) but even though a hospital isn’t a home nor a home a hospital, the outcome for babies is shown to be better at home as long as there is nothing more than emergency assistance available. For the healthy babies nothing is needed other than a few secretive puffs by mouth. For the damaged babies their reality is hard, happened before they could get themselves out of the womb, and the choices their parents have to live with are invariably unavoidable since they didn’t respond quickly to simple measures.

        Since I lack the deeper ways of midwife knowing that makes all this easier to understand, I’ll need to diagram this mess out in flow chart form at some point to work my mind around the home birth NRP protocols.

        Good news report: I won’t have to see a shaman after all, my kid fixed me right up with a fb message to “cleanse my palate”after all that m2m biz and this
        http://news.distractify.com/fun/fails/baby-shower-fails/?v=1
        snarkiness must be genetic

        disclaimer: I don’t know anything about the shaman link, other than it ranked high in my “research”.

        Finding this site has been absolutely therapeutic for me. My thanks to you, Dr Tuteur and every regular SOB commenter! I did notice how that sounds but decided to leave it anyway.

        Excerpted posts from “one of the most experienced midwives and midwifery educators in the US” that lead me to the if anybody cares to read them.
        ————————–
        As I said, I do not know of anyone who makes this decision lightly. they carefully weigh their options. It is rigid laws against midwifery which are forcing so many to give birth without assistance and which is now forcing birth to go underground.
        …..
        “A hospital is not a home. a home is not a hospital. There are benefits and risks. Some families will weigh the known risk of intervention in their local hospital against the very low risk of complications in a fullterm spontaneous labor and conclude they are safer at home. They may investigate and find their local hospital has a 20% cesarean rate for multips (yes there are some that high) and decide they will avoid that known risk and stay home. Even without midwifery care. This is a very personal decision — made according to local conditions — and it is the parents who have to live with those choices.”
        …..
        There are now several large studies comparing ‘place of birth’ and showing essentially the same outcome for babies and much better outcome for mothers. Some families will interpret this as home being an appropriate choice in their particular situation even if there is nothing more than emergency assistance.
        …..
        By far the vast majority of fullterm babies born after a spontaneous normal labor are healthy. If they have experienced distress it is generally short-term and they recover very well with minimal support — IE ventilations with air done by mouth-to-mouth. Often babies are given a quick and gentle few puffs if needed without any fuss and bother… And the parents seem almost unaware.
        …..
        A baby who requires more than this for recovery, or for support while awaiting transport, has likely already suffered severe damage before he exits the womb. Otherwise he would respond quickly to simple measures. That is the hard reality.
        …..

    • Bombshellrisa

      Someone came here last week and commented that since CNMs have training and equipment when they do a homebirth, what could an OB have on them when it came to a resuscitation? It’s about having that whole team of trained people and the meds, equipment and experience they have. To be on a resuscitation team, you don’t just get trained once to do it and there you go. Plus you are required to keep up your skill. This sums it up nicely “Along with the necessary skills, the practitioner should approach any resuscitation with a good comprehension of transitional physiology and adaptation, as well as an understanding of the infant’s response to resuscitation. Resuscitation involves much more than possessing an ordered list of technical skills and having a resuscitation team; it requires excellent assessment skills and a grounded understanding of physiology” http://emedicine.medscape.com/article/977002-overview so take that, “experts in normal birth”

      • Young CC Prof

        My friend Steve took a red cross CPR class, and he has an AED and an oxygen tank in his trunk. Why bother calling 911, when you’ve got Steve? *sarcasm.*

        • D/

          Yep, there’s never much consideration voiced about how any of those unlikely home resuscitations would actually unfold. Just the standard “As long as we don’t clamp the cord, the placental can do all the resuscitation” and if that doesn’t work out “Don’t worry you’ll just need to provide the emergency resuscitation interventions that you learn in the classroom until help arrives”.

          Seldom, if ever, does a NCBer acknowledgement that the point in time that matters is how long it takes those babies to get to the *Advanced* NRP team … not how long it takes them to drive themselves to (just any) hospital, or how long for EMTs/ paramedics (who are not universally required to complete an NRP course) to get to them, (or how long it would take for Steve to run by).

          And once you arrive at the ER it’s a crapshoot how that will go (again, no universal requirement for ER personnel to complete NRP). Hopefully the entire NICU team is ready and waiting the instant the baby arrives (and has a *fully* functional resuscitation station in the ER) or more time is lost.

          Best case scenario of every ER neonatal resuscitation that I was ever called to participate in … A. Hot. Steaming. Mess! It is reprehensible to claim that families are making an informed decision without any meaningful understanding of their choices.

          Truthfully when we were required to open an overflow postpartum floor, my hospital put more thought into how we would- in the *very* rare event of a newborn on the postpartum unit needing resuscitation- be managing the all of the details to get them simply 2 floors down to the NICU than any NCB “expert” ever will!

        • Bombshellrisa

          He probably won’t expect payment upfront or ask if he can traded his services for the riding lawn mower or some remodeling work.

      • fiftyfifty1

        “Resuscitation involves much more than possessing an ordered list of technical skills”

        Although in one of the examples from last week, the CPM lacked even that. The responding police deputy had to bump the ineffectual CPM aside and actually follow the ordered list (airway, breathing, circulation) to clear the airway so the breaths could go in. He then worked on circulation, and kept on working, and eventually saved that baby.

        • Jenny_from_da_Bloc

          If they could actual resuscitate a newborn or at least effectively perform CPR there probably wouldn’t be so many HB deaths. These NCB people think that carrying an oxygen bag and valve mask makes a CPM qualified or knowledgeable is neonatal resuscitation.

          • D/

            Nope, you are soooo wrong on this one.

            How do I know? Because I unwittingly fell down the rabbit hole of WTH this week by asking a clarifying question on a birth professional group post about performing neonatal resuscitations at home births. Went like this … A question is posed : Would/ have you considered UC at home if you couldn’t afford a midwife? Why/why not? …

            So this thread explodes (for their standards at least). Topics go all over … UC, MW-assisted home birth, MW-assisted hospital birth, OB-”managed” hospital birth. Hospital-based nurses swoop in … “UC is reckless/ irresponsible.” “I know what can go wrong.” “You can’t possibly understand what it means if something goes wrong and you’re at home by yourself.” … UC/ Home birth advocates fire back their counter attacks … An uber-prolific poster (CPM) enters as the wise voice of reason … an L&D nurse calls her out her resuscitation philosophy … she is spanked/ shamed by a doula for daring to question a nationally known and revered midwife of 40 years or thinking she can “school” her.

            Somewhere in the middle of all of this the CPM makes the statement: “Mouth-to-mouth is the safest and most effective resuscitation method for infants.” … Which draws in the former NICU nurse (and current NRP instructor of 16 years) who is trying to determine what exactly was being suggested because the thread was all over the place … “Mouth-to-mouth as the safest/ most effective option for parents having UC at home, right? You surely don’t mean that in reference to a paid midwife attending a home birth, do you?” … NOPE!!!!! Wrong!!!! (Multiple exclamation marks intentional, btw)

            “Mouth-to-mouth is the best/ easiest/ most effective/ safest across the board for everyone.” … With several back and forths in which I was schooled in the nuances of ILCOR/ WHO’s “not strong” evidence to prefer resuscitation bags/ face masks and the fact that bag/ mask was introduced in response to the HIV scare and ‘bodily fluids’ concerns. … BTW, What a very silly/ mistaken term: “bodily fluids”!

            Give you one guess how many members even attempted to question that … Yep, just little old me … who sadly came along too many years after those working in the time when bag/mask was introduced and could attest to the superior ventilation and control of pressure and volume of mouth-to-mouth.

            Just for fun, if I may, I’d like to pose a question here:

            As a paid birth attendant would/ have you considered mouth-to-mouth resuscitation of the neonate as your preferred method of ventilation? Why/why not? … (Disclaimer: If you’ve never been paid to attend a birth it’s ok to just imagine that you have for this one.)

          • Stacy48918

            “As a paid birth attendant would/ have you considered mouth-to-mouth
            resuscitation of the neonate as your preferred method of ventilation?”
            No. If I’m unable to intubate, an Ambu bag attached to an O2 source provides a higher percent inspired oxygen than mouth to mouth. (I’m a vet, not a birth attendant)

          • D/

            Small world here. I actually started out intending to be a vet myself but made a change of course just before starting vet school :)

            Yeah, I was never brave enough to get into any of the decision-making for O2 usage in NRP- the developing consensus is that room air, at least initially, is a better option anyway which a self-inflating bag delivers. Actually my mind froze at “You’re really advocating (to an agreeing audience) that *paid* birth “professionals” put their mouths on a baby straight out of the perineum as the best option because it’s too hard to learn to use and stay skilled in using face/ bag masks?!”
            <>

            The final tidbit in the five-point-lesson plan that I was offered suggested that the few people who have actually used m2m for newborns for personal comparison of methods would make for an interesting poll. So I did share a few non-qualifying-but-the-best-I-could-do “mouth anecdotes” and lessons (for fun):

            Did mouth-to-nose as a vet tech in a futile-effort doggie code that made his little old lady hold my hand and thank me for trying so hard to save him … *Probably* would do it again in the same circumstances unless I had a better option to consider.

            Swallowed meconium from a delee once at a delivery. Never used a delee by mouth again … Never will.

            Got breastmilk splashed in my mouth by a co-worker in the NICU once. Still handle breastmilk … Just keep my mouth shut now.

            (Hesitate share here: In my current life I’m now a lactation consultant. )

          • Jenny_from_da_Bloc

            Exactly what Stacy said, I would never perform mouth to mouth on a neonate unless absolutely 100% necessary and there was absolutely no equipment available to resuscitate. My whole point being that they have no qualifications let alone idea how to properly resuscitate or perform CPR correctly.

        • Bombshellrisa

          And the CPMs in training and the placenta alchemist are painting that hero to be the bad guy!

  • Mac Sherbert

    Could someone please elaborate on what the last commenter means by “current childbirth practices will be regulated into history soon.” Which practices does she want to do away with? C-sections? Epidurals? I just don’t understand why we would want to do away with practices that save babies lives on a daily…hourly basis. Not to mention that when things go south during a homebirth it’s these exact practices they turn to.

    Here is an example of what homebirth midwives can’t do. They aren’t about improving outcomes or finding new ways to avoid common pregnancy problems. How about some real research into all those herbs they like to use?

    http://www.abc3340.com/story/26096710/clinical-trial-at-uab-tests-drug-to-treat-preeclampsia-may-offer-alternative-to-early-delivery

    • Elizabeth A

      Could someone please elaborate on what the last commenter means by
      “current childbirth practices will be regulated into history soon.”

      I await, with some impatience, the uterine replicators I was promised in pulp sci-fi. Unfortunately, I don’t think that’s what E. Camp is talking about.

      • Roadstergal

        I was talking to a friend of mine who has definitely bought into a fair bit of NCB, and mentioned, “Wouldn’t it be nice if it were like Star Trek, and you could just beam the baby out?” And got a rather enthusiastic affirmative.

        • sdsures

          I’m a bit of a Trekkie and can’t remember any episodes in which a baby was beamed out. In the TNG episode “Galaxy’s Child”, Dr Crusher uses the Enterprise’s phaser as a scalpel and performs a cesarean section on the dead space being, to get the offspring out. Then, the offspring imprints on the Enterprise and starts “suckling” from its power supply. The Enterprise figures out where a supply of the offspring’s food exists in space, then “sours the milk to get Junior off the hull”. The baby is weaned!

          • Roadstergal

            Hmph. The Galaxy Health Organization clearly states that space beings should be power-supply fed for at least two planetary revolutions (and not Mercury, that’s cheating).

          • sdsures

            Well, the Enterprise accidentally killed the space being when it was scanning the ship and attacking it because it was preparing to give birth. Labor pains must have made it a little on edge.

          • the wingless one

            On DS9, Major Kira chooses to have the baby naturally (pregnancy and birth is supposed to be really easy/straightforward for Bajorans which is why she was a surrogate) but IIRC they mentioned beaming out as an option. I was actually kind of annoyed because they seemed to have borrowed some lines from the NCB playbook, for example, the first time Kira goes into labor, the intended father and Kira’s bf get into a fight which causes the labor to stop and we are told that Bajoran women need complete peace and tranquility in order to labor.

          • sdsures

            “Oh, god, not the Bajoran Death Chant!” ~Ensign Ro Laren -TNG, “The Next Phase”

          • MLE

            Yeah it had to be because they beamed the baby from Keiko to Kira in the first place.

          • Box of Salt

            The beaming the baby out is from Star Trek Voyager – the baby is Naomi Wildman, whose mother (Samantha) is a science officer and whose father (not on board) is from a species with forehead ridges, preventing delivery the usual human way.

    • The Bofa, Being of the Sofa

      It’s kind of like creationists, who think that creationism (in whatever form) is going to overturn evolution.

      They are apparently unaware that creationism was, at one time, the prevailing scientific model, and the reason we even have a theory of evolution is because creation “science” failed.

      Same with childbirth. Why would anyone want to go back to pre-medicalized childbirth? There was a reason why we created a field of obstetrics in the first place, because the other approach was failing.

  • Trixie

    OT: the woman responsible for our current measles epidemic also thinks it’s hilarious to text and drive with her child in the car! http://jezebel.com/jenny-mccarthys-son-called-the-cops-on-her-for-texting-1611943735/all

    • The Computer Ate My Nym

      And to punish him for trying to report her potentially deadly activity.

      • Trixie

        And then shame him before a national audience for the purpose of self-promotion.

        • The Computer Ate My Nym

          It’s not him that was or at least should be shamed by that anecdote.

          • Roadstergal

            Her son certianly comes across as the more sensible person in the car.

            “of course I text and drive” – well, of course. If you can increse the risk of harm to children and adults in this world just a little bit every day…

          • The Computer Ate My Nym

            CPS really needs to investigate this woman. If she were poor and black and were acting this way (texting and driving, throwing the child’s phone out the window to prevent him from calling the authorities about her dangerous behavior, publicly humiliating him), how long would it be before he was in foster care? Not to mention whatever woo she’s forcing on him to treat his “vaccine injury”. She should be charged with child abuse.

          • Trixie

            Oh, I agree. But to him, as a 12 year old boy, his mom mocking him on the radio for trying to keep himself safe…well, I hope she’s saving money for years of therapy.

  • schnitzelbank

    “Saved by Home Birth” is quite the oxymoron.

    • Jacob Wrestled (Danielle G.)

      The idea makes no sense. How would we know who was saved by a home birth. Suppose that mother or baby would have died in the hospital, and then share the story of how they had a home birth and didn’t die?

      • Amy

        Maybe saved from an IV, or a big bad scary c-section, and had a homebirth under high risk conditions and nobody died? Because we all know that getting an IV is BAD and a c-section is worse than death.

  • Sue

    No number of criticisms of medicine will make home birth any safer, just like no number of rails against ”Big Pharma” will make homeopathy anything other than magic water.

    • Paloma

      I’ve always found the claims on “Big Pharma” extremely hilarious as a comparison to homeopathy. I don’t know about the US but in Europe, the big homeopathy labs are learning really well from them. I’ve met the Boiron rep a couple of times and she has the same tricks up her sleeve as any other pharma rep, but at least with other labs I know they are not trying to sell me very expensive water…

  • Guesteleh

    Paul Fleiss died and the LA Times failed to mention that he almost lost his medical license because of his role in the death of Eliza Jane Scovill. I wonder what quack will be taking his place (Jay Gordon can’t see every loon in LA, though I’m sure he’ll try)

    • Sullivan ThePoop

      I don’t know if you noticed but Jay Gordon has been changing his tune a little bit about vaccines and wrote an article saying vitamin K shots are important. So, maybe not.

      • moto_librarian

        All Jay Gordon is interested in is covering his own ass. I loathe him.

  • http://jasonandanne777.blogspot.com/ Anne L

    Dear lord. OT, but did you see her comment about bringing wet nurses back? “We drink cows milk without a thought.” Apparently pasteurization is not a thought.

    • Trixie

      I’m just guessing here, but I bet Elizabeth’s a raw milk enthusiast.

      • Smoochagator

        Of course! If you can’t kill babies through home birth or by refusing vaccines, you have to find some other way to control the surplus population. Why even bother washing your hands after using the toilet or cleaning your cutting board after cutting up chicken breast for dinner? E. coli and salmonella are NATURAL.

        • Trixie

          And campylobacter, and listeria, and….

          • Smoochagator

            Good times :-D

        • Sullivan ThePoop

          I know, raw milk is so very dangerous. It makes me sad that I have intelligent friends that buy into this nonsense more than anything else other than gluten free crap.

          • Smoochagator

            I am equally disgusted/angered by the raw milk craze and the anti-vaccine campaigns. Going gluten-free is, in my mind, pretty harmless because you don’t *need* gluten to live. People who feed their kids a gluten-free diet aren’t neglecting to give them a macronutrient that they can’t live without. (As far as I know – if I’m wrong I hope someone with a better understanding of nutrition will correct me.) However, choosing to give your child raw milk or withhold vaccinations can kill your child, and that’s unconscientable.

          • Sullivan ThePoop

            No, I wasn’t saying gluten free is as bad just that it is the second most common fad that intelligent people I know fall for.

          • Smoochagator

            It is quite a common fad and I’ll admit to falling for it myself for a little while.

          • Burgundy

            I told my “going gluten-free” American friend once that she should just go grocery shopping with me at the Asian market. My family is from South Asian and our traditional diet is low to almost none gluten; we have noodles and desserts made out of rice. But she did not like the flavors so she pay a premium at Whole Food for gluten-free stuff.

          • Smoochagator

            The thing is that it’s very easy and inexpensive to go gluten-free at any old grocery store: just eat meat and vegetables! But a lot of people really want all the snacks they’re used to (crackers, cookies) and can’t imagine not eating pasta, so they pay a ton of money for the pre-packaged gluten-free foods. Which, if that’s what you want to do, is fine. But when people tell me it’s SO HARD and SO EXPENSIVE to go gluten-free, I have to call bullsh*t ;-)

          • The Bofa, Being of the Sofa

            I’ve said before about “raw milk” that it’s not so much that it’s dangerous that I don’t like, it’s that it’s a total rip off. When people are paying upwards of $15/gallon for the stuff, it’s a total scam by the farmer.

            Raw milk should actually be CHEAPER than store milk. More than the farmer gets from the dairy (which is pittance) but less than the store.

            If you are paying more than that, you are getting ripped off. But hey, for that premium, you also get the increased risk of contamination, so it’s got that going for it, too.

          • Mel

            In an area where selling raw milk is legal, yes, I agree with you.

            In my state, though, selling raw milk to consumers is illegal and will get your licenture revoked for at least 10 years. Farmers in those states need to hike the prices up for two reasons. First, you need one hell of a financial cushion if you are going to go from Grade A milk production to veal milk production (non human grade) for 10 years. Second, the high price tends to weed out the people most likely to rat you out.

          • Ainsley Nicholson

            Selling raw milk for human consumption is illegal in my state, as it should be. Interestingly, raw milk marketed to be consumed by pets is readily available and quite expensive.

          • Trixie

            I’ve never seen a price as high as $15/gallon. I’ll look tomorrow at my local market and see what they charge and report back.

          • Trixie

            Reporting back — raw milk was $4/gallon, which is the same as or a bit cheaper than buying a regular gallon of milk in the store.

    • Young CC Prof

      No, no! Our cows milk is totally natural, it comes that way straight from the cow! There are fat-free cows, whole cows and chocolate cows, and the cows make those little cartons to feed the milk to their own babies!

      • Trixie

        They shake the cows really hard to homogenize it.

        • Bombshellrisa

          Omg I am laughing so hard right now-and thinking Mel is going to laugh really hard too when she sees this

          • Mel

            And I did.

        • Amazed

          I’m so calling my grandfather to brighten his day with this groundbreaking discovery.

        • Mel

          And they LOVE it!

          http://cattlehooftrimmer.com/how-i-do-it/

          See, we told people that we flip them over on their sides a few times a year for hoof trimming – which the cows ABSOLUTELY ADORE – but we really do it, oh, daily to homogenize the milk.

          Oh, then we keep them in a 140 degree barn for hours at a time to pastuerize the milk. That’s great for the cows.

        • KarenJJ

          Yummmm.. Milk shakes.

      • Mel

        Our cows come in several different colors – black, white, brown, and red. Over the years, my husband I and I have decided that
        Mostly Black (Over 90% coloration) = fat free
        Mostly White (Over 90% coloration) = 4% (whole) milk
        Black and white spotted = 2% milk
        Brown = chocolate milk
        Red/Brown = strawberry milk

        • sdsures

          BWAHAHAHAHA! (I grew up on a farm that was down the road from a dairy farm, so I totally believed this as a kid.)

    • The Computer Ate My Nym

      Hang on a sec…we are talking about wet nurses for babies, right? The quote about cow’s milk implies that she might be saying that we should feed human milk to adults. That…just won’t work. Never mind the risk of viral transmission or prion disease, never mind the potential for exploitation, never mind the sheer squick factor, it just work on the level of basic physics. Thermodynamics. Can’t get enough food to feed humans from other humans. No go. And I apologize if this wasn’t meant and now I’ve put the image in your head.

    • Mac Sherbert

      Oh, yes. The romantic old days of wet nurses. When poor women were used to nurse other more affluent women’s babies. (sometimes at the expense of that woman’s children)

  • Lizzie Dee

    Lots of myths about negligence claims. Surely most of them rest on the interventions NOT done, the danger signs missed? Anybody ever succeeded because a timely CS done properly went unexpectedly pear shaped?

    What would they do if they found Dr. A was sued because she hung on for a natural birth longer than was wise?

    • The Computer Ate My Nym

      IIRC, Dr. Tuteur once posted a story from her residency in which she attempted a version of a breech baby only to have the cord snap and the baby die. I don’t remember if she mentioned whether she was sued or not, but that attempt at “natural” birth went poorly in a situation where a c-section would likely have been completely routine, with everyone fine.

      • jenny
        • The Computer Ate My Nym

          That’s probably the case I was (mis)remembering.

      • melindasue22

        This story came to my mind when I read this post. The difference with Dr. A was the way that she responded. Lay midwives wouldn’t respond that way. Amy needs to do a blog post if she hasn’t already that connect herself to harry potter movies because seriously they talk about her like she is he-who-must-not-be-named. Haha. They talk in riddles because they are worried someone who hasn’t heard of Amy will check out her blog. And also OT but check out Dr Sara Buckley’ FB page. The memes she made about motherly instinct make me queasy.

        • The Computer Ate My Nym

          The difference with Dr. A was the way that she responded.

          Exactly. Just to start with…
          1. She took responsibility for the mistake and didn’t blame anyone else. Which she could very easily have done, given the bad advice from the attending.
          2. She apologized to the family, rather than blowing it off as “some babies weren’t meant to live” or, even worse, implying that it was their fault.
          3. She learned something from it and didn’t just continue practicing the same way as before.
          4. She cared that the baby died. Didn’t just say “very sad” and go on as though nothing had happened.

          • yugaya

            Had she responded with forging of medical records, performing interventions without patient’s consent or knowledge and denying that she performed them at all, dr Amy would have been no better than any lay midwife who suggests/does that. Instead, dr. Amy responded like an ethical medical professional – something that Elisabeth Cram CPM will never be.

  • The Computer Ate My Nym

    To be fair, she did propose starting a blog that would document cases in which home birth was preferable, which would be evidence of a sort, though not necessarily the highest standard. I’m not sure how “Saved by Homebirth” would work, though. “My home birth went completely normally, I have a healthy baby and am fine myself. Thank goodness I didn’t try to give birth in a hospital or my birth might have proceeded normally but with more machines that go ping”? “Hurt by hospital birth” seems more viable since, unfortunately, bad things can and do happen in hospitals. Indeed, Dr. Tuteur has been known to post on some of those things. Critically. Almost as though she’s not part of the vast pharmaco-medical conspiracy or something. Nah…

    • Lizzie Dee

      Well, if you know for absolute certain that non of the many things that can go wrong is going to happen to you then there isn’t a problem with homebirth, is there?

      And lots and lots of people DO know that – and some of them are right…

      • JC

        They’re not right–they’re just lucky. There’s a big difference between the two.

      • lilin

        Look, if you’re preaching religion, that’s fine, but don’t act like it’s science.

        Thanks, though, for illustrating one of the ways that these women are still in junior high – Delusions of Immortality. A kid will think that when someone says, “a four percent risk of death,” that that risk doesn’t apply to them. And since the risk is only four percent, 96 percent of the people taking the risk will think that they were right. But they weren’t right, because that’s not how risk works. They all rolled the dice, and 96 percent of them got the lucky roll, but they all risked death.

        • KarenJJ

          I’m confused by this comment. Are you suggesting Liz is preaching anything? She’s been one of the most thought provoking and interesting commenters on this site. I’m glad to see her back on here again.

          • Lizzie Dee

            OK, because I have been “missing” for a while, I will clarify: I was, first time, the lowest of low risk mothers. No reason for undue concern at all – so much so, that when I got pre-eclampsia, it took a while for anyone (including me) to notice. Variation of normal, probably a false positive, etc. etc. (Terrifyingly possible with pre-e). So, I’m your very healthy, very positive, low risk mother of a severely brain damaged daughter. Kind of “hurt by hospital birth” – and not my feelings that were hurt, either. It was the interventions missed form of negligence, sadly, that comes with terrible consequences. Would I have been saved by homebirth? Did I feel the need to shun hospitals for my second? Hardly. Pre-e can get nasty fast, we would both have died, and there would never have been a second.

            I get why homebirth appeals. I am happy for any woman who comes through it feeling smugly vindicated. “Low risk” makes my blood run cold.

          • Karen in SC

            Glad to see you back!

          • Sara

            Thank you for sharing and I’m sorry to hear that you didn’t get treatment in time.

            I also had pre-e during my last pregnancy (and probably during my first, but I was with a HB midwife who dismissed the signs, and now have no medical records of it!) It is scary, and can get bad fast. After I developed it, I left the NCB group I had been a part of for years, because I got sick of the “100g of protein a day and you cannot develop pre-e” or “take lavender oil for high BP” pseudoscience they would give to women who asked about the condition. Pre-e is nothing to play around with.

          • attitude devant

            Don’t go missing again! We need you!

        • Sue

          lilin – you may have missed Lizzie’s irony font. We know her well here – she certainly doesn’t preach, and she knows about the odds going against you better than most.

          • lilin

            You’re right. I totally missed that. Damn, I feel stupid.

      • lilin

        Hey there. Sorry about that. I let my crankiness over-ride my sense. Missed the humor.

    • Young CC Prof

      Every home birth story with a complication or near-disaster ends with “And I’m so glad I wasn’t in the hospital, because they would have just made it worse. My midwife knew exactly what to do.”

    • Therese

      “Saved by Homebirth” would probably consist of stories like, “My baby didn’t breathe at first when he was born. Fortunately, we were at home where the umbilical cord was still attached. If we had been in the hospital, they would have cut the umbilical cord right away and he could have died!”

      • Staceyjwsolar

        Someone ought to tell her there is, or was, a Hurt by Hospital birth. It ended up being a bunch of people bitching about their care, but no tradgedies or anything. I’m sure there are instances where the hospital screwed up big time, but there would have to be so many for every HB disaster. And that’s ignoring the HB close calls, and assuming a HB would have been better.
        Oh wait, Dr Amy already did a blog on this and barely scraped together 5 events.

        They would be pitiful if they weren’t so deadly.

      • Sara

        If we were in the hospital, the epigenetic harm to the microbiome would have been devastating.

        • Young CC Prof

          Because Quantum.

          • Trixie

            Because Chopra!

  • Trixie

    Actually, I think it would be a wonderful idea for Elizabeth to devote herself full time to houseplants, for the same reason Jan Tritten should devote herself full time to whatever kind of woo-based gardening it is that she believes in. It’d keep their hands off women and babies.

    Sure, she’d probably kill most if not all of them, but hey, some houseplants aren’t meant to live.

    • MamaBear

      She can always take to Facebook to ask for help.

      • Trixie

        Crowd sourcing houseplant disasters is allowed!

        • KarenJJ

          Houseplants are also pretty keen on getting lots of homeopathy.

    • The Computer Ate My Nym

      some houseplants aren’t meant to live.

      Mostly those in my house, it seems. Except the spider plants. Even I can’t kill spider plants.

    • Sara

      I fully support this. That is why I garden, because gardening-woo is forgivable (but it can be ugly, sometimes.)

  • Serenity

    FYI Elizabeth Camp Wyson Smith is the same person as Elizabeth Camp who was quoted in From Calling to Courtroom:

    http://www.skepticalob.com/2012/12/lie-to-your-patient-and-other-homebirth-midwifery-wisdom.html

    http://www.skepticalob.com/2012/12/midwife-says-she-had-a-good-reason-to-lie.html

    Also the same one who advocates PowerBirth (manual dilation of the cervix without informed consent).

    • yugaya

      Organizations like MANA from all other walks of life and especially health care would never allow themselves the liability of being possibly seen as endorsing such an unethical person’s words or actions. If she does hold a valid CPM credential or a license and these are her public statements given under her name then I guess MANA sees nothing wrong with their birth junkie brigades forging medical documentation and operating without patient consent.

      Unbelievable, how on earth are they allowed to get away with this?

    • Serenity

      I had a birth with her. In fairness to her, compared to the other midwives in the area she was the most safety-conscious one. She insisted that I transfer to the hospital because of little progress and fetal distress. If I had had another all-is-well kind of midwife my outcome (healthy baby) could well have been different.

      Unlike other midwives, she did have a background of a few nursing classes (the fact that these few nursing prereqs make her superior to other CPMs says a lot about the CPM credential), and she worked as a paramedic so hospital people would give her more respect than other midwives got. At the time she bragged about her history of 750 births without losing a baby or a mom. I hear she doesn’t brag about a no-loss record anymore.

      My complaints about my experience with her: (1) she acted more like a drill sergeant than the kind fluffy doula she advertised herself as being, and (2) getting the PowerBirth experience (extreme pain) without any knowledge it was anything more than an aggressive vaginal exam, until she told me a year later.

      She does value competence more than most CPMs. I will give her credit for that.

      • The Computer Ate My Nym

        Faint praise.

        • The Bofa, Being of the Sofa

          Yeah, it’s basically “not all midwives are loons” but with caveat of “she’s still a loon.” As Serenity notes, saying “she’s not as loony as the others” is more of a statement about them, as opposed to her.

      • Stacy48918

        She opposes mandatory licensing. And defended midwives in the wake of the dead preemie twin at a birth center recently. She’s a quack.

      • Karen in SC

        You also can’t really know if she lied to you about anything that transpired during the birth, besides the lie about being “Powerbirthed.”

      • Staceyjwsolar

        The bar for these frauds is set so low that this mess of a MW, that disrespects women, is seen as better than the others.

        If that’s not proof HB MWs are deadly quacks, I don’t know what is.

    • Bombshellrisa

      She came around and posted on that thread about herself the other day, claiming she was practicing “defensive medicine”.
      The way she talked about attending nursing school, I thought she was an RN!

  • Amy M

    I went over to the FB page to look, and noticed another post that someone put there about Vitamin K shots. She linked an article about mothers of injured babies (HDN) joining up with CDC to promote VitK shot education, and wants to discuss it, but she is being ignored.

    Of course, there isn’t much to discuss–the risk of avoiding the shot FAR outweighs any risk that goes along with getting it, but we all know the midwifery community likes to perpetuate bullshit where shots for babies are concerned. I hope she takes the article seriously.

    • Eater of Worlds

      What risks are there, beyond the usual “redness at site of injection” kind of risks you get from all shots?

      • The Bofa, Being of the Sofa

        There was a claim at one point that it caused leukemia, I think. Baseless, of course, but, as Paul Offit says, You can’t unscare people

        • Daleth

          Wow, that’s creative. I thought everything midwives couldn’t do caused autism.

  • MLE

    I think the message to Elizabeth WC Smith should be: have at it. Just try to find a fraction of the preventable injuries and deaths peppering the record of your most beloved infamous CPMs, and I will buy you a coke if you come up with something that Dr. Amy and the hospital system tried to sweep under the carpet while placing blame on the patient simultaneously.

    • Amy M

      And would have been preventable under the care of a homebirth midwife.

      • Amazed

        Yes. Because homebirth midwives tend to botch the births with most common and minor complications that at hospital would be almost no problem at all while doctors usually botch the things that are harder and by definition, out of the scope of a homebirth midwife.

      • MLE

        Agreed. My thought was to contrast the two systems. If errors happen in the hospital, protocols are devised to prevent them from happening again, assuming there was some sort of gap. Anyone with a legacy of errors of personal judgement, lack of ownership of those errors, and inadequate education and continuing knowledge would be run out of town on a rail.

        • Amy M

          Oh absolutely, but considering these people are resorting to smear campaigns in lieu of actual data, clearly they would attempt to use any instance of a bad outcome in a hospital to show that homebirth is better. Which is ridiculous, but we have to make sure to outline the rules very carefully and strictly to avoid that nonsense.

          • MLE

            Maybe I’m over confident, but I figure we could include any preventable injury or death that happened to a mother or baby at any risk level, and STLL never come within the same ballpark as the sisters in chains.

  • Guesteleh

    From the New Yorker: Video: An Unnecessary Cut?

    The most common operating-room procedure in the United States is the Cesarean section. The surgery accounts for one in three American births, and ninety per cent of women who deliver their first child by C-section do the same for their second. But as the American College of Obstetricians and Gynecologists noted in a recent report, the rapid increase in the number of C-sections performed in this country hasn’t led to an equivalent decline in the risk of surgical complications associated with delivery. The report registers “significant concern that cesarean delivery is overused,” and recommends that physicians more carefully distinguish between necessary and unnecessary procedures.

    Most women who have delivered by C-section and choose to have more children are eligible to attempt a vaginal birth after Cesarean (V-BAC), often cited as a way to significantly reduce C-section rates. But finding an obstetrician and a hospital willing to facilitate a V-BAC can be difficult. We spent time with Chileshe Nkonde-Price, a cardiologist at the University of Pennsylvania seeking a V-BAC, during the final week of her second pregnancy. We also spoke to, among others, Neel Shah, an obstetrician gynecologist at Beth Israel Deaconess Medical Center, in Boston, about moving the medical establishment toward a more low-intervention approach to childbirth.

    • Elizabeth A

      Any piece on c/s rates since 1970 seems incomplete to me without a discussion of changes in acceptable obstetrical procedure since 1970. Unless you grapple with changes in assisted delivery techniques, and in maternal demographics, there’s just too much of the picture missing.

      • fiftyfifty1

        And this is why Atul Gawande’s piece was so much better–he explains what we would have to do to substantially decrease the CS rate, and that is return to what we had in 1960 which is a high forceps rate. Since the 1960s C-sections have become a lot safer, and mothers have become older and families smaller. Forceps just don’t make sense the way they used to.

        • The Bofa, Being of the Sofa

          CS rates have gone up because the cost of a doctor’s time has gone up so
          it’s cheaper to do a CS which only takes 30 minutes. He complains that
          nowadays on the labor ward a doctor has to be managing not one but maybe
          3 patients at the same time and his pager keeps going off.

          Doesn’t this contradict himself?

          Yes, a c-section only takes 30 minutes, but it is 30 minutes dedicated to a single patient only. Meanwhile, he can manage multiple patients delivering vaginally.

          I know the obs at our hospital were seeing appts while their patients were laboring, too, so they could do a lot more.

          • anne

            Not to mention the extra staff on hand for a c-section and the longer stay in the hospital. I don’t think it’s a major moneymaker for hospitals. It may prevent some costs from lawsuits.

        • Young CC Prof

          The demographics actually play a much bigger role that I realized. Based on the most recent CDC data available, a 16-year-old first-time mother has an 18% chance of c-section, but an FTM in her late 30s has a 50% chance. That’s freaking ENORMOUS.

    • fiftyfifty1

      Surprised and disappointed! The New Yorker usually produces much more nuanced work. They published a great article by Atul Gawande a few years back on the c-section rate that really did a great job of explaining the risks and benefits of c-sections as well as the many reasons behind the rising rates. So why are they now publishing something so dumbed-down and biased as this?

    • Captain Obvious

      Despite ACOG recommending TOLAC to be done in the hospital so that close monitoring can be done, in case of an emergency, this OB/GYN told this pregnant cardiologist to labor as long as possible at home to be successful? Can you imagine if she ruptured her uterus at home?

    • The Bofa, Being of the Sofa

      Most women who have delivered by C-section and choose to have more
      children are eligible to attempt a vaginal birth after Cesarean (V-BAC),
      often cited as a way to significantly reduce C-section rates. But
      finding an obstetrician and a hospital willing to facilitate a V-BAC can
      be difficult.

      Yes. The staffing it takes in order to a vbacs safely can be expensive.

      You want to decrease c-section rates and increase the number of vbacs? Solve that problem.

      IOW, put your money where your mouth is.

      • fiftyfifty1

        Part of the bias of this video was that they spent a lot of time talking about how VBACs aren’t always available making it seem that low access was the reason that our national VBAC rate is low, but completely glossed over the fact that the majority of women *don’t want to VBAC*. I live in a city with ample access to VBAC. Literally every hospital in the metro area offers it. And yet relatively few women choose it. Dr. Neel Shah dismisses women’s preferences for repeat CS by implying that they just don’t know any better and that if they truly understood that their recoveries after a VBAC could be easier, that they would choose it. Does he think women are stupid? Does he think women don’t talk to each other? Trust me, women know that an easy vaginal birth has an easier recovery than an average CS. But women also know that an easy vaginal birth is not guaranteed. Almost every women has met other women who have suffered horrible vaginal birth recoveries, recoveries far worse than you can expect with a CS. And we all know who can still jump on a trampoline and who can’t! All the CS moms can, almost none of the vag birth moms can, even if they had an easy time of it. Add to that the very real risks of rupture and it becomes a no-brainer for the large majority of women who plan only 2 kids. I see that Dr. Shah runs a company devoted to lowering medical costs. He can take his penny wise, pound foolish cost-saving measures and shove them.

        • me

          I think you meant ride a bicycle, not jump on a trampoline. After my vag deliveries, yeah, I could have jumped. Ridden a bike? Not so much. After abdomnal surgery? The idea of engaging the core muscles enough to jump makes me wince. Riding a bike? No problem (easy pace of course).

          But the point you made stands.

          • Young CC Prof

            I don’t think she means immediately after, rather, much later, when children are old enough to run around and play.

          • me

            So she is saying that almost all of vaginal birth mothers, even those who had easy deliveries are incontinent at their child’s 5th birthday? Maybe I was just extremely fortunate, but that seems like it may be an incorrect assertion.

            At their child’s 50th b-day? Perhaps. But then many (most?) c-section mothers will be incontinent by then too.

            I thought she meant during recovery (like after a week or so, but before you are fully recovered). Of course, she thinks she knows what she means, so I’ll leave it to her to clarify.

          • Staceyjwsolar

            I think it was a general alliteration, people. Not a treatise on pelvic floor issues and trampolines.
            Not every remark needs to consider every woman out there.

          • me

            I don’t feel so bad; I wasn’t the only one who had no earthly clue why a woman who had a vag delivery might not be able to jump on a trampoline. No, not every remark needs to consider every woman, but when using an obscure way of saying something (I, having not suffered from UI, would never guess that one cannot jump on a trampoline, tho once it was pointed out, okay, I can see that) giving some explanation of what is meant can be helpful. And hyperbole is fun and all, but VBAC vs RCS has enough damn hyperbole associated with it on the NCB side; why not stick with reality here? Let the cray-crays exaggerate.

          • JennG

            It’s about the pelvic floor

          • me

            The pelvic floor gets stretched during late pregnancy no matter the mode of delivery. A vaginal delivery certainly causes more stretching and/or damage, but a c-sections doesn’t exactly eliminate the possibility that having a baby will lead to incontinence.

            And, yeah, I jump on a trampoline just fine (and cough and sneeze). I think it’s more to do with genetics than anything else…

          • fiftyfifty1

            “The pelvic floor gets stretched during late pregnancy no matter the mode of delivery.”
            Yes, that’s the line that NCB uses to gaslight women into believing that the damage they sustained could not have been prevented. But the truth is that although pre-labor CS cannot entirely eliminate stress incontinence and pelvic organ prolapse risk, it decreases it substantially. For every 9 women who choose trial of labor rather than pre-labor CS, 1 will need later pelvic repair surgery and over half of these repair surgeries will have failed by 5 years.

          • me

            That’s not merely a line. Women who have had children, regardless of mode of delivery, are more likely to experience UI than those who are childfree. The line the NCB-nutters use is ‘post-menopausal nuns (IOW childfree women) also have a high rate of UI’, which is also technically true (women experience a high rate of UI after menopause regardless of whether or not they ever carried a pregnancy), the fact is the rates are higher for pregnant women, and highest for women who delivered vaginally. I’m not arguing that concerns over pelvic floor health should be dismissed (they should not), but understating risk or overstating risk is not helpful to anyone.

          • fiftyfifty1

            “but understating risk or overstating risk is not helpful to anyone.”
            When the NNT=9, saying “the pelvic floor gets stretched no matter the mode of delivery” is massively understating the risks.

          • me

            Curious, where are you getting your stats? How many women in each group (vaginal vs cesarean) experience prolapse severe enough to require surgical repair? I thought we were talking mostly about stress incontinence, now we seem to be talking about pelvic floor damage severe enough to warrant surgery. I won’t pretend to have a lot of info on that. You seem to be saying that 1 in 9 women who deliver vaginally will need surgery to repair their pelvic floor (and about half will need further surgery because the first one failed). How many women who have not had children end up having these surgeries? How many women who have only had c-sections end up having these surgeries?

            From what I’ve seen, your best bet (to protect the pelvic floor) is to remain childfree and die before menopause. Beyond that, yes, a c-section can reduce your risk prior to menopause, but after that, we’re all pretty much in the same boat. As grandma always said: gravity’s a bitch.

          • araikwao

            As the government’s health promo message states here: 1 in 3 women who have had a baby will wet themselves :/

          • me

            Yes. And that’s *by ANY mode of delivery*. It’s not like a third of women who delivered vaginally pee themselves, and the c-section moms got off scot-free. They are less likely to pee themselves, but many still do.

          • fiftyfifty1

            seriously?

          • araikwao

            Yup, just walked past a stand full of brochures at the geriatric hospital last week. And you get one in the “congrats, you’re pregnant” pack, IIRC.

          • fiftyfifty1

            “a c-section can reduce your risk prior to menopause, but after that, we’re all pretty much in the same boat.”

            No we really aren’t. Prelabor CS moms don’t need hysterectomies for prolapse, nor do they need rectocele repairs and they don’t suffer from anal sphincter incompetence. And you need to be vary careful when considering studies that rely on self-reports of urinary incontinence. A study that asks “do you ever wet yourself” is a poor measure of urinary incontinence. What this question fails to capture is severity. You can answer “yes” and to you that means dampening your underwear once per week during strenuous coughing or perhaps a rare urge episode where you start to wet as you are pulling your pants down in the bathroom. This is a very different “yes” from needing to wear Depends and/or needing to restrict your activities due to wetting. The studies that get passed around in NCB circles are the poorly designed ones that do not properly quantify severity.

          • me

            “Prelabor CS moms don’t need hysterectomies for prolapse, nor do they
            need rectocele repairs and they don’t suffer from anal sphincter
            incompetence.”

            How common are those things? It seems to me you keep moving the goal posts here. Are we talking about the number of women who experience at least some level of incontinence following childbirth, or are we talking about these more severe (and far less common) issues?

            And you are absolutely right – the studies I’ve looked at only report on any incontinence. Obviously some will be severe, and many won’t. That’s why I wonder where you came up with the stat that 1 in 9 women who give birth vaginally will need pelvic floor surgery. That seems off to me, but if you have the citation, I’ll certainly take a look. Seems to me the incontinence would need to be pretty severe before signing up for a surgery that only works half the time, IYKWIM. Again, I’d love to see some sources. I’m not doubting your personal experiences here, but you made some pretty unusual claims. I’m open to investigating the subject in more detail. Just point me in the right direction.

          • AllieFoyle

            I think what she’s saying is that few women get through vaginal delivery without some degree of pelvic floor damage, whether that is incontinence or prolapse. The effect may be subtle and not cause any functional impairments, at least before menopause, but there are measurable changes in pelvic floor strength and function. A significant proportion of women will have more frankly obvious damage–significant urinary or fecal incontinence, prolapse–that is directly caused by the mechanical forces of labor on the urinary/rectal/pelvic structures. It’s completely beyond and distinct from transient UI from just being pregnant.

            Looking at a few studies doesn’t give you a complete picture, as fifty-fifty pointed out. C-sections are protective, but many women who have c-sections have labored beforehand, so you really need to look at pre-labor sections. Pelvic floor repair/incontinence surgeries are very common (though no one talks about them), and they are strongly tied to vaginal birth.

          • Trixie

            I never had UI while pregnant either, and my babies were really low.

          • me

            That is fair enough. And true enough – vaginal delivery does increase the risk of UI. However, stating ‘few women will get thru vag delivery without some degree of pelvic floor damage’ is wildly different than saying ‘few women will get thru vag delivery without pelvic floor damage severe enough that they shall never be able to jump on a trampoline again’. I can’t be the only one who sees that.

          • fiftyfifty1

            “Curious, where are you getting your stats?”

            Huge Kaiser population study.

          • me

            Link?

          • fiftyfifty1

            There are multiple papers that have been done using the Kaiser population data, each that looks at different risk factors (race, parity, age etc). Google “Kaiser pelvic organ prolapse”.

          • me

            Thank you! I’ve looked over a few of the papers that seemed relevant to our discussion. I’m still not sure where you got the idea that “very few” women who deliver vaginally will manage to escape UI/POP. Yes, the vaginally delivered group had higher rates of all types of pelvic floor issues than the nullips or the c-section group. And that follows with the other studies I’ve seen. What I couldn’t find out, and forgive me there are tons of papers using this data and I don’t know which one/ones you are referring to specifically, is what the breakdown becomes after menopause. IOW, in menopausal women, what are the rates of UI/POP based on parity and mode of delivery. I’m sure it’s out there, but I’ve not been able to locate it.

            At any rate, my dispute with your statement that “all of the c-section moms can jump on a trampoline, and very few of the moms who had vaginal deliveries (even easy ones) will be able to” (paraphrasing) was in the fact that UI is startlingly high in the first five years following a c-section (nearly 30%), and while it is higher still in the first five years following a vaginal delivery, it is by no means the vast majority. What happens later in life, first, I’m not as familiar with, and second, as Allie said, this topic isn’t a big area of research. Not to mention, the older women who are now seeking these surgeries aren’t very likely to had has “easy” vaginal deliveries. They gave birth in the day of twilight sleep, high forceps, and (nearly) mandatory episiotomy. It hardly seems right to call that an “easy” vaginal delivery.

            I do hope as the boomers get older (lord knows they’re a vocal bunch) this topic gets more research and attention. By the time I’m old enough to be dealing with whatever fallout (if any) my deliveries may leave me with, it would be nice if the treatments were more effective (50% failure rate is pretty abysmal).

          • fiftyfifty1

            “I won’t pretend to have a lot of info on that. ”

            What? You draw the line at pretending to know about urinary incontinence?

          • me

            On studies about how many women get surgical repairs for pelvic floor problems and the breakdown of how many of them had vaginal vs surgical deliveries. If you have some studies, I’d love to take a look. I’ve no doubt more of these women had vaginal rather than surgical births (it makes intuitive sense), but that doesn’t give the full picture. How many more? How many nullips get pelvic floor surgery? How many c-section-only women get pelvic floor surgery? Of the vaginal birth group, how many were grand multips, how many had episiotomies and/or operative vaginal deliveries (the ladies of the ‘knock em out, drag em out’ era of obstetrics are at that age right now), etc.

            Either you have some info to share or you don’t. Continuing to attempt to smear me is not only ironic, but it makes it seem more and more that you are just making shit up.

          • AllieFoyle

            She’s not making things up. Go figure, but somehow women’s pelvic health is not a huge area of research interest. It’s a complicated subject, lots of variables, but what is clear is that those surgeries are very common (and may become more so, as women are less willing to put up with the lifestyle implications, or less so, as CS rate rises), and that they are tied to damage that is sustained almost exclusively (with exceptions) in vaginal births.

          • Daleth

            A few studies:

            - Urinary incontinence 10 years after one vaginal delivery was 275% higher than 10 years after one c-section.
            http://www.ncbi.nlm.nih.gov/pubmed/22413831

            - Fecal incontinence 20 years after one birth (comparing women with one VB vs. one CS):
            http://www.ncbi.nlm.nih.gov/pubmed/24803215
            14.5% of the VB moms had fecal incontinence, vs. 10.6% of the CS moms; perineal tears greater than 2nd degree (which occur only in VB, not CS) doubled the risk of fecal incontinence. Slight lack of clarity in this article–they do not break out any numbers for prelabor vs. mid-labor c-section.

            - Postpartum stress urinary incontinence (i.e., peeing when you sneeze, laugh, jump on a trampoline etc.) is about equally likely for vaginal
            birth vs. CS performed for obstructive labor, in the 10%-12% range, but incontinence only affects 3.4% of women who had a CS before labor (“It is quite possible that pelvic floor injury in such cases [i.e. where CS is done for obstructed labor] is already too extensive to be prevented by surgical intervention”).
            http://www.ncbi.nlm.nih.gov/pubmed/14694448

            - Urinary incontinence in the first year postpartum was just over twice as likely in women with VB (31%) as in women with CS (15%). Again, study marred by the failure to distinguish between prelabor and mid-labor CS.
            http://www.ncbi.nlm.nih.gov/pubmed/21050146

            - 13.8% of women who delivered vaginally when they were over the age of 30, and 6.4% of those who delivered vaginally at a younger age, ended up needing surgery for pelvic organ prolapse. (No numbers on women who delivered by CS but it says “vaginal delivery consistently increased the risks” of such surgery).
            http://www.ncbi.nlm.nih.gov/pubmed/23021693

            - 20 years after a single delivery (no more kids after that), 6.3% of women who delivered by CS and 14.6% of women who delivered vaginally had symptomatic pelvic organ prolapse. Vaginal birth was especially likely to result in prolapse in women who were under 160cm (5’3″) and delivered babies weighing more than 4kg (8.8 lbs).
            http://www.ncbi.nlm.nih.gov/pubmed/23121158

          • AllieFoyle

            We’re not all in the same boat. We’re all subject to the ravages of aging and hormonal changes, but those who enter menopause with pre-existing structural damage are at a distinct disadvantage.

          • Trixie

            I guess what seems strange is that you said “almost none” of the women who’ve had vaginal deliveries can jump on a trampoline. In my non-random sample of female relatives and friends who gave birth vaginally, no one has UI. It seems like lots of people still can jump on the trampoline.

          • me

            This. And really, this is all.

            Succinct. I need to do succinct better :)

          • AllieFoyle

            Maybe they just don’t want to tell anyone.

          • Trixie

            I’m only counting people I know well enough that they’d tell me. Again, I admit, non-random.

          • fiftyfifty1

            “And, yeah, I jump on a trampoline just fine (and cough and sneeze). I think it’s more to do with genetics than anything else…”
            Genetics do play a part along with fetal size, position, instrumented delivery and other factors.
            It’s also important to note that Pelvic floor dysfuntion is diagnosed in stages. Some women (like myself) have obvious immediate problems. But a second larger wave occurs at the time of menopause when tissue atrophy unmasks occult damage. Now that my mother is post-menopausal she struggles with urinary incontinence and symptomatic rectocele. She can no longer jump on the trampoline (or run or bike). Her sister who had 2 pre-labor CS reports she has no issues.

          • me

            From the few studies I’ve seen on the issue, yes vaginal delivery is associated with about a 40% risk of UI in the first 5 years post-baby (this number drops at 10 years post-baby, to around 10%). C-section is associated with about a 30% risk of UI at the 5 year mark, with a drop at 10 years as well (to about 7%). After menopause, the playing field gets more level, including women who remained childfree – fewer over 60 seem to be able to jump on the ol’ trampoline anymore – tho c-sections still have the edge over vaginal deliveries and childfree is best off overall. Your anecdote certainly makes sense, but it is just that. My anecdote? Two mothers on this site who delivered vaginally had no earthly clue why a woman who pushed a baby out of her vagina might not be able to jump on a trampoline :)

            I’m not trying to make light of what is, while not life threatening, certainly a life altering issue. And I don’t think many women have babies thinking they will be in the market for poise pads in their 30s. Certainly when making decisions about mode of delivery, pelvic floor issues are valid. And since you don’t know whether you might need episiotomy or forceps/vacuum, nor do you know the fetal size or position (though you can get an idea) I can understand why the 30% risk after a c-section might be preferable to a 40% risk after a vaginal delivery (that rate was overall, the study didn’t break down how many vaginal deliveries involved complications).

            The only reason I responded was your assertion that ” All the CS moms can {jump on a trampoline}, almost none of the vag birth moms can, even if they had an easy time of it.” is patently false. Nearly 30% of c-section moms won’t be able to jump on a trampoline. And about 60% of vaginal delivery moms absolutely can (possibly more if restricted to easy vaginal deliveries). Your claim sounded wrong, and, well, it is.

          • fiftyfifty1

            “From the few studies I’ve seen on the issue”

            Maybe you should make yourself familiar with the breadth of the literature then rather than just the favorable studies that your time in NCB circles exposed you to. It would be a good idea to also expand your understanding of pelvic floor issues beyond stress urinary incontinence. Learn about pelvic organ prolapse too. For me personally the issue is not incontinence when I jump, it’s that my uterus pokes out of me.

          • me

            Oh for Christ’s sake. I’ll let the irony of you smearing me with the NCB-nutter brush in light of the topic of main post here speak for itself. The studies I’ve seen on the topic were in the NEJM and the BJOG. But I guess they are “NCB circles” now. Good to know.

            I’m sorry you suffered organ prolapse following childbirth. And I agree that it’s something that needs to be talked about more openly (lord knows I went into my first pregnancy with no idea such a thing was even possible). Here you have the opportunity to share some of your knowledge, but instead you decide to berate me for participating in the discussion. Yeah. Just yeah.

          • me

            “For me personally the issue is not incontinence when I jump, it’s that my uterus pokes out of me.”

            Wait, I’m confused… a few posts up you said you can’t jump on trampolines due to stress incontinence. Now you are saying the issue is prolapse. Which is it?

            And were you saying very few women who give birth vaginally escape incontinence, or very few escape prolapse? Either is untrue, but one is more untrue.

            Just wondering.

          • fiftyfifty1

            ” a few posts up you said you can’t jump on trampolines due to stress incontinence. Now you are saying the issue is prolapse. Which is it?”

            I have both issues, but I can mitigate the stress incontinence by emptying my bladder just before I jump (or run etc). Or I could not worry about emptying it and wear a heavy pad. But the uterus always pokes out no matter what and that’s pretty uncomfortable. But all this takes awhile to explain and in some social situation is TMI, so I generally give the tl;dr version which is “I can’t jump or I’ll wet my pants”.

          • me

            Okay, I understand. Honest question: do you think that the issues you suffer from (and I want to tell you that I cannot fathom the ways in which this disrupts your life and I have nothing but empathy here) are something that the vast majority of women who deliver vaginally will experience? I ask because you did say that “very few” women who deliver vaginally will be able to jump on a trampoline (suggesting that the vast majority of women who have VBs will experience issues similar to what you experienced).

          • fiftyfifty1

            “I think you meant ride a bicycle, not jump on a trampoline.”

            I think I know what I mean.

        • KarenJJ

          I had never heard of restrictions of access to VBAC in the large Australian city I lived in when I gave birth. I also know of only 1 person that attempted (and succeeded) a VBAC. Everyone else chose the repeat c-section. It’s not like we knew that c-sections had risks and recoveries were hard, but there are also benefits to c-sections that are glossed over but that women will consider. Firstly – that a c-section after labour is generally much harder to recover from then an elective c-section and secondly there can be advantages to planning the time of birth.

        • Trixie

          Sorry, I’m dense. Why couldn’t you jump on a trampoline after a vaginal birth?

          • fiftyfifty1

            It’s that I permanently can’t be jumping on trampolines due to stress incontinence. This is a problem for many women.

          • Trixie

            I’m sorry to hear that. Thank you for explaining. I will count myself lucky, then, to have gotten through a vaginal birth with no idea what you were talking about.

          • Ainsley Nicholson

            Because you pee your pants if you do.

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

        Is the percentage of FAILED VBACs noted anywhere? I don’t really know if “most” women who have C/Ss are VBAC candidates, to be honest, but it is probably true. Fetal distress probably won’t recur, and it is probably the commonest reason for primary C/S, and we all know that the “distress” might not be really severe but who wants to wait for the axe to drop?. But dystocia, resulting in failure to progress, very often does, especially as the woman, in subsequent pregnancies is older than in the first, and we know that women are having babies later nowadays. Cephalopelvic disproportion will almost certainly recur, since each subsequent baby usually is a bit bigger. Placental malpositioning often does, as does abruption, for unknown reasons. Multiple pregnancies generally don’t recur, although there is a not inconsiderable number of women who have had more than one set of twins. Breech probably won’t recur, unless there is a pelvic abnormality.

        The whole point of this is that “one size does NOT fit all”. Each case needs to be evaluated individually. One thing which is known is that the risk of uterine rupture is greater in VBAC. Is it worth the risk?

        • The Bofa, Being of the Sofa

          The number thrown out here is that 75% of VBACS attempts are successfully delivered. That’s much of the basis of the “most women could do a VBACS.” Of course, as YCCP points out, that’s “if they wanted to.”

          • Dr Kitty

            Also…
            As I’ve said before if I plug all my data into the most widely used VBAC calculator, it predicts my success rate of a VBAC at about 75%.

            Because there aren’t pull-down menu options for “congenital spinal and pelvic deformity” or “cervical endometriosis with scarring”…which takes my PERSONAL success rate for a VBAC attempt down to somewhere between “miracle if it happens” and “snowball’s chance in hell”.

            My OB, knowing my history, has already made jokes that we’d be pencilling in a CS date at the 12 week scan appointment in any future pregnancy.

            Which is the difference between theoretical and actual application of predictive tools, and shows why the oft quoted
            “90% of women could VBAC and 75% of VBACs are successful” might not be as straightforward as it seems.

          • Trixie

            Well, it seems unlikely that 90% of women are good VBAC candidates. Assuming most VBAC candidates are properly screened, 75% success rate seems plausible.

          • Young CC Prof

            I’ve heard that in health systems where they strongly encourage most women towards TOLAC unless there’s a clear safety reason not to, success rates are substantially lower.

          • The Bofa, Being of the Sofa

            But even if the VBACS success is 50%, if you have twice as many attempts, there is still a reduction in the overall cs rate. That’s going to happen until the rate for every additional attempt is 0.

            I’m not saying it’s a great approach, but in terms of reducing the CS rate, it’s true.

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

            But that of course ignores the question of how many VBAC candidates there really are in a given population of women who previously have had C/Ss. Hospital policy and doctors’ preferences limit the number of women who are suitable for attempted VBAC as well as the state of the current pregnancy or the reason for the previous C/S.

          • The Bofa, Being of the Sofa

            But there are certainly many out there who don’t do a VBACS because of the lack of facilities, and they are perfectly suitable candidates.

            My wife is one example. She could have had a VBACS, and there is no reason to think that her chance of success would have been anything other than 75% (her first c-section was because of breech, and the second was not). Of course, it would have had to be at a hospital more than an hour away from home, and she would have wanted to do it in the first place, but since she didn’t want to do it, it didn’t even matter where it was.

            But that doesn’t mean she couldn’t have.

    • Who?

      I saw this and found it quite confusing.

      It would be interesting to hear all of what she said in the order she said it, and any questions or conversations that happened. My feeling is that there was a fair bit of cutting in and out of her remarks, so I wonder if she was as ‘dewy’ in her attitude as the finished product suggested. There was a remark about ‘not wanting an unnecessary section’ but without the full context the viewer can’t know what she’s saying. I wonder what she thinks of the finished product?

      Is it weird that I remember the lovely images of the new family at the end and not how the little one actually arrived? Though I assume it was the old-fashioned way, given the story to that moment.

  • lilin

    Here’s a list of other things they learned in middle school.

    1. Arbitrary Standards: Some things are just “cool” or “natural” and some things are just not. Throwing a birth party is cool. Live-tweeting your birth is cool. Water birth is cool. Asking your friends to gather at the hospital is not, because it’s not “natural.”

    2. Rigid Conformity: Anyone who differs in any way needs to shut up or gets shut out.

    3. Delusions of Immortality: “Yes, I know that this comes with risks, but the risks can’t possibly apply to me. I’m too special to die. Those close to me are also too special to die.”

    • Captain Obvious

      Couldn’t she have any lessons learned from high school, college, or nursing school? She had to go back to jr high to find a lesson learned?

      • yugaya

        Maybe chess got too complex after middle school and she lost interest?

        Or she considers herself to be an expert in chess for middle school club plus having attended as a member of the audience a few high level tournamets?

  • Squillo

    I’m re-imagining WCC 1972, game 6:

    Fischer: Queen to f4.

    Spassky: You’re just a big poopyhead.

    • MaineJen

      I believe that would have been “your meen.”

  • Monica

    Really, they are worried that the negative hospital stories aren’t getting out there? Yeah, they are out there and you know what, your record could be researched and easily found out if there were any lawsuits against you. However, what public record is there on the midwife who crowd sourced the death of baby Gavin and all of the other atrocious homebirth deaths that continue to just get swept under the rug? That would be right here. Interesting that they so desperately want to know what your “track record” is, but they don’t want anyone harshing their mellow about the bad midwives.

  • Zornorph

    It’s very telling that they referenced learning lessons in middle school given that they act just like middle school ‘mean girls’. Except that it’s no longer middle school and their tricks don’t work on mature adults.

  • http://whatifsandfears.blogspot.com/2014/04/mana-study-part-4-vaginal-birth-after.html Doula Dani

    That’s always been their M.O. “Don’t listen to Dr. Amy bc (insert personal attack)”

    When I was searching for answers, I was pretty much begging people to show me where Dr. Amy was wrong. She HAS to be wrong, please someone show me!!. It never happened. It still hasn’t happened. It’s always excuses and personal attacks…. ANYTHING to try and hurt her credibility. I even heard “I’m sorry I can’t take that seriously bc there was a grammar error.” Ooohhhhhhhhh no.