Milli Hill and Cathy Warwick on the dangers of childbirth: lying or ignorant?

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Is Milli Hill deliberately lying or just ignorant?

Consider the way she begins her latest piece Is childbirth really such a ‘risky’ business?:

If you believe everything you read, then you probably think that childbirth is one of the riskiest activities any human can undertake.

Actually, it isn’t, and statistically you’re massively more likely to meet your maker behind the wheel of your motor.

Ummm, Milli, here’s a newsflash: childbirth IS one of the riskiest activities any human can undertake and you or your baby are MUCH more likely to die in childbirth than in an automobile accident.

Childbirth is and has always been, in every time, place and culture, a leading cause of death of young women and THE leading cause of death of babies. Indeed, according to Save the Children, the day of birth in the most dangerous day of the 18 years of childhood.

Childbirth seems safe only because of modern obstetrics. Obstetrics has lowered the perinatal mortality rate 90% and the maternal mortality rate 99% in the past 100 years. But midwives cannot provide many of the services that have made childbirth so safe and therefore, for their own economic self interest, they and their apologists like Hill deny that those safety measures are really necessary.

Homebirth and natural childbirth advocates keep throwing memes against the wall, hoping one will stick. Obstetricians don’t follow scientific evidence! Except that they do. The media is to blame for the pain of childbirth! Except that it isn’t. Homebirth is a human right! Except that it’s not. A healthy baby isn’t enough! Except that for most women, it is. The latest entry in the midwifery meme collection is childbirth isn’t risky!

Except that it is.

Consider what Cathy Warwick, head of the Royal College of Midwives has to say on the subject:

There is concern at the RCM and among midwives, that our focus on risk, and the way that we are describing risk, is making women feel scared. Ironically, creating fear, in itself, causes risk – if women are fearful then they are less likely to release the hormones needed for a straightforward birth.

Does Warwick actually believe the nonsense that comes out of her mouth?

She’s already been forced to publicly retract one of her completely fabricated claims. Warwick claimed that the Netherlands, which has a high rate of homebirth, the lowest perinatal mortality levels for babies in Europe. Just one problem: The Netherlands has one of the HIGHEST perinatal mortality rates in Western Europe. Oops!

Now, she’s spewing nonsense about risk. Ms. Warwick’s behavior is especially disturbing given the sad state of midwifery in the UK. After a spate of preventable perinatal and maternal deaths due to midwives being unwilling to call other specialists; after a government report that revealed that 20% of obstetric funding now goes for liability; and after another government report that chastised midwives for covering up the deaths at the hands of their colleagues, one might think that Ms. Warwick would be busy doing whatever she could to promote better outcomes. Instead, she seems to think her job is to promote employment opportunities for midwives.

Lying about, dismissing or discounting the risks of childbirth is deeply unethical. We would rightfully be shocked by a physician who represented heart surgery as without risk or even plastic surgery as without risk. Women need to know the REAL risks and benefits, both of procedures AND of refusing procedures. We should be equally shocked by midwives like Warwick (and her cheerleaders like Hill) who represent childbirth as without risk, or refer to the “risks” of childbirth in scare quotes.

No one should forget that midwifery is a business, and it is part of the larger industry of natural childbirth. Both earn profits by convincing women to forgo interventions, pain relief and safety measures. Emotional manipulation of women is key to the success of the industry, and the emotional manipulation includes chivvying women into rejecting safety measures by being fundamentally dishonest about the very real dangers of childbirth.

Warwick and her cheerleader Ms. Hill should be embarrassed by their defense of the status quo and by the fact that they are either actively misrepresenting the risks of childbirth or simply ignorant of them. Either way, they are failing in their ethical obligation to be honest about the risks of birth and serving an industry (the natural childbirth industry) that profits by being dishonest about those risks.

  • Helen

    Dr Amy, may I ask you to point me towards the evidence that childbirth is one of the riskiest activities you can undertake? I do believe you, but I was taken apart on another board when I suggested it, so I would love to have it for future reference 😀 Many thanks. PS I really enjoy reading your blog

  • Hmm hmm

    OT: May I ask the learned commenters here, what is your opinion on the use of ondansetron as a secondary treatment for extreme morning sickness (at 10 weeks gestation)? There appears to be conflicting data regarding the potential for fetal risk with this off-label use.

    • Sue

      There’s a Danish paper in Feb 2013 NEJM – Pasternak et al. They used birth registry data and matched it against the prescription register. Quoting from the paper:

      “Among 1233 women who were exposed to ondansetron in the first trimester (first prescription at a median of 63 gestational days; interquartile range, 54 to 73), 36 infants (2.9%) were registered as having a major birth defect during the first year of life, as compared with 141 of 4932 infants (2.9%) born to women who were not exposed (adjusted prevalence odds ratio, 1.12; 95% CI, 0.69 to 1.82).”

      They discussed various possible confounders, but concluded that ” in this registry-based cohort study, we found that exposure to ondansetron in pregnancy was not associated with a significant increase in the risk of spontaneous abortion, stillbirth, any major birth defect, preterm delivery, or infants born with low birth weight or born small for gestational age.”

      There are a couple of issues with the use of medications in pregnancy. First, it is almost impossible these days to have a medication declared Class A (safe) because there aren’t large enough cohorts of pregnant women prepared to take the medication. Secondly, there is a difference between the first trimester (when organ systems are developing) and the third trimester, when the foetus is essentially formed.

      However, the overriding principle has to be a risk-benefit assessment. Lack of treatment of severe nausea and vomiting can be more risky than the medication – as severe dehydration and acidosis can also be detrimental.

      On balance, the evidence and the risk-assessment suggests that ondansetron is fine as a second-line treatment for hyperemesis, especially if used judiciously, and under supervision.

      • Hmm hmm

        Thank you all for your kind and helpful responses to my question, they are very much appreciated.

    • Dr Kitty

      Since I vomited about 10-20 times a day with nothing, 6-10 times a day with Cyclizine and 0 times a day with Ondansetron, and I took the Ondansetron only between weeks 11 and 16, my personal anecdote is that when your choices are
      a)”vomiting and dying”
      b)”vomiting and requiring IV fluids in hospital and being so tired from the Cyclizine that you can’t function”
      c) “a theoretical risk of possibly increased risk of birth defects, NOT vomiting and being able to go about your life as normal” the Ondansetron is a very, very good option.

      Obviously, YMMV and it is entirely up to you and your doctors to determine the best course of action, but, FOR ME, this one was a no brainer…particularly since the next option up from Ondansetron is Prednisolone, and I wanted to try everything else first before risking my immune system, adrenal glands, gut, pancreas and bone density.

      • fiftyfifty1

        I would love to know why steroids work for hyperemesis (as well as emesis from chemo etc). A friend of mine ended up on prednisone during her pregnancy. It worked like magic, but HOW?

        • Dr Kitty

          I think the theory is that the vomiting is an immune response to detecting the foetus as a foreign body and the steroids dampen it…but who really knows…

          HEG was the least fun thing ever.

      • The Computer Ate My Nym

        A friend of mine had hyperemesis gravidum and was so pleased with how her life changed with ondansetron that she threatened to name the baby Merck. Fortunately, she changed her mind: Merck doesn’t make ondansetron. Little Glaxo is just fine too…

    • VeritasLiberat

      My personal experience with it was that it didn’t really help much. Nothing did.

      • Dr Kitty

        How awful for you!

        I’ll admit that the thought of going through 24/7 nausea and vomiting for 9 weeks again was a major reason for wanting to delay a second pregnancy (and then life and endometriosis and various other factors intervened to delay things more).

        The CS was a breeze compared to the HEG, and mine resolved by 18 weeks and was pretty much under control with medication from 13 weeks (but started in week 5…which was super fun).
        I have nothing but sympathy for those who had it worse.

    • Ceridwen

      I reviewed all the literature I could find and concluded it was well worth it for me. With Diclectin + Zofran I was able to not puke. And by 13 weeks I was even able to get up off the couch. By ~22 weeks I was able to wean off meds entirely. I narrowly avoided hospitalization as it was, I would certainly have been hospitalized if I’d refused the medication.

      I’m planning for number 2 and the meds will be started very early the next time around.

  • PeggySue

    Saw a friend recently whom I hadn’t seen for quite a while. She had a beautiful baby, 4 months old!! She told me she had had an emergency cesarean delivery as there was a complication during labor. She was scared, yes, but she was scared not by the section but thinking about what would have happened had she NOT had access to the section. Now she has her baby, whom she loves more each day, and a deep appreciation for obstetrics.

    • Sue

      HI, PeggySue! (waves)

      Great to have perspective, isn’t it?

  • Sadly Sheena has taken the opportunity to harass Mr. Titcombe on twitter again….sigh….

    • Dr Kitty

      Any more of that and she’ll be lucky if it doesn’t pop up on the RCN radar.

      British Doctors were seriously disciplined for writing abusive comments about colleagues in a PRIVATE, DOCTORS ONLY Internet forum, so it isn’t as if there isn’t a precedent…

      • staceyjw

        She needs to be reprimanded for this shameful action.

    • Guesteleh

      He made his Twitter private 🙁

  • Jenny_from_da_Bloc

    OT: There is a personal essay on xojane.com where the woman is NCB infected and the title: I was forced to have an epidural! Um sorry but how can you be FORCED to have an epidural?

    • Tired

      It means she took it when it was offered and now there’s nothing to brag about and it’s everyone else’s fault.

      • D.D.

        Not that I plan to give birth, but if I would, I would do it in the hospital, with a MRCS, and then go online bragging I had an unassisted childbirth in the Alps with only Heidi and the goats as midwifes.
        Cue for heavily shopped photos of me waving from the summit and of me and a goat breastfeeding looking at each other meaningfully.

        • Tired

          Wait, I’m having mental imagery of a complicated breastfeeding relationship…who is breastfeeding who? Should we even go there?

          • D.D.

            Aha! You wish to know! 😛

    • Guest

      Ugggghhhh…I am SO sick of people acting like they were forced to get an epidural. Have a backbone and say no if you really don’t want one. During my hospital births, I was asked if I wanted an epidural only once upon “check in.” (And this was at two different hospitals in two different cities.) I refused, and no one ever brought it up to me again. I don’t buy her story at all. Her husband is the world’s biggest jerk if he was gone long enough for the nurse to bully her, call the anesthesiologist and have an epidural placed. I’m calling bull.

      • Anna T

        I had exactly the same experience as you had. I was admitted, asked “do you want an epidural”, politely said “no, I’m fine the way I am, thank you”, and the subject wasn’t brought up again. I’m sure the staff had better things to do with their time than to force epidurals upon patients who don’t want or need them.

      • Sue

        (Aside: Just had to comment on the use of ”have a backbone” in the context of epidurals!)

      • EmbraceYourInnerCrone

        I was asked at one of my last prenatal appointments about what I wanted , sort of my OB putting my requests/preferences in my record.
        I thought it was smart because when I was actually delivering I might not be clam enough to have a long conversation about it. I said I wanted an epidural, I would prefer no episiotomy(if possible) that I wanted to try breatfeeding in the delivery room if possible and I wanted to wait a few minutes, after we got to hold her/feed her, before they put the drops in her eyes. The edipidural was placed at about 4 or so cms. I had to have an edisiotomy because she was in distress (they used the vacuum to get her out quick)
        All my other requests were honored. And this was in 1994, in an innner city U.S., Catholic hospital. I am sure that sometimes health care providers are not very respectful of peoples wishes and it helped that I had both my husband and my friend(who had given birth twice) with me the whole time.But I feel like it would help if pregnant women and their partners or friend would see if they could get a tour of the hospital they will probably be delivering in and ask questions about what the delivery will be like.

    • toni

      Are you referring to this article? http://www.xojane.com/it-happened-to-me/it-happened-to-me-nurses-pressured-me-to-get-an-epidural-i-didnt-want if true she was treated disrespectfully and certainly coerced into getting the epidural

      • Jenny_from_da_Bloc

        Yeah I was and I don’t believe her version of events for one second. Nobody can force you to have and epidural. She obviously regretted the epidural and changed her version of events to make it seem like she was coerced into the wicked and evil epidural. Suddenly her awesome husband is gone long enough for the nurse to prop her feet up, run her mouth and get anesthesia to the room? Then for the anesthiologist to set up for the epidural and admin it? I don’t think so. And if she was so unhappy with what happened why didn’t she report the nurse to patient relations? There would have been some serious shit to be had on that nurses part for such unprofessional behavior. Bottom line nobody can force you to have an epidural. Maybe the episotomy part might be true, but otherwise I’m not buying it

        • toni

          Well that’s fine if you just find this particular story suspect. Maybe she’s making it all up or embellishing but do you really think that no L&D nurse would ever pressure their patient into getting an epidural? If you’ve ever watched the British programme One Born Every minute or Midwives you’ll know that NHS midwives routinely discourage labouring women from getting epidurals. they stall, belittle pain, ignore requests and generally dick women around until it’s too late and they have a natural birth because that is what a significant number, if not the majority, of midwives there think is the proper and best way to give birth. In the US most women get epidurals so probably most L&D nurses deliver their own babies with epidurals and are mostly caring for women who get epidurals. I don’t find it at all hard to believe that some of them think giving birth without an epidural is daft and would pester or even harangue their patients into doing it the right and proper way i.e. the way that they and most women they look after do it. people do this, they foist their opinions on others, believe everyone should do things the way they and their friends do, demand explanations when people make different choices etc

          • Anna T

            Yeah, we mustn’t forget midwives are people, too, and have their own opinions. I remember after the birth of my first baby, the midwife (who was awesome, by the way), came over to congratulate me, gave me a spontaneous hug and a kiss on the cheek and told me how much she enjoyed attending my unmedicated birth (if you think the hug and kiss part is excessive, remember I live in Israel, a country where perfect strangers will strike a conversation with you on the bus with the purpose of finding out whether you are interested in going on a date with their nephew).

            Another midwife might have just thought I was silly for not getting an epidural.

          • I bet I know who that midwife was…(and no, it wasn’t me)

          • Anna T

            Well, I don’t… not really, LOL. I don’t remember her name, but then, at that moment I could hardly remember mine!

          • Anj Fabian

            If nurses could dole epidurals out like candy, then I’d be more willing to believe that women are pressured into an epidural.

          • Jenny_from_da_Bloc

            But they can’t force you, that is the truth. If she didn’t want it don’t sign the consent forms. It is pretty simple. They have the American version of that show One Born Every Minute and it must be completely different in America. Every nurse was professional and caring towards her patients while putting up with a lot of crap from some of the patients and husbands. I’m sure some women are pressured when the situation calls for it and they are being unreasonable, but if things were going down like she claims the nurse probably wouldn’t have given a crap if she got an epidural.

          • AccieCat

            Yeah, and if you have any experience with anesthesia in US hospitals, (I’ve got a ton, non-pregnancy related) it takes 30 minutes MINIMUM, to get an anesthesiologist to a room for an epidural, or even to turn one off. Nurses are not allowed to dispense meds that a Dr. or anesthesiologist haven’t ordered. Consent forms are absolutely required, the Anesthesiologist has to order the meds from the RX, they have to arrive, the nurse and whoever else is going to help put the epidural in need to assemble… Are you seeing the picture? So when the birthplan doesn’t call for pain meds, they won’t be at hand. When they do, they typically can already be ordered and just waiting for use. It’s also why so many women end up not getting pain meds if they actually originally wanted them. If you show up at the hospital and you are too far along, there isn’t time to get everything together before the show starts.
            The nurses will only care about your choice of non pain control if you are yelling and screaming and scaring the other patients and their families. Seriously.

          • Jenny_from_da_Bloc

            A very good point. This woman’s story was so suspect to me for that exact point, she acted like anesthesia was waiting outside her door ready to put that needle in her back as soon as the nurse walked out of the room. It takes anesthesia at my work at least 20-45 minutes to show up for anything not scheduled unless it’s an emergency. Drugs need to be ordered, anesthesia paged, an anesthesiologist needs to be available, etc, etc. The hospital I had my son at in FL during the maternity tour they told everybody mother and partner you had to sign consent forms for an epidural before you were admitted and received any type of meds. They advised all the mothers to sign the consent forms during pre-registration or during admission whether they planned for an epidural or not because you just never know and you wouldn’t want to be denied an epidural because you have already received stadol or nubane during labor. They repeated this about 30x during the tour and went over it repeatedly during pre-reg. Things are different everywhere, but like you said anesthesia doesn’t just pop up 3 minutes after the nurses call.

          • Bombshellrisa

            I was reading through the story and I wonder of the nurse was sensing the husband was pressuring the woman NOT to have the epidural and the nurse wanted to be able to offer the epidural when there was nobody else in the room. When I was trying to get my births in to become a doula, I had a friend of the family ask me to attend their birth because the husband wanted to “make sure his wife didn’t have an epidural”. She had never had a baby in a hospital, it was all CPM home births for her and he didn’t want her to “cave” and take drugs since she had given birth and never needed one before. Yeah. Needless to say I didn’t keep her from having an epidural-the nurse asked her and she agreed. She was raving about how wonderful it was to have pain relief (fifth child, first hospital birth) even as her husband grumbled about “the cascade of interventions”.

          • Jenny_from_da_Bloc

            That could have been the issue for sure, but did she seriously have to write a personal essay on how she was forced to have an epidural and blame it all on the nurse and hospital?
            It is so pathetic when people can’t take a stand for what they do and don’t believe in regardless of what other people think or believe they should do. I understand she was in labor and maybe her resolve was weakened by pain or the fact that her husband wasn’t present and caved to the nurse asking her if she wanted pain relief. She either had her true feelings to hide and save face by claiming she was forced or really believes she was forced to have an epidural. Either way the essay was pathetic and stunk to high heaven because you just cant be forced to have an epidural.

          • Bombshellrisa

            I am with you, I am thinking she told her husband before labor that she didn’t want pain meds and he needed to be her advocate for that and when the pain was terrible and she changed her mind she was still getting pressure from her husband. Didn’t she take a picture of her bill from anesthesia for the epidural? Wonder if her husband was complaining about the cost?

      • The Computer Ate My Nym

        Anecdote alert: I was “pressured” to get an epidural. I was having very painful contractions and asked the CNM for some pain meds, but didn’t want an epidural at that point. This was after she examined me and found that I was only about 2 cm dilated (and I suspect she was being generous). The conversation went like this:
        Me: “Can I have some demerol to take the edge off.”
        Her: “When the labor’s this painful this early on, it’s better to just get an epidural.”
        Me: “OK.”
        I don’t know if she already suspected that this was going to end in c-section or not, but it turned out to be very good advice because the epidural being in place meant that I could be awake for the emergency c-section. And my one “birth experience” fear prior to labor was fear that I’d “miss” the birth (i.e. be unconscious when it happened.) So the epidural really enhanced my birth experience. YMMV, of course.

    • Anna T

      Well, if it’s the article below, the title was actually “Nurses pressured me to get an epidural”, not “I was forced to have an epidural”. Pressure from the staff CAN happen, though for the life of me I can’t understand why a nurse would care if she has an epidural or not (unless it’s likely she will end up in the OR).

      This line, however, jumped right at me: “Not once was I given any supportive comments or told I was doing well from the staff.”

      To tell you the truth, this sounds a little childish. However, I can understand how every little thing can get blown out of proportion in the labor&postpartum state.

      Also, it’s disturbing if an episiotomy was really performed without her consent. Nothing should be done without the patient’s consent, unless it’s an emergency.

      • Melissa

        The only reason I can see the nurses “pressuring” and epidural is if she really seemed to be in a lot of pain and struggling.

        The part about not being told that she’s doing well also strikes me as strange, but mostly because that isn’t particularly information I’d want to hear from the medical staff. “Everything is progressing normally” is good to hear, but she seems to want them to tell her that her birth giving ability is really good. Like some type of praise for her delivery prowess. Everyone giving birth is doing as well as they can in the circumstances of their biology. It makes as much sense to praise someone for how they are doing while giving birth as it would be to suggest someone isn’t trying hard enough.

        Then again NCB regularly says that some women just aren’t trying hard enough to have the right birth, so I suppose they might think that some women can be somehow doing things well in the birth process. When I had to get a

        • Anj Fabian

          It seems to be standard for certain midwives to tell women who refuse pain medication how well they are doing.

          I couldn’t have cared less while I was laboring. I wanted it to be over.

      • Guest

        Hmmm, I wish I’d taken a screen shot. I could’ve sworn it said forced and not pressured when I read it.

        • Jenny_from_da_Bloc

          yeah it definitely said forced

          • Anna T

            Perhaps she got lots of comments about how she couldn’t be “forced” to have an epidural and then she changed the headline.

      • Sue

        “Not once was I given any supportive comments or told I was doing well from the staff.”

        Maybe because they don’t define enduring labor and delivery as ”doing well” – it’s just ”doing”.

        • Dr Kitty

          Or maybe, because she wasn’t actually doing well.

          If you’re a midwife looking at someone who is in severe pain, tachycardic, hypertensive, shaking, sweating then no, you don’t tell them they’re doing well.
          You tell them they seem to be having a hard time and an epidural would help.

          The women you tell are doing well are the ones who can laugh and joke between contractions and who don’t appear to be in imminent danger of stroking out during one.

          Just a thought.

    • Box of Salt

      Dear anonymous who wrote “For over six hours, I’d had nurses telling me I needed medication and that I couldn’t manage without any. Not once was I given any supportive comments or told I was doing well from the staff. ”

      It would be unethical for a care provider to tell someone “you’re doing well” when that person is obviously in a lot of pain.

      And there is no way that the anesthesiologist put a needle in her back without her having signed bunches of consent forms.

      When I read her piece, I am reminded of one of the reasons I’m still reading and commenting on this website a full eight years after my last child was delivered: we need to fight the brainwashing that’s caused this woman to think that she didn’t do childbirth the “right” way.

  • Ash

    OT: Would someone be willing to update the wikipedia page for “Postterm pregnancy” with better citations? Citation 6 is no longer available, Citation 7 is homebirth.org.uk, 8 is gentlebirth.org, and some other text has citations needed.

    • staceyjw

      So, a bunch of garbage used as cites? Shocker. I hope someone smarter than me fixes this.

  • Bombshellrisa

    Re: story below about police officer doing CPR- I just found out Tamy Roloff aka Tamara Roloff is attending births in the Spokane area (she is still on probation). Also Beth Morrill, who is also on probation right now. She tried to deliver breech twins at home. Long story short, one was born breech, the other died after being transferred to the hospital. https://fortress.wa.gov/doh/providercredentialsearch/PDF/1215528862.pdf

    • Anj Fabian

      I particularly like Page 3 sections 1.15 and 1.16 which states roughly that although the midwife attending had the patient sign an informed consent form, that does NOT absolve the midwife of providing competent and appropriate care.

      IOW, getting your client to sign an informed consent doesn’t protect YOU when YOU screw up. It doesn’t protect your client either.

      • KarenJJ

        They get their legal advice where they get their midwifery advice from.

        OR – they hope the women that hire them get their legal advice from where they get their midwifery advice from.

        Because it worked so well for Gina Crossley-Corcoran…

        • Bombshellrisa

          They all read “From Calling to Courtroom”

        • Melissa

          One of the things that you realize pretty quickly in law school is that the main purpose of many so-called contracts are just to make people think they don’t have any right to sue. You can’t contract away the duty of care. You can’t sign something that allows another person to act negligently towards you, and that is what is needed in a tort case.

          But people sign a piece of paper saying that they won’t sue and they believe that it means they can’t.

          • lawyer jane

            One of the things that in retrospect creeps me out about the hospital-based CNM group I used is that they make patients sign a piece of paper agreeing that they “They must assume the risk inherent in birth with us.” I never signed it, since I knew that it could never have any legal meaning. I didn’t think too much about it at the time, but now it really bothers me. Are they dumb and venal enough to think it actually provides them with legal cover? Or are there in fact increased risks that they imposed on patients in the name of natural childbirth? My conclusion is that it’s the latter: they increase risks in the name of natural childbirth.

  • Anna T

    “Ironically, creating fear, in itself, causes risk – if women are fearful then they are less likely to release the hormones needed for a straightforward birth”

    I understand the remote logic of this statement – if a woman is feeling uncomfortable, she MIGHT experience stalled labor and MIGHT experience her contractions in a more painful way. However, does this mean we should wildly extrapolate and say that gaining important knowledge and being informed about possible risks is “creating fear”? Should we stick our heads in the sand, so as not to cause fear and disturb the dance of hormones?

    I remember that when I arrived at the hospital in active labor, I was shaking with nerves. I was checked, admitted to the L&D, the midwife patted my shoulder and said I have absolutely no reason to worry and that I’m doing great. The atmosphere was cheerful and relaxed, for which I am profoundly grateful. However, it was also professional. There was EFM. There was a team of medical professionals behind the door.

    Another question… if “creating fear causes risk”, does creating irrational and unfounded fear of hospitals also count? Does baseless scare-mongering count? “You’ll have random strangers stick their fingers up your cervix every 30 minutes, your human rights will be dismissed, a team of doctors and nurses will dance around you in circles, chanting ‘get an epidural! get an epidural!”… sounds familiar? How about “you won’t be allowed to eat or drink” or “you will have an episiotomy without your consent”, or “you will be forced to labor on your back”?

    • Young CC Prof

      Precisely. Natural health folks accuse real health authorities of “scaremongering” when they attempt to warn the public about real health hazards that require real medical care. Meanwhile, the naturalists are running around warning people about “hazards” that are somewhere between loosely supported hypothesis and pure rampant speculation.

    • Amazed

      But Anna T! They’re just WARNING women! It’s nowhere near the same! They’re only empowering women to trust… them.

    • KarenJJ

      Yes – they play the “Scary Hospital Card”. What they don’t talk about is that a scary hospital is still preferable over the death of their baby. ANd that for a scary hospital – if you discuss your fear and inexperience with hospitals – you CAN actually change your outcome and have a very positive experience giving birth in hospital. There’s a much much less you can do to influence a health outcome at homebirth then you can to influence a positive/negative emotional outcome at the hospital.

      • Siri

        Scary places to give birth: Prison. Concentration camps. Up a tree during a flood. School toilets. Alone. Outside in the cold. War zones. Disaster areas. Famines. Rural India. Rural Africa. Afghanistan. Safe, reassuring places to give birth: Western hospitals. Perspective.

        • Amazed

          Scary places to do anything that might require medical attention: every place where said attention isn’t available immediately.

          I’ll never stop wondering at the hypocrisy of their perspective: hospitals are scary places, Western medicine is terrible but when the shit hits the fan, you run to the scary place with the terribke procedures. If something is good enough to save you from the worst case scenario, it should be good enough to save you from just a bad case scenario. But no, Evil Is Evil Is Evil.

          I know a girl who has a small scar on her finger. Turned out that a few years ago she CUT THE FINGER OFF. Two hour ride from her town to the ER in a big city, invasive procedures and voila, she currently does have a finger. Yay for scary places!

    • “Ironically, creating fear, in itself, causes risk – if women are
      fearful then they are less likely to release the hormones needed for a
      straightforward birth”
      I understand the remote logic of this
      statement – if a woman is feeling uncomfortable, she MIGHT experience
      stalled labor and MIGHT experience her contractions in a more painful
      way.

      Actually, there isn’t any hard evidence that this is true. Especially about the “hormones needed for straightforward birth” since there aren’t any.

      • Anna T

        Perhaps no hard evidence – I haven’t read any actual studies – but I doubt anyone will disagree that it’s better for laboring women to experience peace and comfort, rather than fear and distress. The problem begins when comfort is chosen over safety. I was a little uncomfortable when I had to recline back for the EFM, but I didn’t say “no, leave me alone”, because it was important to know that the baby is doing well.

        • Siri

          Fear and distress are caused by pain, not vice versa. Birth complications cause pain and fear, not the other way around. No amount of fear will stall a birth; if it did, pregnancies in Nazi concentration camps would have lasted indefinitely.

          • Box of Salt

            Siri, thank you for expressing this so well.

          • Deena Chamlee

            Siri Siri you are a thinking type girl.

          • The Bofa, Being of the Sofa

            I have always wondered about that, to what extent pregnant women were in concentration camps.

            I actually shudder to think about to what kind of experimentation they might have been subjected.

          • The Computer Ate My Nym

            I had the impression that they were mostly first on the list for the gas chambers.

          • Deena Chamlee

            waterbirth was possibly one.

          • Siri

            Many babies were born in the camps; they were taken away and adopted, drowned in buckets or starved to death. Or experimented on. One girl, however, was born in Auschwitz at the end of the war and survived with her mother!

            See also Wiktoria Ulma; her last baby was born in its mother’s grave. So much for fear/trauma hindering labour…

            The Ulmas are my heroes.

          • Young CC Prof

            I know of several people who were born while the immediate neighborhood was being bombed.

          • Anna T

            Yes, I’ve read several recent accounts of Israeli women who went like, “and then I heard an explosion over Ashkelon in the distance, the hospital shook, and the midwife couldn’t believe how quickly the baby was out!”

            Other women report going into labor after the Yom Kippur fast.

            I wonder if war simulation and 24-hour no-fluid fast will soon be advocated as natural induction methods?..

    • staceyjw

      The whole idea of fear stalling labor is totally ridiculous. I was terrified when I had pPROM and got shot to stop labor, but guess what? Baby was born early anyway! All the fear in the world was not gonna keep her in.

      • araikwao

        They shot you??? See, hospitals really are evil! 😛

        • Tired

          Lol, that’s the last resort when we need to get some good tocolysis going 🙂

    • Poogles

      “Should we stick our heads in the sand, so as not to cause fear and disturb the dance of hormones?”

      That’s what they’re suggesting, pretty much. That’s why all of the “support only!” threads/boards, and why pregnant women planning to homebirth are frequently told to avoid any “negative” homebirth stories – must keep out all the fear and negative “vibes” so it doesn’t interfere with the all-important birth experience.

  • Amazed

    Why am I not surprised that a doula would want to hush the story of the incompetent midwife from the link below? She’s even a Bradley instructor! And of course, she makes it sound like it’s about the family than the midwife.

    Wendy Knudtson If
    you would like it to stop, then take the post off. This is a hot button
    and you have added more fuel to the fire. Please care more about the
    family that is involved than giving your officer a pat on the back.

    • Bombshellrisa

      The birth arts woman who keeps insisting that the midwife was performing CPR is a “placenta alchemist” who is going to be a midwife and is a doula. Truly frightening.

      • Tired

        Placentas are big this day! In Canada we enjoy the services of so-called ‘placenta encapsulators’ who steam placentas with a secret concoction of herbs, dehydrate and grind them. Then dispense the powder into gelatin capsules and put them in cute woo-looking containers. The claims are miraculous. I especially love the one where they say it boosts your milk supply. We need to get rid of the placenta and the steroid hormones it makes in order to liberate prolactin and start lactating. So…how is re-introducing the placenta going to help with lactation? *scratches head*

        Another thing. I read someplace that goat placentas are full of prions. Not sure about us humans….brrrrr. Prions.

        • MLE

          Unfortunately I heard some MD on Diane Rehm promoting placenta consumption as a way to combat PPD 🙁

          • Tired

            Yep, I know an RM around here who suggests this to her clients. Placenta contains oxytocin, she says. What she doesn’t know is that oxytocin, being a peptide, is not going to survive gastric acid and is not likely to absorb well via mucous membranes inside the mouth.

            One of her clients wanted to go for it but her placenta turned out to be a calcified, meconium-stained mess.

          • Melissa

            I have no doubt that there are some amazing results from the placenta, but you’d get the same results with sugar pills. Placebo is a powerful thing.

          • no longer drinking the koolaid

            One of the hormones that the placenta does manufacture is human placenta lactogen, which inhibits lactogenesis (milk coming in). When the placenta delivers, the amount of HPL decreases over the next few days and the milk comes in. If you really want to use your placenta to increase your milk supply, you are going about it wrong. If HPL, even if it survives encapsulation, it will inhibit milk production. I’ve mentioned this a few times on placentophagy discussions and was told that’s not how it works.

          • Tired

            HPL, being a peptide, is unlikely to survive cooking and gastric acid. Steroid hormones, I’m not sure. But the idea remains the same – why re-introduce placental hormones if they are meant to inhibit lactation? Even if it’s all pure theory, it just seems illogical.

          • Amy M

            Also, wouldn’t any peptides just break down during tissue decomposition which would occur naturally over the hours/days after labor? And if the placenta is prepared (cooked or processed in any way) that will also alter the structure of various peptides that are present in the organ, no? And how much oxytocin is actually in the organ anyway? If we could extract all the oxytocin, how many mg would we have? I would guess than any free oxytocin is in pretty small quantities.

    • attitude devant

      Did you catch the part that the cord wasn’t cut yet? And yet the baby was blue!!!! Talk about cognitive dissonance for midwives!!!! Also, got to love the person saying the deputy got there just as the baby was being born. Uh….no.

      • Amazed

        I caught it. A few years ago, I would have leaned down to collect my jaw off the floor. Now, I almost don’t notice such tiny details, it should be something monumental to shake me.

      • Bombshellrisa

        I went back and read the article again and indeed, the cord was not cut and the mother and midwife were “crouching over the baby on the floor”. Crouching on the floor after giving birth, assisting the midwife sounds like a “beautiful” birth experience. Not.

  • Box of Salt

    One more thing: “a constant focus on what might go wrong steals any chance of enjoying childbirth, just as talking constantly about car crashes would take the edge off a ride in a convertible on a sunny day.”

    Hill has obviously never cruised PCH (CA Rt 1) through central California southbound from Monterey.

    • Stacy48918

      I would argue that extreme, unrelenting pain, bodily fluids, and repeated vomiting are what stole my “chance of enjoying childbirth”. Thankfully childbirth wasn’t my goal, the baby was and once he/she was in my arms I didn’t care all that much about the pain or even the blood/urine/feces/vomit from the previous 6-36 hours.

    • Melissa

      I’d much rather take that drive in a car with seatbelts and airbags than without. It would be hard for me to enjoy any drive in a car with no safety features.

    • auntbea

      Yeah. It’s not the fear of crashes that ruin the drive. It’s the 4 million other people on the drive with you.

    • The Bofa, Being of the Sofa

      I sure hope that even someone out cruising in a convertible on a sunny day is practicing defensive driving, and is constantly assessing the situation around them to be aware of potential dangers.

      I don’t care about your fucking convertible, you still need to be ready for a driver running a red light.

      What a horrible analogy. Ask the DOT what they think about your casual drive.

      • Siri

        Bofa!! Kiss Mrs Sofa with that … finger?

        • The Bofa, Being of the Sofa

          (best not to answer…:))

          But seriously, I have no patience for such bullshit these days.

          I mean, how else should you respond to such an entitled asshole?

  • Box of Salt

    I find it . . . interesting. . . that Warwick find HBAC a grey area of risk. To me, this reinforces the idea that the UK midwives are engaging in a turf war.

    (Maybe we need to start reframing our risk arguments: would you buy lottery tickets based on those odds?)

    I am troubled by Hill’s closing paragraph, and this line in particular: “Risk offers a one-size-fits-all approach to birth and blocks its ears to the voices of individuals;” Has she swallowed Warwick’s ideas hook, line, and sinker, or is she borrowing from the anti-vax movement? Has she ever had a consultation on any medical issue? We may add “high” and “low” labels to certain risks, but assessing risk means finding out where you are as an individual on a very large spectrum. That’s hardly “one size fits all.”

    What a worthless piece of propaganda she’s published.

    • Anna T

      Yeah, I was struck by the same thought. VBAC at home? What’s grey about that??

  • Captain Obvious

    Kinda reminds me of The Fugitive, where Dr Amy is Richard Kimble, Homebirth is the drug Provasic, and homebirth midwives is the drug company. Except there is no one armed man, haha

    • Box of Salt

      Captain Obvious: the midwives are Dr Charles Nichols, and the drug company would be the states that allow CPMs to practice. The Feminist Breeder is the one armed man, since she did actual strike out against Dr Amy with DCMA takedowns.

      How are we going to fit in the Federal Marshalls?

      • anion

        You don’t “fit in” Federal Marshalls. You just get out of their way. 🙂

        (Imagine that in a sepulchral voice.)

        • KarenJJ

          Maybe the readers here that have changed their minds. Coming in and arguing with Dr Amy and then realising that there is much more going on then they originally thought.

    • anion

      I had the exact same thought!!

    • The Bofa, Being of the Sofa

      Can I be the guy with the pony tail, so Gerard can tell me, “Don’t let them give you any shit about your pony tail”?

  • lilin

    If you can’t argue that you reduce risk, you have to argue that risk doesn’t matter.

  • MS

    What is the point of claiming your practice is “evidence-based” if you are just going to ballyhoo all the risks based on that evidence?

    After reading the most recent posts regarding UK midwives (this, the Titcombs, a commenter linked to a UK report about lowering the stillbirth rate that was equally horrifying), I have never been so thankful to be in the US with my choice of OB (sorry, no midwives for me). This just make me sad for the poor mothers and babies subjected to these old crones.

    • Young CC Prof

      I suspect the old crone midwives aren’t the problem in UK hospitals. They know what’s what, it’s the younger ones who are motivated by NCB ideology rather than patient safety.

      • MS

        Perhaps I just imagine them all being witchy, crone women. I’ll admit, I have little understanding of how the healthcare system works there, but the seeming lack of choice alarms me. Why can’t a woman choose her HCP? (I read some comments somewhere that women were complaining that they were assigned midwives they didn’t like) The UK stillborn report featured numerous stories of women being turned away from the hospital weeks over their due date, only to have a stillborn. Maybe it’s just me, but I get the impression that women are being subjected to NCB whether they want it or not. Talk about a one-size-fits-all approach! It breaks my heart.

        • Box of Salt

          MS “Perhaps I just imagine them all being witchy, crone women.”

          Perhaps you’ve caught and read all the recent drop-in troll comments complaining that this blog is part of a witchhunt.

          • Heather Dalgety

            I trained in Obstetrics in the UK in the early 80’s and there were extremely experienced older midwives who literally ran Labour Ward , but by the same token , the residents were called the minute things started to go wrong . Now , I gather from colleagues still working in the UK , younger midwives see themselves as ” independent professionals ” and the last thing they would do is call a Dr . The don’t just wait until the shit hits the fan , it has to be clogged in it !

          • Dr Kitty

            It was certainly my experience that the older MWs would call me to deliveries where everything was fine and we’d all have a nice chat, but that the younger midwives would call me when the proverbial was hitting the fan and my role was to rush through the CS consent form as we ran down the hallway to the OR.

          • Ob in OZ

            very similar to a few experiences in New Zealand

    • Sue

      ”What is the point of claiming your practice is “evidence-based”

      Every quack is on the ”evidence-based” bandwagon now. For real medicine, they demand RCTs (now even knowing what that means, or whether it is even approriate for the issue). For their own practice, though, evidence-based means they have seen it before, or someone wrote up the case in their society newsletter (that makes it “peer-reviewed” – the gold standard!)

      • Young CC Prof

        Like all the antivaxxers who volunteer to be the controls in a double-blinded RTC of vaccines?

        • Box of Salt

          YCCP: You phrased it wrong. One does not volunteer to be in a control group.

          If you volunteer to be in a double blind study, you volunteer not to know which group you’re in.

          I’ve had this discussion with my husband, and he’d put our kids in the trial, for the sake of science.

          I won’t.

          I can’t protect them from their own bad decisions, but I will protect them any way I can.

          • Young CC Prof

            I know what double-blinded RTC means, but many antivaxxers demanding one don’t know.

            And yes, you’d have an extremely hard time finding volunteers, because most parents consider getting the vaccines too important and a minority consider avoiding vaccines too important. The ones who’d be willing to be randomized might already be exceptional in some way. That, and of course it would be wildly unethical.

  • auntbea

    1. In what way are VBAC or pre-e “grey areas?” Those would, in fact, appear to be about as clear as indicators against homebirth as one can get.
    2. What does that mother mean she “doesn’t believe” she has a 60% chance of c-section? This isn’t Tinkerbell we’re talking about here.

  • Young CC Prof

    That article is incredibly disturbing. SO many women being encouraged to treat real risk factors as if they are imaginary.

    Getting pregnant in the developed world roughly doubles a woman’s chances of dying within the next year. (This does include a substantial jump in the risk of being murdered by a sexual partner, but medical deaths are also a big piece.) Perinatal deaths are almost twice as common as deaths of children between ages 1 and 18, from any cause.

    Pregnancy is dangerous. Talking metaphysics about risk does not make it disappear. Comparing large risks to miniscule ones doesn’t make the risk look smaller, it just makes you look like an idiot.

  • Zornorph

    I like how she blames women for not having the perfect birth because they are afraid and thus don’t release the proper hormones. Kind of reminds me of that crazy politician who said if women are raped, they release hormones to prevent them from being pregnant. Why are midwives engaged in a #waronwomen?

    • fiftyfifty1

      Great comparison. How depressing that women are falling for it.

  • Amy Tuteur, MD

    The comment I left on Hill’s piece has already been deleted. Unethical.

  • mikerbiker

    A timely post, the same day a police officer saved a baby as a midwife looked on https://www.facebook.com/SpokaneCountySheriffsOffice/posts/761491567207339

    • FormerPhysicist

      I’m SO happy with the comments I saw. Lots of slams on the midwife and calls for medical training and medical intervention when needed.

      • Amazed

        And the homebirth advocates on call. It was CLEARLY a joint effort of the midwife and deputy! ALL midwives wold have administered CPR in the right way!

        But yes, most of the comments are quite sane and reasonable.

        • fiftyfifty1

          And then the comment that was critical of the deputy for being a bully and pushing aside the midwife to save the baby when he should have just stood back and let her keep trying and she surely would have gotten it eventually. That yes, he was responding to their 911 call, but surely they did not want any help with the CPR but rather were calling because they knew they might want transport to the hospital for observation once they had gotten the baby breathing.

          Homebirth advocates are delusional.

          • Amazed

            My personal fav: the deputy arrived JUST as the baby was being born and took over. So they call 911 for a baby who isn’t breathing BEFORE the baby is even born?

            They are getting desperate.

          • Young CC Prof

            I like the one who says that “The mother AND midwife were both trained in infant CPR” because of course that’s totally the same thing as neonatal resuscitation.

          • Bombshellrisa

            Trained doesn’t mean experienced.

          • KarenJJ

            Such an important distinction. I’ve been trained in CPR and you really don’t want me to be the only one in a emergency because I have never ever done CPR on anybody.

          • PeggySue

            Yup, I’m a hospice chaplain and up until this year at my workplace chaplains had to be CPR certified. I know, I know… The last time I took a class, the instructor asked, “So WHAT would you do if you saw someone fall and when you got to them they had no pulse and weren’t breathing?” I said, “Call the coroner?”

          • Ob in OZ

            Too funny

          • Certified Hamster Midwife

            Then, pray.

          • Amazed

            The mother was clearly the second trained person in this birth! Who needs an assistant when mom is trained in infant CPR and can use it on her own, still unwashed newborn?

          • fiftyfifty1

            “”The mother AND midwife were both trained in infant CPR””

            Pretty pathetic in that case. The CPR mnemonic which is drilled time and again is “ABC”. Airway, Breathing, Circulation. Apparently both mother and midwife either forgot it or never actually learned it. But the deputy remembered what he learned. Just as he had been trained, he gave a couple quick breaths trial breaths to see if air was going in properly. He ascertained that it was not, which meant the airway is blocked. So he quickly moved to the infant airway clearing step which is to place infant face down and slanted head down on your outstretched forearm and deliver back strikes. This was successful in clearing the airway so he then moved on to breathing and circulation. That is what someone who is actually trained in infant CPR will do.

          • Bombshellrisa

            They didn’t want help for the “purple, not breathing baby with no pulse”. That visual makes me ill. It took a sheriff who surely has attended less births than this midwife to do CPR.

          • fiftyfifty1

            Yeah, the description makes me almost sick with fear too. This deputy really did a great thing. Bringing back a baby with no respiratory efforts and no pulse is no easy task. He really kept his head about him. I like the way he went immediately to the back-strike step of CPR when he figured out that his breaths weren’t going in very well. Getting that mucus plug out was key. He also *kept going* with all the CPR parts until baby was both breathing on her own and having a pulse of the correct rate for a newborn (didn’t stop when pulse hit normal range for an adult). I am really impressed with how accurate and persistent he was with the protocol considering I doubt he has ever done this before in real life.

          • Amazed

            And they’re still claiming he was just a nuisance in the midwife’s path. These Amanda and Synthia chicks are real pieces of work. Future midwives, if you please, and eager to start the rigorous CPM training (at least one of them is).

            Sometimes, I think humankind is a lost cause.

          • Jenny_from_da_Bloc

            She probably was panicking and shitting her pants while yelling the baby’s name instead of doing proper CPR. I’m sure she wasn’t doing anything to help that baby because she was trying to save her own ass! Thankfully cops have basic medical training and common sense to recognize the severity of the situation. The parents are dumb asses and hired an incompetent and useless midwife to maim and damage their baby for life.

        • Bombshellrisa

          Oh yes, Amanda the midwife cheerleader who assured everyone the midwife was doing CPR already. Yeah right, the midwife didn’t even know how to use a suction bulb apparently.

          • Junebug

            The midwife in training that claimed homebirth was 100% safe with a trained midwife made me throw up a little.

          • Amazed

            Poor girls. This is not their facebook page, so they cannot “reframe the conversation” using the DELETE button! I am quite enjoying looking the big fat hole they’re digging for themselves.

            On the other hand, we have not one but TWO believers who are going to be CPMs and unleashed on the public.

          • Bombshellrisa

            Well, she is training to be a CPM, so the statement wouldn’t apply to her even if it were true

          • fiftyfifty1

            “the midwife didn’t even know how to use a suction bulb apparently.”

            Or doesn’t carry one with her. Either is damning.

          • Bombshellrisa

            All I can think of is Faith Beltz, who had her suction bulb packed already.
            Maybe the birth kit the family bought didn’t
            Include one. You know those midwives make the family buy everything down to the gloves and chux pads.

          • Anj Fabian

            Not only buy their birth kits, but from a supplier that the midwife has an arrangement with. Very cozy.

      • Awesomemom

        The poor baby was with out oxygen for 20 min, I don’t think things will be going well for her if she survives. I hope I am wrong though.

    • fiftyfifty1

      Nice work officer. It must have been pretty scary to have to do mouth-to-mouth on a just-born, unwashed baby. Some serious body fluid risks there. Wish he hadn’t had to do that, but glad he did because he saved that baby.

    • Anj Fabian

      The eyewitness claims that BOTH the mother and midwife were working on the baby.

      That sounds so odd.

      She also claims that the mother had two previous home births and those went well. 30% chance of needing to do an emergency transfer with baby ending up in NICU doesn’t sound like great odds to me.

      • Amazed

        They were doing their job, she says.

        What a bunch of idiots. I’d think that the mother’s job is to, you know, give birth to this baby, not doing CPR on her!

      • Young CC Prof

        How well could the mother have been resuscitating the baby if the umbilical cord wasn’t cut? I really doubt it was long enough for her to get a good angle!

        • Captain Obvious

          Uh, the baby only did well after the cord was cut and someone who knows a little about resuscitation stepped in. Was there a hint of cinnamon odor when the EMT arrived?

      • Anj Fabian

        Either I’ve been blocked by the eyewitness or she’s deleted her comments. Sorry, I didn’t think to take screen shots.

        • Box of Salt

          Someone posted a link to a news report about it when it first happened (i.e, not the later Facebook report) but I can’t remember under which post.

          When I googled the details, I found the correct source, but the report seems to have been edited since I read it the first time. For accuracy, or just revisionist? I don’t know.

  • FormerPhysicist

    I’m sure she’s right that you are more likely to die behind the wheel. But that’s unadjusted risk. I’m more likely to die falling down my stairs than skydiving, too. But that might be because I DON’T skydive and I climb up and down my stairs 20-40 times a day, and miss a step at least once a month. That doesn’t mean I should skydive instead of walking to my second floor. The stupid, it burns.

  • Jenny_from_da_Bloc

    Now we don’t want facts to get in the way of ideology! How else would we be able.to get all those hormones working correctly! Ugh, idiots

  • Amazed

    Err, if being happy and relaxed is going to give me all those much needed hormones for a straightforward birth, then what the hell should I give midwives a few thousand bucks for? Hold my hand and cheer me on? I have two friends who will be happy to do it for free. Those are the ones I know for sure will do it. I can think of a good deal of others I can ask.

    I can use my friends, have my straightforward birth for free and use the bucks to pay for childcare!

  • Stacy48918

    Gotta love articles that reference “statistics” in the first 2 sentences…but never actually include any STATISTICS!

  • It is appalling behavior .