#FightFear: the hateful truth at the heart of UK midwifery

fight fear

What would you think of tobacco companies if they marketed cigarettes with a campaign entitled #FightFear? Why should people miss out on the pleasures of smoking just because they fear getting lung cancer, right?

Or how about beer companies promoting drunk driving with a campaign entitled #FightFear? Why should people miss out on the pleasures of partying just because they fear killing themselves and others while driving home drunk, right?

Disgusting? Yes. Hateful? Yes. Deadly? Absolutely!

Not if you are a British midwife, apparently. The latest meme to hit the world of UK midwifery is #FightFear. Why should women forgo midwifery care just because they fear killing their baby? Why should midwives forgo promoting “normal birth” just because it leads to dead babies?

Think I’m exaggerating? Think again.

Check out the tweets emanating from a UK conference “Fighting the Fear: Providing positive maternity care in a litigation culture”:

fightfear1

fightfear2

fightfear3

The tweets are hardly surprising considering the nature of the conference. According to its sponsor Birthrights (motto: “Protecting human rights in childbirth”):

“Fighting the Fear: Providing positive maternity care in a litigation culture” offers a day of supportive discussion and reflection about fear of litigation, its impact on maternity care and strategies for overcoming it. We will hear from leading lawyers and midwives in constructive sessions designed to improve understanding, confidence and assertiveness in those who support women during pregnancy and birth…

Speakers include the typical apologists for crappy midwifery care:

… including Hannah Dahlen, Sheena Byrom, Mary Nolan, Alison Brown and Janet Sayers. Fiona Timmins will also join us in the afternoon to offer assertiveness training, with strategies specifically developed for midwives. We will be seeking, and expect to receive, RCM accreditation for the event.

How illuminating and tragic, then, is the juxtaposition of this conference of apologists for deadly midwifery care against the report detailing the hideous stillbirth rate in the UK.

LEADING experts are to tackle the country’s stillborn baby “scandal” which sees 17 infants die every day either near or shortly after birth.

The Royal College of Obstetricians and Gynaecologists is so alarmed at the death toll that next month it will launch a five year project to reduce the fatalities.

The government funded plan, “Each Baby Counts” will specifically aim to halve the number of preventable still births and cases of brain damage. Many of these have been linked to under staffed and overstretched maternity units together with poor quality care.

The first stage of the project will be to build a sophisticated data base of all still births and brain damage occurring during labour. This information will be analysed and the results used to develop national strategies to prevent future tragedies occurring.

The last comprehensive comparative study, a 2011 report carried out by the Lancet, put the UK well down the league table of 193 nations, including some of the world’s poorest countries, on a par with Belarus and Estonia.

It came 33rd of out the 35 high-income countries, with only New Zealand, Austria and France having higher stillbirth rates.

Many of these babies are dying because the midwives who care for them are so anxious to promote “normal birth” that they shun the interventions that would save their lives:

More than half of stillbirths in the UK could be prevented if the NHS implemented additional scans, a leading obstetrician has told Panorama.

Each year, more than 3,000 babies are stillborn in the UK, one of the worst rates in the developed world.

Prof Kypros Nicolaides says offering all women Doppler scans, which measure blood flow between the placenta and foetus, could save 1,500 babies a year…

Three-quarters of a million babies are born in the UK each year. One in 200 dies before birth, mostly to mothers with no known risk factors.

Many deaths are caused by a failure in the mother’s placenta – if the blood flow is abnormal, babies are starved of food and oxygen.

Often the problems occur towards the end of pregnancy, but, if identified, the baby can be monitored carefully and delivered by Caesarean before the placenta fails.

This can be spotted by a Doppler scan, but most hospitals use these only on the 15%-20% of women who are deemed high risk – as per national guidelines.

So let’s see if I get this straight: The UK has one of the worst stillbirth rates in the world and that stillbirth rate could be lowered dramatically by the use of regular ultrasounds even in low risk pregnancies. Meanwhile, UK midwives are worried not about the dead babies, but about the fact that efforts to save these babies will interfere with their mindless and deadly promotion of “normal birth.”

It seems to me that the problem isn’t fear. Fear is the ENTIRELY APPROPRIATE RESPONSE to preventable perinatal deaths. The problem is UK midwives who place ideological purity above the very lives of their tiny patients.

#FightFear should be replaced with #FightUKMidwives who are willing to let babies die in order to protect their professional ideology.

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  • Roadstergal

    Oh god. My UK friend was just talking to me today about how her friend had a great HBAC and the midwives in the area are totally supportive of an HBAC for the pregnancy she’s started the planning process on. WTF is up with these women? I want to be supportive of my friend, but she just parrots all of the NCB bullshit – _that she gets from midwives_. Supposed healthcare professionals. What am I supposed to say to that? How am I supposed to be a good friend?

    These women are evil. Just evil. I’m a goddam atheist, and I think they’re evil.

  • Hannah

    I just moved to the UK… and reading these numbers, along with other previous posts, I’m starting to become grateful I’ll be high risk… all the testing and OB-led care for sure…

  • rh1985

    I truly don’t get this belief/concept that any kind of fear is an inherently bad thing. Most of us probably exist today because our prehistoric ancestors feared and avoided things they knew weren’t safe. Fear and avoidance of dangerous things is evolutionarily advantageous. Sure, not all fear is good, but there’s the fear that’s good and useful, like being afraid of what will happen if you run into the middle of traffic a 65MPH highway. Then there are fears which are neutral if they don’t do anything too bad to someone’s ability to live a functional life, like being afraid of flying but not having a job or a life where flying is at all a necessity. And then there are the fears that are bad and would ruin your life, like being unable to leave the house because you are convinced that if you do, a meteor will drop on your head.

    Given the historic death rates of mothers and children due to complications of pregnancy and childbirth, I’d say fear of a bad outcome and choosing interventions that reduce the odds of those outcomes falls very easily into category one, the fears that are good and make sense and will help keep you and your family alive.

  • micro

    OT:
    http://www1.wdr.de/studio/dortmund/themadestages/Urteilhebammenprozess100.html

    A German midwife and doctor (a self-proclaimed expert in “normal birth”) has been sentenced to 7 years of prison for manslaughter for the death of a breech baby. She delivered the baby in in a hotel room, and did not transfer the mother to hospital, although the mother was passing thick meconium and the birth did not really progress during 17 hours. She lost her license to work as doctor already last year, now additionally she is not allowed to work as midwife anymore (for life).

  • I used to be very proud of my SCM from Cambridge. Now, seeing the depths to which British midwifery have fallen, I’m not so quick anymore to praise it. Very, very sad.
    But, alas, it seems to be only part of something which has gone very wrong in British society. Commentary magazine this month has an extensive article on the Rotherham scandal [ http://www.commentarymagazine.com/article/britains-heart-of-darkness/ ] in which more than a thousand girls were sexually abused but the authorities did nothing for fear of being non-PC.

    • Christina Maxwell

      Antigonos, you should still be proud of it. There are midwives here in the UK doing a wonderful job, in hospitals, without woo. There are also some appalling ones but hopefully the good ones will win out. There are also many of us who would like to see all those involved in the Rotherham scandal hung up by their thumbs and pelted with rotten fruit before being sent to prison for a very long time. When I say many I am talking about a vast, quiet majority, including a lot of police officers who are sickened by the way their hands are tied. The political placemen from a decade or so ago cannot stay in positions of authority for ever… they must retire at some point.

  • Who?

    OT:

    A six day inquest into the deaths of three babies in homebirths in Western Australia is under way.

    http://www.abc.net.au/news/2014-10-01/woman-opted-for-home-birth-after-earlier-trauma2c-inquest-told/5782808

    It’s a depressingly familiar story so far.

    • Dr Kitty

      A 40hr labour in a multip is not “progressing well, if slowly”.
      That old adage about never letting the sun set twice on a labouring woman existed for a reason.
      Poor baby, poor mum.

      • Who?

        Just so sad. And what’s really sad is there was no one in her world-or no one in her world she’d listen to-who told her that.

      • Amazed

        Cases like this one strenghten my belief that insisting that the labouring mum takes responsibility for her birth (aka her dead or injured child) is particularly unfair. She’s IN LABOUR. And sufficiently brainwashed to think it’s all “progressing well, if slowly”. It’s YOUR freaking responsibility to see that it isn’t, midwife!

      • The Bofa, Being of the Sofa

        That old adage about never letting the sun set twice on a labouring woman existed for a reason.

        Yeah, this is a bizarre part. Midwives on one hand claim to use the wisdom of the ages…but then ignore the wisdom of the ages?

        • attitude devant

          Bofa, Bofa, Bofa…. You’re forgetting the Supreme Rule of midwifery: every idea is judged first and foremost by the yardstick of “Is this good for midwifery, or bad for midwifery?”

  • KarenJJ

    Trust your instincts. Unless your instincts are telling you that something is wrong. Then ignore your instincts.

    • KarenJJ

      “Trust your instincts. Unless your instincts are telling you that something is wrong. Then ignore your instincts.”

      Actually I think I need to amend that:

      Trust your instincts. Unless your instincts are telling you something different than the midwife. Then ignore your instincts.

  • theadequatemother

    I find it terribly ironic that for so long the cry has been that OBs fear lawsuits and so are scalpel happy and too quick to do tests. Now the midwives are starting to fear law suits but their solution isn’t overtreatment…its no treatment. Well, other than creating enmeshed relationships with clients so that hopefully they will accept a bad outcome and not sue in the first place.

    Um…how about learning strategies to ensure happy outcomes and then aggressively applying those? Hmmm?

    • That pesky scope of practice rears its head again….most of the proven strategies might be out of scope. Here – have a “drawing” of your baby instead of an actual ultrasound so that you avoid the radiation….

  • Jocelyn

    Oh, there’s a woman commenting at the bottom of my post right now that I want to cuss at, and I don’t cuss. She says that “Threats, horror stories, fear and ‘dead baby’ stories have no place in a supportive, loving birth and pregnancy environment.” http://jocelynandjason.blogspot.com/2014/09/10-reasons-id-never-ever-ever-have-home.html (You might not see her comment at first. It’s at the very bottom. There’s a little blue “Load More” button under the comment box.)

    I seriously want to cuss at her.

    • Sally RNC-NIC

      A) Killer post. Solid work! B) I’m thoroughly, THOROUGHLY enjoying reading the comments. I’m trying really, really hard not to go psycho-nurse on some of these loons!

      • sdsures

        Oh, please do! I’ll get the popcorn.

    • Guest

      Uggghh…I need to step away from my computer! I’m having to restrain myself from replying to every one of those crazy commenters. (I’m not doing a very good job, as I’ve commented my fair share.) I just want to see ONE of them come back with some evidence, something that backs up their position, besides just “well…safety isn’t the ONLY concern.” Maybe not the only concern, but to anyone SANE it should be the top concern!

      • Sally RNC-NIC

        My favorite was the moron who posted: #brainwashed
        A hashtag? That’s your argument? So hilarious!

        • sdsures

          LOL

    • SporkParade

      You, my dear, have the patience of a saint. Keep up the awesome work in the comments section!

    • sdsures

      I’m sharing your post on my FB page!

  • Anj Fabian

    I skimmed through the slide show and stopped at the Sheena Byrom slide.
    She is a member of this FB group
    https://www.facebook.com/groups/Birthineastlancashire/

    The current birth story is a baby with IUGR or as the mother put it, “stopped growing” and she didn’t want an induction. She did get the induction and a healthy baby. [whew]

    September is NICU awareness month and there are plenty of posts about NICU graduates. Some are the usual suspects – preemies and twins. Some are cases which should be very rare if the mothers had gotten proper prenatal care.

    “Thought I’d join in with the NICU awareness month thing!
    This is my Aj, he was born full term in October 2012. He wasn’t breathing and had apgars of 0,2,2.”

    ” He was born 5 weeks and 4 days early at 8lb 6 and was taken straight to
    NICU as he needed help with his breathing and his blood sugars.”

    ” was born at 40+4 weeks. After a nightmare labour, by emergency
    c-section. His size wasn’t picked up during pregnancy, he came into the
    world at a massive 11lb 7oz!”

    “my son was born at 41+4 and didn’t breathe for 6 minutes. He was
    intubated on life support in intensive care for 4 days after being
    diagnosed with HIE Grade 3”

    With less than 1400 members – admittedly a non scientific sampling – I did a lot of eye brow raising.

  • MaineJen

    Pregnant women are “programmed to keep the baby alive?”…well, I should hope so.

    Also…assertiveness training for midwives? #justwhatweneed

    • The Bofa, Being of the Sofa

      Pregnant women are “programmed to keep the baby alive?”…well, I should hope so.

      We wish. Does that mean that my sister had a programming error? Improperly beta tested?

      Because despite how much she wanted to keep her baby alive, it didn’t work.

      • auntbea

        I think she meant emotionally programmed, rather than physically programmed, I was confused too.

        • MaineJen

          Yeah, that’s what I took it as…I thought they were trying to say “Laboring women are programmed by FEAR to agree to interventions just to save the life of their baby.” To which I say…um, yeah. Duh.

          • The Bofa, Being of the Sofa

            Yeah, I guess that’s why I don’t understand it.

            If women are (emotionally) programmed to keep their babies alive, and that’s why they agree to interventions, then, um, what is the point?

            What is the alternative? Altering their programming to make them not keep their baby alive?

            Preventing them from having interventions to save their babies’ lives?

            Sounds like OBs are giving women what they want by offering them those evil interventions!

          • Young CC Prof

            I sincerely hope that most women who are at term with a viable pregnancy want the baby to survive and be safe, enough to go through inconvenient medical interventions to make sure of it. The alternative doesn’t bear thinking about.

  • Sue

    Slightly OT but related – this morning on Australian public radio, there was a discussion about the shaming of women who formula-feed, with the launch of the book “Guilt-free bottle feeding: why your formula-fed baby CAN be happy, healthy and smart”
    http://www.abc.net.au/radionational/programs/lifematters/why-it27s-ok-to-bottle-feed-your-baby/5775278

    One of the callers talked about giving birth in a UK hospital, having a hungry baby and having to sign a form to be given a list of ‘risks’ of formula, before being able to give a small supplement before BF was established. You guessed it – a certified “baby-friendly” hospital.

    This sort of holier-than-thou, bossy ideology has to go. It doesn’t help women. Or babies. And it’s not friendly.

    • Young CC Prof

      Actually, I think the extreme lactivists are taking on some of the characteristics of a denialist movement. Except they’re wrapped in the mantle of the public health authorities, which makes them all kinds of fun.

      Think about it. Anyone discussing downsides to breastfeeding? Uneducated. Even if you’re a pediatrician.

      • SporkParade

        Right now, I’m looking into the ethics codes of various doula certifying organizations (because I understand the need for belonging to one). It is frustrating because even the less ideological ones want to make me promise to never promote products that “interfere with breastfeeding,” including pacifiers. Because clearly babies can’t tell the difference between a nice, milky boob and a lifeless piece of rubber, so we should all ignore that pacifiers are associated with reduced risk of crib death….

        • Joy

          The whole pacifier denial thing is centred around the theory that the babies who died used pacifiers, but they just didn’t have them when they died. I think they all say the baby spit it out, or they just didn’t have it that night or something. So if you never start it, it doesn’t matter.

      • Joy

        Well, that is because they only get like one hour of training in breastfeeding and don’t know what they are talking about because that one hour was sponsored by Nestle.

  • guest

    http://www.washingtonpost.com/blogs/wonkblog/wp/2014/09/29/our-infant-mortality-rate-is-a-national-embarrassment/

    Has this been discussed? More or less confirms much of what Dr Amy has been arguing in various posts.

    • Guesteleh

      I’m saving that to whip out the next time some moron starts bleating about infant mortality.

      Also, I’m completely disgusted that our country allows so many babies to die needlessly.

      • Dr Kitty

        One British hospital has halved their stillnirth rate in the years since introducing Doppler scanning if you check the original BBC article Dr Amy links to.

        • Dr Kitty

          Sorry, this is for Adelaide.

          • Adelaide

            Is my understanding correct in that a Doppler scan during an ultrasound is different than the hand held dopplers used to check heartbeats at most visits? (FYI I’m in the US.)
            Hubby wouldn’t even allow those. We had to listen with a fetoscope even during labor and delivery, because we all know how easy it is to stay perfectly still during a contraction when you are in transition with no pain relief.
            On a side note he didn’t want “us” to have an epidural for dumb reasons like “it will hurt the baby”. I didn’t want an epidural because there was no way I was going to let someone put a catheter in me if it wasn’t absolutely necessary, and I was a little bit worried about getting a botched epidural that left me with sever headaches for weeks.

          • Dr Kitty

            Third trimester Doppler ultrasounds that we’re talking about look at the blood flowing in the umbilical vessels, and often represent the flow with colours. This is usually an additional function on a standard modern Ultrasound scanner.

            “Doppler” is the effect of a wave changing frequency when an observer moves relative to its source. Like an ambulance siren change when it comes behind you and then overtakes you and drives away.

            The Doppler heart rate monitors “hear” the blood flow past the probe and turn it into a sound, and are actually pretty low-tech. The Doppler US scanners “see” the flow past the probe and turn it into colours, which is pretty hi tech. Both are completely harmless.

            http://en.m.wikipedia.org/wiki/Doppler_effect

          • Joy

            Now I am sure I had that on my 20 week scan. I know that there were different colours and they checked how the blood was flowing through the kidneys and everything.

          • lawyer jane

            Adelaide – It worries me a bit the way you talk about your husband allowing/disallowing things having to do with your baby’s health. I’d recommend seeing a counselor to work this out, and remembering that you have a responsibility as a mother to take care of your child’s health as you see fit – especially when it comes to things like vaccines. I have faced some similar issues in my relationship and I’ve ultimately just had to pull rank and do what I thought was best. You need to listen to your mama bear instinct sometimes (and your doctor too, of course).

          • lawyer jane

            Oh, I just read your update below about your cultural views. I’d recommend taking the path of least conflict that gets you what you want – healthy baby, healthy kids, and healthy you. If that requires a certain amount of deception, so be it. I think you’ll find that medical professionals will really try to help you in this endeavor.

      • guest

        There was someone on the FB post I found this on who actually said something like “I’ll tell you why, US OB care and L&Ds!!!” with multiple likes. Clear NCB reading comprehension, if those people even bothered to read the article.

    • Dr Kitty

      That article doesn’t look into the causes of death in detail.
      I’m sorry to say this, but many of those babies do not die of natural causes.
      Compared to other developed countries the USA has very high rates of deaths caused by child abuse and neglect.
      improving access to healthcare is only part of the puzzle.

      • Young CC Prof

        True. However, reducing economic and mental stresses on poor families may help substantially.

        • Roadstergal

          I think it absolutely needs to be both. Access to long-term reversible birth control, and all of these dealios with better wages, more predictable hours, maternity and paternity leave, and reasonable accommodation for pregnant women that people have been protesting about.

          One might even call that ’empowerment.’

        • Dr Kitty

          It may.
          Although abuse is not solely a problem of deprivation.

          • The Bofa, Being of the Sofa

            Yep, even rich NFL players are guilty….

      • lawyer jane

        I wonder about the correlation with birth control and access to abortion. Wanted babies may be healthier babies.

    • lawyer jane

      Those are truly awful stats. What causes the increased infant mortality for lower income people in the US? Smoking? SIDS due to unsafe sleeping? Prematurity due to poor prenatal care & maternal health? Accidents/abuse in substandard childcare?

      • Smoochagator

        I cannot offer specific citations because it’s been a long time since I read this, but I once heard that the number one risk factor for a premature baby is maternal stress. It’s even riskier than SMOKING. For women in poverty, the stress in pregnancy is off the charts, especially considering that she might have a poor relationship with the child’s father, and no familial support system, no health care to speak of, may lose her job because she’s pregnant or be unable to find good childcare so she can keep working, etc. I imagine that the same risk factors carry over into the child’s first year. Even if the child receives free health care from the state, that won’t change the fact that mom may be unable to get time off from work or find reliable transportation to take her baby in for well child visits & routine immunizations, let alone for treatment when he/she gets sick.
        The marginalization of poor women and children in the US *is* truly awful.

  • Adelaide

    Use of ultrasound technology has been a huge point of contention between my husband and I. (He buys into the woo in a big way.) Do you have any references for “stillbirth rate could be lowered dramatically by the use of regular ultrasounds even in low risk pregnancies.”

    • Sue

      Or even ”sound waves don’t harm babies”?

      Two main counter-arguments to those who claim it causes harm:
      1. Audible sound waves penetrate the uterus also – that’s why some people think babies recognise the voice of their parents; and
      2. Any temperature-rises from the sound wave energy are short-lived, and no more than having a fever. (There are studies on this)

      • Amy M

        Also, the sound waves are at a frequency beyond the range of human hearing….we can’t hear them and neither can fetuses.

        The type of radiation from ultrasound is not the same as ionizing radiation like from uranium. Sound waves are not ionizing and won’t cause cell/DNA changes.

        • The Bofa, Being of the Sofa

          It is true that ultrasonic “irradiation”* can lead to extreme local heating (“cavitation”). It’s well known, and used very regularly labs for that purpose. It is effective in heating processes to increase rates of slow processes and it is very effective for cleaning. I’ve used it myself, even.

          Those who oppose USs often refer to this as an indication that it COULD still cause problems.

          Of course, it’s complete nonsense, because the one thing that is not mentioned in my description above is the POWER being used. Ultrasonic heating and cleaning uses really high power densities to create those spots of localized heating, while US imaging uses trivial power.

          *Recall that sound is actually a longitudinal wave resulting from compression, which has no relationship in any way to electromagnetic radiation, so calling it “irradiation” is pretty much a misnomer. Acoustic waves are not light.

          • Adelaide

            Thanks for the info on cavitation. My husband was sighting a study about that being a problem, but I could never find it myself. Do you know of any references to studies that would refute that point?
            I also know that one thing floating around the over-the-top NCB community is that ultrasound technology is unregulated, untested, and often uses very high levels of exposure. It is so hard to find accurate information because so much is tainted by what people want to be true instead of facts.

          • The Bofa, Being of the Sofa

            Do you know of any references to studies that would refute that point?

            Look up sonication on wikipedia, and it talks about how you need high intensities to get cavitation

          • Adelaide

            Thank you!

    • Young CC Prof

      The place where ultrasound really shines is when the baby is anatomically normal, but there is a problem with the umbilical cord or placenta that threatens the baby and, in some cases, the mother. This happens surprisingly often. As long as the doctors know about it, it can be managed by early delivery, scheduled c-section, or just extra monitoring during labor. Those are the cases where ultrasound turns a tragedy waiting to happen into a rapid happy ending.

      An ultrasound at 32 weeks probably saved my son by identifying his slow growth, which was caused by his placenta breaking down. He was delivered by 37-week c-section, and his placenta was close to total failure. He never would have survived to his due date.

      • Smoochagator

        Why did they do an ultrasound at 32 weeks? I ask because I’m confused as to whether this post (and the BBC article linked) is advocating more standard u/s scans? In my first two pregnancies, I only had a dating u/s at the beginning and an anatomy scan at 20 weeks. In this pregnancy, I’ve had four, the last one at 22 weeks because the tech was unable to get good measurements of baby’s brain at 20 weeks. My doctors haven’t recommended any scans in the third trimester, but I’ve had friends who measured very big or very small and had hypertension or diabetes and for those reasons had frequent ultrasounds and non-stress tests in their last trimesters.
        So – is the issue in the UK that doctors aren’t running tests when they are indicated by low-tech warning signs?

        • Young CC Prof

          A lot of doctors ARE now doing routine 3rd trimester ultrasounds, specifically to catch stuff like that.

          • Smoochagator

            Good to know!

      • Adelaide

        Young CC Prof. Thank you so much. That exact piece of information was what I was looking for. I would still be interested if anyone has references to exactly how often 20 week or 32 week ultrasounds improve out comes in otherwise low risk pregnancy.

        Just a little background… My CNM insisted on an ultrasound with my first (of now three) because I was measuring small. My husband forbid me from having one. No CNM or OB could give him a reason good enough for the ultrasound. I know many of you will object to this, but due to cultural reasons I generally always try to submit to his wishes.

        This time was different. I was under extreme duress with my practice ready to fire us as patients and we were already driving over an hour to go to the only all female practice we could find. They were berating me for talking to my hubby and he was berating me for even considering an ultrasound.

        I had the ultrasound alone. The tech was amazing. To this day her compassion almost brings me to tears. She talked me through the ultrasound and after I explained my husbands objections she only used it for several quick pictures and one longer spell to listen to the heart beat. She was amazing. All I could think of was how amazing the techs methods were. What a wonderful happy medium between long continuous ultrasounds and no ultrasound at all.

        I thought my husband would be thrilled I was able to get the ultrasound we needed with less than 2 minutes of ultrasound “exposure”. He wasn’t. He was furious. The info came back that our baby looked well proportioned and the cord and placenta looked fine, but our baby was too small.

        In the end we had a healthy baby, after a spontaneous 37 week delivery, a NICU stay, and about a million fights, but the experience left my husband even more immersed in the woo.

        • Dr Kitty

          I’m sorry for that experience.
          It must be so hard for you to juggle your desire to take care of your baby and your desire to respect your husband’s wishes when there is conflict between the two.

          I’m saying this out of love and concern for you.
          A marriage where you do not feel free to disregard an irrational and dangerous request, when you know it is irrational and the danger is to your child is concerning.
          Because then that request begins to sound like an order.

          Even soldiers can refuse to obey illegal and immoral orders.Being asked to ignore medical advice and endanger your child, against your own judgement, could be argued to be immoral.

          I’m sorry, not my marriage, not really my business. Please don’t be offended, I know you are doing the best you can.

        • toni

          I’m sorry for your predicament also. I have a controlling, often unreasonable, easily enraged husband and every day is such a struggle, I get so tired of trying to keep the peace. He’s never tried to keep me from getting healthcare though! (He works in the medical technology industry so that’s not something I would ever expect lol) I doubt you took any vows saying you would obey him in putting you (and your children) in danger? That is a dereliction of duty on his behalf. You mustn’t let him stand in the way of your physical wellbeing. Let him sulk!

          If you were in a car accident and needed an x ray to see which bones were broken would he try to stop you getting it? And if he did object what would you do? Tell him to get knotted I hope.

    • Amy M

      I have twins, so clearly I was considered high risk which is a whole
      different ball of wax. But because of the twins, the OB was monitoring
      for TTTS, so I had probably 10 or so ultrasounds throughout the
      pregnancy.

      My boys didn’t develop TTTS (or if they did, it was very slight and near the end) and are now happy, healthy 5yr olds. One is left-handed (I heard something about u/s possibly a factor in left-handedness), but both of their grandpas are lefties also, so who knows how that happened. They never had any developmental or cognitive delays, and were born 4wks early, due to being twins. They just started kindergarten and I swear that neither one has an extra head or anything.

      In our case, the ultrasounds were there as a monitoring tool, just like they would be in a low-risk case, only more often. Evidently, no harm was done.

  • auntbea

    Are we using a different measure of stillbirth here? Because the CDC reports a stillbirth rate in the US of 6/1000, while the linked article says stillbirth in UK is 3.5/1000.

    • Joy

      The US counts stillbirth from 20 weeks, the UK from 24. Before that in the UK it is considered a miscarriage and not a live birth.

      • MaineJen

        I had thought that a baby born before 23-24 weeks was not considered viable. Has that been changed? 20 weeks seems…unrealistic.

        • Young CC Prof

          It is unrealistic in that very few of those babies could have been saved, but it’s still the way it’s measured.

          There are actually all sorts of stillbirth definitions. Some use 20 weeks, some 24, some 28. Researchers like to keep people confused, I guess.

        • Joy

          It does, but that is what the US does. http://www.nih.gov/news/health/dec2011/nichd-13.htm

        • NXTangl

          Oh, that’s intentional. It’s to give women a smaller window in which they may legally get an abortion. This practice considered necessary because, here in America, we think that the best people to make decisions about the lives of young women of various races is old white men who flunked out of sex ed.

  • araikwao

    Wow, this evoked a really strong, visceral response for me.
    For one thing – fight fear? I remember feeling absolutely terrified during my son’s birth because the pain was so overwhelming, and I felt so alone in it (even though I wasn’t physically). If I had been able to let go of the MWs “real women give birth unmedicated” ideology, maybe I wouldn’t have been so fearful.
    And now they are dismissing maternal satisfaction?? I though NCB was (according to them) what women wanted? So it’s really ideology at any cost, isn’t it?

  • Amy Tuteur, MD
    • Susan

      Seductive. Bullshit.

    • DaisyGrrl

      Slide 15: “Knowing about human rights helps make clear where responsibility lies when a woman makes a choice that goes against guidelines #FightFear”

      Wow. Let me translate this one: we will use the rhetoric of “human rights” and “choice” to blame the mother for any bad outcomes and avoid accountability. Never mind whether we actually informed women of why the guidelines were instituted – that’s not the issue. #humanrights #educateyourself #ownyouroutcome

    • D/

      Slide # 23: “Calming our Fears”

      Most NICU invitations are for higher-risk deliveries. Even in those circumstances the prospect of being in attendance at birth was a truly fearful event for me on exactly three occasions out of 16 years. All were maternal transfers in labor by standard ambulance who were too high risk to choose to deliver at our then Level II facility, were considered stable enough to make the 30 minute trip to a higher care facility, but required a NICU nurse in attendance for the what-if scenario.

      My “fear” in those instances was not misplaced. Had I actually been required to resuscitate any of those babies on the side of the interstate in the back of that well supplied ambulance with 2 paramedics immediately available, I would have been in an only slightly improved position from a midwife at home. Guaranteed *at best* to be a hot steaming mess!

      If only I’d known to knit for those rides …

      • Guesteleh

        That slide just blew my mind. They seriously, no kidding, suggest knitting during birth to calm your fears. Other suggestions: Have a cup of tea, centre yourself with affirmations such a “trust in the process,” shed the fear and do not carry it with you to the next birth.

        • Guesteleh

          Slide 37: “We have guidelines but we are v willing to compromise. Is challenging to work outside them- others think we are being reckless”

          Slide 45: “Honesty trumps sugar coated bullshit” Orly???

          • KarenJJ

            “Slide 45: “Honesty trumps sugar coated bullshit” ”

            Sure, except when it’s a “dead baby card”…. Then you need to sugar coat away..

        • Young CC Prof

          Or, you know, you could listen to those fears and take action to prevent problems. But perhaps that’s just way too radical.

          • D/

            I came to the Nursery/ NICU as a graduate nurse after a complete turn-over of staff and before the Neonatal Resuscitation Program was even started. My “experienced” preceptors on the night shift had graduated only one year before me, experienced their first resuscitations as baptisms of fire, and did everything possible to share every one of those hard lessons with me.

            If I left for coffee during a down time, I would come back to an unannounced “dead baby drill”. Walk into the nursery with cup in hand to find a baby drawn out on scale paper lying on the warmer … Here’s your scenario … What are you going to do? … Where will you find what you need? … Do you know how to use it? …. Get it out and let’s handle it!

            This was very low-tech version of our resuscitation simulations of today with full-blown codes on mannequins and video debriefings. I absolutely credit those two nurses and everything that had scared them with making me a much better nurse than I would have been otherwise.

  • Ardea

    Off topic but here is a class being offered through Coursera: Childbirth, A Global Perspective, about a six week course staring October 1. It would be interesting to hear your voices and reactions to the material.

    • Young CC Prof

      I so do not have time. I so signed up anyway. All your fault.

      • Ardea

        The best part is that it’s free and you can hit the “un-enroll” button at any time…

        • Karen in SC

          I’m trying it, too. thanks!

  • moto_librarian

    Okay, homebirth/midwifery advocates: Time to face facts. Even in countries where midwives are well-integrated into the system, they still have appalling rates of perinatal mortality. The Netherlands, the UK, New Zealand – all of these nations are coming to the realization that physiological birth kills. And what are the midwives in these countries doing? Closing their ranks and protecting their turf. Can someone explain to me how this utterly callous attitude towards women and their babies demonstrates that midwives are “with women?”

    • KarenJJ

      “Can someone explain to me how this utterly callous attitude towards women and their babies demonstrates that midwives are “with women?”:”

      That’s exactly what I want to know. Why are midwives trying to manage another woman’s feelings instead of reassuring her through testing and evidence? ie “baby is doing fine in there, I checked the EFM strip” – which is what my obgyn did when I showed up in labour with meconium – my main fear abated quite nicely after that! Much better than being told to bloody well knit and ignore my fears….

      It’s so close to the old “women are just being hysterical” attitude from health care professionals of old.

      • Young CC Prof

        Exactly. If I express a fear to a healthcare provider, the one thing I absolutely do not want to be dismissed. If my fear is unreasonable, give me a reason why it’s unreasonable. If my fear is reasonable, believe it or not, I can actually deal with a certain degree of fear and NOT shrivel up into a raisin or something.

      • Amazed

        And what would they suggest to someone like me who can’t knit, can’t sew, and abhores tea and milk?

        Actually, I am much more soothed by writing stories and live in the world I create in my head for them. Think they’ll let me have my lappie over there?

        Well, given the fact that midwives claim the IV lines get tangled, I imagine they’ll take my electronical comforter away. Plus, if I prop it against my belly, heat can hurt baby!

        • KarenJJ

          I quite like soldering. Perhaps I can take a soldering iron in and a PCB.

          • Amazed

            OK, if you happen to be in labour any time soon, give me a call, would you? I’d like to place a small order with you. The greatest comfort ever! And I’ll give you a discount! You’ll be soothed, I’ll be served, baby will come earthside happy and calm. See? Win for all!

      • The Bofa, Being of the Sofa

        Why are midwives trying to manage another woman’s feelings instead of reassuring her through testing and evidence? ie “baby is doing fine in there, I checked the EFM strip” –

        When I was hanging out in the monthly boards at WTE, I knew women who would rent their own dopplers just so they could check the heatbeat every day to make sure everything was still fine. They would try to find excuses to get an US just to make sure everything was ok.

        They said that we were lucky because we got have an early US. I told them, you are crazy if you think that having to get an US because of unusual bleeding, with a diagnosis of “Abortion – threatened” is “lucky.” It was the scariest time of either of our pregnancies, and I hope no one has to go through that. But that’s how desperate they were for assurance. Not “don’t worry your pretty little head” assurance, but “Yep – everything looks good”

    • SporkParade

      But is it all countries with midwife-based systems, or just English-speaking ones plus the Netherlands (which is culturally pretty similar in many ways)? I suspect, based solely on anecdote, that these countries are more prone to woo because they are wealthier and have forgotten that nature is less a mother and more red in tooth and claw.

  • Dr Kitty

    Surely a more accurate representation of NCB ideology is
    “Feel the fear… and do it anyway!”

  • Amy M

    How can anyone read those tweets and NOT see these people as total psychos? It is amazing to me that they are willing to be so public with their idiocy and that there are so many of them! Discourse of risk fosters dependence? Whaaaaa? Let’s just pretend there’s no risk, and then those gullible women won’t depend on…doctors/lawyers/drugs/? They should be just as upfront about what they believe is the measure of success, so at least they can claim informed consent.

    Hey pregnant lady, you want to contribute to my birth drive? I’m trying to get to 500. 500 healthy babies? Oh no, 500 vaginal births. I get bonus points for breech twins delivered at home to a mother who had a previous cesarian, GD, pre-e and pre-pregnancy hypertension.

  • Comrade X

    I’m actually trying to think of any other area, aspect or specialism of health care in the UK where practitioners would think that this was a remotely acceptable way to talk and think about patients and their conditions.

    Who cares if cancer patients actually survive? Who cares if they are treated with dignity and respect and have their pain treated? Who cares if heart surgeons are operating on their critically ill patients using the most up-to-date skills and procedures? Why should I give a shit about being sued if I royally fuck up the care of a guy with a broken leg? I don’t want to have to FEAR that stuff. Lets have some workshops to train you in how to be assertive against both patients and other medical personnel when they demand you do your fucking job, because how dare they and who do they think they are?

    It would be unimaginable. It’s completely insane. Absolutely nobody would tolerate it.

  • Comrade X

    Yes, bugger those pesky “outcomes” and “maternal satisfaction”.

    Who the hell are these bitches who want to be safe and pain-free and go home with healthy bouncing babies? Fuck ’em all.

  • Dr Kitty

    Grim, just grim.
    BTW standard of care in the UK for a low risk pregnancy is US at booking and anomaly scan at 20 weeks. The end.

    Doppler costs £15 if done at 20 week scan (except it doesn’t, if you already have the right type of scanner, because it take 5 minutes and with all due respect a radiographer’s time is not worth £150/hr).

    It costs 50p to individualise a growth charts, BUT it assumes that the weights of previous pregnancies were ideal, and that none of your previous babies were smaller than they ought to have been because of mild undiagnosed placental insufficiency.

    I think standard of care should include Doppler at 20 weeks and a third trimester US at 32-34 weeks. THAT is how you decrease stillbirth rates.

    Personally if the stillbirth rate is decreased by 50% at the expense of a CS rate of 35%…. Who cares.

    • Mishimoo

      I’m shocked that doppler scans aren’t standard procedure in the UK. It’s the norm here (Australia), same with ultrasound growth charts. As far as I know, we don’t have the scans at 32-34 weeks in low-risk pregnancies, but I think they should be brought in.

      • KarenJJ

        I had one 34 week scan with my eldest in Australia (checking on location of a previously detected low lying placenta) and didn’t get an ultrasound at 34 weeks for my second baby. I really missed the reassurance of that 34 week scan with my youngest.

        • Mishimoo

          I had one at 38 weeks with our second to confirm a breech that my CNM had detected. Then had another one the next day to confirm that bub had flipped back down into a cephalic presentation when we saw an Ob/Gyn for an external version. She took one look at my belly and said “I think that baby has flipped back down again, but let’s make sure that everything’s okay.” It was really reassuring!

        • FormerPhysicist

          I was in a minor car accident around then. Standard of care including a trip to the hospital, 4 hours on the (contraction?) monitor, an US and I think something else. Probably not worth people deliberately braking in front of an idiot.

      • Dr Kitty

        I got a scan at each appointment with my private OB.
        That mattered to me, and meant I never needed a vaginal examination, because he could see my cervix was long and closed on the scan.

        Having done antenatal clinics with scanners which were older than I am, and which were almost impossible to interpret (before they brought in the only two scan policy, when we still did scans at each visit) my feeling is that this was a way of cutting costs by not replacing obsolete equipment.

      • Karen in SC

        What we really need is an improved imaging technology that can see it all, including fit through the pelvis. Any biomedical engineers here?

        • Mishimoo

          That would be awesome!!

        • Young CC Prof

          As I understand it, you really need x-ray to properly see the shape of the pelvic bones. Which is obviously not a good choice.

      • araikwao

        I was surprised and disappointed to find that my local hospital network no longer provided the 18-20 week anatomy scan during my last pregnancy (2012). I paid privately for that one, (and a 3rd trimester one given some family history). Call me crazy, but I’d kind of like to know if there are any abnormalities so we could deliver in the hospital with the appropriate level of care. I don’t know what happens to the people who don’t have the means to pay for the anatomy scan.
        I don’t know anything about US growth charts, either…

        • Mishimoo

          Oh wow! Maybe we’re in different states? I’m in Qld, and had dating scans, 12-14 week scans, and 20 week scans with all of them (last born in 2013). The first two were through my GP, the last ones were through the hospital. The youngest also had a scan at 24 weeks as the experienced sonographer couldn’t properly view the LVOT at 20 weeks, and wanted to be sure everything was okay.

          We got to be guinea pigs at the 24 week one! The trainee sonographer got to learn and practice how to identify/image the LVOT on a wiggly foetus, as well as identifying the internal and external os, measuring how far away the placenta was, and playing with the 3D scanner. It was really cool.

          • Young CC Prof

            I wound up having a total of about 10 scans, most of them BPP + doppler after I got bumped to high-risk. And there was a student observing at most of them! Sometimes it was a sonography student, sometimes it was a medical student. Having the student there was kind of fun, and it meant the experts explained what they were actually doing and looking at.

          • Mishimoo

            I love having students around. It’s really fun, they learn things and so do I.

          • araikwao

            We are in different states 🙂 I got exactly zero scans in my last pregnancy (via the hospital), although perhaps it fits in well worth my local hospital network’s cost-cutting initiative (I work for them,so I promise you this is real – they like staff to c chime in with different ideas for saving $$)

          • Mishimoo

            Oh, I know. Funding is a bit of a mess thanks to bureaucratic nonsense, it needs to be fixed. I just don’t want to lose my social healthcare!

          • araikwao

            I once had to be treated in QLD in a rather urgent situation, at RBWH, and they were utterly fabulous. If that experience is representative of healthcare in QLD, then your state is particularly awesome!

          • Mishimoo

            I’ve had hospital-based care in two states and I greatly prefer my current one. The wait times are pretty equal but the professionalism and empathy are generally much better here*.

            (Excluding the rural hospital where I had a miscarriage)

            The only thing that my old state (WA) did do better was provide access to a rheumatologist who finally diagnosed my joint condition. He was a bit cranky during my appointments, even though I’ve since read online that he’s the nicest doctor ever, so I think it was because my mother was into the woo at the time and probably has NPD.

    • Joy

      I thought I had a doppler scan at the 20 week U/S, but maybe not? I agree a third trimester scan is good practise. It would be one thing if you saw the same midwife each time, so she measured your stomach from the same point. I never saw the same one twice, so who knows if they all measured it the same way. Not that the measuring tape is all that accurate anyway.

    • Young CC Prof

      In the USA, the standard of care is moving toward a third-trimester US for all pregnancies, in a proper American fragmented and disorderly sort of way. Most insurances still don’t cover it, but my OB likes 32-week scans and has an unofficial policy of finding a risk factor to justify it if possible.

      • Karen in SC

        I got one. I think it might have been for advanced maternal age. Or suspected big baby. Memory is fuzzy. I think I was able to go back to my RE’s office, too, and the techs were thrilled since they usually only see egg sacs and brand new pregnancies.

        They estimated the baby at around ten pounds. I was into the woo then and did not even think of discussing a c-section, though if given a choice or a recommendation, I would have consented immediately. Ended up being 9 lbs and I did need an episiotomy.
        Which was okay, it was after a long time pushing and I was begging for the vacuum.

    • Montserrat Blanco

      In Spain the standard of care includes a third trimester US for all low risk pregnancies. When mine went from low risk to very high risk due to severe preeclampsia I had three US per week.

    • SporkParade

      That’s horrifying. In Israel, the standard is a 1st trimester dating scan, NT scan, anatomy scan (2 anatomy scans if you have supplemental insurance), and a 3rd trimester growth scan, even for completely low-risk pregnancies. Furthermore, all the GYNs I’ve seen have had ultrasound machines in their offices and will do quickie ultrasounds at all prenatal visits. Not to mention that fetal monitoring including ultrasounds cost about $3 (the fee is waived if they find contractions or a problem), and it’s free if you are going because you are post-term.

    • toni

      How do they know what position the baby is in before the birth without an ultrasound? Can you just tell that from looking at/palpating the abdomen?

      Two scans is so miserly! I had at least six.

  • lilin

    At this point it’s not even process over outcome. Process over outcome would be #fightfornaturalbirth

    It’s a style, a fashion, an attitude, a mindset. “We’re not afraid! And we don’t need your rules!”

    It reminds me of the No Fear! skater t-shirts they used to sell. Which is fine if it’s a t-shirt. It’s not so good if its a medical procedure. They really don’t get that some people are dealing with reality, not how cool they look on twitter.

  • staceyjw

    Please tell me what other measures matter, outside of outcomes and maternal satisfaction? All the NCB, avoided CS, VBACs, breech, water births, refusals for induction, etc, mean NOTHING if there are dead, damaged, traumatized babies and moms because of it.
    Only a woo filled MW would think this way. They are all about Process over people.

  • Roadstergal

    Okay, I looked up the Elixhauser and Wier reference. The reference did not say that 94% of births had some sort of complication. It said that 94% of births had _pregnancies_ with some type of complication listed. The footnote notes that ‘complications’ was very broad, and lists some examples.

    http://www.ncbi.nlm.nih.gov/books/NBK56037/

  • Christina Maxwell

    Amy, thank you, thank you thank you. I have been whining about the state of maternity care in the UK for years. It is ruled by ideology and women and babies come a very, very distant second. I am about to become a grandmother for the first time and my daughter is one of the lucky few who is getting a decent standard of care… she is only getting it because she is at slightly higher risk than the norm. The midwives she has met have ranged from wonderful, informed and not-woo to totally idiotic.

  • no longer drinking the koolaid

    I love this one: “The evidence is not god. We need to bring more evidence to the fore.”
    It should read something along the lines of “We don’t believe in your evidence because it proves us wrong. We’ll use our own evidence so we can be right.”

    • Amy M

      “We reject your reality and substitute our own!”

      • namaste863

        Ha, ha! Go Mythbusters!

        • Amy M

          You know, i think someone else actually said it first, but I don’t know who. I’ll have to look that up…

  • Guesteleh

    What’s up with the slide that reads 94% of U.S. births reported as having some degree of “complication?” Are they talking about active management of the third stage as a complication?

    • guesty

      They have no idea either…

    • Amy M

      Maybe they include any use of an ultrasound as a complication?

      • Stacy48918

        or an epidural

    • Roadstergal

      They misrepresented what that study said (see above). Hell, the very first summary bullet point in that survey was “Among the 4.2 million deliveries in 2008, 94.1 percent listed some type of pregnancy complication.” This isn’t my field at all, but from the footnote, it seems like some decent bouts of morning sickness would get you on that list.

      (The survey was just looking at the drivers of costs in maternity care. It wasn’t a great survey, IMO, as they defined ‘complication’ in pregnancy in such a broad way that it didn’t really usefully break out the population… they did find that older women had more non-delivery hospital stays and more complications in pregnancy, surprise surprise.)

  • The Computer Ate My Nym

    It came 33rd of out the 35 high-income countries, with only New Zealand, Austria and France having higher stillbirth rates.

    Um? How can it come in 33rd out of 35 high income countries in stillbirth rate and yet have three high income countries have higher stillbirth rates? Was one of those countries tied with the UK?

  • The Computer Ate My Nym

    “As long as the medical profession will support evidence lawyers will use it.” What? So we should hide the evidence of what does and does not improve the health of women in labor and their babies because lawyers might use it? Use it how? To document that the patient has a legitimate grievance perhaps?

    • lilin

      Maybe they left off the ending bit, which reads, “and that’s how it’s supposed to work.”

      If there is evidence that doing something causes an unnecessary danger, and lawyers use it to either sue for damages or make laws to prohibit it, that’s the system working exactly the way it should!

      It goes to show how deluded they are that they think this is an injustice and actually advertise it as something that needs to change.

  • anne

    “sees 17 infants die every day either near or shortly after birth.” How can you be against preventing that?

    • Zornorph

      But some babies are just meant to die.

  • DiomedesV

    The idea that pregnant women are “programmed” to keep a baby alive at any cost to self is simply false.

    Mothers have evolved to balance the needs of a current pregnancy against the needs of already born children and the possibility for future pregnancies. This is why mothers routinely abort pregnancies that threaten their own health and the financial security of their families. Parental investment theory is the area of evolutionary biology that deals with these tradeoffs. It certainly does NOT predict blind devotion to a current pregnancy to the exclusion of all else.

    The idea that a mother *should* keep a baby alive at whatever cost to herself is not only biologically inaccurate, it is harmful to mothers and their
    families.

    I agree with DaisyGrrl that this was probably a dig at C-sections. But by the time the baby is term, the mother has invested a great deal physically and emotionally in the pregnancy. It is not at all surprising that mothers will opt for a C-section when they perceive a threat to their baby, especially when families now routinely have fewer children (e.g., 2-3) than at previous times in the evolutionary history of humans.

    A good place to start to learn about parental investment theory is actually wikipedia:

    http://en.wikipedia.org/wiki/Parental_investment

    • SuperGDZ

      I think they may be using “programmed” in the sense of “indoctrinated” (by the evil doctors).

    • DaisyGrrl

      That link took me down a wikipedia rabbit hole!

      And while I think they mean programmed more in the sociological sense, it’s still an incredibly stupid statement. I think the overwhelming majority of women in today’s society, faced with a term pregnancy not going well, would choose the course of action that maximizes the chance of everyone surviving intact. That’s not a bad thing.

      I’m in my mid-thirties and have not had a child yet (who knows if it will ever happen). Considering my age, I would go to great lengths to ensure the survival of a baby should I become pregnant and carry the baby to the point of viability. Because, as you said, I would have to consider the potential of having another baby, the non-existence of other children, and whatever investment I’ve put into getting and staying pregnant in the first place. I only want one or two pregnancies, so there’d better be a live baby at the end.

  • DiomedesV

    I don’t understand the tweet that complains that the measure of success is outcomes and maternal satisfaction. What the hell else is there supposed to be?

    • toni

      They think a lack of interventions in and of itself is a success. The baby can be battered and bruised and mother torn every which way but if there was no c section they pat themselves on the back. I have read their forums. Or rather the forums of their students.

  • PrimaryCareDoc

    I’m so confused by the tweets about “evidence.” They make it sound like evidence is a bad thing.

    • mostlyclueless

      For NCB advocates, it is.

      • lilin

        Exactly. Imagine if a defendant said that in court.

        “But your honor! All this evidence makes me look guilty and that’s bad for me! You have to make it so the evidence gets taken away!”

        • FL

          Actually, that happens all the time!

    • staceyjw

      They believe in “other ways of knowing”, and praise the non-rational. This would be fine if they didn’t throw out actual evidence, and if it didn’t have such deadly outcomes.

  • Cobalt

    Pregnant women are not “programmed to keep that baby alive whatever the cost to herself”, not physically, mentally, or emotionally. If they were, there would be no preeclampsia/eclampsia, no abrubtions, no fetal alcohol syndrome, no babies born addicted, no abortion or selective reduction, no babies abandoned, no HELLP syndrome, no prematurity, and no need for cesareans because the pelvis would just break itself open to get the baby out.

    Biology is, in theoretical terms, an exquisite and elegant dance of myriad complex interactions that produce the precise results necessary for life to exist. Nature, which is the practical application, is a brute that only strives to get it right often enough that the game doesn’t end.

    • Roadstergal

      That Tweet bothered me on a lot of levels. You captured one level perfectly. In addition to that – it feels very anti-choice-y (maybe just because I’m American), and also smacks of guilting moms out of epidurals and the like.

      • DaisyGrrl

        I felt it was more of an attack on c-sections. Since the natural-birth-at-all-costs types seem to think that OBs play the “dead baby card” in order to dupe them into having a c-section so the doc can get to his golf game.

        But yeah, my jaw dropped when I read that tweet. I think that most women nearing the end of their pregnancies are going to be willing to pay a pretty high price for a living baby. Yeesh.

        • Roadstergal

          Yeah, I wondered about that when I read it, too. “Why do I have the feeling that they consider a C-section scar a cost too far?”

      • namaste863

        Based on what I’ve read, women in the UK are routinely tricked out of epidurals using stall tactics. Apparently it goes something like this:
        Laboring woman: “I want an epidural!”
        L&D midwife: “You aren’t dilated enough. Let’s check you in an hour, see how you feel then.”
        An hour later
        Laboring woman: “Okay, it’s been an hour, can I get my damned epidural now?”
        L&D midwife: “I’m sorry dear, we can only check you every four hours.”
        Three hours later
        Laboring woman: “Okay, NOW can I get my fucking epidural?”
        L&D midwife: “I’m sorry dear, it’s too late for that.”

        • Roadstergal

          Wow, that’s awful. 🙁

        • sounds like the Netherlands… it actually happened to a friend of mine!

        • Christina Maxwell

          Yes, that is absolutely how it is and has been for more years than I care to remember.

        • MaineJen

          I’m remembering back to my first labor, how painful it was and how scared I was and how I actually remember thinking “Wow…wouldn’t it be easier if I just died right now?” I would be so angry at these stalling tactics. Shame on them.

  • Susan

    You know Dr. Amy you really do get to the heart of it. These people are so lost. The lawyers will use the evidence? You bet they will! But that isn’t reason it hide it. These people are gross. Revolting lack of ethics. Thanks for what you do. Tell the truth, do the right thing…. do the safest thing even if it doesn’t comply with your screwed up wordview. These people are just nuts.

    • staceyjw

      We NEED lawyers. Malpractice suits may sometimes some happen for BS, but without them, parents of hurt babies or moms with damaged bodies would have no recourse. IN the US lawsuits keep docs following evidence. After all, suits are filed when things go badly, not when everyone is alive and healthy.

      • Susan

        Agree on that. Hope that was clear. My point was that the fact that lawyers will have the same evidence we do is not a reason not to look for evidence or worse yet to hide it.

  • Roadstergal

    “Fiona Timmins will also join us in the afternoon to offer assertiveness
    training, with strategies specifically developed for midwives.”

    Because nothing prevents stillbirths as well as assertiveness on the part of midwives.

    Ugh, I remember when my UK friend was reassuring me that midwifery care in the UK was proper care and nothing like the crazy shite that goes on in the US. I read all this stuff here and think, man, she dodged a bullet with her first, but it makes me terrified for the still-in-planning-stages second.

    • staceyjw

      Yeah thats is all they need, even better skill at stopping people from getting what they need, and blocking docs. Because you know that is what they use it for.

  • Anon1

    Keeping the baby alive at whatever cost to the self is the most primal definition of mothering. How could that possibly be inappropriate?

    • DiomedesV

      No it’s not. Mothers have evolved to balance the needs of a current pregnancy against the needs of already born children and the possibility for future pregnancies. This is why mothers routinely abort pregnancies that threaten their own health and the financial security of their families. Parental investment theory is the area of evolutionary biology that deals with these tradeoffs. It certainly does NOT predict blind devotion to a current pregnancy to the exclusion of all else.

      Pretending that a mother *should* keep a baby alive at whatever cost to herself is not only biologically inaccurate, it is harmful to mothers and their families.

      • Dr Kitty

        Indeed.
        Sacrificing one’s own life for the sake of the baby is NOT what most women would do (and that’s ok) and that is why Catholic women who do so are lauded.
        St Gianna Beretta Molla being a pertinent example.

        I have no issue with a woman choosing her own health over that of her child, if that is what she is actually doing.
        My issue is more that women who choose HB or low intervention care often believe that they aren’t sacrificing safety when they really are.

        You go in as a primip, eyes open, to HB in the UK knowing your risk of perinatal death is 3 times higher, that is one thing.
        You go in thinking HB is as safe as the hospital, that is another.

        Tell women the truth and trust them to make the choices that are best for them and their families. That is all I want.

        • DiomedesV

          Actually I think that many HB moms know that they’re making a tradeoff between a C-section, which will restrict the number of future pregnancies, and the survivability of the current baby. I don’t think it’s an accident that, at least in the US, many HB moms have more children than the average. I think it’s a considered choice.

          • Dr Kitty

            Which I would be OK with, if it was openly admitted as such.
            All this “as safe or safer” stuff muddies the waters.

            If you make a decision to HB, knowing all the risks, go for it.
            You make an uniformed decision to HB, either because you are lied to about the risks, because you refuse to listen to the risks, or because you think the risks aren’t real, well, I have an issue.

          • Roadstergal

            But can’t they refuse C-sections in the hospital? That’s what I don’t get. There are all kinds of things short of a C-section that a hospital can do to ensure the health of you and your baby if it’s critical to you to not have a C-section so you can have 20 kids or whatever.

            From all of the data, actually, it seems like going in for an induction would help out a lot if your goal is to have 20 kids…

            (Also, amusingly, someone near and dear to me who wants a second baby but has fertility issues just contacted me to ask me for eggs, so I might be an Alien-style queen implanting pseudo-momma, if it all works out…! I have to talk to the fertility clinic nurses, but info from the local knowledgeable OB types is always appreciated.)

          • DiomedesV

            Most people are not going to refuse a C-section in the hospital, no matter how uninclined they may be for one before they get there. Better to avoid the scenario where it’s offered at all.

            The data linking inductions to lower C-section rates are relatively new. The older story is that inductions cause C-sections. That’s still a very prevalent meme.

  • Ash

    What is the standard of care for ultrasounds in the UK?

    I am quite perplexed about this #fightfear hashtag. Why is it not ” #fightforwomens health, we demand research and policy changes to improve preventable stillbirths”? But instead…fight fear? Dumb.

    • Amy M

      Or #fightforlivinghealthybabies