I chose homebirth and now a disaster has occurred. Rescue me!

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There’s a paradox at the heart of homebirth advocacy. It depends entirely on the deeply held belief that no matter how poor the prenatal care, how stupid and incompetent the midwife, and how dangerous the unanticipated complication, the obstetricians at the local hospital will be able to save the baby’s life and the mother’s life.

There is probably no group of individuals in the world who has greater faith in obstetricians than homebirth advocates.

How do I know that? I learned long ago that watching what people do is far more revealing than listening to what they say. Sure homebirth advocates have lots of nasty things to say about obstetricians — they don’t follow scientific evidence, they just want to cut you, and horror of horrors, they think your baby’s life is more important than your birth plan — but in the end, what they do indicates that like they believe obstetricians have far more knowledge, skill and powers than even we think we have.

Every homebirth advocate and every homebirth midwife implicitly and explicitly assumes that in the event of disaster, they will simply transfer to the hospital (“It’s only 10 minutes away!”), where the obstetricians will do whatever it is they do to save the baby’s brain function and life.

But unlike the 99% of women bright enough to realize that obstetricians have the best chance to prevent injury, preserve brain function, and save lives of both mother and baby when you come to them BEFORE a disaster happens, homebirth advocates and homebirth midwives think so highly of obstetricians that they trust them to prevent injury, preserve brain function, and save lives of both mother and baby them AFTER the disaster has occurred at home.

Most people recognize the value of preventive medicine. It is much easier to prevent medical complications than to treat them. Obstetrics is preventive medicine writ large. Nearly every test and procedure in obstetrics is designed to predict complications by recognizing risk factors and by monitoring so that the complications can be detected in their earliest stages when they are easiest to treat.

But homebirth advocates and homebirth midwives often reject preventive medicine. They often refuse the routine tests of obstetrics designed to identify risk factors because they don’t want to know about the actual risks an individual patient faces. They often refuse the routine preventive care measures like antibiotics to prevent group B strep infection and vitamin K to prevent hemorrhagic disease of the newborn. It apparently makes perfect sense to them to wait until the disaster occurs before they seek treatment.

The types of complications most likely to prove deadly to babies share common characteristics. They typically result in oxygen deprivation to a baby and require either an emergency C-section or an expert neonatal resuscitation with intubation. They are situations which require operating rooms, anesthesiologists, neonatalogists and specialized equipment, none of which can be found at home or carried by a homebirth midwife. They are situations in which literally seconds matter, yet homebirth advocates are typically 30-45 minutes away from help of any kind. Despite all that homebirth advocates and homebirth midwives believe that obstetricians can save the day.

Simply put, homebirth advocates can promote the absolute nonsense that they so adore ONLY because they expect obstetricians to rescue them from their own folly. The dirty little secret of homebirth is that advocates and midwives don’t trust birth, they trust obstetricians.

  • jane

    I deleted my comments bc I want no part of this, which I see now was never going to be the actual lively and indepth discussion I thought I was partaking of, but an attack on me. End of story.
    Like a pack of lionesses finding it’s first real feed in months you were all over me.
    Many things I said were not heard for what they were. Many things I said went unanswered.
    I will not be attacked like this under the guise of a discussion by what appears to amount to several people (only) in need to rip someone else to shreads.
    Jane (Suzanne) Townsend of Auckland New Zealand.

    • moto_librarian

      Jane, it will now be difficult for anyone who did not participate in this conversation in real time to piece together what actually happened. When I did express actual sympathy for a difficult experience that you had, you accused me of sarcasm. When your beliefs were challenged, you could not respond with evidence to back them up. And now you are flouncing because you linked your identity to your Disqus profile, and I had the audacity to ask you some pointed questions that seem to explain your hostility towards AIM.

      • Karen in SC

        And her tweet where she referred to us a “bigots.” So yeah, who insulted who?

        • The Bofa, Being of the Sofa

          Hey, she was just looking for lively discussion.

          Interesting how, knowing so very little about her, we had her pretty much pegged from the beginning.

          • Amazed

            When I first discovered this site, I actually believed people who said they were just looking for discussion. Now, I mostly wait for them to give themselves away. Some of them are really after discussion but others, like Jane, duly deliver.

          • Bombshellrisa

            They all say that until the questions get hard and then comes the grand flounce because we are mean (although in this case we are hungry animals)

          • Amazed

            Yeah, hungry animals. Reminds me of another visitor who had named herself An OB Eating Mama (not quite sure where the capital letters were). She demonstrated a great confidence and zero knowledge. But her nickname was great.

          • Guesteleh

            I thought Jane was going to turn out to be more thoughtful and instead her mega-assholery is putting her into SOB Hall of Fame territory. That whole business of dismissing AIM and not disclosing her interest in the Hooper case is reprehensible. And then the jaw-dropping stupidity of tagging Amy on twitter because it’s not like you get a notice or anything when that happens, right? And then accusing people of outing her. Yep. I think she’s up there on the top 5 list at this point.

          • moto_librarian

            I outed her only in the sense that I looked at her profile and found out that she was affiliated with Simply Midwifery in NZ. From there, it was quite easy to guess her last name.

          • Bombshellrisa

            Something makes me want to see her and He who shall not be named get into it.

          • Guesteleh

            Do you mean Mr. Obama Hater?

          • Bombshellrisa

            If he is the one who traveled with rice and beans so his family would not be subjected to the food his hosts were serving, yes.

          • KarenJJ

            Yeah, me too. How depressing. Part of the rot after all. Good luck NZ midwives, I think you’ll be needing it…

          • The Bofa, Being of the Sofa

            Well, their version of “discussion” is “everyone agree with me”

            The problem is, they come here and think they have something interesting to say, not appreciating the fact that they aren’t telling us things we haven’t heard dozens of times before, all the way up to the flounce. Same old, same old….

          • Bombshellrisa

            She called you a lioness, if I were you I would have at least insisted on being called Mufasa or if you want to be “the bad guy lion” (what dd called him) you could be Scar. (Disney Jr and Disney channel have been playing almost nonstop this summer and we just got back from Disneyland!)

          • The Bofa, Being of the Sofa

            Well, ever since I shaved my mane, it’s an easy mistake to make.

            (we watch a lot of DJr, but it is mostly Mickey Mouse/Jake/Sophia/Nena Needs to Go (I love Nena); few movies; going to DisneyWorld in a month)

          • Bombshellrisa

            My just turned eight month old son loves Mickey Mouse, the problem is the Hot Dog dance song and the way it gets into your head! My son also likes Sheriff Callie and Doc McStuffins, with a little Jake and sometimes Chuggington or jungle Junction thrown in for variety. Makes getting to comment here a little easier, he just started crawling and is into everything, with a show on he plays in one area. I have never been to Disney World, I am envious! Have a great time

          • The Bofa, Being of the Sofa

            We watch some Doc, but mostly just on weekends. The timing on the other ones just doesn’t work out well.

            Until last Dec, we didn’t have DisJr, so I didn’t know much about a lot of these. We went to a 4 yo bday party with a Doc McStuffins theme, and I didn’t have a clue who it was. Suffice to say, I know them all now.

            We still watch Caillou ever night, though, and if we’ve have a good day, we watch Scooby Doo Where Are You? (I love those – we don’t watch any of the modern ones, or even anything after those)

          • Empliau

            When your kids are old enough for the Magic School bus, try it – Miss Frizzle is the best! “Ah, the passion of science!”

        • Bombshellrisa

          Yeah, us bigots who have suffered at the hands of women’s healthcare providers like her who want us to “feel ok about the pain” and are free with “support” but no actual help.

        • LibrarianSarah

          Don’t forget that she called Dr Amy a bitch.

      • Dr Kitty

        The painful experience of an IV infusion of erythromycin during labour, right?

        A pain which Jane found intolerable and frightening, and which no amount of support seemed to make bearable.

        And yet everything she wrote seemed to dismiss women reporting that labour was intolerably painful, that support didn’t ameliorate it and that epidurals did, without major downsides. Including her dismissal of your posts comparing your unmedicated delivery with cervical lac and PPH and your medicated, painless second delivery, Moto.

        I thought I asked a relevant, interesting question about health economics, touching on ethical ideas of justice, utility and reducing health inequality.
        Her response was basically “get more midwives” which kind of missed my entire point.

        • moto_librarian

          Yes, that is correct, Dr. Kitty. She was being purposely obtuse about your question as well. She simply cannot grasp that when resources are scarce, home birth is a luxury that cannot be feasibly supported.

    • Amazed

      How touching!

      You see, Jane Suzanne Townsend dearest, while people were engaging with you respectfully here, you were pretending to do the same while showing your true colours in the tweet you so stupidly left wide open for all to see.
      Lively and indepth discussion? Please.
      We might be lionesses but you, dearest, are the worst sort of hypocrite. You can pretend to be all white and fluffy, a poor little bunny but now all can see what you are.
      Good riddance of bad rubbish, fellow lionesses.

    • Bombshellrisa

      “Many things I said were not heard for what they were. Many things I said went unanswered.” I don’t know how in the world anyone can mistake what you were saying for anything other than what it was. If even one other midwife in NZ shares your warped ideology, I feel even worse than I did before for every pregnant woman who can’t afford the extra money to get private care from an OB.

    • Dr Kitty

      If you go to a blog, perhaps a blog where the commenters are known to be knowledgable and to hold strong opinions and where you know you will be in the minority, it might be sensible to take some precautions.

      1) Lurk for a while. Read old threads, see which topics have been done to death already and if any of your proposed arguments have already been refuted and dismissed by your audience.

      2) Learn about who you will be discussing things with. Which commenters are Dr or midwives, who are the loss mothers, who suffered adverse events and at whose hands, where people come from.

      3) Maybe do some background reading. If it is a site run by an American, with a primarily American audience, maybe, for example, learn something about how OOH care is provided in the USA, before weighing in, or maybe have some hard data or statistics to back up your claims.

      4) If you want anonymity, use a guest account. By logging into Disqus it makes your email, Twitter and other social media activity visible to anyone who clicks on your profile. So maybe don’t use a Disqus account to post comments if you don’t want people to use it in the way it is intended, to track all your activity.

      • Bombshellrisa

        5) and for the love of all that is holy, DO NOT insist your country has “the best midwifery system” when there are 650 families who would beg to differ.

        • Young CC Prof

          650 families in a country that has only 30,000 births a year. (Not sure what time frame they were collected over, and I’m not going to check since reading AIM is so horrible it makes me want to rip out my eyes to get away.)

          • Amazed

            I get the feeling that homebirth advocates think that in the countries where midwives are integrated into the health system, the system is the best one by the very virtues of having intergated the midwives.

          • Bombshellrisa

            We have midwives who work within the system too, it’s just that they are not the default healthcare providers for women. If you get the default provider, you get the default care and birth plan which is usually all within the scope of that providers practice. So of course unmedicated birth is best and support is best to them.

          • Amazed

            Yes, I meant midwives having the default provider status or even the chance to practice more independantly. Everything that can make a midwife look like a provider that is equal to an ob is good!

          • Bombshellrisa

            Exactly!

          • attitude devant

            Funny, I get that same feeling!

          • Dr Kitty

            60,000 births a year, not 30,000.
            Northern Ireland has 25,000 births a year, so that figure didn’t look right to me.

          • Michelle

            Actually, it’s more than 62,000 and around 446 perinatal related mortalities excluding lethal and terminated foetal abnormalities (NZ definition from 20 weeks) and using UK definition (from 24 weeks) is 348.

            It’s only if you add in foetal abnormalities and include all you might approach 650 or anything like that. Midwives are not responsible for those obviously as they pre-exist, and not all cases are described as preventable (the perinatal mortality committee say around 14% are preventable). Just saying, while I understand why you are critiquing, be careful about the figures as it doesn’t make it look like there is understanding what is actually going on. Myself, I’m a fuss pot about that because if criticising we should be sure we are criticising real things and working on solving the actual problems not getting side tracked on distortions. Also, AIM is not reflective of the health care system in it’s entirety, it’s an advocacy group so it’s worth looking into it more and also doing cross country comparasons (everyone else also having a non-zero rate of perinatal mortality). Obviously though, they have an important role in what they do in highlighting when care is deficient and nationally, it’s really important to keep an eye on what is happening and work on improving things as a constant process.

            In addition, please take note of demographic differences when expressing horror – NZ is less than 70% European, with 15% Maori and around 8% Pacific population (the Cook islands, Niue, Tokelau etc being NZ dependent states) plus other ethnic groups, and a much less urbanised population compared with majority European high population density UK or Australia which is about 92% white and nearly the most urbanised in the world. Those facts pose extra challenges on top of other issues such as service provision. Australia seems to have some issues with provision of services to indigenous women though, their perinatal mortality for them is widely cited as being double that of Europeans whereas the gap, while still there is much less for NZ despite having many of the same issues of higher rates of prematurity and so on.

            Eight report: http://www.hqsc.govt.nz/our-programmes/mrc/pmmrc/publications-and-resources/publication/1576/

    • rumpusstiltskin

      Youre a liar.

  • Jane

    Maybe they’re all kooks in that country? Drs and MWs alike?

    http://tvnz.co.nz/breakfast-news/fear-childbirth-could-bumping-c-section-numbers-video-6061248

    http://tvnz.co.nz/breakfast-news/friday-july-29-4331375/video?vid=4331792

    Mind you she is Canadian so ? that’s why in this particular case?

    Jane

    • Young CC Prof

      That’s a very strange interview, honestly. First she explains exactly why the hospital has a high cesarean rate (more older mothers and more referrals from other hospitals), and how the overall rate within Auckland and across NZ is comparable to other countries, then she insists again that the rate is a problem.

      She puts a great deal of the “blame” for the high rate on women who simply request cesareans, though primary MRCS is rare in English-speaking countries. Maybe her particular practice sees more than average? The women who do want MRCS tend to talk to each other, and word gets around when they find a doctor who says yes.

      The second interview is very different and looks at avoidable deaths. According to the professor, many of the preventable deaths involved delays in accessing care, like presenting for prenatal care late in the pregnancy. I have no data with which to make any other comment, beyond that asking those sorts of questions is good.

  • jane

    Ok.
    I am not from the US, I have no clue what the system is like. I therefore apologise and will refrain from further comment. A lot of what you have all said in reply to me shows me that what happens in the US is not relatable to my experience of maternity services, and that therefore my comments have been ignorant in that respect.
    It seems we have a better system of care in my corner of the world – We have very good maternity care and free access to it from the primary to the tertiary level. Apparently our system is one of the best in the world. Apparently. Having a homebirth or a birth in a primary birth centre is not so unreasonable here. A lot of our Obs happily support our midwifery body to support women to birth outside of hospital with access to it.
    You’re going to skin me alive for this, but I am truly just trying to have conversations bc they matter, I’m not an idiot, I’m not a flag waving NCB advocate, and I’m not a loony midwife. Yes I stamp my feet Sue, and yes I get rude as well, bc I get pissed at stuff the same as you all.
    Tone trolling and netiquette – love it!
    Jane

    • Young CC Prof

      Actually, the US has a lower perinatal death rate and stillbirth rate than the UK. Sweden is lower still, but unfortunately an ethnically and economically diverse country isn’t going to be Sweden no matter what we do.

      • SporkParade

        True, but what about maternal mortality? I think what the UK lacks in maternity care, it makes up for in the availability of primary care, so there are fewer women showing up in maternity wards with uncontrolled or poorly-controlled chronic medical conditions.

        • Young CC Prof

          Definitely a major issue in the USA. And it’s not as simple as access to primary care, all the health issues of poverty are driving maternal mortality.

          Which, interestingly enough, is sort of what one of the videos above said about New Zealand.

      • The Computer Ate My Nym

        an ethnically and economically diverse country isn’t going to be Sweden

        Are you sure? It’s not entirely clear to me that the ethnic differences are due to genetic issues and not to the chronic stress of dealing with prejudice 24/7 your entire life. Eliminate the prejudice and the maternal and perinatal death rate may decrease significantly, even with growth in the minority population. And I’d like to see the US be a little less “economic diversity”, i.e. have a higher minimum wage, higher tax rate in the top bracket, etc.

        • Young CC Prof

          Oh, I’d like that, too. But the medical system is not the place where changes like that will originate.

      • toni

        I think she said she was from Australia. How do they fare?

    • SporkParade

      Welcome! I, at least, am interested in the contrast between maternity care in different countries, so I am glad to have you here now that you have gotten your feet wet. 🙂

  • Dr Kitty

    Jane, question for you.
    I think you’re a UK midwife.

    You’re railing against deaths in hospital, and think Homebirth is the solution.
    How do you feel about hospital deaths caused by midwives choosing NOT to act, or being so overworked and understaffed that they can’t act?

    As a British midwife you must be aware of the issues at Furness General Hospital and Queens Hospital in Romford.

    When there is a crisis in midwifery staffing levels, the appropriate short term response, surely, is to try and get all the midwives in labour ward, rather than to have two midwives attending every Homebirth.

    Every Homebirth in the UK is reducing available midwives from the labour ward rota. When you don’t have enough midwives as it is, and a Homebirth requires two MWs present at all times, while a midwife on a labour ward can look after multiple women at once, do you REALLY think that promoting Homebirth with the current numbers of midwives is compatible with increasing patient safety on a population basis?

    Or will promoting Homebirth for low risk women simply increase the risks for high risk women who have to deliver in hospital, by further reducing staffing levels and care provision?

    Why should the choice of a low risk woman to be able to deliver at home matter more than the right of a high risk woman to safe care in hospital?

    Your thoughts please.

    • Dr Kitty

      Also, thoughts on the fact that Homebirth automatically excludes many vulnerable women, because the “home” isn’t an appropriate place to deliver.
      Women in prison or immigration facilities, young women in Children’s homes, women in hostels and temporary accomodation, young women sharing bedrooms with their siblings, women in high rise flats with unreliable lifts, women from the Travelling Community, women in multiple family dwellings who share their bedroom with their entire family, women in very remote or rural locations….

      Again, removing resources from these women and their necessary hospital births and diverting them to support the choice of healthy, well-off women to deliver in their own homes does not strike me as equitable, rather it seems to be a way to further entrench health inequalities.

      But I’m open to being proved wrong.

      • jane

        I’m not suggesting closing down hospitals. Never did. Merely suggesting being mindful tht hospital birth comes with it’s own downsides.

        • Young CC Prof

          I think you’re missing the point. There are only so many resources right now, not enough, in fact. Diverting them to home birth means the hospital has even less.

          • jane

            Yes I do get that point
            Sounds like there is no way around the status quo

            J

          • Young CC Prof

            Funny how that works, concentrating all the medical resources in one place allows caregivers to attend the maximum number of patients and provide the best care with the resources that are available. It’s almost like the people who invented hospitals planned it that way.

          • Jane

            Yes almost. Good point there, not one I’d ever considered. Amazing. Certainly having 5 women on a CTG (not the same CTG of course – pathetic attempt at humour) that one nursemidwife can monitor at once from the cockpit is a very good use of resources. As is the epidural that minimises the need for one:one care and support. It does make sense. It’s very efficient.

          • Young CC Prof

            Don’t like it, tell your government to hire more midwives.

            Though honestly, if I had to choose between an epidural and someone holding my hand and cheering me on, I’d be all over the epidural.

          • Jane

            My government has hired more midwives – we’re all good in that regard. They have a strong policy around the Woo.
            Not hand holding and singing kumbaya whilst someone writhes in agony, just being there with someone who wants the company and support over the epidural, and happily, with that support finds strength and does as she wants.
            Epidurals are great. They seem less necessary for women who have support over those that don’t.
            So my comment about the CTG and a ratio of 5:1 was in reference to need for epidural being somewhat based sometimes for some women in the fact that they have no alternative, because there is no human support.

          • MaineJen

            Sometimes, though, the best “support” is knowing when a woman has had enough and needs real pain relief. It is not supportive at all to tell a woman begging for relief that She can do it! Yes…she can…she just doesn’t want to do it this way. I had it in my birth plan that once I decided I wanted pain relief, I didn’t want anyone to argue or try to talk me out of it. That was my worst fear…

          • Jane

            Yes totally agree there. Some MWs seem more intent on the outcome in terms of their wants and needs than that of their client. Totally agree. In partnership an astute practitioner should be able to recognise that.
            In regards to women who can come into partnership – ie aren’t disenfranchised by socioeconomic status etc.
            Where I am from Pacific women are seen to just get on and do it – no fuss no epidural… are they too thick to feel pain? Are they stronger than the uptighty whiteys? Or do we just assume that they are simple souls and therefore don’t feel pain like the more evolved?

          • SporkParade

            “Or do we just assume that they are simple souls and therefore don’t feel pain like the more evolved?”
            Yes, that is basically the philosophical underpinning of the natural childbirth movement as enunciated by Grantly Dick-Read: only wealthy, white educated women feel pain in childbirth because they are too cultured and therefore afraid of birth.
            I have to say, I’m not exactly sure what we are all disagreeing on here. It seems like we are all in favor of supporting women’s choices, including providing adequate staffing to do so, and excluding providing bad information in order to promote our own choices.

          • Roadstergal

            My white-as-can-be, highly educated boss ‘just got on with it’ because she was lucky
            enough to have an uncomplicated pregnancy, a baby of moderate but good
            weight and without an oversized head, a quick
            labor and a quick and painless delivery. If someone is that lucky, I hope they appreciate
            it, rather than thinking their unique situation means ‘anyone can do it with no
            fuss.’

            (She gave birth in a hospital, just in case something went wrong. She had no interventions, because she needed none.)

          • The Bofa, Being of the Sofa

            Or do we just assume that they are simple souls and therefore don’t feel pain like the more evolved?

            I’ll see your “Pacific women” and raise you with “3000 years ago.”

            3000 years ago, childbirth was recognized as being so painful that it was attributed to a punishment from God.

            That wasn’t “uptight whitey” saying that. either.

          • Young CC Prof

            Funny how people who don’t have access to epidurals get by without them. The same could be said of dental anesthesia.

            That doesn’t mean they like it, or would turn down pain relief if they had the option. It also doesn’t mean that enduring pain is beneficial or safer, and in some cases it makes things LESS safe.

          • Jane

            So are you agreeing with me or not?
            What I was saying is that we call women who ask for pain relief and refresh their lipstick with each contractions as uptighty whiteys, likewise we assume quiet, ‘staunch’ brown women just accept pain because as quiet brown people that is what they are good at doing.
            Assumptions based in bias at the very least.

          • The Bofa, Being of the Sofa

            What I was saying is that we call women who ask for pain relief and
            refresh their lipstick with each contractions as uptighty whiteys,

            Who is “we”?

            I certainly don’t say that.

            What is YOUR explanation for why the Pacific women don’t cry out?

          • jane

            We as in the royal we. A espoused opinion. I don’t personally think that either. But I see and hear it a lot.
            I think there are many reasons Pacific women deal with labour pain differently. Some of it I’ve found out by asking women, some by observation of the different cultures I’ve worked with, the different expectations and ‘ways’ I see brought to the birth, some of it obviously from the research.
            Typically it can be based in religion. It can be related to not knowing what their options are, to being disenfranchised in general and therefore not ‘asking’ for anything of anybody. And of course the individual who is not affected by any of the above generalisations that just doesn’t need to cry out in pain – pain might not be that bad or is bad but crying out won’t help. You know what I mean?
            And more right?

          • The Bofa, Being of the Sofa

            So they just put up with the pain?

            But why is that preferable to having an epidural?

            The description you provide above sounds like despair to me. Funny how NCB types claim an unmedicated birth is “empowering” but what are describing are the actions of the most powerless people imaginable.

            I cannot for the life of me see how anyone can see it as a virtue, or something to emulate. I can’t imagine anyone who is caring and compassionate could view that case, AS YOU’VE DESCRIBED IT, and not feel that it screams for being an example of why we need to expand access to epidurals. That anyone could view this as an argument against epidurals and/or for NCB is unfathomable.

          • LibrarianSarah

            I’m sorry but your last paragraph is one of the most racist things I have read on this sight in a long while.

            When talking about racial and ethnic minorities (or any disenfranchised group really) we can’t just rely on how they “are seen” because how they “are seen” is clouded by racial prejudices. What we need is data to ensure that the phenomena we think we see actually exists (so we have to compare the percentages of “pacific” women and white women who get epidurals) and control for confounding variables (are “pacific” women less likely be offered an epidural, are there cultural considerations,etc) before we make any judgements.

          • Siri

            I think that’s what Jane meant, Sarah! I might be wrong, but I didn’t read her comment as racist, quite the opposite.

          • jane

            That was my point.

          • The Computer Ate My Nym

            First off, who’s this “we” white woman? Second, maybe they’re too intimidated by racism and sexism to ask for an epidural or even scream (excuse me, vocalize) when they’re in terrible pain.

          • Jane

            That was my point. Sorry I didn’t spell it out. The assumption, because they are ‘brown’ and big and strong, is that they don’t quite feel pain like us tender white women.
            That was my point, we can make huge assumptions based on biases we don’t even know we hold.

          • Bombshellrisa

            http://www.pacifichealthdialog.org.fj/Volume%2015/v15no2/Case%20Study%20and%20Short%20Communications/A%20Tonga%20Health%20Professionals%20Perspective.pdf

            Some excerpts from this article

            “For Pacific women, finding a midwife they can communicate and feel comfortable with is one of the biggest challenges”

            “Language barriers affect Pacific women’s relationships with their midwives, and may be the source of misunderstandings that create unhappiness and tension. In turn, this tension may prevent the woman from sharing her concerns with her midwife, or asking questions about matters she is unsure of. The poor and low cultural competency and social literacy of the midwives are the reasons many Pacific women allegedly seem to not communicate or show their real feelings and moods. Many Pacificans are very good at hiding what they really feel. To avoid sounding critical, a Pacific woman may simply say what she thinks the midwife
            wants to hear”

            “Because of language difficulties, some midwives find it hard to hold meaningful conversations with Pacific women about the options and the safety implications of each. For the same reason, women may find it hard to ask questions that elicit the information they need to make their choice.”

          • The Bofa, Being of the Sofa

            So the reason Pacific women don’t cry out in pain is because midwives don’t/can’t/won’t listen to them!!!!!

            You hear that, Jane?

            I’m sure that’s a biased source, because, you know, you’ve asked around.

          • Jane

            Ease up Bofa – Pacific women don’t speak out about a plethora of things because it is not the norm etc as above in that article – and yes bc midwives don’t listen, so we can get way better at that – but it society in general that does this to the disenfranchised, not just MWs. Teachers, employers, doctors, and on it goes.

            And don’t be rude about me asking around – surely my experience with the women I’ve cared for helps give me insight into some of the things that are in play for them?

            I try to learn from the person sitting in front of me, try to learn from what she brings. Not just from the research but as well as the research.

            http://www.taha.org.nz/

          • The Bofa, Being of the Sofa

            And don’t be rude about me asking around – surely my experience with the
            women I’ve cared for helps give me insight into some of the things that
            are in play for them?

            According to people who aren’t midwives, folks like you are the problem.

            Women aren’t comfortable talking to you. You think they are telling you the truth?

          • Jane

            Yes I do think they were talking straight – I was in a relationship with them for around 9 months, it included going to their home to visit antenatally, it involved being with them in labour and it involved visiting them around 12times in the 6 weeks following birth. I am not a git talking shit for the sake of it, I was saying that having considered my conversations with those women, women whom seemed to trust, like and appreciate me in their life, I had made some observations, as well as asking them their thoughts regarding this and that as we have mentioned.
            I don’t think they felt the need to lie, I think they trusted me, liked me, felt safe with me, and talked to me about what stuff meant to them.

            I am not ”folks like you”. I am me and I am a professional who goes to work every fucking day and have done since I was 17 in order to try and make some difference somewhere. To assume anything else is pretty fucking shit.
            What do you do for a living? I’ll hack that to bits shall I? Assume you are the essence of every negative feature that ever came from that.

            Jane

          • The Bofa, Being of the Sofa

            I don’t think they felt the need to lie, I think they trusted me, liked
            me, felt safe with me, and talked to me about what stuff meant to them.

            Of course that is what YOU thought.

            However, when women talk to others, they report that they cannot be honest with their midwife.

            But you are different, I’m sure, right? It’s just the other midwives who have this problem?

          • jane

            Maybe I’m wrong, hope I’m not because I try hard to be what women need. There’s a chance I’m kidding myself that women are genuinely pleased with my care, but yep you’re not wrong, if it’s all then it’s clearly me too. If it’s some it’s quite possibly me too.

          • Amy Tuteur, MD

            I don’t know about what your own patients say to you, but it’s pretty clear that you are kidding yourself about the effectiveness of epidurals and the effectiveness of support.

            There is simply no question that epidurals are BY FAR the most effective form of pain relief. In survey after survey women ALWAYS report epidurals to be extraordinarily effective and support dramatically less effective. Even the Childbirth Connection report had to acknowledge the effectiveness of epidurals and women’s overwhelming demand for them.

            You are not a stupid person; you must be aware of this. Yet you choose to ignore what tens of thousands of women actually say for what you would prefer to believe. Why? Why make false claims about epidurals except to handle your own cognitive dissonance?

            Until you learn to listen to what real women say, not simply to what you’d like them to say, you cannot provide good care to patients. Providing good care means meeting the needs of the patient, not your own. Your absurd claims about epidurals reveal all too clearly that your beliefs about epidurals are a function of your ideology not reality.

          • The Bofa, Being of the Sofa

            Maybe I’m wrong, hope I’m not because I try hard to be what women need. There’s a chance I’m kidding myself that women are genuinely pleased with my care,

            But read the article above. You think they are telling you the truth? They aren’t. For whatever reason, because they feel that it won’t do any good or they are out to please you for whatever reason, they are not telling the midwives how they really feel.

            You have women that you describe as being so resolved in their fate that they won’t cry out if it hurts. Why don’t you want to do everything you can to help them? They need options, they need empowerment. You give them hand-holding and let them wallow in it.

            It’s pretty sickening to me.

          • Young CC Prof

            Keep in mind, the way you ask things matters.

            “You can handle it, right? You don’t need that epidural.”

            “Do you want an epidural?”

            Some patients will indeed say “No epidural” to the first one and “yes” to the second. Even, perhaps especially, if they like you and want to please you.

            Getting through it with support is not in any way inherently better than taking the epidural, and appropriate anesthesia may decrease the risk of PPD, make complications, if they occur, easier to deal with, and help women feel more present and in control during and after the birth.

            Avoiding an epidural is not a goal for most women, and it should never be a goal for the practitioner.

          • The Bofa, Being of the Sofa

            I’ve been trying to sort out why Jane is so adamant about getting women through without epidurals. There are a few possibilities I have come up with

            1) Resources – epidurals cost more, and therefore, going without is more cost efficient. Of course, I can understand why an administrator cares about that, but why would a practitioner, who’s focus should be on providing care for the patient, not about how cheap it can be done. As I have said, I would think that a CARING practitioner would be advocating for expanding the availability of epidurals to those who don’t have access.

            2) Somehow, a non-medicated birth is inherently better, and therefore more desirable overall. I’ve never seen an argument for it that makes any sense or doesn’t rely on false claims about the risks. Sure, some women want to have a non-medicated birth, and to each their own, but as noted, the stats are pretty clear, when women have access to epidurals, they far and away use them. Anyone can always refuse, but if you don’t have access to epidurals, it limits options.

            3) Or it is just self-serving, because if women have access to epidurals, midwives can’t claim to be able to be the great supporters that they are now.

            Whatever it is, as Dr Amy notes, you can see that her entire perspective is framed from the view that epidurals are bad, and if you start with that as a premise, then everything else makes sense.

          • theadequatemother

            I’ve seen the argument go something like this: even if the risks are small, if women can get by without them, that is worth something because the risks aren’t zero. But that argument, when you really examine it, has the root value that labour pain isn’t worth treating with associated justifications (its natural, its productive pain, its the way things should be blah blah blah). Consider for a moment, post operative pain. We treat post operative pain because we see the value in preventing pain and discomfort. It’s compassionate. Even though there are a minority of patients that will suffer harm through the treatment of pain. For example, acute kidney injury after NSAIDs, respiratory depression and arrest secondary to opioids. Some will die. SOme will go home with rx for oxycodone andi nadvertently overdose. The numbers are small…but it does happen. and yet there aren’t fringe groups popping up to tell surgical patients (especially elective surgical patients) that there is value in toughing it out the same way there are people campaigning against labour epidural use. Sure, we get a lot of people that want to minimize exposure but not to the same extent that morality and vilification is heaped upon the epidural.

          • Roadstergal
          • The Bofa, Being of the Sofa

            It is not supportive at all to tell a woman begging for relief that She can do it! Yes…she can

            As I’ve said before, that’s not support, that’s cheerleading.

          • moto_librarian

            I had great support during my first birth. My husband, my nurse-midwife, and a L&D nurse (who happened to be my CNM’s mother). I got to the hospital dilated to 9 cm. after laboring at home for several hours. I still remember the shock I felt when I discovered that pushing was absolutely agonizing. It was the most excruciating pain that I had ever experienced. I did not ask for pain medication because I knew that it was too late to get any. I distinctly remember thinking, “well, this was your brilliant idea, so you had better just get on with it.” By the time I finally pushed out my son, I was completely out of it. Then the pph started, I went to the operating room, etc.

            I sometimes wonder if I would have had that natural high that I always hear about from NCBers if I hadn’t suffered such awful complications. I can say that there was absolutely no question in my mind that I would be having an epidural when our second child was born. No complications, healthy baby (after an initial scare because of sudden distress while crowning and mec in the waters). I was on a high for weeks after his birth, mainly because it wasn’t a horrible clusterfuck like the birth of our eldest.

          • Jane

            Yes that’s very true right: the experience has a lot to do with PND and a clusterfuck of an experience will no doubt leave you with a clusterfuck of an aftermath.
            I’m pleased your 2nd experience was not as your first. A PPH sucks. As done being in excruciating pain.
            In hindsight what would have been better (apart from not being unable to get out of pain and having a PPH)?
            It sounds like you were feeling pretty good at home to 9 cms. In retrospect should you have gone in earlier and had the epidural in readiness for the pain of pushing that you weren’t expecting? It is so hard to predict, therein I guess if you are somewhere that gives you immediate (albeit related to the availability of the anaesth) access to pain relief.
            Other women talk of the reverse right – going to hospital for the epidural and finding it a clusterfuck in itself… then don’t do that 2nd time around.
            Not minimising your experience, just continuing to talk 🙂
            Thanks
            Jane

          • moto_librarian

            I had been told many, many times that pushing would “feel good.” Transition was not fun, but I was managing, and truly believed that once I could push, the worst would be over. I also had a very short labor for a primip. My water broke around 6 am, and I did not start having contractions until around noon. I was already 3 cm. and fully effaced at my 38 week checkup. We left for the hospital around 2:30; our son was born at 5:49 that afternoon.

            So my decision not to go in earlier was based entirely off of the expectations set up by the natural childbirth movement. I believed that it would not be nearly as painful as it was, and I felt utterly betrayed. Having the added joys of a cervical laceration, 2nd degree tear, and pph were the icing on the cake – I had to have a manual examination of my uterus with absolutely no pain medication. I am not kidding when I say that we very nearly did not have a second child because of this experience. What I did not do was blame the fact that I was in a hospital for my complications and pain. What could easily become a story of a “birth rape” in NCB circles (when you’re in a true obstetric emergency, they aren’t asking what they can and can’t do – they are telling you what they’re doing as they are doing it), is actually a story of how easily things can go south in the most low-risk of deliveries and how I am thankful to this day for the medical professionals who saved my life.

          • Jane

            Yes agree.
            My unbearable pain came in the form of the IV erythromicin for the PLPROM and GBS. It was unresolvable bc obviously the epidural would not cover my right arm, chest and neck.
            That was horrible and I felt utterly betrayed. Noone told me that the antibiotic would be so painful. But I was glad that my daughter was not in receipt of GBS so…

          • theadequatemother

            I cannot believe that you are comparing the IV infusion of erythromycin to a manual examination and attempted extraction of retained placenta without analgesic. That’s just…callous. The first is non-emergent. Slow the IV down, give concurrent meds, put it into a bigger vein, stop it for a bit etc etc. The second is life threatening where no matter how much a woman yells no one can in good conscience stop. Earlier you say that people are getting rude with you here….this is the farthest I’ve gone down the thread so far but man, this is the RUDEST and most CALLOUS thing on this thread so far.

          • Jane

            I wasn’t comparing my experience, I was just referencing what caused me pain and disappointment. I apologise if it was not bad enough to be referred to, but for me, it was fucking revolting and really caused me pain, anguish and fucked me right up. As would have the experience that Moto speaks of – my IV trouble would have paled in comparison. Thing is, at the time, noone slowed the drip, noone used a bigger vein, noone stop it for a bit, noone suggested a concurrent med. It just hurt like nothing has ever hurt before, for the hour that it ran. And that was my experience. Sorry I should have thought twice before talking about something that hurt me but was nothing in ‘comparison’ I will no longer speak of my own experience until I make well sure it is up there with others.
            Sorry, I was having a discussion using myself as a point of reference. I was not suggesting that my experience was anything akin to the other, I was just talking re pain and my experience.
            Moto, I was not being callous. If I came across that way apologies. Jane

          • moto_librarian

            I have no doubt that what happened to you was very painful, and I truly wish that they would have tried some things to alleviate your pain.

          • Jane

            Sarcasm?

          • moto_librarian

            No, it truly wasn’t. I was trying to be empathetic.

          • Jane

            Well there you go assuming I was in any way as a woman in labour able to think ask or advocate in my time of need – and yes I knew that they hurt – as you knew that labour hurts – it did however, when it happened TO ME take me completely and was really painful.
            I was not comparing I was sharing, with another person about something that happened to me – I will say this again from my heart, I was not comparing your trauma to my small burn under the skin, I was talking with you.
            I am sorry.
            Jane

          • Jane

            Why did you have no pain relief for the manual exam? No time?

          • moto_librarian

            No, there was no time. I also did not have a heplock. My husband was a Navy medic, and he later told me that he has only seen one other person bleeding as much as I was, and that person died.

          • Jenny_from_da_Bloc

            Support doesn’t change the amout of pain or the need for an epidural

          • Jane

            I think you’ll find that actually it can.

          • The Bofa, Being of the Sofa

            When I was little, my parents used to have me bite on a spoon when they would get a sliver out of my hand.

            It didn’t help it hurt less. It

          • Jane

            Epidurals are by no means consistent or effective. Many women I’ve worked with had poor epidural cover and were pretty traumatised by that. So I held their hand, and we sung, and she felt better. No that last part was not true. That was the fantasy of hand holding being of any help at all part coming out.

          • The Bofa, Being of the Sofa

            Epidurals are by no means consistent or effective.

            Compared to “support of another human” they are far more effective and consistently so.

            You can’t seriously deny that, can you?

          • theadequatemother

            With a dedicated anesthesia service the rate of an epidural providing adequate pain relief is upwards of 95% with first insertion and can get to 98% with an aggressive approach to top-ups and replacing faulty catheters as a different level or changing to a CSE technique. If the women have poor cover they really need an anesthesiologist to troubleshoot…not hand holding.

            I’ve walked into rooms for top up requests and found catheters dislodged, disconnected…and I’m always very irritated when the LDR nurse or midwife has let a less than perfect epidural alone without calling me.

          • Jane

            And I’ve called an anaesthetist to come figure out a poor block and been asked to withdraw the catheter 1cm… and been asked to untwist the top, snip some of the tubing, withdraw it a bit and twist it back up…
            Not even sure what all of that meant but was asked to do it and call him back if there was no better relief after doing tht and giving another top up.

          • The Bofa, Being of the Sofa

            So let’s see…

            Me: “How is better than just getting the friggin epidural, which is more consistent, and more effective,”

            Jane says:”Epidurals are by no means consistent or effective.”

            An anesthetist says: “With a dedicated anesthesia service the rate of an epidural providing adequate pain relief is upwards of 95%”

            Hey Jane, you think hand holding provides adequate pain relief more than 95%?

          • Jane

            No it will not anaesthetise you from the waist down. Therefore it will relieve pain in the experience of that pain. But it will not irradicate it.
            And they do not always work.

          • fiftyfifty1

            huh?

          • Jane

            Hand holding will not anaesthetise you from the waist down. It’s a fact. Clever me to know that one. Must have paid more attention than I thought at the “handholding as a means to completely eradicate, well it actually can’t, pain” lecture (well not so much an actual lecture as an interpretive dance from memory).

          • The Bofa, Being of the Sofa

            Nice strawmen, I have to say.

          • moto_librarian

            No, they don’t always work, but when they do, they can indeed completely eradicate the pain. My epidural catheter dislodged during transition with my second child. I was having some pretty severe pain, and I was having flashbacks to my first birth. The anesthesiologist arrived just when I was complete, and she was able to insert a new catheter and give me a bolus of anesthetic. I was numb to my toes, but I felt plenty of pressure for pushing. I can honestly say that I had a completely painless delivery. Not even the dreaded “ring of fire.” I was able to watch our son being born in a mirror. It was an amazing moment for me that was not possible during my unmedicated birth because I was out of my mind from the pain.

          • Jane

            So the epidural did fail. But was then quickly sorted.

          • moto_librarian

            It did not fail at the crucial moment, Jane. It worked beautifully for the most difficult part of my delivery. If they had not been able to redose me, then yes, I would have called it a failure. But the blissful hours of sleep that I had prior to the coverage diminishing due to the catheter problem were wonderful, as was the actual delivery. To me, it was more like a hiccup. But in your book, even a temporary problem is a failure.

          • Bombshellrisa

            No, unless your support person is the doctor giving you the epidural, a support person is not the same thing. This is always an argument that home birth and natural birth advocates make “having a doula is shown to decrease the need for an epidural!”. It may reduce the incidence but not the need. A doula might help you stick it out and remind you of your desire to labor without an epidural, but that reminder will not block the sensations you are feeling, just gives you something to set your mind on as a distraction.

          • Jenny_from_da_Bloc

            No, it really doesn’t. Somebody holding my hand is not going to make the pain less intense or feel better.

          • fiftyfifty1

            “As is the epidural that minimises the need for one:one care and support”
            This idea that hospitals push epidurals because it is less labor intensive for the nurses is a complete NCB myth. You cannot lower nursing ratios by increasing epidural use. You may save nurse time on encouragement and “handholding” but you increase it on other tasks (vitals monitoring, urine catheter management, repositioning etc).
            Epidural use is high wherever epidurals are freely available not because hospitals or nurses “push” them but because most women want them.

          • Jane

            In your opinion. Do you suggest there is no substance to my statement? Like no research backing my statement? Is there research backing yours?

          • theadequatemother

            There is some research that shows that when epidurals become freely available (ie 24/7 anesthesia coverage for LDR) the epidural rate quickly shoots upwards of 60%. When this happened in our local women’s hospital, the epidural rate seemed to exponentially increase from 60 to upwards of 80%…why? because the LDR nurses, doctors and midwives saw that epidurals didn’t do all those things that some of them were taught (stall labour, cause cs, cause instrumental deliveries) and they saw women who were happy with their experience and level of comfort so they stopped stalling, obstructing and delaying epidurals when they were requested.

    • Jane

      I’m not a UK midwife.

      • attitude devant

        Then what and where are you? You are remarkably cagey about that….

        • Jane

          Yes sorry it is a bit like a where’s Wally – me being the Wally of course.
          I am 43 and have 2 children aged 7 and 5. I had them both via c section – one PLROM and augmented to fully in an hour with abs for GBS and a trial ventouse to impacted deflexed/brow presentation c section – at 38.2 The other I got to hospital fully thinking I was probably about 3 due to lack of ‘real’ contractions with another SRM at 37.5. Another direct OP deflexed to theatre for another trial of ventouse – c section. Breastfeed them both – 1 for a year, the other for 2 something years. With breast implants so that was nice because I did enjoy all that BFing.
          I was born in Auckland and have lived here my life to date. I trained as a nurse from school bc dad said it was a good thing for a lady to do – lots of options. Wasn’t set on it but loved it, so another bonus, then at 27 I went into uni again to train as a midwife bc I didn’t know which part of nursing would see me through the forever of a working life. Midwifery was it for me – loved it.
          I have worked as a case loading LMC, as a primary birth core, as a base hospital core, a hospital based community MW, and did a short stint up in Abu Dhabi whilst fleeing a reasonably shit marriage. Now I teach in an undergrad MW degree.
          I wasn’t trying to be cagey just trying to avoid comments that might hurt my feelings re being from where??? and thought I’d just be like someone from nowhere. Not sure why.
          Sorry about that.
          I had a bookstore some years ago – it went bust, we lost our home and that was tricky.
          Ummm what else?
          Nothing really. Oh I’m white. I think I might learn Maori, it’s lovely. Doing my PG Dip so not a scholar. Hope to keep going though. Not sure whether to do MW or education.
          Hope that helps
          Jane

          • Jane

            I have officially joined.

          • Karen in SC

            Are you aware of the blog Action to Improve Maternity Care (on the list to the right). Read those stories of failed maternity care by the system in your country that relies on midwives for the most part. From what I’ve read there even the hospital protocols with OBs need to be improved.

            I had a doula who was supportive and still my labor pain was excruciating. If I hadn’t believed all the crap about epidurals harming the baby, I would have gotten one and enjoyed the process a lot more than being out of my mind and even unable to speak.

          • Jane

            Yes I know it well of course – it focuses solely on the failings of my profession so is obviously very pertinent for me to be aware of.
            It raises those cases that are seen to be the fault of the midwife, and every so often mentions a doctor as well. And yes it calls for AIM. It does also however not provide any answer that stacks up related to the empirical evidence.
            That it calls for better maternity care is good no? We all want the optimal? It is selective in it’s approach though. Fair enough, they have a point to make.
            There would however be a larger blog of those women who were not in receipt of such appalling outcomes in the care of midwives.
            Our system has 70 something% LMC MW care and in that regard our stats as a profession are good.
            Jenn Cooper is own a mission and tht’s good, she is not unbiased in what she chooses to use to illustrate her cause.
            And many that post on her FB page make wide sweeping comments that just are not based in truth.
            “That’s the midwife that killed our baby” from a woman who had a massive abruption at 25 weeks.

          • moto_librarian

            Jenn Cooper is on a mission for a damned good reason. Charley is a sweet and lovely child, but she has the mental capacity of a newborn baby because the midwives completely fucked up. I have seen plenty of other stories from families who have suffered profoundly because of the failures of midwifery in NZ. It is likely unfair to blame midwives for an abruption at 25 weeks, but there are other cases where it’s quite clear that ideology and turf battles trumped care with disastrous results.

          • Jane

            We don’t know that Charley is sweet and lovely and yes she has many many other than mental disabilities resulting from her birth. I believe she is the most disabled but alive person in NZ.
            At her birth the midwives did not resuscitate her correctly and made other mistakes. It sounds appalling.
            Other stories on the site speak of other tragedies – all laid at the feet of midwives – some deserving and some actually not.
            MW in NZ is more than this site. If you investigating more than this site you would have a rounded set of information on which to base your perception of MW care in NZ.
            Is this a similar blog/page/effort AIMed at the doctors in maternity in NZ? No.
            That is not bc the doctors do not fuck up. It is bc such a page/blog/effort would not be tolerated.
            What we need in NZ is excellent MW care for all provided by intelligent and critically aware, among other things, practitioners. In most cases I see that we have that. In cases like we see on AIMS there is the need for improvement.
            Wholesale blame on all MWs is not however the answer.
            As a side note I know a couple who had a baby die at the hands of the negligent (found to be negligent) OB. They wanted to tell their story to AIM – they wanted the support of others who had suffered, and they wanted to able to share their story. They were declined by AIM. Their story does not appear on the wall of sorrow. Not sure why. It was a tragic story, it was clearly a case of malpractice/negligence/ineptitude.
            Jane

          • moto_librarian

            “We don’t know that Charley is sweet and lovely and yes she has many many other than mental disabilities resulting from her birth.”

            Actually, Jane, I DO know that Charley is a sweet little girl. I’ve gotten to know her mother quite well over the past couple of years. Is your purpose here simply to be nasty? Because why else would you say something like this? What in the hell is wrong with you?

          • Somewhereinthemiddle

            I really would hope that that part is a typo of some sort…

          • Jane

            I was trying to be factual because I have been pulled up here when I have used first person or personal experience, so I was saying, one thing we (it turns out you do but I don’t and nor does many others) KNOW the sweet and lovely nature of Charley.
            From whatever I can gather it appears, I assume and it seems to be that smiles love and amazing spirit exudes from her. So going back to the first person less scientifically based approach, that comment need not be.
            Jane

          • Amazed

            No comment here as well?

            Tell me something, Jane dearest. How many sweet and lovely babies have fallen flat and lifeless into your hands to lead lives of many many other than mental disabilities resulting from their birth?

            While we’re at it, how many such babies have your lovely mommy and her dearest partner caught?

            Come on, Janey/Jamesy boy/girl. Comment. Don’t be shy.

            Oh, it isn’t so fun now, when we know who you are, who your mother is and whose foul mouth the words about Charley originate from, are they? *pats on the head*. Making a fool of oneself is no one’s first choice. Don’t tweet about our conversations here, and we can be best buddies again. We won’t give you up, we promise. Don’t we, moto? Karen?

            Sarcastic hat off* I feel dirty for wasting my time on someone dissing the ultimate failure of her profession like this.

          • Jane

            Actually she does suggest some changes: http://aim.org.nz/suggested-changes-for-nzs-maternity-system/
            None of it related particularly to midwives though it seems. Standardised documentation. Remove the extra $250 that MW get if women give birth in a primary facility. (She calls it a bonus it is not).
            And some other stuff…
            Not that robust though considering that ACTION to IMPROVE is called for.
            Action would be a little more active than better paperwork right?

          • Jane

            And the other change: 2. Standardised, evidence-based monitoring: To improve the overall quality and safety, the Maternity Payment system to all LMCs should be dependent on standardised, evidence-based monitoring in both pregnancy and labour as a service specification.
            What is this? Intermittent auscultation for low risk women has been deemed acceptable by our MWs and Obs based in the evidence so I am told via policies/guidelines etc. And that’s what we do. So what change is she asking for here?

    • Jane

      Surely keeping the low risk women out of the high risk area would free up the hospital midwives from spending time with low risk women labouring and requiring support and attention? The best outcomes don’t come from midwives looking after several high risk women at once do they: 1:1 care would see those women have the best outcomes as in HDU/ICU etc.
      Typically women at home require the continued presence of the MW later than those being intensely monitored bc of complications: for example IOL.
      Just a thought. Works for us, or so I’m told. So well in fact that our biggest mat hops is setting about moving primary women out of the secondary/tertiary hospitals. Apparently they are not suitable for such high tech environments, and their presence and the staff they take from women with higher needs, is not seen to be reasonable. Midwifery care in the primary setting is now advised for those women – for several reasons, the above being one of them: logistics and ‘best use’ of resources.
      Jane
      Go figure.

      • Young CC Prof

        No problem with moving low-risk women to the primary hospitals, as long as these primary hospitals have the ability to perform a STAT c-section and do resuscitation and life support for a newborn.

        I did, however, hear about a few perinatal deaths that were the direct result of high-risk women being (probably inappropriately) downgraded to low-risk care at 36 weeks. One woman suffered a stillbirth because her midwife allowed her to go post-dates despite being AMA, one delivered in a facility that was apparently called a hospital but had only one person on staff in the middle of the night, and did not have the ability to stabilize a sick newborn for transport. (The newborn’s problems were a direct result of her previously diagnosed complication.)

        • Jane

          Yes I’ve heard of a few similar problems too. The woman who had an eclamptic fit 4 minutes after the ok for discharge at 35 weeks…
          The woman who ‘delivered’ at 24 weeks into the toliet so was given the uterotonic (then ecbolic) and then produced the baby…
          The twin 2 that was not taken to theatre as time and forceps would do it… it didn’t do it, she died.
          But this has nothing to do with being at home or ina primary unit of course, I was just giving comparison stories that I’d heard that were similar to yours.
          Stat C sections are not available in primary units, nor are epidurals or augmentation: due to the fact that therein a woman clearly changes to high risk o at least is having intervention.
          All midwives can resuscitate newborns: with a neopuff or a bag mask. Granted we don’t intubate (although rural midwives attain that skill based on the fact that they are far from a base hospital). Problems in labour would ellicit transfer and therefore only the completely unexpected NNR would be required in a primary unit, and while we never can say never, that baby should have been monitored in labour and therefore not be in secondary apnoea etc.
          Primary units are within 15 minutes of the base hospital in the city, given that there is also an average wait for an emergency ambulance transfer of 8 minutes.

          • AlisonCummins

            These are not problems caused by delivering in hospital. They are problems of insufficient obstetric care.

          • Jenny_from_da_Bloc

            What you are describing as resus is just bagging the baby.The completely unexpected happens often and that is not sufficient enough to prevent brain damage or brain death. It takes quite a bit more than that to resuscitate and 15 minutes plus an 8 minute transfer in an emergency is a very long time. I understand your defense of homebirth and the services offered by your country, but just because something is offered does not make it safe or the best option. Women here have the option to choose their medical providers, so why not choose the safest option?

          • Jane

            I’m not defending homebirth I’m suggesting that IN MOST CASES we can resuscitate a baby, or we have transferred before birth.
            And I’m not defending my country, I’m discussing what happens where I live.
            Initially resus is just that no? Bagging and masking. And adequate vnetilations will sustain a baby for a good while. Not optimal but an option. An

          • Jenny_from_da_Bloc

            Initially, yes that is what you start with, but what if there is no heartbeat or a serious arrythmia? What if the baby needs immediate advanced resuscitation? You might as well just call it if you don’t have the meds and equipment and a 23 min transfer time.

          • Jane

            Yes ok

          • Young CC Prof

            Yeah, the obvious safety issues aside, I think it’s incredibly misogynistic to be encouraging women to deliver without pain relief just to save a few bucks.

            Can you imagine if that logic was applied to any other medical procedure? If the orthopedic department replaced drugs with biting sticks?

          • Jane

            But you were suggesting that homebirth took the bucks… so where do you stand suggesting that taking the bucks to homebirth is not ok?

          • Young CC Prof

            Home birth takes the strictly finite resource of skilled midwives. Hospital birth uses other resources.

      • Karen in SC

        I think Jane is a man considering how little priority she places on access to epidural pain relief.

        • jane

          That’s not fair – I was responding to the comment re staff ing levels and the etc.
          I didn’t say epidural is not necessary if there are midwives for comfort, I said that apparently women often, sometimes, might, occassionally, a lot of the time, choose an epidural related to a lack of support from another human in labour. It’s not an impossible thought is it?
          Surely not all women that take an epidural do so through empowered choice and self worth? Or they do? Only those that don’t choose an epidural are prone to vagaries of the mind?
          And it wasn’t my opinion it was an explanation of what is happening where I live.
          James

          • Bombshellrisa

            I don’t understand how having someone to support you blocks sensations of pain like an epidural does.

          • jane

            It doesn’t numb you no. But it can make you feel ok about it.
            Like I don’t know maybe grief – nothing will numb the pain like 9 scotches and a dose of propofol of an evening, but a hug and some comfort might be a good start and lead to a different ending?
            Just an analogy, not my personal wedded to with my life opinion.

          • Roadstergal

            Grief is not physical pain. I’ve experienced grief, I’ve lost people very dear to me, I’ve felt torn apart mentally from it. I’ve also experienced physical pain from acute physical injury. The latter is much more straightforward to address – and hugs and love don’t do it.

            You’re not seriously comparing drinking away your sorrows to properly administered pain medication for acute pain management?

          • Jane

            Yep I am. I have suffered so badly from anxiety and overwhelming grief that I would have rather been dead. I wanted to be put out so I didn’t have to feel that way anymore. I didn’t feel that way in labour.

          • Bombshellrisa

            For some women, the pain of labor causes overwhelming anxiety and the only way to ease that is proven and effective pain relief. Whatever reason a woman wants pain relief in labor should be a good enough reason to have access to it.

          • Jane

            Yes absolutely.
            Howeve my point was just that some women won’t need an epidural if support of another human is enough for them.

          • Amazed

            And some of those “some” women don’t care to find out whether the support of another human is enough for them. They want pain relief. NOW.

          • Jane

            Yes I know but they can choose to be at home and then if it was awful bc an epidural was not on hand then so be it. So they made a choice and live with the result. Why is that not ok?
            I get that you think NCB advocates/kooks hoodwink women into believing that nature nature is all good good, but are women inclined to be so swayed by that? Or are they swayed by thoughts and beliefs that have been forming since they were born? Based on their life experience etc and etc

          • Amazed

            Since there is no way to know which women would find labour completely tolerable and which ones won’t, I think it’s unfair to set them for a birth that would supposedly be empowering when it might not end this way. And when it doesn’t, blame them for doing something wrong. Like, not being positive enough. Not trusting birth enough. Where is that “trust burth” meter that guarantees FOR SURE that once you pass the “trust enough” block, you WILL have this tolerable labour?

            And trying to dissuade women in labout who change their mind and now want the epidural or even block them from getting it is downright inhumane.

          • Jane

            Yes agree on all counts.

          • Bombshellrisa

            So they choose to be at home (a choice which is made before the labor pain, however terrible it might be, hits) then they reach the point where they have to transfer and they are absolutely in agony. Even with a system where transfers are part of the system and the midwife can admit the patient to the hospital, you have to 1) call an ambulance or arrange for transport 2) throw a hospital bag together 3) get the laboring woman who is in absolute agony into the mode of transport 4) get to the hospital, where said woman has to endure an admit and someone starting an IV and waiting for the epidural and then waiting for it to take effect. The transfer from home birth to hospital is often trauma in itself, not to mention the emotions that go into having something turn out completely different than you expected, in a way that you didn’t expect.

          • Jane

            Yes that is true. That is a down side to having to wait for pain relief.

          • Amazed

            No comment? Why, Jane? You had so much to say before. Sure, it was rubbish, and loads of it, but we could not shut you up.

            Why so silent now?

          • The Bofa, Being of the Sofa

            my point was just that some women won’t need an epidural if support of another human is enough for them.

            And some women won’t need an epidural even if they have no support.

            So what?

            What’s the point of your point? What difference does it make if support of another is enough for them? They can just refuse the epidural.

          • Jane

            My point was just what I said. Plain english – some women don’t ask for an epidural bc they don’t feel the need for one bc they have support. They feel it was the support that helped. It may not have been, it may have been that they had less pain – of course we’ll never know that.
            Your point was good too re not needing one irrespective of support. So what was the point of your point?
            I’m just chatting. Sorry. Dang.

          • Bombshellrisa

            And so? Distraction and companionship might might work and if so, then they won’t ask for an epidural. The problem I have is that it can be assumed at all that this will be a common occurrence when attending laboring women. And why settle for just “enough”? There is no good reason to be able to just be able to tolerate the discomfort/pain/agony of labor and birth. If there is a safe and proven way to block the pain, why settle for distraction?

          • Jane

            Because choosing distraction suits some women better than choosing regional anaesthetic
            I don’t know maybe they hate needles but love swiss balls.

          • Bombshellrisa

            I will admit that distraction can be better than nothing-I didn’t have benefit of pain medication but I had someone with me. I didn’t choose this, so I had to take what I could get. A great deal of the women in the US who are hell bent on refusing an epidural do so because of the “risks” and many of the risks they name are made up bull crap spouted by the homebirth and natural birth community who make a living from women choosing distraction over regional anesthesia.

          • Jane

            Sure.
            I make/made my living out of supporting women in pregnancy labour and birth. I make no more money whether they be at home hanging from the rafters refusing auscultation or in hospital with an epidural and CTG or anywhere in between.
            What I want is not part of the picture is it? Does what I want matter of a day? It’s not about me last time I looked. As a professional what I want plays no part.

          • Bombshellrisa

            Good. At the end of the day, women always have the right to birth at home, nobody here suggests that we make home birth illegal. What we want is every woman who does make that choice to be fully aware of the risks and the reality of the transfer process whether for pain relief or a medical crisis.

          • Bombshellrisa

            But “feeling ok” is an emotional thing, I am talking about the real physical pain of labor. Distraction is all well and good but it’s not pain relief.

          • The Bofa, Being of the Sofa

            But it can make you feel ok about it.

            Why should anyone have to “feel ok about” pain?

            When I go to the dentist, I sure as hell don’t want to feel good about the pain. I want relief from it.

          • LibrarianSarah

            I am sorry but that is a bunch of ablest bullshit. Taking advantage of pain medication as prescribed and managed by a physician is constructive. It helps you function in a day to day life. Drinking away your greif is destructive and can lead down a dark road to addiction.

            It is hard enough to be in incredible amounts of pain without healthcare “professionals” like you compairing people who need pain management like potential drug addicts.

            A better analogy would be if that grieving patient talked to a psychiatrist and was prescribed SSRI’s for complicated grief.

          • Mishimoo

            I can’t upvote this enough.

          • Roadstergal

            They seem like two unrelated things. Having support on-hand to help guide you through the process and be a comforting and sympathetic presence, having relief from physical pain – those both seem like things that should kinda sorta be available to women who want them, in a civilized society – not either-or.

          • Jane

            Yes

          • Roadstergal

            So it sounds like we do agree. Then why promote homebirth? Women can have emotional support in the hospital, if they want to bring a friend/partner/doula/ask for a favorite helpful midwife – they can’t have epidurals at home, if they find the pain to be too much.

          • Jane

            I don’t promote homebirth. I just think if women want that then sure choose that.
            Women can do what they want in my humble opinion. Why women/we/I/you choose as we do is what is very interesting. None of it is in a vaccuum, it is all related to how we have learned to view the world, the info we’ve gotten, the pervading discourse of the time.
            It’s interesting.

          • moto_librarian

            Oh, so you’re “James” now?

          • Jane

            I was being silly – as in I was called a man so I was being silly.
            I’m sorry.

        • Amy Tuteur, MD

          No, Jane is a midwife in New Zealand.

          • Jane

            That’s why you’re the doctor you is the clever one.
            🙂
            I know smileys are probably banned here but I well :/

          • Amy Tuteur, MD

            No cleverness needed, just this tweet:

          • Jane

            ??? tweet?

          • Jane

            Oh that tweet. Hmmm. I should redact that really.
            Someone must have been ‘mean to me’.

          • Jane

            Yes not very nice was it.

            Forgive me?

            Bigots was the correct word though at the time: http://www.merriam-webster.com/dictionary/bigot

            It was fair in my mind at the time.

          • Amy Tuteur, MD

            I really don’t care what you call me, but I don’t think it was ever fair. A bigot is someone who is prejudiced against a group that shares characteristics that they cannot (or should not be expected to) change like race, religion, nationality, sexual orientation, etc. Simply disagreeing with you and pointing out that you are wrong about a variety of empirical claims does not make a person a bigot.

            I don’t disagree with you because of who you are. I disagree with you because you make empirical statements that are flat out false.

          • Jane

            I wasn’t calling you a bigot I was speaking about some of the people that were ploughing into me re my comments. Bigoted as in totally intolerant without it seems drawing breath.
            You aren’t a bigot in my mind, although as I’ve said you can be quite cutting personally to those you disagree with – such as the pig in lipstick comment and calling Milli Hill pathetic, or suggesting that women that choose a homebirth do so with no regard for anything other than a dedication to NCB or a misguided fear of hopsital, all the while knowing they can be saved if they really need it by the doctor. Broadly speaking really. There can always be justification for that – ie you think they are this and that that, but it annoyed me. Now I see that is just what you do and I’m going to look beyond that bc what you say is interesting and I can learn a lot from it.
            Go me taking the high road right.

          • moto_librarian

            I am quite familiar with AIM, Jane. Color me unimpressed with the state of midwifery care in NZ.

          • Jane

            And the state of obstetrics?
            And is AIM the sum total of MW in NZ?
            Or is it just one side?
            Or is what you see there enough to make your call?
            Would you be able to say it is a fair representation of MW in NZ?

          • Amy Tuteur, MD

            One side? Ensuring the safety of patients by calling attention incompetent and irresponsible care, not to mention unsafe ideology of care, is not a “side” obstetrics. It is an ethical requirement of all patient care. The fact that you see it as airing dirty laundry as opposed to protecting patients speaks volumes.

          • Jane

            I do not see AIM as airing dirty laundry – never said anything like that. I suggested that they have one view, let’s not call it side let’s call it view – that is that MWs are incompetent. Solely that as the poorness of maternity care in NZ. Then I suggested that a fuller picutre would be the full picture.
            As in like you suggest the empirical evidence, the stats.
            Therein not dismissing or minimising or seeking to justify (because I can’t and wouldn’t presume to think I could) the loss the families on AIMs have suffered.
            I see viewing every angle from every angle as something that will continue to make a difference. Not just viewing how MWs have fucked up in isolation.

          • Amy Tuteur, MD

            Their view is that incompetent midwives ought to be discplined and that the New Zealand model of obstetric care provides too much latitude for midwives and not enough supervision for them. I haven’t seen a single case that they have reported that did not involve substandard care, have you?

          • attitude devant

            Waiting……

          • attitude devant

            Upon further research, it appears that Jane’s mother Margo (same last name) used to work in the same midwifery group in Otago as Jan Scherp. If you do a little internet research on Jan and her poor client Sara Gutzewitz you will find a true tale of woe that I won’t repeat here. My point in mentioning this is that Jane knows full well that AIM is not just about Charley Hooper–her own mother’s call partner abandoned a patient in labor with grievous results. There are 650 families involved in AIM.If that is ‘a view’ as Jane alleges, it’s 650 views of a flawed midwifery-based care system.

          • anon

            I won’t go into this bc it cannot be sorted here but if you go to the tribunal report re this the MW was utterly cleared of all counts.
            Can you tell us your understanding of what the grevious result was?

          • attitude devant

            Yep. The whole sorry story is online, including the fact that somebody clearly lied in her testimony to the tribunal. Was it the mom and the second midwife, whose testimony was in agreement, or was it Jan, the midwife being investigated? Under the circumstances, I’d say the failure of the system to sanction the midwife is the same as being “utterly cleared.”

          • Poogles

            “Can you tell us your understanding of what the grevious result was?”

            Not to speak for her, but I read it as a “grevious result” for the mother, not the midwife. And I would call an “exploded” perineum that required 140(!) stitches and the fact that the midwife left her and the wet, uncovered, still attached newborn alone in the delivery room directly after aforementioned “explosion” without examining the mother or even clearing the newborn’s airway to be grevious. She abandoned the poor woman, who was suffering from a very significant birth injury (and still screaming in pain), to go to the nurses station and graphically describe what just happened because her anxiety condition was apparently keeping her from fulfilling her professional duties.

          • Anon

            The abandonment and the grievous results:

            http://www.hpdt.org.nz/portals/0/mid12221ddecisionweb.pdf

            A point of reference

          • anon

            No. I have not seen the same degree of public debate re poor OB practice though. Why? Because it doesn’t exist.

          • KarenJJ

            I work in a volunteer capacity at the school and other things and one thing I’ve come to learn is that these types of roles and organisations can become a “target” for unscrupulous people. Funds go missing, people lie, and some people use these roles for personal gain (eg sexual). A few friends have worked in local organisations including one where a pregnant woman ended up going to jail after stealing thousands from a local non-profit and another where she accidently booked a pedophile for a local school event (back prior to working with children checks).

            The problem with midwifery is that they are not immune to human behaviour and people trying to take advantage. Not all midwives that are in the profession are going to be ethical and have the safety of their patients as their first priority by virtue of the fact that they are human like everyone else. It doesn’t mean midwives should be protecting them.

          • fiftyfifty1

            So maybe AIM should be encouraged to “sandwich” any point of criticism between two layers of praise or something? barf

          • jane

            No of course not – I am not suggesting a shit sandwich in any sense – I am suggesting using the stats. And talking about ALL the poor outcomes that we can learn from. That’s all.

          • KarenJJ

            This sort of deflecting I’m picking up from MRA (lets talk about ALL victims of domestic violence) and also midwives (lets talk about ALL poor outcomes). jane – the spotlight is on midwives with AIM. The deflection, the obfuscation, the victim blaming – can you not see how wrong it is? Some midwives are practising out of scope, incompetently and unethically. Why would you defend that? I can only think of two reasons:
            1 – you are clueless and trying desperately to maintain an image of a profession you once believed in, or
            2 – you are part of the rot.

          • KarenJJ

            If there are some incompetent midwives that are practicing in ways that are damaging the public preception of the profession then why would you want to “protect” them. Is the profession more important to you then patient safety? Isn’t this the sort of damaging mindset that allows institutional abuse to flourish? Just because priests or scout leaders or doctors or midwives are “nice caring types that are helping people” doesn’t mean we shouldn’t hold them accountable?

          • jane

            I agree. But to make it seem/sound/insinuate/indicate that it all ‘us folk’ is not fair.
            I know that we need to hold accountable those that make errors. I know that.
            I am asking why we don’t have a rounded approach.
            I am defending the MWs tht are being maligned by association despite having done nothing wrong.

          • AlisonCummins

            By “rounded approach” you mean why does this site not focus equally on inadequate OB care?

            The answer is that the medical professional associations and the insurance companies do a pretty good job of that already. In the US there is no similar body to hold midwives accountable and since midwives do not buy insurance the insurance companies have no leverage.

            (note my full legal name)

          • KarenJJ

            So make sure it isn’t “us folk” and take a strong stand against incompetence and poor maternity care. Similarly not all obgyns are Dr Graeme Reeve, all midwives shouldn’t be incompetent nutters. Obgyns had to learn to be discerning as to who they claimed as their own. Isn’t it time for midwives to do the same?

            Incidentally I know someone whose obgyn was Dr Graeme Reeves. She said he had a great bedside manner with her and was very nice. Nice means very little with regards to competence.

          • Dr Kitty

            Did I miss Jane going back and editing her posts, replacing them with “no comment”. Nice.

          • KarenJJ

            That’s all I’ve seen on here too. Good to see a midwife showing that kind, caring and ethical behaviour we’ve come to expect. What are these midwives being taught?

          • attitude devant

            Yep. And now she’s commenting as ‘anon’. So original.

          • The Bofa, Being of the Sofa

            Funny.

            On all these NCB, you say something contrary or negative, and you get your post deleted.

            An NCBer comes here and posts all over, and nothing is deleted. However, she gets in so far over her head that she deletes her OWN posts!

            She needs to start her own blog so she can delete comments that make her look bad

          • Karen in SC

            Excellent point! What a coward!

          • Poogles

            Ugh. Reading through the comments and seeing your “no comment” over and over because you have redacted almost every comment that you wrote on your disqus account has revealed that you are not only intellectually dishonest, you don’t even have the integrity to stand behind your own views and values.

          • Jenny_from_da_Bloc

            Milli Hill is pathetic, she proves it herself quite often.

          • moto_librarian

            So are you Jane Townsend? Pretty sure that Margo Townsend has not been particularly kind to various AIM families – are you two related? Also, AIM does not turn away any families from sharing stories. It just so happens that 95% of them are related to midwives rather than OBs.

            And before you wonder how I figured it out, your Tweet made it quite easy.

          • Jane

            Honest to god really? Give me something where she was not very nice to families? She asks questions as do I and asks them of all sorts of things. She has NEVER EVER been unkind, unfair or not very nice to the families? Examples please?
            And yes we are related. She is my mother.
            Ask Jenn to go through her posts and find anywhere that Margo has been unkind, as opposed to not wedded to the emotive, because it is not her’s to be emotive about, therefore tries to be circumspect.
            Jane

          • attitude devant

            Never piss off a librarian, Jane. They have mad computing skillz. And moto happens to be friends with the Hoopers. And you were just a wee bit nasty to Charley, who after all is severely disabled (thanks to Kiwi midwifery care) and unable to defend herself….

          • Jane

            I did not diss.
            And while you are able to post anon I was identified. That is unfair.
            Jane

          • theNormalDistribution

            Aww, muffin.

          • moto_librarian

            Here’s the thing: figuring out who Jane was presented no difficulties, because her Disqus profile gave key information about her identity. I don’t think it was unfair to ask her directly about that. I didn’t do any deep sleuthing or anything shady – it was readily available information!

          • Jane

            And while I’m here, we also find that sometimes, believe it or not, midwives suffer from malignment that we are not all due. And as a human, a woman, a professional, that can be really hard. When you head out each day doing a good job, work hard at being excellent, keep studying and learning to keep up to date and excellent, then it can be hard to hear that we are all apparently idiots.
            Anyone who knows me, knows me: I am a good person and a great midwife.
            Jane

          • fiftyfifty1

            “When you head out each day doing a good job, work hard at being excellent, keep studying and learning to keep up to date and excellent, then it can be hard to hear that we are all apparently idiots.”

            Negative feedback isn’t fun. But having fun isn’t the purpose of feedback. Improving patient care is the purpose. And healthcare providers don’t get to be exempt because they work hard or try hard. Midwifery, as a profession, has a problem with issues surrounding pain in labor. This is at a leadership level, and frequently, as you have demonstrated, at an individual level. It doesn’t mean all midwives are idiots or that they aren’t caring individuals, but it does mean that change needs to happen.

          • Jane

            I don’t mind negative feedback to me about me about something you know I have done and are doing or haven’t done when I should have but I do mind being cast in a certain light unfairly.
            I get your point re feedback and fun and I know that we have to seek to do better nad better – that is however different from being personally held to task for the real and supposed failures of my profession.
            I do pain relief well – whatever someone wants they can do. Anything, anytime as per what is available for use in maternity.
            I have NEVER on this thread/site/blog suggested that epidural is a poor option – NEVER.
            I have said
            1. sometimes women wouldn’t choose one if they had support
            2. they do not always work

            That was all.
            Just saying that for some women not having and epidural is an option they want to choose. I see here that some reason for that is fear for complications – instilled in them by NCB fanatics perhaps (not me so can’t comment), but your posts all seem to indicate that. And I said earlier that in tht regard fear is not a good reason to choose anything. Unless of course you fear pain and don’t want any – then choose not to have any.

          • attitude devant

            A good person who dissed a disabled girl, whose disability was caused by the very midwifery system she praises. Uh-huh.

          • jane

            I did not diss I made suggested that she was etc etc was not fact – as in evidence tested – it was stupid of me.
            Jane

          • attitude devant

            Also edited. Jane acknowledged that she was indeed Jane Townsend

          • Jane

            Is it reasonable in a medium like this that my full name is written here? It seems unfair? And makes me feel quite vulnerable. Apart from Dr T everyone else has anonymity.
            Would you remove that for me? Please.

          • attitude devant

            Why Jane? Are you embarrassed by something you’ve said? Are you not willing to embrace your writings here?

          • jane

            Please! Of course not. I was like you not giving my full name on here.
            Why are you not identifyng yourself? Are you embarrassed by something you’ve said? Are you not willing to embrace your writings here?
            I guess we can ask that of everyone here?

          • moto_librarian

            If you had not chosen to say things about AIM that can be easily refuted, I would not have dug any deeper. What you said in regards to Charley pissed me off big time. I wanted to know why you were so invested in that particular case. Now I know why.

          • Poogles

            “Are you embarrassed by something you’ve said? Are you not willing to embrace your writings here?”

            This is obviously the case, since she has gone through her comments and redacted most of them – looking at her disqus comments is basically a list of “no comment”. SMDH.

          • Jenny_from_da_Bloc

            You removed your own anonymity by using your twitter acct and tagging the Skeptical OB in the tweet. If you were trying to remain anon tagging Dr.Amy wasn’t the way to go.

          • Jane

            I did not post my own name on here. Therefore no one else had the right to. It is as simple as that.
            And my full name was not and is not on my TWITTER acc. so someone did take the time to do more than link my twitter. They did some other search – as was their right.
            It is however not reasonable. It is unfair and it is betraying the trust of this blog.

          • Jenny_from_da_Bloc

            You can’t expect complete and utter anonymity if you use social media, hence the name, social media. You put yourself on blast and even tagged the Skeptical OB looking for attention or reinforcements. Either way, the pendulum swings

          • MaineJen

            Well it seems that your twitter profile is linked to your disqus profile…and the name of your place of business is attached to the twitter profile too. And then you tagged Dr. Amy by name, allowing them to link directly to that tweet. Sooooo….I’m not even tech savvy, and it wouldn’t have been hard to find you…

          • anon

            I know tht now so more fool me but that doesn’t mean it is ok to write my full name here
            It’s just not.

          • Kory Oransky

            Jane, I have posted on this blog several times using my full name. I think the whole world knows by now that I had a uterine rupture that would have been catastrophic for me and my beautiful daughter outside of a hospital setting.

            I have nothing to hide about that, as much as you and your fellow midwives would love for women like me to go away and shut up when they are trying to convince women that HBAC is perfectly safe.

            It has never come back to bite me in the ass, and it happened over 4 1/2 years ago.

            But then again, I don’t go out of my way to post heartless, malicious and flat out untrue statements on this blog.

          • attitude devant

            Actually, you DID comment, Jane. But you edited it to this later

          • Dr Kitty

            So, apparently Jane’s response to the old conundrum of whether to remain silent and be though a fool, or to speak and remove all doubt, is to speak, remove all doubt, and then pretend you didn’t.

            Which means that the people who saw the original comments know what she said, and the rest of us are free to suspect the worst.

            I’d almost always prefer a retraction, clarification, apology or explanation over a redaction.

            If you aren’t prepared to stand over your comments, to defend, explain or, if necessary, apologise for them, maybe don’t write them at all.

          • Young CC Prof

            She was expecting us to fall all over ourselves in awe at her words of wisdom.

      • theNormalDistribution

        This response makes no sense at all. You were asked why it makes sense to allocate a ridiculously high number of resources to the women who need them the least.

        • Jane

          My response does make sense. Read it again.

          • theNormalDistribution

            I already read it twice because I couldn’t find a coherent response to what Dr. Kitty said:

            When there is a crisis in midwifery staffing levels, the appropriate short term response, surely, is to try and get all the midwives in labour ward, rather than to have two midwives attending every Homebirth.

            Let’s try to break that down with a thought experiment. Say, for the sake of argument, you have twenty women in the labour ward, and eight midwives. That means each labouring woman will receive an average of 40% of one midwife’s time, where of course, and this is key, high risk women would receive more attention than low risk women. But send one low risk woman home with two midwives, and now the women on the labour ward are, on average, recieving 32% of one midwife’s time. You can be sure that this deduction is going to affect high risk women more than low risk. Send two women home, and the women in the ward are getting a 22% average. Etc etc. Meanwhile, the low risk mother at home is using up more than five times as many resources than she would have had in the ward, to the detriment of all other patients. Surely you do not think this is the best use of resources?

  • SisterMorphine

    Somebody remarked about them trusting EMTS/paramedics too much–not them I don’t trust, but traffic, rural roads, lousy GPS, etc. Friends of ours have a son who (having a prior but previously controlled history of absence seizures) went into full-blown status epilepticus. The parents dialed 911 when they realized what was going on, but it was, sadly for the poor kid (9 at the time) a blizzard night, after it had been snowing for days. They got there, but almost as soon as they got him in the bus, the boy went into respiratory arrest. They heroically managed to keep him alive till they arrived at the hospital 20 minutes later and he was in the ICU comatose for 4 days. He returned to consciousness, but still has severe cognitive disabilities and will likely never live independently. And this is a case that was a true emergency–as in, no way it could be predicted, what EMTs are trained to handle–and while the parents are grateful the outcome wasn’t worse, they still struggle daily, and in this case it was nobody’s fault. In a homebirth: You know ahead of time the risks–dead, brain-damaged, or disabled child and/or mom–even if the risk is low, in a situation so fraught w. risks you can’t foresee, Why.Take.The. Risks.

  • fiftyfifty1

    Hey, I’d like to invite your kid to a special party! This is literally a once-in-a-lifetime event for your child. We will be doing an extreme sport obstacle course. As part of that, your kid will be pushed headfirst through a tight muddy tunnel. Now it’s true that some kids suffocate in the process, but it’s also true that most make it through just fine. We’ll see how yours does when he comes out the other side, eh?! If he’s seriously screwed up or dead or something, we’ll drive him (fast) to the hospital where they will do whatever uptight annoying bullshit it is that they have been trained to do, and your kid will almost certainly be brought back to life. Either way, it’s bound to be an unforgettable event! All the coolest parents are sending their kids.

    • fiftyfifty1

      ETA: let’s HOPE it’s head first LOL! You should see what sometimes happens to the ones we send through feet first. Have you ever seen a kid literally break his neck? Unforgettable!!

    • fiftyfifty1

      ETA: If what I said about “suffocate” is getting you uptight, don’t worry! I’ll put my ear to the tunnel occasionally and if I hear noises that sound like obvious suffocation we can always bring your kid (along with the tunnel I suppose, how inconvenient!) to the hospital or something.

    • fiftyfifty1

      ETA: Did I also mention that I’ve turned my love of hosting these awesome parties into a business? So there will be a cover charge! A big cover charge actually. Send the $ along with the RSVP.

      Oh and also I hate when I get hungry hosting the party. So it’s up to you to send the cake and ice cream.

      Oh, and also clean up the mud etc afterwards.

    • Bombshellrisa

      Mud is natural!

  • birthbuddy

    Where I practice, the government has adopted a policy “of maternity care by midwife with Obstetric rescue.”
    There is just a small problem.
    They haven’t been transparent about the policy and no one asked the Obstetricians if they agreed to be part of it.

    • Karen in SC

      Obstetric Rescue? What country is this?

      • birthbuddy

        Australia but I think it could also apply to NZ and UK,

        • KarenJJ

          Refer also to Hannah Dahlen’s “towards Normal Birth” policy in NSW.

        • Anj Fabian

          Could we have a link to a document?

          I want to see this craziness in person.

        • Theoneandonly

          I’m in New Zealand and I haven’t heard of this. Granted, I’m not a midwife/doctor/anyone in the medical industry, and all my obstetric care has been under a private obstetrician. Our system is primarily midwifery based (which is state funded), with referrals to hospital based OB’s for complications (also state funded). This was instituted in 1990 (I believe), and as far as I’m aware it’s been accepted by all parties.
          We have chosen to pay ~$5000 NZD for the privilege of having an OB from the start in both my pregnancies though, so you can go outside the state system as well if you wish.

  • Jane

    Amy women having a homebirth and needing to transfer to hospital are not really that different to the women in hospital needing that secondary level of care: both need intervention: the woman from home sought it when it became clear that things were going awry, and the woman in hospital was already there when things did go awry. The exception in my mind, is that we can be very sure that the complication leading the homebirth woman to transfer did not happen in hospital… We cannot be so sure that the complication for the woman that started labour in hospital, was not caused by the mere fact that she was in hospital. What is so bad about CHOOSING not to go to hospital unless things are pathological as opposed to going to hospital in case things become pathological? If we all did the latter based on the ‘risk’ we face in living, we may as well all pack our bags now and live in the hospitals… just in case.
    Rigid dogma one way or the other is not helpful right? You say as much every time you speak about the NCB or the crazy midwives forcing ‘natural birth’ on everyone like sadists. How come you cannot see what you espouse is exactly the same – dogma – not moderation, not critical thinking, not even scientifically based ‘truth’, just dogma.
    There is of course a degree of ‘truth’ in everything you write here day after day, however there is also a degree of truth in many many things you espouse as untruth as well.
    Women who choose to give birth at home, do not do so to spite you, so why do you write your blog in such a way as to spite them?
    Thanks for your time
    Kind regards
    Jane

    • Sue

      ”What is so bad about CHOOSING not to go to hospital unless things are pathological as opposed to going to hospital in case things become pathological?”

      Is that a serious question? Assuming that it is, the answer is this: because, in hospital, (a) you have a team of skilled people with equipement that identifies the pathological; and (b) you are already in the place with the people, skills and equipment to fix it.

      This is nothing at all like transferring to a higher level of hospital, because, in that case, you are already within the system of care.

      And the silly statement ” If we all did the latter based on the ‘risk’ we face in living, we may as well all pack our bags now and live in the hospitals… just in case. ” WOW – if your everyday life is as dangerous as giving birth, you must live very differently to the rest of us.

      (Please tell me that this is some twelve-year-old having a joke at our expense. The ”kind regards” gave it away.)

      • Jane

        Sue no I am not 12 I am 43 (cue snide comment).
        All you did here was paraphrase what I said and question whether I was serious and then call me silly.
        An answer to my questions would be helpful – as opposed to the pathetic, rude, personal, uninsightful, completely useless response you just gave.
        I will ask again, what is so bad about not going to hospital unless things are pathological? And if pregnancy and birth is so risky perhaps you suggest we should begin confinement at conception…
        You people are infuriating and soooooooooo revolting to other people it is worrying.
        What threatens you so much about someone choosing something else?
        Ugggghhhhhh (said the 12 year old)

        • Kerlyssa

          Because heavy monitoring and availability of life and function saving interventions on that one day can prevent vast amounts of crippling injury and death. The cost/benefit ratio of living in a hospital your entire life is much lower- a child would have to be inpatient for its first 18 years to break even, riskwise, with being inpatient for labor and delivery + a day. Also, saving an infant or young woman from that adds up to more years saved than doing an intervention on an 85 year old. A newborn has 80-100 years ahead of them, if all goes well.

          • Jane

            BUT honestly, the stats aren’t good when you give birth in hospital. Seriously you need to look further than this blog. The numbers don’t stack up.
            Look at the rates of morbidity and mortality… this stuff is happening in the hospitals – and it is not the transferring homebirths that make up these numbers. The transferring homebirths are a small number.Find out what the reporting requirements are for the hospitals in your area: often internal processes that don’t see the light of day.

          • birthbuddy

            Jane, you sound moderately intelligent. You do realise we compare RATES don’t you? More people deliver in Hospitals than home birth and they are ALL RISK not only low risk. Despite this the baby has a 3-7 times higher risk of dying at home birth.

          • Jane

            Yes my moderate intellect, albeit possible of a 12 year old (than you for the compliment) does get that.
            Where do you get the 3-7 times higher – I will read it if you reference it for me?
            Others can espouse different figures right? So it must depend on where the figures are obtained and where the focus is placed when interpreting?
            Ina May will tell you they loose very few in birth, others will tell you they are dying left, right and centre. Who is telling the truth – and why?
            Is there a better way of birthing at home in the US then? Or must it simply be the hospital.
            The article I posted re EFM/CTG is interesting.
            Jane

          • birthbuddy

            Numerous references available on this site. I genuinely think you find them interesting.

          • Jane

            I genuinely do.
            Cheers
            Jane

          • Dr Kitty

            The article is written by a neurologist (not an OB) who got his JD in Eugene, Oregon and a personal injury lawyer who, as his own website puts it:

            “Defended to verdict the obstetrician in one of the first successful defense verdicts in Texas in a birth-related permanent brain injury cerebral palsy case

            Represented numerous physicians and hospitals in cases involving alleged birth asphyxia, brain damage, and cerebral palsy”

            Just FYI.

          • Young CC Prof

            In the USA, all infant deaths are recorded. If you look up the CDC Wonder database, you can examine the rate of neonatal death (before 30 days of life) for babies born out of hospital with midwives versus babies born in the hospital with midwives. (Remember to limit the search to babies born at full term, since preemies are almost never born at home, and most babies who die in the hospital are premature.)

          • Montserrat Blanco

            Even in the Netherlands it is riskier to give birth at home than at the hospital. I think that women should be able to make that choice but it should be an informed choice.

            In any case, in the USA not all the homebirth midwives are appropiately trained. It increases very much the risk. I live in a country where all the midwives have university training so that is not comparable to USA. I could consider to give birth at home with real midwives but I would never ever consider that with someone that has not a real midwifery degree.

            In my case, being pregnant right now, I have to say that I have chosen a hospital to give birth because I want to be absolutely sure that the baby will have the best possible chances if something goes wrong. The hospital is 10 min walking from our house, and about three minutes by car. Even with those circumstances I will give birth at a hospital.

          • moto_librarian

            Have you looked at the demographics of the population of birthing women in the United States? Do you understand how many women go without adequate prenatal care due to disparities that fall along racial and socioeconomic lines? Do you know that women in the States are generally older, more overweight, and more prone to serious preexisting health conditions than the birthing populations in other countries? You are intellectually lazy, and then get all pissy when you are called out on it.

          • TsuDhoNimh

            “and it is not the transferring homebirths that make up these numbers.”

            We do not have a good system for prenatal care. It SUCKS!

            Way too many women encounter the maternal health care system when they are 9 months pregnant, fully dilated and pushing.

            Or at 7 months when they go into convulsions from the pre-eclampsia that could have been detected if she had been poor enough to qualify for free care, worked a job that provided health care , or made enough money to buy her own care.

            Or they live 3 hours from the closest clinic, have no car and there is not public transportation.

        • Who?

          I don’t think Dr T or anyone feels threatened by being disagreed with-they feel babies are threatened by incompetent ‘care’.

          And how ‘pathological’ is ‘pathological’. If the strip is printing and it shows heartbeat problems, how long to wait before packing up?

          If people truly understood the risks of homebirth in the US to both mortality and long term damage, they wouldn’t risk it. They don’t, and that’s what this blog is about.

          • Jane

            http://jcn.sagepub.com/content/early/2014/09/01/0883073814543306.full.pdf+html

            If the strip is printing and it shows heartbeat problems, there’s a chance it helps not t all.

          • The Bofa, Being of the Sofa

            If the strip is printing and it shows heartbeat problems, there’s a chance it helps not t all.

            And there is a chance it DOES help, and if you don’t do anything about it, the baby will die.

            So let’s see….if we don’t act, the baby might live but it might die. If we do act, the baby will live either way.

            Sounds like a good idea to me…

          • Jane

            Fair enough. BUT why does it have to be so mean spirited. It just seems like a constant attack. Cutting and snide remarks about midwives, HBA, NCB… is it necessary to be so foul to get the point across.
            I like hearing all sides of things – otherwise dogma takes hold – but why so mean?
            Look back at the one about put lipstick on a pig it’s still a pig… really? That is a rude and unnecessary personal attack that we shouldn’t accept.
            If the argument is strong it will stand without insults and snideness surely.
            Jane

          • Who?

            Yep, Dr T is sometimes rude.

            For me, people who tell familiies their babies weren’t meant to live, that their deaths could not have been foreseen or prevented, or that they didn’t believe hard enough, therefore needing interventions, are the actual villians here.

            If your best argument is ‘Dr T is mean’ then so what? If I have to choose between being wrapped in the warm embrace of someone or other, or having high quality care, then I’ll pick the care any day of the week and console myself in other ways.

            Have a look at ‘Hurt by Homebirth’ in the list of sites on the side of this page and come back and say it isn’t important to get the message out.

          • Jane

            Ok I’ll take a look.
            You miss my pint. I couldn’t give a flying monkeys about being wrapped in any embrace. I just question why outright rudeness is necessary. To me it smacks of bullshit egos that can’t just say it as it is without having a personal dig.
            It undermines the intent: unless the intent is to come across as a rude misogynist bitch.
            Not once have I had a direct answer to a direct question. I can only imagine this is because a. Dr T only likes others to speak when they are sopken to, or b. because Dr T cannot sustain a reasonable debate.
            We can all espouse singular opinion, quote research and attack others; surely we assist others far better, and further our cause far more by allowing some reasonable debate.
            And yes I know cue “blah blah if you were having a reasonable debate, 12 year old fool who loves seeing people die just so she can be all natural is best”
            Jane

          • Mishimoo

            Dr Amy advocates for ALL women to have the ability to make informed choices about birth, how is this misogynistic?

          • Jane

            She advocates for all women – ok… but clearly not to choose homebirth. That is a paradox no?
            So a selective misogynist then?
            Jane

          • Amazed

            Jane. Please google Gavin Michael, Jan Tritten, and Christy Collins. And Danielle Yeager, the mother in this case. I am warning you in advance, there will be mainly links to this site. Not because Dr Amy is a selective mysoginist but because the lovely midwives deleted it.

            You can keep making snide comments. Or you can be appalled with the rest of us. The informed choice is yours.

          • The Bofa, Being of the Sofa

            She advocates for all women – ok… but clearly not to choose homebirth. That is a paradox no?

            Not a paradox, it’s illogical.

            In your first part, the object of her advocacy is women. In the second, you switch to choices. Those are different concepts.

            Does she advocate for all choices? Of course not.

            Does she advocate for women who choose homebirth? YES! She advocates for them by insisting that they get good information about what they are doing, and that they get competent care instead of the non-care they get from CPMs.

            She’s evil for sure.

          • TsuDhoNimh

            “She advocates for all women – ok… but clearly not to choose homebirth. That is a paradox no?”

            Advocating for a person, not a procedure, means sometimes “Don’t do it” is the best advocacy of all.

            The home birth advocates are letting their zeal for the process get in the way of the cold hard statistics … hospital birth provides the best chance at a good outcome for mother and child.

            Maybe hospital birth is not the preferred process, but if you are more concerned about the purity of the birthing process than the outcome of a healthy child and mother ….

          • LibrarianSarah

            It is ironic that you called Dr. Amy a misogynist when you are using plays from the misogynists handbook yourself. First off you insist that for a women’s opinion to have value or to be listen to she has to be “nice” about it. Then when she fails to meet your standards of “niceness” call her a “bitch.” I suggest you work through your own internalized misogyny before throwing stones.

          • Who?

            Hold on a second. Advocates for all women-yes. You suggested not all women are suitable home birth candidates, so how would advocating for choosing home birth be advocating for all women?

            The challenge is that in the US there are a lot of charlatans, adrenaline junkies and flat out irresponsible incompetents peddling misinformation about health care during pregnancy and the realities of giving birth.

            If Dr T advocates any idea, it’s that the truth should be told and misinformation should be recognised. Further, she proposes that people who don’t tell the truth, or tell selective bits of truth, or who spread misinformation, should be called out.

            Dr T values live babies over birthing experiences and pushes buttons to get people talking about this.

            And honestly misogynist? Really? For saying that spreading misinformation about healthcare during pregnancy, prenatal testing and high quality care during delivery is a bad idea? If that’s woman-hating I want to move to where you live, here we have poverty for single parents (overwhelmingly women), a woman killed each week by a current or former intimate partner, and disparate incomes.

          • Jane

            Also… before I turn in for the night… how on earth can someone that clearly has a singular opinion and a clear dislike or bias for one thing or another, possibly be an advocate for choice. They absolutely can’t. At all. Ever.
            If all we all want as women is choice for women then why the battle lines?
            Jesus if we actually hope that women can make choices that optimise their lives and that of their children etc why are we so pissed at each other for having a differing point of view?
            How can one view be all things for all people – it cannot. Stereotypes and judgements without individualising is not going to see us progress, and will never truly advocate for women.
            Jane

          • Mishimoo

            Please continue to read this site and follow the links for further research. People are being denied the information required to be able to make an informed choice and this site attempts to remedy that. There are a lot of things wrong with the homebirth community, most of which are deleted or shouted down elsewhere. Here, they are discussed and allowed to stand or fall on their own merits.

            Providing information to women who may not otherwise see it or have access to a decent explanation of it is, in my opinion, the opposite of misogyny. Tone-trolling has no place here.

          • Jane

            Ok
            Tone trolling – so now I can’t even have an opinion without being given this odd title.
            Fair enough to provide information to women that may not otherwise have access to it. But is singular opinion ever providing full information.
            No tone-trolls = no discussion.
            Fine by me.
            Enjoy your own company and singular views and expressions.
            Meanwhile the real world continues on.
            Rather a tone-troll than a narrow minded pillock.

          • The Bofa, Being of the Sofa

            Tone trolling – so now I can’t even have an opinion without being given this odd title.

            Yeah, because you know what? Your actions in this thread are not unfamiliar to anyone who has been here for a while. We see it all the time. You come in with all these objections based on ignorance of the US midwifery system, get informed, then move onto some other objection, get informed there, and, ultimately, the only criticism you have that holds up is that Dr Amy is mean.

          • Mishimoo

            I find it interesting that you appear to think that you’re allowed to hold an opinion without drawing any criticism, but do not extend that courtesy to others.

            As for opinion vs. information – the information is provided here in full, with opinions on the value. It is often picked apart to explain whether or not is it something to take into account when making a decision.

          • Who

            Bit less sensitive would be more your colour I think.

            And of course you’re right, it is not good to be narrow minded: most people here aren’t. They are open minded and aware of the risks and pitfalls of homebirth as it is practised in the US. They are open minded about the benefits proper medical support and attention can provide.

            However, they are really intolerant of home birth ‘midwives’-we need a more appropriate word for the unqualified, ignorant adrenalin freaks who give actual midwives a bad name-who put babies’ lives at risk by lying to their mothers.

            You’ll see if you look around the site women who came to scorn and stayed to praise, when they learnt what had been hidden from them by people claiming to have their best interests at heart. And some of those women lost babies at the hands of these ‘midwives’, were shunned, and have found understanding and acceptance here, and real acknowledgement of their grief and suffering.

            You might also find ‘not buried twice’ interesting-it acknowledges babies who died at the hands of homebirth enthusiasts, rather than keeping the stories quiet so as not to ruin the ‘legend’ and income stream of the incompetents who presided over their birth and death.

          • Belle

            From reading your posts, it sounds like you work in the Canadian system, am I correct? I have worked in both systems, and I am against home births. I do believe the midwifery model in Canada is better than the CPM/DEM model in the US, but I still do not advocate for home birth. It’s just too risky IMO no matter how you try to spin it otherwise.

          • The Bofa, Being of the Sofa

            Also… before I turn in for the night… how on earth can someone that
            clearly has a singular opinion and a clear dislike or bias for one thing
            or another, possibly be an advocate for choice.

            Because she accepts the right of a patient to make a bad choice. She only insists that they are AWARE of the consequences of that choice. And the consequences of that choice are not dependent on “your point of view.” The accepability of those consequences might, but the consequences themselves do not.

            The problem that Dr Amy is fighting is that people are choosing without being told of the consequences, or even being lied to about the consequences. One cannot make a rational choice when information is not available.

          • Amy M

            And I would also add, awareness of REAL and SERIOUS consequences, because that’s a popular line among lactivists too: “I just want you to be aware of ALL the RISKS of formula, so you can make an informed decision.” But of course, the risks of homebirth FAR outweigh the risks of formula, and that statement, when used by a lactivist, is incredibly disingenuous. The slight possibility of an extra ear infection is in no way comparable to the greater risk of death/brain injury in homebirth.

            I did read that Jane is not from the US and works in a country where midwives are integrated into the system. That is not, of course, who we are talking about here. Here, the problem is with what are essentially lay-people, taking lives in their hands and refusing to take responsibility when things go wrong.

          • Rlbobg

            And once you have been on the receiving end of a homebirth transfer gone “bad” ( I have seen four now, from hemorrhage, to feet protruding from the vagina, to fetal heart rate of 40 on arrival) you will NEVER say that it is “just as good” to treat these conditions after the fact than it would have been to recognize and prevent them in the first place!

          • Belle

            Very true! And unfortunately, many parents have to experience these horrible things in order to fully realize how truly stupid home birth really is.

          • D/

            The NRP program was developed when I was a new nurse. I remember being awe struck at every one of the early neonatal resuscitations that I participated in when the baby survived (and survived intact). Over time it became more of an expectation on my part that the majority of resuscitations would be successful since I saw that was the case. It was never a guarantee, but it was not some sort of accident that these babies survived either.

            Homebirth-gone-bad presentations in the ER were always among the worst of the worst resuscitations. Nothing hits the pit of your stomach like no notice, stat call to the ER, resuscitation in progress, pediatrician/ neonatologist en route from home. Guarantee here … This is NOT going to go well.

          • Amy Tuteur, MD

            So if I tell women that smoking increases the risk of lung cancer I’m a bigot? So the tobacco companies that for years denied the link between cigarette smoking and lung cancer were just supporting “choice”?

            What’s the difference between a midwife like you denying the risks of homebirth and a tobacco company denying the risks of cigarette smoking? Not much; both are defending their source of income.

          • jane

            Yes sure, but you seem to be saying that there no risk inherent in going to hospital. And that is not true.
            You know it is not true.
            Since it is your job/blog and not mine, how about giving us both sides of the picture. Give us the stats re morbidity and mortality in hospital – for those women that are not high risk and for those women that did not start labour etc at home
            Do like a them and us piece. You must know both sides right, in order to make your points so well.
            Jane

          • Young CC Prof

            We don’t have enough data to study maternal mortality at home, and morbidity may suffer from inaccurate reporting. There are single cases of maternal deaths at home that probably could have been avoided, but we don’t know how common that is.

            However, here’s a post she did, discussing a study on the causes of near-miss maternal mortality in hospital birth:
            http://www.skepticalob.com/2012/01/near-miss-maternal-mortality.html

          • moto_librarian

            If I hear one more person blather on about the rates of maternal and infant mortality without providing the appropriate context, I am going to rip my hair out! Instead of just trotting out the ranking, do a little damned research into why we rank this way. The U.S. actually has a very low rate of perinatal mortality (I think we are 3rd in the world). Infant mortality is up to age one, and as such, is a better indicator of pediatric care. It is hardly a secret that the United States continues to have huge disparities in care based on racial and socioeconomic lines. We also are, as a population, heavier, older, and more likely to be suffering from pre-existing health conditions. These factors certainly impact pregnancy. I believe Dr. A shared information from a conference at Harvard that showed cardiac issues to be a leading cause of maternal mortality. What we seem to need is better care for high-risk patients, not more midwives, who by definition can only care for low-risk patients.

          • The Computer Ate My Nym

            Give us the stats re morbidity and mortality in hospital

            Oooh, me, me! Can I answer this one?

            Data from the CDC Wonder web site, for the years 2007-10, infants dying within 28 days of birth, GA 37+ weeks, at least 2500 grams at birth, singleton, vaginal births born to white women who had at least some prenatal care.

            Deaths for infants born in the hospital with MD attendant: 0.38 per 1000. For CNM in hospital 0.26 per 1000. For non-CNM midwife out of hospital: 1.21 per 1000. For CNM out of hospital approximately 0.84 per 1000, though the number is considered unstable due to small numbers of events.

            So a term, normal weight baby born outside the hospital with a CNM has a greater than 3x higher chance of dying than an equivalent baby born in the hospital. Presumably CNMs out and in the hospital have equal training, etc. That suggests that simply being outside the hospital and not having the evailable emergency equipment is the major factor in the increased death rate. (And it’s probably an underestimate because it doesn’t count those who made it to the hospital before dying.)

          • Happy Sheep

            There is a massive canyon of a difference between an opinion and proven facts. Time and time again, the same data points show up, 3x risk of mortality, and increased risk of HIE and injury, especially with a CPM at home. This isn’t an opinion issue, and to claim that it is ypu are being disingenuous.
            Dr Amy is not out to ban Homebirth, she has staunchly defended a woman’s right to autonomy, this blog’s purpose to to give full, actual information to the risks. If a woman knows as accepted these risks, that is her choice, but she has a right to know.

          • AmyH

            The same reason you’re getting rude with the first couple of paragraphs in this comment. She’s tired of making the same polite arguments over and over and over without anyone paying attention.

          • moto_librarian

            “unless the intent is to come across as a rude misogynist bitch.”

            This coming from someone who advocates for home birth, which requires a woman to eschew effective analgesia during an event that may well be the most excruciating pain that she has ever experienced.

            But yeah, Dr. T is the misogynist. LOLZ forever!

        • Sue

          ”An answer to my questions would be helpful ”

          Sure – but, in your tantrum, you missed it: “‘because, in hospital, (a) you have a team of skilled people with equipement that identifies the pathological; and (b) you are already in the place with the people, skills and equipment to fix it.”’

          You really did compare the safety of labour and delivery with everyday life, didn’t you? (“If we all did the latter based on the ‘risk’ we face in living, we may as well all pack our bags now and live in the hospitals… just in case. ”) But you’re surprised at my reaction.

          As far as the safety of HB goes, check out the UK Birthpalce study. Formal HB system, well-trained nurses, tight risk-outs, 40% transfer rate, and still a 3X mortality rate in the babies of first-timers. And they didn’t even count hypoxic injury.

          Then come back and tell us how infuriating we all are. And stamp your feet a bit more.

        • Lindsay Beyerstein

          If you wait until a problem is bad enough that lay people can tell there’s an emergency, the problem is probably already very serious. The damage may already have been done by the time untrained people with virtually no monitoring technology can tell that an emergency is happening. Once a problem is detected, more time must elapse to transfer from home to hospital, which is more time for the problem to get worse.

          Whereas, if the same problem were developing in the hospital, trained professionals with sophisticated technology might be able to recognize it and intervene BEFORE it became a problem.

          • The Bofa, Being of the Sofa

            Yes. The goal of intervention is to PREVENT emergencies. If you wait until an emergency has arisen, you have waited too long.

            Emergencies are dangerous situations. By definition. So avoid them if you can.

        • DaisyGrrl

          “And if pregnancy and birth is so risky perhaps you suggest we should begin confinement at conception… ”

          Since pregnancy and birth represent an elevated risk to the mother over a non-pregnant state, I think it is wise to provide an elevated level of health care. THis involves regular health checks and screening for conditions that further elevate her risk profile (such as gd and pre-e). Likewise, since pregnant women generally want a healthy baby to be the result of pregnancy, appropriate screening and monitoring of the fetus is also essential.

          Absent medical intervention, giving birth is the single riskiest thing most women of child-bearing age will do. Being born is also highly risky for the baby. So yes, it makes sense to give birth in a hospital that has all the resources necessary to minimize that risk.

          Look, when people engage in activities with higher risk profiles, we take precautions. If I’m organizing a marathon, I will have paramedics on standby since the risk of injury or death is higher when running a marathon. I’ll put my seatbelt on when I’m in a car, and wear safety glasses when using power tools.
          If you don’t want to take similar precautions, that’s on you. Just don’t pretend that the risks aren’t there, and don’t misrepresent the risks to a woman who is choosing where and how to give birth. That is profoundly disempowering to her and demonstrates an ideological, rather than evidence-based, approach.

          • The Bofa, Being of the Sofa

            Yeah, there are so many howlers in Jane’s comments that I can’t keep up with them.

            As DaisyGrrl notes, we absolutely DO increase our extent of heath care for pregnant women. Monthly wellness checks, instead of annual, at the beginning, ramping up to bi-weekly, weekly, or even more by the end. Why do we do that? Because of it is an elevated health risk.

            Of course, it is nowhere near the risk that presents around labor and delivery, so the “let’s just confine her from the beginning” strawman is just nonsense.

            Our SOP with pregnant women absolutely reflects the additional risk involve, and is a properly measured response. If something does come up, we absolutely will admit pregnant mothers, and there are absolutely pregnancies that are so at risk that extended hospitalization is appropriate.

        • moto_librarian

          Because you can’t predict certain bad outcomes!!! I am one of those women who had an extremely rare complication that would have killed me if I had been at home. It occurred with no warning. My delivery was described as “textbook” by my midwife (yes, both of my children were delivered by CNMs, the equivalent midwife to those in other developed countries) right up until I delivered the placenta. Since I was in a tertiary hospital, everything was in place to manage the situation competently, but it still left me feeling anxious and upset. Passing out from a combination of pain and blood loss right after delivering your first child is a pretty sobering experience. It made me aware of just how dangerous childbirth can be, even in a low-risk pregnancy.

        • Happy Sheep

          I find it terrifying that you are a university educated midwife.
          Please tell us, with citations what are the specific issues that are caused by hospital staff? What are the outcomes from these issues? How does being at home prevent them? How do these things compare to the delays and subsequent death and damages that occur after something like a PPH or a cord prolapse occur at home and the EMTs don’t get there in time?
          Hint: c section /= dead or brain damaged baby

          • Karen in SC

            Also, I dislike saying the OBs are needed when birth becomes “pathological.” Who thought of that term?

    • Who?

      I think the challenge is that if there has been no prenatal testing or screening, and the baby can’t have its heart checked during labour, and mum won’t have examinations to see how she’s progressing, how can anyone know there’s a problem until it presents in a really ugly way.

      And if the midwife/doula/supporter isn’t checking things like bp regularly, and isn’t keeping clear records, then the hospital gets a crisis and no proper information.

      • Jane

        But she is.
        Checking everything – the same as in hospital – intermittent auscultation, descent, VE, maternal vital signs, hydration and coping. And we document everything, in real time, as we go, in professional/medico/legal frameworks
        At least that what happens where I am from.
        Maybe we’re just a little ahead of the US?
        Jane

        • Bombshellrisa

          Hello Jane-the midwives who attend the majority of home births in the US are NOT university trained RNs with specialty training. They are birth attendants who have apprenticed other birth attendants who also lack formal medical training. They can’t give medications and don’t have privileges at hospitals. There are two classes of midwives in the US.

          • Jane

            OK thanks
            That will make a difference.
            Here we study a 4 yr degree, half superivsed clinical practice/half theory.
            We practice autonomously caring for what we call ‘primary care’. We care for the woman antenatally, in labour and for 6 weeks pp. Transfer guidelines written by midwives and Obs outline when consultation/transfer to Obs is advised.
            Women can of course choose to forgo scans, screening, FHR auscultation in labour. MWs don’t espouse that, but we will support women in their choice – what we hope is an informed choice.
            Jane

          • Bombshellrisa

            There are Certified Nurse-Midwives in the US who are RNs (four year degree) and then they specialize. They work as independent practitioners who can do well woman care and attend women throughout their pregnancy. All the ones I know work within practices and all have hospital privileges. I don’t know any who would continue to care for a woman who refused scans and routine testing. Dr Amy has written about working with nurse-midwives and how she found them to be well trained and utterly professional.

          • jane

            Again, thanks 🙂
            The system sounds different. So like comparing apples with, well, not apples.
            Jane

          • Anj Fabian

            Comparing apples with horse apples.
            (Non Americans may have to look up “horse apples”)

          • Siri

            In Scandinavia we call them horse pears.

          • Bombshellrisa

            I just called my friend from Sweden-laughing my head off now, thanks Siri

          • Guesteleh

            This is a good comparison of the difference in training between CNMs and CPMs: http://www.safermidwiferymi.org/issues/education-certification

          • Roadstergal

            You hope it’s an informed choice? As their primary caregiver, isn’t it your responsibility to actually give them that important information surrounding foregoing that data-gathering, and the risks to mother and baby?

          • Jane

            Yes and I do. And well I hope.

        • moto_librarian

          Oh, so you are a midwife? If you’re one in the NHS, don’t expect me to feel particularly impressed or confident in your abilities. You’re better trained than a lot of our midwives, but you and your colleagues are not immune to the woo that kills women and babies.

          • jane

            You’ve never heard of a doctor ‘killing women and babies?’… just the midwives right?
            Killing fields are only at home? Women that die and babies that die are only at home, or transferred in to die? Only cared for by midwives?
            You’re telling me that only woo kills women and babies? Surely not? Surely you know that doctors also do this – not out of woo but out of, what can we call it, medicine I guess. The supposed antithesis of woo.
            I’ve been there when doctors and their colleagues other doctors have killed women and babies.
            Just as I’ve been there when shit midwives have caused harm (but not death in MY experience) to women and babies. The shit midwives were not always using just the woo, they were sometimes just not very clever, and using the woo. The doctors in these cases just not very clever: not a woo in sight.
            Jane

          • moto_librarian

            Note that I did not say that doctors never commit malpractice. We were talking about midwives, and from what I’ve been reading about the NHS, there are some glaring problems that are caused by midwives who are too willing to “trust birth” and would rather engage in turf battles with OBs. And there are also doctors who are into woo – Andrew Wakefield comes immediately to mind.

          • Roadstergal

            Wakefield isn’t a doctor anymore as far as the UK health service is concerned, isn’t he? When was the last time a midwife was kicked out due to being too much into the woo?

          • moto_librarian

            Absolutely, Roadstergal!

          • Liz Leyden

            Wakefield now lives in Texas. He’s not licensed to practice medicine, but he still has a doctoral degree, so he can still call himself Doctor.

            http://www.skepdic.com/wakefield.html

          • The Computer Ate My Nym

            I’ve been there when doctors and their colleagues other doctors have killed women and babies.

            Care to give examples, with as many details changed or omitted as you feel necessary to avoid possible breach of confidentiality?

            Here’s what happens, at least in the US, when a baby dies at birth or within 30 days or birth: the hospital does a morbidity and mortality conference on the birth, examining what went wrong and how it could be changed. If an error is identified, attempts are made to ensure that it will not happen again. If it is simply bad care by the practitioner, that person may be reprimanded or fired. If there is a systematic problem (i.e. it is simply easy to make a specific error that could lead to disaster), then the protocol is changed to make that mistake hard to make (i.e. most EMRs will pop up a notice if you try to prescribe a medication to a patient with a listed or possible allergy or contraindication). There will likely be a lawsuit as well. If the hospital tries to cover up bad care, the lawyers will go after them.

            What happens when a baby dies at home due to bad midwifery care? The parents are told “some babies weren’t meant to live”. They can sue but midwives don’t carry malpractice insurance so there’s little point. The midwives can reflect on their care and try to improve it, but no one will make them do so. Nothing changes on the systems level at all.

            Which system sounds to you more likely to result in errors and damage?

          • Jane

            Your first example is what happens for us, no matter where the birth or death etc took place. And no MW in my 16 years have I ever heard suggest that death of a mother or baby (or both as was my experience) is anything other than a tragedy that is investigated exactly as you say above.
            We don’t have freebirth (as a rule but I’m sure there is the odd one out there that chooses to do that for whatever reason) and we don’t have doulas, and we don’t have lay midwives.

    • Cobalt

      “What is so bad about CHOOSING not to go to hospital unless things are pathological as opposed to going to hospital in case things become pathological? If we all did the latter based on the ‘risk’ we face in living, we may as well all pack our bags now and live in the hospitals… just in case. ”

      The big difference between birth and daily life is that birth has a high natural pathology rate, daily life doesn’t, and we take further steps to reduce the risk in daily life (seatbelts, helmets, car seats, red lights, vaccinations, etc.) The natural death rate of birth complications is 10%. The overall risk of any negative outcome is much higher. It is a very reasonable choice to have medical staff present when engaging in an activity with a 10% death rate. Especially when it’s your baby who is most likely to die.

      Negative outcomes at the hospital are rare, unless you count medical interventions as negative, instead of actions taken to prevent a negative. Which is like calling taking medication a negative outcome, when the actual bad outcome is dying of untreated illness.

    • lawyer jane

      “The exception in my mind, is that we can be very sure that the
      complication leading the homebirth woman to transfer did not happen in
      hospital… We cannot be so sure that the complication for the woman
      that started labour in hospital, was not caused by the mere fact that
      she was in hospital”

      If you don’t see the obvious lack of logic in this sentence, then you really don’t deserve to be talking to women about their health & safety, and that of their babies.

      • EmbraceYourInnerCrone

        Its as if some people in the 21st century have the same attitude toward hospitals that people in the 18th and 19 century had(and back then they would have been justified in a lot of cases)
        ” Only sick people go to hospitals/doctors! When people go to the hospital they die, so if I DON’T go to the hospital everything will be a-OK! There would be no bad outcomes if there were no interventions!”
        Does it not occur to people that with the availability of modern medicine and OB care(in places that are lucky enough to have them…) people live longer, people have access to more plentiful food, people put off having children until later in life AND (ironically) if your country requires insurance and money forr health care some people may have to forgo prenatal and preventative healthcare.
        In the US this adds up to more older mothers, more mothers with Pre-E/high bloodpressure, more older mothers with possible earlier breakdown of the placenta, more preemies due to the other things I just mentioned, more people with diseases that used to kill them, living long enough to decide to have kids (diabetes, etc), more people using fertility treatments. And since the VAST majority of these women deliver in hospital, the more difficult deliveries end up on the hospitals side of the ledger.
        But being in the hospital did not CAUSE the difficult delivery! It just meant that there was a possibilty that it would not end in disaster. Sorry for yelling..I have a high school /some tech school education and I know this. How is it such a mystery to so many people.

    • Amy Tuteur, MD

      What’s so bad about it? You’re joking right? Your claiming that treating a medical complication is just as good as preventing it.

      • Jane

        No Dr T not joking. Seriously not joking.
        I am asking you why every low risk women having a baby must be in hospital. I am suggesting that emergencies happen irrespective of location. I am also suggesting, as I’m sure you’re aware, yet unwillingly to talk to, that some of the emergencies that happen in hospital are related to being in hospital, and the use of intervention when it was not necessary.
        My point is moderation, my point is choice. My point is something you seem to consider pointless, as do you loyal bunch of merrymen; women can and do have babies without medical intervention. They also can and do have care with medical intervention.
        My point is that intervention should be necessary in the clinical sense, not a product of simply giving birth.
        You see birth as too risky, I see being in hospital in every instance as too risky.
        Your sincerely
        A pig in lipstick

        • Young CC Prof

          Please provide three examples of death or critical injury that occurred in a hospital that most likely would have been avoided at home.

          Note an episiotomy or cesarean delivery is not an example of critical injury or death.

          • jane

            A cord prolapse and resultant EMLSCS under GA with massive PPH and hysterectomy to a primiparous woman being induced at 38 weeks because she was 38 yrs old. The ARM with high head at 3 cms when not in labour was the cause of the CP.
            The baby was pretty good but was more like 36 weeks as opposed to 38 weeks (said the paed), she developed TTN and spent 5 days in hospital on IV abs and CPAP.
            This would not have happened at home of course bc an ARM would not be done at home. So this could have been avoided by beginning labour in her own time, and at home… ie not being in hospital being induced.
            Re risk of SB – movemnts, scan, liquor etc were ‘perfect’, she was however 38 yrs old and therefore at increased risk.
            Case in point or ???
            Jane

          • Young CC Prof

            OK, hysterectomy? I’ll accept that as critical injury, though not all women will see it that way. There’s one. Details are similar to but not exactly the same as the other story, however.

          • jane

            CP is pretty critical.
            So what critical injury is thre that is simply a result of being at home: like CAUSED by being at home?

          • Young CC Prof

            Cord prolapse is an emergency, not an adverse outcome.

            Abel Adams, HIE leading to cerebral palsy. In a hospital, he would have been promptly resuscitated.

            Ruth Fowler Iorio, post-partum hemmorhage requiring 4 units of blood. In a hospital, she would have quickly received attention for retained placenta and suffered minimal blood loss.

            Caroline Lovell, homebirth activist in Australia. Lost consciousness an hour after giving birth, hospital was unable to resuscitate. Died of PPH, midwives had no idea she was bleeding too much.

            Wren Jones, died of Group B Strep.

            I could go on and on and on. These deaths are caused not by “being at home” but by lack of immediate access to advanced medical technology.

          • moto_librarian

            So that’s one example. Find me at least two more.

            Being AMA is a risk factor for stillbirth in of itself (I assume you know that). It is awful that she lost her uterus, but it could have happened even had she not been induced. TTN is not fun, but I’d take it over a dead baby. My oldest son spent two days in the NICU for it, despite his all natural labor and delivery, probably because my water broke at 38 + 3.

    • attitude devant

      Why are YOU so rude as to come into a conversation regarding a system of care about which you have no knowledge and tell US off? There is quite a lot of context informing this discussion, but you are oblivious. There used to be a rule in netiquette: newbies don’t comment. Perhaps you should consider it before trying to school others when your own understanding is deficient.

      • The Bofa, Being of the Sofa

        Why are YOU so rude as to come into a conversation regarding a system of care about which you have no knowledge and tell US off?

        The funny part is, she is the one who complained about Dr Amy being a meanie. But she’s not been Miss Politeness herself in any sense. On the whole, I don’t care, except for the irony of the tone troll insulting everyone. Of course, ending her comment with “kind regards” makes it better #apopathy

        There is quite a lot of context informing this discussion, but you are oblivious. There used to be a rule in netiquette: newbies don’t comment. Perhaps you should consider it before trying to school others when your own understanding is deficient.

        Pablo’s First Law, of course.

        • attitude devant

          Of course!

          • The Bofa, Being of the Sofa

            Yeah, I didn’t want to say it earlier lest she complain that she is not allowed to give her opinion “without being labeled.”

      • Jane

        Newbies don’t comment. Excellent: pretty sure this means your blog will remain just you lot talking to each other about things you already completely agree on. Go for it. Sounds inspiring.
        Maybe there should be a new rule in netiquette: one you’d be happy to follow I’m sure: every else shut up.

        • The Bofa, Being of the Sofa

          Newbies don’t comment. Excellent: pretty sure this means your blog will remain just you lot talking to each other about things you already completely agree on

          That does not follow.

          You are certainly able to read without posting. People do it all the time.

          • Jane

            Clearly not you though huh. You’re too important not to be heard. Whereas me, well…
            You are an extremely clever wordsmith. Just saying. It’s astounding. Never.ever.don’t.say.anything.

          • The Bofa, Being of the Sofa

            Clearly not you though huh. You’re too important not to be heard.

            You have no idea how long I lurked here before I first started posting.

      • attitude devant

        Way to miss the point. You came in here guns blazing (as we say in the US) when you didn’t even understand the most basic aspects of what we were discussing. That’s rude. You could have asked for clarification, or read around. Instead you shot first (to continue the US metaphor) and asked questions later. We actually debate a lot here. But it’s tiresome dealing with know-it-all attitudes from people who are actually spectacularly uninformed.

    • TsuDhoNimh

      “going to hospital in case things become pathological”

      Because the things that “become pathological” during childbirth can be fatal in minutes … going to hospital can take enough time that mother, baby, or both arrive at hospital to be pronounced DOA at hospital. (DOA – dead on arrival)

      In hospital, you are already there, so the transport time is more a sprint down the hall (the beds are wheeled for a reason) instead of call for an ambulance, wait for the ambulance, load onto the ambulance, drive to hospital, unload from ambulance, roll into ER and head for surgery.

    • lilin

      ” What is so bad about CHOOSING not to go to hospital unless things are pathological as opposed to going to hospital in case things become pathological?”

      What’s so bad about it? Well, let’s see.

      “She’s bleeding out! The doctor will start treating her right away!”

      “She’s bleeding out! Let’s carry her to the car, drive her to the ER, explain what happened, have a doctor assess the situation, and then they can start treating her!”

      Guess which one of those people is more likely to end up dead.

      But, and this was the actual point of the post, there’s a lack of logic here. Homebirthers often say they don’t trust doctors to give them adequate care, but whenever they roll out the line, “The hospital is only ten minutes away,” the show that they actually know that home birth care is what’s inadequate and they can run to doctors to give them top notch care even if they’ve gotten themselves into dire situations because of their midwife’s inadequate treatment.

      • Bombshellrisa

        Don’t forget the stat type and cross that will have to be drawn-anyone who is in the middle of a crisis is really hard to get blood from even if they usually have great veins. Someone already laboring at a hospital will have had bloodwork done and usually will have at least a heplock in and won’t be as dehydrated as someone who is coming in mid emergency after laboring for who knows how long.

      • rachel

        Also don’t forget that the obstetrician may not even be in the hospital. I take home call meaning I’m in the hospital if I have someone in labor but home if nothing is going on. The same thing is true of the anesthesiologist. We don’t have a 24/7 laborist. We’re required to live within 20 minutes of the hospital. I’m the closest at 8 minutes. Add 5 minutes for the patient to be placed in a room, fetal monitors attached, and nursing assessment, and another 1-2 minutes for the page to go thru and be returned and that “only 10 minutes from the hospital” is potentially 20-25 minutes from MD evaluation. That’s a long time when mom is hemorrhaging or baby is suffering anoxic brain injury.

        • jane

          Or the MW discerns the problem early, related to clinical and profession skill – some of us do attain an excellent degree of skill and critical assessment and thought – and arranges timely transfer, wherein she calls ahead, gives verbal handover accompanies her client, hands over comprehensive and robust documentation, aids in the next step ie monitors and etc.. Or in emergencies discerns it immediately and as above mobilises, calls ahead, meets in theatre, aids with the pre op process as she knows her client’s history and the process and waits for the Obs to come in from home or finish with another women as does the woman who transfers directly from the labour ward to theatre.

      • Sadlady

        I think her point was that maybe the “she’s bleeding.out!” is a result of hospital care. So they could be fixing their own disaster…not that I agree. I think this is a reference to the alleged cascade of interventions that leads to bigger problems…

        • jane

          That was my reference.

          • Young CC Prof

            Except there is no cascade of interventions. Here’s how it works: A problem develops. The doctor attempts a minor intervention to fix it, such as changing the mothers position to try to fix a dropping fetal heart rate, or drugs to speed up stalled labor. Often, this solves the problem. Sometimes it doesn’t, and the doctor must use a more aggressive intervention, up to and including cesarean delivery.

          • jane

            Ok here’s how it also works, a woman who is considered AMA at 37 yrs old is induced at 39 weeks as her risks of SB have doubled. She has a long induction with several lots of PG to a long closed cervix, ARM, cord prolapse, EMLSCS under GA, 1600ml PPH, does not establish Bfing, gets PPD.
            She could have laboured in her own time and none of the above could have happened? Potentially?
            Isn’t that the other take on intervention? That we use it too freely and cause problems that might not otherwise have been?

          • Young CC Prof

            Except induction reduces a woman’s chances of cesarean delivery, rather than increasing it, as per several recent meta-analyses. A woman who doesn’t go into labor after several lots of prostaglandans was unlikely to have an easy delivery in any case.

            Did you know the incidence of cord prolapse has actually fallen from 1 in 300 to 1 in 500 due to hospital birth practices? And PPH just from emergency cesarean in the absence of bleeding disorders or placental abnormalities? Do you realize how rare this scenario of yours is, and that stillbirth in a woman identified as “at risk” is actually more likely?

            As for the hypothetical PPD, I’d rather approach this woman and say, “Look, you did what you had to to get your baby out safely. I’m sorry you had such a scary experience. And not breastfeeding is fine, lots of women have trouble breastfeeding. Concentrate on enjoying this time with your baby. Let me know if you need to talk, or if you need some help with the baby or the household.”

            Claiming that the cesarean delivery and inability to breastfeed are disastrous endpoints in themselves will only compound the tendency towards PPD.

          • The Computer Ate My Nym

            She could have laboured in her own time and none of the above could have happened? Potentially?

            Maybe. Or maybe the fetus would have died in utero before she went into labor. Or maybe she would have gone into obstructed labor due to a larger fetus at 40 weeks and needed a c-section to avoid both her and the fetus dying. Or maybe she would have developed pre-eclampsia and eclampsia prior to or during labor and one or both parties been badly damaged or killed by that.

            You can speculate endlessly on what might have happened,but didn’t.The real question is, what is the data. What evidence is there to suggest that induction is more or less likely to lead to a good outcome? Are there specific sub-populations more or less likely to benefit? Where does the patient fit in in terms of the known data? If the data suggest that waiting is better then you’ve got a point. If there are no data then you’ve got an argument for a clinical trial. If the data suggest that induction is better, you’ve got no real case.

          • The Computer Ate My Nym

            Oh, and anecdata, but…I had an emergent c-section. Breast fed for two years afterwards. Not clearly correlated. Moo.

    • Bombshellrisa

      “women having a homebirth and needing to transfer to hospital are not really that different to the women in hospital needing that secondary level of care” perhaps in countries where the midwives who attend homebirths are part of the healthcare system this might be true. This is almost never the case in the US. It’s very different to have a woman who has had comprehensive prenatal care with a qualified healthcare provider within a system that has clear guidelines for who is a good candidate for homebirth. Usually those systems have set guidelines for what supplies and medicines go in a birthing kit, a firm guideline for transfers and a mechanism that goes into motion to make the transfer as smooth and quick as possible if need be.

      • jane

        Ok so you agree sort of that in places where there is great primary care that it is not insane to consider not going to a tertiary hosptial to give birth?

        • Bombshellrisa

          I think I failed in my comments to let you know that home birth midwifery was my goal and I studied at a well known school that trains midwives who can attend only home birth and births in centers that are midwifery led. So I can see the benefit of a system that has an emergency plan written and followed, with midwives are properly trained and who can give medications and admit a patient to a hospital. HOWEVER…home, even within a system like the one I mentioned will never be as safe or as efficient in an emergency as a hospital. It seems that women who insist home is best do not fully understand the risks of home birth. MOST women who choose home birth will come through just fine with a baby who is just fine. But there are some who don’t. Many of the people who post here have had home births and most come through fine. Others have not been so lucky. I have never said home birth was insane, but I think that women are making it a choice based on less nan the facts and out of irrational fears about interventions.

          • jane

            Right

        • Young CC Prof

          Insane is an inappropriate word. There is no evidence that most of the women attempting home birth are suffering from psychosis!

          However, as Bombshellrisa said, many of them may be acting on inaccurate information or irrational fears.

          • jane

            So like the reverse of being scared of home birth and going to hospital now women in the US are scared of hospital birth and heading home…
            Being scared is probably not the best reason for making any choices in isolation

          • Young CC Prof

            Nope, a rational risk benefit analysis is a good way to make choices, much better than instinctive fears.

    • The Computer Ate My Nym

      What is so bad about CHOOSING not to go to hospital unless things are
      pathological as opposed to going to hospital in case things become
      pathological?

      What is so bad about choosing not to wear your seatbelt unless things are pathological as opposed to putting on a seatbelt in case things become pathological? It takes only seconds to put a seatbelt on. Surely you don’t need to muss your clothes and deal with the restraint every time you drive just because you MIGHT get into a traffic accident…

  • Lisa from NY

    Postpartum hemorrhaging is never a problem because Vitamin C will cure it. (Says the NCB!)

    • Bombshellrisa

      Placenta and kale and cinnamon breath in your face will cure it! Woo contradicts itself-I was expressly taught that cinnamon thins blood and pregnant women using it to control their blood sugar need to stop taking it between their 37th and 39th week (because gestational diabetes “ends” then).

  • Bombshellrisa

    It’s always interesting to talk to homebirth advocates about what they “know”. They “know” that doctors push interventions from the start, don’t practice evidence based medicine and play the dead baby card so they can go home/play golf/make more money. They “know” because they are “educated”. And they are so smug and smart that they don’t bother to find out how a basic admit in the hospital is done. If you come in and don’t have your chart in the hospital system, you are going to have to be asked some questions. It doesn’t matter if you have been in labor for 36 hours and spent the last six hours pushing at home-before we can pull out that IV the midwife started that turns out was never in your vein anyway, we have to assess you so we know what step to take next. It seems like the home birth community thinks in such huge leaps without considering the small steps in between. No, we can’t use the vitals or the field start the EMTs did, we have to do those again, and yes, we have to ask about allergies and any current medications. It doesn’t matter that you come in with some scraps of charting your midwife did, we do a full h&p and for good reason. One of my friends transferred care to an MD and her chart stated she was being treated for cancer of the esophagus by a naturopath. Her treatment consisted of gargling with wormwood, taking herbal tinctures and following a strict diet. Turns out there was never any blood work or biopsy done.

    • Bombshellrisa

      Adding because Disqus is acting up: so my pregnant friend didn’t have cancer. She had swollen glands. No refund from the midwife/naturopathic doctor who misdiagnosed her (cause you know Bastyr doesn’t turn out anything but medical scholars who are the best of the best).

      • Anj Fabian

        First thought:
        I shouldn’t read this before my first cup of coffee.

        Second thought:
        There is no amount of coffee that will make this any easier to read.

      • Mishimoo

        Honestly, I’m amazed that bub survived the wormwood gargle and herbal tinctures because wormwood is sometimes used to fix amenorrhoea (and who knows what was in the tinctures)

        • Cobalt

          Wormwood is an abortifacient. It was used in biblical times to test if a woman was faithful. They would make a decoction of wormwood, have it blessed or whatever, and make the woman drink it. If she miscarried, she had been unfaithful and was carrying another man’s child. If she didn’t, she was clean.

          • Mishimoo

            I’ve read that, unfortunately. I couldn’t remember if it was true of all types of Artemisia or not. One of the abortifacients that surprised me was celery seed (different family though)

        • Bombshellrisa

          Who knows what was really going in there-the gargle was prepared with a couple drops of tincture and never swallowed and the other “doses” were tinctures taken in water. The diet was all about keeping the body from being acidic and of course, no sugar because it “feeds cancer cells”.

          • Mishimoo

            Sugar feeds everything, apparently *eyeroll*

      • AmyH

        So gotta ask… what does she think about it now?

        • Bombshellrisa

          She decided to overlook that minor hiccup in care. She did end up having her baby at the hospital and seeking treatment from a doctor there for some minor things but reverting back to the care of a CPM for the birth of her next child (at home, in the water, gently, blah blah blah). Everyone had been telling her to get a second opinion about the cancer diagnosis, even the crunchiest, home birthing, non vaxing types.
          Forgot to add that she was also doing baking soda gargles to make the area less acidic so the herbs could “do their job”.

    • Dr Kitty

      Seriously?
      That is BAD.
      Oesophageal cancer is vanishingly rare in women under 40.
      To jump to that as your FIRST diagnosis, without any kind of supportive investigations is just…weird.
      You know the medical saying about hoof beats and Zebras…this was more like a Quagga.

    • LovleAnjel

      THIS is why ND’s think they can cure cancer. They’re not. They’re treating something else, then get all excited when their patient doesn’t die of cancer.

  • MaineJen

    It always confounds me that HBAs think they can just waltz into the hospital and the OBs will descend and save the day immediately…not knowing them or their client, the client’s medical history, and having to rely only on your charting skills (HA!) for a record of how labor has gone up to this point. Nope nope nope. Ambulance to ER to evaluation and exam…assuming everyone is cooperative and forthcoming…you’re still looking at a good hour before a c section can realistically be performed. Unless, of course, your midwife has hospital privileges, in which case the hospital already has your chart and medical history, and the midwife will have called ahead and handed over her chart and they’ll have all the information they need in a timely manner…OH WAIT.

    • Liz Leyden

      I had to be transferred by helicopter for my birth (my daughter has a congenital heart defect, we were planning to deliver
      in the big city, my water broke 4 days before we planned to leave). I’d filled out paperwork for both hospitals beforehand. The receiving hospital had my records. The C-section started almost 5 hours after I arrived.

    • Who?

      They’re likely thinking not of the mother and baby but of their own liability-in their non-professional, non-responsible, non-caring world, hands off means that nothing bad is anything to do with them.

      And that’s regardless whether it was made inevitable on their watch because testing and screening was avoided, or whether because something otherwise normal went off-piste and they missed it.

    • The truth is that most lay people think medicine is a form of magic, entirely beyond the ken of normal mortals. [to be fair, for centuries, doctors encouraged the idea that they had esoteric knowledge, too]

      This is why they cannot separate, in their minds, between knowledge and the most ridiculous tosh.

      Non-medical professionals — I use the word “professional” advisedly — are medical IMITATORS a good deal of the time — if they pretend, hard enough, to do what doctors do, then they expect to get the kind of results that doctors get. Abracadabra!

    • Jane

      But that is what Obs are for – they are trained to sort out the complicated. They are not meant to only do that if women agree to give birth under their roof. Women do not choose to birth at home to spite the Ob – they choose to birth at home because they think it is best for them – in all manner of ways. If it goes wrong and they transfer then they are asking for help from the Obs. They did not cause themselves a complication by merely labouring in their own lounge. If that were the case then women who get into trouble when labouring in the hospital can be said to get into trouble because they were labouring in hospital.
      Not all women are uncomplicated and well enough to give birth at home – and those that are compromised need to think carefully through their options – or lack of them. But why can’t a well woman who thinks and makes a choice, have her baby at home.
      As you all say- the doctor is there at the hospital when needed.
      Thanks
      Jane

      • kerlyssa

        Because a doctor is a human being, not a machine, and said human beings tend to care when they know someone has drastically worsened or eliminated all their options by not practicing protective, defensive care.

        Imagine your son or daughter saying to you, from their hospital bed, that it was the car’s responsibility to stop at the crosswalk and that’s why they didn’t waste their time looking both ways before stepping out, physics be damned. Would that actually make you feel better about it?

        Would you think that the car’s driver could then alter physics so they’d be capable of going from 35 to 0 in 2 meters, because that is their job? Would you then think that the driver has no business about being upset at hitting a child with their car, because it’s their job to prevent pedestrian accidents?

        • jane

          I kind of get your analogy, but I also kind of don’t. What I’m saying is: with excellent care given in continuity by a midwife or GP, women can and do give birth very well without intervention. And at home. Therefore going to hospital in the first instance is not necessary for all women – they give birth well. Because they are well cared for and care providers make constant assessments and use critical thinking, if things deviate, if things are no longer uncomplicated, then women transfer. Emergencies happen, at home, in hospital, in theatre. Not always avoidable, and not always solved by being in hospital.
          What we also need to think about is the degree of complications and morbidity that women and babies suffer because of hospital, not in spite of it.
          Thanks
          Jane

          • Dr Kitty

            Jane, which specific morbidities do women and babies suffer because of hospital that the same mother-baby dyad would not have suffered if they had been at home, what are the rates of such complications, and are there any steps being taking to reduce them?

          • SisterMorphine

            Dr. Kitty, jut curious, are HB midwives in the UK allowed to administer any kind of pain relief? We actually started TTC in the UK (DH was on a Fulbright) but we returned home before it could happen. I definitely would NOT have liked giving birth w/o drugs, esp. since I needed a section! (Though I hope they give drugs for that in any case). Some of the other benefits I could live with.

          • Siri

            UK community midwives carry Entonox (gas & air), and can administer pethidine obtained on prescription (by the woman) prior to labour.

          • SisterMorphine

            Sorry for being such a dweeb, but when you say “gas” do you mean “nitrous,” or is this stuff like, ether? Also, pethidine (which wikipedia assures me is sort of like our Demerol) is it admitted IV, or is it oral? Can you get IV hydration in a homebirth? Do they also use pit?

          • Joy

            Yes, it is nitrous oxide and oxygen. The pethidine is an injection, not an IV. I don’t think they can do IVs for hydration and I think they can use pit, but I am not sure.

          • Deborah

            1. We (mostly) don’t have that kind of midwifery care here for homebirth (see multiple above comments, HB midwives here are NOT the same as other countries) and
            2. Even assuming that hospital transfers happen absolutely appropriately (which in my experience they don’t, women are staying home WAY too long); even then there’s a 20-60 minute delay in the transfer process. Which is fine for slow/stopped labor and completely NOT fine for any kind of distress/abruption.
            So even if the complications are exactly the same as in the hospital, the 20-60 minute delay in the transport process makes the outcomes much worse.

          • moto_librarian

            Most women want pain relief during labor and delivery. That is not something that can be provided during a home birth. That is good enough reason for delivering in a hospital.

          • TsuDhoNimh

            “if things deviate, if things are no longer uncomplicated, then women transfer.”

            Until you can teleport the woman directly from her home to the appropriate hospital, transport is the place where having to transfer is deadly when things go pear-shaped and all deviant.

            Looking at the UK’s stats, it appears that 8 minutes from call to arrival is considered good for London, and in most areas of metropolitan London, 75% or more calls arrive within the allotted 8 minutes. Double that for round trip plus the 3-5 minutes to load patient gives you 15-20 minutes between placing the call and arrival at the ER (where you will spend more time unloading and admitting)

            Unfortunately it only takes 5 minutes for brain damage to begin in cases of oxygen deprivation, and you can bleed out and go into hypovolemic shock in under 3 minutes if a major artery is involved.

            The best-equipped ambulance with the best-trained paramedics doesn’t have the ability to get a stuck and anoxic baby out to where they can do resuscitation on it, and doesn’t have the surgical training or the blood supply to deal with massive internal bleeding.

            How many women are you willing to let die during transport because you think home birth is adequately safe?

            REFERENCES:
            http://www.nhs.uk/NHSEngland/AboutNHSservices/Emergencyandurgentcareservices/Pages/Ambulanceservices.aspx

            http://www.londonambulance.nhs.uk/about_us/how_we_are_doing/meeting_our_targets/latest_response_times.aspx

      • Bombshellrisa

        Of course, if there were complications that could have been treated earlier with more extensive monitoring at the hospital, then yes, choice of venue is the issue. As for the women thinking it’s “best”, who and what influences that thinking and what happens when a woman clearly isn’t a good candidate for homebirth but thinks and insists on going ahead it it anyway? That is really the problem. This blog calls attention to how many midwives take on clients who clearly are NOT low risk, who use the term “variation of normal” and then refuse to take any kind of responsibility when there is a bad outcome. Please, read some of the articles written from earlier this year, such as the article about Christie Collins.

        • Jane

          OK.

      • attitude devant

        sigh. I receive those transfers. In the US, a homebirth transfer is a disaster in progress. The vast majority of our homebirth midwives are undertrained and accept clients who should NOT be delivering at home, and transfer WAAAY too late. And THEN the client doesn’t want me to examine her, doesn’t want me to monitor her baby, doesn’t want an IV. So exactly why she came, I don’t know, but she seems to think that I can teleport the baby out or somehow my spidey-sense (American pop culture reference there) can assess her without examining her.

        • fiftyfifty1

          “But that is what Obs are for-they are trained to sort out the complicated”…and turn back time…and be magical.

          • attitude devant

            That’s why if they transfer and everything doesn’t magically turn out right they sue the OB and not the midwife (oh and the fact that the midwife carries no insurance and has no accountability)

          • Dr Kitty

            If it makes you OBs feel better, I have patients who seem convinced I possess X-ray vision (“but I don’t want to go to A&E for an X-ray, can’t you just tell me if you think it looks broken?”), clairvoyancy (“I thought I’d phone you and describe my rash and you could tell me what is is and get me a cream or something”) and telepathy (“I’m not really sure I can describe my symptom, maybe you can just tell me what is wrong anyway?”).

            People complain that Drs have big egos and ascribe God-like powers to themselves, but patients seem quite happy to do it too.

            I spend a significant amount of my day explaining that no, I can’t do the thing that they want because it requires superpowers, and my name is Dr Kitty, not Dr Manhattan.

          • Amazed

            I remember my GP sending me straight to have this foot X-rayed, although, since I lingered for a while in the waiting room, I heard her telling her secretary that yes, they can definitely enter it as broken. Since she didn’t possess X-ray vision, she didn’t tell me what looked very obvious to her. At the end, an X-ray scan it was. Care to guess what it showed?

      • Guesteleh

        This is a shitty position to put a doctor in. The doc has no say in prenatal care or the management of the early stages of labor but if things go sideways suddenly they have the full responsibility for getting mom and baby through it alive. Truly shitty.

        • Medwife

          ITA, however that’s the nature of medicine/health care, in all specialties, not just obstetrics. People don’t take their meds, they don’t make the lifestyle changes, don’t pay attention when you go over warning signs of impending emergencies, then they come in having a heart attack/in DKA/overdosing on heroin/with am entrapped breach baby. It does suck. And you just take care of them no matter what, while silently praying you don’t get used for the outcome.

          • Guesteleh

            I’m thinking of it more from the POV of one medical professional being held accountable for the shitty decisions made by another professional. Because if a midwife fucks up it’s still likely that the physician is the one who will be the one sued, even if the midwife is licensed and carries malpractice insurance.

          • Sue

            That’s true, medwife, but does anyone come along and encourage people to exercise their right to overdose on heroin or omit their insulin, or even encourage it, with the knowledge that the hospital will back them up?

            (and btw, we should also recognise that HB disasters impact on hospital nursing staff too, including NICU, not just OBs)

      • lawyer jane

        Jane, you misunderstand completely. Nobody is saying that it’s not the OB’s job to help the home birth transfer. What they’re saying is that transferring to an OB is not a magical solution to a birth complication, and that the delay in transfer may compromise the care the OB is able to give.

      • TsuDhoNimh

        “But that is what Obs are for – they are trained to sort out the complicated.”

        Expecting them to “sort out” a birth complication that was several hours or even months in developing in the few minutes they have before mom and/or infant dies is putting your emphasis on what we call “salvage medicine” … you are actively preventing them from being able to do their best prevention in favor of a system that expects them to pick up the pieces after the midwives have failed.

        It’s like saying “We have a superb fire department, therefore we don’t need smoke detectors or building codes and we don’t need to keep matches away from the toddlers. We’ll just call them when the house is aflame and they’ll sort it right out”.

        It’s like taking your auto to the top mechanic after months of driving with the oil warning light flashing, having never had routine maintenance done and expecting them to tune it up all spiffy.

      • Amazed

        Ah, so sweet. So you homebirth midwives can miss a complication and then shrug yout innocent little shoulders and say, “That’s what obs are for.” Touching. And of course, you cannot be hold responsible for not sorting out the complicated cases – LIKE GAVIN MICHAEL’S MOM. You know, the baby who DIED. And then you collect your sweet fees. Gag.

        Yes, I’d say the morons attending homebirths are not trained to sort out a complication, as evidenced by the fact that some of the bitches who recommended bloody Stevia were TEACHING other midwives on complications.

        And don’t try to pretend you’re defending educated midwifery. You’re commenting on a post about US homebirth midwifery. Ascribing hypothetical education to US homebirth midwives misleads mothers into making choices that end up in brain damage and DEATH.

        Do you see that, Jane? I think you do. You’ve commented since I wrote my post about Gavin Michael and midwives. You didn’t deign to write that you looked for the case. I guess you didn’t look for it.

        Better a narrow minded pillock than a babykiller defender.

      • MaineJen

        Our problem is not with ‘well women who make their own choice.’ If a woman is truly low risk, and she decides to home birth, then okay. *I* may not think it’s a good idea, but okay. Our problem is with the midwives who TELL a woman she’s low risk when she’s really not, who tell her she doesn’t need prenatal testing, that GD can be prevented with a certain diet, that GBS screening is unnecessary. Midwives that tell women that breech birth at home is just fine, that VBAC or VBA2C or VBA3C at home is perfectly fine.

        Our problem is with Christie Collins, who told a 42 weeks pregnant woman with ZERO amniotic fluid that she still had the option to deliver outside the hospital. Who went on FACEBOOK and asked her buddies what their opinion was about “how safe is it really” for a woman to continue on with zero amniotic fluid? Meanwhile, she was advising the mother that she didn’t really have to go to the hospital, that they still had time.

        They did not.

        Our problem is with lay people masquerading as professionals. Not with the women that they falsely reassure. We are not trying to take anything away from you: again I say, if you are low risk, and you have been properly informed of what you’re getting into, go ahead and homebirth. You are not the problem; you appear to KNOW that some women are too complicated to homebirth. A lot of “midwives” in this country will deny that anyone is too complicated to homebirth. They are the problem.

  • Brains in my shoes

    This is my favorite article of yours, Dr. Amy. Having crossed the threshold of motherhood and remained solidly in the privileged upper middle class, I have struggled for the words to solidly explain why I find home birth logic so ridiculous(aside from the woo). Its not that I didn’t have reasons to rattle off, including the near death of my infant and myself with a very necessary c-section that would have easily been death at home birth if I had been foolish enough to consider it, it is just that this is so well put and perfectly explains the Jackal and Hyde stance homebirth has on modern medicine. I now have something easy to reference that I cannot improve upon. Thanks. Now I will go back to finishing my dissertation with the best link ever for the nonsense I hear.

    • Amy Tuteur, MD

      Thanks!

    • Floss in socks

      I don’t know you or your situation Brains but if you had such a terrible time and you were in hospital could it be the fact that you were in hospital that you had such trouble?
      I’m picking, that to enable you to make the comparison, you were not induced, not augmented syntocinon and did not have an epidural right?
      If you did, then off course you would not have had a baby at home – you were not a candidate to have your baby at home, and yes it would easily have been death at home. It sounds like even though you were in hospital it was near death anyway.
      Eeeekk
      Jane

      • Brains in my shoes

        I had a low risk pregnancy. We had a trial of spontaneous labor and did not get to full dilation. After 6 hours of being what I refer to as stuck at 9cm, and seeing the monitor of my child’s heartbeat go nuts with each contraction, I asked the nurse to bring my Ob. She initially refused saying I had come so far I shouldn’t give up and we could try another position…My Ob came, I then had a spinal and was in surgery in 10 minutes. My child was limp, apgar 2, did not breathe for a full minute and was actively rescucitated by a small army. I lost a lot of blood and there was a debate about transfusions. I spiked a fever. My child and I were on iv antibiotics for three days. At hour 6 of my recovery, three nurses arrived with my child and manhandled my boobs to breastfeed. We were both in an intensive ward for three days.

        That explained, I am thoroughly relieved I went to a hospital. It was better than home birth.

  • fiftyfifty1

    My parents are stupid idiots who don’t know anything and just want to control me. Oh, what? Something’s going wrong?! Mom! Dad! Help me!

    • Amazed

      Pretty much.

  • Liz Leyden

    Home birth advocates also have far too much faith in EMS. I have nothing against ambulance crews or EMTs, but they can’t help you until they reach you, especially in rural areas. When seconds count, they could be 30 minutes away.

    • Amazed

      I have! Nothing against crews themselves but the fact that homebirth is less than 1 percent of all births and the percent of those who transfer via ambulance is even smaller, I’d hate to be the first c-section needed mom these guys see while she’s frantic, with a baby or self in trouble. Hate, hate, hate.

    • Elizabeth A

      Rural areas, heck. I live in a major metropolitan area. There are three fire stations, with ambulances and crews, within a mile of my house. The night my daughter was born, all three were out on other calls, and it took them 20 minutes to get a truck to my house.

      (Also – Don’t use medical Latin with the 911 dispatcher. It makes them think you’re calm and things are okay.)

      • Amazed

        But you can always hop in the backseat of your own car with your DH driving! That is, if your midwife doesn’t try to block your car which was the case with a formerly homebirthing commenter here. Bomb, I believe? Midwife didn’t even want to dump her in the ER and run. Good thing mommy sense worked this time.

        • Bombshellrisa

          Someone else who commented here had the midwives refuse to accompany unless the family paid her more money to be there as a doula, so they had to get into their own car and drive on the freeway and over a toll bridge in rush hour traffic to a hospital by themselves after the woman spent hours and hours pushing.

      • Bombshellrisa

        Not to mention the ambulance has to navigate the same road construction and rush hour traffic any car on the road does. The fire station is a minute at most from my house by car, but the street that leads to my neighborhood has had utility and road work the past couple weeks and the lanes have been redirected with the middle turning lane closed. A trip to the post office that takes 30 seconds turned into 23 minutes because traffic wasn’t moving out of my neighborhood.

    • TsuDhoNimh

      ” they can’t help you until they reach you,”

      Some of the longest moments of my life have been doing the best I could at car crashes, holding someone’s life in my hands, desperately wanting to hand it off to the EMTs and having to stay in commend until they get there … in one instance the fire station was within sight and it still took forever for them to get to me. It was all slow motion.

      In another instance, despite all those at the scene could do and the EMTs could do and the helicopter crew could do … I got a phone call from the highway patrol the next evening telling me the woman we were helping didn’t survive.

    • Therese

      When it comes to birth, EMTs can’t really help a whole lot even when they get there…besides driving you as fast as they can to the hospital. I would hope it would be extremely rare that they’d take 30 minutes though, because that would mean certain death for many people, like heart attack victims.

      • Young CC Prof

        In some places, it really is 30 minutes. Yes, occasionally people die from the delay, but if you are in a remote area, you’re in a remote area.

        • Many years ago, I had a couple in my preparation for childbirth class, who almost experienced an inadvertent home birth because she had an extremely precipitous delivery. They rang for the ambulance with virtually the first contraction, but they lived in lower Manhattan, and were to deliver at Columbia Presbyterian, which is at the other end of the island, and it was RUSH HOUR. In the event, the EMS crew headed for the nearest hospital and even that took nearly half an hour to reach.

          You don’t have to be in the boondocks. It just takes 5 miles of traffic gridlock.

          • Young CC Prof

            Actually, earlier this year a friend of mine welcomed his second child in a car, without medical assistance. Due to New York traffic.

          • LovleAnjel

            My friend gave birth on the sidewalk two blocks from the hospital because of a traffic jam. They live in Chicago.

          • Guesteleh

            I’m glad it wasn’t winter!

  • guest

    I think this is one of the most compelling arguments against homebirth, and one that has a good chance of changing people’s minds if they’re on the fence. I know that not many of the true zealots want to talk about what happens if something goes wrong in a homebirth, but for on-the-fencers, if they find out that the answer to the question is “go to the hospital anyway,” that might be enough to get women to choose the hospital in the first place. It obviously discredits the homebirth midwife, but even if the woman still trusts the homebirth midwife, she can see that the homebirth midwife trusts the hospital more than she trusts herself in an emergency.

    • Alas, the mindset is “it’s not going to happen to me”.

      • Anj Fabian

        It’s not going to happen to me.
        It’s not happening to me.
        It’s something trivial.

        What? Crisis? Surgery?
        It’s NOT going to happen to ME! No. I refuse.

  • AmyH

    I’ve mentioned it here before, I think, but people upstream are talking about how unaware we can be as moms of the risk. I first heard of “homebirth” in my teens and immediately was sure that’s what I wanted. When I was about 18-19, my mom met a lady who’d had one or two homebirths, and another friend of ours who first had children 13 years earlier in a small backwoods hospital decided she wanted to try homebirth with her last two, and everything went great.

    Four out of four success rate; everything’s good, right? Why would my mom be so dead set against it? She didn’t have stats to back her up, just good common sense. And that other lady who lost her baby at 6 weeks old (probably SIDS, but I’ve never asked), what’s with that “you’d never forgive yourself” stuff?

    Well I got married in my late 20s and my hubby and I started TTC, and I was trying to explain to him how safe homebirth was and how great everything would be. My reasoning was, of all the things that could go wrong, surely only a small percentage of them would be emergencies that would cause you to lose the baby before you made it to the hospital. And I got a hold of a copy of BOBB.

    My hubby is Mexican, and he believes his mom had a 6 kg baby naturally. Let’s say it was 5.X – I’m sure she still gave him good reasons to not trust birth. (She has passed away, so I can’t know for sure how big it was.) I researched “safety of homebirth” online to be able to educate him properly, and found all the info I wanted.

    Then I decided to be intellectually honest I should look at the other side too, and looked up the “mean Dr. Amy.” I was blown away. I spent several days reading the archives, and that was that. It’s a passionate topic for me now, especially after a dear friend chose to go postdates to avoid Pitocin, tried an evening primrose oil suppository, thought she broke her own water, and refused to go to the hospital for 36 hours “because it’s only vaginal exams that raise the probability of an infection and she didn’t want to get Pitocin again.” Fortunately her water hadn’t even broken yet, but she continued waiting well into 41 weeks and had a very wrinkled baby.

    I have friends pushing this stuff, and lots of them don’t vaccinate. Another friend is planning her 2nd attempt at a HB, although her 1st baby was preterm due to pre-eclampsia and her 2nd baby, planned HB, had to be induced due to pre-eclampsia. Now she refers to the “small chance” that she might have to transfer to the hospital this time. I suppose she’s doing the Brewer’s diet or something… who knows. People know not to get into this stuff with me; they think I’m as crazy as I think they’re crazy. Oh, well. I’ll take that 2,599:2,600 chance of a live baby at the end of my labor, and I found out I like epidurals, too.

  • from cali

    The woman that lost her baby at a home birth with Robert Biter is trying to plan a protest of his new birthing center. If you live in the San Diego area stay tuned. Also Paul Krueger from NBC San Diego is looking for information on Biter’s role in the center since he cannot practice medicine. Biter filed for bankruptcy after the death of the baby since he has no malpractice insurance and now has $$$ to spend on the birthingcenter.

    • Amazed

      His WHAT? Didn’t he LOSE HIS BLOODY LICENSE?

      Edit: Sorry, I wrote before I read the whole thing. I am not wrong. He opened a birthing center. With his lincense revoked. So my point still stands: WTF?

      • attitude devant

        I’m beginning to think a silver stake (made from a crucifix, if I remember Van Helsing’s instructions correctly) through the heart might be necessary. Possibly we’ll need to do it during the day when he’s resting in his coffin?

        • Amazed

          A crucfix? Are you sure about this? I am ready to donate a silver ring to the cause but I can’t help with a crucifix.

          P.P. It’s a very special silver ring. My mom bought it for me during my first travel abroad. It was the first jewel I ever chose in my life, I had no interest in those before. But I am ready to donate it to fight evil.

        • Young CC Prof

          I think we should try to find his caul and burn it. That might work better.

    • Guesteleh

      I wonder if Navelgazing Midwife is involved with the protest. Wasn’t Biter her Dr. Wonderful?

    • Bombshellrisa

      http://www.pinterest.com/drrobertbiter/babies-by-the-sea/
      Here is Dr Biter’s Pinterest board

      • MLE

        Super creepy. I like the early design sketches for the sign. Orange for the starfish? No, I’ve got it – lime green!!! So glad the important things are settled!

        • Bombshellrisa

          Especially love the quote about people hating on those who “speak the truth”. Which truth would that be?

  • Amy M

    And I imagine, many of the women who transfer from home, may not even realize how serious the situation is, and continue to fight the hospital staff about things like IVs or vaginal exams or whatever. And if they are lucky and baby is saved, then “the hospital ruined their birth.”

    I know one woman who had her first in the hospital. She ended up with a Csection, and is convinced, to this day, that if she’d just been given more time, she would have had the baby vaginally. She went on to HBAC for the 2nd child, all went well luckily, but the fact that the 2nd baby was born vaginally, further convinced her that the 1st should not have been a Csection.

    I once asked if she knew anything about the EFM tracings, did her doctor look at those and decide baby is heading to distress,and got no answer. I’m not sure if that meant that is indeed what the doctor said, or if it never occurred to her (the woman) that maybe there was a real reason for a Csection. She’s a huge fan of ICAN these days, and likes to post articles on FB about how unnecessary Csections are.

    • HilKim

      Hi, just thought I’d jump in since I can totally relate to your comment. My sister in law planned the crunchiest of home births, but after laboring for 3 days she had to have an emergency c section. She bled very badly and may have had to receive a blood transfusion (this was all kept very hush hush by her husband because she would have been against it). The baby had to have an IV of antibiotics immediately. All is well with them both now thankfully, but to this day she still thinks she could have done it if they had only given her more time. We found out later that she had lied to us all about her due date (due date was February 28 and she didn’t give birth til March 20) because apparently it was more important to stick to the plan. Of course, her midwife did not refund any money for her “services” and now my brother in law is stuck paying two maximum deductibles since she had paid her midwife in full by the end of one year and had unplanned complications – and huge hospital bills – the next year. Of course this never occurred to them, as they were trusting in this woman and my sister in law’s body to do the “right” thing.

      • Smoochagator

        It really freaks me out when people give totally vague answers for their due dates, like “October” or “early 2015” because I know they’re trying to head off the postdates induction talk. I mean, I get it if you don’t want folks pestering you every day about whether or not you’ve “had that baby yet” (hahaha, such an original joke, and if you can’t figure out the answer from my Jabba-the-Hut-esque physique, you really shouldn’t be allowed to mix it up with the rest of the human race) but when people do it so they don’t have to be held accountable for refusing interventions that could save their baby’s life (or because they really do not understand how high the risk of still birth is), it gives me the willies.

        ETA: Okay, I don’t “know” why they do it, I assume. There’s plenty of moms whose dates get all kinds of screwed up because they have weird cycles and didn’t get an early ultrasound so they really have no idea when the baby is due. But you know what I mean.

        • Ash

          If people are vague about their due dates to friends, family, and acquaintances, I assume it’s so they don’t get bombarded with questions “IS THE BABY HERE YET?” and family members ringing up the hospital to ask them if So and So is there

          • Aussiedoc

            I was vague for precisely that reason! Due date was October 30, so I told everyone early November so they’d leave me alone, lol.

            As it turned out he was a very compliant baby and came on his due date! And I only got two irritating phone calls from people who knew- which both went to message bank because I was pushing 😉

        • HilKim

          You know, at the time I hadn’t even considered that people are vague about their due dates for that reason. I didn’t really know the whole natural birth culture then, plus my sis in law told us an exact date – just two weeks after her actual due date. And now being 29 weeks pregnant myself and already getting the “just a few more days, huh?!” comments (well, about 80 more days actually!) I can see why expecting moms don’t want the added drama of “oh it’s your due date! Where is your baby!”

          But for her, it was definitely because they were anticipating being late and didn’t want anyone suggesting anything other than giving birth in their tiny guest room, in a tub of water with inspirational music playing and the subtle scent of lavender in the air….

          Another thing I noticed after we finally allowed in to see her and meet the baby was that the hospital staff was overwhelmingly nice and supportive.

    • mostlyclueless

      I know 1 woman who labored at home for ~3 days, and then grudgingly transferred to the hospital. She had an epidural, slept for the first time in days, and then a few drops of pitocin later, she pushed out a healthy girl.

      She is now a staunch crusader against hospital birth and is in fact becoming trained as a homebirth midwife.

      I can’t for the life of me understand her logic.

    • Smoochagator

      I wonder if I had had my first child as a planned hospital birth if things might have turned out differently for me. It was a planned home birth, and after I was complete and trying to push, his heart rate sounded a little off during contractions so we called an ambulance, transferred, and he was born vaginally seventeen minutes after we arrived at the hospital, absolutely fine. I wonder, if I had been at the hospital and on EFM, if perhaps his heart rate may have signalled to the OB that I needed a C-section and (after he turned out okay) I would have become super-anti-doctor and attempted an HBAC. As it was, I had such a pleasant experience in the hospital that when I realized we couldn’t afford to attempt a home birth the second time around I really wasn’t upset about it, though I still decided to forego pain relief and argued about the IV and EFM.
      Just one of those “what if…”s, because when you think about how different things could have been and how you might have reacted, sometimes you feel like you really dodged a bullet. I know I lucked out having a healthy baby in spite of subpar prenatal care… but I also lucked out in not having an experience that would push me to further embrace the NCB mindset.

      • Bugsy

        Interesting…I had a friend who had a very similar first birth story to your own. However, she’s gone the more anti-doctor, all-natural route. Not only is she intending for a birth center birth, but she’s also declined all ultrasounds and other prenatal testing. As a mom who had a hospital birth at 39 weeks following a high-risk pregnancy (with plenty of ultrasounds), I just can’t understand why she’d willingly make these choices.

      • Cobalt

        If I had had a different environment or different friends after my first was born, I might well have gone the NCB route. My hospital experience with my first was awful, even though I had no complications and it was a relatively easy first birth. The nurses were brusque (one was an outright howling bitch, I have no idea what was up with her attitude), the doctors didn’t explain anything, and the postpartum protocols were incredibly stressful and aggravating. It felt really impersonal and assembly line, starting from when I first put the hospital gown on.

        If someone had told me right after that that there were other safe options, I would have believed it. Cobalt 2.3 would have been fine. The baby I’m holding now wouldn’t have been, and I might not have been either.

    • Belle

      I’ve seen several people like the one you describe.. they are unhappy about coming to the hospital so they fight us, but when the situation is dire and they don’t get a perfect outcome, the doctors/nurses/interventions, whatever gets the blame.. they accept no responsibility for their role in the outcome..and the midwife, of course, did NOTHING wrong..

    • Aussiedoc

      There’s a horrifying coronial report of a homebirth transfer resulting in death in Australia of exactly that. They refused IVs, midwife stood in front of the monitor, refused instrumental delivery until the very last moment, refused episiotomy over and over and over. Baby died.

      Then they tried to blame the doctor and the instrumental delivery.

      I’m trying to remember the case, it’s a horrifying and yet enlightening read. That poor baby had no chance, and those doctors and hospital midwives were trying to help and every step of the way were blamed.

  • Smoochagator

    Or they truly believe that the risks are small enough to be negligible. They listen to one-sided arguments or read slanted, grossly in accurate statistics. They are unable to correctly interpret the science on their own but won’t trust the doctors to interpret it for them because of their problems with authority and their desire to be “different” and “special.”
    At least, those were the reasons why I chose home birth.

  • Zoey

    It apparently makes perfect sense to them to wait until the disaster occurs before they seek treatment.

    And in the NCB mind-set, you can’t even plan for a disaster because planning for an adverse outcomes means you didn’t trust birth. If you just do all the right things – bounce on a birth ball every day for 9 months, read Ina May’s books, visualized your body opening like a lotus flower, build a birth altar and cover it in affirmations, surround yourself with “supportive” people – then you won’t have any complications. If you have any complications, it’s your fault because you didn’t trust your body, or forgot your affirmations, or the lights were too bright in your birthing room, etc. It’s hard to plan for something that you’re entire wold view/business model says can simply be wished away.

    • Roadstergal

      “And in the NCB mind-set, you can’t even plan for a disaster because planning for adverse outcomes means you didn’t trust birth.”

      That seems to be a general case with alt-med… and even just with the population at large. Preventive measures for the worst outcome is a mumbo-jumbo-quantum-universe dare thing to _make_ the outcome happen. If you never acknowledge or prepare for the worst outcome, it won’t hear you, and won’t come calling.

      You see it in medicine, in flying, in so many everyday activities. To some people, wearing a fullface helmet and Tpro armor on my bike means I’m going to crash. (I’ve never crashed on the street, but I prepare for the worst with gear and regular skills practice anyway.)

    • EmbraceYourInnerCrone

      Ah, the “Clap harder! You just have to BELIEVE!” school of healthcare.. With extra bonus guilt points ” well if you just BELIEVE you won’t have any problems, the magical unicorn sparkles will make everything work right” So if everything isn’t OK it was because you didn’t trust/believe/whatever enough, and not becuase the midwife didnt know what the hell she was doing…

      • The Bofa, Being of the Sofa

        Ah, the “Clap harder! You just have to BELIEVE!” school of healthcare..
        With extra bonus guilt points ” well if you just BELIEVE you won’t
        have any problems, the magical unicorn sparkles will make everything
        work right”

        Hey, it works for LCs…

  • The Computer Ate My Nym

    But homebirth advocates and homebirth midwives often reject preventive medicine.

    And say, with a straight face, that the problem with “allopathic medicine” is that it never works on prevention or treating the underlying issue, only with dealing with emergencies and symptoms.

    • Young CC Prof

      Well, you know, if you reject vaccines, prenatal care, most screenings, cholesterol and blood pressure treatments, etc etc, then you ARE basically just left with treating emergencies.

      • Sue

        The same argument as Dr Amy uses in this article can be used for the anti-vaxers – it’s relatively safe in our vaccinated communities to be unvaccinated because the rest of us will coocoon you, and you can always go to hospital if you get sick.

  • OldTimeRN

    Been there done that and I never wish to do it again. One baby could not be saved despite a good 30 minutes of desperately trying. Once baby was “saved” if that’s what you want to call it. Intubated, with no tone, no reflexes, no breathing on his own, a decent heart rate thanks to Epi. The baby went on to be transferred to a different hospital to be trach’d and live her life of mental impairment.
    The above of course is the ultimate. But there are other examples of home birth creeping into the hospital at what hospital personnel feel is a detriment to baby. From trying to refuse Vik K, to immediate skin to skin without a quick assessment, to refusing formula when medically necessary, to not wanting to use a shield for breastfeeding, to rooming in when mother is exhausted. The list goes on and on. It’s a scary world out there.

    • EmbraceYourInnerCrone

      I also love the assumption that they will fly past all the ER protocols and be admitted to OB immediately(I don’t work in a hospital but a lot of my family members do, as nurses or ambulance staff)…well first off many hospitals don’t just have an OB hanging around the ER waiting for people to show up, and then theres the fact that you might call for an ambulance and if they just think its some one in normal labor, then the 3 car wreck on the highway and the stroke victim on the other side of town may take priority….
      And finally if you (generic you) and your midwife want to argue with the ER staff about whether you are willing to have a vaginal exam or U/S so they can ascertain what is actually going on then everythings going to take even longer

      And then there’s the fact that if you DO need a C/S there may not be an available OR and also you will need an anesthesiologist…
      Some how I don’t think that any ER (US ER, I realize that in a lot of countries the midwives are nurses and have a working relationship with a hospital)) just lets a CPM midwife come into the emergency department and yell “We Need a C Section STAT”….
      I guess part of what pisses me off about this is after 2 miscarriages all I wanted was a live, hopefully healthy baby…

      • The Bofa, Being of the Sofa

        Some how I don’t think that any ER (US ER, I realize that in a lot of
        countries the midwives are nurses and have a working relationship with a
        hospital)) just lets a CPM midwife come into the emergency

        Gene, I think, described how this type of transfer is treated basically as a person who walked in off the street.

        • Sue

          Of course – it IS a person who walked in off the street.

      • Bugsy

        I’m the same way as you – after IVF and a difficult pregnancy, all I wanted was a healthy child. I posted above that one of my oldest friends is declining all prenatal testing/ultrasounds and planning on having her second child at a birth center (after an ER-transfer during the supposed birth center labor of her first child). As someone who struggled so much with both fertility and maintaining my pregnancy, I find that I’m actually disgusted by her willingness to take such risks with her child’s health. Granted, she doesn’t believe they actually exists…

      • Who?

        Haven’t you seen ER? Someone comes in with the ambulance or in husband’s car and gets swept in and rescued by the team? Or actually in the one I’m thinking of it was an unplanned quick delivery, twin babies delivered in the ER and mum died in theatre of bleeding from an accreta. I looked it up-nasty.

        Come to think of it emergency births don’t tend to end well in ER despite all those lovely doctors and nurses being so compassionate, competent and very, very pretty.

        I’m not ashamed to say we discovered ER in 2011 and got through the entire back catalogue in less than 12 months, though now I see it written down I wonder if I should be just a little bit.

  • Or, alternatively home birth activists will simply declare that “some babies are meant to die”. If my baby dies, or if I were to die, I would want to know, for certain, that everything that could have been done was done – not that everything that could have been done at home was done. The guilt and mental gymnastics to recover from that kind of loss otherwise would just be too great, too crushing.

    • Squillo

      I think those kinds of things are very easy to say until they happen to you, which is another reason they often shun loss parents.

      • The Bofa, Being of the Sofa

        Great point. It’s real easy to say “some babies are meant to do,” but, “Your baby was meant to die” not so much.

  • moto_librarian

    And the greatest tragedy of this mindset? The women who believed it and paid the ultimate price: the loss of their precious children.

  • mythsayer

    This is a really good point… they don’t want to go to the hospital to labor and birth because doctors are MEAN! But they’re perfectly willing to trust that the doctor will save them if something does go wrong.

    • ArmyChick

      Of course. They are nothing but hypocrites.

      • Karen in SC

        Definitely. Like the freebirther who had a vbac. She can’t wait to save up the money for a tummy tuck.

        • attitude devant

          Oh my god. Is that the most jaw-dropping story ever? That pic of her in the cranberry colored birth tub? And her bleeding disorder, and the retained placenta?

          • Dr Kitty

            Link please. Don’t think I’ve seen that one, I think I’d remember that level of malarkey.

          • Karen in SC
          • attitude devant

            I wish I could link her birth story for you Kitty. She had a multiple previous sections, previous rupture with TOLAC, von Willebrands, and footling breech baby. She had no midwife, no care. Birthed in a tub. Her husband pulled on the baby for eight minutes to get the head out and she has some unexamined untreated tear. Placenta was in for 16 hours IIRC. Insane.

          • Dr Kitty

            So…FUBAR and still counting as a UB/HBAC win. excellent.

          • attitude devant

            Only, no pics of the baby, whom she describes as “quiet” and “sleeping a lot”. She says he was completely unresponsive for at least eight minutes. So maybe not so much win. I hope he’s ok. It IS kind of hilarious the sheer word vomit that she lets out about her ‘achievement’ compared to the next-to-nothing we have on the babe.

          • Dr Kitty

            Oh dear.
            That is all kinds of wrong.
            She reports that she had symptoms of depression during her pregnancy. Her decision making might have been impaired somewhat.

            I’ve never heard a uterus repair after a rupture described as a “special scar”. Which is the kind of thing that is said by people who have never seen what a uterine rupture actually looks like.

        • Certified Hamster Midwife

          Just as Mother Gaia intended.

    • Amazed

      Indeed. They are so willing to follow the Law of Gentle Birth dictating that birth should be intimate, sacred and so on. But they are only so willing because deep inside, they believe that dreaded obstetricians won’t let them die under a tree to follow the Law of the Jungle.

    • just me

      Oddly enough, the doctors and nurses have now BECOME mean because of the naturalbirthers. As we’ve read on this site, doctors and nurses now bully women about breastfeeding, withhold pain medication and formula, and force rooming-in on exhausted mothers. They also withhold elective c-sections from first time mothers who would like to request them.

      Midwives have managed to make their competition worse. I bet Pepsi would love to have that sort of free rein to ruin Coke’s product.