We need to talk about obstetric violence: midwives are letting babies die

Letters A-Z and 1-10 dripping with blood on white background

Talk about bad timing!

Kim Lock has an opinion piece on obstetric violence in Australia’s Daily Life, on the same day that the Australian media is discussing yet another inquest into yet another series of homebirth deaths.

According to Lock:

A horrifying video recently appeared in my news feed. Earlier this year in California, during the birth of her baby, ‘Kelly’ has an episiotomy cut against her will. Human Rights in Childbirth shows Kelly, who had earlier disclosed to staff she had been raped twice in her life, flat on her back with her legs up in stirrups. Kelly clearly begs, “No, don’t cut me.” Despite her repeated protestations, and without any urgent medical reason, she is belittled by the doctor before he makes 12 cuts to her perineum.

Remove the crowning baby, gowns and masks, and put this same situation in another setting, what would we have? Sexual assault. Lawsuits. Worldwide outrage. And yet, because this occurred between hospital walls and beneath the gloved hands of a doctor, the woman remains powerless. As yet unable to find a lawyer who will take her case, Kelly has been told, “The problem is, you don’t have any damages. Your baby is fine and you are alive.”

“Remove the crowning baby, gowns and masks”?

In other words, only by taking this incident totally out of context can Lock make this into an episode of violence.

What’s a traumatic birth?

Australian organisation Birthtalk, describes traumatic birth, “A birth that you can’t let alone. It stays with you … It might not look ‘that bad’ to an outsider. It might not look ‘that bad’ to your partner … It could have been a caesarean or a natural birth. It might have taken 30 hours or 3 hours. A bad birth is defined by the way you feel, not just the events that occurred.”

In other words, there are no objective standards. That pretty convenient when you consider that Birthtalk produces the book How to Heal from a Bad Birth. A bad birth is whatever natural childbirth advocates want to pretend that it is.

Make no mistake, there is a problem with obstetric violence in contemporary childbirth care and it’s occurring at the hands of midwives. Midwives are letting babies die preventable deaths because “normal birth” is more important to them than whether babies live or die.

Consider the ongoing inquest into 3 preventable deaths at homebirth in Western Australia:

The traumatic hospital birth of a first child led a Perth woman to opt for a home birth with her second, the mother has told an inquest into her baby’s death.

The woman, who cannot be identified, gave birth to a boy at home in 2010 after a 40-hour labour assisted by two midwives.

The infant died in hospital from an infection and meconium aspiration two-and-a-half hours later.

The coroner is examining why the woman was not taken to hospital during the labour and what caused the baby’s infection.

In emotional testimony, the woman said she did not want to give birth in hospital because she had a traumatic experience with her first child and suffered from post-traumatic stress disorder.

She told the inquest she wanted to “maintain my own autonomy” and to have a support team around her.

When asked if there was anything that would have caused her to have a baby in a hospital environment, she replied: “If there was a clear pressing medical need, obviously I would have.”

But there WAS a clear pressing medical need, two in fact. The baby was infected with Group B strep and had aspirated meconium. Why didn’t this mother recognize these pressing medical needs? Because her midwives told her is was fine to ignore these warning signs.

A midwife has told the Perth coroner’s court the woman was not transferred to hospital during a home birth because it was not felt it was required.

One of the midwifes, Sally Westbury, gave evidence at the inquest today.

She rejected suggestions she should have transferred the woman to hospital much earlier.

Ms Westbury testified she talked to the mother and a back up midwife about going to hospital because of concern about the length of time since the woman’s membranes had ruptured.

However, Ms Westbury said because the mother was “afebrile” and “the baby was in good condition, it wasn’t felt that was required”.

She rejected suggestions that after the baby was born and the placenta had a bad smell, which indicated infection, she should have immediately transferred the woman to hospital, testifying that “observation” was the normal practice.

Ms Westbury also denied that her level of care was below what was expected, saying she “actually would do the same again”.

“Babies die in hospital in exactly the same circumstances,” she said.

This is pure ideological cant and it is killing babies who did not have to die.

The tragedy of this baby’s death follows the playbook of contemporary midwifery business generation to such an extent that it is practically a farce:

A “traumatic” first birth

A mother who wants to maintain her “autonomy

Multiple risk factors

Midwives determined to ignore those risk factors

A dead baby

Midwives who refuse to accept any responsibility

And the flourish of stupidity with which no story of midwife negligence is complete: the claim that babies die in the hospital, too.

The claims of obstetric violence toward mothers is part of an incredibly cynical plan to increase market share despite horrible outcomes. An unfortunate amount of contemporary midwifery practice is devoted to fomenting mistrust of obstetricians and hospitals. The plan has several critical aspects: the claim that obstetricians don’t follow the scientific evidence, the simultaneous (though totally opposite) claim that midwives don’t need to follow scientific evidence because they have “other ways of knowing,” and the demonization of obstetric treatment as “violence.”

Don’t get me wrong. I’m not claiming that hospital care is perfect. Although there is rarely any violence, there is a great deal of poor and disrespectful treatment. However, the chief victims aren’t Western, white, well off women; the chief victims are the elderly, people of color and those of lower socio-economic status.

Yesterday I wrote about the complete moral bankruptcy of UK midwives and the campaign of Birthrights to #FightFear of being held responsible for dead babies, so midwives can continue to promote “normal birth.” Not coincidentally, Hannah Dahlen, spokesperson for the Australian College of Midwives, was featured in both the Australian article about obstetric violence, and at the British conference organized to #FightFear. Yet on the day of the conference the British press was covering the appalling stillbirth rate that occurs at the hands of British midwives and could be halved by a simple ultrasound exam.

We need to talk about obstetric violence, but obstetric violence is very different from what midwifery marketers claim that it is. Obstetric violence is the chilling willingness of midwives to let babies die on the altar created to worship “normal birth.” Obstetric violence on the part of midwives comes from a desperate need to promote their own services regardless of whether or not those services are appropriate for an individual woman. Obstetric violence in midwifery is based on the notion that dead babies are a small and necessary price to pay for midwife autonomy and income.

The take home message is this: Birth is a business for midwives and the sole source of their income. They are willing to say and anything to maintain and increase market share;  prattling about “obstetric violence” while ignoring dead babies is just the most obvious manifestation of their obsession with themselves.

The real question about obstetric violence is how many babies will die because midwives, in an effort to promote themselves, sow fear of medical interventions and distrust of obstetricians? If the views of midwives are any indication, there will be no limit.

  • Jj

    this “physician” is unlicensed.

    • MaineJen

      No, you’re thinking of CPMs.

      Having a lapsed license because you no longer practice (by choice) is different from having no license at all.

    • momofone

      This physician (no scare quotes; she’s actually a physician) is retired.

  • For someone in the medical community, it’s shocking how you take literally ONE story of a horribly mistreated situation and create an entire hypothesis based around that. Midwives as a collective whole are wonderful, caring humans who’s main objective is a healthy mom and baby AND a happy, respected, supported mom. I truly cannot say the same for all OBs. But I won’t sit here and say ALL OBs are evil. It’s absurd to write a blog post based on such a blanket statement.

    • Nick Sanders

      Morcambe Bay.

    • Bombshellrisa

      Sisters in Chains
      From Calling to Courtroom

      • Nick Sanders

        I swear, Sisters in Chains sounds like the name of some punk or *metal band.

        • Bombshellrisa

          I wish that was the case!

  • CAM

    Jesus Christ, i have never read a more shamelessly appalling article. A good midwife would never do this. I wholeheartedly believe in the concept of obstetric violence by obstetricians and that the support of good, competent and safe midwives can go a long way to redress the damage done by previous traumatic birth. Skeptical OB indeed – i’m sure you’d prefer to give every woman a c-section so it was all managed and done on your schedule and ‘safe’ (yes the quotation marks are there on purpose – i’m sure you do truly believe that they are the safest option!). You are a disgrace to your profession and to the women that you ‘care’ for (see i did it again there).

    • Wren

      “A good midwife would never do this” and all midwives are good, right?

    • moto_librarian

      But you believe that midwives are incapable of perpetrating such violence? Given that Dr. Amy had vaginal deliveries for all four of her children (two “natural” births), you might want to rethink your assumptions about her.

    • Stacy48918

      So you support increased education, nursing degrees, hospital experience and malpractice insurance for all midwives so that they will be “good” midwives? Because we already have that – CNMs…but most homebirth midwives have NONE of that (CPMs).

      “A good midwife would never do this” except of course many, many of them do.

      • Jj

        you don’t need a magic piece of paper. experience makes a good practitioner. i went unassisted instead of hiring a mEdwife, and I am so glad. will do again many more times.

        • Gæst

          Doctors and CNMs HAVE experience – often more than CPMs. The paper certifies that they have received training from someone with vast amounts of experience as well as had supervised experience. It’s not “magic” paper, it certifies that a particular person actual has the skills and experience they say they do.

        • MaineJen

          So what’s your gripe with Dr. Amy being “unlicensed” above? You don’t need a magic piece of paper, after all.

  • Ron

    I would have been safer if I had stayed home. I was stuck to a fetal monitor, refused support, encouragement or information, forced to lie down, denied movelment, drink and privacy for nine hours. When they over-rode my body, first by breaking my waters, then by administering syntocinon, the baby went into distress because his head wasn’t ‘quite’ straight in the birth canal. This is obstetric violence, perpetrated by obstetricians. This divisive zéro sum game that some doctors and midwives are playing is just stupid. Clearly, if a low risk woman can walk away from her birth saying, not only would I have been happier if I had stayed home, but I and my baby actually would have been safer, then there is a serious problem with maternity care.

    • Amy Tuteur, MD

      Or there is a serious problem with your understanding of the situation.

      • Ronnie G Chapman

        No Amy. There was no problem with my understanding. They were stressed and had no time for me, they haven’t updated their practices and they didn’t know how to support any positions that didn’t involve the stirrups. The maternity ward doesn’t even have a toilet, let alone a private bathroom for each labouring woman. There were no pillows, no air-conditioning and nil by mouth. They projected their perception of my pain onto me, or they resented me because epidurals are more convenient for them. It really is that simple. If there had been a problem with my understanding there must have also been a problem with their communication, i.e. it was minimal. I had an obstetrician standing at my feet, asking why I wasn’t pushing and laughing that perhaps I had forgotten my prenatal classes. They used syntocinon to force me to push in lieu of allowing me to change position, it is that simple.They even gave the baby artificial milk as soon as he was admitted to the nursery, I was eating dinner and having a shower for god’s sake. He was only three hours old, they just made the decision for me. This was a private hospital, restricted resources doesn’t explain what happened, it is their mentality. Your problem isn’t really that what you say isn’t correct in some situations. It’s just that you don’t want to hear the other extreme. In fact you actively work to silence it. There is a natural birth industry. There is also a c-section industry. There are homebirth midwives that fail to transfer. There are obstetricians that fail to listen. There are women with high expectations.There are women with realistic expectations who are treated miserably. Your relentless castigation of midwives and refusal to believe that a woman might have a clear perception of events surrounding a birth is quite telling. It’s probably as dangerous and disempowering as ‘the cult of homebirth’. There are more reasonable and respectful voices out there than yours to advocate for safe and respectful care. Your discourse is divisive and ultimately has the potential to increase danger for a significant proportion of birthing women. That’s why you’ll only ever be a rabble rouser and never really a leader in this discussion.

  • Sarah

    Not planning on watching the video…..all I can say is that if I was 99% happy with my decision to choose a c-section, I’m now 200% happy with that decision.

  • MaineJen

    Ms Westbury “would actually do the same again?” Oh, FFS.

  • Who?

    Lack of follow up, buck passing, responsibility denied…the WA homebirths inquest tells the same old story. So much for individual care.

    http://www.abc.net.au/news/2014-10-03/centre-should-have-followed-up-on-birth-plan-concerns/5789480

    • Amazed

      This poor mother. She wasn’t even that intent on a homebirth. She simply wanted it, the way children will try to live on chocolate all day if allowed to. Unfortunately, the one whom she had let to play “the parent” part in the scenario felt that eating chocolate instead of anything else was a wonderful idea.

      “I trusted my midwife above the obstetrician. I was reassured and very happy to accept that reassurance.” So sad.

      And later…”I did everything differently. It was the complete opposite. I had an elective caesarean in hospital,””I was not going to risk another one”.

      As I wrote down the thread, comes to show which trauma is worse in this trauma survivor’s mind.

      But I love how the programme manager claimed she couldn’t be personally responsible, cause you know, she had to rely on the staff to report back. Our Ministry of…well, anything would love her and take a leaf out of her book.

  • Lena

    That OB needs to lose his license. And if it were possible for him to be criminally charged, I’d be all for it.

    What a fucking animal.

    • Amy Tuteur, MD

      But if he said he supported homebirth all would be forgiven and homebirth advocates would be holding rallies on his behalf and giving him money.

      Who is the doctor? Where is he licensed? Why hasn’t anyone complained to the medical board?

      • Lena

        Don’t confuse me with a homebirth advocate, because I’m not in any way. And I really cannot believe that you’re so wiling to ignore what you saw in that video. You’ve always called out bad medical practice, but a homebirth fan criticizes an OB and all you can focus on are bad midwives? You know you can do both, right? Criticize lay midwifery AND call out the unconscionable behavior of a medical professional? The two aren’t mutually exclusively.

        What do YOU see in that video? What is your opinion on that doctor’s actions? Could you imagine a situation where you would have done the same? Why or why not? What makes that OB’s treatment of his patient so acceptable to you that harsh criticism of him has you throwing out a red herring?

        I’m genuinely shocked by your reaction, Dr. Amy. You’ve crossed a major line with this. There’s example after example out there of the stupid shit midwives say every day, and you pick the one with video evidence of the sadistic actions of an ob?

        Holy shit.

        • attitude devant

          I don’t think she’s ignoring it. She’s just wondering, as many of us have, why the hell the woman in the video did not take any of the SEVERAL avenues available for redress. Easiest one: complain to the medical board. That will scare the poop out of any doctor, I promise. Next step: charge him with assault. Hell, she’s got evidence in the video. What he did was wrong. She has avenues. Why not use them? On the other hand, look up poor Margarita Sheikh’s story. Her midwife literally held her captive. She has NO recourse because the midwife wasn’t licensed and she has no evidence like this lady has.

          • attitude devant

            Also, don’t you find it just a little strange that no one identifies the doctor in the video. What is up with that?

          • dbistola

            So…are people thinking the video is a fake? Could that be? I suppose it it strange that the doctor’s name hasn’t been shared yet…or has it? Usually names of midwives and patients are known pretty quickly.

          • attitude devant

            It’s weird. None of the docs commenting here can imagine anyone they know behaving this way. At the hospitals where I have practiced this guy would be up in front of the department peer review in a New York minute. It would be nice if the people posting the video named the doc or the hospital.

          • toni

            If there is an inquiry taking place could there be a gag order? Or maybe she took her family’s advice and ‘got over it’. I’m not sure the fact that most physicians can’t imagine their colleagues doing anything like that means all that much. They’re always shocked to learn that another doctor has been abusing or having illicit relationships with patients under everyone’s noses. It can take decades for a predatory doctor to get their comeuppance because they are good at hiding it from their ‘equals’ (for want of a better word) and choose their victims carefully, intimidate witnesses etc. They’re smart, they’re doctors ffs. http://www.theguardian.com/society/2007/jan/28/health.socialcare The Clifford Ayling case is so infuriating.
            Maybe this doesn’t happen much in the states being more litigious and customer focused in healthcare, idk.

            What you said just reminded me of the time a guest poster (Kate B, I think her name was?) talked about her experience (amongst other unpleasant things) of being manually dilated by an obstetrician in Britain. The same thing happened to my mother in an NHS hospital in the mid 90s (she was forcefully dilated from 5cm to 9cm – according to the doctor/bastard who did it – without warning or pain relief. She had a homebirth for her next delivery partly because of it). There are several threads about this procedure being used on unsuspecting patients on mumsnet http://www.mumsnet.com/Talk/childbirth/a1400159-Manual-dilation and other UK sites and yet if I recall correctly Dr Kitty said she didn’t know of any doctor that would do such a thing. here it is:

            http://www.skepticalob.com/2012/12/lie-to-your-patient-and-other-homebirth-midwifery-wisdom.html#comment-1138656693

            http://www.skepticalob.com/2012/12/lie-to-your-patient-and-other-homebirth-midwifery-wisdom.html#comment-1138674617

          • Lena

            I think it’s partly that–like midwives–doctors defend their own, at least publicly. I mean, for an OB to look at that video and see a doctor in need of retraining and not a sadistic asshole who shouldn’t be allowed to have a pet gerbil let alone treat human beings…

            Look at the list of Biter’s offenses before he finally suffered any kid of official reprimand, and how many more before he lost his license. It seems to me that doctors have to catastrophically fuck up–SEVERAL times–before there are any tangible consequences.

          • birthbuddy

            Sorry Lena, we doctors do not defend our own against criminal behaviour.
            There are many examples where we have helped jail our colleagues for unacceptable behaviour.
            The same cannot be said for NCB.

          • Lena

            Oh, FFS, enough with the comparisons to midwives when anyone criticizes doctors, ok? I have not at any point defended midwives so why you all feel the need to throw that out there is beyond me.

            And, please, enlighten me…how many allegations against a doctor have to happen before they’re suitably punished? I’m not even talking about criminal behavior, just bad practice. Because you are flat out lying if you’re claiming that bad doctors are immediately slapped down. There’s a hell of a lot of leeway given to doctors and you know it.

        • Amy Tuteur, MD

          I am not condoning the doctor’s action in any way. It looks like sloppy practice and assault, if not outright malpractice.

          I am, however, concerned about whether the video actually represents what we are told it represents. If it does, why didn’t the mother use it to obtain redress? She says that she wanted to sue but no lawyer would take her case. I understand that would be no spectacular jury award because there was no long term physical harm. But I would think that a lawyer would look at the video and see easy money. Just threaten to show it to the public and expose the doctor and hospital and a large payment would be on its way.

          Human Rights In Childbirth thinks this video has spectacular propaganda value. So why are they hiding the identity of the doctor and the hospital? If this really happened the way they say it happened, and if the audio is real and not added later, why are they afraid to show the doctor’s face or even to publicly identify him? They are clearly afraid that they would be sued, yet why would they be sued if the situation is what they represent it to be? They wouldn’t.

          The video shows a doctor that at the very least needs remedial training. He cut an episiotomy much to early and his “technique” was dreadful. So why is Human Rights in Childbirth protecting HIM?

          • Lena

            I have no idea what’s in that woman’s head. I imagine it’s not dissimilar to rape victims who don’t report, so let’s please not go there.

            To others who replied to me…yes, it’s great that he has a license to lose. So? I absolutely agree that if that ob made pro-homebirth statements midwives would be on his side (and you all would be willing to drag him like he deserves, but I digress)…you are preaching to the choir here. I’m all for the criminalization of lay midwifery. I don’t need to hear about the several example I already know of about abusive midwives, because I’m actually fully capable of thinking–AT THE SAME TIME–that lay midwives AND that ob in the video are bad practitioners and shitty human beings. Trust me, guys–you aren’t hypocrite and your opinions on lay midwives aren’t invalidated just because you unequivocally acknowledge a bad ob when you see one.

          • Who?

            I’m really uncomfortable with the idea that it is okay for a victim not to lay a formal complaint, and is also okay for her trauma-and let’s acknowledge again here that it is her trauma-to be spread all over the internet for one and all to dissect over and over.

            If she needs privacy or doesn’t want to be re-traumatised then surely it is disrespectful to drag it out by sharing and discussing, in some cases in florid and emotional language, what purports to be a record of what happened.

            Could anyone in that room, including camera carrier, have notified the hospital where the incident occurred, and asked them to look into it? After I’d passed out, and got back up again, that would be my first reaction whether or not the patient wanted me to. Did someone? Is there a record of that? If not, why not?

            Who knows if she could/couldn’t find a lawyer; but I doubt you need one if the goal is to have his employer look at his behaviour, and sanction if necessary.

            There are parts missing in this story. I have no particular view about what they might be, but no doubt they will come to light.

          • Amazed

            Sorry, we cannot not go there. It isn’t similar at all to rape victims who don’t report. I cannot imagine a rape victim who wouldn’t report but be OK with the video of their rape all over the internet.

            I am someone who barely escaped a child molester – twice. My parents didn’t report either case. The reasons? Child molestation was something that just “didn’t happen” in our country, so they didn’t know how to react. It was not a problem society recognized, officially. That was the first time. But my father very dearly wanted to beat the hell out of the teenager who had tried to rape me.

            The second time, they were afraid that the wife of the man who made passes at 12-year-old me would leave him and stay with two boys to raise and no money (she was a friend of my mom’s.) Now, they think they made a mistake.

            I promise you, if someone had posted a video in the internet, they would have been furious.

          • Amazed

            I can only guess that the reason is not to protect the doctor in this horrifying video. God knows that they are always ready to throw doctors under the bush for coercing a woman into a c-section for no better reason that she’s overdue, with a transverse baby and no fluid. And if the woman in this video issued a formal complaint, the doctor would not even have the right to tell his side of the story in the internet because confidentiality…

            My guess is that the only reason for them only using the video to shock is that they are protecting their own sweet asses because the video is a fake. Sorry but I refuse to believe that anyone can be this stupid as let himself be recorded while doing such thing and then the woman would just let him be while howling all the way to high hell and back in the internet.

          • toni

            Well he was at least stupid enough to do a crummy job with the epis whilst on camera. Or the grandmother was filming surreptitiously.

          • Amazed

            I doubt that this level of care had anything to do with the camera. I guess it was just the limit of his abilities. Unless, of course, camera made him feel nervous and perform worse. I doubt it.

          • toni

            He was at least middle aged, if that is just how he does his episiotomies then that means he has been doing it like that for a long time and no one has had a word with him about it, the nurses haven’t told the attending or whoever would need to be informed. He’d be known as the surgeon that can’t use scissors. That or he just did it like that because he didn’t like her. Both explanations are horrifying.

          • Amazed

            Indeed.

    • Who?

      What’s awesome though is that he has a licence to lose. And a job to lose, with an organisation that takes notice when these things happen. And insurance to not be able to get again.

      All that said, as Dr T points out, if he pops up next week supporting home birth, the same hb crowd who are rightly castigating him now will welcome him with open arms. The mystery is why-if doctors are so evil, why are the hb crowd so pathetically needy when a supportive doctor comes calling? I’m not asking you specifically, but it’s an interesting question.

      Compare that with a midwife, who dusts (herself) off and says ‘oh well, some things can’t be avoided, that baby wasn’t meant to live/have an intact clavicle/have an undamaged brain’ as she totters off to her next assignment. She can safely ignore any complaints, knowing she’s untouchable and if things get really hot, change her name and carry on.

  • “12 cuts” for an episiotomy? Someone’s not telling the truth here. However, if a woman so badly doesn’t want an episiotomy, the doctor should have let her lacerate — which would have been far more traumatic and much more likely to result in dysparunia or possibly permanent damage.

    • Cobalt

      Video is posted down thread. It’s definitely one of those “should not happen” scenarios. It really is 12 cuts, the woman yells “don’t cut me” several times, and there is no indication she even needed an episiotomy.

      Nothing at all like how interventions should be, and normally are, used.

    • toni

      She’s not lying. It’s not so much an episiotomy.. more like how a not too dextrous four year old would hack at a piece of paper with crayola scissors.

    • CanDoc

      The video is sightly nauseating. He makes these tiny little progressive snips in the perineum in what looks to be a nearly-midline episiotomy… certainly not the way I or any of my obstetrical colleagues (who have trained in Canada, the US, South Africa, and the UK) have learned how to practice. With no clear indication that I can see – there was certainly no discussion about fetal status, and the perineum appears to be bulging appropriately, no prolonged crowning or short/edematous perineum.

  • dbistola

    Dr. Amy Tuteur is probably one of my biggest heroes, imperfect as she might be sometimes. I cannot say enough about the service she is providing, especially because pregnancy is still such a mystery to so many women, and that’s a big reason many are taken in by frauds.
    That being said, I really wish she would have spent more time, like a few more sentences, condemning the behavior of the ob. While it is true that what he did isn’t the same as destroying a woman’s body, life, or that of her child (which is standard issue for some of the Midwife Hall of Shame) it is unacceptable. Twelve cuts out of anger is an attack. Why did this happen?
    Dr. Amy’s message is starting to really hit a lot more people. I can see where a reading challenged or quick skimming person might not comprehend Dr. Amy’s disapproval of this ob, and believe that Dr. Amy would find this treatment acceptable.
    This person may then get distracted from Dr. Amy’s message, which is just SO crucial. This blog has come such a long way. We don’t want to look like we support doctors who act like all those fraudsters claim.

    • AmyH

      You’ve expressed my thoughts very well.

      TBH, I only watched the subtitles on the video – scrolled it down because I am 5 months pregnant and didn’t feel like exposing myself to something like this. I even had the sound muted (my toddler was in the room). But even as much of it as I exposed myself to and reading the comments of professionals about it, I thought it deserved more forceful treatment in the original blog post. I honestly couldn’t even tell from there that Dr. Amy felt like it was a big deal. It almost sounds like she’s saying it shouldn’t be considered a traumatic birth, even. And I’m a long-time reader (since mid-2011).

  • CanDoc

    Having said that, I watched the video and it is heartbreaking. I would not want this OB to be a partner in my practice, a colleague in my hospital, or looking after anyone I cared about. His disregard for “Kelly” is not dissimilar to the disregard we so criticize in other situations, including one recently discussed here in which a woman underwent cesarean section without consent.

    • CanDoc

      And for the record, I’ve been the situation, where the perineum looks like it’s about to explode, or the fetal heart tracing is poor, or the vacuum is about to pop-off from perineal resistance. And I’ve bargained, occasionally desperately, with women to explain that I can’t and won’t FORCE them to have an intervention BUT that I feel it’s important because there’s a lot of swelling and the risk of a tear to the anus is high which has a higher risk of fecal incontinence, or because the baby is in trouble, or whatever.
      But in this video, the physician’s demeanor is deplorable, and without him giving any cogent explanation, I can’t for the life of me figure out why the darned epis was so critical.

      • toni

        Sounds like it was just impatience. According to the woman’s account she had literally pushed twice before he said he was going to do the episiotomy..

        “Dr. A came into the room and after two pushes he had scissors in his hands and told the nurse that he was going to perform as episiotomy. I said why? … I pushed two more times and he was going to cut and I said “No, Don’t Cut Me”. Then I said “why, why can’t we try?” He said why you don’t go home and try or go to Kentucky! So then after he yelled at me he cut my Vagina twelve times. So before the episiotomy the nurse said it’s only going to be a little cut. A little cut turned into Dr. A’s horrific rage against me as a human being and against my will to begin with. I wanted to cry so badly and I was so horrified while he was cutting me.”

        • toni

          Well, impatience followed by anger that she was not complying, I guess

          • Susan

            I thought it was awful too. I actually get a lot MORE upset when it’s someone within the mainstream system because I feel these people behaving badly ( including the nurse ) reflects badly on my own profession. Hope they are held accountable. I have worked with doctors asking to do very needed episiotomies and when patient says no it’s end of story, no consent, informed choice, not done. This undermines the rest of us who do respect our patient’s rights. Revolting video and yes, in this case human rights in childbirth were violated. Doesn’t matter to me at all that homebirth midwives are worse. Patients deserve better than this.

        • guest

          Cut 12 times???Sounds like exaggerated bullshit to me.

          • PrimaryCareDoc

            Watch the video. That’s what I thought at first, too. It’s true. 12 slices with a scalpel. Horrific.

          • Medwife

            Wait- slices with a scalpel? He didn’t use scissors?

          • PrimaryCareDoc

            No. A scalpel. I’m telling you- it’s insane.

          • guest

            It was scissors.

          • PrimaryCareDoc

            You’re right. I just watched it again. Scissors. the way he was holding the scissors when I watched it on my phone looked like how you hold a scalpel.

            Time to get my eyes checked. 🙂

          • CanDoc

            Not exaggerated. Watch the video. These bizarre little tiny snips.

          • Medwife

            I watched it once months ago and I can’t bring myself to watch it again. Very disturbing.

          • guest

            I retract my bullshit call.
            This guy should be reported to the Medical Board immediately. Why didn’t someone stop him?

          • Medwife

            If I recall correctly the others in the room included a nurse and the patient’s mom, who was cheering the doctor on.

          • guest

            I know, the mother was very domineering, telling the doc to go ahead and “do it”. I think she was trying to get her daughter to “just listen to the doctor, he knows best”. Notice how she said, “Just let him do his job”.very “old school”. It could be the entire labor was a “push-pull” situation between the patient and the doctor, what she wanted vs how he thought it should be. He may have gotten impatient and exasperated, but it’s no excuse for him to have treated her that way and exert his so-called authority. Instead of asking him “couldn’t we just try”, I wish she could have felt strong enough to tell him he did NOT have permission to cut her. Maybe that would have got his attention.

          • guest

            I would like to know what happened during the entire labor. I don’t think this video is telling the whole story, just a piece of it. Maybe the patient did file a complaint with the Board.

        • guest

          The baby looked big and it looked like there might have been a mild shoulder dystocia. Maybe they were anticipating that given the position the mother was in (bed almost flat), legs pulled back.. it doesn’t excuse the doctor’s behavior though. The nurse was irritating with her coaching too and inappropriate with her comment about the baby coming out wearing a sombrero. He should have let her push longer though, and perhaps if he had respectfully explained the issues with a possible 4th degree tear, maybe she would have consented.

      • Medwife

        Do you cut mediolaterals or medians?

        • CanDoc

          Mediolaterals – and the classically recommended urogyn mediolateral, meaning it’s directly lateral towards 9 o’clock (I’m right handed) while I cut, so during the repair it’s at 45 degrees off the midline. I do 200 deliveries per year and about 10 episiotomies, so not a lot, but when they’re needed, and I really believe they reduce morbidity (esp with forceps.)

          • Medwife

            By far the most common US practice is the median, which is SO much more likely to extend. I was never trained how to cut or repair mediolaterals and I’m not about to “wing it”, but from reading research from Europe and Canada, it looks to me like mediolaterals might be preferable, in some ways. I guess they heal slower and with more pain, but they actually can protect the anal sphincter. If it was my bottom, that’s what I’d want.

    • staceyjw

      I wrote a reply down thread about a mom that was traumatized, and had her entire genital region and reproductive system destroyed, by negligent lay MWs botching epi’s at her HB/BC.

      This OB is horrible, and blatantly violates the woman’s autonomy. No one denies this. But as horrible as he is, the lay MWs dealing with a similar situation, are even worse.
      Why?
      BOTH the OB and lay MWs decided to do epi’s to get the baby out.
      BOTH were disgustingly, unethically, rude and uncaring.

      BOTH were verbally abusive and violated boundaries.
      BOTH ought to be named, shamed, and fired.

      BOTH ought to be charged with criminal prosecution for battery.

      But,
      ONLY the lay MWs patient had to scream and suffer without pain meds, while her lay MW used normal scissors to cut her, OOH!

      ONLY the lay MWs patient had her genitals reduced to “ground meat with no recognizable anatomical sites” because of the unskilled, cruelly done epistiotomy.

      ONLY the lay MWs patient had to have a series of very painful, painful reconstructive surgeries to repair entire systems (genital/reproductive/urinary/anal).

      ONLY the lay MWs patient LOST HER UTERUS!

      ONLY the lay MWs victim was bullied into silence by the lay MWs.

      ONLY lay MWs were protected by their peers, and community; they are held up as wonderful wise MWs who were unjustly persecuted!!! Other lay MWs and HBers are unwilling to say what she did was an egregious violation and totally dangerously, unethically, negligent.

      While NO ONE has condoned this OBs behavior.

      No one would think that a bad MW experience is a reason to ignore a victim of an abusive OB!

      • CanDoc

        Well said, stacyjw.

  • CanDoc

    THIS. THIS. THIS. A thousand times over.
    Women need to understand that the paradigm is not Obs=greedy=bad, Midwives=altruistic=good. This is about marketing and market share on an institutional, not an individual level. An amoral institution, even though on an individual level, there are many excellent CNMs and RMs (and OBs, for that matter).

  • Deborah

    People choose homebirth for many reasons, some of them valid, as the example above with the botched episiotomy very clearly showcases. Women seek to avoid this kind of treatment and rightly so. What is unfortunate is that when they find a provider/midwife who is so minimally interventionist that even simple safety measures are not practiced, screening for GBS for example, or transfer to hospital with prolonged rupture of membranes, they have unknowingly placed themselves and their babies in very real danger. Midwives will often get round this by exclaiming “but the woman chose not to” but I know as a practicing hospital midwife that many midwives play down the risks and do not offer the woman accurate information in order for her to make a truly informed choice.
    Choosing a homebirth after a traumatic hospital birth is understandable. Providing substandard care and holding the woman accountable for the choices she made in ignorance is morally and ethically reprehensible.

  • Amy Tuteur, MD

    Hannah Dahlen, spokesperson for the Australian College of Midwives, excusing homebirth deaths:

    • KarenJJ

      I find the difference between what the midwife says the woman wants, and what the woman actually shows that she wants, interesting. In today’s info from the inquest, the mother had a traumatic hospital birth and wanted a homebirth. The midwife encouraged her, even after a doctor said she was too high risk. The woman continued with her homebirth plans and her baby died. The next time the woman gave birth she chose an elective c-section and had a healthy child.

      So did the midwife listen to the woman and support her needs?

      • Amazed

        The answer to a hospital trauma was CLEARLY giving her a homebirth one. And the answer to THAT? A c-section! An elective one, at that.

        Comes to show which trauma was worse in mom’s book.

        • Anj Fabian

          Hospital birth #1
          Unexpected hypoxia, respirator, seizures

          Could be traumatic.

          Home birth for #2
          Long labor, baby born not breathing, ambulance to hospital, baby lingered on for days and died of complications from hypoxia.

          Extremely traumatic.

          Hospital birth #3
          Bypassed labor completely via elective cesarean, apparently healthy baby.

          No idea if the woman thought that was traumatic or not.

          • CognitiveDissonaceHurts

            I’d be willing to guess that #3 was traumatic as well – there would be fear there that another baby would die, because now mom and dad know sadly that this is a possibility, whereas going into #2, they probably weren’t giving death much thought.

            I personally think every birth is traumatic to some extent. There’s the agony. The body fluids. The big head forcing its way out of an itty bitty hole.

          • guest

            Absolutely births are traumatic, especially for first-time moms who don’t know what to expect. The majority of women, especially those not exposed to the NCB brainwashing understand that, deal with it in a healthy way and are able to move on. Some women need help and get therapy. But I would bet that women who have a traumatic birth with a midwife suffer a lot worse, blame themselves and suffer a lot worse PTSD than a woman who has a traumatic hospital birth.

          • CognitiveDissonaceHurts

            I was definitely traumatized by my first birth – and mostly because I believed the Bradley lie (I had read “Husband Coached Childbirth” and clung to the belief that now that I “knew” that birth didn’t have to be painful, then it wouldn’t be). I wasn’t prepared for the unrelenting torture of back labour, for the vomiting, diarrhea (sorry if that’s too much information), for thinking “I am dying”, for the burning of crowning, for receiving an episiotomy even though I also said “Don’t cut me!”, for the painful stitches, the afterpains, the hemmorhoids, the inability to sit or walk, the sore incision for months, the hallucinations from lack of sleep combined with Demerol after-effects…

            And I did want a better experience the next time, and continued to believe the NCB lie that if I just did the right things then it would be different. So, I did have some home births, but guess what, there was still the unrelenting torture of back labour. But because I knew what to expect, the whole process was less traumatic (but not less painful) the next times.

            But I associated the trauma with the first hospital birth and thus, with the hospital. It is easy for me to understand the thinking of the NCB crowd.

  • Jocelyn

    OT: I’m seriously thinking about closing comments on my blog post. http://jocelynandjason.blogspot.com/2014/09/10-reasons-id-never-ever-ever-have-home.html I don’t know how Dr. Amy deals with the stupidity day in and day out; I’m exhausted from replying to people and having to give them the same answers over and over again. Thoughts? I don’t know if I should announce on the blog that I’m going to close the comments or just go ahead and do it.

    • Cobalt

      Once you’ve said it, leave it alone. You can’t do one-on-one education for hundreds through a blog post. Let them post and let someone else answer.

      • Anj Fabian

        Agree. If you’ve laid out your arguments and people are going off on unproductive (YMMV) tangents, then wrap it up.

        This is one example of a useless comment:
        “I’m wondering what, if any, positions you agree with Henci Goer
        http://www.hencigoer.com, Rebecca Dekker http://www.evidencebasedbirth, and the
        writers at http://www.scienceandsensibility.com. Anxiously waiting your
        insight….”

        Translation:
        I’d like you to write a book, which I will either not read or pick one sentence to denounce.

        • toni

          ^ Haha, yes! You’ve done all you can. I’d just let it run it’s course. Go and put on a face mask and read a book. Check back in a day or two to see if there are any genuine questions from open minded people.

    • Sally RNC-NIC

      Don’t close it. The crazies will think they “got to you” and that they “won.” Just stop replying, or make a blanket statement that you will no longer be answering questions already addressed 50 times in the preceding posts. You did an amazing job keeping your cool. There’s really nothing else to say! But don’t close it. What will I be entertained by tonight? Hahaha…

    • Jocelyn

      Thanks guys, for your advice. That’s what I’ll do.

    • lawyer jane

      Don’t close comments – but do consider doing a second blog post responding to the criticism point by point (e.g., that the studies DO excluded unplanned homebirth.)

      • The Bofa, Being of the Sofa

        Yeah, Joc, you need an FAQ

      • Jocelyn

        I don’t know if I’ll do second blog post, I’ll have to think about that, but I did just go add a sentence in there before the mortality statistics that said these studies were all on planned, midwife attended home births.

    • Smoochagator

      Remember that Dr. Amy doesn’t get many dissenting comments any more because NCBers refuse to even read this blog and expose themselves to her “lies” and “hatred” and “negativity. When they DO read and comment, Dr. Amy may respond once but her readers usually do most of the arguing. I agree with Anj below – some of these folks just want to exhaust you or trumpet their own agenda. Respond thoughtfully to thoughtful (even if dissenting) comments. All the “OMG YOU JERKFACE TRUST BIRTH DOCTORS ARE EVIL BABIES DIE IN THE HOSPITAL TOOOOO!!!!!1!” stuff can just be ignored.

  • SporkParade

    Okay, I know that Dr. Amy affects a “mean” persona because it is effective at getting people to pay attention, but this post really bothers me. I get the larger point, but it just seems wrong that there is no acknowledgment that what happened to Kelly shouldn’t have or what courses of redress are available, especially if she is having trouble finding an attorney. So, yeah, it’s pretty gross that this woman is taking advantage of the video to promote her own agenda and her own bottom line, but this feels to me like Dr. Amy is sinking to her level.

    • Karen in SC

      What? She is commenting on how another blogger viewed the video. And she clearly denounces poor/criminal OB care.

    • Cobalt

      I agree. Per the video, Kelly was an actual victim of assault that could honestly be described as obstetric violence. It isn’t the same level as the lethal actions of the midwives discussed, but it’s still wrong. There is no inconsistency in prosecuting both violations, and contrasting them feels like a push to silence a true assault.

    • Who?

      Acknowledging that there are issues on both sides of the fence isn’t taking advantage. This video is a clear example of how not to behave.

      The difference is this doctor isn’t working out of his kitchen. He has an employer, a registration board to answer to, an insurer who may or may not want to continue to cover him, perhaps business partners, and who knows who else, all of whose jobs it is to sanction him for this behaviour.

      An attorney-so that the patient can have a crack at punishing him herself-isn’t a solution for this problem, though I suppose it could be a ‘nice to have’.

      Life isn’t a suffering competition. Yes, Kelly was treated badly. I won’t say ‘she had a bad experience’ because the subjectivity is unhelpful here. Women who have all their desires fulfilled, and their birth plans followed to the letter, are also treated badly if their babies die or are damaged because the ‘professionals’ they trusted to care for them are too ignorant, prideful or stubborn to offer them what they need, not what they want.

      • The Bofa, Being of the Sofa

        The difference is this doctor isn’t working out of his kitchen. He has
        an employer, a registration board to answer to, an insurer who may or
        may not want to continue to cover him, perhaps business partners, and
        who knows who else, all of whose jobs it is to sanction him for this
        behaviour.

        Moreover, look at the response that has come from here. The bad OB? Needs to be sued, or, if not sued,contact the DA and see if you can get assault charges.

        Bad midwives? Create a support group and rally around them.

        Doctors want bad eggs thrown out. Midwives don’t admit the eggs are rotten.

        • Cobalt

          And no one will be deleted or banned for speaking out or disagreeing with the comparison.

        • Who?

          And that’s around the enmeshed relationships that midwives develop with their clients.

          Would you sue a friend for injuries after an accident they caused? Maybe not, but your insurance company will, in the blink of an eye, and especially if your friend has an asset or two or also has insurance that might cover you. Car accidents are a great example.

          You might feel bad for your friend after the accident but if they have insurance, and you’re badly injured, you might just go ahead. And in the US, where there is big money to be won, the stakes are even higher.

          One thing insurance companies are really good at is measuring risk. They won’t insure home birth midwives, or not at a price the midwife can afford, which tells the thoughtful reader everything they need to know about the risk proflle of home birth midwives.

          So the home birth midwives know you won’t sue, because of the relationship they foster, and back that up with their uninsured status, which makes them practically of no value to sue.

          • Amazed

            I cannot understand the excuses for the lack of insurance. Honestly! I claimed damages when a taxi driver caused an accident and I got hurt. Thankfully, it was nothing this serious but it caused me some damages in the terms of health and working capacity. I have to say the taxi driver didn’t demand the tax for almost getting me safely home before failing to stop at a road sign. As far as decency is concerned, Taxi driver – 1, midwives – 0.

          • Who?

            An insurance company refusing to insure you is a reason, not an excuse, for not having insurance. It means they think they can’t make a profit out of their insured, nothing more, nothing less. The fact that someone can’t get insurance should set off all kinds of warning bells.

          • The Bofa, Being of the Sofa

            The fact that someone can’t get insurance should set off all kinds of warning bells.

            Exactly. Expensive insurance is a BAD sign. As noted, insurance companies don’t care about the moral aspects, they care about making money. And if premiums cost a lot, it is because insurance has to pay a lot.

            That’s not good.

          • Roadstergal

            People die when they obey road signs, too!

        • SporkParade

          The response from the commenters here is great, and I expected nothing less because you guys are great. I just feel like Dr. Amy glided a little too quickly past the fact that what happened in the video was criminal and evil before pointing out that letting babies die preventable deaths and failing to take responsibility is even more evil.

          • The Bofa, Being of the Sofa

            The response from the commenters here is great,

            But I don’t know of any indication that Dr Amy feels or says anything otherwise.

          • SporkParade

            “In other words, only by taking this incident totally out of context can Lock make this into an episode of violence.”
            That’s the line that’s bothering me. What’s out of context here?

          • Stacy48918

            Well, in what OTHER context would it be acceptable for a woman to be flat on her back and have her perineum cut by a strange man? Only within the hospital, birthing context.

            *Assuming of course that it is a properly performed episiotomy. The NCB crowd views ANY episiotomy as an act of violence, not just the horrifically botched ones. That’s the point Dr. Amy is making. The NCB crowd wants to view ALL episiotomies as evil because such a thing would be UNTHINKABLE out of the hospital context. Well, so would an appendectomy.

          • Amazed

            Well, how can the crowning baby, gowns, and masks be removed from the equation? Say what might, but this wasn’t the first woman the doctor grabbed from the street to cut her.

            Lock clearly shows what her problem is. It isn’t that the episiotomy isn’t properly done. It’s that it is done at all.

    • toni

      I agree. I too appreciate the wider point. It is highly hypocritical for the same people who ignore widespread, deadly midwife incompetence to cast aspersions on the entire profession of obstetrics because of this one jackass. A dead baby is worse than a botched episiotomy and being belittled by a belligerent doctor, sure, but his actions were still bad and inexcusable. And I have it on good authority that it *was* botched and that a half decent doctor just simply wouldn’t have done what he did (I emailed a family friend I recently got back in touch with who is now practicing as a GP in the Home Counties but was awarded a ‘gold medal’ in obstetrics from the RCOG – not entirely sure what that means but it sounds impressive – and asked for her opinion. She said her jaw hit the floor. In the UK OBs by and large don’t attend normal deliveries so she mostly only dealt with instrumental deliveries, emergencies, babies in distress etc and still she said she’d never ever seen an episiotomy done like that or an OB so obviously angry with his patient in the patient’s presence. She says in her mind the only plausible explanation was that he was punishing her.) It’s not just violent out of context. There was no mention of the baby being in trouble, all the doctor said was that she was risking a bad tear. She still didn’t want it, that’s her business. Acknowledging that ‘Kelly’ was a victim doesn’t minimise the damage that CPMs do. Like I was mugged and assaulted once, which is not anything like as bad as being raped and left for dead but it doesn’t mean being mugged and assaulted is no biggie.

    • lawyer jane

      People who follow Dr Amy closely know that she’s actually an extremely strong advocate for bodily integrity, so it’s a foregone conclusion that she would condemn that OB.

  • Burgundy

    I went to watch the play Our Town by Thornton Wilde last Sunday. The mom died from giving birth to her second kid. It was part of life and it was nothing spectacular. This made me appreciated that we had all these wonderful modern technology now a day so giving birth was not a life-or-dead struggle as the generations before us. Why would anyone want to revert the birth back to the “good old days” (ie, giving birth at home) dumbfounded me.

  • GiddyUpGo123

    “Babies die in hospital in exactly the same circumstances,” she said.

    Babies die from meconium aspiration and Group B Strep in hospitals? Is that a true statement? When I was in labor with my oldest boy, there was meconium in the amniotic fluid. So, there was a team of pediatricians standing by to suction his lungs and make sure they were clear immediately after birth. When I was in labor with my oldest girl, I was Group B positive. So, they gave me antibiotics. Neither of my children had any health issues because the hospital was proactive about making sure that these problems never became real problems.

    I know, anecdotes. And maybe sometimes hospitals don’t get it right, and a baby will end up dying from meconium aspiration and Group B strep. But my guess would be that that’s really not very common, and being in a hospital when those two problems arise is a whole lot better than being at home and completely ignoring them.

    • Medwife

      Sometimes babies come flying out and don’t get adequately prophylaxed. Mec aspiration and GBS disease are definitely possible at the hospital, but so much less likely. You are unlikely to be laboring for 40 hours post term without GBS prophylaxis and with little resuscitation capabilities at hand.

      • Dr Kitty

        Break it down.
        THIS baby would probably have been delivered at least 24 hrs earlier in a hospital.
        IF there was mec there would have been suction and close monitoring of vitals.
        Mum would have had antibiotics in labour and/or baby would have had antibiotics after delivery.

        Would THIS baby have survived if he had been de,inverted earlier, had aggressive resuscitation and 24hrs of IV antibiotics?

        Possibly not.
        But he could well have done.

        What the MW means is that if this baby had been delivered in a hospital after 40 hrs of labour, had the same resuscitation and monitoring in hospital that she gave him at home, and had antibiotics delayed for two hours after delivery, the outcome would be the same. Which I don’t doubt.

        I disagree however that the standard of care she offered would have been replicated in a hospital.

    • Kesiana

      I would venture to guess that it does happen… but very, very, VERY rarely. Especially because in hospitals, preventative measures can be taken.

  • Young CC Prof

    How delusional or just plain stupid do you have to be NOT to comprehend that stalled labor is real and, prior to the 20th century, was a huge killer of babies and mothers? (It still is, in some areas, although thankfully that’s less common than it once was even in the poorest nations.) Are we next going to start denying that heart attacks exist?

  • Mel

    I find it chilling how incompetent these midwives are compared to dairy herdsmen (roughly equivalent to a CPM…ish).

    If a calf is born and the placenta smells bad, the calf gets a massive amount of colostrum ASAP since they need the antibodies while we call the vet to double-check best antibiotic choices. Dam and calf get a course of antibiotics.

    When a calf dies and we don’t know why and EVERY time a cow dies in the postpartum period, we obsess over what went wrong. Videos are watched, temperature trends are analyzed, necrotosies are performed and massed meetings of the cow health workers, vet and nutritionist occur until we figure out how to prevent this from happening again if we caused the problem. (We work from the starting point of “We did something wrong” rather than “Shit happens.” which is another difference.)

    We don’t say “Eh. I’d do it again.” Ever.

    WE DEAL WITH COWS! HUMANS DESERVE EVERYTHING WE DO AND SO MUCH MORE!

    I feel sick.

    • Young CC Prof

      We work from the starting point of “We did something wrong” rather than “Shit happens.” which is another difference.

      That’s how incident investigations SHOULD work!

    • Bombshellrisa

      You mean you don’t just shrug your shoulders and say “some cows aren’t meant to live”?
      ((Mel, I love your cow stories!))

    • Anj Fabian

      Part of what you do is out of genuine concern.

      Part of what you do is because every dead animal represents lost income.

      If midwives don’t lose any income when they lose a patient, then they only have their concern to motivate them. If no one holds them accountable, they only have their concern to guide their actions. If there are NO CONSEQUENCES to contributing to the death of another human being, then what is standing in the way of them doing the same thing again?

      • toni

        One would hope the horror that must be watching a full term healthy baby die. But that would require something a lot of lay midwives apparently don’t possess..

  • Amazed

    Actually, I am starting to think that the good old times weren’t so bad, mind-wise. Sure, there were mothers and babies dying left and right but if a mother and child made it through birth healthy, mother rarely complained, “I was trauuumatized!” They knew that birth sucked. They didn’t feel robbed, just reconciled with this nasty fact. Now, we have many resources that could help wit the sucking part, with PPH, with basically everything – but no, NCB is there to helpfully hold mother’s hand and reaffirm how much it all sucked, how robbed she was and how she absolutely needs to heel by giving THEM her money.

    And it’s only birth that get this “special status traumatic”. I’d say that my 7-year-old brother, a kid who had visited a hospital only once – at his own birth – had it pretty bad with almost dying and being in intense, severe pain. Two months of intense pain in hospital is BAD for a kid who never knew he had a pancreas, let alone an inflamed one, unlike an expectant mother who is a woman grown and is supposed to know that hey, birth hurts.

    Lucky us that no one was there to explain to the kid that he was legitimately traumatized and instead, everyone tried to help him overcome it, so he would go to the hospital to continue his very necessary treatmenr.

    The idea that he could have been brainwashed enough not to go there when 8 years later the problem arose again and he was alone in our flat since we were all out of freaking city?

  • PrimaryCareDoc

    Has anyone seen this supposed video? Because I have a hard time that someone was cut 12 times for an episiotomy.

    • Cobalt

      I watched. It’s the one we were discussing recently where the doctor tells her if she doesn’t want it to go to Kentucky. The doctor does make a lot of cuts, and well before crowning. The mom says “no, don’t cut me” several times also. Definitely wrong. She clearly doesn’t consent, even after he warns her about tearing, and the doctor does a serious hack job.

      • Karen in SC

        It seems damning evidence but so extreme it’s like it was a fake video used for training in “what not to do.” If this is a real case, I hope there is a lawsuit and full investigation.

        • Cobalt

          She’s had a lot of trouble trying to get redress. The baby was totally fine and the episiotomy healed, so there’s no damages according to the lawyers. I disagree, if a patient is screaming “don’t cut me”, the correct response is to not cut them.

          • PrimaryCareDoc

            She might not be able to get financial compensation through malpractice, but she could certainly file charges for battery. Also, I know the state medical board would take action.

          • Cobalt

            I hope so. If a badly performed episiotomy on a clearly unwilling patient doesn’t violate the rules, then we need better rules.

          • Amy M

            Several hours after I had my babies, I had a PPH. A whole bunch of people rushed into the room, and, after I insisted on making it to the toilet, convinced me to let them load me on the wheeley-bed. Clearly I was not in my right mind at this point. I remember they started to do uterine massage, which hurt, so I was saying “No, no” and pushing their hands away. They didn’t stop. Was this violence or assault? Absolutely not. It was an emergency and they were following protocol. It was unpleasant, but I was not left traumatized. Instead, they managed to stop the bleeding in time to avoid a transfusion, so I was grateful for their quick and competent actions.

            Certainly, I could imagine a situation where a doctor would override a woman saying “no” and cut an episiotomy—if there is an emergency and a life (or two) hang in the balance and there is no time for true consent. In that case though, it would be done according to protocol, not slicing and dicing like a hibachi chef. And hopefully, the doctor (the competent one, not the Benihana one) would have some sort of debriefing with the patient afterwards. I could even see how a woman could feel upset or even traumatized by an unexpected/unwanted emergency episiotomy, but hopefully she would be able to understand its purpose, express her feelings, and eventually move on.

          • jenny

            From the video it seems like there was a breach of ethics. Patient was saying no clearly and repeatedly. Doctor went ahead and did episiotomy after woman’s mother told him to. I thought only the patient could consent to procedures so long as the patient was competent to make decisions for herself. Hopefully she did/does report him.

          • Guesteleh

            She needs to send the video to JCAHO. Anything that threatens a hospital’s accreditation sends people scrambling.

          • jenny

            I wonder if anyone has suggested this to her.

        • auntbea

          I have a hard time believing that if this were real she can’t get a lawyer. It seems like very cut-and-dry assault. Why wouldn’t the malpractice attorneys be all over this one?

          • Poogles

            “Why wouldn’t the malpractice attorneys be all over this one?”

            Because there are no “damages” to be compensated for – no one was left with long-term physical damage (because her cut apparently healed ok). Since medmal lawyers usually take a cut of the damages awarded as their pay, they typically only take cases that they’re fairly sure they can win or settle for a large chunk of money so they can be sure to get their cut. Unless the patient is independently wealthy and can afford to pay all the legal costs (which are typically astronomical, especially if the doctor’s insurance co is dragging their feet) out of pocket, they usually don’t have any options. It sucks, but that’s how it usually works.

          • auntbea

            So no emotional distress then? No fine for the hospital for violating the law?

          • Poogles

            “So no emotional distress then? No fine for the hospital for violating the law?”

            AFAIK, “emotional distress” alone wouldn’t qualify as “malpractice”. In order for the hospital to be “fined” (as opposed to paying a settlement/reward to the patient) other avenues besides suing would need to be pursued (I think others more knowledgeable than I have mentioned some of these other avenues).

      • Amy M

        And if that happened (and that sort of thing probably does), then its wrong. But, for these people to claim that that is standard behavior on the part of all obstetricians, is insane. And in no way absolves them of their atrocious behavior.

        • Cobalt

          I don’t think it’s a good reason to give birth at home with an unqualified attendant, but I really hope that doctor gets busted.

        • Amazed

          Clearly, the fact that there are doctors like this one practically absolves midwives of any responsibilities for their own violations.

          Lovely.

    • staceyjw

      Yeah, that doc was a total POS. No one anywhere said that it was acceptable!
      (Doesn’t mean those MWs are not morally bankrupt)

    • Kesiana

      Honest question: under most circumstances, are episiotomies a good idea? I read… somewhere (honestly don’t recall where) that tearing is actually better for you than being cut, because the jagged edges heal more easily than a surgical slice. I also remember reading that a cut can make you MORE prone to tearing further than you’d like.

      • Karen in SC

        If that was true, why don’t surgeons use pinking shears?

      • Cobalt

        The most recent ACOG statement I can find (2006) says to restrict the procedure to only when necessary, there are potential adverse effects like severe tears, and it doesn’t generally improve outcomes.

        https://www.acog.org/About-ACOG/News-Room/News-Releases/2006/ACOG-Recommends-Restricted-Use-of-Episiotomies

      • AlisonCummins

        *Routine* episiotomies are a bad idea. OBs thought they sounded like something that would routinely help so they did them routinely, sometimes at every delivery. Then OBs collected data to see whether routine episiotomies were as good a routine idea as they sounded, they looked at the data and determined that no, they weren’t. Not routinely.

        An episiotomy may sometimes be *indicated* though. For instance if the baby needs to be out NOW and the perineum is tight and swollen.

      • Poogles

        “tearing is actually better for you than being cut, because the jagged edges heal more easily than a surgical slice.”

        Think about that – if you were trying to bring 2 pieces of something together to form 1 whole piece, is it going to be easier if the edges of those pieces are both straight or if they’re jagged? Which is more likely to look better when finished? Imagine trying to sew together 2 pieces of cloth or other material with jagged edges, or better yet, imagine you’ve cut yourself – do you think it will heal better if it’s a clean cut from a sharp knife or if it was done with a dull serrated knife and is more of a “tear” than a cut?

      • Roadstergal

        http://youtu.be/TaQlQjLDsvI
        I regret that the clip alone is not available, but please skip to 53:50-55:10.

        (Dara is generally excellent on NCB woo as with all woo, IMO… it starts out at 49:00.)

    • jenny
    • jenny

      He cuts 12 times in the same spot. I don’t know what is considered normal for an episiotomy.

      • PrimaryCareDoc

        Ok, I finally got to watch the video. That was horrible. And she clearly did not consent. I’ve seen episiotomies done, and it’s one cut while the head is at the perineum. He like hacked away and wrestled the baby out. Thank god that baby wasn’t injured.

        The way he spoke to her was unconscionable. Unbelievable.

        I hope she gets in touch with the medical board and that he is put on probation and forced to have a preceptor. If he’s a resident, I hope his program cans him.

  • Stacy48918

    “Babies die in hospital in exactly the same circumstances,” she said.
    Yea…no. They don’t. Psycho murderer.

  • attitude devant

    So, if you had anything done to you without consent by a licensed physician, you have two very clear avenues for redress: complain to the medical board in your state AND sue the physician for assault and battery. Both are open to you and both will put the fear of God into your doctor. Have at it. You have my full support.

    However, if your soi-disant midwife Darby Partner (now calling herself Kavita Amrita) locks you up, takes away your phone so you can’t call for help, and turns away your family and friends and your son dies, you’ve got a lifetime of hurt and no respect from any ruling agency and certainly no support from other midwives. You are sunk.

    If Christi Collins lies to you about her credentials, her history, and her (nonexistent) expertise, all the while soliciting reassurance from ignorant clowns on Facebook regarding her management of your postdates pregnancy and your beautiful boy dies, you have nowhere to go, and the midwives will close ranks around her. But you will be left with a lifetime of anger and sorrow.

    Or if you are foolish enough to trust Jennifer Gallardo to deliver your breech-breech twins at home and the second one suffers a skull fracture (this is a true story, btw), she will tell you that the baby would have died at a c-section, and you (incredibly) will believe her and be angry with anyone who tells you differently.

    Who is stopping these killers? These are only three of the literally dozens of cases I know. Who tells these people to stop? What legal redress do these mothers have? Can ANYONE point to a case where a midwife was successfully stopped from continuing to kill and maim?

    • Karen in SC

      ^^ a vote for this to be the featured comment.

    • staceyjw

      And to think, these are but a few of the egregious violations and flat out murders that these so called MWs have been responsible for. There are many more, and many are even more horrific examples of negligence and flat out nastiness.

      They also leave behind the utter destruction of women’s bodies, without apology or accountability.

      I cannot even think of the terror, and pain, one mom I know personally, went through. After a first HB with these MWs, in which they badly damaged her perineum (she thought it was normal), she was left with nasty scarring. Her MWs blew this concern of hers off with kid #2!

      The end result was another birth, with 2 epistiotomies, zero pain meds, *with common scissors*, in a birth center, in order to get her baby stuck baby out. The baby was stuck because of the scar tissue from the first botched HB. She was screaming and bleeding out, and when she was finally transferred, the OB said there were no recognizable landmarks left on her genitals. “Ground meat” was the description. The doc did the best they could do, but the damage was done.

      So, please, never forget the women that needed full reconstructive surgery on her entire reproductive systems and genitals, including the bladder and anus. Think of the time spent healing after the birth, and the time spent with mere millimeters between vagina and anus. Then there was the painful surgery needed, the long recovery, and the damage to her life and marriage. Oh, and she lost her uterus too. Who fixed this lay MW mess? Real HCPs.

      Then think of how the MWs got to keep on with their “practice”, and only had to sit in front of their peers for a slap on the wrist. Mom was so traumatized, I am not sure if she was even able to go. Who would blame her if she skipped it? Both she and I know of cases where the MW had to be reviewed due to a serious complaint, and during the event, the mom was ridiculed while the MWs winked at each other and cracked jokes. No, really. It was recorded, and uploaded online for awhile. I am not sure if its up still, the hate mail was intense, and she quit blogging.

      Rant over.

  • DaisyGrrl

    Ms Westbury also denied that her level of care was below what was expected, saying she “actually would do the same again”.

    WHAT?! They say the definition of insanity is repeating the same actions and expecting a different outcome. So this lady is either insane, or she has no problem letting another baby die a preventable death. Chilling either way.

    • attitude devant

      That case is particularly chilling because it sounds as if the mom is Group B strep colonized. So the likelihood of her next baby being infected if she foregoes prophylaxis in labor by birthing at home is very high. How is this not a form of psychosis?

      • DaisyGrrl

        This quote is from the midwife. Can you imagine having her attend your homebirth?
        Patient: “is that meconium? Also, should I be worried about being GBS+”
        Midwife: “Nah, I’ve seen this before. Don’t worry.”
        Patient: “So what happened?”
        Midwife: “Baby died, mom was fine. But that would have happened no matter what.”
        Patient: “…”

        I really hope the poor mother has learned that she needs to have her next one in hospital.

        • LovleAnjel

          “Don’t worry…Baby died.” WTELF

    • Roadstergal

      ““Babies die in hospital in exactly the same circumstances,” she said.”

      I vote insane.

    • Amy M

      She must not have read “From Calling to Courtroom” then, if she is so willing to be so transparent about her actions.

      • DaisyGrrl

        Since this is in Australia, I hope that these statements are used to revoke her license. No one with such poor insight into their actions has any business being in charge of another person’s health care.