Why do so many babies die at American homebirth?

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The increased risk of death and serious injury at American homebirth is well established and a remarkably robust finding across multiple studies, including:

Grünebaum A, McCullough LB, Sapra KJ, et al. Early and Total Neonatal Mortality in Relation to Birth Setting in the United States, 2006-2009. Am J Obstet Gynecol. 2014 Mar 21. pii: S0002-9378(14)00275-0. doi: 10.1016/j.ajog.2014.03.047.

Cheng YW, Snowden JM, King TL, Caughey AB. Selected perinatal outcomes associated with planned home births in the United States. Am J Obstet Gynecol. 2013; 209: 325.e1-8.

Grünebaum A, McCullough LB, Sapra KJ, et al. Apgar Score of Zero at Five Minutes and Neonatal Seizures or Serious Neurologic Dysfunction in Relation to Birth Setting. Am J Obstet Gynecol. 2013; 209: e1-323. e6

Wasden, S., Perlman, J., Chasen, S., and Lipkind, H. 506: Home birth and risk of neonatal hypoxic ischemic encephalopathy. Am J Obstet Gynecol. 2014; 210: S25

The most remarkable finding is the analysis of Oregon data from 2012 by Judith Rooks, CNM, MPH demonstrating the planned homebirth with a licensed (CPM, LM, DEM) midwife has a perinatal death rate 800% higher than comparable risk hospital birth.

Oregon homebirth death rates 2012

Even the data from the Midwives Alliance of North America survey of their members (Cheyney M, Bovbjerg M, Everson C, Gordon W, Hannibal D, Vedam S. Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009. J Midwifery Womens Health. 2014; 59: 17-27) shows that homebirth increases the risk of perinatal death by 450%.

Why do so many babies die at homebirth? A new paper Perinatal Risks of Planned Home Births in the United States by Grunebaum et al. provides answers.

Data from the United States (US) Centers for Disease Control’s National Center for Health Statistics birth certificate data files from 2010-2012 were utilized to analyze the frequency of certain perinatal risk factors which were associated with planned midwife-attended home births in the United States and compare them with deliveries performed in the hospital by certified nurse midwives (CNM). Home birth deliveries attended by “others” were excluded; only planned home births attended by midwives were included. Hospital deliveries attended by certified nurse midwives served as the reference. Perinatal risk factors were those established by ACOG and AAP.

What did the authors find?

Twins:

… 1 in 156 (0.64%) of midwife-attended planned home births were twin pregnancies, even though ACOG considers twins a contraindication for home births, as there is no adequate fetal monitoring, no experienced team, and no ultrasound available in home births. Studies on safety of home births from Canada, England, and the Netherlands excluded twins as candidates for home birth because of increased risks..

Breech:

… 1 in 135 (0.74%) of planned home births attended by midwives were vaginal breech deliveries. Breech vaginal birth is associated with significantly increased risks… Azria et al. recommended that a trial for vaginal births in breech presentations should be attempted only with continuous electronic fetal heart rate monitoring (EFM) and presence of ultrasound during labor and delivery. Neither EFM nor ultrasound is available in home births. Janssen from Canada and the Home birth in England Study excluded breech presentations from their home birth eligibility requirements. Therefore it is not surprising that the Midwives Alliance of North America (MANA) study of planned home births, reported an intrapartum death rate of 13.51/1,000 and a 9.16/1,000 neonatal mortality rate in breech presentations.19 When compared to the neonatal death rates from hospital deliveries these adverse neonatal outcomes are significantly increased

Postterm:

ACOG and AAP criteria for home births specifically exclude pregnancies ≥41 weeks from their home birth eligibility. In this study, 28.19% of home births were ≥41 weeks. Postterm pregnancies are associated with multiple, well-known complications, such as labor dystocia, increased perinatal mortality rate, low umbilical artery pH levels at delivery, low 5-minute Apgar scores, postmaturity syndrome, fetal distress, cephalo-pelvic disproportion, postpartum hemorrhage, and increased risk of neonatal death within the first year of life.

Attempted vaginal birth after C-section (VBAC):

A trial of labor after prior cesarean delivery (TOLAC) is associated with a greater perinatal risk than is elective repeat cesarean delivery without labor. TOLACs have an overall small but significantly increased risk of uterine rupture with often catastrophic consequences to mother and/or fetus.22,23 This study showed that nearly 1 in 23 (4.4%) of midwife-attended home births (n=2,463, 4.4%) had a home VBAC in spite of the fact that ACOG considers prior cesarean section an absolute contraindication to planned home birth… The recent MANA study showed a very high 2.85/1,000 intrapartum fetal death rate with VBACs.

In other words, babies die because American homebirth midwives ignore the risk guidelines accepted by ACOG, the American Academy of Pediatrics, Dutch midwives, British midwives and Canadian midwives. What’s the difference between American homebirth midwives and every other provider who accepts the risk guidelines? American homebirth midwives aren’t real midwives. They lack the education and training of ALL other midwives in the industrialized world and they are ineligible for licensure in ALL other first world countries. American homebirth midwives are lay “birth junkies” who made up their own credential and awarded it to themselves in order to trick American women into thinking they are healthcare providers.

American homebirth midwives are frauds and ignore the safety guidelines accepted by midwives and obstetricians around the world. It is hardly surprising then that so many babies die at American homebirth.

  • Ash

    http://believemidwiferyservices.com/homebirth-practice-accreditation/
    A HB midwife explains why there should be no restrictions on homebirth breech deliveries:

    “Instead, providers and couples in their care are motivated to ignore indications of breech presentation prenatally and skip obtaining consultations for external versions or ultrasounds, because these would confirm knowledge beforehand. Rather, the attendant would be inclined to overlook indicators so she can innocently claim she was simply managing a surprise breech.”

    BTW this statement was made specifically in light of the MANA stats report.

  • Stephanie

    There has got to be a way to allow safer home birth with competant attendants. Low risk women can be cared for by competant CNM in a home or hosptial setting. There needs to be some additional training required for CNMs and only CNMs allowed to be midwives. I would not have a homebirth because of my health history. I needed to be under a doctors care during my pregnancy. It would have been nice though to have appts where the doctor could have had more time to answer my concerns and questions. I think more women would be willing to go to hosptial to have their babies if they could be assured it was safe. We know its safe, but they have been brainwashed to believe otherwise. Many choose homebirth because they are scared of hospitals or they had a traumatic experience with hospital birth. That is the number one reason I hear many choose home over hosptial. Sadly the NCB cult reinforces those fears and the medical community does little to alleviate it. Fear can lead to many things and if homebirth were outlawed, that would not lead to more women coming to the hospitals. They would simply go even further underground and be less likely to recieve prenatal care or go the hospital if something went wrong. We would see more deaths, not less. It is fear that motivates many to choose unsafe birth practices.

    • fiftyfifty1

      Nobody advocates making homebirth illegal. The principle of medical autonomy means that women always have the right to refuse going to the hospital to give birth. Besides, there would be no practical way to enforce a homebirth ban because precipitous births happen.

      What should be banned is the CPM “credential”. These fake midwives should not be allowed to do what they are doing now, which is practicing medicine without a license.

      Right now, CPMs (and other lay midwives) create fear of hospitals and then cash in by offering their services to the women whom they have frightened. Although fear is not they only way they promote their product. The bigger way is flattery: homebirth makes you SPECIAL.

      • Stephanie

        I was almost tempted to have a homebirth with my son because I was afraid of hospitals and morbidly afraid of needles. Being a sexual assault survivor, letting someone have that power and control over me is a very scary thing. Lucky I ended up with a doctor who avoided any interventions until it was needed.Other than the IV for the epidural I requested. I had to have an episitomy and I was one of the rare cases that it was indeed nessecary. I had an ok birth, I would not call it great or anything I would ever repeat.

        • Stephanie

          And there are some horror stories even if they are rare of women being ordered to have Csections via court order. Or the case of the woman in CA who was alledgely cut by the doctor despite her pleas. While I want a safe outcome for every mum and baby, bodily autonomy takes precedence. If a mother refuses care than the doctor should be immune from the outcome. Being an SAS I could not imagine being cut after being told no…if it indeed is true, that doctor needs to be in jail and have his liscence revoked. It is cases like those, that also scare women from the hospitals. The medical community needs to step up and do some PR work. Reassurance that hospitals are safe and that a woman will be treated like a person would go alot further than condemnation.

          • Amazed

            My guess is the doctor WAS punished. I see no other reason the group who supposedly is all about human rights in childbirth not only to refuse multiple offers of legal help to take legal actions against him but scramble to delete the exchanges showing that such offers were ever made. Since it’s a group focused on advancing homebirth midwives, they would not want it to be known that the doctor was punished, meaning – the system works.

          • guest

            What about the home birth midwives who are completely immune to any malpractice they commit? A mother has absolutely no recourse against a home birth midwife, and the atrocious acts of malpractice they commit in the name of “autonomy” are far worse. Unfortunately, we don’t hear about a lot of them, so women are duped again and again into believing HB midwives are safe and that home birth is a better option. At least doctors have licenses that can be revoked, HB midwives have NO qualifications whatsoever. I’d take a doctor with a luke-warm bedside manner over an incompetent HB midwife any day.

          • Stephanie

            Some HB midwives are qualified, they are called CNM. If a person is going to have a homebirth than they assume all risks and liabilites. Personal responsibilty. A CNM has medical training. In some areas they also have hospital admitting privalages. Its very simple, you choose to give birth outside the hosptial, than you assume all the risks. But we cannot legally, morally and ethically take away their choices. But they are not free from the consequences of their choices. Unless you enact fetal personhood laws, which would be a disaster, the mothers wishes are upheld. I would not want a lukewarm doctor myself.. if I do not feel comfortable with them, I do not want them attending me. Doctors are not God, although Ive encountered some who have a God complex. If I was going to have a midwife, it would be a CNM in a hospital setting. My ideal option would be a female OB/GYN, which is what I had. A male I would not see unless it was life or death. Being an SA survivor.. I dont want a male doctor examining me.

          • LibrarianSarah

            First of all, nobody is advocating making homebirth illegal so you can put down the torch and step away from the strawman. Secondly, you can talk personal responsibility without informed consent. Women are constantly being told by NCBers that homebirth is as safe or safer than hospitals. They are not told that homebirth have a 3-5 time hire perinatal mortality rate. How can you take personal responsibility when you are being lied to? Should the owners of the Ford Pinto take responsibility for their exploding gas tanks as well? Way to blame the victim.

            Also if I never hear the phrase “doctors are not gods” again in my life I would die a happy woman. Doctors are not gots but they know a lot more about medicine than most of their patients. They have more than a decade of education under their belts so it is pretty safe to assume they know more than someone who googled their symptoms. They also have acces to life saving equipment and a team of people to help them.

  • The idea of having a lay person attending my birth is terrifying. In my country, midwives train at university, they are true medical professionals, not people with an interest in birth.

    • Stacy48918

      Unfortunately, in many cases (Canada, England, Netherlands) even university training isn’t enough to purge the woo-based ideology from midwifery. See “Yonifest” held in Canada recently. See the worse neonatal outcomes for low risk women attended by midwives at home in the Netherlands. See the worse outcomes for women attended by midwives in England.

      They do have better training and so outcomes overall are better than lay US midwives…but there is still a LOT of NCB ideology of “trust birth” and corresponding preventable bad outcomes including dead babies.

      Training is a good thing…but it’s the ideology of birth that’s at the root.

      • Here like 80% of births take place with midwives in charge, and the vast vast majority would be at hospital. The only person i know to have given birth at home did so because labour was incredibly fast, but she went to hospital afterwards to be checked out. Most people only see an obstetrician if they have some complications or a high risk pregnancy.

        • Stacy48918

          I guess I didn’t make myself clear – even the *hospital* births attended by many university trained midwives in the countries listed sometimes turn out worse owing to their ideology. This is the case in England.

        • Theoneandonly

          I see you’re also from NZ. While you are correct about our midwives getting university training, more and more of them are getting sucked into the woo. I’m currently pregnant with #2 and I know many women in my due date FB groups and some family who are forgoing GDD tests, Vitamin K, and vaccinations on advice from their midwives.

          • guest

            NZ midwives are addicted to the koolaid.

          • Karen in SC

            See Action to Improve Maternity website all about deficient midwives and failure to intervene in time.

          • Bombshellrisa

            Were you here for the discussion with Jane the NZ midwife? Eye opening about the ideology that so many NZ midwives have embraced.

          • Theoneandonly

            Can you recall which post/posts it was? I have somewhat engaged with someone in here before, but I’m a layperson who doesn’t keep a lot of stats/studies at my fingertips so I don’t tend to argue too much as I can’t be bothered finding stuff back it up easily.

          • D/
          • Theoneandonly

            Wow. Just wow. Thanks for linking that – I had commented before she came in, but hadn’t been back in that thread since so missed the party.
            It’s the chance that I might end up with a care provider like her which lead me and my husband to choose to go to a private OB for maternity care.

          • Bombshellrisa

            She came on strong but ended up deleting her comments when it was found out her mother was involved with one of the AIM families, they are both midwives. Some of her more memorable comments include insisting women need support, NOT epidurals to cope with the pain of labor and insisting Pacific women don’t need pain relief, they just “get on” with the discomfort of childbirth.

          • Margo

            Margo here, from NZ. just to put the record straight I am not, never have been ‘involved’ with an AIMS family. I do visit the AIM page and have posted comments there….but I repeat…have not been involved with an AIM family. I visit the page because I am interested in what is shared there. I also read the HDC reports that inform about midwifery care ,obstetric care etc. I did sit in on a HDC for a three day
            hearing ….and in that particular instance a case was not found against the midwife. Sometimes debates can get overheated as we are all very passionate are we not and as individuals hold strong views.

          • Bombshellrisa

            I am not sure what record you are trying to put straight. We were referring to an NZ midwife named jane who was posting on another thread.

          • MJ

            I think this might be Margo Townsend, mother of NZ midwife, Jane.

          • Bombshellrisa

            Which would explain a lot. Also explains why she is willing to ascribe our replies to her daughter’s SOB hall of shame level comments to “individual strong views”.

          • Guesteleh

            She’s Jane’s mother.

          • Michelle

            What lena247 is talking about is having lay people attending birth which is indeed truly scary. Even if the system is imperfect, this still means everyone still has access to having the attendance of a health professional at their birth who has been trained, is registered and is required to maintain practice standards. Much preferable to nothing at all, which is essentially what these birth junkies provide.

            So out of interest, which page or pages would this be being said on? And for that matter what is being done about it if it is happening, as that sort of advice would fall below practice standards (which state midwives must be able to prescribe and administer medications, including immunisation and counsel patients appropriately during and after pregnancy) and against official policy (including that of DHB’s e.g. http://www.adhb.govt.nz/newborn/Guidelines/Blood/VitaminK.htm ?) That sort of thing should be highlighted and drawn to the attention of bodies like that when it happens because it simply is wrong to misinform and not provide correct information to patients. I’d be interested enough myself to do something about it if I saw that.

          • Bombshellrisa

            Please see the link below. An NZ midwife jumped in here and despite all the education and training, said everything a lay person would including how women should be “ok about the pain” if they have “support”. She deleted her comments, but she was quoted in our comments back to her, so you get an idea what she was about. Having a midwife like that is worse than having a lay person, since she should know better and yet still provides mediocre care

          • Theoneandonly

            I agree – people take what they say without question because they are the professionals and should know better, but really they are sometimes giving dangerous advice. I read on the Health and Disability Commissioner website about a woman who had a bad outcome – she worked in healthcare, but took everything her midwife told her as gospel. After the bad outcome she was asked why she didn’t question what the midwife told her, her answer was why would I? She’s the professional.
            As for reporting substandard practice – it’s just too wide, and too subtle to do. Unless you have been reading a site like this one, you don’t know the care you are getting is substandard. And while I try to question women on the advice their LMC is giving them, it’s actually none of my business.
            In the case of my sister in law (midwife advised Vit K not needed as she didn’t give it to her own kids, and birth was uncomplicated), my husband specifically asked me not to say anything so as to not rock the boat. I don’t know the midwifes name, and even if I did report it, what would happen? The Midwifery council would close ranks and back her up, as half(!) (of surveyed) midwives agree. See the first comment on the post below.
            http://www.skepticalob.com/2014/03/the-terrifying-result-of-refusing-newborn-vitamin-k.html
            I support the work of organisations like AIM, and am considering going to talk to my local MP about maternity care- but other than that I’m not going on a one woman crusade.

          • Michelle

            And to reply to this on, actually I do understand your point that sometimes these things can be hard to define but if they are advising patients in breach of the guidelines/standards of practice and this can be proven there is something that can be done about it as you can clearly point to a big failing there that does need to be addressed. I am in the position that I would do something about it, I know I couple of people that I can talk to about it outside of here that work in government/health areas and look at how to address that particular issue. But I’d need a bit more than third hand to back it up.

            If you are questioning people, then with all due respect you have made it your business and it does to my mind come with a bit of responsibility to say that what information they have been given is incorrect, if in fact it is. I was certainly given information on and offered Vit K as per standard procedure myself, and that survey (with a 56% response rate) showed 71% thought it was “important” or “very important” with the remainder “neutral” (presumably a sliding scale rating system?). Would be nice to see that higher, but it’s not really half.

            As for the old “closing ranks” trope, if care is substandard this goes to the Health and Disability Commissioner, and the Midwifery (and Nursing/Medical etc) Councils are required by law to forward any such complaints to the HDC if they do receive them. Also, the Midwifery Council is responsible for training standards, initial and ongoing registration and ensuring competency is maintained. Any disciplinary hearings for all health professionals are heard by another independent body. So they don’t really have much to do with the complaints system until later, when they might be asked to assess competency or look at registration.

            Not rocking the boat I can understand if it’s about family and the issues that might occur there(!). Don’t cop out with hand waving about the Midwifery Council though, because that’s not really true in the way the system works and also you can do things to address it and do not necessarily have to bring a formal complaint or go on a one woman crusade to do that. Writing or contacting MP’s or Minister of Health in general terms might be something you might further consider and do, the more people highlight issues like that the better.

          • Theoneandonly

            It’s not my job to police midwifery standards in NZ. And while I may ask why a midwife might be giving particular advice, I actually haven’t made it my business at all. Most of the women I talk to in these groups do actually read up on things on the internet, and a lot of them actually agree with what the midwife says – because it’s easy to get access to the same misinformation that they spout, and they might not know that it’s potentially in breach of standards of practice. Having said that *I don’t actually know* what might be in breach of standards of practice, because as I have said in other threads before, I am not in the heathcare industry, I have no degree in anything (let alone midwifery), and my interest in this matter is more on a personal level. I am happy and confident that my Obstetrician is doing her job correctly, so I haven’t much of a reason to investigate that deeply into it. That doesn’t mean I don’t take note of what other’s LMC’s are saying – but it’s not up to me to dob a bunch of midwives in.

            As for the statistic – this is the one I was referring to – “When asked which babies should receive vitamin K prophylaxis, 100% (41/41) of doctors and 54.7% (35/64)of midwives said that all babies should receive it. Of the remaining midwives, 45.3% (29/64) said that only babies ‘at risk’ should receive prophylaxis, with common clarifying comments being prematurity,
            instrumental/surgical delivery and bleeding disorder.”
            I said nearly half of surveyed – I should have said half of surveyed who responded. And I didn’t say that they didn’t think it wasn’t important, just that half agreed with the particular advice given to my SIL – so the point I was trying to make was that this was the exact advice given to my SIL, and it’s not just one midwifes opinion.

            From what I can gather, the HDBC is mostly concerned with major breaches, I wasn’t sure what to do (if anything) about what seem to be relatively minor differences in advice.
            I may consider writing to my MP and the Minister of Health with things that I have referenced here – but without specifics or anything major I’m not sure about what can be done, if anything.

          • Michelle

            It’s not about policing at all, really when engaging, if you are asking questions and all of that it does in the end become, well, actually business and the topic of discussion and I think it important to correct misinformation when it comes out and from my perspective more importantly try and address it if at all possible as that sort of thing could be a big issue and it’s vital that people get good information. Even more important in pregnancy and childbirth situations.

            This is kind of like how we’re discussing this now, I think it’s worth exploring, and worth looking at possible solutions or actions. And I am fussy about this, never worked in obstetrics (nurse, mostly medical/respiratory/cardiac) but quality of care is incredibly important, as is the work in making sure standards are maintained.

            That said, it’s becoming less clear from the first statement that it “I know many women in my due date FB groups and some family who are
            forgoing GDD tests, Vitamin K, and vaccinations on advice from their midwives.” that this is a direct thing, you’ve now talked about other misinformation sources and it being reinforcing or agreeing with it. I’ve informed that if that is true and women are being given that sort of information, that’s a breach of standards and DHB policies. That would include the Patients Code of Rights, specifically Right 6. To my knowledge, HDC will look at any complaint but in some cases if lower level would look to mediation as a solution.

            It’s not something I expect someone to specifically know, but I’d think it pretty clear though that if that is the source even not knowing that, it’s simply wrong and especially if it is at all widespread, I’d be keen to pipe up and would encourage others to do so even if this is only in general terms and simply correcting the narrative when situations like that arise. The other side of the coin I suppose is that of course, it would be unfair to charge people with things they haven’t done if the misinformation is coming from other sources instead and it’s not clear that they did do such things. We’ve had such differing experiences there – in my case I definitely got all the standard testing, information and got the Vit K, in your experience in at least one case it’s been very different and I think it’s important to at least try and address it when it occurs. It’s just a little hard with so few details to get a grip on a extent of any problem that might be there or who is actually doing what, but it is possible to at least raise the issue with people that will listen as a general point. Which I think I will do anyway.

          • Theoneandonly

            I would be on the fast track to losing friends and alienating people if I went around doing what you are urging me to do. I am willing to ask people why they are taking a certain stance or making a certain decision, and I’m willing to share what my own LMC tells me, but it’s up to them to decide whether they are happy with the care they are getting. What you’re telling me I should be doing would be bordering on giving medical advice in some cases, and I am in no way qualified for or prepared to do that. I always tell them to go back to their LMC for further information or clarification, but if they’re happy relying on their pee stick, rather than doing the glucose challenge – it’s not my place to push it. If they’re happy accepting that Vit K is optional, and are told that only high risk babies should get it, it’s not my place to tell them they’re wrong. If their midwife tells them that the flu jab is not worth getting, and that they didn’t get one themselves, it’s not my place to tell them to get it. All I can safely say is; my obstetrician recommended it and it’s better to have the full picture than not, my obstetrician recommended it, and it’s a no brainer for us, and my obstetrician advised me it was safe and recommended it.
            Like I said above – I will consider writing to my MP and the Minister of Health, but other than continuing to take note of what other LMC’s are telling their clients, I will not be an agitator.

          • Michelle

            Sorry, that wasn’t what I was asking for. I was asking for the facebook
            page as the claim is women are forgoing GDD testing, Vitamin K and
            vaccination on the advice of midwives. The conversation you direct me to
            isn’t anything to do with that, and while it’s difficult to follow what
            was actually said, I don’t think any of that was stated there.

          • Bombshellrisa

            The midwife deleted every one of her comments, so yes, it’s impossible to cull from reading it now just how downright stupid the midwife was.
            The Facebook page was a due date group someone was in. There is no Facebook page for it, but a local CNM group that won’t do home births (at one point one of the midwives had a website for her women’s health practice with a whole page devoted to why she would never a courage a woman to home birth, she has since taken down the page) are ok with women refusing testing and vaccinations. They were the midwives my sister in law and her friends used.

          • Theoneandonly

            It’s a closed Facebook group for women who are due to have their babies in the same month as me. Nothing official from any named midwives – just mothers discussing how their pregnancies are going, and discussing decisions they are making and advice their midwives are giving them.

  • Amy M
    • Amy M

      In case they get deleted from the site—a bunch of anti-vaxxers think ebola is a hoax, perpetrated by the US govt, possibly to test dangerous vaccines on the West Africans. And they get their information from anti-semitic conspiracy theory sites.

      • Sara

        Mothering anti-vaxxers… ::sigh:: they once tried to argue that they are a persecuted group, much like African Americans under the Jim Crow laws, because physicians considered separate waiting rooms for unvaccinated kids. They love using terrible racist history to try to advance their cause even when it’s totally wrong and inappropriate.

        I had posts removed over there because I was so terrible to suggest that the conspiracy theories they spread are the same conspiracy theories that get polio workers killed in places like Pakistan and Nigeria. How insensitive of me.

        • Dr Kitty

          MDC, good luck trying to get isolation facilities and quarantine restrictions for infectious disease overturned by relying on civil rights legislation.

          “Separate but Equal” shouldn’t apply to segregating schools, definitely should apply to people who are potentially infectious.

          MDC is full of people who don’t understand medicine, biology, world geopolitics, economics, science, law, civil rights, human rights, agriculture or feminism.

          • Young CC Prof

            They don’t understand the difference between discriminating among people on the basis of their words and actions and discriminating on the basis of how they were born.

          • Sara

            They don’t want to understand the difference.

        • Sullivan ThePoop

          Also, they are the same conspiracies that are making the situation worse in Africa right now.

      • Dr Kitty

        Because…we don’t live in an age of electron microscopes where we can look at viruses or in an age of genomic research where we can sequence viruses.

        Have these people heard of Occam’s razor?

        1) There is a viral haemorraghic fever killing people. We know what it looks like and have developed tests for it, but as yet no cure or vaccine, although we are trying to figure out treatments. Human immunoglobulins (which naturally occur in the blood of survivors, and are not made in a lab) seems to be the best option we have at present.

        2) Ebola is a hoax. The test results are faked. People showing symptoms of Ebola have been poisoned somehow.
        All the drug companies and developed nations are in on it, but have managed to prevent word getting out to any except a few special conspiracy theorists who know the truth.

        The simplest explanation is likely true. Therefore I go with option 1.
        Also, I’d prefer not to agree with whacko anti-vaxx loons.

        • Sullivan ThePoop

          Well, the antibodies they have given are not from the actual people. They are monoclonal antibodies so they are made in a lab from antibodies that were from actual people.

          • Sara

            The monoclonal antibodies are in the experimental drug Zmapp.

            They are also giving blood plasma directly from survivors. That’s been a standard approach to treating Ebola and similar viruses in the past.

          • Box of Salt

            One of the patients did receive serum from the first US patient who recovered (scroll down to Dr Sacra):

            http://www.cnn.com/2014/10/06/health/american-ebola-patients/index.html?iref=allsearch

            If I remember correctly from reading the Hot Zone (Richard Preston) years ago, that treatment also helped others back in the earlier outbreaks

          • Sullivan ThePoop

            Yes, I know they have also given blood and serum from people that survived. I am just saying the actual antibodies were monoclonal.

      • Amazed

        Sure. And Holocaust never happened.

      • Stacy48918

        I’m willing to bet that the lines for the vaccine, tested or otherwise, will be enormous.

        • Young CC Prof

          There are a couple of vaccines in the pipeline, one already in human trials. Fundamentally, it’s an easy vaccine to make. I mean, it’s just a virus, it doesn’t have any special tricks to defeat the human immune system. The symptoms are horrible and often fatal, but the interaction with the immune system is simple

          However, it’s going to take months, maybe years, to ramp up vaccine production to the needed levels. The first round of production will be for healthcare workers in active epidemic zones only.

          • Amy M

            Clinical trials and approval in multiple countries can take years, though I imagine things may be expedited here to some degree. And of course, no one would want a vaccine that wasn’t tested adequately, like the flu shot. (kidding—that’s one of the most frequently heard arguments against it–“But it wasn’t tested enough!!” Of course it was. You just don’t understand the way pharmaceuticals get to market. As of next Tuesday, my entire family will have received our flu shots this year.)

          • Stacy48918

            Yes, I know that there are vaccines in the works. I think it would be very interesting to see non-vaxxers’ response to news reports of the lines of folks waiting to get an Ebola vaccine, even if it hasn’t been through the standard rigorous testing as a means of expediting the process.

          • Sara

            Healthcare workers in epidemic areas, and then close contacts of those who test positive might be all that’s needed to get the situation under control anyway.

            It’s not like Ebola vax needs to be distributed the way flu vaccine is.

    • Cobalt

      “I am not worried about ebola. I am more concerned about the millions of people in this country, and in other western nations, with chronic conditions like diabetes, heart disease, cancer and the many auto-immune diseases we have these days.”

      But not the millions of people in the western nations who have or had or died from diphtheria, measles, pertussis, tetanus, etc. BECAUSE OF VACCINES! We do still have losses from those diseases, but most of those could be prevented with MORE VACCINATIONS.

      • Amy M

        I take it you mean “lack of vaccines” 😉

    • yugaya

      As long as racism and bigotry are served as a side dish and in support of their insane beliefs, these people are perfectly ok with spreading it.

    • Stacy48918

      When you think you’ve seen it all…

      What a bunch of idiots…

    • Yoooozers. Yikes. These people are real, huh? I found another crazy personality who I currently can’t quite accept as being a real person with a real heart-beat and not a attention whore who just wants attention…. https://twitter.com/Todd__Kincannon Super scary.

    • Elaine

      That poster is completely out of touch with reality and always has been. Back when I used to post on MDC I pretty much ignored 98% of everything she said, and didn’t feel I was lacking anything for it.

    • Jocelyn

      I’m at a loss for words.

  • Amazed

    Aaaand… three… two… one… Amos Grunebaum hates homebirth and is a troll. That’s what the chicks on MDC will say, anyway.

    Oh, and he isn’t a real doctor. He doesn’t have a li… oh wait.

    Well, he’s a MAN. What can he possibly know about birth? You need to be either a woman or Robert Biter to get any idea.

  • Bombshellrisa

    OT:has anyone watched the PBS special called Medieval Lives? There is a whole segment devoted to what it was like to give birth during that time. It’s on tonight late and I am hoping to catch it.

    • Stacy48918

      I’m watching it right now. Part 1, 28:00 “You can’t learn midwifery from books.”
      Tell that to all the distance learning CPMs….

      • Bombshellrisa

        I watched it too! The thing I took away from it is that a midwife in those times would NEVER say a baby wasn’t meant to live.

        • Stacy48918

          Kinda bothered me though that the former midwife, now priest couldn’t bring herself to acknowledge that having a wall of pictures, candles or a string of beads at your homebirth might be nothing more than placebo effect because (my paraphrase/interpretation) it’s “another way of knowing”.

          In a shoulder dystocia I fail to see how your BlessingWay beads will be of any use at all.

          At least she’s not delivering babies anymore….

          • Bombshellrisa

            Bothered me too and really emphasized the point that ideology is interfering with care in the UK.
            I learned that a woman is supposed to get beads, not pedicure, at a Blessingway ceremony.

  • TDW

    Dr. Amy, a FB friend posted this article and I’m sure with your trained eye, you can debunk it:http://news.therawfoodworld.com/largest-homebirth-study-completed-reports-97-percent-babies-carried-fullterm-minimal-interventions-used-labor-delivery/. I can’t wait it hear what creative steps they used to conceal the truth!

    • Young CC Prof

      In the MANA study, it is indeed true that 97% of babies were recorded as full-term.

      However, the “study” had a dropout rate in excess of 20%, and outcomes of women who transferred to hospital care prior to the onset of labor were not recorded at all.

      In other words, most women who plan a home birth and then go into premature labor go to the hospital. Disturbingly, some do not.

      • Ceridwen

        Yeah, I love how that article attempts to present it as though homebirth CAUSED a lower chance of preterm delivery. How would that even work?

        • Young CC Prof

          Plausible biological mechanisms are for rationalists. Midwives have other ways of knowing.

        • Amy M

          You know how babies know when to be born? Babies that know they will be born at home are more likely to wait, because they don’t like bright lights and strangers’ faces.

        • Roadstergal

          Well, according to all that Ina May sphincter business, fear will stall labor. So women see the homebirth stats, are properly fearful, and go into labor late? :p

    • Amy Tuteur, MD
      • tdw

        Thank you, Dr. Amy! My dad was an OB (ret.) and I have so much respect for the specialty and all this homebirth nonsense I find insulting to a very hard-working group of physicians. I also used to defend OBs and remember a placental pathologist testifying against my client said she originally wanted to be an OB, but decided against it because of the hectic schedule! Ha! Thanks again for all you do to provide information to expectant mothers (myself included — 2nd C-section already schedule for 4 weeks from today!)

    • Guest

      A friend of my sister posted this as well, stating “since everyone loves statistics, here are some numbers to back up how safe home birth is.” Sigh. An article that doesn’t once mention the death rate at home birth…but look how safe it is!!!!

      I also always love reading the comments on these types of posts. Not a single NCB activist ever has actual studies or numbers to back up a single thing they say. It’s sort of amusing. And sad.

      • Amy M

        The comments usually give me hope, because most of the time, the vast majority think homebirth is dangerous and crazy and do not understand why anyone would risk life and limb for that. There are always the homebirth bingo posse with their “as safe as, or safer than” and “interventions cause problems” but in the real world, they are truly a minority.

        • Young CC Prof

          That’s because most people remember their fairy tales, if nothing else, and know that in nature birth kills with alarming frequency.

  • fiftyfifty1

    OT: JAMA study today looks at the 2 Quality Indicators that are used to measure supposed quality on OB floors. The first is the rate of non-medically indicated inductions before 39 weeks, the second is the CS rate in low risk first time mothers. Turns out that these measures show NO real life correlation with outcomes that actually matter: maternal and baby death rates and rates of severe complications (ICU stays etc).

    So hospitals and OBs are being punished if they don’t reduce C-sections and elective inductions…but it turns out that doing these things doesn’t lead to safer maternity care after all. And hospitals and OBs are punished if they have high inductions and CS rates, but it turns out that these practices are perfectly compatible with extremely good outcomes.

    • Stacy48918

      Can you link it? The abstract at least?

    • Young CC Prof

      As they say, be careful what you measure, because that’s what tends to change.

      • Dr Kitty

        True.
        UK GPs are partly paid on a points basis, where points means prizes.
        The government keeps changing the points.

        We used to have to do PHQ-9 scores for new diagnoses of depression. So we did them.
        Now we have to do biopsychosocial assessments.
        So we do them.
        The clinical management hasn’t changed.
        We still ask the same questions:
        Who is at home with you? How’s your sleep? How are you coping at work? How’s your memory and concentration? How’s your appetite? Any thoughts of harming yourself or others? Etc
        Except now we’re doing it in a less rigid, more individualised way.
        Now we don’t have to do PHQ9s, we’ve stopped doing them entirely, when they were measured we did them.

    • D/

      Only two of the five core measures in the Perinatal set are even looking at the right sort of outcome (‘Antenatal Steroids’ and ‘Bloodstream Infections in Newborns’). I fully expect ‘Exclusive Breastmilk Feedings’ to create more problems than it solves as well and serve out “punishments” all around.

    • DiomedesV

      What, you mean we can’t just glean that low hanging fruit? We need to actually address structural barriers to health care access for millions of women? Figure out how to prevent prematurity? Find new treatments for pre-eclampsia? But that will take real work and money!

      • Young CC Prof

        Or, you know, just set up the hospital’s systems to ensure that existing treatments are optimally delivered. That’s another idea, though also not easy.

    • The Computer Ate My Nym

      I’m rather surprised that there wasn’t a negative correlation, i.e. hospitals refusing to do c-sections for low risk women who end up with complications because they don’t want to ruin their c-section rate causing worse outcomes.

  • attitude devant

    I love this post so very much, because it confirms what I see in my transports. I just want to scream when midwife C (she knows who she is!) brings in yet another HBAC in trouble. Each time, like some binge drinker, she swears she’ll never do it again, but the lure of the fee, or of SOMETHING, always calls her back. And the midwives who ‘specialize’ in breeches but have no idea who’s a good candidate and who isn’t, or the midwives who, a week after the due date start talking about how that particular date wasn’t exactly the right one, even for mothers with early ultrasounds.

    As one doctor in my area says, over and over again, if you just avoid certain situations, you’ll get a good outcome most of the time. There’s no magic to it. But the midwives here refuse to follow her advice, with lamentable results. After the particularly ugly death of one breech baby boy we held a meeting with them to urge them to follow standard (Netherlands) risk criteria, to no avail. They did tell us that WE were the problem—-for not making transport easier, this being somehow our responsibility. (We actually did respond by bending over backward to accommodate intrapartum transfers, but that’s another story.)

    • Young CC Prof

      Just based on the stories here, there are occasional HB disasters that really couldn’t have been anticipated, but almost all involved either clear risk factors in advance, or refusal to transport in a timely manner when things were obviously abnormal. Adherence to reasonable risk-out and transfer criteria would get the same outcomes that UK or Netherlands homebirth has!

      • Anj Fabian

        It’s logical to say that in order to get the same results the Netherlands study gave, we should use the same protocols that the Netherlands use.

        Right?

        Kind of, sort of. If you ask the midwives, the essential part is giving midwives more power, not more restrictions.

    • MaineJen

      …how is this even allowed? Seriously. How are they allowed to continue doing this? They are clearly, clearly having bad outcomes. And I’m sorry, but they’re holding YOU responsible when you can’t salvage a disaster they created? If you can keep your cool when someone says that to you, you’re a better person than I.

    • Melissa

      I think it makes sense that this keeps happening. The start from the premise that home birth is better. That isn’t the conclusion, it is the axiomatic fact that they begin all other analysis from. Home birth is better because it is natural and women have been doing it on their own forever. Or it’s better because you can be in total control and in your own home. But whatever the “reason” they all start with the idea that it is better.

      And if you start with a flawed premise than you will get flawed results. If home birth is better for normal pregnancies then why should we send twins or postdates to the subpar hospital system? If it is all about doing things naturally than why have c-sections or antibiotics?

  • Young CC Prof

    If you look at the outcomes for CNM versus other midwife at home birth, they’re equally bad. THIS IS WHY. Because the small fraction of CNMs who take on home births are no less likely to take on stupidly risky situations than the less-qualified midwives.

    • Stacy48918

      Before I put my foot down with hubby on the homebirth thing (among others…) I was till planning a homebirth with my last baby. My CNM (I insisted…no CPM) looked at me like I was crazy when I said I wanted a heplock in labor. She said “I won’t talk you out of more interventions”…but still. I made sure pre-labor to have a discussion of “if you have ANY concerns, we transfer, period.” As well. In the end we had decels and transferred but I later learned I was her first emergent transfer ever in like 2-3 years of independent practice. I’d rather have her than a CPM…but still. Hospital all the way if there’s a next time. 🙂

    • Trixie

      They are? I thought I had read here that CNM home birth carried a slightly lower risk.
      There is a CNM group here with hospital privileges and an accredited birth center that does mostly Amish home births as well. Their outcomes are pretty good, probably because they have physician collaboration, and hospital privileges, and they actually do transfer. I realize that’s a very rare setup in the world of home birth midwifery.

      • Guest

        I was gonna say the same… CNMs have almost acceptably low mortality rates according to the Wonder website, 2X higher than hospital birth IIRC. They are well-regulated by nursing boards, so I would expect them to be more accountable.

        • Trixie

          Which is not to say there aren’t some crazy rogue CNMs out there — but you’re right, usually at least the nursing boards oversee them.

        • Young CC Prof

          The Wonder “out of hospital” includes birthing centers, many of which are very well run. The home-birth alone numbers, which require a bit more digging, are exactly the same.

          • Trixie

            What happens if you sort them by level of oversight in their state?

          • Young CC Prof

            I don’t think there’s enough data to do that.

          • Guest

            State midwifery laws are always changing. You’d have to use state homebirth stats over a large number of years to get a large enough sample, but if half the states have changed their laws significantly, perhaps several times, in that time frame, you wouldn’t be able to draw any meaningful conclusions.

          • Trixie

            I’d like to see a comparison of NY, where physician collaboration agreements aren’t required, with PA, where they are. Similar size states, similar populations, I don’t think either one has had recent major regulatory changes.

  • Guest

    Has anyone done a side-by-side comparison of homebirth mortality rates in the U.S. and other countries?

    • Young CC Prof

      Take a look at intrapartum deaths in MANA stats versus UK Birthplace study. Almost identical sample size, (17,000 home births in each) vaguely similar demographics.

      MANA had 22 intrapartum deaths, versus 6 in the Birthplace study.

    • I did a comparison between Netherlands and USA. Here’s the full comparison for rates:

      https://www.facebook.com/douladanielle/posts/701873499881382

      I wrote out intrapartum and intrapartum + early neonatal (late neonatal were not available for Netherlands in the study I used, which is the de Jonge study referenced in the MANA study).

      Here’s combined intrapartum plus early neonatal mortality rates::

      Home births in the USA: 1.7/1000
      Home births in the Netherlands: 0.6/1000

      That means a baby born at home in the USA is 3 TIMES more likely to die during birth or during the week after birth compared to a baby born at home in the Netherlands.

  • ArmyChick

    They will do anything to pat themselves on the back and give the medical community the middle finger. The dead and injured babies in the process are just collateral damage.

  • Mel

    Reasons my husband stays late at the farm to watch a cow giving birth:
    1) Known twin pregnancy – Twin calves line up in all sorts of freakish ways – just like human babies do – and getting them straightened out is a matter of life or death.

    2) Suspected twin pregnancy “God, that cow looks huge…”

    3) Lack of 2nd stage progression – usually caused by breech position. Getting the calf straightened out is life or death.

    4) Post-Date pregnancy. We know the breeding date. If she’s over more than 2 days, we watch carefully since the calf might be huge or decaying – either is a life or death situation.

    We have no VBACs because a CS is fatal in a dairy cow. (I’m very glad I’m a human, FYI)

    Takeaway: PEOPLE, RISK FACTORS ARE REAL AND UNIFORM ACROSS MAMMALS. DON’T BE A LUNATIC.

    • Stacy48918

      “We have no VBACs because a CS is fatal in a dairy cow.”
      Cows can have C-sections….

      I mean, maybe it means you’ll send her to market, but a standing left flank C-section is pretty routine stuff.
      http://www.syracuse.com/news/index.ssf/2014/08/birthing_center_at_nys_fair_turns_into_surgery_as_vets_perform_c-section_on_dair.html

      • Mel

        They can work – but we’re 45 minutes minimum away from a vet. We have a good chute system, but often the cow is down and the calf is already dead and so a fetotomy is performed instead.

        Nico’s been around for 3 terminal CS that I know of. They tear him up.

        • Stacy48918

          Ah, gotcha.

          Yea, terminal procedures suck.

        • Dr Kitty

          This will reveal that I am neither a vet, nor a farmer.

          If the cow is dying and the calf is dead, why do a fetotomy at all ?
          Why not just get the humane killer/ bolt gun?
          I would understand the CS if saving the calf was possible, otherwise I’m not sure why you’d bother.

          I would understand if the cow carcass was to be butchered, but AFAIK you can’t sell meat from animals that haven’t been slaughtered in a slaughterhouse, so I don’t think that is it.

          Is it just too hard to know beforehand if the calf is alive or not, so you hope it is and do what you have to?

          • Stacy48918

            Sometimes it depends on the value of the cow. The cow in the link above? VERY expensive I would imagine. Her calf was stillborn but her future calves (not to mention embryo transfers) will likely more than pay for the procedure.

            I’m a small animal vet – it’s been 3 years since I’ve touched a cow in a medical setting – so the day to day farm/vet decisions I’m not as versed on. Mel will definitely fill us in, I’m sure. You’re right you can’t sell the meat, but one might keep it for themselves or give it away. I don’t know if arranging slaughter/butchering is feasible in a 2am dystocia though.

          • Dr Kitty

            Ok, thanks.
            My BIL’s people are dairy farmers (Holsteins and Friesians, nothing fancy). My SIL had to explain to me that when one of their cows starts calling for a bull, BIL has to go online so he can choose a bull and get the semen ordered. The explanation was necessary after he came in and said “I’ll be in the study on the computer. I want the semen here tonight”.

            My husband and I now have a running joke about Cow Tinder ( because we’re weird).

          • Mel

            A pregnant heifer from an average line costs $2,500 right now. A pregnant cow with proven lactation is at least twice that since you know she’ll produce the milk. If the cow is phenomenal (ET worthy), then each heifer daughter you get out of her is worth $2,500 and I think the average is 4 embryos that implant per round of ET so that would be 13 cycles a year x 4 embryos x .8 (sexed semen gives 80% female calves) x $2,500 sale price is $1,040,000 before costs. If one of her bull sons makes it as a proven AI sire, he’s worth a similar amount as all of the daughters.

            (I don’t know the costs because we don’t do much ET. The only time we did one was when my MIL’s last 4H cow’s last daughter was clearly on her last legs and we didn’t want to lose her line. )

          • Mel

            If the cow is dying and the calf is known to be dead, we either OD the mom on Rompum or shoot the mom. There’s no benefit in torturing a cow.

            Very rarely, a cow is clearly in a very bad way from an acute condition and has a living calf that is within a month of term. (The only one Nico’s talked about in detail was a situation where a cow had something like a stroke – suddenly downed cow; fixed pupils without a pain response, reflexive movements of the hind-legs and gasping breathing. She’s brain-dead, but the calf might be saved.) In that case, the cow isn’t going to survive the CS. The vet usually gives an inhaled anesthetic and everyone works really fast to try and get the calf out before the calf suffocates.

            Most of the really bad births are less clear cut. The calf is dead, but wedged in the pelvis in a bad position (and calves are active participants in birthing so a dead calf creates a much less effective labor dynamic). Most adult cows have a fairly deep physiological reserve, so if we can get the calf out of her, she’s got a decent chance at both recovery and even re-breeding. There’s also a weird Catch-22: If a cow is standing, the vet/herdsman has a wider set of options to vaginally remove the calf rather than CS. Once a cow goes down, the number of options for vaginal removal drops – and the CS gets much harder. Plus, you need to find enough people to roll the cow on to her back – which the cow hates – and tie her legs to a secure object. That usually causes the cow to panic which can cause the cow to go into shock a lot faster.

            In terms of percentages: 90% delivery no human intervention. Of the 10%, half of those need nothing more complicated than removing a trapped hoof or using chains to prevent the calf from sliding backwards between contractions – the easy stuff. 4% are resolved using a calf-jack by someone trained on the farm. 1% require a call to the vet – usually because the dead calf is twisted into a freakishly weird position and cow is pushing so hard we can’t untwist it. (Hello, epidural!) A tiny number (about 1 every 5 years on our farm; the vet sees about 3 a year in practice) is so complicated that the vet has to perform a fetotomy. For cows that have a fetotomy, about 80% recover enough to rejoin the herd for the lactation. The other 20% die within a few days after birth.

            When birthings go wrong, there’s no way to salvage the meat. The family has field-dressed cows who died of broken legs before, but a cow that dies in labor or soon after generally dies from an infection started by a dead calf…not safe for eating.

            We actually bury the cows out back. We keep track of where the cows are buried so we can show that we are well below the carcass per acre limit and it’s a whole lot cheaper than taking the body to the dump. Apparently, you can compost a cow…

          • Dr Kitty

            Thanks for your really helpful reply!
            Totally makes sense now.

    • Montserrat Blanco

      So, if a cow needs a C-Section and there is no surgical team available… The cow or the calf or both die… Makes me wonder why a woman would like to give birth in such circumstances…

      • Stacy48918

        On a Farm, you mean?

        /snark

    • Bobsie

      Don’t forget a cow that doesn’t feed her calf or acts ‘spooked’ and rejects the baby. My uncle often has to check closely with a mother that isn’t allowing her baby to feed or a calf that is having troubles. Sound familiar? Trouble breastfeeding and PPD affect cows and humans.

  • Zoey

    And yet midwives in my Canadian province are still doing VBACs at home births. Just about no other province allows it, and even some of the midwives won’t attend VBACs at home (against their own guidelines). I think this is a good argument as to why an industry group shouldn’t develop and enforce their own standards.

    I also think it’s only a matter of time until something goes terribly wrong at one of these births, if it has not already.

    • Guestll

      Are you in Ontario?

      My clinic of RMs would not do HBAC. Also, something has already gone terribly wrong, at least once, at an Ontario HBAC.

      • Zoey

        Manitoba. The out of hospital birth centre here won’t do VBACs, but you can still access HBACs subject to some risk out criteria (distance from hospital, medical conditions, etc.).

      • DaisyGrrl

        So your comment got me searching the Ontario Midwives newsletter website and I found this beauty: http://www.ontariomidwives.ca/newsletter/page/experienced-midwives-maintain-primary-care-during-planned-breech-births

        I really hope I’m reading that wrong and the hospital is not allowing midwives to deliver breech babies. Because really, what could possibly go wrong?

      • Haelmoon

        There have been more than one bad outcome with home VBAC in Ontario – and there will continue to be. However, the case I saw as a resident was actually a good example of a collaborative practice – in spite of the poor outcome.
        We had a women who refused to have care in hospital after a previous C-section. She was counselled by her midwife that she was not a good candidate, and referred for OB consult too. Pages and pages of documentation. She still refused. The midwives still attended her labour – her records were already available at the hospital. We were called when she was in labour. We were called when labour dystocia was diagnosed and they were trying to convince the patient to come in. We were called again when the fetal heart rate was lost (then found to be bradycardic), ambulance was called. One midwife brought her lab samples (drawn on route) to the core lab, two IVs were already in place and we were all waiting for her. Fetal presentation was lost, and a suspected uterine rupture was actually wheeled directly to the OR. Unforntunately, we still lost the baby. However, I do believe these midwives saved her life (in addition to the surgical team).
        However, there are other midwives attending HBAC that make me more nervous – we have some very excellent midwives in Canada that I am happy to work with, others are too into patient choice (evidence be damned).

        • Ash

          The number of USA CPMs who would have two IVs and samples drawn upon admission is so, so low.

  • Amy M

    But..but..but..those are just variations of normal!

    • Stacy48918

      And that’s the problem.

      To these midwives and homebirth advocates, those things ARE NOT risks. So this paper’s results are completely useless to them because they are so blinded by their ideology.

      • Amy M

        I especially hate it when I see a twin homebirth story, even if the outcome was good. Obviously, because I have twins, that hits close to home, and I know first hand, how risky it is to carry and give birth to twins. And these jerks are just so cavalier about it: It’s natural! No it isn’t. Sure, multiples happen in nature, but the human body is really only equipped to handle one at a time. How they can just blithely decide that THEIR pregnancy isn’t risky, and nothing will happen to THEM, and one dead twin and the other severe CP after 100 days in the NICU later, oh it was meant to be?!

        No, doctors aren’t over-reacting when multiples happen and things get even more “medicalized.” My twins are in kindergarten now, learning to read. One of Annie Borgalt’s (sp?) twins is dead. Maybe she should have worried more. I guess that’s harsh, but that kid didn’t have to die.

        • Stacy48918

          My “expert” veterinary opinion?

          Humans are not meant to have litters.

  • Cobalt

    I just don’t get it. I can understand wanting to be or have a doula or support person, women supporting each other in labor is as old as time (dads too, sometimes, there’s a lot more cultural variation on fathers in the delivery room). Having someone that understands the experience you’re having and is there to help with all the little things you might need and can answer questions and commiserate can make birth easier and less unpleasant. I’ve sat with friends and relatives for their deliveries and had help with mine, there is a use for non-medical attendants and it’s fulfilling work to support women in labor and birth.

    THAT DOES NOT MEAN YOU WON’T NEED A DOCTOR. A CPM IS NOT A DOCTOR. A CPM IS NOT A MEDICAL PROFESSIONAL.

    A CPM might be qualified to be a doula, but a CPM cannot use anything in the last 100 years of medical advancement to get a mother or baby through the experience alive and well. Why would you offer to deliver a baby, knowing that you cannot really do anything other than provide extensive doula care? Knowing that things could go wrong and you can only watch and hope an ambulance arrives in time? I just can’t get into a mindset that makes that ok.

    • guest

      Why would they do it? I think some of them actually think they are “helping people.” But then there are the others who are just birth junkies. They have no medical training or education so they are woefully ignorant of the risks or they just don’t care. Of course, anyone in their right minds wouldn’t dream of trying to deliver a baby with no education or training so it really goes to show not only are they ignorant, but they have no concept of morality or ethics. A very dangerous combination.

  • Amazed

    Did I mention that I was Amos Grunebaum Number One fan?

    • Stacy48918

      I think you’ll have to fight more than a few of us here for that title.

      🙂

      • Amazed

        What? Shoo! Go away! I am A.G. Number One Fan! I am! I am! I am!

        What the hell is this? 28 percent?

        Her Majesty’s gone mad as a hare. That was a phrase I translated just today. Gods, CPMs are a bunch of hares.

        • Amy M

          A March hare?

          • Dr Kitty

            I love hares.
            They have so much more personality and panache than rabbits.
            It always makes my day when I see one.

          • Amy M

            I don’t think they are native to New England, so I’m not sure I’ve ever seen one. We have Disney amounts of wildlife in our neighborhood though, so if hares lived anywhere in Central Mass, I’m sure one would have traipsed through my yard at some point.

          • Dinolindor

            Maybe at Davis Farmland? I would think they’d have hares with their rabbit section. But I haven’t been in awhile and I’m allergic to rabbits, so try to guide my little guy away from that part. (Yay for Central Mass!)

          • Amy M

            You know, I’ve avoided taking my boys to Davis Farmland because of the insane admission price. Their corn maze, however…totally worth it.

          • Dinolindor

            We did a membership for 2 years, but once we started preschool we were too booked to go (like hell I’d go on the weekends. So crowded), but also I started wondering if the animals really had enough space and were protected enough from crazed toddlers. I think it worked out that if we went 3 times it paid for itself and we went way more than 3 because it was already paid for (“Need to kill an hour or 2? Let’s go to Davis!”). You can also check if your public library has discounted passes (West Boylston offers them for non-residents). But we haven’t done the corn maze. I plan to rectify that this year…but I suppose time is running out on that one.

          • Amy M

            Corn maze goes through Oct 31. I found the Ecotarium membership to be very excellent.

          • Dr Kitty

            Some mad people introduced hares in Wisconsin and Michigan and much of South America according to Wiki, but they aren’t native to the Americas.

            Irish hares don’t change their coats to white in the winter and are genetically distinct from British and mainland European hares.

            I like the way they’ll stop and look at you for a while before they run away, and they look like big, gangly, awkward rabbits until you see them run.

          • fiftyfifty1

            Naw, we have native hares here too. They are called Snowshoe Hares.

          • Dr Kitty

            With the big feet and white fur?
            Cute.

          • Amazed

            We don’t have those, so we don’t have the saying either. I am still not sure what to do with it.

          • yugaya

            Footnote it for now and revisit a couple of times later but not too many – you will probably come up with the perfect solution two years from now on a random sunny moment and. beat yourself over however you solved it originally. 😀

          • Amazed

            Did that. For now, saying-hunting it will be. In a year or so, it’ll be, “How stupid can one get?”

          • Dr Kitty

            Do you have a culturally appropriate fertility symbol that could be described as a bit crazy?
            I’m guessing “mad as a box of frogs” is out.
            Idioms must drive you crazy.

          • Amazed

            Still hunting. No success so far. But I was reminded of a saying we link to Ascention Day, and an interesting tradition. If a childless woman spent that night with a man other than her husband, it was not considered adultery. I don’t think we have another day like this.

            People in the good old days were not this stupid. They had some idea of incompatibility and the fact that when such problems arose, the husband might be the one with the problem.

            Now, if only it helped me…

          • Siri

            You mean you slept with another man than your husband and you’re still not pregnant, or you’re still struggling to find the right expression? 😉

          • Amazed

            Now, now, Siri, how could you think such ugliness about poor little me in the age of IVF? Of course it’s the expression struggle!

            But then, even if it wasn’t… I couldn’t SAY so, eh? *laughing*

          • The Bofa, Being of the Sofa

            I am always on the lookout for a pooka.

          • Guestll

            Big Nutbrown Hare and Little Nutbrown Hare. <3

          • Stacy48918

            I saw a mink Monday! Scampering down the lake beach. A bald eagle coasted right over the tree tops a couple days ago.

            Still haven’t seen a blasted moose though…

          • Mishimoo

            I saw one for the first time the other day, it was huge! I thought it was a kid (of the dwarf goat kind) that had wandered off, so we slowed down to pick it up. Understandably, it bolted!

          • Amazed

            Yes, that was the meaning. But March was missed.

            The bad thing is, I cannot use the L.C. thing. Her Majesty (Bloody Mary) lived well before he did.

    • Young CC Prof

      Nope, sorry, I am his number-one fan. I’m going to get his autograph and prove it.

      • Trixie

        I’m picturing a bunch of us milling around outside his hospital waiting for him to appear so we can get a copy of his latest paper autographed. Kind of like Bieber fever.

        • Amazed

          OK, I am ready to negotiate. We can wear identical T-shirts with variations of “Dr G.’s Number One Fan”. You know, like vatiations of normal.

    • Trixie

      Sorry, Amazed. I’m his number one fan and have been since he got himself banned by Jan Tritten and Midwifery Today.

      • Guest

        From the greatest hits file (on a Jan Tritten thread).

        • Trixie

          Sorry, I tried to post Grünebaum’s comments but my tablet wasn’t cooperating.

          • Amazed

            Dr Amy, you really, I mean REALLY need to find a way to insert emoticons here! How am I supposed to show an adoring face with small pink hearts all around if you don’t?

        • Dr Kitty

          To paraphrase LeMay- when you don’t like the evidence, pretend it isn’t useful, because birth is too special to be studied.

          Next she’ll claim the MANA stats aren’t reliable because measuring and observing a phenomenon will change it…

        • guest

          Ha! Grunebaum kicked her butt!

          • Trixie

            Those weren’t the same thread, just separate screenshots filed next to each other. I tried to delete it because it was irrelevant to the discussion.

        • Cobalt

          There are lots of ways of seeing birth that don’t involve medicine. For those aspects we have doulas, religious figures, families, friends and photographers. But none of those people will be able to save you or your baby if things go wrong.

          It’s like taking your car to a body shop for engine repair. Of course the painter will look at the car differently than a mechanic. But only the mechanic will guarantee the engine repair.

        • Amy M

          Oh my god. If you don’t like the data, sweep the whole study under the rug?
          I like the “birth is fundamentally an elimination process” bit—did she mean that in the physical sense (the body expelling a baby)? Or the eugenic sense (anyone who dies during a natural birth wasn’t “fit” to live)?
          And what does flat earth have to do with it? Is that some kind of mixed metaphor? Like: What does the flat earth theory have to do with the price of beans in China?

          • guest

            I took it to mean the body expelling the baby, but God only knows what she really meant! I am thinking the “flat earth” comment means the study is outdated thinking and/or backwards, but again, there is no telling with that loon.

          • Cobalt

            “Flat earth” is counterintuitive to Lemay’s point. The Earth may look and feel flat most of the time, but science and math prove it is in fact always round.

          • Amazed

            “Oh my god. If you don’t like the data, sweep the whole study under the rug”

            Err… yes. Obviously.

        • fiftyfifty1

          “Birth is fundamentally an elimination process. When they find that out they won’t need to study it anymore”
          -Gloria Lemay
          What?! What does she meen an elimination process?! Does she mean elimination like urinating or stooling? Or does it mean elimination as in Survival of the Fittest?
          I suspect the second, and that is really screwed up.

          • The Bofa, Being of the Sofa

            Besides, it’s not like we aren’t spending a lot of time studying things like peeing or pooping, despite having figured that out a long time ago.

          • Stacy48918

            I think she means like pooping. They really do like comparing babies to poop. Just think of Ina May’s sphincter theory.

          • DaisyGrrl

            And the lady in the Yonifest thread who compared a c-section to wanting surgery for constipation.

          • Cobalt

            If I had ten pounds worth of constipation, I’d want surgery. And lots and lots of meds.

          • Stacy48918

            That’s what chronically constipated/obstipated cats get – subtotal colectomies.

          • guest

            We had a cat once with megacolon. He was a stray that just showed up on our street, so the whole street adopted him and we all pitched in for his vet care. He would visit every house on the street and “pick” where he wanted to spend the night… He’d just sit outside the front door until he was let in!. He had personality plus! We started noticing he was straining to poop and passing small hard stools so we took him in. Poor thing was miserable, he had to be euthanized.
            🙁

          • Certified Hamster Midwife

            Aw, poor kitty. I love the idea of a neighborhood cat, though.

          • DaisyGrrl

            One of my cats had to get an enema once. I swear the vet and her techs had waaay too much fun with that! Kitty gets extra fiber now.

          • Certified Hamster Midwife

            I love having a vet who comments here.

          • Amy M

            That’s exactly what I was wondering! (and wrote below) And like you, I was also leaning towards the second.

          • Trixie

            She’s spraying out her armpits.

      • Trixie

        From the greatest hits file:

    • Guesteleh

      Amos Grunebaum. Sigh.

    • KarenJJ

      Rooks, Grunebaum.. Every year or so another name speaks out and starts building the professional documentation that shows that homebirth with unregulated and untrained lay midwives is a bad idea. This is great 🙂

  • Stacy48918

    And for all their “education”, I’ve yet to see a pro-NCB, pro-homebirth person address these studies in any way. They just completely ignore them. Like they ignore risk profiles.

    So frustrating.

    • yugaya

      They would have to add to their disclaimer pages sth like “while we support you and your choice to birth whichever way you like the most, please keep in mind that homebirth is never safer or even remotely as safe as giving birth in a hospital – neither for low risk pregnancies nor for pregnancies with known risk factors such as previous c-section, twins or breech.”

  • PrimaryCareDoc

    Grunebaum does it again with another kick-ass paper.

    28% of homebirths were post dates??? Holy shit.

    • Cobalt

      I didn’t think post dates was so common. It scares the crap out of me, but thankfully I never had to worry about it. I’m a total March of Dimes failure, my longest pregnancy only came within hours of 39 weeks. I grew them fast.

    • Dr Kitty

      Of course they were, because the competent HB MWs send their post dates clients to the hospital, meaning that a higher percentage of HB are done by the loons who think babies aren’t library books, 44 weeks is a variation of normal and there is no reason to seek OB care for a post dates pregnancy.

  • Ash

    There is a deafening silence in the NCB community about MANA stats death rate, Judith Rooks’ presentation, and Grünebaum’s study re: Apgar scores. I bring up these studies because aspects of them are them are easy to understand (number of breech baby deaths /total breech babies is very easy, as is the table by Rooks)

    Has “Midwife Thinking” or statewide CPM communities published any statements saying “Breech babies and multiples should never be delivered at home”? No! I don’t know if their members don’t bother to look or if they simply don’t care.

    • Amy M

      I remember seeing a discussion on mdc after the MANA paper and the Grunebaum papers were out, where people who had been considering homebirth were seriously questioning the safety. The situations that led to the most skepticism were breech and VBAC, because it was clear to several of the conversation participants that those things were appallingly dangerous at home. Of course, there were the “variation of normal” idiots and the “well, if your midwife sucks, that’s your fault for choosing her, you should have done your research” crowd, but the most frustrating were the ones who either couldn’t accept that there was an increased risk (crossing the street is dangerous!) or were just convinced that x bad thing would not happen to them because they (did their research/ate healthy/did yoga/whatever).

      Hopefully, as more papers like this come out, it will be harder for homebirth people to stick their fingers in their ears and go la-la-la when it comes to risk. They can do all the birth affirmations they want, but facts are facts.

      • Cobalt

        I’m seeing a lot of the same la-la-la stuff on my baby message board about SIDS. A lot of moms want to do tummy sleeping because they’re exhausted and babies do sleep better belly down, so they announce that there’s no real evidence that SIDS has anything to do with the actual sleep position as long as the baby has some head control. Because years ago doctors said belly down was better for preventing choking, and we’re still here. I’m afraid for them.

        • Fuzxy

          As someone old enough to have put all the babies face down to sleep, I can state that the reason face up babies don’t have fatal sleep apnea episodes is because they don’t sleep. Not the way face down, butt up in the air babies sleep…..

          I’ve watched babies have reflux and choke face up as well, and wonder what the science behind the increase in infantile reflux which requires medication previously not studied in this population is.

          In addition, I’ve noticed that face up babies take much longer to achieve simple milestones such as head and neck control, crawling, and quite possibly visual skills than their face down counterparts.

          Barbecue away: once the babies are 3 months old or so, we flip them if they haven’t been already, but most of our babies, who nap on their tummies if nothing else, can easily roll by then.

          • Cobalt

            Babies certainly almost always sleep better belly down, hence the increased risk of SIDS. It works so well that there is actually an extra increase in risk for tummy sleeping if the baby is usually a back sleeper.

            And I can understand wanting to go ahead and tummy sleep because you’re too exhausted and don’t have any other way to get a break. Extreme situations call for nonstandard measures, and the absolute risk is still very low. My issue is with denying the research and recommendations and making up justifications, and then telling others the risk isn’t real. Parenthood is full of calculated risk taking, it’s important to have accurate information to help manage those risks.

          • Stacy48918

            “My issue is with denying the research and recommendations and making up
            justifications, and then telling others the risk isn’t real.”
            This, exactly.

            With my second she started out back sleeping for all of like 3 days. Then I was so freaking exhausted it was just “SLEEP! However you want to sleep, just do it!” 😛

            I knew that, statistically, it increased the risk of SIDS to put her on her belly. I would never have denied that. But I needed the sleep.

            Folks that deny there’s any increased risk or want to pretend like there’s an equally awful trade off to back sleeping are information deniers. Like homebirthers and anti-vaxxers.

          • Young CC Prof

            Yes, definitely. The increase in risk from stomach sleeping is quite clear, however, it is small enough in absolute terms that it may sometimes be outweighed by other factors, including dangerous levels of parental exhaustion.

            For example, if my child needed emergency medical attention, and no carseat was available, I’d transport without if needed.

            And my baby suffered from reflux too severe to sleep in ANY position other than held upright by a parent for half an hour or so after each feeding. Vomiting, milk going up his nose, screaming. We didn’t medicate only because I had enough help to do this round the clock for a few months. If it had been any worse, or if it hadn’t gone away as he got bigger, or probably if I’d been on my own with him more, he’d have been medicated.

          • Cobalt

            I also wonder about any potential link between back sleeping and ADHD. Infancy is a time of rapid brain growth, and back sleeping does inhibit deep sleep. Does anyone know if this has been studied? ADHD is obviously a preferable outcome than SIDS, but I’m curious anyway.

          • Box of Salt

            Fuzxy “As someone old enough to have put all the babies face down to sleep” = “well, since I did it this way that’s no longer recommended, I’m going to make up a bunch of excuses to justify what I did.”

            “Barbecue away” I’m calling BS on every claim in your comment.

            Anecdata for moms worried about milestones: one of my babies spit up incessantly, was medicated for reflux (oh, the horrors of now being able to treat a problem instead of pretending it doesn’t exist!), slept ON her back without choking, and hit every infant physical milestone very very early.

            “Not the way face down, butt up in the air babies sleep”

            When I imagine the most peaceful image of a sleeping baby, it’s not the amusing rear end up of an active older infant, but the “W” image, with baby’s head facing to the side and both arms uprasised. My own mother concurs.

            Women who take your comments here seriously will put their own infants at increased risk.

          • Fuzzy

            No, I didn’t do it “the way it wasn’t recommended”. My point was that I am old enough that I was doing it the recommended way. I’m somewhat older than dirt, and my oldest is now 33….but I’ve been raising or watching children since I could toddle.

            The SIDS risk is increased because babies actually sleep face down, so a much greater chance of apneic episodes is present. As for your babies not choking face up, one of mine and my refluxy niece did just that. Luckily I was able to clear my son’s airway quickly. My niece still has problems due to aspiration causing lung damage as an infant.

            Just because statistics say something is safer overall, does not mean that it can be less than safe in an individual.

          • AlisonCummins

            The milestones stuff sounds like you’ve done some long-term follow-up on a randomized sample. Or like confirmation bias. Hard to tell. (Hard to tell for you as well as anyone else: confirmation bias is a tricky thing.)

      • Roadstergal

        Facts are facts – but unfortunately, stats are stats, and humans are poor at risk assessment. The majority of people who birth at home have it go just fine. The majority of people who put their kids belly-down will not lose their kids to SIDS. So not only will they feel good about their choice – they’ll feel a need to critique the women who do have losses, to feel reassured that their choice was not risky and the reason they did not have the bad outcome wasn’t due to plain luck.