Dr. Amy’ 5 reasons NOT to have a homebirth

5 reasons not to choose homebirth

Wow, it happened again!

No sooner did I write a post about confident idiots than one of them stepped forward to offer a perfect example of why, despite their certainty, they cannot be trusted. Thank you Jennifer Margulis for your new post 45 Reasons NOT to Have a Home Birth. It is a delightful amalgamation of the mistruths, half truths and outright lies tossed back and forth between clueless homebirth advocates, who actually think it is knowledge.

As Dr. Dunning of the Dunning-Kruger effect has noted:

What’s curious is that, in many cases, incompetence does not leave people disoriented, perplexed, or cautious. Instead, the incompetent are often blessed with an inappropriate confidence, buoyed by something that feels to them like knowledge.

Jennifer Margulis has ZERO qualifications to offer medical information on homebirth. She’s not an obstetrician, not a midwife, not a medical professional of any kind. She hasn’t delivered any babies, cared for any pregnant women, or managed any pregnancy complications. Her degrees are in English Literature, so she lacks the fundamental knowledge of science and statistics needed to read and analyze scientific papers. She appears to have no idea what the scientific literature says about anything, and swallows every lie that the Midwives Alliance of North America chooses to spoon-feed her.

What’s curious is that her utter incompetence when it comes to the field of obstetrics does not leave her disoriented, perplexed, or cautious. Instead, she is blessed with entirely inappropriate confidence in her conclusions, buoyed by something that feels to her like knowledge, but is actually unbounded ignorance, with a heaping helping of arrogance. She, a travel journalist with a PhD in English literature, actually fantasizes that she has more knowledge about the risks of homebirth than the tens of thousands of obstetricians, pediatricians, and neonatalogists who have done the research that shows that homebirth dramatically increases the risk of perinatal death.

Of course, you can’t expect much from someone who offered what has to be the single stupidest excuse ever when presented with evidence that homebirth leads to preventable perinatal deaths. When I asked her about Judith Rooks, CNM MPH analysis of 2012 Oregon homebirth statistics that showed that planned homebirth with a licensed Oregon homebirth midwife has a death rate 800% HIGHER than comparable risk birth, Margulis responded:

Amy, Oregon has some of the safest best homebirth stats in the country IF YOU DON’T COUNT PORTLAND…

Yes, she really wrote that.

I’m not going to bore you with the latest nonsense that Margulis recycles in her post; you are free to read it if you can stomach it. However, I will offer MY 5 reasons not to have a homebirth. It’s a much shorter list because it gets to the point immediately.

Dr. Amy’s 5 reasons NOT to choose homebirth:

1. A healthy live baby is your first priority.
2. You don’t want to take even the tiniest risk to your baby’s brain function.
3. You don’t need to impress other privileged Western white women with faux achievements.
4. You actually read the scientific literature.
5. You take medical advice from medical professionals, not confident idiots.

My 5 reasons are not particularly startling. They reflect the findings of ALL the scientific literature on homebirth, as well as state, national and international statistics. They reflect the mainstream views of ACOG and the AAP, as well as the overwhelming majority of obstetricians, pediatricians and neonatologists.

But, of course, Jennifer Margulis is confident, oh so very confident, that she knows better than tens of thousands of medical professionals. The only question for women contemplating homebirth is this:

Who are you going to trust for medical advice on childbirth, medical professionals or a travel writer who is inexplicably confident in her utter ignorance?

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  • Melissa Marsh

    This is why we need better home births supported by doctors, not less of them.

    • Guest

      Why should doctors support a practice that have been shown time and time again to result in worse outcomes for mothers and babies? Even “ideal” situations with highly educated midwives in an integrated system (The Netherlands) have worse outcomes than hospital births with OBs.

    • Happy Sheep

      Until a doctor can have an entire resus team, an OR and a NICU transported to your home, they will not be doing home births.
      There is a reason that Doctors and many CNMs do not do homebirths and it is because of bad outcomes. Some may claim it is due to their malpractice insurance and in a way it is – no one sues for a great outcome, only bad ones, and the data shows time and again that HB has more bad outcomes than equivalent births in the hospital.
      Any professional worth their salt isn’t going to voluntarily preside over births in situations that will increase the risk of a poor outcome and not because of insurance but because *gasp* they are human beings with actual hearts and they don’t want to see the pain and anguish that comes along with a bad outcome, let alone be partially responsible for it.

  • Kris Hawkins

    Ha! It must really piss you off to see so many of the reasons people don’t trust having their children at hospitals lined up in a row. I love how you don’t bother to actually refute the validity of her criticisms of modern medicine but instead just attack her with meaningless insults.

    • Who?

      It really does piss me off, Kris, because the lies of Ms Margulis and her ghoulish supporters kill and damage babies and leave bereft loss families who they shun for asking questions. But heck, if a literature major wants to criticise modern medicine, tell lie after fearful lie and make a buck doing it, what’s to stop her?

      I’ll call her out though, and support others who do the same, every time.

      • Kris Hawkins

        I don’t know much about Ms. Margulis and maybe she is a self serving liar. I couldn’t tell you. However I do know that from what I’ve read there is no reason for doctors to administer Hep B vaccines unless the mom had Hep B but they do… and babies die from it. According to WHO many of the women who receive epidurals, inductions, and c-sections don’t need them for medical reasons and yet they get them. I could go on and on. I am not a doctor. I love and trust my GP… its just a shame that last year they changed the rules in my city so he can’t deliver my baby anymore even though he has delivered hundreds. Therefore I have to try to find an OB. The first I go to spends approximately 5 minutes each appointment with me. Doesn’t explain anything to me and doesn’t listen if I tell him I am having a health problem. My new OB was recommended by my GP and so far he seems much better. However, of course there is not guarantee of getting him and not one of his partners. He explained that while he would, let’s say, leave the umbilical cord to pulse so my baby can receive the 40% of oxygen and blood they need to avoid anemia while they are taking their first breaths his colleagues would not generally do that. So he advised me several times to make a birth plan.

        I was critical of that idea because I feared that doctors and nurses would NOT appreciate it. Having been hospital after a terrible car crash I know how big a difference having care staff on your side can make. I also know (due to hours of research) how often care staff are doing things that are detrimental in L&D so I decided to take my OBs advice and make a birth plan (knowing full well things rarely go according to any plan but having real concerns and practices I want honored as long as there is no life threatening reason not to).

        That’s when I find your site. I can tell you that as a pregnant woman who is already nervous about all the horror stories of hospital births she has read, who is already concerted that any specific requests she has won’t be honored, and who has honestly wondered if she wouldn’t be better off just staying at home and trying to do it on her own (can’t afford to hire a midwife right now) but is too worried about the possibility of a medical emergency to do so finds your site. I can tell you it really made me think I should stay home for as long as I can and hope for the best when I read all these medical professionals who are unwilling to even consider that everything they do isn’t perfect, every woman who tries to form a plan based on her research is a nut and deserves to be ridiculed, and folks who want to try to do whats best for their baby are just misinformed idiots who need to shut up and allow doctors to do whatever they want.

        It really scares me just when I was starting to think maybe I could trust my new OB. I will bring him the birth plan HE asked me to write but I am afraid to share it with other hospital staff now. I also think I will try to stay at home and see how it goes. The last thing I want is an unnecessary c-section or for some potentially harmful procedure to happen to my baby against my wishes. So… considering is was never a green/crunchy/whatever the slang is before I got pregnant. Know that your website was the final tipping point for me to be totally afraid of going to the hospital. It certainly seem like your objective is the opposite so you might ask yourself, why? Why when my goal is to get people to not birth at home did a first time mom who was trepidatious get completely turned of by what I had to say. I hope that question is hard enough. I will take my idiot self elsewhere and leave all you folks to feeling good about yourselves.

        • Dr Kitty

          Kris, Hep B doesn’t work like that, you can’t just test mum, you need to test dad, grandparents, nannies and anyone the child will share a cup, straw, spoon or chopstick with.

          The most risky time for someone to contract Hepatitis B is in their first year of life, if you contract Hepatitis B before you turn 1 you have a 90% chance of developing a chronic infection. Vaccination at birth therefore gives the biggest decrease in chronic infections- the biggest bang for your buck- and is a very safe vaccination.

          If your population’s background incidence is very low, you can just target high risk babies (parents from endemic areas or in specific at risk groups). If your background incidence is higher (the USA) universal vaccination is more appropriate.

          The prevalence of Hepatitis B in the USA is 0.4%, at a minimum. Since 15% of people born in endemic areas may be carriers, some populations (urban, immigrant) will have much higher chronic infection rates.

          There are about a million people in the USA with chronic hepatitis B. Not all of them will be aware of that as a significant proportion will have no obvious risk factors and will never have been tested.

          http://www.ncbi.nlm.nih.gov/pubmed/19399791
          http://www.cdc.gov/hepatitis/statistics/2010surveillance/Commentary.htm
          http://www.cdc.gov/Hepatitis/Statistics/index.htm

          • Bombshellrisa

            Not to mention testing every surface the child will touch in a lifetime, Hep B really lingers on surfaces.

          • Roadstergal

            It’s really, really good at that.

            Sure, it can be sexually transmitted. And it can be transmitted in all sorts of other ways, too.

          • An Actual Attorney

            Also, kids bite other kids. And lick them. And share chewy toys. And share them with the dog. And lick the sidewalk.

          • Young CC Prof

            My child thinks that all toys are chewy toys. Including parts of other people’s bodies. I try to discourage that one, of course, but it’s going to be a while before that lesson “takes” reliably.

          • Kris Hawkins

            Dr. Kitty… here is my problem. I read an article saying that a leading immunologist admitted that basically all of the vaccines before the one year appointment were basically useless and to “train” parents to bring their kids to the doctor regularly. As if I wouldn’t bring my kid to the doctor as often as necessary!!!! The article talked about how the US gives more vaccines than anywhere else (26 in first year) and that our infant mortality is far higher than Sweden and Japan who give very few. It goes on to say that even in Vietnam they stopped giving Hep B after 3 babies died. Then I read your information here but here’s the thing. I know that myself and my husband don’t have it nor does my mother who will be my sons other caretaker. It is just SO frustrating when I had a GP who I could trust and who I plan to take my baby to once their born and I will take his advice very seriously and likely follow his recommendations but for the “big event” of delivery I have to trust total strangers. There is so much conflicting information out there. I would not have even felt the need to do this intense research had my first OB even given me simple dietary guidelines or any information about how to be “good” during pregnancy. Now I feel like no matter what I do… I will be making a mistake and I don’t know who to trust. Maybe the natural childbirth people are trying to make a buck off of playing on my fears but how are they profiting from it? I have not paid anyone. Why would WHO and these other organizations lie? When they say that doctors will do procedures like inductions to make things go quickly to satisfy HMOs are they wrong? What about making women lie on their backs? That has just never made any sense to me. Listen, I really appreciate any advise or info anyone can give me at this point. I don’t really want to give birth at home. That seems crazy. At the same time I need to advocate for what is best for my son. Even if I go through some painful unnecessary procedure I am okay with that as long as nothing bad happens to my baby that I could have prevented.

          • The Computer Ate My Nym

            Want to give a reference for that extraordinary statement or at least name the “leading immunologist”?

          • Kris Hawkins

            I just searched for the original news article I read but haven’t found it yet. I did find some non-news site that put the q & a from the article I read. This one doesn’t one the name of the doctor. http://gaetacommunications.com/site/?p=1092

          • Dr Kitty

            Non-news site…
            That’s one way to describe it!
            It’s quacktastic!

            I’m going to go out on a limb and suggest that a female immunologist with a PhD, who is anti vaccine is probably Dr Tetyana Obukhanych, author of “Vaccine Illusion”.
            http://www.amazon.co.uk/Vaccine-Illusion-Tetyana-Obukhanych-ebook/dp/B007AW2CLG

          • The Computer Ate My Nym

            So an unnamed immunologist says that vaccines prior to age 1 don’t work. Here are a couple of articles that disagree:
            http://www.ncbi.nlm.nih.gov/pubmed/25253666
            http://www.ncbi.nlm.nih.gov/pubmed/24843060
            http://www.ncbi.nlm.nih.gov/pubmed/24560676

            I’m only stopping out of respect for the spam filter. There are a lot more articles demonstrating that infants do mount an immune response to vaccination and that the repsonse is durable.

          • Dr Kitty

            You’re wrong about Vietnam by the way. Public confidence in the vaccine fell, but the government never stopped giving it, and the country is working hard to meet a target of 90% vaccination by 2017, which it is on track to achieve.

            http://www.path.org/publications/files/CP_vietnam_hep_b_fs.pdf

            I find your writing very hard to read.
            Paragraphs might help you better convey things.

            Maybe your OB, having realised your pregnancy was planned, you’re a non smoker with a normal BMI who already knows not to take drugs or drink to excess in pregnancy and didn’t really need their advice about diet.
            Perhaps they trusted you to look at appropriate sources of information?

            Personally, I just direct people to this website:
            http://www.nhs.uk/conditions/pregnancy-and-baby/pages/healthy-pregnancy-diet.aspx

            I only have in-depth conversations with people who either cannot understand that information or would have challenges putting it into practice.
            You strike me as someone who is smart enough to make healthy choices.

          • Kris Hawkins

            Sorry I am writing all this on my phone. I will go back and edit things. I’m not sure why that OB told me… nothing. Not just about diet but anything. He obviously didn’t remember me. Each time he asked me the same thing “is this your first?”. He listened to the babies heart beat, measured my stomach, and left.

            I really do know better than to just trust everything I read on the Internet. I love to research. I agree women who want to micro manage their births, who believe it is going to be some amazing pain free experience and expect their doctors to make that happen… are setting themselves up for failure.

            I expect it to HURT and be scary. I expect I may feel like “I can’t do this!” However, I am willing to go through hell if it means I’ve done the best for my baby. I know that doctors and nurses are there to save my life or my baby’s life. I want to trust them.

            Can you (or anyone) recommend a good book? Something that is sound and up to date? At this point I am concerned about vaccines. I am concerned about post labor procedures that will inhibit my ability to successfully breastfeed or will be more detrimental than beneficial to my boy. I am worried that if I accept an epidural it will make a c-section more likely or interfere with the bonding right after birth.

            I have lived though a lot of pain in my life I am prepared to suffer if need be. However, I don’t want to insist on nonsense that will hurt me or my baby based on bad information. There must be some resources that are balanced out there. I have spent hours and hours trying to figure this out. At this point I don’t believe I am discerning the valid information from the bad.

            Any help is appreciated.

          • Dr Kitty

            Kris- you sound a bit overwhelmed. This must be tough for you.

            You want to do the right thing, which is excellent.

            What I will say is that looking for “balance” when it comes to vaccines is a fool’s errand.
            The CDC, WHO, UK Public Health Agency employ really top notch epidemiologists, immunologists, infectious disease specialists and public health doctors. They carry out research and interpret it, making recommendations based on the best evidence.
            They have done all the heavy lifting, so you don’t have to.
            I, like most doctors, trust them about vaccines.
            I trust them so much that, like the vast majority of doctors, my child was fully vaccinated on our national schedule.
            I’m not asking you to do anything I wouldn’t do for my own child.

            I have cared for children who have been permanently and seriously disabled or killed by vaccine preventable diseases.
            Protecting your baby from VPI is a privelege.
            Please take advantage of it.

          • Who?

            If I could like this a hundred times I would.

            It’s like ‘balance’ on climate change: there is wide consensus among people who know all about it, and a few rowdy dissidents who get lots of airtime.

            So many people who really support the need for big changes in greenhouse gas emissions are also anti-vax. It hurts my brain to think how those two thoughts can be side-by-side in one head.

          • Bugsy

            “The CDC, WHO, UK Public Health Agency employ really top notch epidemiologists, immunologists, infectious disease specialists and public health doctors. They carry out research and interpret it, making recommendations based on the best evidence.”

            This.

          • Cobalt

            This is where a good childbirth education class is really helpful. Unfortunately, most “childbirth education classes” aren’t very good. Even ones run in hospitals can be taught by NCB advocates pushing ideology over outcomes.

            I’m not sure how to help, but I would try making a list for the doctor and requesting a longer appointment just to address your concerns. Sometimes you can schedule a consultation appointment and be booked for a longer slot.

            Go for semi-specifics: “What are the risks of an epidural to me? To the baby? What available pain relief options are lowest risk? What are your criteria for recommending a cesarean? For other interventions? What procedures can make my baby’s birth as safe as possible?” Tell the doctor that you are very risk-averse when it comes to your baby, your doctor is probably very risk-averse too. The difference is your doctor has seen thousands of deliveries after close to a decade of specialized education, they know what works.

          • Kris Hawkins

            I tried to find information for classes. The hospital ones are an hour and don’t cover much. A lady near me does the bradley method but she wanted $350 for it and between everything we have to buy and the very mixed reviews I wasn’t sure it was worth it. My town is pretty small. Right now, unfortunately, I as poor as I’ve been my entire adult life. My work in health care ended suddenly just before I found out I was pregnant due to my back completely failing me. At this point I am only able to do daily cares and physical therapy to avoid bed rest during pregnancy.

            Anyway I wish I could afford to invest more in classes but I’m spending every extra penny on high quality crib, car seat, organic mattress, cloth diapers, and nice used items for everything else. I never thought I would be so poor and pregnant at the same time. My husband and I had been trying for awhile and happened to succeed at the worst time.

            Wow, way more than I intended to get into. Anyway I will talk with my OB some more. His telling me to make a birth plan really brought up a lot of nervousness. How should I make all these choices with only the internet for guidance? How can I make sure it doesn’t just immediately annoy the staff if I don’t get him?

            Everything will work out I’m sure. I just have way too much time to think about everything.

          • Young CC Prof

            Some hospitals actually have a sort of multiple-choice birth plan posted online. Try looking for one of those to get an idea of what a realistic birth plan might contain.

          • toni

            Yeah a quickie appointment is probably a good sign, it means they aren’t worried about you. I understand feeling a bit short changed when youve been kept waiting over 45 minutes in the lobby and another half an hour in the exam room and all they do is measure your belly and use a Doppler. It worried my mother that they weren’t very thorough with me compared to when she was having babies . But maybe they just figured out that full obstetrical exams are overkill. They probably save the lengthy appointments for the women with complications or who haven’t quit smoking, have multiple sexual partners or obvious signs of abuse. Things like that.

          • Who?

            I agree.

            But this is where the m.o. of the alternative crew is so effective. Just like chiropractors, homeopaths and all the rest. They spend ages, make people feel cared for and valued, sell them some sugar water or whatever, and send them on their way. Has the added benefit of developing co-dependency, so if something bad does happen, the patient doesn’t feel they can sue their ‘friend’.

          • Who?

            Kris, I’m sorry I was too blunt with you earlier. I had you pegged as a routine troll. For anyone who is familiar with Ms Margulis’ ‘work’, seeing her enthusiastically defended is galling.

            It’s understandable you are frightened and anxious about what you’re taking on. Any thoughtful person would be. But as they say in investor world, ‘if it seems too good to be true, it probably is’. Anyone telling you they can guarantee you no interventions and a healthy baby and well you, is lying to you. Birth is a wild ride, the aim is to get through it. I understand it feels like a big event, and of course it’s important it goes as well as possible, but it is one day out of your whole life, a day that will soon be overshadowed by the rollercoaster of parenthood.

            Please don’t let your fear guide you to people who can’t care for you and your baby.

          • Kris Hawkins

            I don’t mind blunt. I appreciate it in fact! No need to apologize for that. I want the truth. Maybe the bulk of my research has been in the wrong places. I do want to strive for minimal procedures. Who wouldn’t? Surgeries aren’t fun. Being drugged up (in my opinion) is not fun.

            I want to face this with strength and courage but not foolishly so.

            I want answers with data to back them up. In school I could get articles with references and statistics. Now I am at the mercy of the internet.

            Should I vaccinate or not?

            Circumcise or not?

            The list is endless…

            I have my OB telling me to make a birth plan, so I do. Then I read several articles about how that will make me seen as difficult or a joke to my providers. I’m at a total loss.

          • Who?

            Truth is big.

            Surgery isn’t fun, drugs can be less un-fun than what they deal with.

            You’re stronger and braver than you think.

            The internet is not your friend, nor is it a suitable place for actual ‘research’. Conspiracies are notoriously difficult to organise and almost impossible to keep secret, so if a conspiracy is the basis for any thesis, reject that thesis.

            Vaccinate yes.

            Circumsision-we didn’t-noone did at that time-I don’t know what is recommended now.

            Talk to your OB about your birth plan-what happens if you don’t do it? Probably nothing. The boy won’t have read it, and he’s really a key player.

            Good luck, try to enjoy this time, go to the movies-you won’t see many for a year or two.

          • Bugsy

            The internet is a tough place. What shows up on searches isn’t necessarily reputable nor accurate, and (correct me if I’m wrong), Dr. Google’s top search results are based on popularity, not accuracy. It’s taken me a while, but I’ve been working on not simply trusting anything I see online, and instead trusting the experts who are knowledgeable in their fields.

            That being said, it’s darn near impossible to not take into account what we read online…even when it otherwise seems ridiculous.

          • Kris Hawkins

            I know it! I really do know better. My previous OB just… made me feel so rushed and like I was wasting his time if I brought up having terrible nausea, heartburn, etc. I wasn’t looking for a bunch of drugs but advice about diet or anything really.

            Therefore, since he brushed aside health concerns about me I really didn’t feel comfortable asking him lots of questions about the “big day”. To be honest I’ve always been terribly frightened about the whole thing. I know its supposed to be some natural wonderful thing but to me… it just doesn’t seem that way at all.

            So I’ve been trying to change my mind and attitude by reading as much as I can about natural childbirth and how to make the best of labor. With all the sites I looked at they gave tons of warnings about every medical procedure and why it would hurt me and my baby. I actually looked into a birth center near me but my insurance doesn’t cover it and the midwife is not even RN certified.

            The new OB does seem awesome. I’ve only met with him once so far though so I still have a lot to learn from and about him.

            I think perhaps I need to research outside of the natural birth stuff because I thought that it would ease my fears but it hasn’t.

          • Bugsy

            I’m so glad you found a new OB. The OB I had during pregnancy was great and willing to put up with my nonstop questions. It’s so important to have one that you like and trust. I was utterly terrified about the prospect of L&D as well.

            For what it’s worth, my OB’s nurse gave me some fantastic advice regarding labor and birth plans: “Go with the flow, because the reality is that birth is unpredictable. A birth plan (or too rigid of one’s expectations) can set you up for a lot of disappointment if it doesn’t go the way you intended.”

            I had an epidural at 7 cm, and hope to do the same for any future children I have, complications notwithstanding. Natural childbirth is great, but it just wasn’t for me.

          • Kris Hawkins

            The only reason I even care about going natural is if it will improve results for my son or prevent any cutting of my body. I went through many surgeries (had the bones in my dominant arm crushed… like to bits). They woke me out of the first most awful surgery with NO medication. I can honestly say I wanted to die. I no martyr. I will take drugs if its okay.

            I also don’t think that I can actually make anything happen when I’m giving birth. I can move around to help keep things going. I can try to relax and not tense up. However if you’re in insane amounts of pain you’re going to tense and not move around.

            I just hope that the folks who care for me will CARE enough to respect my wishes when possible.

          • Bugsy

            Wow, you’ve been through quite the ordeal.

            Regarding your OB care team respecting your wishes: if it’s any comfort, I think a lot more of them are supportive of labouring moms than are given credit for in internet forums. I generally felt very much supported by my L&D team, and most of the moms I know personally have similar stories. It seems like many of the most vocal moms online are ones who not only had a bad experience, but who feel the need to validate it repeatedly.

          • Roadstergal

            Echoing the comment below – can you tell us the name of the leading immunologist? I’m an immunologist, so I’d love to go have a nice little discussion with that ‘leader’ of mine about why they’re making inaccurate statements like that.

            (BTW, I’m fully vaccinated, including HepB, all of my boosters, and annual flu. My biologist mother made sure I had my childhood immunizations before I was old enough to take care of myself. Those things work.)

          • Kris Hawkins

            I’m vaccinated too. I intend to get my sob vaccinated but am worried that doing so that young before his own immunity is developed could be riskier than waiting. I am putting my own career on hold to stay home with him. Therefore the risk seems minimal. I have read many frightening stories about children dying, seizing, exhibiting signs of developmental issues not present prior to the shots.

            I have no way to know if these claims are true, any more than I can be sure when I read opposing view points.

            I do know that apparently lawsuits have given huge chunks of money to folks whose babies had adverse effects (unless that is a lie). To me money always tells a story. Why would courts rule against the medical professionals if they are not in the wrong at all?

          • Roadstergal

            There is a lot to break down in that one post.

            As far as developmental issues are concerned: there are indeed people who claim that their children had developmental issues after vaccination. In the cases where these claims could be investigated, signs of developmental delay were present prior to the vaccination. We all know now that Wakefield fabricated his data.

            There are some ‘table injuries’ that the vaccine court will compensate parents for, because it’s impossible to 100% rule out that they might have been caused by vaccines. They are vanishingly rare. The incidence of these events after vaccines are orders of magnitude less frequent than the incidence of these events after VPD. So if you want your child to avoid seizures, your best odds are vaccinating. (Oh, and they avoid VPD that way, too.)

            I highly recommend the book The Panic Virus as a nice lay guide to the anti-vaccination movement and some of the politics around it.

            Even if you’re doing the SAHM thing – childhood diseases are very contagious. HepB can live on surfaces for weeks. Measles is highly infectious. Etc. You can’t keep your kid in a bubble – and it’s not healthy to. The vaccines we give are constantly being improved, to the point where many of the shots have fewer antigens than they used to. All of the antigens your kid is exposed to through their childhood vaccinations won’t touch the number they’re exposed to when they fall and skin their knee, or get licked by the family dog, or put _that thing_ in their mouths _oh god spit that out it’s dirty!_ Etc. Kids’ immune systems have to put up with a _lot_, regardless of whether you vaccinate them or not. And if you do, they don’t have to put up with the daily deluge while dealing with a serious VPD.

          • Kris Hawkins

            Thank you for sharing that with me! Also, thank you to everyone who took the time to comment and reply to a pregnant woman at her wits end. I will take my birth plan to my OB as he requested. Maybe he can assure me as to whether certain partners/nurses will accept it or be turned off by it so I don’t shoot myself in the foot with a particular staff.

            I will talk to him about the vaccines and see what he says. It certainly seems like there are a lot more than when I was a kid but I’m sure he can tell me more about it.

            Who?- I will try to relax and enjoy this last bit of time before I am a mother. More than once I have cursed my own nature to research and study everything knowing I am using a flawed tool (the internet) to do so. However, I feel it is important that I learn as much as possible, even of sometimes I have to unlearn bad information.

            Thanks again to everyone. I will continue to explore all of these topics with my OB.

          • Dr Kitty

            I wish you all the best for a safe pregnancy and delivery, and hope your baby is healthy, happy and a good sleeper!

            If you ever want grumpy, blunt people to talk to, you know where we are.

          • Kris Hawkins

            I will Dr. Kitty. Thank you!

          • Bugsy

            And from me, three. 🙂

            A great book I recently read (and highly recommend) is Eula Biss’s “On Immunity.” She is pro-vaccination but does a nice job of laying out a nuanced description of vaccinations as well as the fears we feel as moms. I think it might be a great read for you!

          • Kris Hawkins

            Thanks! I will look it up.

          • Who?

            What Dr Kitty said from me too.

          • araikwao

            Although there are more diseases that we vaccinate against now, there are actually fewer antigens in total, because the vaccines are better. And ditto to everything Roadstergal said re the amount of stuff babies are exposed to on a daily basis. The childhood vaccination schedule is made to provide the best balance between getting babies immune to diseases as early as possible (leaving them the least vulnerable), giving the shots when they will form the most lasting response possible, and the lowest likelihood of adverse effects.

          • KarenJJ

            I’m not an immunologist but speak to immunologists regularly enough. I wish everyone had a chance to speak face to face to a practising immunologist at a teaching hospital. They’re awesomesauce and the ones I had were great at explaining things. They know so much about the immune system and underlying biology. And there is so much they don’t know, but they admit to not knowing, because they are careful to give facts and not make shit up. The idea that immunologists are secretly anti-vax etc goes against everything I’ve seen from my specialists.

          • Bugsy

            Kris, I was exactly where you were two years ago…I have a now two-year-old son, and was completely scared of vaccinations when he was born. A friend had told me of her son’s personality changes following the 4-month vaccinations, and when my little boy got sick after his 4-month Rotavirus vaccine, I was terrified.

            What has since made me a pro-vaccination activist were two discussions. The first was with a good friend who vaccinated her boys. I mentioned my fears to hear, and her reply was that while she’ll never _like_ the idea of injecting her perfect little boys’ bodies full of things she doesn’t understand, her dislike doesn’t mean that they’re not important. I’ve found this distinction helpful in that it separates out personal feelings from scientific thought.

            Our fears may be somewhat beyond our control; it’s how we act (or fail to act) to them that is in our power. The reality is that there’s a lot of medicine out there that I don’t understand; simply because I don’t understand it does not negate its importance.

            The second was taking an epidemiology course through Coursera (“Vaccines”) taught by Dr. Paul Offit. If it comes up again, I highly recommend it. Dr. Offit highlighted the personal stake he and other researchers have in vaccines. When they develop one, they feel so strongly about its importance that they vaccinate their own children with it first. For some reason, this point has really stuck with me, and reminded me of both the purpose and the safety of modern vaccines. I truthfully have yet to meet a doctor who willingly does not vaccinate his/her own children, which says a lot to me.

            I still don’t like watching my son get injections, and I doubt that will change. However, every time I hear of a new outbreak of a vaccine-preventable disease, I’m just glad I’ve done everything I can to keep my little boy safe. I wish you all the best.

          • MaineJen

            http://www.amazon.com/Epidural-Without-Guilt-Childbirth-Pain/dp/0975993933 A good factual resource about pain relief during childbirth.

            I get it. AS SOON as you get pregnant, you have people coming at you from all sides, giving unsolicited advice. If you have an OB you trust, that’s the only person you need to be taking advice from. 🙂

            I gave birth in a hospital twice…I took a tour of the family birth center before my first birth and it REALLY reassured me. I saw what intake looked like, where I’d have to go, what a L+D room was like and etc.

            What really helped me during my OB appointments was to come in with a list of questions in hand. That way I could ask the questions I needed to ask and I wouldn’t forget. They were probably “silly” questions looking back, but I needed sane advice from somewhere. 🙂 I agree with what others have said, a quick appointment isn’t a cause for concern, it’s a sign that everything is going smoothly. I am someone who needed a lot of matter-of-fact reassurances. The fact that the OB hasn’t discussed diet with you probably just shows that he/she is not concerned about you having adequate diet or weight gain!

            Labor…is unpredictable. The only sure thing is that it WILL NOT go the way you picture it in your head. It just won’t. You don’t know ahead of time how you’re going to deal with the pain…you could be fine with nothing, or you could be getting an epidural as soon as you walk in the door.

            Interventions are not just done for no reason. Doctors work in shifts…if your labor is long, you are simply handed over to the next person on call, there is no reason that anyone is going to “rush” you for their own convenience. That just wouldn’t make sense. You may be augmented if your water breaks early and labor is slow to start, or if the baby isn’t tolerating labor well, but there’s no way to predict whether that’s going to happen.

            A c section could happen. I imagine they’re not fun, but they’re also NOT done for no reason. In the moment, if it seems like the right decision for you and the baby, it probably is.

            For what it’s worth, I’ve had 2 epidurals, they’re not fun getting put in and they don’t always work perfectly, but BOY did they make labor more enjoyable. And they didn’t slow things down at all for me (I pushed for 10 minutes for #1 and less than 5 minutes for #2); I think the most recent data shows that they make labor longer by only a matter of minutes.

            Breathe…you will do fine. 🙂

        • yentavegan

          Kris, I admire your honesty. There is so much negatively tinged information about the process of labor and birth it is completely understandable why a mother to be is fearful and mistrusting of the “experts”. If I can share with you briefly my 5 different experiences with the births of my 5 children and re- assure you that the common denominator was serenity. I knew with an unshakable certainty that my doctors really truly professionally knew what they were doing. I knew that we all had the goal of delivering a health infant and bringing me through the process with the least amount of damage. I;ve had induced births, c/sec’s, and natural intervention free deliveries. All under the careful professional medically liable watch of a hospital staff. I implore you do not yield to the fear and mistrust of those who tell you that doctors are scalpel wielding money hungry control freaks.

          • Kris Hawkins

            Thank you! I truly don’t think most doctors are bad people!! However just like any profession there are good and bad. I know they are under a lot of pressure and it is their job. What will be a life changing, pivotal moment for me will be another day for them and the nurses who care for me. I worked in the health care field for some time. I know most folks are in it for the right reason. I knew some that I worked hard to get rid of (I was in management). I knew many who just burned out. I never would have expected there to be SO much controversy over seemingly every L&D practice. So much contradiction in the information available to women. I would love to have no fear that getting an epidural wouldn’t mess up my labor or cause problems for my baby. Who wants more pain than they have to have?

          • yentavegan

            I have learned that whether or not a mother experiences excruciating pain during a normal labor is a genetic roll of the dice. You can not predetermine or avoid how you will experience labor. I had two of my 5 births with epidurals and my kids are 100% normal, breastfeeding was not difficult . For me, there was no negative side effect from the epidural.

          • Kris Hawkins

            That’s a relief to hear. My OB had just convinced me at my last appointment that while he agreed with all of my concerns that the research I had about epidurals was outdated (haven’t talked to him about vaccines). It is a nice thought that if I was out of my mind with pain I wouldn’t be a bad mother for taking something.

            Honestly I found this site when I was trying to ask if healthcare providers will really read a birth plan… since my OB asked me to write one. I was tired and had just read articles (which I agree have questionable validity). I was confused and just… angry that there seems to be no right answer. That no matter what I do some group is out there to tell me I am wrong and that I am putting my baby in danger.

            I just want answers. There are no perfect facts… I know that. There is always a chance that what works great for 99% will backfire for 1%. I just want to make informed decisions.

          • Who?

            Pregnancy is a great preparation for parenthood.

            You’re facing a lifetime of not knowing whether you’ve made the right decision. There are no invariably right decisions, just ‘best’ or ‘best for me/us today’ or even, unfortunately sometimes ‘least worst’.

          • DaisyGrrl

            Re: epidurals. I suggest you read through the comments to this post: http://www.skepticalob.com/2014/11/the-liars-at-lamaze-epidural-edition.html and pay particular attention to anything theadequatemother says. She’s an anesthesiologist, and also has a blog that’s listed on the blogroll to the right. Her blog has some excellent posts on epidurals and the benefits and risks. Another great blog is Doula Dani’s blog (heck, they’re all great blogs). She discusses various tropes of the natural birth movement and refutes them with facts.

            For the birth plan, there seems to be a common theme among birth workers that the longer the plan, the more likely the mother will end up with a c-section. I suspect this is because the mothers in these cases are so focused on giving birth *their* way that they don’t want to listen to the professionals when they suggest interventions. By the time they agree to an intervention, complications have progressed and worsened and so a c-section becomes necessary.

            That being said, there’s nothing wrong with having a plan so you can make some preferences known. Some hospitals have sample plans or forms you can fill out to state your preferences. If your hospital has a form, use that. The staff will be used to looking for info in a certain place, and it will be easier for them. If not, maybe you can come up with a list of your top preferences and have that ready to discuss with your doctor. I suggest avoiding the word “unnecessary.” That word will telegraph to the medical staff that you don’t trust their medical judgement and set you up for an adversarial relationship.

          • Kris Hawkins

            Thanks for the info! I will read through these. In the plan I wrote I put an “introduction” of sorts thanking everyone who works with me and letting them know that while there are things I feel strongly about I appreciate that they are the experts and that I understand things rarely go according to anyones plans. If it wasn’t for the introduction my “plan” would be much shorter. I really don’t want to alienate anyone working with me.

            I also don’t want things to happen that I was against if there was no medical reason for them to happen simply because I’m in too much pain or whatnot to properly express myself or notice them happening.

            Having worked with people my whole life I can understand why doctors and nurses may be offended by a birth plan. I really do. I know what it is to work with people who you have to obey even though they are shooting themselves in the foot and belittling you for it throughout. I have no intention of being that person.

            I think it is a hard line for modern mamas who aren’t all “and I will wear silk pajamas while listening to Bach amid tulip scented candles as I lovingly gaze into my nether regions and blissfully birth my child with no assistance whatsoever” but who do want to, lets say walk around, breastfeed as soon as possible, wait for the cord to be clamped.

            I think a lot of primadonna people have caused healthcare providers to fear and ridicule folks who have some birth preferences because they don’t want to be undermined and fought at every turn. I can appreciate that. There are a lot of unreasonable people out there.

          • DaisyGrrl

            I really think there’s a difference between the birth plan that dictates everything in a way that says “I know better than you” and a way that expresses preferences for how you would like things to go if possible. It sounds like you are sensitive to this so I’ll say no more! 🙂

            As for epidurals, you won’t know if you’ll want one until you’re in labour, so just go with the flow. Hopefully theadequatemother’s info will help ease your mind about getting one if you want one. And don’t forget that your needs are just as important as your baby’s needs! He’ll need a healthy, happy, well-rested mum so don’t shortchange yourself in that department.

            I wish you a normal, uncomplicated labour and delivery and many happy years ahead with your new little one!

          • DaisyGrrl

            I just realized that Doula Dani’s blog isn’t linked to her name in the blogroll. Her blog is What Ifs and Fears are Welcome. whatifsandfears.blogspot.com

        • birthbuddy

          How does a Hep B vaccine kill a baby?

          • Bombshellrisa

            The same way vaccines cause autism! Don’t you know they are evil?!

          • Poogles

            “How does a Hep B vaccine kill a baby?”
            “The same way vaccines cause autism!”
            Indeed: http://www.howdovaccinescauseautism.com/

  • john

    My name is yurich jerry am from USA. i want to use this opportunity to thank my great doctor who really made my life a pleasurable one today. This great man DR.Ogboni brought my husband back to me, i had three lovely kids for my husband, about four years ago i and my husband has been into one quarrel or the other until he finally left me for one lady. i felt my life was over and my kids thought they would never see their father again. i tried to be strong just for the kids but i could not control the pains that torments my heart, my heart was filled with sorrows and pains because i was really in love with my husband. Every day and night i think of him and always wish he would come back to me, until one day i met a good friend of mine that was also in a situation like me but her problem was her ex-boyfriend who she had an unwanted pregnancy for and he refused to take responsibility and dumped her. she told me that mine was a small case and that i should not worry about it at all, so i asked her what was the solution to my problems and she gave me this great man email address. i was doubting if this man was the solution, so i contacted this great man and he told me what to do and i deed them all, he told me to wait for just two day and that my husband will come crawling on his kneels just for forgiveness so i faithfully deed what this great man asked me to do and for sure after two days i heard a knock on the door, in a great surprise i saw him on his kneels and i was speechless, when he saw me, all he did was crying and asking me for forgiveness, from that day, all the pains and sorrows in my heart flew away,since then i and my husband and our lovely kids are happy.that’s why i want to say a big thank you to DR.Ogboni spiritual temple. This great man made me to understand that there is no problem on earth that has no solution so please if you know that you have this same problem or any problem that is similar, i will advise you to come straight to this great man. you can email him at: ogbonispelitemple@hotmail.com ,,…,.,.

  • SandraDee

    Wow guys thanks for the links! I will definitely have a look at some of this. Certainly some firey debat happening too! Seems like some very dedicated people on both sides. Although I never realised that home birth was such an issue because I think its not the same in my country. Anyway thank you to those of you who have been helpful, I still don’t know what is fr the best but I suppose it’s not a snap decision is it?

    • Bombshellrisa

      Hello again-remember that if you aren’t in the US that homebirth may well be an option for you with trained attendants. In the UK, Australia, The Netherlands, Canada or New Zealand, all midwives have the same university level training. Not so in the US-the large majority of midwives who attend homebirths have never attended university and have no medical training at all.

      • araikwao

        Australian data still.shows a 3x increase in neonatal?perinatal mortality, IIRC. RANZCOG specifically recommends against OOH birth.

      • Stacy48918

        Though in those countries, with increased education it may still carry a higher risk of death than comparable hospital birth. As we know, low risk birth with a midwife is more dangerous than high risk birth with an OB in the Netherlands.

        Less bad than in the US…but still not “as safe as hospital birth”.

        • Bombshellrisa

          Oh exactly. I am hoping that where ever she is, that the midwives are more the professional kind who do strict risking out. I especially hope that she isn’t in New Zealand, we have seen the quality of the midwives there and I am not impressed

  • SandraDee

    I am currently 20 weeks pregnant and planning a home birth. This article is making me doubt it, but I’m not totally convinced by the way which Dr Amy portrays it having heard about my sisters recent experience with home birth care – which was immensely positive. Does anyone know of some less commercial material I could have a look at? At a loss here trying to make my decision, HELP!

    • Young CC Prof

      The fact is, most women who have a home birth report a positive experience, because most births turn out basically OK with or without any real help. About one time in 10, however, something goes wrong, and then if you’re lucky it’s a frantic rush to the hospital, and if you aren’t lucky you or the baby suffers serious harm.

      What kind of information are you looking for? If you want another perspective, try this blog, from a doula who became concerned about certain issues within the home birth community: http://whatifsandfears.blogspot.com/

    • moto_librarian

      SandraDee, I can honestly say that Dr. Amy’s writing are NOT commercial material. She is retired and does not have any financial stake. Groups like Lamaze, MANA, and ICAN, on the other hand, cannot exist without people purchasing their products and services. Given that the home birth rate is still hovering around 1% in the United States, this does not represent a danger to obstetricians, CNMs, and hospitals either.

      Here are some things that you need to ask yourself and (most importantly) your provider before you decide to home birth:
      1. Is this your first baby? If not, have you had a previous successful vaginal delivery with no complications? Women who do not have a proven pelvis are not good candidates for home birth.
      2. What are the credentials of your midwife? Is she a CNM? If she is anything less than a CNM (meaning CPM, DEM, or even LM), you are relying on a class of provider that does not meet the clinical and education requirements to be a midwife in any other industrialized nation.
      3. Does your midwife carry malpractice insurance? This is important, because if something goes wrong and your child dies or is disabled, this is the only way you will get any financial recourse.
      4. How many births has your midwife attended? Realize that CNMs and OBs will likely attend close to 1000 births before they are fully trained. If your midwife has attended far fewer than this, you should be concerned.
      5. Does your midwife adhere to her scope of practice? Meaning, has she done the necessary testing to verify that you are truly low-risk? Does she monitor your blood pressure and check your urine for signs of pre-eclampsia? Did she recommend testing for gestational diabetes? Has she sent you for an ultrasound to be sure that your baby doesn’t have any congenital defects or problems with the placenta/cord? Does she refer patients who have breech babies, twins, or who go postdates? Will she test your for Group B Strep and refer you to the hospital for antibiotics if you test positive?
      6. Have you met her backup OB? Do you know which hospital you will transfer to in the event of an emergency? Have you preregistered at that hospital?
      7. How will your midwife monitor you during labor? How long will she let you labor after your membranes rupture? How will she monitor your baby? What will cause her to transfer you?
      8. How will she manage a sudden emergency? If the baby gets stuck, what maneuvers will she use to resolve it? If you start to hemorrhage, does she carry pitocin? If your baby isn’t breathing, how good is she at rescuscitation?
      9. Generally, does she seem to have an adversarial attitude towards doctors/hospitals? If so, you need to investigate this carefully, because if things go wrong, you need to be able to trust that she will give accurate information and records to the medical staff when you transfer.
      10. Has your midwife had any poor outcomes? Has she lost any babies? Have any of the babies that she has delivered been brain damaged or physically injured during birth?

      I am not a doctor, but these are the things that you need to think long and hard about before you go with a home birth. It is possible to have a beautiful unmedicated delivery in a hospital – I had one with my first. I will also tell you that had I not been in the hospital, I would be dead. I had a cervical laceration that caused a massive pph that required surgical repair. Because I was in the hospital, my CNM was able to get me into the OR with an OB within minutes. Our son also had some breathing problems and went to the NICU. While he probably would have been okay, a home birth midwife would have been in real trouble dealing with one emergency, let alone two.

    • Bombshellrisa

      Hi SandraDee, welcome!
      Has your midwife had you sign any contract of care? Reading over those very carefully can tell you a lot about what you may or may not be getting with prenatal care, also if the midwife and your chart will accompany you to the hospital if there is a need to transfer and any additional fee for the midwife going to the hospital with you (most midwives do charge extra to stay at the hospital with you if there is a transfer, the ones I trained with charged between $750 and $1000)
      I have found this ebook to be helpful to others who want info about home birth but not from a doctor. It’s called “From Calling to Courtroom” and it’s written by midwives for midwives, primarily those who practice as CPMs and who only attend home births. http://www.fromcallingtocourtroom.net

    • Ellie

      I would advise you to look to the government statistics wherever you’re from. Also maybe have a look at some literature on both sides. I think that home birth can be scary and the rates (depending on health care systems) of perinatal mortality do vary. I would also ensure that your home birth practitioner is up to scratch. The list which moto-librarian has put up is a very good guide if you’re here in the US but may not be so relevant elsewhere! Do not take what you’ve read here as absolute truth. Dr Amy is not very well thought of in some circles and her writing is less information and more anti-home birth propaganda, although she would have you believe it was gospel! Good luck with your choice, do whatever is best for you and whatever you feel most comfortable with.

      • The Bofa, Being of the Sofa

        Dr Amy is not very well thought of in some circles and her writing is less information and more anti-home birth propaganda,

        Really?

        My impression is that she has a lot of posts that are pretty much straight informational content only, and they are generally very scathing to the homebirth crowd. Which probably explains why no one from the homebirth crowd bothers to comment in those posts, and focus on those where we discuss personal stories, not to provide any real insight but to whine that Dr Amy would mention those stories as examples of situations gone bad.

        • Ellie

          Well naturally that will be the impression of one of her legions of supporters, but you can hardly argue that she has a balanced view now can you? She also hasn’t had a medical license for over 10 years. So technically calling herself an OB isn’t all that accurate. If an article is scathing it isn’t going to be only information is it? Its going to be taking a stance.
          I personally much prefer to get my information from statistics that are straight from the source and not to trust a jaded second party to confer them to me.
          Just a thought from a logical person.

          • The Bofa, Being of the Sofa

            Well naturally that will be the impression of one of her legions of supporters,

            Personal Insult #1

            but you can hardly argue that she has a balanced view now can you?

            In what way is she not?

            If the data support one side of the equation, saying that and supporting that side is not unbalanced.

            This is just like saying that a biologist is giving an “unbalanced” viewpoint by teaching evolution and not creationism. Given that there is no credible evidence for creationism, it’s not bias to say that.

            She also hasn’t had a medical license for over 10 years.

            True, but then again, the information she provides is overwhelmingly the mainstream position of the ACOG, and thus reflects the position of working OBs, so there goes that objection.

            Besides, OK, she hasn’t been working as an ob for 10 years, and even if we assume that she has done nothing since then (Hint: she has; she spoke at an ACOG conference just last year), what are the qualifications of the other sources? Have they ever been to med school ever? Or are they just lay midwives with no medical training?

            Besides, as noted up above, it’s not Dr Amy’s data, it’s other people who are doing these things, and she’s talking about their work.

            Amos Gruenebaum has the same conclusions as Dr Amy and he is a working clinician and research active OB. Are you going to try to ad hom him, too?

            So technically calling herself an OB isn’t all that accurate.

            Nonsense. She isn’t licensed, but she’s still an OB. But I will note for the record, personal insult #2

            If an article is scathing it isn’t going to be only information is it?

            It’s the data that’s scathing, irrespective of what the words are, so it doesn’t matter what stance anyone takes. The question is, what do they data tell us? And the data against homebirth are scathing.

            I personally much prefer to get my information from statistics that are straight from the source

            You realize that is what she does in those informational posts, don’t you? She tells us, “Here’s what has been published in a recent paper” and she links to the paper.

            You should like that, I would think.

            and not to trust a jaded second party to confer them to me.

            She provides the original data, so you can look at it yourself and you are welcome to come back and tell her what she got wrong. Oddly, all those NCB supporters who are supposed to be providing that balanced view don’t do that.

            Read Doula Dani’s blog above, and read about her transformation from homebirther to not. This is one thing she actually comments on – she showed Dr Amy’s comments about the data to her NCB friends and asked, what’s wrong with it? They didn’t answer, all they did was to attack Dr Amy.

            Kind of like what you are doing here.

            Just a thought from a logical person.

            “she doesn’t have a license therefore it’s not accurate to call her an ob” is an example of logic?

            Then again, personal insult #3. Fuck off.

          • auntbea

            DDDAAAAAAAMMMMNNNN, Bofa.

          • Ellie

            You find the fact that being a supporter of her is an insult? Interesting. And probably the most accurate thing you said. She doesn’t have a balanced view. She is anti home birth and posts majorly home birth negative material and ramblings. When I say other sources I’m talking about academics including doctors, nurses and midwives who actually have their material reviewed by independent parties, rather than having to make her own blog to have a platform for it. She is not an OB that implies she is practicing it would be more accurate for this to be called skepticalbutretiredobwhosskillsprobablyarentuptodateandlivesonahighhorse.com
            Data can’t be scathing, it is numbers and facts and is therefore unable to embody any kind of feeling so it must be the way it is portrayed. I do agree with you that she is scathing which is probably why she doesn’t get published in journals. I prefer to see them as they are reported first rather than through Dr Amy’s lens. Dr Amy looks only at some of the data and portrays home birth as something which it is not. I’ve never actually read any of what you call propaganda from pro home birth parties and I still think all this about what I read here. Because I have gone straight to the actual academia.
            Once again she is a retired OB personally I find it an important distinction. Would you rather have an OB or a retired OB attending your birth?
            Hmm Fuck off? Very grown up. Good point well made. You should be proud.

          • The Bofa, Being of the Sofa

            You find the fact that being a supporter of her is an insult?

            No, I find your implication that I have that impression because I am a supporter of her to be an insult.

            Because it is, just like your implication that you are the the logical one …

          • The Bofa, Being of the Sofa

            Dr Amy looks only at some of the data and portrays home birth as something which it is not.

            OK, so what data is she overlooking?

            Come on. Instead of crying about how she does it, bring it on.

            Put up or shut the fuck up. I am so tired of this nonsense.

            You are a fucking creationist whining about those evil, biased biologists. That’s all you are.

            You wanted doctors. I gave you Amos Gruenebaum. You completely ignored it to whine some more.

            Where’s all this DATA that supports the safety of home birth?

          • Ellie

            All you have to do is look into any recent research on home birth in academics. Try Google scholar. And if you can (although I doubt it) try it with an open mind. You gave me Gruenebaum, I’m still not convinced. I really am not anti hospital birth, ive had three very positive hospital birth experiences. I just find myself questioning Dr Amy. You’re tired of people opposing your views? How sad for you. My original point was only to look at some literature which wasn’t spun from dr amys crap factory, which is clearly a big problem for you. Afraid of what else is out there for people not happy to get their info from one place? Again sad.
            I’m not a creationist I’m an agnostic, I really have no interest in what you think I am or am not.
            Its quite clear that this little online world means an awful lot to you. So I’ll stop agitating you. I’ll go out and do some real work actually helping people, as a nurse, which is my job, instead of spending my life behind the keys of a message board.
            Where, incidentally, absolutely zero percent of what you say is of any real significance.
            I wish you a happy ignorance.

          • moto_librarian

            Why don’t you try reading some of the studies that Dr. Amy links to in her posts? If that is too difficult, plug the titles into Google Scholar. If you’re as educated as you claimed, why can’t you find some research that disproves Dr. Amy?

            I too am tired of idiots who parachute in here, bitch and moan about how Dr. Amy is “meen,” and then flounce because they can’t back up their claims. It is tiresome.

          • The Bofa, Being of the Sofa

            I too am tired of idiots who parachute in here, bitch and moan about how
            Dr. Amy is “meen,” and then flounce because they can’t back up their
            claims.

            It’s not even that Dr Amy is mean, it’s the claim that Dr Amy is ignoring really important data that shows how wonderful homebirth is, but then, when asked to provide that information, they run, duck, shuck and dive more than Mohammed Ali doing the Rope-a-dope.

            Man, given how much these people hate Dr Amy, you would think they would dying for the chance to prove her wrong. They claim that the data is there to do it, but no one ever provides it. Imagine the hero you could be if you were the one to expose Dr Tuteur?

            If I were an NCB/HB advocate and hated her so bad, that’s what I’d be doing. I would be loading up with all the data and piling it on her. I wouldn’t be just claiming that there is data and that everyone should go find it. No, I’d be doing my damndest to expose her panties and then I’d run them up the flag pole for everyone to laugh at.

            Assuming, of course, I had the goods. Maybe that’s the problem?

          • moto_librarian

            And Google Scholar? Is that the best that you can do?

          • PrimaryCareDoc

            That’s where all the really smart people get their info.

          • Stacy48918

            YOU are the one making the claim about this vast information that’s being overlooked and you can’t even be bothered to give us one teeny tiny link?

            Pathetic.

            Flounce away.

            ETA: And it’s of tremendous significance. As a direct result of reading THIS BLOG I have changed my view on homebirth. I have had a homebirth before and I refuse to ever again. It is too dangerous and I will not jeopardize my child’s life that way. THAT is the significance of this blog. If you can’t provide something substantial to stand up to that, why should I care what you think about anything?

          • Roadstergal

            In a fraction of the time you’ve spent keyboard-bashing, you could have posted a few links to articles. Really. If you have all of these good papers right at your fingertips, stop wasting time yelling at us for being closed-minded and post the dizam links. I read papers. I like papers. I find good data convincing. I find the lack of good data 100% unconvincing.

          • birthbuddy

            Please don’t go Ellie.
            I want you to please provide one (only one required) example of false information provided by Dr Amy’s crap factory.
            Alternatively, please provide evidence (proper evidence) supporting the safety of homebirth.
            Take your time.
            Just one example required.
            I’m waiting.

          • birthbuddy

            Still waiting.

          • birthbuddy

            Just one.

          • Samantha06

            *crickets*… I think she’s flounced…

          • The Bofa, Being of the Sofa

            Probably, but it doesn’t matter.

            Of course, now what she’s going to do is to go around telling people how Dr Amy’s Minions were all meen to her and called her names and still ignore all the data in support of homebirth.

            She won’t mention the fact that multiple commentors asked her to provide all this data that we and Dr Amy were supposedly ignoring and that she refused to provide it. She also won’t mention that no one resorted to insults until after her comment that was loaded with insults and ad homs.
            She was out of her league here. It’s not just Pablo’s First Law that took her down, it was the fact that readers here don’t put up with fluffery. You start weighing in here, you better know what you are talking about or you are going to get torn to shreds. Some people can deal with that, others can’t, and just dig their hole deeper and deeper.

          • Samantha06

            Yep.. and her responses were not factual and she engaged in personal attacks, which only served to discredit her even further.

          • birthbuddy

            And…….waiting.

          • The Bofa, Being of the Sofa

            Afraid of what else is out there for people not happy to get their info from one place?

            WHAT ELSE IS OUT THERE????!!!!!

            You keep talking about all this information that Dr Amy is missing, but where is it?

            Come on, Oh Wonderful Goddess of Logic, tell us the information that is being missed. It shouldn’t be hard, because you claim it. And don’t tell me “Google Scholar” tell us something specific.

            You whined about Dr Amy not being an actively practicing OB, so I gave you Gruenebaum. Your “not convinced”? About what? Come on, assuming you know your Google Scholar, you should have already known about him. So what’s your complain? He’s a practicing OB, and he agrees with Dr Amy. Actually, Dr Amy agrees with him, is probably the better description, since he’s the one doing the studies.

            What is there to not be convinced about Gruenebaum?

            And you are exactly a creationist. You are complaining that the evil scientific establishment isn’t balanced because they don’t give any credence to the creationists. If that’s not what you think, why not? Because it’s exactly what you are doing here.

          • PrimaryCareDoc

            Forget it, Bofa. If she;s not convinced by Gruenebaum (a licensed, practicing OB at Cornell with excellent research published in high impact journals), she’s not going to be convinced by anyone. You’re wasting your breath.

          • The Bofa, Being of the Sofa

            Yeah, but I needed that. The whole “just an opinion of a logical person” really set me off.

            But look at my first rebuttal. Although I pointed out her insults along the way, I actually did address her comments in full. It was after strike three at the bottom that I went off. And her reference to my fuck off comment about how that was real reasoned was ironic, considering that I pointed out three insults she included in her comment. The difference is that I didn’t try to hide my insults of her with silly passive aggressive language.

            So typical of these dolts.

            Of course, you are right. “I don’t believe Dr Amy, she’s not a Real Doctor (TM).” OK, you’re wrong, but how about Famous Amos? He’s a Real Doctor, and he says the same thing as Dr Amy. “I don’t believe him, either.”

            IOW, this crap about how Dr Amy is not a practicing doctor and that is important is all an excuse. Being a doctor doesn’t matter in the least. She’s admitted it. But it’s easier to put up a smoke screen to divert the attention away from that.

          • Samantha06

            If you are a nurse, as you say, you’re an embarrassment to the profession.

          • Sue

            ”All you have to do is look into any recent research on home birth in academics. Try Google scholar.”

            Sure, let’s try.

            There’s the UK Homebirth study, published in BMJ, and the Australian public homebirth study, published in the MJA. Both show an excess neonatal mortality of at least X3 in comparison with euqivalent-risk hospital births. And they don’t even report hypoxic injury.

            Both are seachable on Google Scholar. Read the full papers -you could then come back and present your critical review of both papers. Many here have already done that.

          • Guestll

            The flounce. You need to stick it.

          • moto_librarian

            MANA’s OWN DATA shows a higher perinatal mortality birth for home birth than for high risk hospital birth!!! That fact is inescapable. Dr. Amy has no skin in the game BECAUSE she is no longer practicing. It’s not like home birth is depriving her of patients and income. Since the vast majority of misinformation about home birth is coming from blogs, why shouldn’t Dr. Amy use her blog as a means of linking people to the actual evidence that factually demonstrates that it is unsafe?

            But by all means, whine about her tone. I guess we’re all just a bunch of silly wimmenfolk who can’t be bothered with facts and truth.

          • Bombshellrisa

            Dr Amy asserts that women have the right to home birth, but they need to know and understand the implications and risks of doing so with a CPM.

          • Poogles

            “Data can’t be scathing, it is numbers and facts and is therefore unable to embody any kind of feeling so it must be the way it is portrayed.”

            “Scathing” is not a “feeling”. Data show the increased mortality rates of homebirth, which is a scathing indictment of the safety of homebirth – no feelings, opinions or criticism needed, just the “numbers and facts”.

          • The Bofa, Being of the Sofa

            Once again she is a retired OB personally I find it an important
            distinction. Would you rather have an OB or a retired OB attending your
            birth?

            I wanted to jump on this stupid comment, too.

            Where has Dr Amy or anyone suggested that SHE attend a birth? In fact, she never says anything of the sort, it’s just your dumbass imagination again.

            In fact, if you asked Dr Amy, I bet she would tell you don’t deliver with her, and use a qualified practitioner in a well-equipped and safe location. Like with a practicing OB in a hospital Or with a CNM in a hospital with OB oversight.

            So you claim to be Super Logic Woman, but you apparently have a Strawman Sidekick.

          • Sue

            Personally, I would prefer a retied OB to an HBMW any day!

          • The Bofa, Being of the Sofa

            She didn’t give that as an option.

            But yeah.

          • Samantha06

            Love it, love it, love it!

          • moto_librarian

            If somebody like Robert Biter can still go around calling himself a “doctor” after being stripped of his license to practice medicine for malpractice, I fail to see why a doctor who retired in good faith cannot refer to herself as an O.B.

          • Insider

            I wonder whether Ellie can appreciate the hypocrisy of her claim that Dr. Amy is not “technically” an OB. Dr. Amy practiced as a licensed OB during a long career, attending thousands of births. Yet many midwives practice without having obtained a license in the first place. Are those midwives without a license “technically” not midwives?

            Take Christie Collins for example. Christie called herself a “midwife” in California, but she pleaded guilty to practicing midwifery without a license (she had at first been charged with practicing medicine without a license). She then fled to Nevada, a state that does not license midwives at all. While practicing as a “midwife” in Nevada without a license, Christie’s incompetence led to the death of a baby.

            Would Ellie deny that Christie is a midwife, even though she isn’t licensed currently, has never held a license in any jurisdiction, and is so incompetent a birth practitioner that she caused a baby’s death?

            Take Jan Tritten, the owner and editor of Midwifery Today, for another example. Jan hasn’t had an active midwifery practice since 1989, and she attended during her practice a mere 300 births. Jan continues to call herself a midwife.

            Would Ellie deny that Jan Tritten is a midwife, even when she hasn’t practiced midwifery in a quarter century and has attended far fewer births than Dr. Amy?

            Yet Ellie objects when Dr. Amy calls herself as an OB!

          • birthbuddy

            I don’t think Ellie will be back and I doubt she would get the irony.
            NCB don’t do irony.

          • Sue

            ”I personally much prefer to get my information from statistics that are straight from the source”

            Then you’re in the right place, because Dr Amy does to. That’s why she references so much real research and data.

            Between a retired OB who rights a daily blog and reads every piece of obstetrics research, vs your average Mommy BLogger, who do you think might have the best grasp of the evidence?

      • moto_librarian

        Oh really, Ellie? Unlike the pro-home birth drivel spouted by Lamaze, et al, Dr. Amy links to evidence-based research to back up her claims. You are also wrong when you state that perinatal mortality varies – the data coming in from the Netherlands and the UK suggest otherwise. Why else would RCOG be initiating a campaign to reduce the number of stillbirths? The UK is averaging 17 PER DAY! The best systems still have 3 times the rate of perinatal mortality compared to hospital birth. The only way that you are correct is that in some parts of the States, the rate can be up to 8 times higher.

        • The Bofa, Being of the Sofa

          Yeah, interesting, while Ellie asserts that “results vary,” one of the more interesting things that has arisen in the investigations of homebirth mortality is just how robust that 3 – 4 times more death rate actually is. It shows up all over the place.

          • MLE

            UNLESS YOU DONT COUNT PORTLAND!

      • Bombshellrisa

        http://www.fromcallingtocourtroom.net
        Here is an ebook written by home birth midwives, for home birth midwives and those who support them. It gives a realistic view of how home birth midwives treat bad outcomes.

        • AgentOrange5

          Wow. That is indeed pretty telling. Licensed professionals working in the health field learn about legal matters such as risk management, knowing and following the law & accepted standards concerning their scope of practice, obtaining proper insurance coverage for their scope of practice, proper documentation and communication with other health professionals…….there is NONE of that in that helpful little e-guide. Instead the e-guide is filled with tips on how to hide evidence, how to operate illegally without getting caught, how to lie to medical professionals in the event of a transfer, having a lawyer on-call and a legal fund (financed by patients.) Anyone who has worked at any level in a real medical system should immediately see the major problems and the SCAM going on.

      • Amazed

        I am liking this simply because it fulfills all requirements for a professional homebirth advocate: Attacking the messenger. Glossing over the perinatal mortality. Acceping the NCB circles as legitimate equals to an OB/Gyn. Claiming that you’re all for impartiality. all the while guiding someone else’s choice while whistling innocently. If a bad thing happen, you’ll howl, “Personal choice!” and hide behind it.

        For this, Ellie, I tip my hat off to you. You’re about Gma Gardner’s level of educated and impartial.

        • Samantha06

          And she says she’s a nurse.. yeah right..unless maybe she’s really Rebecca Dekker, a cardiac nurse..

          • Bombshellrisa

            Some of the midwives who have presided over home birth disasters in my state were nurses-not nurse midwives, licensed practical nurses who also became CPMs.

          • Samantha06

            I’ve heard of this happening.. and it makes sense.. I’ve never seen an LPN working in Labor and Delivery so they wouldn’t have L&D experience, much like a CPM… most L&D’s are RN only..I’ve worked with some excellent LPN’s and most are good, but their level of education is not comparable to an RN’s.

          • Bombshellrisa

            I have worked with LPNs too, and the ones I knew understood their scope of practice and didn’t overstep that. It sounds like the CPMs who also have an LPN are doing it to be able to say they are nurses too, not because they actually care if they have training or not.

          • Samantha06

            Exactly! What’s unfortunate too, is that their patients might be lulled into a false sense of security with the nurse thing.. very unethical on the LPN’s part too..

    • Trixie

      Welcome, Sandra, and thank you for being willing to question your beliefs.

    • Jocelyn

      Hi Sandra! Welcome. If you’d like, you can look at a post I wrote on my own blog about a month ago, about the reasons I’d never choose a home birth: http://jocelynandjason.blogspot.com/2014/09/10-reasons-id-never-ever-ever-have-home.html. I put in all the stats and research I could find about the safety of home birth in the US, which all show that it’s more dangerous than hospital birth.

    • Sue

      SandraDee – you could look at the actual evidence yourself – not opinion pieces and ideology, but the actual data.

      Here are two references from non-US systems, where all all participating MWs are trained specialist nurses:

      UK Birthplace Study BMJ 2011: found 3X mortality for the babies of first-time mothers, despite tight risk-out rules and a 40% transfer rate. (Only mortality measured – no reports of hypoxic injury etc)

      Aus: Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years – MJA 2013 – and letter in response:
      https://www.mja.com.au/journal/2013/199/11/publicly-funded-homebirth-australia-review-maternal-and-neonatal-outcomes-over-6
      This report of outcomes also showed excess neonatal mortality for HB over equivalent-risk hospital birth (2.2 per 1000 births v 0.4 per 1000). Again, neonatal hypoxic injury not reported.

      Sure the outcomes of HB are mostly good – like the outcomes of drink-driving are mostly good. But when they’re bad, they’re very bad.

  • gingergirl

    We tried to do it the old-fashioned way (with an induced labor) for 18 hours, but could not. The catheter and epidural were my saving graces. We ended up with a c-section at the end. I was OK with it then and I’m OK with it now. It got my children here healthy and whole which was the entire point. If I
    had a do-over I would have skipped the TOL for all of our sakes, because there was a brief but very scary moment. My children were never going to come out the conventional way and were post-dates for twins. My OB worked a long shift that day and night, and into the next morning and I’m still grateful to him for it.

  • lola

    Also, I just looked at her blog, and she supports AutismOne. The conference that advocates for given autistic children bleach enemas. Holy fuck.

    • mythsayer

      No… that can’t really be a thing, right? BLEACH????

      • Who?

        Oh it is, believe me. And when bits of their gut lining come out, they are identified as the gastro worms causing the autism.

        Respectful Insolence covers it periodically, this is a nice primer on the subject: http://scienceblogs.com/insolence/2012/05/25/selling-bleach-as-a-cure-for-autism/

        • KarenJJ

          How to make a gut leaky?

        • Guesteleh

          How is it that child protective services hasn’t taken these kids away and locked up the parents???

    • Sullivan ThePoop

      Or chelating agents that are more toxic than methylmercury. Even chemical castration of autistic boys. Oh and let’s not forget that autism is so horrible we shouldn’t punish the mothers of autistic children that murder them. They are disgusting

  • lola

    All of these are the reasons I decided to have a maternal request caesarean. Everyone washes their hands going into the OR, no medical students gawking at my nethers, I was able to stay with the OB who had seen me throughout my pregnancy, I get to give birth like Britney and Christina and Kim Kardashian, among others, no one sticking their hands in my vagina, no catheter in my vagina, I didn’t throw up or lose control of my bowels in front of uncaring nurses (ormy family, not that vomiting and defecating in front of trusted friends makes it that much better), no one told me to stop making noise, in fact, I was having great conversations with the lovely people in the room who helped welcome my baby into the world, no one screamed at me to push, because it was scheduled there was no rush and my doctor could focus on doing a good job, and the focus of the day was entirely on the baby and not my experience. IT WAS FANTASTIC. Thank you Ms Margulis for sharing this.

    • mythsayer

      Me too! I LOVED my elective CS.

    • Theoneandonly

      This is exactly me in 6 weeks time (especially avoiding the episiotomy). So excited for my MRCS!

      • OttawaAlison

        I’m having mine in 6 weeks to on the 18th. Mine is an ERCS after being given the choice, however with me having GD and the baby looking like she’s huge, I’m thinking the doc would have tried to convince me to have a csection if I hadnt elected one.

  • LibrarianSarah

    For a group of women who claim to be “feminist” and “supportive of women” they sure like to shame and belittle women who are not like them. In this little essay Margulis badmouthed nurses (a mostly female profession), OB (ditto), women who choose to get pain medicine (your drugging your baby you terrible selfish mommy), women who choose to give birth in a hospital, prostitutes (who are often victims of domestic violence if not straight up sex trafficking), drug addicts, those with Hep B (for being a prostitute or a drug addict), people with an STD’s (only prostitutes and drug addicts get STD’s you know) and Jessica Gotlieb. Did I miss anyone else? It is hard to keep track.

  • JoMo

    I was seriously considering a homebirth until I read this! Has scared me straight to the hospital.

  • Piran Jade

    Oh my. This comment to the article is inadvertently funny:

    “Megan Stevens, November 4, 2014 at 7:38 pm
    I loved my home birth. I would feel very insecure giving birth in a hospital.

    Megan Stevens recently posted…Flower Power: A Milk Tea Recipe for Depression and General Wellness”

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  • SporkParade

    My favorite was #1: You’d like an episiotomy. I was very happy with my episiotomy, thank you. It meant that I had a live baby with APGARs of 9. Whereas, if I had done a home birth (I would have been an excellent candidate), I might have had a perinatal mortality statistic instead.

    • The Bofa, Being of the Sofa

      And it’s not like midwives don’t do episiotomies…

    • As well as possibly being spared having dysparunia [painful intercourse] for the rest of your life. Laceration repairs are often much more traumatic, and have more sequellae, than episiotomy repairs. I have seen some terrible damage done by laceration that required additional surgery — sometimes more than one — to try and fix.

      • Roadstergal

        I really thought Dara O’Briain was kidding or had gotten a weirdo when he was talking about his pre-natal class where the midwife informed everyone present that a tear heals better than a cut. Then my UK friend told me that her UK midwives had all told her the same thing, and she fully believes them on that (along with all of the other NCB propaganda they see fit to ram down women’s throats). I can’t even… yeah.

        • Ash

          I have heard that every time the time “episiotom” is mentioned on the Internet.

          “Paging Dr Bear, Paging Dr Bear”

          • AmyH

            Yes, it’s the constant refrain (among many) from NCBers on Baby Bump.

          • The Bofa, Being of the Sofa

            What’s the basis for it? Aside from “someone made it up”

          • AmyH

            That, to me, is the hard part in arguing it. I’ve given up trying. They just say so. They proffer some hazy argument about the ragged edges offering something to grab onto and heal faster… I don’t remember if I went to the trouble of typing out a suggestion that surgeons cut their incisions in a zigzag, if that’s the case. (Or they could rough them up with…something. Or hey, just rip into you when you go to have your bypass surgery. It’ll heal faster.) It’s the closest thing to an argument they have, though.

          • AmyH

            Not signed in and can’t edit… I wonder what they’d think if the ACOG announced that from now on they will be ripping C/S incisions with a couple pairs of vise grips, since tears heal faster.

          • Roadstergal

            In Dara’s routine, he mentioned that a surgeon friend said yes, of course that was true, and that was why, for the initial incision in his surgeries, he used a bear…

          • Dr Kitty

            Wife. Not friend.
            Dara O’Briain’s wife is a urologist.

            He has said
            “She finds my career as a ‘public intellectual’ quite hilarious because she properly has to know stuff that matters.”

            Can you imagine the challenges of being in a stand up comedian/ surgeon marriage?
            Talk about work-life balance issues and scheduling problems!

          • Roadstergal

            His wife said it was ridiculous in the class, but the bear comment was a friend. I’m a major Dara fan – I think he has a wonderful foundation of science and skepticism, but doesn’t loose his empathy and humanity for it…
            https://www.youtube.com/watch?v=0aUzxylyYU0

          • Dr Kitty

            I misremembered, obviously, and I’ve seen that show!
            D’oh.

          • Ash

            It sounds nice and it’s a pat little explanation.
            Common responses:

            *The tear will occur at the weakest part of the area, rather than the strongest
            * A tear heals better than a cut. If asked why this is true, someone may respond that the jagged edges can grab onto each other and that the tear will be in the “right” area for healing since that is what happened naturally.
            * A cut is easier for a surgeon to repair but doesn’t mean it’ll heal more quickly than a tear
            * OBGYNs are surgeons and like to cut, when the damage could be avoided by walking/massaging anyways
            * Try tearing a piece of fabric vs cutting it. See how easy it splits when you cut it? Never mind that the human body is not 1 layer of flesh.

            The “tear heals better than a cut” is the most improbable part to me. I don’t think most people would like to hear the words “Well, we’ll just tear this part of the body by using excessive pressure from inside of the bodily cavity instead of making an incision.” You wouldn’t want to hear your GI doc saying that.

        • Dr Kitty

          I love Dara O’Briain.
          I still remember watching him on Echo Island when I was a student in Dublin.

          He’s not exactly a natural fit for a bi-lingual Irish and English kids TV show (complete with puppets) which made it quite enjoyable for me, a student, to watch.

        • anonymous

          No he wasn’t joking. This seems to be par for the course among midwives in the UK and a fair amount of the US. My sister’s midwife told her this and pop and I both cringed.

        • AlisonCummins

          The example of episiotomy is one that Amy Tuteur, MD uses as an example of obstetricians changing their practice from routine episiotomy to episiotomy only when specifically required when presented with high-quality evidence. It’s not an NBC myth.

          http://summaries.cochrane.org/CD000081/PREG_episiotomy-for-vaginal-birth

          Note in particular: “fewer healing complications at seven days.”

          “For women randomly allocated to routine episiotomy 75.10% actually had an episiotomy whereas with a restrictive episiotomy policy 28.40% had an episiotomy. Restrictive episiotomy policies appeared to give a number of benefits compared with using routine episiotomy. Women experienced less severe perineal trauma, less posterior perineal trauma, less suturing and fewer healing complications at seven days (reducing the risks by from 12% to 31%); with no difference in occurrence of pain, urinary incontinence, painful sex or severe vaginal/perineal trauma after birth. Overall, women experienced more anterior perineal damage with restrictive episiotomy. – See more at: http://summaries.cochrane.org/CD000081/PREG_episiotomy-for-vaginal-birth#sthash.GHry2jjg.dpuf

          • Medwife

            I don’t understand some commenters’ insistence on defending routine episiotomies “to protect the perineum”, “to prevent a worse tear”, unless these commenters are referring to mediolateral episiotomies, which certainly none of the Americans are.

          • The Bofa, Being of the Sofa

            I don’t understand some commenters’ insistence on defending routine episiotomies

            Where is that going on?

      • mythsayer

        OMG I CAN’T HANDLE TALKS ABOUT EPISIOTOMIES OR TEARING! You just scared the crap out of me again. I just can’t even think about them! The thought of tearing scared me so freaking much that there was no way any kid was coming out of me that way. Thank god there will be no more kids.

  • K

    I couldn’t get past Margulis’s #5 reason “…plant and light-filled office.” I just can’t tell you how many times I’ve thought “That health-care practitioner seems knowledgeable and helpful, but there were simply not enough plants or light in their office!”

    • KarenJJ

      Well that nixes homebirth for me immediately.. My home is NOT filled with green plants….

    • Bombshellrisa

      I thought they were against light, it seems to be a drawback to them in the labor room

      • PrimaryCareDoc

        Right. I though votive candles were the only acceptable light source for a delivery.

    • Dr Kitty

      I have orchids on the shelf over my desk and an entire wall of my consulting room is glass (with blinds for privacy).
      Next.

      • KarenJJ

        Who needs degrees and experience when you have plants?

        • Sarah

          I read that as ‘penis’. Reminded me of that Australian woman who HBAC’d twins and snuck off for some sexytime in the middle.

          • Dr Kitty

            No! You had to go there.
            I’m getting Currawong trauma flashbacks…

          • araikwao

            See? Unmedicated vaginal birth reality can cause PTSD!

      • lola

        My OB’s office is in a fabulous, well lit LEED Gold certified building with wood accents, and tasteful tile, in addition to state of the art medical equipment. I know that last bit isn’t really important, but it was a nice soothing touch.

  • KarenJJ

    “19) You’d rather throw up in front of labor and delivery nurses who will shake their heads in revulsion ”

    Wow, she’s down on nurses, isn’t she? I had a nurse holding the vomit bucket for me. Nurses deal with all sorts of shit (literally). If you can’t handle bodily fluids, you don’t go into a nursing career.

    • Medwife

      Oh that’s hilarious! L&d nurses, yeah, known for being snooty about bodily fluids.

      • MLE

        Mine were more concerned that they weren’t seeing bodily fluids, but it’s because every last drop was forcefully expelled from my body in the 7 hours of early labor before I got to the hospital.

    • MaineJen

      Please. Those nurses don’t bat an eye at vomit. Or poop. Or anything else that comes out of you. They see that stuff all day, every day. Revulsion? Not buying it.

    • Are you nuts

      You now who would be revolted by vomit? My husband if he had to clean it up at home! L&D nurses, not so much.

      • PrimaryCareDoc

        Right. It was like magic how they whisked away that vomit-filled bucket for me.

        They even held my hair back as I puked.

    • Bugsy

      Lol, I didn’t vomit during labor…but that was only because they’d pumped my IV full of some anti-nausea medication while I wasn’t looking. I greatly enjoyed both the med and the epidural, thank you very much!

    • The Computer Ate My Nym

      I’ve never seen a nurse, L&D or otherwise, be revolted by any bodily fluid except perhaps for spit when the patients aim it in their direction. Sometimes not even that: the last time I saw a patient spit at a nurse the nurse was angry at the doctors for not giving him/her better antipsychotics, not at the patient.

      • Samantha06

        Well, I can tell you that I worked on a med/surg unit for a year after graduating from nursing school and I cannot handle sputum. We would have to get patients to cough up specimens to send to the lab and I couldn’t look at it without gagging! I’d have the patient put the container in a small, brown paper bag so I couldn’t see it. I still feel gaggy just thinking about it!

    • OttawaAlison

      So a midwife would never ever cringe at vomiting ever, but nurses must be cringing all the time?

    • D/

      #19) What a load of crap!

      For 27 years as a nurse I have held basins for vomiting mothers, when needed, and have to deal with puking little babes retching up their toenails on a daily basis. Make no mistake though I do not handle vomit well At. All.

      It is the only bodily fluid I have issues with and relates to every aspect of vomit … sight, smell, sound, sometimes even just the thought of it. Doesn’t matter if you’re my own child I love dearly, a patient I’m being well paid to take care of, or a stray cat on my back porch with a hairball, it’s gonna take every ounce of self-restraint to not puke in my own mouth just a bit while I’m dealing with you.

      While no family at work has ever been aware of my distress (nor will any ever be), my youngest when she was four told me one morning that she had thrown up during the night and I was like “Oh sweetie, why didn’t you come get me?” with eye rolls she responds”And why in the world would I do that?”

      In caring for people as a professional there is no magical exemption from having to do whatever needs to be done. At work I just use every ounce of self restraint *plus* a bit … and deal with it! At home evidently not so much so.

  • Allie P

    I honestly don’t know if the people writing these articles ever attended a birth in a hospital. They make it sound like Bedlam. I was “electively inducted” at 40+5 in a sweet, dimly lit, well appointed room, surrounded by loved ones in “regular clothes”, and the medical professionals who only “barged into” my room when my fetal monitor told them that my baby was in trauma, and I WISH my “baby friendly” hospital did more formula feeding! Why do they try so hard to make folks feel shame about epidurals?

    • Bugsy

      Maybe they’re jealous that we (a) felt no pain and even worse, (b) feel no remorse? Who knows? I had an epidural based on a coworker’s recommendation, and it was the best decision I could have made during my son’s L&D. The epidural made labor an almost enjoyable process!

    • EmbraceYourInnerCrone

      I do wonder where they get their information. I gave birth to my daughter 20 years ago in a Catholic, innercity hospital. I labored and delivered in the same room and I think I had my own bathroom. I had constant fetal monitoring(they asked first) and I got an epidural, at MY request at 4.5 cm. Things got scary towards the end because when they broke my water there was meconium and at that point they asked if they could attach the internal fetal monitor to her scalp( the strip on the monitor indicated some late decels)
      No one did anything without talking to me and when they decided they needed to get her out quick they asked before doing the episiotomy and using the vaccum. They had to suction her lungs as she inhaled some of the mec.
      I was luck becuase I could room in if I wanted to but they said they wanted to keep her in the nursery for the first night in case there were any problems. They had nurses/LC who came around and assisted getting breastfeeding started( I was not really interested in BF but played along as it seemed really important too them) they had readymade bottles if you did not want to breastfeed, that was nice.

  • Trixie

    The funniest part of this, to me, is that despite her literature degrees, she’s wrong about how that birth went down in Anne of Green Gables.

    • PrimaryCareDoc

      Yeah, she conveniently doesn’t mention how Anne almost died during the birth.

      • Who?

        She wouldn’t want to be negative, after all

        snarky

      • Trixie

        Or how they all thought something would be wrong with the baby before it was born, which, how would they know that if it was a heart anomaly? And how did they even diagnose those at home?

        • KarenJJ

          Ironic given that when there is a homebirth gone wrong post, one of the criticisms levelled at Dr Amy and other posters here is how we can work out a likely diagnosis based on the information on the patients made available on the internet.

        • Jocelyn

          I’m actually reading the series right now and I JUST read this chapter tonight…not a single mention of a congenital defect. None. Just says the labor was perilous and the baby died soon after birth.

      • Kq

        Anne also almost died with her second youngest – Walter, if I remember correctly. When Rilla was born, I remember her friends were all very worried because she’d had a terrible time with her previous birth – it’s why all the children were sent away for Rilla’s birth.

        I love the Anne series and took tremendous comfort in Anne’s House of Dreams when I lost my own first. I thought of “wee, white Joyce” many times during the worst of my grief.

        • Mishimoo

          “Wee, white Joyce” still brings a tear to my eye; I cried so hard the first time I read that book. I also found it comforting after the loss of my first. (And oh, poor dear Walter!)

        • KarenJJ

          Oh I thought that was Shirley’s birth? Where Susan claimed him more as “her brown boy” because she cared for him so much after his birth as Anne was so ill for such a long time.

          • Kq

            Yes, it was Shirley’s birth! I forget about Shirley because he was so poorly developed as a character!

        • Sarah

          I am sorry for your loss.

    • Bombshellrisa

      As I remember it, Anne’s husband was a doctor, Anne’s birth attendants were a doctor and “a trained nurse”, and her labor was very long. The baby was described as being “very white” when she was born. I will have to pull that book out and reread it. The Anne series and the other books set in Avonlea were my most beloved books growing up (also the television series)

      • KarenJJ

        Most women’s babies were born at home back then. Sometimes they died too. It’s interesting that she’s adamant that the baby’s condition was “incompatible” with life, when she would have no idea if that might be the case with modern medical care.

        From memory her husband refers to there not being a ‘passage perilous’ during her next birth, which I always thought referred to a difficult labour.

        • MaineJen

          I know that book well; there was reference to a long and difficult labor during which Marilla has to stuff her ears with cotton, and to the baby being very white and having something apparently wrong with its lungs. (Potter syndrome?) The entire thing is heartbreaking.

          The author, LM Montgomery, lost an infant herself shortly after his birth, and probably was drawing on personal experience in describing what her character went through.

          • KarenJJ

            Perhaps for some homebirth advocates any infant death is “incompatible with life” because only babies that can be born without medical care are “compatible with life”. The rest of us shouldn’t be in the gene pool.

        • Jocelyn

          There are a lot of things in the Anne of Green Gables books that were “incompatible with life”…back in Canada in the early 1900s. Anne’s friend dies of tuberculosis. Her baby dies after a difficult labor (and I just read the passage tonight, and there is not a single mention of a congenital defect). Numerous people in the books die of illnesses that could have been cured with today’s medical care. Reading the books has actually opened my eyes to how much longer our life spans really are now because of modern medicine.

          • KarenJJ

            One of my kids was diagnosed with Scarlet Fever earlier this year. Some antibiotics and some rest and she was happy and healthy again within a week. No slow decline after developing Rheumatic fever, no sending away siblings and no death.

      • DiomedesV

        Just looked it up. Anne’s first baby dies shortly after birth. Not a homebirth success story.

        • Stacy48918

          Yes, but Margulis seems to be saying that it’s totally A-OK that the baby died because it had a defect anyway so of course modern medicine intervening wouldn’t have made any difference and it still would have died.

          Callous bitch.

    • DiomedesV

      Isn’t Anne’s first baby a stillbirth?

      • Allie

        She wasn’t stillborn. She lived briefly, although Gilbert (who was a medical doctor) knew the baby would not survive. The details are hazy, but I’ve always suspected meconium aspiration.

        • Anne

          I believe she (Joy) was premature- Marilla was very concerned as it was too early for her to be born.
          Official “Anne” tragic here…

  • AL

    Number 2 is pretty funny considering everyone I know in the health care field have the driest hands ever because they was ALL THE TIME. She’s such an idiot.

  • That was the stupidest thing I’ve ever read. I think I lost, like, 10 IQ points.

    • Samantha06

      I know, it was disgusting. You’d have to be totally brainwashed to fall for that garbage. I couldn’t read any further after about #25.. ugh..

  • 45 reasons? Narcissistic much?

  • Bugsy

    Oh my gosh. Margulis’s post is disgusting. I’m dumbfounded.

  • The Computer Ate My Nym

    22) You don’t feel comfortable in your own home.

    How about “You want to continue to feel that your home is a safe place. You don’t want to have to live in a place you associate with horrible pain and trauma. If worst comes to worst, you don’t want to live in the place where your baby died–or for your partner to have to live in a place where you and/or your baby died. You’d much rather you, he, or all of you including the baby hate the hospital for what happened there than hate your home.”

    • KarenJJ

      22) You don’t feel comfortable in your own home.

      And for many women, not feeling safe in their own home is absolutely an issue and a very good reason to tap into the resources of a hospital…

    • Ceridwen

      While I felt perfectly comfortable in my own home under most circumstances, we had two male roommates at the time I gave birth and I had exactly zero interest in laboring in front of them. They were great people, but they didn’t want to see that, and I didn’t want them to. When the hospital gave me the option to go back home to labor longer if I wanted or stay there, I was all about staying there.

      • Guest

        Why you didn’t want them to see that!?
        It is NATURAL!!

    • SporkParade

      I am comfortable in my own home. I am not comfortable having people in my home for hours and hours without offering them tea and cake.

  • The Computer Ate My Nym

    Ok, here’s a couple more to play with:

    39) You think it’s best for a baby to be born into bright lights and a cold, sterile room.

    Oh, yes, I’d much rather have my baby in poop laden water or with a midwife who does not wear cold, sterile gloves and transmits flesh eating bacteria to me instead.

    41) Immediate cord clamping causes anemia.
    You’re grateful to be in the hospital where they have technology to
    help your baby overcome the anemia the hospital’s policies caused.

    Actually, she almost has part of a point here: there is some evidence that delayed cord clamping can be useful–in premature birth (i.e. Backes et al 2014 Obstet Gynecol). In term infants (the only ones who should be born at home, if any infant should)…not so much. In fact, you can make the infants polycythemic and hyperviscous by delayed cord clamping in term infants.

    So maybe #41 would be more accurate if it read “Timing of cord clamping is a complex issue, albeit one with only a marginal effect on outcome. You’re grateful to be cared for by experts who can both consider the optimal time of cord clamping and the relative importance of optimizing cord clamping versus concentrating on other issues that may have a bigger effect. For example, making sure the baby isn’t hypoxic due to a prolonged second stage because deoxygenated hemoglobin is no help, no matter how much of it the baby has.”

    • Guest

      41) In the hospital, you can donate your baby’s precious cord blood to a public bank, providing potentially life saving stem cells to a critically ill person in need. (See BeTheMatch).

    • The Bofa, Being of the Sofa

      39) You think it’s best for a baby to be born into bright lights and a cold, sterile room.

      Can I just note that the delivery rooms at our hospital had hardwood floors and had paintings hanging on the walls. And yes, there were bright lights that pointed down to where the baby was to be born, but that was to help the doctor see. What is the alternative, have them feeling around in the dark?

      And the temp of the room is adjustable to what is comfortable for mom.

      And I find it ironic that she used the word “sterile” to describe the hospital room.

      I bet somewhere else in the document she says something about hospital germs.

      • fiftyfifty1

        They were fake hardwood floors actually. So they can be fully cleaned between patients.

        • The Bofa, Being of the Sofa

          OK, they were probably laminate, but it was certainly a warm atmosphere.

          Then again, we didn’t spend much time in delivery, as we went to the OR and then to post-partum.

          • Does anyone think the actual decor of the room where the baby is born matters to the BABY?

            Since birth, my grandson has been wearing his elder sister’s Babygros. They are all pink. Will this scar him for life??

          • Bombshellrisa

            There is a much repeated statement among home birth midwives that women and babies do better when the environment is cozy and pretty. The local birth center has lace curtains and candles and tubs and they think that is why so few women have complications. Couldn’t possibly be because they are only supposed to be attending low risk women /snark.

      • Bombshellrisa

        http://www.swedish.org/services/pregnancy-and-childbirth/birth-center-locations/issaquah-birth-center
        The “cold, sterile room” where my son was born. There were bright lights and thank goodness. I wanted that apgar score to be correct, also for my tear to be assessed and stitched correctly.

        • PrimaryCareDoc

          You know, I’d kind of like to take a vacation in that cold, sterile room. Gotta say, it’s a hell of a lot nicer than my bedroom at home. And cleaner.

          • Bombshellrisa

            This picture makes it look really small too. The tub is enormous! And the room itself has plenty of space for all those people whose job it is to make sure everything goes well without it feeling crowded. There were on demand movies and music channels on the tv, my son was born while “Moonrise Kingdom” played.

        • Guesteleh

          To be fair, most hospital rooms don’t look like that. The place where my son was born was very basic, not particularly warm or homey. But it has a level 3 NICU and is the hospital for two of the best MFM practices in my city, so there you go.

          • Bombshellrisa

            Yeah, this is a fairly new hospital. I wasn’t planning on giving birth there, I was actually going for the bigger facility in downtown Seattle where 10,000 babies are born a year and they have the best NICU in the city. Labor just came on too fast and got going so I stayed put. The hospital where DD was born was decidedly less beautiful, but had the important stuff like a level 3 NICU.

    • MJ

      The hospital where I laboured had lights on dimmers and a CD player for my own music (among other things). It could have been as dark or light as I wanted. I honestly didn’t care and the lights stayed up.

      • fiftyfifty1

        Yeah, if you even notice, much less still care about lights, music and eating during your labor, you are having a very easy labor indeed.

      • Medwife

        The awesome thing is I can have a glaring spotlight on the region I’m repairing while mom’s top half and baby are in semidarkness. So many luxuries are available to us in developed countries!

        • Mishimoo

          That glaring spotlight is also lovely and warm, which makes the pre-shower mess just a little more bearable.

          • Medwife

            I never thought about that! Although knowing how hot and sweaty I get under those lights in my gown etc, of course mom would be feeling it too.

          • Mishimoo

            I had to have stitches with my eldest, thanks to a nuchal arm. Being resistant to local anaesthetic and wanting nothing more than to sleep, having been awake for 3 days at that point, I loved the warmth so much because it also made getting the 3 or 4 stitches tolerable. (I was so exhausted that I just wanted it to be over with, so didn’t speak up about the non-working anaesthetic even though they would have done something to help.)

        • MJ

          The other nifty thing, of course, is the beds that go up and down. During labour the bed could be at a height I could get up or down off but once we got to the business end of proceedings my midwife explained that she needed to put the bed up to give her easy access to my ‘business end’.

        • LovleAnjel

          My room had a DVD player. I got to labor to my favorite movies.

          BTW, comedies are not so funny when the epidural wears off.

    • Guest

      What is wrong with bright lights!? It is like delivering in nature under sun rays! LOL

    • Starling

      Ugh, I just want to slap people when the immediate cord clamping thing is trotted out. After consultation with my OB, we opted for immediate cord clamping, since the delivery was at nearly 8,000 feet altitude and the baby and I had incompatible blood types, both risk factors for jaundice. Additional blood in the baby would have exacerbated the issue. Even with our precautions, there was a day under the bili lamps. More blood =/= better health.

      • Young CC Prof

        Babies with growth restriction who are reasonably close to full term are at risk of having too many red blood cells! Another reason why DCC isn’t always best.

        • The Bofa, Being of the Sofa

          This is where doctors will provide “personalized medicine” whereas midwives don’t.

          Doctors know and recognize there are certain situations where DCC is a good thing, and if you are in that situation, they will do that. They also know there are situations where it isn’t a good thing, and in those circumstances, they won’t do it. And then they know there are times when it doesn’t matter, and they may or may not do it, but that’s a personal thing, and, most importantly, it doesn’t matter.

          Then there are midwives, who will insist on doing it with everyone, because, you know, DCC is good and therefore everyone has to do it regardless of their personal circumstances.

  • Stacy48918

    We’ll see if she posts my comment:

    “You forgot a couple! Here are my biggest reasons:

    1. I don’t want my baby to have Hypoxic-Ischemic Encephalopathy and need brain cooling.
    http://www.ajog.org/article/S0002-9378%2813%2901604-9/abstract
    2. I want my baby to have an Apgar >0 at 5 minutes (i.e. I’d like my
    baby to be breathing, have a heartbeat…you know, little things)
    http://www.ajog.org/article/S0002-9378%2813%2900641-8/abstract
    3. I want my baby to be alive.
    http://weill.cornell.edu/news/pr/2013/09/birth-setting-study-signals-significant-risks-in-planned-home-birth.html

    But I guess episiotomies and dust bunnies are more important to other people.”

    • from cali

      post it to her Facebook, she tends not to delete.

      • Stacy48918

        You have my permission to copy and paste. I prefer some measure of anonymity, especially where these crazies are concerned.

  • Bombshellrisa

    The first one on her list was completely ridiculous. I would rather have an episiotomy done with sterilized equipment by a doctor trained how to cut and stitch than a midwife who has been trained to do neither. By their own admission (“From Calling to Courtroom”) home birth midwives attempt episiotomies too.

    • Jocelyn

      On that blog post I wrote last month someone just left a comment about her wonderful homebirth, ending with this – “I think a homebirth should be a wonderful experience for everyone with a FULLY QUALIFIED midwife. My baby had a pinched cord during the last few pushes and my midwife performed an episiotomy and everything was great.”

      • Bombshellrisa

        “Fully qualified”= been to 100 births, worship Ina May and have a disdain for science and medicine. These people have no idea how low the bar is when it comes to “qualifying” to be a CPM.

        • Jocelyn

          She also adds some nice NCB mother-blaming: “If a mother is hiring a midwife who is underqualified and doesnt have much experience, that’s negligence on the mothers part not on anyone else.”

          • Bombshellrisa

            Oh yes, it always comes back to the choices the mother makes!

          • The Bofa, Being of the Sofa

            Not the fault of the incompetent midwife parading herself around as an expert?

            Oh no…

            You know, we do hold people responsible and call them suckers when they fall for the schtick of a used car salesman, but then again, we also use “used car salesman” as a derogatory term to reflect their culpability. Or a snake-oil salesman. Yeah, people are making a mistake buying snake oil, but that doesn’t let the snake-oil salesman off the hook.

          • Young CC Prof

            “Fool me once, shame on you.” Anyone can be fooled once.

          • The Bofa, Being of the Sofa

            “Fool me twice, we won’t get fooled again”

          • MaineJen

            Really? Really???

      • Young CC Prof

        I wonder what kind of scissors she used.

        • We carried two pairs of scissors; one for a possible episiotomy, one to cut the cord. Both sterile, but slightly different in shape

    • CNMs are trained to do episiotomies.

  • Liz Leyden

    #6- My daughter has a congenital heart defect that is incompatible with life unless treated surgically. If I’d chosen to forego the surgery, I could have had a home birth, and watched my daughter die afterward. Otherwise, why would I want the medical care available in the rural Canadian Maritimes of the early 1900s?

    #11- My OB was a man.

    #12- I didn’t want to eat or drink during labor. At all. I even vomited twice.

    #17-I was attached to fetal monitors for 3 separate hospital visits: 2 for falls, one for labor. I was only strapped to the bed once, during the helicopter ride to the Big City hospital.

    #19- Vomiting at home means I have to clean up the vomit.

    #31- Hell yeah, I was looking forward to the drugs!

    #37- I’ll take “a little nick? Or a missing finger?” over a dead baby.

    #42- Hep B is also spread via blood transfusion. My daughter had a few of those in her first week of life.

    • Stacy48918

      My first labor I vomited more times than I could count. Eating during labor? No thanks. Just get it over with as quickly as possible.

      • Rabbit

        I vomit during labor too, but I preferred the labors where I was able to eat, because for me, vomiting > dry heaving.

      • Elaine

        I didn’t vomit in either labor. But I didn’t really want to eat either. The second time around my CNM strongly encouraged me to eat. I managed to get down half a cherry twin pop. I think she was concerned I’d be in labor longer (baby was born within a half-hour of that) and need a few extra calories. But left to my own devices I wouldn’t have bothered.

        I did keep drinking water though.

    • Roadstergal

      I simply cannot get over this meme of “Don’t vaccinate your child against HepB, because it’s a sexually transmitted disease!” When you take bloodborne pathogen training (about thirty million times, you have to re-up regularly), they never hesitate to mention the absolutely insane ability of HepB to live on surfaces for weeks and weeks. Sure, you can transmit it via sex – and via lots of other things, too.

      Pet peeve. (Also, I was once curious about the transmissability of HepB via acupuncture needles, given that the anti-real-medicine crowd that isn’t a fan of vaccines has a fair Venn overlap with the anti-real-medicine crowd that likes acupuncture; I found a decent handful of papers showing acupuncture as a risk factor for HepB.)

      • KarenJJ

        I went over this with my immunologist (baby had a 50/50 chance of a condition that could cause a bad reaction to vaccines). What I got told is that the immune system issue was already plenty to deal with and you really don’t want to complicate that with liver issues if kid is unlucky enough to pick up Hep B too. Baby got vaccinated. Baby also managed to skip inheriting the immune system issue.

        • araikwao

          A smart baby like that must’ve known when to be born, too, I’m sure

          • KarenJJ

            Smart baby stayed in until the elective c-section 🙂

      • WordSpinner

        Yeah–the anti-Hep B propoganda claims that it is a sexually transmitted disease and tends to imply that anyone who needs it is immoral.

        I wonder how well that goes down with all the doctors and nurses.

        If I have kids, if anyone gives me shit about it I’ll just tell them I’m getting my kids vaccinated so they won’t have to do it at work if they go into the same career as Mommy.

        Edited: I am a biology researcher, and had to either get the vaccine or sign a paper saying I understood the risks in order to work with human-derived cell lines. (I was probably already vaxxed, but I got them anyway.) I can’t imagine that health care workers don’t get prodded to get the shot.

        • Elaine

          I had to either get the shot or prove my immunity to start pharmacy school. I didn’t know if I’d had the shot, so I had titers drawn, which showed I was immune. Now each year at work we do a blood-borne pathogens training module and it emphasizes that anyone who has not already had the Hep B vaccine can either a. opt out of it or b. get it at our employer’s expense, and if we choose a. we can change our mind and switch to b. any time. I imagine it’s similar for other health care workers.

        • Liz Leyden

          I had to get the entire Hep B series for nursing school. I managed to get it done by the time clinicals rolled around.

      • Dr Kitty

        All you need is one vaccinated pre-schooler who didn’t seroconvert and goes to visit granny in China for the summer holidays and you can have an entire class infected by next Christmas.
        Awesome!

        Most of the people I know with Hep B were just born in a place where it is endemic and vaccination wasn’t accessible.

        The UK has a different population with different risks to the USA so newborn HepB isn’t routine, although it is offered at birth to some populations, and is available for adults in at-risk groups (HCW, travellers, MSM etc).

        If I lived in the USA- my kiddo would be vaccinated ASAP.

        • Sarah

          I’m British, I’d be glad to have my baby given Hep B vaccine at birth if it were available.

      • DaisyGrrl

        Honestly, as a layperson, my reasoning for following vaccine schedules is this: a bunch of doctors and public health experts got together and agreed upon a suite of vaccines that are necessary to public health. They also agreed on optimal timing for each vaccine. I am not a doctor or a scientist and I lack the expertise of these people.

        I am also lazy. I don’t want to become educated to that level simply to make a decision about when or if I’m going to get a needle. And if I’m going to disagree with the scientific consensus, I’d better be an expert in that field.

        So while I’ve learned a tremendous amount about immunizations online, my basic thinking remains unchanged. Vaccines good. Herd immunity good. Get immunized.

        • Young CC Prof

          Probably the best reason I’ve ever heard for giving Hep B to newborns is, “because you can.” Most vaccines won’t “take” in the newborn immune system, but this one will, so that’s one disease you can vaccinate your child against before there’s ANY chance of exposure.

          • fiftyfifty1

            Good point. Back when I trained, how effective a newborn dose would be long-term was not 100% known. So most babies did not get their first Hep B until 2 months. We only gave HepB at birth to babies that we deemed “high risk”, e.g. babies with a parent or household member with Hep B or immigrants from endemic countries. But using this plan there were always babies who caught it anyway. Turns out that every baby is potentially “at risk”. At the same time, there was increasing evidence that Hep B is an immunization that works well even when given as a newborn. Thus, why not?

          • Roadstergal

            Even if it turned out that it didn’t ‘take’ for lifelong immunity, that’s what boosters are for…

      • anne

        Even if it was only sexually transmitted I can’t see my son asking me if he was vaccinated for x, y or z disease before he has sex.

        Not to mention child sexual abuse, etc.

  • yentavegan

    I could not read the whole Margulis essay. The stupid starting burning my eyes.

    • guest

      Me too. I tried but my brain started melting.

      • CrownedMedwife

        My migraine was aggravated by the shaking of my head and constant wrinkling of forehead as I mouthed “What the …”, so I stopped reading and made my own short list of why NOT to have a homebirth.
        1. Mother Nature is fickle. Trust her all you’d like, she doesn’t particularly care whether you do or don’t. She’ll do as she pleases.
        2. Hospitals have real resources and providers who know how and when to use them. Whether it’s pain management, operative delivery or resuscitative care, it’s there. Period. You know, for when Mother Nature makes it hurt like hell or gives a surprise lesson in how she can’t be trusted.

  • Guest

    Do any of these people actually READ the MANA study? And compare it to hospital birth stats? I don’t understand how they can get away with saying “The research shows home birth with a qualified birth attendant is as safe or safer than hospital birth.” It’s just out and out lies.

    • Guest

      Also, how is it legal for the abstract of the MANA study to state this: “Low-risk women in this cohort experienced high rates of physiologic birth and low rates of intervention without an increase in adverse outcomes.” What are they considering an adverse outcome??? ‘Cuz even low risk women are about twice as likely to have their baby die at home birth. How is that not an adverse outcome???

      • Amy M

        They think interventions are adverse outcomes. Things that other people consider adverse outcomes, like death and maiming, are variations of normal.

        • Roadstergal

          It’s the ‘natural’ childbirth movement, after all, and what’s more natural than death?

      • DiomedesV

        People can say whatever they want in their abstract. It’s up to the reviewers, editor, and journal to keep it accurate. But when those people are all your best buddies, well then…

    • Stacy48918

      Of course not. MANA said in the “study” that their rates were “comparable”…but didn’t actually bother to include them. They just swallow whatever tripe they’re fed and call themselves “educated”.

  • Zoey

    Oh man, that list… What angers me most is the heavy handed implication (using really bad and unfunny sarcasm, I might add), that anyone that chooses hospital birth is uneducated and ignorant.

    Even most of the hard core NCB folks (that I know anyway) would not go as far as to say that homebirth is a safe or appropriate choice for every woman. Hell, even the graphic at the top of the page says “birth…every home should have one.” That’s some pretty black and white thinking for someone that claims to be “educated” about childbirth.

    This list is specifically designed to make homebirthers feel better about themselves and hold themselves superior to those of us that make different choices. Screw her. Nothing (well nothing human anyway…) is giving birth in my home.

    • KarenJJ

      I like how Dr Amy brought up how NCB flatters you in yesterday’s post. We had a door to door salesman at the house the other day (my husband let him in..) and it was fascinating watching his tactics – flattering my husband for his intelligence and me for my looks (indirectly via the kids). I had my defences up from the beginning, because he was a door to door salesman, but people seeking out midwives don’t walk into the conversation with that level of awareness.

      • Dr Kitty

        Yeah, there’s a reason my husband doesn’t open the door.
        Seriously, he’d sign any petition, have the drive tarmac’ed or get solar panels without blinking if they told him a sob story.

        Instead they get me, and I don’t give anything to solicitors.

  • slandy09

    Wow, the things on Jennifer Margulis list were the things I had at my hospital birth! Nope, not at all. Of course, I was induced and had an epidural after making no progress, so maybe that’s why it wasn’t a horrible experience.

  • PrimaryCareDoc

    Of course she’s moderating comments.

    • from cali

      is she? I added some and people are responding with “nuh uh” comments.

  • GiddyUpGo123

    I’ve got four out of five. I did not read any of the scientific literature. That’s because I’m actually smart enough to know that people who went to medical school and became trained professionals know more about pregnancy and childbirth than I do. I trust *them* to read the scientific literature, because I know I don’t have the qualifications or the medical background I need to thoroughly read and understand it myself. And that reason alone is enough for me to choose a hospital birth with a qualified OB.

  • PrimaryCareDoc

    OMG. Her sources. Health Impact News. YouTube videos.Blogs. Midwifery Today.

    I especially love how much she cites her own blog.

    I thought she was supposed to be a journalist?

    • Anonymous

      General rule of thumb…never cite yourself.

      • Anj Fabian

        There should be a internet law for that…

        It’s almost as bad as creating a sock puppet to comment on your posts.

      • Haelmoon

        I will have to admit to citing myself before – but it was in basic science, and citing a previously peer reviewed study. But citing a previous opinion, why bother, it is still just your opinion.

        • Amy M

          I think, in some instances, its ok to cite a previous paper you’ve published. For example, if the current paper is building from the last one—“In our last paper,{23} we showed that macrophage phenotypes blah blah blah, which led us to explore this particular aspect of macrophage phenotypes further.” Or if you are using the same materials/methods.

          • Young CC Prof

            Yeah, that’s legit. Everyone cites their previous published papers. Or, in a blog post, putting in links with “Here’s where I explained all that in more detail.”

            However, including actual citations to more of your own non-peer-reviewed writing is kind of circular and not very supporting.

      • As someone who makes my living writing on the internet, I’ll tell you why you cite yourself. It’s all about SEO. You link back to your previous writings and it increases your clicks and your search engine results. I don’t know how Ms. Margulis gets paid, but I get paid by the hit. So, like today, I writing about typos in resumes, so I’ll link back to three or four other articles I have written about resumes.

        It’s just how writing on the internet works. It’s not the sign of bad journalism, it’s a sign of today’s standard online journalism. At one publication I write at, we’re supposed to link back to other articles on the site in the first two paragraphs. And so, of course, I’m going to link to my own stuff whenever possible rather than my colleagues, because, hey, more hits for me!

        • The Bofa, Being of the Sofa

          At one publication I write at,

          I know grammar criticism is tacky, but come on, you’re a writer, you know better than this.

        • anonymous

          I’m aware of that. My concern is that she is generating more BS by citing her own BS again and again and again. It’s kind of the old “I say so therefore it is” mentality.

  • Anonymous

    Wow. Just wow. My faves:

    5) You’d rather be rushed through 15-minute appointments with an
    obstetrician who can’t remember your name and really wants to get on to
    the next client than spend an hour or an hour and a half talking about
    diet, exercise, stress, and having any questions or concerns you have
    addressed with a midwife in the comfort of your own home or in her plant
    and light-filled office.

    You’re giving birth. During labor isn’t exactly the best time to go over diet, exercise, stress, etc. Our OB had a lovely ficus in her office, and it was beautifully well lit. When my wife had our first, she was checked, albeit briefly, every 15 minutes by the OB until our OB got there, and both knew our names. What’s the problem here?

    28) You find hospital birth professionals wearing blue pajamas to be
    more reassuring than experienced home birth midwives wearing their
    regular clothes.

    Yeah, because nothing says sterile environment like jeans and t-shirts.

    36) You like the idea of scheduling your baby’s birthday. 11/11/11 was a popular C-section day.

    Actually, we induced on a Friday because I wanted to be there, as did my mother, father, and my wife’s mother, father, sister, etc and my wife could recover over the weekend with the help of our mothers there.

    42) You think your baby should be vaccinated at birth against a sexually transmitted disease (hepatitis B) for which you and your partner have both tested negative and that is most common in prostitutes and IV drug users. You know that’s good thinking and good science but home birth midwives don’t administer the hepatitis B vaccine.

    Yeah, actually I do, Hep B is transmittable through body fluids, and I don’t like the idea of playing fast an loose with my child’s health.

    44) You don’t want to breastfeed and are glad to know that the hospital does product placement and covert advertising for the formula companies and will be loading you up with “free” formula and coupons.

    My wife wanted to breastfeed a whole lot. The problem is that she’s absolutely tiny(she didn’t even need maternity clothes, just a few pairs of pants that were a few sizes too large for her. She was never, ever able to produce much milk. We had a “lactation consultant” show up while my dad, an MD was in the room. When he was done with her she left, red faced and broken when he shot down every single useless suggestion she threw at us. The final straw was when she suggested that a white woman would have no trouble while my wife being Asian was the real problem.

    • anne

      Going over this list makes me think of how profoundly small homebirthers want the world to be. Your kid should never leave the house, or interact with kids that might have diseases that could be transmitted. They need no food other than what you produce.

    • OttawaAlison

      I spent 5 minutes with my OB. I have GD abd am also seeing an internal medicine specialist. I really don’t know how much more we could have discussed really in the 5 minutes. I was worried about my baby’s size in the ultrasound (she’s big) but having a big first baby and not being a small person she’s not shocked and told me not to worry. The nurse took my weight, blood pressure abd urine sample, those things are all good. There is literally no need for me to be in there any longer. I’m not looking for a friend and she’s highly regarded. That’s all I need.

    • PrimaryCareDoc

      Don’t these people have lives? I would freak out if I had to chat with a doctor for an hour and a half about all that shit. Get in, get out, get it done.

      • anne

        Doctors have malpractice insurance. They don’t have to create a codependent relationship so they don’t get sued when the s**t hits the fan. Brainwashing takes time.

        • Sullivan ThePoop

          I completely agree that a lot of CPMs are in the brainwashing business.

        • Life Tip

          Nailed it.

        • The Bofa, Being of the Sofa

          Then again, what else do these midwives have to do with their time? It’s not like they have a lot of other patients to get to, so they might as well sit around and socialize.

          Yeah, our doctor had to move on to other patients, because, you know, she HAD a lot of other patients to care for on that day.

        • SuperGDZ

          It also takes time to go through the entire list of possible “interventions” like heplocks, epidurals, Vit K injections and Hep B vaccines and convince the client/patient/victim that these are all BAD THINGS.

      • slandy09

        Yeah, I don’t get the 90-minute appointments either. Even the appointment when I was going through the testing procedures for cholestasis was only 20-30 minutes.

      • Liz Leyden

        Short appointments are a good sign! My longest appointment was the 20-week anatomy scan that detected my daughter’s heart problem. Several detailed scans and consults with an MFM and a pediatric cardiologist kept us there almost 3 hours.

        • KarenJJ

          Good point. I once spent 4 hours at a hospital eye clinic when I came in for a routine exam. Good outcome in the end (ie NOT a brain tumour) but it took a while to work some of that out and required a bit of subsequent testing (MRI, lumbar puncture).

        • Yes, isn’t it amazing how pregnancy “isn’t an illness” yet pregnant patients want more medical attention from their health care practitioners than really sick people do? I don’t get hour-long sessions [or even half-hour ones] with my endocrinologist who monitors my diabetes and has to keep track of my blood test results and write my prescriptions, arrange for neurological exams and eye tests.

      • Rabbit

        No kidding. If there wasn’t too long of a wait before my appointment, I could make it to my appointments and back during my lunch hour, and not have to take leave or work late. I never felt like my doctors were rushing me, and when the appointments needed to go longer (like when I reported significantly decreased fetal movement), they did. I don’t need my OB to be my friend, I need her/him to be my doctor.

      • carr528

        If you have other children, who even WANTS to be there 90 minutes?? I mean, either you have the kids with you, or they’re home, and you’re thinking about the homework you have to help with and the dinner you have to cook when you get home. Let me pee in the cup, listen to the heartbeat, and get the heck outta there!

        • fiftyfifty1

          ” who even WANTS to be there 90 minutes??”
          Me, me, special me! I want to be the star of my own birthing drama!!! 90 minutes of pandering and flattery for ME! 90 minutes of me telling my midwife how super healthy and organic my diet is and her agreeing and praising me!! 90 minutes of me telling her some “fact” about childbirth that I “educated” myself about online and her telling me how clever I am and how ignorant others are! ME!!!!

          • CrownedMedwife

            Unfortunately THIS is one of two situations that make appointments run over.
            Case #1: Pregnancy has a new complication or diagnosis. Extensive counseling, planning and support. Keep patient in the office while arranging immediate appointments with MFM, Geneticist, Hematologist, etc.

            Case #2: Pregnancy has no new complication, but patient (My apologies, but cannot bring myself to call patients “Mommas”) and partner present 6 page plan on how they intend for labor to proceed. Spend an hour refuting Vaccine, Vit K, pain management myths, complete with AAP and CDC handouts. Even more time spent discouraging her consideration of transfer for homebirth at which time ACOGs Position Statement is provided and discussed ad nauseam, complete with discussion HB plans as a deal breaker and will no longer provide care for duration of pregnancy, specifically as not able or willing to provide emergency or backup care in event of transfer.

          • CrownedMedwife

            Apologies, Disqus froze. Case #2 addition: completely left out EFM, heplock, no etc. I’ve been hearing the organic boasts for too long I cannot even bring myself to feign a congratulatory smile.

            It’s frustrating to spend as much time dispelling myths for the “educated” crowd as I do for a family experiencing the threat to health or the future for themselves or their baby. My guess is that family wishes their biggest concern was physiologic 3rd stage or encapsulation and not a litany of specialist appointments. It’s hard to wear my customer service hat when I’m more concerned with using my science brain.

          • fiftyfifty1

            So true.

            I am so sick of the boasts disguised as questions. “I already do yoga and pilates. What other suggestions do you have for working my core?”

            Like I care, lady.

          • DiomedesV

            Ah, brings back memories. I used to be that way. God, I was such a narcissistic jerk. I constantly talked about exercise and how much I was doing. I’m surprised I still have friends! Now when I hang out with people like that I just try not to roll my eyes.

          • Dr Kitty

            “That sounds like more than enough to me. Talk to a personal trainer.”

          • Haelmoon

            I routinely spend more time on some of my midwife consults for VBAC or post dates management (in my general clinic) than I do with patients newly diagnosed with a fetal anomaly (in my high risk clinic). And I book 45 minutes for first appointments in the high risk clinic.

          • moto_librarian

            And this is exactly why the NCB crowd needs to get some fucking perspective. It blows my mind that you have to spend more time dealing with women with healthy pregnancies than women who are suddenly facing serious problems.

    • The Bofa, Being of the Sofa

      spend an hour or an hour and a half talking about diet, exercise, stress, and having any questions or concerns you have addressed

      How does that take an hour?

      What is there to say about exercise? Exercise is good. There are exercises you might want to avoid while pregnant, but, for the most part, not really. As long as you are comfortable to do them, I recommend it. Any type of exercise you would do will be good.

      OK, that took 30 seconds. Next topic?

      Diet.
      Eat healthy, if you can. Fruits and grains are good, limit your portions in fats and carbs. Of course, it depends on what you are able to handle. We’ll keep an eye on your weight gain to make sure it stays in a healthy range.

      OK, that took 20 more seconds. Now on to stress…

      I can’t tell you not to be stressed. What are the things you are stressed about? What do you have for coping mechanisms?

      I can see that going on for another 5 – 10 minutes with no problem. So now I am up to a 11 minute appointment.

      She can be doing physical exam things in the meantime, so that won’t add too much more to it. And now time for questions.

      Answer all your questions, and then out the door.

      Actually, I don’t see how this is inconsistent with any of our OB appointments. It’s just that our longest lasted 15 minutes, not 90.

      What were we missing?

      • Amy M

        Our first appt with the OB lasted 45 min, because we had a lot of questions about my surprise twin pregnancy. But, since we got a lot of that out of the way then, she usually spent 15-20 with me on subsequent visits. I did tend to spend more time in the office, because of u/s too, but the OB wasn’t in the room for that.

      • Therese

        Well, if I wanted to be nit picky, your diet advice isn’t the most impressive. You say to limit carbs but then the only foods you recommend as being good are foods that are mostly all carbs. I wonder if diet advice is so easy that it takes 20 seconds why are dietitians even a thing? Now if you wanted to argue that midwives are not dieticians then you might have an argument, but don’t act like nutrition is so simple it can be adequately addressed in 20 seconds.

        • The Bofa, Being of the Sofa

          I wonder if diet advice is so easy that it takes 20 seconds why are dietitians even a thing?

          Because their are people for whom diet issues are important.

          Is there any reason to think that applies to pregnant women? Those with issues, sure, but until you have identified a problem? Is there any really nuanced diet requirements?

          The problem is that the whackos way overstate the role of diet for the general population. Our problem is not lack of any nutrients, it is the excess and empty calories. We have access to plenty of perfectly healthy food. The problem is that we have a side of super-sized french fries instead of a normal serving of canned green beans.

          • Who?

            So true. My nutjob food obsessed friends drive all over town buying organic this and that, top it all up with ridiculously overpriced supplements, and come over all faint when I tell them I think they are wasting their time and money.

            There are good reasons to avoid supermarkets here in Australia-to do with their anti-competitive cartel behaviour and the resulting jacking up of prices while screwing producers. Nothing to do with the ready availability of fresh, healthy food.

            We just had two weeks in Japan, walking all over the place and eating ‘japanese’ portions, and we both lost a kilo or two off frames that were already healthy weights. So now we’re staying on Japanese portions, which are perfectly fine.

            For the record I have never seen a canned green bean.

          • Young CC Prof

            I can’t imagine life without canned green beans. Serve them next to baked mac and cheese, or square pizza, and that’s the best of grammar-school lunch come back for me. Total comfort food.

          • Who?

            Square pizza!!!

            Isn’t it funny how different comfort food is for all of us? I’ve just made mac and cheese for my daughter-she’s engaged in high level procrastination ahead of her engineering exams-but I don’t bake it (Mum does, though) just boil the mac, make the cheesy sauce (butter, flour, milk, cheese at the end) then put it all together in the pan before tipping into the bowl. Add spinach (at butter stage of the sauce) and tinned tuna at the end, for pasta and green cheese sauce, my son’s staple comfort food for the last 20 years.

            We didn’t have school lunches either, ours was a sandwich from home and maybe a piece of fruit or even cake if you were lucky. But I can see how something hot and tasty on a school day could become a life-long favourite.

          • The Bofa, Being of the Sofa

            Actually, I used to not get to go to recess because I wouldn’t eat my green beans in grade school. Couldn’t stand them.

            Always told my wife that story, but she can’t believe it that I actually like them now.

            Not as much as fresh green beans, but I still like them canned.

        • fiftyfifty1

          Well Bofa isn’t a doctor, but his advice isn’t bad. The only thing I might quibble about with him is his advice to limit carbs and fat. Unless you are diabetic or borderline, you really don’t need to be counting carbs. His advice of plenty of fruits and veggies and try to gain a healthy amount of weight is spot on. Healthy pregnant women can generally be advised to eat a well-rounded, culturally appropriate diet, avoid or greatly minimize alcohol, be mindful of avoiding food poisoning risks (unpasturized cheeses, deli foods etc), avoid large predator fish from contaminated waters. Take your prenatal vitamin.
          We use dieticians for people for whom a “regular” diet is not enough: people with diabetes, eating disorders, extensive food allergies, malabsorption syndromes, failure to thrive, severe obesity. A healthy person, pregnant or not, doesn’t need a dietician.

      • Bombshellrisa

        The less than one minute explanation with the wallet size hand out that tells you how much/often you can eat different kinds of fish

      • AmyH

        Duh, you’re not talking about all the other sheeple who aren’t making intelligent choices like YOU.

      • KarenJJ

        “spend an hour or an hour and a half talking about diet, exercise, stress”

        The only people that want to talk about that for half an hour are people that have very few issues with diet, exercise or stress and just want to flatter themselves..

      • AlisonCummins

        “Eat healthy, if you can. Fruits and veggies are good, limit your portions in fats and carbs. Take folic acid supplements.”

        That’s easy advice to follow if you’re already following it. If you aren’t following it, you probably have reasons. Addressing those reasons takes knowledge, training and tact.

        If money is an issue, where can you get extra food baskets in your community? Do you know how to cook? Are you set up to cook? Do you have time to cook? Are there community kitchens where you can pool staples and cook together economically? Do you know what “fats and carbs” are? Do you know how to read the nutrition labels and ingedient lists on prepared foods? Are there any vegetables you like to eat? How can you improve your diet without eating vegetables? Is fresh, not-spoiled fruit available in your neighbourhood? Are there particular concerns with the traditional diet in your community?

        Related: do you smoke, drink or use any recreational drugs? If so, would you like cut back or stop during pregnancy? If not, how can harm be minimized?

        • AlisonCummins

          … Are you on a fad diet? Do you have any risky notions about what constitutes “extra-healthy”?

          Anyway, a dietician will be aware of local resources and be able to coach someone through changes, which are *always* difficult. A doctor may ask a few questions and determine that someone is at higher risk (smoker, underweight, overweight, recent immigrant, low-income, low-literacy, low status within current household) and refer them to a dietician who can take the time to help.

          It‘s not rocket science, but it’s naive to assume that because it’s easy and obvious for you that it must be easy and obvious for everyone.

          • Young CC Prof

            Yup. My OB addressed all my real questions about diet and exercise, plus the basic advice she gives everyone, in a total of about 10 minutes during the first few appointments. I decided that, due to food allergies and digestive issues, I needed some more in-depth help in working out a good diet, so I called a registered dietician. (She was annoyingly half-quacky, however. Not a total flake, but still believed some flaky things.)

    • slandy09

      Your wife’s ethnicity being blamed for not being able to breastfeed? Seriously? Not being able to produce enough milk is no respecter of ethnicity.

      • anonymous

        Yes. I was out of the room when this was apparently said but I heard pop yelling at the top of his lungs at her for even suggesting it.

    • The Computer Ate My Nym

      #5: I’d much rather have a doctor who remembered the latest ACOG guidelines and forgot my name than the other way around.
      #28: Dam straight I do.
      #42: Yes, I want my baby vaccinated against a cancer causing virus and as soon as possible! I don’t want to increase the risk she might get a hepatoma some day by even a very little bit. Plus, how do you know I tested negative? Are people who test positive too inferior to read your post or what?
      #44: I breast fed for 2 years. But before all that I had a day or two where I was dehydrated and not producing good milk. This meant that baby got dehydrated and had a small fever. Yes, I was very grateful that she could get a little formula and pedialyte and recover.

      • fiftyfifty1

        “Are people who test positive too inferior to read your post or what?”
        Yes, her implications about people with Hep B are so offensive. You wouldn’t want your kid vaccinated against THAT virus or people might think you are a prostitute (shameful sluts!) or a IV drug user!
        Do I have a number of patients with Hep B? Yes I do. Are some of them prostitutes? Not that I know of, but perhaps. Are some of them IV drug users? Yes, a few. A much larger number, however, are former drug users. Tons of “children of the 60’s” who are now grandparent age. A lot of these did not use IV drugs however, but rather caught the virus from snorted cocaine use with a shared straw or sexual activity. Hep B is actually easy to catch. Much easier than HIV. It doesn’t have to be IV or sex. It can be household contact. The vast VAST majority of my patients with Hep B are neither prostitures nor drug users of any sort. The majority picked it up as children. Either at birth or within the first few years from household-level contact. Your kid could pick it up at daycare or school (maybe from one of those immigrant children who came from a country where Hep B vaccination is not widely available!) Or maybe from Gramma who doesn’t even know she carries it.
        But if after all this, you STILL think your precious baby is too special to possibly ever catch Hep B, and you don’t want the shot, then don’t sign the consent paper for it at the hospital. Simple as that!

        • Guest

          You left out vaccinated nonconverter providers who count on herd immunity to reduce infection in an at-risk population. I’ve often wondered whether nonconverters get a feeling of warm appreciation for modern medicine each time a new baby receives its first in the series at the hospital. It would be nice to take immunity for granted in an environment with daily exposure to blood and bodily fluid.

        • SuperGDZ

          I bet some of the same people who think it’s impossible for their child to catch Hep B are terrified of Ebola.

        • LovleAnjel

          A few years ago I witnessed a car accident, and we pulled over to help. People were bleeding. Later I found out one of them had Hepatitis. So I was exposed because I was a good goddamned samaritan (I had the shot in high school and grad school). I guess they are going to raise their kids to just drive on past people in need of help.

          • Stacy48918

            That’s terrifying.

          • fiftyfifty1

            Well those people in need of help are probably prostitutes and IV drug users anyway!

        • Mishimoo

          My late stepmother-in-law picked it up when she was 9. Watching her die slowly and painfully over 2 years when her liver finally packed it in was more than enough incentive for us to be very pro-vax.

    • LovleAnjel

      My OB was happy to answer my questions until I was satisfied. He even got a page from L&D and still took the time to carefully go over things with me – no rushing out the door to slice and dice. It didn’t take an hour and a half because I wasn’t there on a social visit.

    • Bombshellrisa

      My doctor, the PA and the two medical assistants all remembered my name AND my husband’s name. The hospitalist and the nurses in triage also remembered my name when I came in to deliver, after having visited triage three days before. Even if they didn’t know my name, they all had access to my chart and knew my allergies, medical history and all the results from tests, and every note from my visits. That, in my never to be humble opinion, matters much more.

      • Haelmoon

        We remember names, sometimes it takes a little prompting. I was on call the other night, and a lady showed up with a normal pregnancy. I had cared for her in the last pregnancy because of fetal anomalies. I recognized her, and as soon as she said her name, I remembered everything about her last pregnancy and asked about how the baby was doing. She was pleased that I even remembered it was a girl. We care about our patients, even if we don’t take two hours per visit.

    • araikwao

      #28 – who is seriously making decisions based on the clothing of the accoucheur? And after that, what you said ^^

      • The Bofa, Being of the Sofa

        who is seriously making decisions based on the clothing of the accoucheur?

        All of those people who love Dr Oz, apparently. His parading around in scrubs is no accident.

        Then again, I am not going to hold up the Dr Oz Fan Club as the model of great wisdom in determining the quality of medical care.

      • MJ

        And my hospital midwife wore normal but professional clothes anyway. Geez. This should be a list of “lots of things Jennifer doesn’t know about hospitals.”

        • KarenJJ

          Not all of these homebirth midwives wear “normal” clothes anyway.

    • Mariana Baca

      The Hep B thing is such a “western priviledge” mentality. In places where Hep B is common, children are the main vectors of transmission, not sex and drugs — I was actually surprised to read that it was considered an STD here. It is only where vaccination rates are high that the disease is confined to fringe groups, and one can even think of not vaccinating kids — who tends to spew bodily fluids everywhere.

    • spend an hour or an hour and a half talking about
      diet, exercise, stress, and having any questions or concerns you have
      addressed with a midwife in the comfort of your own home

      When I did district midwifery antenatal visits, I never had even half an hour to sit with a patient, or I’d never make all the home visits scheduled for that day.

      experienced home birth midwives wearing their
      regular clothes.

      For a home delivery, we always put disposable [non-sterile] disposable OR gowns over our uniforms, as well as wearing a plastic apron underneath, so the uniform would not get stained or wet.

    • Mac Sherbert

      #5 – If could could get out of my OB’s office in 15 minutes I would have been happy! I loved that my Dr. didn’t talk down to me about nutrition or anything else. Treated me like a big girl and was always open to any questions I had as were the nurses in her office.

      #28 – Don’t remember what any one at the hospital was wearing. Including my OB. I do remember what my husband wore…as he managed to wear the exact same shirt for both births.

      #36 — I feel somewhat cheated on this with my scheduled c-section. Dr. was out of town and I wanted it scheduled on actual due date which would have made the day born the same as the year born…just like my first child. —

      #42 – You can tell the hospital no for the Hep B vaccine, if you so desire. (Not saying it’s a good choice, but it is do able.)

      #44 – I like those product placements…Still BF.

    • Mac Sherbert

      #5 – If could could get out of my OB’s office in 15 minutes I would have been happy! I loved that my Dr. didn’t talk down to me about nutrition or anything else. Treated me like a big girl and was always open to any questions I had as were the nurses in her office.

      #28 – Don’t remember what any one at the hospital was wearing. Including my OB. I do remember what my husband wore…as he managed to wear the exact same shirt for both births.

      #36 — I feel somewhat cheated on this with my scheduled c-section. Dr. was out of town and I wanted it scheduled on actual due date which would have made the day born the same as the year born…just like my first child. —

      #42 – You can tell the hospital no for the Hep B vaccine, if you so desire. (Not saying it’s a good choice, but it is do able.)

      #44 – I like those product placements…Still BF.

    • Starling

      #28) My doctor was wearing street clothes, including a white vest, when my son was born. (Baby was out unexpectedly in two pushes, unusual for a first-time mother, and everyone at the nursing station ran in to help. I think one of the nurses had only one glove on, a la Michael Jackson.) My husband apologized afterwards for the bloodstains.

  • PrimaryCareDoc

    “15) You also won’t mind having a group of young residents, mostly men, stand around the bed where you are lying and each take a turn measuring your cervical dilation with their fingers, which they do so roughly and awkwardly that it causes your cervix to swell. Someone’s got to teach ’em, why not you?”

    Where are all these male residents coming from? Aren’t about 90% of OB residents women?

    • lawyer jane

      You know, this one REALLY bothers me. She makes it sound like you get practically gang raped in the hospital. That might scare a woman with a history of abuse into thinking she has to give birth at home! And for the record, the only person who painfully abused my cervix at my own birth was my own extremely crunchy (albeit hospital based) midwife, who manually stretched it without pain relief and without my consent, while I screamed at her to stop.

      • Elizabeth A

        I completely agree with this, and I can’t say it enough.

        All of the hospitals I had the option to give birth at were teaching hospitals, and there were always residents involved in my care, but “a crowd”? No. “Taking turns checking your cervical dilation”? Hell no. I had maybe three cervical checks the entire time I was in labor – one on admission, the other two because I asked if I could push yet. “Mostly men”? HELL no. Most of the trainees in OB are women. Residents were always introduced to me as residents. They usually showed up one at a time, under the supervision of a preceptor. The limits of their ability to provide care, and when it was and was not appropriate for them to touch me were quite clear.

        I was sad when the resident who helped deliver DD moved out of town, but it was not surprising – she was a great doctor, and it was clear that her preceptor thought so too. She got a well-deserved dream job on another coast.

        • moto_librarian

          I am fairly certain that the doctor who repaired my cervical laceration was a resident or fellow. I wish I had gotten to see him again so I could thank him for taking such good care of me. It also wouldn’t surprise me if there were a number of people in the O.R. while I had my repair done. Given that I was high on fentanyl, I don’t remember, nor do I care if they were there. They need to learn.

          • Amy M

            That’s a good point…a ton of people came in when I had the PPH—several of them may have been residents or students, I only recognized maybe 2 of them. But since they were all trying to help me, and succeeded, I was totally down with that. (and in the moment, was barely aware of all the people)

    • moto_librarian

      I delivered both of my children at a teaching hospital. Number of residents that checked my dilation = zero. There were some residents on the NICU team that was there when our second was delivered since there was mec in the fluid. Since he needed a bit of help to get going, I was glad to have them there.

      • The Computer Ate My Nym

        Likewise. Two cervical checks during the whole time and neither was the least bit painful. Though to be fair, I did check laboring women’s cervixes during medical school. Not one of them ever said it hurt, but perhaps they were distracted by the “rush” of contractions.

        • moto_librarian

          I always found cervical checks to be somewhat painful, and I have had them done by many different CNMs and nurses, so I don’t think it’s anything about their technique. I can see how someone who is more sensitive to them might blame it on a student’s inexperience when in reality, they simply find them uncomfortable no matter what.

      • Amy M

        I think I saw three residents when I had my children. One, a woman, was there for most of the labor and delivery. She told me she wanted to specialize in perineal repair. The other two, and I’m not sure if they were residents or what, were men. One did a cervical check when I came in. The other hung around until I kicked him out when the pushing phase began, because I thought he was smirking at me.

      • Rabbit

        Two of my children were delivered at teaching hospitals. At the first, I never set eyes on a resident or med student. At the second, a resident helped with the preliminaries before starting the induction, but it was made clear at the beginning that he was a resident, and that I could decline any care from him.

      • MaineJen

        At both of my kids’ births (I think…), there were medical students observing during delivery. For my son, it was the resident (male) who actually delivered him, with the OB (female) right there beside him. I only had one bad experience with a student/resident; a very painful cervical check from a woman who obviously hadn’t done very many before! Ouch. But I still see how valuable it was to be a part of her training. I was asked permission each and every time someone was to observe or train, and honestly, by the time I delivered, I didn’t really care who-all was in the room. The pope could have walked in, and I wouldn’t have cared.

    • Mel

      In cattle, delivering a calf causes cervical swelling. I’m gonna assume that is true in human women as well, so how EXACTLY would you tease out the difference?

    • Guesteleh

      FYI to anyone who doesn’t know this, but even if you give birth in a teaching hospital you can explicitly refuse to allow students and residents to examine you. I used to work at a hospital and made it a point to say no because I didn’t want those goobers to see my in the altogether and then have to help them out with getting rotations or whatever.

      • Dr Kitty

        You can decline students in the room.
        You can decline to be examined, at any time, but especially if the examination is for educational purposes rather than clinical need.

        Where I worked there was only one junior doctor on labour ward at any time. So the most any labouring women would ever have is the midwife doing a check, asking the SPR or consultant to come in and repeat it if they felt it was necessary and *maybe* me or the other junior on asking if it would be ok to check.

        I never did intrapartum cervical checks as a medical student, precisely because it was felt to be an unnecessarily invasive examination, that was more appropriately taught to qualified doctors.

        I don’t want to be friends with anyone who is doing my gynae exam. I want them to be professional, quick and well practised. Pretty sure someone with 50 births a year who does maybe two cervical checks in each labour ( because they’re unnecessary) is not going to be as good as the OB or hospital midwife doing four or five cervical checks a day.

        • Dr Kitty

          I should clarify, by “unnecessarily invasive”
          I don’t mean cervical checks are unnecessary, I mean that it was not considered an appropriate exam for medical students to learn, because to teach it would have been unnecessarily invasive for the patients.

          They make models- the med students got taught with those, not real people.

      • Young CC Prof

        There weren’t any medical students when I delivered, but there often were when I went for ultrasounds. I was always introduced to the student and asked if I was OK with the student observing.

        It was actually more fun when the student was there, because then the doctor explained a whole lot more, like how to measure fluid pockets and why they’re measured that way.

        • Kelly

          That happened to us. I thought it was so cool to hear everything that they look for. I came out with a greater respect for the people who do ultrasounds because I had not realized how much they did.

    • Melly

      I gave birth in a teaching hospital.
      Here it’s standard for the OB resident to do most of the work during the delivery, with the OB supervising. Both births I had ONE resident, ONE OB, and ONE med student who just observed the birth.
      In my second birth, I was asked if the intern could do a cervical check and I politely declined. And that was that.

    • MJ

      I find this just a disgusting statement. I had all my children in a teaching hospital. When I was induced with my first son I was very explicitly given the option to have a medical student attend. I was more the happy to have him there. I honestly don’t remember if he touched me at all, but I don’t think so. I laboured from 8pm through to 7am by which time his shift was long over. The first thing he did when he came back on shift the next day was come to see how my son and I were. I asked if he wanted to hold my baby and I watched as he gently held my precious new son and tears welled up in his eyes.

      How dare this ridiculous, ill-informed woman malign him – and every other person who works their arse off to learn how to take care of us – in this vulgar way.

      • araikwao

        As a medical student, thank you so much for letting him attend (even more so because he was a guy, I think they get a tough break in women’s health!)

        My last delivery I had a resident and a student midwife. Neither of them checked my cervix, only the reg did that, twice I think?

        • MJ

          Please don’t thank me. I think the work that our medical professionals do is amazing and I feel it is my obligation to contribute to the learning process any way I can, given that I use and value their services.

          My third child was delivered by midwives in the same hospital. They also have a regular (but not frequent) program of giving staff a day in another area of the hospital. My midwives asked if I would mind if they were joined by a non-midwife nurse who usually worked in the OR doing something to do with anaesthetics. I remember as my baby was being delivered seeing her standing quietly a few feet away from the bed – but she was bouncing. She was so incredibly excited. How can you not feel good about that?

          The last time my eldest was in our tertiary children’s hospital for asthma the registrar (is that the right name for the grand poobah doc on the emergency ward?) asked if she could use him to test three of her students. One of them had to do a complete physical exam on him. One of them had to interview him (he was 9 at the time and very comfortable with it all). And one of them had to take a complete history from me. She was drilling them really, really hard. It was quite a privilege to see what goes in to preparing these students for the very deft, very deliberate work they end up doing.

          Good luck with your medical studies and thanks for heading down that long and demanding road.

          • araikwao

            Ah, but I completely understand that you didn’t have to let anyone extra/superfluous in, and it was really generous of you to do so, so my thank you stands 🙂
            Thanks also for letting the consultant and students see your son – we had a lot of bedside tutorials like that, and they are so great for learning! And thanks for your good wishes, too! Speaking of that long and demanding road, I should go and study for my exams now…sigh.

      • Anonymous

        It’s a teaching hospital, emphasis on teaching. I don’t see why people are so shocked. When I got shot(long and surprisingly funny story) there were 5 residents in the room with me, mainly because none of them had ever seen a gunshot wound like the one I had. OBTW, I was stark naked at the time. Did I object? Nope. That’s the whole point of a teaching hospital.

    • Liz Leyden

      About 15 people were in the OR when I had my babies, and I guess a student or 2 was in there. Since I had a C-section, no one checked my cervix. Then again, I don’t remember much of anything after the epidural started.

      On the other hand, I saw a lot of med and PA students at my OB’s office. Once I got to the every-2-weeks stage, every visit included a student or 2. I was the interesting case- an obese elderly primipara carrying spontaneous di-di twins, one of whom had a severe cardiac problem. I didn’t mind.

    • GiddyUpGo123

      When I had my first c-section there were two students who requested permission to watch. They requested permission from *me,* and I said yes, because I am perfectly happy to help someone’s education and I really felt like that was a small thing, as far as I was concerned. I seem to recall they had spent the last couple of weeks watching colonoscopies or something really horrible like that, so they were really excited to get to see a baby come into the world. Of course I was having a c-section so no need to check dilation, but I can’t imagine if they had to get permission just to watch that they also wouldn’t have had to get permission to do actual exams. Some of the stupid shit I read from NCBers makes my head spin.

    • Leslie

      I initially agreed to have a student nurse observe my induction, labor and delivery. But, the young woman chattered incessantly and would. not. shut. up. And, she didn’t just ramble — she kept asking me a constant stream of inane questions for at least two hours. I kept telling her I didn’t want to talk; two minutes later, she’d start in again with the idiotic questions. Finally, I gave up and asked my main nurse to ask her to leave. I felt badly about it because her feelings clearly were hurt, but she really was driving me batty.

      • Who?

        The student was probably nervous, but it was up to her supervisor to manage her behaviour, that should not have been left to you.

    • Kelly

      Most of the things she had on there are things that you have to say yes to. Every time they checked me, they asked me and gave me a chance to get past a contraction. They are just scare mongering.

  • PrimaryCareDoc

    MY IQ just dropped 20 points reading that list.

    • anne

      You probably understand it better now.

      • PrimaryCareDoc

        Excellent point.

  • lawyer jane

    Did she really use the term “birth haters”? And use “scientific” as an adjective, as in the “most scientific birth”? What is a “scientific birth”?

    • Trixie

      I’ll happily admit that I’m not fond of the birth process. Does that make me a birth hater?

      • anonymous

        Good question. Based on all the things my wife was hollering at everyone in the room when she was in labor, she’s a hater of literally everything in the hospital. I think she even was cursing the door knobs at some point.

        • Trixie

          At some point it was suggested to me to ride contractions like gentle ocean waves. I’m pretty sure the whole hall heard me scream, “I f*cling hate the ocean!”

      • Bombshellrisa

        You mean you would rather cuddle a cute baby and dress it up and show it off than spend hours in agonizing pain while feeling nauseated and pooping with every push? Birth Hater!!!

        • Trixie

          Yeah, I’ve had them out both escape routes and can’t say I was particularly fond of either method.

          • Bombshellrisa

            My mom has said many times that labor was hell and she actually preferred her emergency c-section to pushing but hated all of it. She did enjoy actual parenting, she loved going to “Gross Out Fest” at the Pacific Science Center as much as we loved going and she was never bored doing kid things or going to kid movies. She hated birth but loves what she got out of it.

      • anne

        You probably hatted your baby too.

        • Trixie

          Hatting is hating, I always say.

  • Monica

    And if ever there was a post that perpetuated mommy wars Ms. Margulis has got it. Lets keep shaming women. I know they live in a fairy tale land where women shouldn’t be feeling the need to give birth in the hospital, but surely Ms. Margulis must admit that some women do require a hospital. What does she say to those women about this snarky fear mongering piece of hers? Oh no this doesn’t apply to you because doctors and nurses are only cruel to the women who don’t really NEED the hospital?

  • Young CC Prof

    #6: You want pain relief, or at least want to keep your pain-relief options open.

    #7: You want someone else to clean up.

    #8: You want to reduce your risk of postpartum hemorrhage.

    • Anj Fabian

      You do NOT want to get out of bed and cook dinner for the family that night.

      They’ll be fine even if dad burns the fish sticks and french fries. That’s what the ketchup and tartar sauce is for.

      • Bombshellrisa

        For that matter, you don’t want to cater a buffet for your birth team-this is pretty common when you have a home birth (at least the ones I have been to). The professionals who cared for me got their own food, thank you very much, and I didn’t even have to lift a finger to order my meals postpartum (ordering food via remote control on a tv is really too wonderful. The food was incredible too)

    • anne

      11) You want trained medical professionals to keep an eye on you and your child in the hours after giving birth to make sure you don’t develop an infection or other problems.

      • Roadstergal

        12: You can have that ‘perfect’ natural birth if you want and if everything goes smoothly. They don’t ‘intervene’ for shits and giggles.

        13: Your daughter will forevermore think of that hospital as a lovely and special place and the workers within as kind, helpful people, and won’t fear going to professional health care providers if needed.

    • OBPI Mama

      Oh, I LOVE your #7!!! My midwife left my mom with 6 loads of laundry to do, a tub to drain and disassemble, and blood all over the floors to scrub away… Not to mention all the care my Mom gave me those first few days… she was exhausted, poor woman.

  • Anj Fabian

    Ms. Margulis,

    Are you saying that women in Portland shouldn’t have home births?

    “Amy, Oregon has some of the safest best homebirth stats in the country IF YOU DON’T COUNT PORTLAND…”

    • anne

      The Portland Metro Area (not including parts of WA) has half the population of the state of OR. The thought of leaving out half the population of a state when considering the safety of homebirthing is mind boggling.

      Numberzz is hard.

      • Anj Fabian

        I think she’s accusing the women in Portland of dragging the HB numbers down.

        • anne

          She is. It’s just crazy to say that half the population (the population with the most and easiest access to a variety of hospitals and hospital based midwives) should be ignored because they make the numbers look bad.

          Looking at it logically you would assume that to make HB numbers better you should exclude the other half of the population in OR – the part that lives in much smaller cities or in rural areas, has fewer birthing options, and a much longer drive to specialty medical care.

          • Anj Fabian

            So if you look at those numbers and say that the area that should have the worse numbers because of scarce resources has the better numbers….

            …and the area that should have the best numbers due to better resources and access to the same has worse outcomes..

            …what is the difference?

            a) The women choosing home births are the problem.
            b) The midwives attending those home births are the problem.

            Hey! Jennifer Margulis!
            Over here! I have a question for you….

      • Who?

        Oh I think she understands the numbers perfectly, which leads to her wanting to leave some out.