Rebecca Dekker, Evidence Based Birth, and the seductive marketing tactics of the natural childbirth industry

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I’ve often remarked that no sooner do I write a post about some aspect of the natural childbirth industry than advocates leap to validate my concerns and demonstrate the truth of my warnings.

Today Rebecca Dekker demonstrates the seductive marketing tactics of the natural childbirth industry.

Her latest piece is What is the Evidence for Inducing Labor if Your Water Breaks at Term?, which, as it typical in the natural childbirth industry, an alternate world of internal legitimacy, was immediately trumpeted by another industry outlet, Lamaze International’s Science and Sensibility.

In a piece nearly 10,000 words long, Dekker and associates break no new ground, come up with no new recommendations, but act as if they’ve reinvented the wheel.

For perspective, let me tell you how prolonged rupture of membranes was managed 30 years ago when I started my training:

If a woman at term presented with ruptured membranes but not in labor, she was assessed for fetal well being (using the fetal monitor), maternal well being (including fever) and risk factors. No vaginal exams were done; occasionally a sterile speculum exam was performed. In the absence risk factors, the woman was advised to wait 24 hours and then return for possible induction of labor since the risk of an neonatal sepsis (severe infection of the newborn) begins to rise after membranes have been ruptured for more than 24 hours.

What did Dekker and associates recommend after their 10,000 word review? EXACTLY THE SAME THING!

Specifically:

Evidence shows that in women who meet certain criteria (single baby, head-first position, clear fluid, no fever or signs of infection in mother or baby, negative Group B Strep test), waiting for labor to start on its own for up to 2-3 days is as safe for the baby as inducing labor right away, although the mother is more likely to get an infection herself.

So what’s the big deal? Why the hoopla, the avalanche of words, the charts and lists?

That’s all part of the seductive marketing tactics of the natural childbirth industry that Dekker is so helpfully illustrating for us.

To wit:

1. Never forget that natural childbirth is an industry

Dekker is constantly branding and constantly selling. And she doesn’t let you forget it.

Through December 1 only, you can download a printer-friendly PDF of this entire article, plus a 52-page annotated bibliography PDF, for FREE!! Included with your download is copyright permission to print and share the blog article PDF with anyone you like– friends, health care providers, coworkers, clients! The cost of these two PDFs is “pay what you want,” meaning that you can download them for free, or you can pay what you feel is the value of these materials (suggested value = $5-10).

All flyers preview

Those who give $25 will receive a high-resolution of these 8.5 by 11 inch PROM flyers to print and share with anyone you like!

If you want to purchase the PDFs, I have a special “thank you” for those of you who pay $15 or more. In addition to the printer-friendly PDF and the annotated bibliography, you will get access to an online quiz about PROM that you can take to earn a continuing education certificate for one nursing contact hour!! Nursing contact hours are accepted by most doula, childbirth educator, and some midwifery organizations (check with your certifying organization to see if they accept nursing contact hours.)

Finally, for those of you who pay $25 or more for the materials, you will get everything listed above– the printer-friendly PDF, annotated bibliography, quiz plus contact hour, PLUS four colorful 8.5 x 11 inch handouts about PROM that you can print and share with anyone you like! These beautiful flyers are perfect for placing in client folders, hanging at the nurse’s station, or giving out at maternity fairs.

To download the printer-friendly PDF and annotated bibliography for $0+ (suggested value $5), click HERE. (PayPal users, click here!) …

I’ve helpfully bolded the standard sales pitches. Hey, if it works for the Ginsu knife, why shouldn’t it work for the nonsense that Dekker is selling?

The key point: Dekker tries to monetize everything, no matter how trivial (“Those who give $25 will receive a high-resolution of these 8.5 by 11 inch PROM flyers”).

Dekker, a cardiology nurse, is trying to monetize a blog post about obstetrics, when the information is available anywhere for free.

Does anyone really pay for this crap?

2. The primary product being sold by the natural childbirth industry is distrust of obstetricians

Dekker disgorged a 10,000 word post on prelabor rupture of membranes that tells us nothing that we didn’t know decades ago, but you’d never know it by looking at the 24 point font, the exclamation points, and the charts and handouts.

Why? Because Dekker’s secondary purpose (after her primary purpose of enriching herself) is to encourage distrust of obstetricians.

There are many examples within the post, but the most egregious is probably the claim that obstetricians view prolonged rupture of membranes as an indication for C-section. Dekker trumpeted this claim several days ago on yet another outlet of the natural childbirth industry, ImprovingBirth.org.

When I questioned the provenance of this claim, I was offered a paper written back in 1966, not corroborated by any others and NEVER recommended by an obstetric organization. Shortly thereafter, my comments were deleted, I was banned from ImprovingBirth.org, and now I can’t find the post on their Facebook page.

Why? Presumably because I publicly pointed out the deliberately misleading attempt to portray obstetricians as incapable of following scientific evidence. Removing my comments and banning me is an indication that Dekker and ImprovingBirth.org are well aware that the claim is misleading. That didn’t stop Dekker from including it in her post:

Many doctors at this time said that women should give birth within 24 hours after their water broke, even if that requires a C-section.

In 1966, Shubeck et al wrote,

“With rupture of membranes, the clock of infection starts to tick; from this point on isolation and protection of the fetus from external microorganisms virtually ceases…Fetal mortality, largely due to infection, increases with the time from rupture of membranes to the onset of labor.” (Shubeck et al., 1966)

One doctor, Shubek, who no one listened to, back in 1966 said women should have a C-section if they hadn’t delivered within 24 hours is maliciously and misleadingly transformed into a policy that “many doctors” followed.

The entire point is gratuitous. No one really care what anyone said back in 1966, let alone someone that everyone else ignored, but Dekker couldn’t resist including it (and lying about it) because one of her primary purposes (after enriching herself) is to promote distrust of obstetricians.

3. Natural childbirth advocacy seeks to create personal conflict and hostility between women and their obstetricians

Dekker has learned nothing new. She has simply reiterated a policy that has been in place for at least 30 years, but you’d never know that. The implication of the piece is that Dekker has discovered something new, something ignored by obstetricians, and now is teaching women how to protect women from their ignorant doctors.

Dekker said everyone should feel free to use this image on their own blog, so I am doing so.

Dekker PROM

Dekker reiterates this in the Science and Sensibility piece:

Finally, probably the single most important thing that women need to know is to not let people put hands up your vagina after your water breaks! That is the single most important risk factor for infection, and hands need to be kept out as much as possible.

But who was recommending vaginal exams for prelabor rupture of membranes in the first place? No one.

What is the point of emphasizing to women that they should not let an obstetrician do what he or she wasn’t planning to do anyway? It’s like mentioning outdated procedures like shaves and enemas on a birth plan. It’s only purpose is to create conflict and mistrust between women and their providers.

Finally, Dekker’s piece, indeed her entire blog, is notable for one other feature characteristic of the natural childbirth industry. Dekker takes no responsibility for anything she writes. According to her disclaimer:

The Evidence Based Birth® website and blog content only provides general information that may or may not apply to your personal health condition or circumstances. The opinions expressed on this website and blog by Rebecca Dekker, PhD, RN, APRN or any other Evidence Based Birth® team members or volunteers on behalf of Evidence Based Birth® are strictly their own personal opinions and not the opinions or policies of any third party, including any health care provider, employer, educational or medical institution, professional association or charitable organization… (my emphasis)

If you rupture your membranes before labor begins, your obstetrician takes full responsibility for any advice, recommendations, examinations or procedures. Rebecca Dekker fills your head with misleading claims, implies that your obstetrician is not to be trusted and tells you what you should refuse and she takes no responsibility for any of that. Why? Because it’s just her personal opinion and if you are gullible enough to follow it, that’s your (and your baby’s) problem.

Thank you to Rebecca Dekker for publishing an plethora of words about nothing (and trying to make money from it) and for Science and Sensibility and Improving Birth.org for promoting it. All have helpfully illustrated the seductive marketing tactics of the natural childbirth industry.

They are in it for profit, not for your well being or your baby’s well being; natural childbirth advocacy is an industry and you should never forget it.

  • Spanish-speaking mom of four

    Yeah, I’m still having a unmedicated home birth. Sorry 🙁

    We live two minutes from the nearest ICU, we have a trained nurse-midwife who had done her training in the UK, and we’re paying for a EMT to be parked in our driveway, on-call.

    I’m not white, or upper-class, , all my children are vaccinated, I’m not eating my placenta, I’m not cloth-diapering, and yes I’m breastfeeding just as The American Congress of Obstetrics and Gynecologist, The American Dietetics Association, The American Pediatrics Association, and The World Health Organization, have all encouraged me to.

    In fact I read on a paper by ACOG, that states,

    “Evidence continues to mount regarding the value of breastfeeding for both women and their infants. [ACOG] strongly supports breastfeeding…[OB GYNs] and other healthcare professionals…should provide accurate information about breastfeeding…and be prepared to support them should any problems arise while breastfeeding.”

    http://www.acog.org/~/media/Committee%20Opinions/Committee%20on%20Health%20Care%20for%20Underserved%20Women/co361.pdf?dmc=1&ts=20130902T1739309412

    Ironically, you seem to do the opposite quite chronically… in each of your over-the-top, overemotional, and pathological posts you write…every other second. Could it be the fact that you aren’t a licensed OB?

    So, there. I really don’t appreciate the nonsense of this blog, the open jeering at women you don’t know, and the chronic attacking and stereotyping of women who choose unmedicated births, in the privacy of their home. It’s desperate, childish and pathetic. Especially for someone who is supposedly a grown woman, who should have her own life and her own children to worry about.

    Also, birth is not a industry, you can’t industrialize a woman giving birth. Its a natural occurrence, regardless. Of course, you can pay for assistance. However, but that process, (of meeting and forming a long-term bond with the people who are eventually going to help deliver your child) is nothing like paying to leave your house, stay in a place where you’re required to give birth before a certain time, bombarded by strangers, and cared by people you hardly know. And yes, I’ve experienced such treatment first hand, with my first son.

    The place of birth should remain the mother’s choice.

    Have a lovely day.

    PS:
    https://www.youtube.com/watch?v=nTJ1Dp3ZwtU

    • yugaya

      – If you live “two minutes from ICU” you live in a hospital

      – if you can afford to pay EMTs to work off the clock a private gig for yours truly then you are not poor either ( I am not even sure how that is legal or ethical or possible but let’s take your word for it for the sake of the argument, I am quite aware of places where that can be done)

      – birth “in the privacy of their own homes” is usually accompanied by a team audience and a designated photographer.

      – someone who is a grown woman should a) exhibit more maturity when articulating their reasons for choosing anything than what you exhibit in your opening sentence here and b) feel no need to identify themselves under the label or screen name that describes their reproductive and/or linguistic accomplishments and abilities

      – industry (commerce): a branch of commercial enterprise concerned with the output of a specified product or service: the steel industry …thus the birth industry or the natural birth industry as legit usage

      – “The place of birth should remain the mother’s choice.” I agree, but mothers who choose a less safe environment to give birth in should not go around claiming that their choice is the safest possible. Incidentally all of the things you listed as your homebirth safety mechanisms do not make your choice of location safe, just a degree safer than let’s say an unassisted childbirth in the middle of nowhere. It’s not safety, it’s just mimicking it.

      Good luck with your homebirth because luck is what you are relying on more than anything else.

      • D/

        “- If you live “two minutes from ICU” you live in a hospital”

        … but only in one of those primo apartments *on the same floor*!

        When running mock neonatal codes at our hospital during the logistics planning for an overflow postpartum floor, it became apparent simply navigating the 2 floors down was a risk in itself. Even with practice, it added an eye-opening amount of time to the baby’s arrival to the NICU. Hint … It was more than two minutes.

    • Amy Tuteur, MD

      Why do you think we care that you are having a homebirth? If you want to risk your baby’s life for your “experience,” go right ahead … and if something goes wrong, take full responsibiity for your decision.

      • Guest

        Because it’s much more fun to boast about breastfeeding in accordance with an ACOG statement, while choosing to ignore ACOG’s Homebirth and Waterbirth position statements to fit her own agenda. Just demonstrates her ignorance and ability to ignore the statistics, risks and recommendations of position statements that truly have a measurable difference in perinatal morbidity and mortality.

    • KeeperOfTheBooks

      Two minutes from the nearest ICU? Awesome. Assuming for the sake of argument that’s correct, and your baby goes into distress during labor for whatever reason, you’re looking at…
      2-5 minutes at home to ascertain that baby is indeed in distress and positional changes or oxygen won’t help
      2-3 minutes to grab gear etc and get to the car
      2 minutes to get to the ER door
      At least 5 minutes to get your vitals and get an IV started, possibly more than that if you’ve crashed and they can’t easily get an IV on you
      At least a few more minutes (say 3-5) to get you to and into an OR, prepped for a C-section, and knocked out so they can start operating
      (don’t forget that a surgeon and team will need to scrub up and otherwise prep during this time)
      Another minute or so while they cut you open and get baby out ASAP…
      Yeah, you’re looking at *least* 15-20 minutes of fetal distress (or just plain no heartbeat), causing all sorts of things from brain damage to death. It will probably be longer than that because I doubt your midwife is constantly monitoring the baby’s heartbeat during labor.
      Are the odds good that that won’t happen? Sure. Many moms and babies survive homebirths just fine, and have for a long time. If they didn’t, given the conditions until the last century, the human race wouldn’t have continued to exist. But if something bad does happen, then the odds go catastrophically against you–see above for a rather idealistic timeline. In a hospital and being monitored, you can be in an OR in 2-3 minutes and they’ll know EXACTLY when your baby starts to go into distress, rather than “15 minutes ago baby sounded fine, but now I can’t get a heartbeat/the heartbeat is horrifyingly low.” Things can go that bad in a good deal less than 15 minutes.
      Hospitals aren’t home, but they are filled with people who genuinely care about moms and babies. The non-essentials of homebirth are great: being in your own space, being with people you know very well and *only* people you know very well, not being bothered by monitors or people checking vital signs. The essentials of birth in that space, though, can go horrifyingly wrong in a very short amount of time: bleeding out, no fetal heartbeat, you having a stroke, baby comes out not breathing (your midwife probably carries oxygen, but I doubt she can intubate a newborn)…like I said, horrifying. I’d rather have my babies surrounded by people I don’t know as well (though I know my OB quite well and have an excellent relationship with him) and who check my vitals and so on than bet on my baby and I being lucky. Because at the end of the day, I’ll give anything for us both to come out of it well, even if “anything” includes a more pleasant birth experience. (All that having been said, my C-section was a beautiful birth experience, and we were surrounded by people who loved moms and babies so much they made taking care of them their lives’ work. How awesome is that?)

    • AlisonCummins

      That sounds an awful lot like homebirth in the UK, except that … in the UK you’d be checked into the hospital ahead of time and they would have all your records so that transfer would be efficient. Also that you would have two highly trained midwives, likely with more experience than the one you have hired. Also that you would be transferred to the hospital at the first peep of anything unusual. Also the tolerance for long labours would be even lower at home than in the hospital, not higher as you seem to think.

      In the UK you would be *planning* a homebirth. You might get risked out along the way and you would be prepared for that too. You, on the other hand, are *having* a hmebirth, meaning that you will ignore risk factors.

      The UK birthplace study concluded that with extremely stringent exclusion criteria a woman who had delivered vaginally before and had never had any complications or risk factors in any pregnancy including the current one, homebirth is a reasonable option. It’s a little less safe for mother and baby than hospital birth, but not by a lot.

      If this is your fifth birth I don’t think you’d qualify for a homebirth in the UK under the exclusion criteria used by the Birthplace Study.

  • Busbus

    So, I have a question about something that seems to come up frequently… Is there any evidence for (or against) contractions being worse when the labor is induced? A lot of people seem to claim that that was the case for them. However, I have always wondered if it couldn’t be an effect of being “thrown” into the hard part of labor – which would be just as hard had you built up to that point over a longer period of time – and not actually a sign of the contractions hurting more per se. For example, one of my relatives got pitocin after a long and unproductive early labor and said that it just became unbearably painful after that (she got an epidural not long after), but of course her contractions had been uneffective before then and, in my experience, there is simply a point where labor becomes unbearable, no matter what you do. Does that make sense?

    • Cobalt

      I know I frequently hear that induced labor is harder, but if it is, it’s not “harder enough” to prove it. There are too many confounding variables, and pain perception is too individual.

    • Sue

      One of the main confounding factors is that first labors are statistically more difficult/long/painful and (iirc) more likely to require induction. People have a second (easier) one and assume that it is easier because of all the things they have learned from that first experience, when, in fact, it;s just easier.

  • Ob in OZ

    Exams seem to be a hot topic.

    Here is an article that is well done, and basically there are more important things to worry about than the number of exams one needs.

    CONCLUSION: During term labor management, mater-
    nal fever risk is not significantly increased by the number
    of cervical examinations.
    (Obstet Gynecol 2012;119:1096–1101)

    More interesting is that induction is associated with higher patient satisfaction (seriously,only one study, but it was a big one).

    Hannah ME, Ohlsson A, Farine D, Hewson SA, Hodnett ED, Myhr TL, et al. Induction of labor compared with expectant management for prelabor rupture of the membranes at term. TERMPROM Study Group. N Engl J Med 1996;334:1005–10.

    Even though the Cochrane review when talking about risks and benefits of induction at term for PROM specifically lists this as a benefit, every policy I have seen always neglects to include it. Can’t imagine why.

  • Sue

    Wondering about whether Dekker was any sort of expert in her own area of training (Cardiology), I found a small number of qualitative papers on depression in cardiac disease – probably the subject of her PhD. This is a worthy topic, but doesn’t make her a cutting edge researcher.

    WHere does she think the data on infection rates from PROM came from? No the HBMW community, I’ll guarantee. It’s those pesky OBs who are annoying enough to look for evidence about what to do in what circumances. Sheesh!

    Oh – and I wonder whether the term “PROM” irritates those radical-NCBers who think the mammalian body is a perfect organism – how could those silly membranes not know when to rupture? It should be ”precicious” rupture of membrans, not “premature”!

    • Sue

      Oh – and another thought. PROM is when your baby knows it is time to be born but your uterus doesn’t agree. The first diagreement between mother and child, expressed in body language.

      • Box of Salt

        I joke that my PROM followed by c-section for FTP was my baby “knowing” it was time to be born, then changing her mind. My uterus agreed it was time, but the baby just wouldn’t put her head in the right place.

        I hope it’s not foreshadowing adolescence.

      • Mac Sherbert

        Ummm. I don’t know what was more confused when my water broke. My uterus or my breech baby. I guess my baby wanted out, but my uterus knew something wasn’t right and refused to let him out.

        Of course, I always joke that once we got to know him it made perfect sense that he would have been a surprise breech baby. Always moving still and usually in the wrong direction.

  • Ash

    http://www.nytimes.com/2014/11/24/business/media/home-birth-film-prepares-for-redelivery-worldwide.html

    And the final sentence from Ricki Lake about a new edition of the “Business of Being Born”

    “It’s an entertaining film,” Ms. Lake said. “No one should go into this and watch our film and recreate what they see on screen.”

    So are you saying that no one should “try this at home” so to speak? OK by me.

    • Anj Fabian

      It’s a fluff piece promoting the release of the “updated” BOBB.

      It pretends to be journalism but the gushing fangirl vibe keeps bubbling up.

      • Young CC Prof

        “The most accessible media celebrity to women of childbearing age!”

        Um, no. Not unless the other option is Jenny McCarthy.

  • Dr Kitty

    The only thing to be gained by waiting is the possibility of spontaneous onset of labour, and another day or two of being pregnant.
    Which is not a big gain after 38 weeks.

    My mother’s waters broke at almost 42 weeks. In a 32 year old primip, in 1982, she still got to wait almost 24 hrs before labour was induced.
    The fact that my head never engaged in her pelvis and that she ended up with an emergency CS after 8 hrs of induced labour, zero dilation and bradycardia on the strip was an outcome that, while unfortunate, probably was not going to have been any different if she had waited another 24 hrs.

    Does Rebecca Dekker honestly think that my mother would have had a smooth, easy, straightforward birth, and a live, undamaged baby if only she had stayed home and waited another day or two?

    Nope.

    • Elaine

      If you don’t want an epidural, and you believe that pitocin-induced contractions are stronger and harder to endure than all-natural ones, then wanting to avoid an induction makes logical sense. I’m not saying it’s a good idea (of moms who have their water break and don’t go into labor in 24 hours, how many are going to go into spontaneous labor and actually have their baby, vs how many have some issue like your mom did that is preventing them from going into spontaneous labor?) But the position is consistent with other positions taken by NCB advocates. If the disinclination to be induced is being to some extent driven by the disinclination to get an epidural, the fear of the epidural needs to be addressed.

      My water broke before labor started with my daughter, and my nurse-midwife told me they generally gave it 12 hours for contractions to start if everything was in order otherwise.

      Actually, giving this a little more thought–after having my second baby (in that birth my water didn’t break until right before he was born) I learned that it is generally believed that labor is more painful after ROM takes place, which is consistent with my experience and which I wish I would have known. Which now makes me doubly wince at the thought of waiting to go into labor because you want to stick it out without an epidural–that labor is going to be worse than it would have been without the ruptured membranes.

      • Sue

        Hi, Elaine. You don’t think your second labor was less painful just because second labors are generally easier than firsts?

        • Cobalt

          Mine are worse after water breaking, and for all but the first, I had AROM, so it wasn’t that the contractions themselves changed right then. Maybe there’s a padding effect? The first was the hardest though, both before and after ROM.

          • Amy M

            Well, both make sense. I thought that first pregnancies were usually the hardest labors for most women (though certainly not all.) And before the sac breaks, wouldn’t it be preventing the uterus from contracting as completely, or absorbing some of the sensation or something? Like an inner tube.

        • Elaine

          That’s what I thought at the time, and there probably was some of that in play, but then I learned that about the waters breaking, and I bet that was a factor as well. The contractions did get pretty awful after my water broke with my second, but the time between it breaking and him being born was a lot shorter. (I didn’t have an epidural with either.)

  • Samantha06

    OT: I wonder if the NCB crowd has one of these at all their baby showers/births/birthingways, etc, etc…

    http://9gag.com/gag/aYbDpjm?ref=fbp

    • Cobalt

      Wow.

      • Samantha06

        I know, isn’t that wild?? A unicorn, how appropriate for the NCB crowd! I laughed myself silly when I saw that!

    • Amy M

      Ha! That’s actually very beautiful, but why would anyone want to cut it up and eat it? Could you imagine taking a knife to the neck, a la Steel Magnolias and the armadillo ass?

      • Samantha06

        I know! It’s kind of sick isn’t it? I could see the NCB crown going for it though..

  • Sarah

    Jaunty little graphic, but it doesn’t seem to have occurred to EBB that the more vaginal examinations a woman has, the longer it is likely to be since membrane rupture happened.

    • Sue

      Yep. And not to mention that those exams are being done for some clinical reason.

  • Allie P

    My horrible Lamaze instructor (also a doula, constantly hawking her doula services) loved to pull this “clock is ticking” BS. She actually recommended that if our waters broke, that we do NOT inform our doctors, because “the clock is ticking.” I raised my hand and asked if she was honestly recommending to us that we lie to our medical providers about our condition. How can they provide the proper care if they don’t even know what is happening with us? She didn’t have an answer to that, but she wanted to make sure I understood the risk I was taking by informing the doctor and starting the clock. Yeah, because THAT’S the risk.

    • Bugsy

      Could there be legal ramifications to her bad advice? It seems like there should be some accountability for it.

      • Samantha06

        The least that should happen is that she should be fired if she is working for a hospital. There was a doula teaching pre-natal classes at a hospital I worked at who pushed NCB and was giving false information about pain relief in labor. Someone filed a complaint and she was fired.

        • Allie P

          she was independent. My doc wanted us to take the class at the hospital or the one her nurse sometimes taught in the evenings, but I had to pick something near my husband’s work so he could go. Totally my error in judgement. Had I known what Lamaze actually was, I never would have signed up for it, but I had been under the misunderstanding that “Lamaze” = “childbirth class.”

          • Samantha06

            You didn’t know, and I think that’s how they deceive people. It’s a shame, really. From what I remember of my first dealings with lamaze in the early 90’s, it just didn’t seem that radical.

          • Jocelyn

            Yeah, my sister chose a hypnobirthing class last year. To her she just thought hypnobirthing = class on how to manage pain. She didn’t realize it was hypnobirthing = NCB indoctrination. (Ugh, just remembering all the crud her teacher “taught” her makes me mad.)

          • Samantha06

            I hate it when a patient tells me they are going to use “hypnobirthing” techniques. The last woman I took care of who tried that was a midwife patient who had a horrible labor and delivery. She fine in early labor but when active labor kicked in, the hypnobirthing went out the window. It’s sad really. So many women think it will work and are totally unprepared for the pain of active labor and then blame themselves because the “hypnobirthing” techniques don’t work.. sigh…

          • Mer

            I took a (free) hypnobirthing class for my last birth. (Almost a year ago! wow does time move fast!) And test it was filled with woo, but it was taught by one of the hospital midwives and she did go over the other options for pain relief and said that in the middle of labor we might change our minds about what we wanted and that was fine. Not the most ringing endorsement of an epidural but at least it wasn’t demonized.
            I took the class because i thought it might be helpful to learn some sort of technique to use until I could get my epidural, and let me tell you if I could have I would have had one for the last 2 weeks of pregnancy, so I was planning on getting it fairly quickly. In the end though I was pretty grateful for that stupid class and the breathing thing I learned because that was all I had for pain management in my precipitous labor. Everything went too fast to get an epidural, they barely got my IV in and one round of antibiotics for GBS in before baby came barreling out. That said, it was only effective in giving me something to focus on during contractions and I was pretty traumatized afterwards at the lack of pain relief.
            I could’ve gotten opioids, but I did choose to forego them, because I knew baby was coming pretty soon and I decided I didn’t want to risk the little guy being affected by them, still wondering about that choice.

          • Samantha06

            I’m sorry you weren’t able to get your epidural! Some babies just don’t want to wait! lol! Where I work we use IV fentanyl in labor and it works fairly well, at least to help mom cope better until the epidural is placed. It’s a short-acting narcotic, so we can give smaller doses every 15 to 20 minutes or so but we don’t give it when delivery is imminent. I’m glad the breathing techniques helped though. Did they have the entenox gas available?

          • Mer

            Yup that boy was very impatient to get out! I can’t remember what it was specifically I was offered, but the only thing that would have helped was fentanyl and I really was too close. I think about 5 minutes after my ob offered it I was ready to push. I don’t think entenox is available, I’ve not heard it mentioned as an option in any of my pregnancies. As far as the breathing helping, it didn’t really, but it gave me something to do with my mind rather than focusing on how bad everything hurt. I just remember the counting, breathe in for 4 and breathe out for 4. My husband said that you could see the difference on the contraction strip though when I was focusing and when I wasn’t.
            Going through these memories again makes me so ridiculously happy I’m done with having babies!

          • Samantha06

            It sounds like it happened very fast indeed! I’ve only seen entenox in the last couple of years, but from what I’ve seen, it seems to help women focus with precipitous deliveries. It doesn’t work for everyone, but some swear by it.

          • The Bofa on the Sofa

            IOW, it wasn’t so much “teaching hypnobirthing” but was a hypnobirthing marketing seminar.

            That’s the kind of thing that does piss one off.

          • Bugsy

            If it’s any consolation, sometimes the hospital classes aren’t much better. We took a few through our hospital, with the breastfeeding class being the most in-your-face. My husband reminded me yesterday how the hospital-employed lactation consultant teaching the class told us that even a drop of supplemented formula would change your baby’s digestive track. It’s a great way to scare pregnant mommas.

          • Samantha06

            You’re right about the LC’s in some hospitals. Not all of them are like that, but many of them are. Very unfortunate. I think it’s all about that BFI thing.

  • MLE

    OT: Is my OB going to judge me harshly if I ask to be induced at 40 weeks exactly? Is that something that’s even done? I am asking for two reasons: first, i went a week over with my first kid and that scares me now; and second, I need to be recovered enough six weeks after my due date to travel to an important work event, and would prefer to leave an older baby, although I will take additional time off after the important event. Is this done these days or am I just so anti NCB now that I can’t see how terrible this request is?

    • Guest

      My last baby’s hospital did not allow maternal request inductions prior to 40 weeks exactly. My current hospital and OB is fine with anything after 39 weeks.

    • Cobalt

      I think it depends non your OB. One of my friends had a maternal request cesarean for her first at 39 weeks with no medical indications, another’s OB wouldn’t even induce prior to 42 weeks without “a good reason” (she spontaneously delivered at 41 1/2).

      Ask what your OB uses as criteria for induction; I think overall induction at 40 weeks just to get it over with is pretty common and not an outlandish request.

    • Allie P

      It depends on your OB and on the policies of the hospital where you will deliver. Some hospitals have March of Dimes induced preterm quotas they are forced to meet. My OB was fond of saying “nothing good happens after 40 weeks.”

    • Elizabeth A

      Your OB really *shouldn’t* judge you at all for asking that – it’s a totally reasonable thing. If your dates are solid (dating ultrasound? IVF? Any other way of pinpointing conception?), the risks of induction at 40 weeks are small, and the benefits can easily outweigh them.

  • Stacy48918

    I love that she has a graphic that includes “know your GBS status” but one of the example mothers in the side bar had PROM twice and neither time knew what her GBS status was.

  • The Computer Ate My Nym

    waiting for labor to start on its own for up to 2-3 days is as safe for
    the baby as inducing labor right away, although the mother is more
    likely to get an infection herself.

    Even if this were true, isn’t increased risk of maternal infection a reason in and of itself to not wait? A mother battling infection is less likely to be able to care for and bond with her infant than a healthy mother. And a woman who is dead from preventable postpartum infection sure can’t bond with her newborn.

    • Bugsy

      Yes, but you can’t be a mommy martyr if you put your needs ahead of giving your child the *perfect* natural entrance to the world.

      • guest

        My mom delivered me almost 2 days after her water broke (this was in the early 80s). She didn’t know about the clock ticking. By the time I was born, she was running a fever and I was very, very sick. I spent my first 3 days in the NICU. Needless to say, I personally recommend getting that party started asap! What’s the point in waiting days?

    • Samantha06

      Her statement makes absolutely no sense at all. What kind of maternal infection does Obstetrics expert Dekker think the mother will get? A cold? More like chorioamnionitis, which is definitely not a good thing for a baby! Good grief!

    • Sarah

      Yeah but everyone will donate breastmilk, so even if the baby is minus a mother it won’t need formula.

  • Samantha06

    My guess is that she couldn’t make it as a cardiac nurse and got her butt whipped in the cardiology community. So not knowing jack about Obstetrics but knowing there is money to be made in the NCB industry she cultivated her con-artist and marketing skills and uses them with her RN “title” to scam vulnerable women. As for her “nursing continuing education contact hour” .. well, *real* nursing continuing education hours are ANCC (American Nurse Credentialing Center) certified and hers obviously is not. I don’t understand how she keeps a nursing license with the deliberate misinformation she spreads. Maybe her page-long disclaimer gets her off the hook.

    • Box of Salt

      She describes herself as: “Rebecca Dekker is Assistant Professor of Nursing at a research-intensive university in the U.S.”

      Does anyone know which university?

      If she’s doing research supported by grants at her university, why is she soliciting money via blogs?

      • Samantha06

        Apparently she is on the faculty at the University of Kentucky.

        • Box of Salt

          From the nursing department’s faculty directory:

          “Dr. Dekker’s expertise is related to depression in people with heart
          failure. Over the past four years, Dr. Dekker has received funding to
          conduct three randomized, controlled trials testing cognitive behavior
          therapy for the treatment of depression in this population.”

          • Samantha06

            Wonder how that’s working out for the University?

          • KarenJJ

            I wonder if the university is getting invoices at $10 a pop every time she writes a memo.

          • Samantha06

            Wow. Is that what happens with research funding? So she’s probably getting a base salary, plus whatever else from the U of K, then her profits from EBB…

          • KarenJJ

            No, sorry, not like that. She just likes charging for information that can be found anywhere.

          • Sue

            She couldn’t me making much cash on the basis of her PhD work cos there aren’t many publications in her name that she could copy and re-sell.

          • Dr Kitty

            Uh…CBT is an evidence based treatment for depression in pretty much EVERY population.
            Her research would not appear to be expanding the current knowledge base much.

    • Sue

      Did she become an expert in childbirth by having a baby? She’s just as irritating as those people who once renovated their house and think they’re experts in architecture, or went to court once and think they know more than the lawyers.

      • Samantha06

        Actually, I think she did, in a round a ’bout way. If you look at her EBB site, she says when she had her baby, something just felt “off” with the whole experience, (not enough candles, incense, or whatever) so she started doing “research” and started EBB. I don’t think she has actually bought into the woo, I think it’s more like she knows she can make money in it.

  • Vg2010

    What I find really mind blowing, is how we are portraying birth as this very natural and safe event where everything will be sunshine and rainbows… Until very recently, giving birth was an event that made women and their families FEAR for their lives – because there were no guarantees.

    So I try and understand the women that focus on the process and not the end result, and the idiots saying that giving birth at home for low risk women is the same as giving birth in the hospital with equipment and prepared professionals to step in at any time… BUT why would you not run to the nearest doctor once you are CLEARLY at risk of infection>????

    • Smoochagator

      Because, as Dr. Amy said, we (meaning privileged women in countries with great health care) have come to take a good outcome for granted. NCB advocates say that any adverse outcomes that occur in the world today are because of too many interventions – doctors that are eager to induce and cut. Never mind that most interventions were introduced to prevent and treat adverse outcomes… and that’s WHY we can *usually* assume that a low-risk mom at term will live through birth and take her baby home with her when she leaves the hospital.

  • expat

    The way in which she interpreted literature about “big babies” and waterbirth tells me that her conclusions are not to be trusted. With big babies, she cherry picked and made conclusions beyond what the research showed. With waterbirth, no RCTs showing it is dangerous = > safe. She thinks she is smarter and better qualified than she is. A cardiac nurse with a birth obsession does not an OB make.

  • Mac Sherbert

    Really none of this makes any sense. If your water breaks at term, you are going to deliver. Given some of the recent information provided on inductions lately showing that they are safe and have better outcomes than the woo would have anyone believe…Why wait for labor to start at all?? My water broke with my first 2 weeks early. I was already dilated some and so I laid in the hospital bed waiting for labor. Of course, we didn’t know at that time my baby was breech. I could have ended up walking around with ruptured membranes, dilated for 2-3 days with a breech baby, if I had listened to the woo. That would not have been good (I’m thinking possible cord prolapse)! So happy with my eventual c-section and healthy child. They make all these claims and apply them to all, but every labor, woman and baby are not the same.

    • Young CC Prof

      Exactly. Her own post says that the risks of infection in the mother are higher if you wait, and the probability of c-section is the same whether you wait or not. The only apparent advantage to not inducing is that you don’t have to be induced. If you follow the woo, I suppose, induction is a terrible experience, way worse than spontaneous labor, but for the rest of us…

      • Amy M

        Well, if you are a homebirth midwife, you lose a client if she chooses induction. And you are a homebirth advocate, losing your homebirth is the worst thing that can happen.

        • fiftyfifty1

          “Well, if you are a homebirth midwife, you lose a client if she chooses induction.”
          This is 100% it. Homebirth midwives have to demonize inductions because they can’t do them.

          • Sarah

            But castor oil nipple stimulation raspberry tea, though.

          • Anj Fabian

            Eat an entire raw pineapple, walk ten miles, do twenty minutes on the stairmaster, get acupuncture, see a chiro to be adjuster, have a foot massage, eat spicy food, have sexual intercourse…

            ….and you’ll be too busy to call your midwife and ask if you should go to the hospital.

          • Karen in SC

            And dates! There is a study out that shows eating nine dates does something. Maybe Dr. Amy should look at that!

          • SporkParade

            Yes. It will give you diarrhea. Which can cause contractions that don’t lead to labor. Just like castor oil, spicy food, nipple stimulation, sexual intercourse, and a whole bunch of other “natural inductions.”

          • Allie P

            You know, I did all those things except the acupuncture and the chiro, and I still went 40+ with a thick, closed cervix. You know what worked? 4 hours of cervadil. Popped like a baloon.

        • Trixie

          Not if you have them pay in advance at 36 weeks!

      • Ash

        The NCB movement seems to also assume that everyone loves to be in labor and waiting is always better. I, however, assume that if it were possible, most women would prefer to be done with the entire childbirth process in a relatively expedient manner.

        I imagine most women would sign up if there was a “beam me up, Scotty!” option.

        • Young CC Prof

          The teleportation birth plan was a recurring joke on my due date club. I think just about everyone was in favor of it.

          • The Bofa on the Sofa

            Which is just a good reminder that we have to remember that we are still talking the fringe here.

            Seriously, most people get it.

          • Theoneandonly

            But..but… The microbiome! Gut flora!

        • Samantha06

          Oh but labor, especially natural labor, is an “empowering, spiritual experience”, so what good NCB advocate wouldn’t want that? You’re right, I think most sensible women would want to get on with it.

        • Allie P

          I will be first in line for Scotty. Actually, I’m baffled that Kirk’s mom in the Star Trek reboot seemed to be having natural childbirth with Kirk, though I assume it was only because it was a preterm labor brought about by the attack on their ship and Chris Hemsworth’s imminent death and the escape pod didn’t have the regular birthing implements necessary. I’d have thought all childbirths in the future were via beaming.

          • Young CC Prof

            I think in the episode where they did beam out the baby, the baby had some side effects.

          • Box of Salt

            The beamed out baby was Naomi Wildman in Star Trek Voyager, set later than Kirk’s era. She was beamed out because her father was an alien with forehead ridges which prevented vaginal birth.

            I don’t think she had any side effects from the beaming out, but she did have some typical newborn issues – as a plot device bonding the crew (stranded on a planet during a natural disaster) with the native indigenous culture (grandma native helped the baby).

            How nerdy am I that I posted this without actually looking anything up?

          • Box of Salt

            I’ve been corrected by my more nerdy better half who reports Naomi did actually die of untreated hemocythemia (a condition invented for the episode) due to the beaming out, but since the ship had already been duplicated her alternate timeline treated self was handed off to grow up during the series, and play her role as mentioned above. The beaming out birth is in the episode “Deadlock.”

      • guest

        I’ve had both a spontaneous labor and an induced one. The induced one was way, way, way harder, and took me much longer to recover from – physically and emotionally. I know that isn’t true across the board, but if I can avoid an induction with my next baby I wholeheartedly will (and remain safe, of course – my induction for #2 was a soft call in terms of medical need, but I wasn’t willing to risk his safety at all). My point being, there are some legitimate reasons for not wanting to be induced. I think if I PROM’d I would probably wait a couple of hours, but a whole day sounds crazy to me.

      • TAM

        I had prom with my first. It was a high and very slow leak that I didn’t recognize for a couple of days. I just thought I was getting more incontinent at term. The hospital still sent me home even though I told them I was sure it had been > 48 hrs and I wanted to be induced. Reason? Their ldr was full. I did get endometritis and have to be readmitted a few days after the birth for IV antibiotics. I had a few other risk factors like an instrumented delivery for example.

        My second labour was induced because the first was nearly precipitous. The contractions felt the same for both. Especially from 5-6 cm on. Same spacing (tetanic ie no breaks) same intensity. I am of the camp that effective contractions hurt more than non-effective ones.

    • moto_librarian

      I had SROM with my first child, and it was a good six hours until contractions started. We called the midwife as soon as it happened. She asked about the fluid (clear), and made a note in my electronic chart. I was told that I could wait for labor, but if it didn’t start by the next morning, I would definitely be coming to the hospital. I just don’t understand why anyone would want to wait more than 24 hours. You continue to leak fluid, which I found to be uncomfortable and gross, and most women are simply ready to get the show on the road.

      • Mac Sherbert

        My MIL had her water break some 50 years ago and she thought she had a bladder infection. She called her doctor and he just prescribed her some meds. After a few days she talked to her sister who told her to go the hospital that her water had broke!! I’ve always wondered, if the antibiotics she took for the “bladder infection” is what saved her and the baby from getting an infection.

        And yes I found it uncomfortable and gross. I was leaking enough to soak towels. I wonder if it could be bad for the baby if the mom lost to much fluid??

        • KarenJJ

          This – I was leaking all over the place. I can’t imagine doing that for days on end.

          • Amy M

            (TMI)I had gotten up to pee (again), and was just going to wash my hands and head back to bed when my water broke–so I was hovering over the toilet already. The linen closet was mere steps away, but required me to move, and risk leaking all over the bathroom. After several false starts, I finally just leaped for the closet and pulled out a towel as fast as I could.

        • Cobalt

          I’ve not had my water break/be broken before 7 cm, but the feeling of consistently peeing myself afterwards was really unpleasant. I would not want to walk around like that for a day, it was icky enough laying on the pads at the hospital for a few hours.

        • Mer

          I have an anecdote that it is bad for the baby. I had slightly PROM, took about 20 minutes for labor to start and then it went crazy fast. But each contraction squeezed more fluid out and by the time I was at 9cm (took less than an hour) baby started having problems and they had to roll me around to find a good position that wasn’t squishing his cord. Well I’m assuming that’s what was happening, I was too busy at the time to specifically ask. Based on the amount of fluid that had been coming out, there couldn’t have that much left in there.
          Just an anecdote, and from fuzzy memory to boot so you know, don’t put much trust in it.

  • Zoey

    Right on Dr. Amy. Rebecca Dekker has created a business model of taking information readily available to women from a variety of reputable medical sources, repackaging it, and leveraging her reputation as a “trusted” source of information in the NCB community to sell women what they could get for free. It’s actually kind of brilliant, in a sick sort of way.

    • Samantha06

      Sick and extremely unethical.

      • Zoey

        I was thinking about this a bit more. The NCB movement places a lot of emphasis on women doing their own research into childbirth and medical interventions. However, the reality is that most women (myself included) do not have access to the primary obstetrical literature (beyond open access articles available on the internet) nor the time or qualifications necessary to objectively evaluate the literature. So, in fits Evidenced Based Birth to do that research for you…for a fee, of course.

        What’s really unethical about the whole thing is that she passes herself off as a subject matter expert who is qualified to do this research, when she is not.

        • Samantha06

          Exactly. It’s bad enough that uneducated CPM’s do it, but for an RN to engage in it is really disturbing. Did you see the recent posting by Box of Salt about her from the U of Kentucky website? Her area of expertise is in studying depression in people with heart failure and she has received funding to do it! A far cry from being an “expert” in Obstetrics! What’s equally disturbing is her disrespect for women by assuming they are not intelligent enough to see her for what she is and realize she is bogus. Of course that’s the heart of the NCB folks’ agenda and she fits right in with that. What a disgrace to the nursing profession.

        • realitycheque

          I also find it somewhat dishonest the way that she mentions her PhD on everything, without making it clear that it’s in a completely unrelated field (literature, if I remember correctly?). People are going to see that title and assume that she is more knowledgable about what she’s talking about than she really is, and I kind of get the feeling that it’s not entirely unintentional.

          • Samantha06

            Absolutely. I think it’s totally intentional. That’s what makes it that much more disturbing. People see RN and PhD and think she’s credible. I’m glad Dr. Amy is exposing her lies.

          • Box of Salt

            Let’s be accurate.
            Actually, the PhD is in nursing:
            http://academics.uky.edu/ukcon/pub/ContactUs/Pages/Profile.aspx?userId=729545

            But (assuming she’s continuing to research the same subject) it’s cardiovascular nursing.

          • realitycheque

            My mistake, thanks for the clarification!

            Interesting that she has a PhD in a health-related field, yet still somehow manages to fail at interpreting scientific literature, not to mention the cherry picking mentioned above (re. that single 1960s paper).

            Also, I still don’t feel that a PhD in cardiovascular nursing gives her any authority to making assertions about correct/incorrect obstetric practice, not to mention undermining the ACTUAL relevant professionals.

          • MLE

            You might be thinking of Jennifer Margulis.

          • realitycheque

            Yeah, I think you’re right.

          • Samantha06

            That’s what makes her behavior so unethical. According to her website, she got into all this based on her “birth experience” and something just felt “off.” So she decided to “do some research” and started EBB. She has NO obstetrical clinical experience, so how can she objectively interpret obstetric practice? I can’t imagine myself as an OB RN starting a website about evidenced-based cardiology because I had cardiac surgery and I decided to so some research about it! She uses her PhD and her RN to give her supposed credibility where there is none. The co-authors of her article are a doula who is “completing her PhD in human evolutionary biology” and “is considering becoming a CNM,” and a CNM who teaches hypnobirthing and supports waterbirth. And the doula was “invited by a Harvard lecturer to develop an undergraduate course on birth.” A lecturer? Really? In her article credits she states, “We would like to extend our thanks to our expert physician/obstetrician reviewers” but doesn’t name them. It may look totally legit to a lay-person. In reality, she is no better than a CPM or other lay-person playing obstetrical expert. “I’m not a real doctor, I just play one on TV” comes to mind!

          • DiomedesV

            It gives her more authority than other NCB advocates.

            Honestly, someone who publishes research in a related medical field has more qualifications than most to comment on obstetrics. It’s more relevant that she cherry picks the data than the fact that her specialty is in cardiology.

          • Bombshellrisa

            “It gives her more authority than other NCB advocates”
            That is the problem-she has the credentials that make anything she says carry more weight. The problem is that she doesn’t say too many things that are different from NCB advocates.

          • Samantha06

            Exactly. She has obviously totally bought into the woo.

          • Samantha06

            She has no clinical experience or specialty education in Obstetrics so she may have general medical knowledge, just as I have general medical knowledge of other specialties. Even if I published research, I wouldn’t consider myself even remotely qualified to comment on Cardiology.

          • realitycheque

            True, although her cherry picking and obvious inability to look past personal bias in this instance would make me question the quality of her research in other areas. She certainly has greater potential to provide quality, evidence-based information than other, less educated NCB advocates, but she doesn’t appear to be applying her skills correctly at all and is just abusing the title for credibility’s sake. If anything, her PhD makes it even more appalling that she’s spreading misinformation, since she should KNOW about cherry picking and bias and actively aim to avoid it in her work.

          • Samantha06

            Yep. Using her RN is appalling too. Part of her title is APRN, Advanced Practice RN, which lends even more “credibility” to her claims.

    • Anj Fabian

      This is done constantly in diet and fitness. Someone tracked the low carbohydrate diet back to the 1800s. Although they didn’t track every incarnation and rebranding of the diet, I’d guess it’s been presented as a new and original concept at least a dozen times by different people.

    • Smoochagator

      Or what they could get from a licensed medical professional who would actually stand by their recommendation…

  • The Computer Ate My Nym

    I’m confused. It sounds to me like Dekker is not recommending the same thing as OBs do: the standard advice, if I understand correctly, is to consider induction after 24 hours, whereas Dekker appears to be stating that one should wait 48-72 hours before considering induction. Am I missing something here? Also, I don’t see where Shubeck is demanding a c-section after 24 hours.

    • Amy Tuteur, MD

      Dekker is trying to put a different spin on it, but she’s essentially saying the same thing.

      Most women will go into labor within 24 hours of ruptured membranes. Of the remainder who don’t go into labor, some will have contraindications to waiting (like GBS colonization) and others will develop signs of infection during the first 24 hours.

      The remaining women face a choice to induce or to continue to wait. What are the benefits of waiting? There are none. What are the risks of waiting? Rising incidence of infection. Since the risks are outweighed by the benefits, induction is recommended.

      What Dekker is saying is that some small percentage of women who wait more than 24 hours after rupture of membranes might not end up with neonatal sepsis. That, of course, is true, but it’s not a reason to wait.

      • The Computer Ate My Nym

        That seems to me that she’s not even saying nothing, but rather saying something misleading and potentially dangerous.

      • Sue

        Not everyone with a heart attack dies of it, or even gets depression, so why would we need cardiac nurses at all?

    • Amy M

      I”As long as both mother and baby are doing well and meet certain
      criteria, waiting for up to 2-3 days for labor to begin on its own is an
      evidence-based option. At the same time, induction is also an
      evidence-based option”

      She kind of says that waiting 2-3 days is equivalent to getting induced.

    • Amy Tuteur, MD

      Dekker is also using the term “evidence based” in a misleading way.

      The definition of evidence based practice is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”

      Dekker is using it to mean “evidence exists that this choice won’t kill anybody.” It’s like saying that refusing treatment for high blood pressure is “evidence based” because there is evidence that some people will not die from refusing to treat their high blood pressure.

  • The Bofa on the Sofa

    I’m looking at the table that shows the number of infections with the number of exams.

    Of course the question is, have the controlled for the length of time? Because it seems to me that the reason someone has 8 vaginal exams is because they have been waiting longer.

    • Amy M

      Does that even happen anymore though? That many vaginal exams? Would u/s cut down on vaginal exams at all? Not for checking dilation, but for determining presenting part or other information?

      • Sara Lucy

        A sterile speculum exam as needed is not the same risk as checking w/ fingers, either, though I think many NCB people equate the two.

      • Mac Sherbert

        In my case an ultra-sound first would have meant zero vaginal exams. They would have seen the baby was bottoms down and we would have gone straight to the OR. So, I’m going with yes.

      • Allie P

        Some of these folks are against U/S because….something about left-handedness? I couldn’t really follow the argument. Trauma causing left handedness. Which of course, is a sign of the devil. (Says the southpaw).

        • Amy M

          Ha! Yeah, I heard that one, but even if it were true, would an ultrasound during labor really make a difference? Meanwhile, only one of my ID twins is a lefty, which we don’t really understand, since they aren’t mirror image. Both of their grandfathers are lefties, so its in the family, but why not both twins? Even if it was all the extra ultrasounds, wouldn’t both be affected? Or maybe it WAS that last u/s during labor—Baby A (the righty) was out, and they were checking Baby B’s position. I bet that was it!!! (j/k)

          • fiftyfifty1

            How do you know they are not mirror images? Usually the only way that “mirror image” identical twins can be known to be such is by handedness.

          • Amy M

            I guess its possible, but their cowlicks are on the same side, and when they need haircuts, there’s an area of hair at the napes of their necks that grows longer first–also on the same side.

          • Box of Salt

            A silly question: which way does their hair grow? Clockwise or counterclockwise?

            (I’m just curious. It has to do with something I read, and I’m not sure if I’m remembering correctly, when I was pregnant with my older child . . . who is now 10).

          • Amy M

            Their hair grows clockwise–both have a cowlick right of center near the top/back of their heads.

    • AmyP

      Exactly. With a fast labor, there’s no time for a lot of exams.

    • Mac Sherbert

      They act like nurses just want to do exams every 30 minutes or so. In my experience I found this not to be true. My nurse only did them when she felt we really needed to know. If my doctor had not done one, we would not have found out my baby was breech until it was time to start pushing…that would have been bad.

      The other thing is that if you are planning on inducing labor by 24 hrs. then is there really that much worry about exams causing infections?? Of course, if you plan on being suborn and waiting for days it could be a real issue….

  • Susan

    Should be called “Evidence I found which supports my beliefs about birth” instead of pretending she will present evidence that doesn’t support what she likes to believe. And how tone deaf does a person have to be to market herself like a Ginsu knife… ?

    • Susan

      and Ginsu knife was spot on there Dr. Amy!

    • Anj Fabian

      A Ronco advertisement for NCB?

      It would be the opposite of a Ronco advertisement. The essence of those ad campaigns is that you only need this one – ONE – handy gadget that will do dozens of things for you!

      NCB has dozens of products to sell you. BWF is happy to sell you printed birth affirmations and essential oils. They are probably both equally effective.

    • Box of Salt

      Actually, between this one and the offer Dr Amy posted about on Tuesday, it should be called “Evidence I want you to pay me to provide.”

  • Cobalt

    Stupid question: what is so terrible about vaginal exams/cervical checks for L&D? Is the infection risk in a normal labor really that high? Is it just patient discomfort/awkwardness? Vaginal exams are frequently described as this really awful thing to have done, but my experience doesn’t line up with that at all.

    • Amy M

      I don’t know..I found them uncomfortable, but not the worst thing in the world. And whoever did it wore clean gloves. It wasn’t like the doctor just got in from mucking out the pigs, and decided to do a vaginal exam with a rusty pitchfork.

      • Cobalt

        It’s like a blood draw, I thought. A minute of discomfort, but worthwhile for the data.

        • Amy M

          The worst part about it for me was when they tipped the bed back, so the resident who was doing it could get a better angle. I have twins, so it was a lot of weight pressing back on my diaphragm, and it was hard(er) to breathe. I understood that I wasn’t in danger, but I had to actively think of something else to keep from feeling panicky.

    • Trixie

      I found them to be pretty painful. I think it varies some from person to person. Still, you just have to be a big girl about it because it’s sometimes necessary.

      • Jennifer2

        Does being a big girl include trying to crab crawl backwards away from your CNM’s hand? Because that’s how I responded to vaginal exams. Until the epidural, that is. Then she could have shoved her whole arm up there and I would have been like “okay, cool, whatever.” My cervix is a big wimp.

        • Trixie

          I’m going to say yes. I think I attempted to crawl through the wall and into the next exam room when I got my membranes stripped.

        • Kelly

          I did too. I am glad I am not the only one.

        • Medwife

          You know what, there’s some level of pain that stops allowing you to even ATTEMPT to be a big girl. It blows your mind. No one should feel bad for how their body decides to respond to that pain.

    • Medwife

      It varies vastly among patients. Many patients have told me that my exams are gentle (and that is what I’m going for- gentle, but not so gentle I don’t gather the information I need). Other women seem to have significant pain. Depends on where you are in labor, how your cervix is innervated, and of course, whether or not they have an epidural 🙂

      I am a believer in that you should perform tests/exams when it will inform your plan of care. If someone has prom and there is not an indication to immediately induce, and she’s sitting there totally comfortable, not contracting, I can pretty safely assume her cervix isn’t making change. I don’t need to do a cervical check.

      ETA: I consider the patient desiring an immediate induction an indication for induction in this scenario btw.

      • moto_librarian

        I have always found cervical checks to be at best, uncomfortable, and at worst, painful. I don’t think that anyone who has ever given me one was bad at it – I just think that I am more sensitive to it than others.

      • fiftyfifty1

        It is striking the difference in cervical innervation! There are some women who feel reproducible discomfort at even a Q-tip swabbing their cervix. There are other women on whom you can do a pinch biopsy of the cervix and they literally do not feel it. It doesn’t seem to correlate with pain tolerance in general, it seems specific to the cervix.

        • Cobalt

          I wonder sometimes about my cervical wiring. I don’t feel productive contractions strongly until the very end, but I am very aware of unproductive Braxton-Hicks contractions for weeks.

          • fiftyfifty1

            double posting deleted

          • fiftyfifty1

            It’s possible that your cervix just doesn’t have much sensation. You feel the muscular tightening of the uterus, and you feel the tissue stretching once you hit transition and the head starts to make its way down, but you cervix may not feel any pain dilating. The pain of the cervix dilating is a big part of the pain of a typical labor.

          • Anj Fabian

            ^^
            Yes.

            I talk about the uterus using the baby’s head as a battering ram to open the uterus because that is what I felt. Contractions? Discomfort. Cervix? Pain. Definitely pain.

          • Cobalt

            That’s something to think about. I know there is at least some sensation, because pap smears sting really bad, and I can feel exams (not fun, but not awful) and exams feel different if I’m already dilated, but not painful unless during a contraction.

    • Kelly

      It did not hurt me the first time but my water had not broken by then. The second time, it hurt a lot but they need to know because I progressing quickly and my water had already broken.

    • KarenJJ

      I wonder if they get a bad rap because some women are unknowingly getting the “power birth” experience from unscrupulous home birth midwives and spreading the fear of vaginal exams amongst their friends.

      • Cobalt

        That’s evil.

    • MLE

      They never bother me when I am not in labor, but when I was, it suddenly became the most painful thing ever. As in I was yelling involuntarily.

    • Therese

      I think sometimes it’s that vaginal exams might show no progress, which may lead to the dreaded interventions. Whereas if you don’t know you aren’t making any progress, you’ll be less likely to consider interventions.

      • Cobalt

        I personally lean the other way for my labors. I want the data, and wouldn’t refuse a chance to find out what’s going on up there. I’m always considering interventions.

        • Allie P

          They never want the data. They refuse fetal testing, maternal testing, ultrasounds, vaginal exams, heart monitors, GBS testing, diabetes testing… they want to stick their fingers in their ears and go aalalalalallalalala because it’s all about the magical thinking.

    • Cobalt

      So my totally unscientific survey is leaning strongly towards pain risk, not medical risk, assuming a clean and trained attendant following standard germ control protocols.

  • Ellen Mary

    If I had followed the advice to stay @ home for 2-3 days, my baby would not be here. Thank God I did not want to stay @ home anxiously doing kick counts & wanted to be in the hospital, on the monitors.

    I’ve never had PROM before & it was a sign that something was wrong (in my case a compound true knot & a nuchal arresting descent).

    • Amy M

      Yeah, me too. Luckily, I followed my doctor’s advice, which was to call if anything untoward happens. Water breaking at 36wks, no labor=call right away.

    • Cobalt

      I LOVE those monitors. The belts are annoying but hearing baby’s heartbeat is so reassuring they’re totally worth it.

  • Amy M

    If even Ms. Dekker here can admit that inductions for PROM do not increase Csections, and can get baby born faster, thereby avoiding infections, why is the NCB crowd so hell-bent on waiting? I can see that homebirth midwives would be unable to administer oxytocin…are there any other induction methods available to them (prostaglandin gel, foley bulb), that they could try first? Of course, after that, the woman has to go to the hospital, which neither she nor the midwife want.

    So it makes sense for homebirth situations, why they would avoid induction. But for women who want to have natural births in the hospital, this sort of information should convince them NOT to wait, because it probably increases their chances of having a vaginal birth.

    Fun anecdote time: I had pPROM. In the hospital, they waited 12hrs, while I was fully monitored, and then gave me pitocin. I had a choice: Csection right then, or try pit and see if babies could be born the more traditional route. They limited vag. exams, gave me abx, and all was well. See! Those doctors know what they are doing after all!

    • Ash

      Don’t know about other areas, but here, CPMs can’t prescribe prostaglandin gel,

      • Amy M

        Aha. Of course, we also hear all those stories about Castor oil, and blue cohosh and whatever other crazy things they do for “natural” inductions. So on some level, the homebirth midwives also think induction after PROM is good, because if any of their woo stuff works (or more likely if the mother just goes into labor coincidentally), she won’t go to the hospital.

        So its not the actual induction that’s the issue, it’s their inability to prescribe safe and effective induction drugs.

        • yugaya

          Yes, same as with pain relief – only pain relief that they can provide is allowed. Remember that homebirth story with lay midwife who answered the request for pain relief with offering rum?

    • Samantha06

      I think it’s the entire mentality of NCB.. the “cascade of intervention” thing which, of course, “always” leads to C/Section..so NCBers delivering in the hospital think they should wait anyway. But the most important thing for NCBers is that anything that might prevent a home birth means NO MONEY for the HB midwife.

    • KarenJJ

      I think it is part of enabling the anxiety towards hospital and medical procedures that some mothers feel.

    • Allie P

      You’d think that, right? Like if the goal is v-birth, then take the little interventions so as to avoid the surgery. But every single one is seen as a failure, and it’s the “cascade” whereby if you do anything, you are definitely getting a c section. whereas if you do none, somehow magically you’ll be fine?

  • Bugsy

    Floored by Dekker’s comment: “Evidence shows that in women who meet certain criteria (single baby, head-first position, clear fluid, no fever or signs of infection in mother or baby, negative Group B Strep test), waiting for labor to start on its own for up to 2-3 days is as safe for the baby as inducing labor right away, although the mother is more likely to get an infection herself.”

    Fail #1: Ignoring risks to the baby. According to Dekker, “waiting for labor to start on its own for up to 2-3 days is as safe for the baby as inducing labor right away,” which is in direct contrast to the OB training Dr. Amy received, stating “the risk of an neonatal sepsis (severe infection of the newborn) begins to rise after membranes have been rupture for more than 24 hours.”

    Fail #2: Ignoring risks to the mother – “…although the mother is more likely to get an infection herself.” And the mother’s health isn’t cause for concern WHY?

    Truly glad that I stay clear of NCB activism. I’ll take scientific fact any day over feel-good ideas, particularly if it concerns the health and well-being of my family.

    • Mel

      Yeah, Dekker’s attempt to sweep the maternal health risks under the rug chilled me. I know maternal infections are usually easily treatable, but one of my aunts nearly died of a staph or strep infection after her son was born about 15 years ago. Her son was fine and discharged within a few days but she had multiple organ failure and was in ICU for several weeks. Her prognosis was really, really scary and bad. She pulled through, but they thought they were going to lose her for an awful few days.

      It’s not so easy to ignore that once you’ve seen it.