Dear Ms. Lake,
According to The New York Times:
One of the most talked about and provocative documentaries about childbirth is having its own rebirth.
“The Business of Being Born,” the 2008 film by the former talk show host Ricki Lake questioning the American medical system’s approach to childbirth and presenting the benefits of home birth, will be rereleased digitally in late January, becoming available globally for the first time. The updated version of the documentary, which also spawned a DVD series and a book, will include interviews with celebrities like the actress and model Stacy Keibler who were swayed by the film and, like Ms. Lake, gave birth at home.
I’ve noticed that you have been quick to claim credit for a rising number of homebirths:
The impact of the documentary was monumental. The blogosphere blew up (I can handle a few people yelling at me if it means my message is being heard!) Every day women stop me on the street to share stories of their safe, successful, meaningful births. Many say they felt “in the dark” about their options until seeing The Business of Being Born …
I wonder if you’re also willing to accept blame … for the babies and mothers who have died because they believed your nonsense.
What do you say when women stop you to share stories of their dead babies, babies who died because their mothers saw your movie and believe that homebirth was safe and empowering? What do you say when they share their stories of a ruptured uterus, a breech baby with a trapped head, a severe shoulder dystocia? What do you say when they tell you how their “midwife” encouraged them to labor for days and push for hours, all the while unaware that the baby had died from the stress of labor?
What do you tell them, Ms. Lake? How do you explain why you ignore the large and growing amount of data and statistics that show that homebirth leads to the preventable deaths of babies who didn’t have to die?
I know, and perhaps you know, too, that in January 2014 the Midwives Alliance of North America (MANA), the organization that represents homebirth midwives, published their landmark “study” (actually a non-representative survey of less than 30% of their members completed 5 years ago) claiming that homebirth is safe but ACTUALLY showing that homebirth increases the risk of perinatal death by 450%.
In March 2013, Oregon released an analysis of homebirth deaths prepared by Judith Rooks, CNM, MPH that showed that PLANNED homebirth with a LICENSED Oregon homebirth midwife had a death rate 800% higher than comparable risk hospital birth.
In June 2013, Grunebaum et al. demonstrated that homebirth increases the risk of a 5 minute Apgar score of zero by nearly 1000%.
In February 2014, he presented data showing that homebirth has a 4X higher risk of neonatal death than comparable risk hospital birth:
In January of 2014, Wasden et al. demonstrated that the risk of anoxic brain injury is more than 18 times higher at homebirth than comparable risk hospital birth.
And those are just the highlights. Other papers and datasets were also published and all, without fail, showed that homebirth has a death rate 3-9 X higher than low risk hospital birth.
Let’s be honest, Ms. Lake, the homebirth industry ignores safety in order to make money and you are the leading example, as you mentioned in explaining why you made BOBB in the first place:
She said that she made the film because she was contemplating her legacy after the September 11th attacks, and that her only goal was not to lose money.
Indeed, you turned homebirth into an industry, both for yourself and others. There’s an entire industry of homebirth midwives [unlike real American midwives (CNMs), homebirth midwives (CPMs, LMs, DEMs, lay midwives lack the education and training of all other midwives in the first world], doulas, childbirth educators, birth pool rental services, etc. profiting by risking babies lives, and just like you, Ms. Lake, they take no responsibility for the death and destruction they leave in their wake.
Ms. Lake, you ought to set some of your profits from YOUR business of being born (books, DVDs, etc) into a no-fault compensation fund for those parents who have lost babies at a homebirth. I’m not sure how much money would be available for each family, since, unfortunately, there is a large and growing number of such families, and I don’t know if would be enough to cover the millions of taxpayer dollars that are going to be spent caring for the babies who were left brain damaged by homebirth. Nonetheless, it seems to me that it is the least you could do.
But if you don’t plan to take responsibility, and I’m not holding my breath because I would turn awfully blue, the very least you could do is amend your film, books and website to reflect the increased death rate of homebirth. I don’t doubt that you were unaware of the dangers of homebirth when you started, but you can’t be unaware now. It doesn’t take any specialized knowledge to count the growing number of dead babies, babies who died preventable deaths because their mother listened to you. But if you don’t correct the mistruths, half truths and outright lies in the original issue of BOBB, any money you make now is just blood money.
Sincerely (and with a great deal of sadness and anger),
Amy Tuteur, MD
OT- My local transit authority is running ads for the NVIC. I’m already composing a strongly-worded letter of complaint.
Everything will go alright if women would just believe in themselves, right?
http://media.oglaf.com/comic/conviction.jpg
this article makes me too sad to even comment on it – I do have a question for old readers. Has doctor Amy written an article about what a regular hospital birth looks like? Once I am giving birth, I will put my confidence completely on the medical team (except that I dont want forceps or vacuum to be used, I would prefer to have a csection in that case). But I would like to know if any of you have good non-anti-hospital and inductions articles to share.
There are some stories on the Happy with Hospital Birth blog and the Childbirth without Guilt blog. Nothing recent but the stories would still apply.
Hospital births are what I had for all 5 of my kids. I had great care, everyone was kind and considerate and the nurses were caring and lovely. My first baby was a planed induction, the next was a planned c/sec…the 3rd and 4th were births without any hitches or glitches, text book perfect all natural because I did not require any assistance.5th was maternal requested c/sec..
This isn’t an article, but it is a delightful epidural birth without drama or complications. http://mealsandmovesblog.com/2014/09/07/foxs-birthday/ I have read a lot of birth stories and for some reason I just kind of love this one.
http://hospitalbirth.blogspot.com/
“except that I dont want forceps or vacuum to be used, I would prefer to have a csection in that case)”
I can understand your preference. That said, have you talked to your doc about this? Because there is a point when the baby is so far down the birth canal that it is often faster and safer to do a outlet assisted birth in the case of distress than try to pull baby back up from inside.
Yes. Both my babies were sunny side up and kept getting sucked back in. My OB had to use vacuum both times. No problems whatsoever.
Of course this was discovered once I was already well into pushing. As much as I am not against c sections it probably wouldn’t have been prudent at that point. In retrospect I do wish I’d pushed for a csec with number 2. My OB thought maybe my anatomy somehow caused both to be sunny side up.
Same here, and I had a short cord with my son. So, his head would come out then go back in. At that point, the vacuum is warranted. They only had to use it for a second. He’s fine.
I have my next appointment in 2 weeks, and I am getting ready with my questions (forceps, episiotomy, vacuum, etc). That being said, the chances my OB will deliver are close to non-existent… I have a few friends who have given birth at my hospital, and they seem to want to move births along, but respect maternal requests when they don’t pose risks… That’s why I am trying to do my research on procedures. I am not crazy about vaginal birth, and would definitely not want to be surprised.
I was a low-forceps birth. Mom had said it wasn’t bad. Then again, my sister was two failed inductions and ended up 44 days late with a more difficult delivery (she was bigger than me)(still is). She’s been that late ever since.
They used a vacuum on my Baby A…it was fine. One pull from them, while I pushed and he was out. I did tear a little from the vacuum, but nothing significant. I realize its an anecdote and I can understand why you’d rather avoid, but just to let you know, its not necessarily a horror show.
Thank you for the comment! It is nice to hear from different perspectives. I obviously wouldn’t be against it in the case where they are needed or the best option, but would prefer to avoid them if necessary.
I guess I am puzzled by your comment.
Maybe the doctors can weigh in, but are you suggesting that they use vacuum for no reason? That they are just pulling them out whenever?
Are there instances where doctors used vacuum when they thought they were NOT a better option than not using vacuum?
(aside from cases where the patient refused an even better option)
My ignorance on this whole matter might be showing :). I am most definitely not of the opinion that doctors do procedures for the fun of it…
I will try to explain myself better. If I have a choice (safely) between a c-section and vacuums/forceps (which happen to my mom with my brother) then I would choose the c-section anytime.
If (like fiftyfifty said) the csection could cause risks because the baby is too far down the birth canal then I wouldn’t oppose it.
Hope I made more sense now
No, I think she is concerned about perhaps having a doctor that is intent on a vaginal birth and rather than move to a c-section….ends up doing a difficult vaginal delivery.
If you’re not really into the idea of a vaginal birth, ask about getting a maternal request cesarean. One of my friends went that route and loved it, her babies were “lifted into the world”. If you’re not planning a lot of pregnancies, there’s really not a lot of extra risk.
Mine were all uncomplicated vaginal deliveries in the hospital, except for some third stage hiccups with the last one, easily managed by the team. Instrumental delivery happens, but is pretty uncommon. Definitely something to know about and prepare for, but don’t let it take over your birth preparations (and I agree that stitches on front are better than stitches underneath, if you have a choice). I was really happy with my deliveries, except for one bad nurse with my first, she was just not a happy person. Do the hospital tour and ask about standard protocols so you know what to expect as far as monitoring, timelines, 39 week rules, etc.
Already asked! Long story short – my OB’s practice doesn’t do them since it goes against the Canadian Ob/GYNS association policy and I like the team that is following my pregnancy, so I won’t start searching for someone to ok a maternal request c-section with 13 weeks to go.
That being said, I am not afraid of giving birth or the pain (maybe a bit of the unexpected consequences) – and I trust the hospital where I will give birth (so I am not concerned they will not take required action once the time comes).
I will take your advice about asking a lot of this questions during the hospital tour. My biggest concern is actually making sure that my husband knows what to expect since he is completely clueless and will need to cue cards when the time comes! 🙂
L&D nurses have tons of experience with clueless dads, even the well prepared can forget EVERYTHING when there’s an imminent baby. My husband forgot our hospital bag and camera when our fourth was born.
Ask about pain relief timeframes on the tour also. If it takes a long time to get an epidural, for example, you want to know to request it sooner if you want one.
Some OBs will do physical therapy referrals for pelvic floor strength after delivery, although I personally recommend horseback riding as very effective for floor recovery.
There really is good advice that a maternal request Caesarean section is safer than planned vaginal birth for women planning three or less children without other big surgical risk factors. I am a Canadian ob and I do maternal request caesarean section not infrequently. Check out Magnus murphys book “choosing caesarean: a natural birth plan.” The SOGC’s views on maternal request caesarean are outdated and unjustified in my opinion.
Is there a chance you practice in Quebec? 🙂 To be fair, my doctor agreed that it was much safer for the baby (even if perhaps not for me) but that the SOGC’s view dictated his choices (he has a fairly high ranking position on the hospital, so I understand he wouldn’t want to risk his status/position by inviting potential liability)
I am fairly at peace with giving birth (even if I find it upsetting that home birth is somehow a more acceptable option than a csection, and that I do not get to have autonomy over my own body). That being said, as much as I hate the SOGC’s view, they are perfectly aligned with a health system that is interested in keeping costs down…
I practice in British columbia. Health care costs are NOT lowered by refusing elective caesareans. One bad outcome from a vaginal birth costs way more than elective caesareans ever could.
It’s an invalid argument. It’s misogynistic and paternalistic to refuse on that basis. It’s a bad argument that denies women the right to choose. If men had babies, you bet your ass there would be a policy for elective caesarean.
Ricki Lake is just like every other healthy, wealthy, self actualized white American cis-gendered woman. She is an expert in normal birth. She wants everybody to benefit from what she has to share. She holds the secret to a life fulfilled if only you all weren’t
so stubborn and would PAY attention!
Well said, Dr. Amy.
I also wanted to mention that Dani has stated she’s been misquoted in this article, and is working on trying to get that corrected. ETA I see AuntBea already mentioned that below.
As a lawyer I can’t help but think regulation is the answer. Problem is it’d be state by state probably unless congress could be convinced to pass national laws/regs. And the home birth people would fight. But really, you can’t practice other kinds of medicine, dentistry, etc. without a license (medical/dental), why should people be allowed to birth babies without a medical license? Or at the very least an RN? And you can’t do open heart surgery, pull teeth etc. at non medical facilities (at least I think so), do why is birthing at home allowed?
Exactly! Even hairdressers have to have a license! I don’t understand it.
As a former lawyer I get that impulse.
It’s really important though to appreciate what drives an element of the homebirth movement, which seems to be a desire to spurn the authority of government and regulators, who are believed to be untrustworthy or driven by ulterior motives of some kind. For those people, anyone not having succumbed to regulation could be an even more desirable birth companion. Letting people know about the registration etc rules would probably help some make a decision to seek high qualtiy care, and drive others even further into dangerous territory, seeking their freedom, or whatever it is they want.
Homebirth is a thing (rather than home dentistry or home heart surgery) because all you need for home birth is a pregnant woman. Something’s going to happen regardless of the attendant, who can either take credit when no one is dead, or run and hide when they are. Add a few incantations, poultices, affirmations or whatever, and there you have ‘expertise’.
With great power ( and big bucks ) comes great responsibility. Interesting to see how this plays out.
OT
Do you guys remember this?
http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON287006
European advice is not to prescribe codeine to breastfeeding mothers, due to risk of morphine overdose in ultra rapid metabolisers.
I remember Canadian and American OBs and anaesthetists here telling me that you prescribe Oxycodone or other opioids.
I’ve been through this rigmarole with one local maternity hospital, who to,d me that as our population is more than 95% Caucasian and Irish, the incidence of URM is so low that they will happily continue to prescribe codeine.
The other local maternity hospital has a new policy.
They have interpreted “do not prescribe codeine” to “do not prescribe anything stronger than a combination of Diclofenac and paracetamol”.
I finally lost it today after I had someone in tears saying she’d sent her husband out to buy formula and bottles because she just couldn’t take the pain anymore, so could I please prescribe her something stronger (she had an emergency CS less than 5 days ago).
I’m waiting for the anaesthetist who came up with the “nothing stronger than paracetamol and diclofenac” policy to get back to me.
I will explain to him, using small words, that if someone has had a failed forceps delivery and a crash CS, hasn’t slept for more than 2 hrs straight in days and is breastfeeding a newborn and caring for toddlers, that policy is not going to cut the mustard, and what would he like me to do next time?
Because this time I prescribed codeine, and told her to keep feeding the baby because that was important to her and monitor for drowsiness or jitteriness, and if that happened we could think about bottles, which would be ok.
The midwife I spoke to seemed surprised that this was an issue. I suggested that pain that might be well controlled in a hospital ward might be less well controlled once someone was at home and back to mothering full time without help.
No one would be expected to manage with simple analgesia alone 3 days after a hysterectomy, appendicectomy or lap chole- and those patients don’t have to feed a baby and might get a full night’s sleep.
Apparently I’m the first GP to have raised this issue.
I suspect this is not because my colleagues haven’t been getting the same phone calls from tearful, sore patients, but because they just do the scripts for stronger analgesia and don’t worry about the root cause.
that’s ridiculous. Pain management should be tailored to the individual. There is a vast range of sensitivity and side effect profiles between individuals. While paracetamol and diclofenac may work just fine for elective cs they will not work for all and some women will need opioids. We have a diverse population and so got rid of codeine and instead prescribe PO morphine (5 mg roughly equiv to 30 mg codeine) or oxycodone. This is what I instruct the surgical residents (registrars) to do for ambulatory BF patients coming for things like choles.
Thanks.
You know it, I know it…now I just have to convince this guy.
I have a feeling the way I’m going to do this (if simple common sense doesn’t work) is to point out that their breast feeding rates are going to plummet if women have to choose between adequate analgesia and BF.
For the purposes of my conversation with this guy, you may become “a North American anaesthetist who has been informing me how they safely manage pain in Breast feeding mothers in a more diverse population where codeine use is contra-indicated”.
🙂
I have no patience for this type of nonsense.
None.
My colleagues were joking today that I should be the practice pain management specialist because I take such a hard line with inappropriate opioid requests. I am not a bleeding heart who throws morphine at anyone who looks at me sideways, just to be clear.
Poorly treated acute pain in women, specifically because they are women who are feeding their children, is bad medicine and horrible doctoring.
Our patients get diclofenac and acetaminophen suppositories in the RR post spinal or epidural. Then they get the supps for another 24 or 48 hours or so, and either po/ SC morphine or dilaudid. It all seems to work very well.
I believe it.
I’m not saying every woman will need opioids after a difficult delivery, but some definitely will, and it just does not make sense to have step two on the analgesic ladder as a ceiling.
For sure. Even women with difficult vag deliveries here get something more than tylenol or ibuprofen if they need it..
I’ll say it again – this culture of withholding effective pain relief for anything to do with childbirth is antithetical to the rest of good clinical practice, where improved awareness of pain management progressing in leaps and bounds.
Please stand your ground on this Dr K. I’m from your neck and have faced this problem with each of my three children. Was discharged after no.1 with severe second degree tear with paracetamol only, it wasn’t til the community midwife saw me retching when I moved that I got some (amazing) codeine and diclofenac. With no.3, after a not great c-section and relaparotomy, the hospital had standard 48 hour discharge policy so the midwives interpreted this as meaning you had to be “down to oral paracetamol only” 24 hours BEFORE discharge. So the anaesthetist who had written me up for paracetamol IV for 48 hours plus diclofenac and morphine was overruled by the officious ward midwives who tritely informed me that paracetamol orally “is the same dose you know!” when I pointed out it should be IV, and refused me my morphine point blank. 24 hours after relaparotomy. Thanks for that! The consultant was lovely but it wasn’t until I told her that I was discharging myself as I had a stash of codeine at home that I could take myself that she intervened. And even after she did, I had to ‘buzz’ for the midwife for literally every single dose and had to have the argument (tearfully) to please please please just get me what the anaesthetist has written me up for, without having to beg. Horrible really. One week after a section your pain levels are SO much lower, why not just control it as best as is safe for mum and baby?! Good luck Dr K your patient is so lucky up have you fighting her corner! Don’t cave!!
I see. And for those of us who had c-sections and can’t tolerate NSAIDS? I didn’t need a lot of pain medicine for long, but if I’d had none, I would have been one incredibly cranky mommy.
Oh dear me, I’ve had two c-sections. That sounds terrible!! I had a great recovery for my planned c-section, but I needed something a little stronger than “than a combination of Diclofenac and paracetamol” for a few days after I got home. I was able to be more active knowing I had the stronger stuff, if I needed it….and I think that being active helped me recover so much faster and BF. Thanking my lucky stars I didn’t have to deal with inadequate pain relief.
Barf. If they don’t want to prescribe codeine, they should have a different opioid alternative… completely ridiculous to not have any available at all.
Now that hydrocodone has gone C-II Stateside and oxycodone is already C-II, meaning neither can be phoned in (hydrocodone previously could), I’m frankly surprised I haven’t seen more of an uptick in scripts for acetaminophen/codeine. I do think I’m seeing more tramadol scripts.
I have loved ones in Belfast, some of whom are women of childbearing age. Can you tell us which one of the hospitals is the one with the sane and humane policy, so I can pass the information on?
The hospital I have issues with is in the South Eastern Trust, but the Greater Belfast Area.
The Belfast Trust is the one with the sensible policy.
I’ll pass that on…
Can you edit this to discuss how the journalist blatant misquoted Dani?
“Every day women stop me on the street to share stories of their safe, successful, meaningful births.”
Every day? Every single day? I call bull-shit. OOH births aren’t that large of a group for Ricki Lake to have a random stranger see her, recognize her, stop her, and blab out their homebirth story every freaking day for the last 6 years.
That would be about as realistic as a teacher saying that former students stop in to thank them EVERY day. Actually, a professor teaching large introductory classes at a college may well by the end of 30 years have more former students running around (especially in the local area) than Ricki Lake has people for whom BOBB changed their life.
You know, I don’t fully doubt her statement about women stopping her to talk about their homebirths. It seems to be the first thing those women always talk about upon meeting someone else. They don’t waste time bragging about it whenever they can.
Oh sure, it probably happens, but how often, is what Mel was getting at.
“This is Brad Hall, filing a special report on crime. I’m standing in the streets of New York City – streets virtually teeming with violent crime. In fact, statistics show, that in New York, a man is mugged every 11 seconds. I would now like you to meet that man. His name is Jesse Donnally, and he’s mugged every 11 seconds. Jesse, welcome.”
So I guess the reporter is about to mug Jesse?
He didn’t, but a little girl did.
Ouch. I felt that