Top 10 posts of 2014

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These are the top ten most read posts of the year on The Skeptical OB.

The topics vary widely from Rhogam to vaginal tears, from stories of babies who died unnecesarily at homebirth to the hideous statistics of homebirth deaths in the US, from the ridiculous to the sublime.

Without further ado, here they are:

10. What is Rhogam?

9. Hold the guilt! New study finds benefits of breastfeeding dramatically overstated.

8. Jan Tritten crowd sources a life or death decision and the baby ends up dead

7. In memory of a baby boy who did not have to die

6. Vaginal weight lifting

5. Six red flags you need to recognize to quack-proof yourself

4. The best method for getting pregnant? Have sex.

3. Baby Jacob: a victim of the 39 week rule

2. Vaginal tears

1. Homebirth midwives reveal death rate 450% higher than hospital birth, announce that it shows homebirth is safe

My personal favorite post of the year is: Dr. Amy’s Plan for a safe, sane, satisfying birth.

What was your favorite?

  • sdsures

    From http://www.fml.com:

    “Today, I gave birth to our first child at home. What was supposed to be a beautiful moment of us peacefully greeting our newborn, ended up with the cops knocking on our door. Apparently me giving birth sounds like a domestic dispute. FML”

    • Roadstergal

      I’m surprised that doesn’t happen more often. What are you supposed to do if you hear a woman screaming in obvious agony next door? I’ve called the cops when I’ve heard a woman screaming…

      • sdsures

        The crunchies probably snip those bits out when gushing about their homebirth stories. “Aaaand we need to set aside some money this month to fix the front door, dear.”

  • GiddyUpGo123

    Wait what about vaginal knitting? That one was awesome.

    • sdsures

      *shudder*

  • guest

    Very OT; Mayer Eisenstein died just before Christmas. You may remember him from his homebirth advocacy, along with his record with autism and some other things. Chicago Tribune 2009: http://www.chicagotribune.com/news/chi-autism-doctor-eisenstein-may22-story.html#page=1

    • Guesteleh

      That article, WOW. Good riddance to that old fraud.

      • guest

        leftbrainrightbrain.co.uk/2014/01/22/mayer-eisenstein-files-for-bankruptcyagain/ Kind of an interesting 2014 update re homebirth parents and malpractice insurance.

  • Wendy Hinds

    Ok I see Amy Tuteur isn’t a practising medic.

    However, Susan Bewley who was part of the team who developed the recent NICE guidance on place of birth IS a practicing medic – professor of complex obstetrics at Kings College Hospital, London.

    Details: https://kclpure.kcl.ac.uk/portal/susan.2.bewley.html

    • Amazed

      Yeah, Dr Wakefield, or was it “Dr Wakefield”, was a respected physician once as well.

      • Wendy Hinds

        What point are you trying to make?

        That because one previously respected professor (who is unconnected to the field of obstetrics) was found to have produced fraudulent research then we can easily disregard the opinion of a professor of complex obstetrics at a world class medical school whose reputation is entirely intact? Is this the point you’re trying to make?

        • birthbuddy

          The point is, Wendy, that no matter how many times you mention your “mind-blowing” argument that Dr Amy isn’t registered anymore, it remains completely pathetic, predictable and irrelevant.
          That is the point.

          • Amazed

            With Wendy’s support for obstetricians and respect for their knowledge in their own field, she should have been awed by the fact that mean old Dr Amy was invited to speak at the ACOG conference only a year ago.

            But I guess ACOG might not deserve the respect its British counterpart does. After all, they all have an axe to grind with homebirth. Especially Dr Grunebaum, this mean, MALE troll.

      • sdsures

        He’s been stripped of his medical license. Tosser.

  • Wendy Hinds

    I find the comments here really interesting. You have a very politicised and polarised birth culture in the USA compared to the UK. The main concern for UK mothers isn’t where or how they have their babies (we’ve long had a system of care where midwives are the lead professionals for low risk women) but poorly resourced postnatal care which leaves women floundering with breastfeeding.

    • Anj Fabian

      Considering that a maternity patient walked off a unit with her child and was later found dead, I think the postnatal care has issues more serious than breastfeeding.

      • Wendy Hinds

        Yes – postnatal care is very under resourced. The mother in question had pre existing mental health problems and I’m not aware of how her care was being managed. In London where I come from women like this are referred to a specialist perinatal mental health team and offered case-loading care, which is good. Breastfeeding is also an issue – most women in the UK choose to breastfeed and need support in overcoming their difficulties, just as they do with other aspects of postnatal life.

        It is hard at the moment in the NHS – a bigger and bigger bite of the maternity spend is going on intrapartum care, and postnatal care has always been treated as the ‘Cinderella service’. Some of our hospitals have c-section rates of well over 30% – this has rocketed in recent years (as has the birth rate generally) . We just don’t have the capacity to care adequately postnatally for the number of mothers full-stop, never mind the increasing numbers who are post-operative. Especially as in the event of short staffing on the labour wards midwives are often pulled off postnatal to plug gaps. It’s a very challenging environment to work in for everyone who is trying to keep mothers and babies safe.

        • Wendy Hinds

          Would add, that despite our small spend on maternity care per head we still manage to achieve a maternal mortality rate less than half that of the USA, so it can’t be all bad.

          • birthbuddy

            And your stillbirth rate?

      • sdsures

        That and the mental health care system, sadly. Not enough money.

      • Sarah

        There is, of course, the issue of whether Charlotte’s meds had been changed due to breastfeeding too.

    • Amy Tuteur, MD

      Actually, it’s shockingly policitized in the UK, so politicized that the government is fundamentally dishonest about the safety of homebirth, there have been multiple hospital scandals of incompetent midwives letting babies die, and fully 20% of the obstetric budget is spent on liability.

      • Wendy Hinds

        I appreciated you are heavily invested in making a case for the US model of obstetric led care for low risk mothers, but USA rates of maternal mortality (more than double the UK) don’t support your view that the model of care where most women are cared for by doctors is either the safest or the most efficient.

        Incidentally – are you still a registered and practicing obstetrician?

        I’m surprised challenging people like me on a blog leaves you time to keep abreast with current practice and research in obstetrics.

        • fiftyfifty1

          Have you looked at the underlying causes for maternal deaths in the US (or the UK for that matter)? How do you believe midwife-led care leads to lower death rate?

          • Wendy Hinds

            I’m not sure fiftyfifty. All I know is that despite having one of the fattest populations in Europe, and most women having midwife led intrapartum care we have maternal death rate half that of the USA. It may have nothing to do with the midwife led model of care – who knows. I think my point is that despite most women never seeing an obstetrician, birth in the UK appears to be very safe.

          • Amazed

            Unless you count the 17 stillbirths taking place every day in the UK. But I gather that isn’t your area of interest.

            Since you aren’t a midwife or a doctor, what makes you think you’re in any way qualified to judge clinical evidence? Maybe you have spoken to an ACOG conference on the topic of childbirth? Because, you know, Dr Tuteur has. Very recently.

            Where, exactly, do you, as someone who has never practiced obstetrics anywhere, take your confidence that you are capable of interpreting what clinical evidence means?

          • kisarita

            how ridiculous. an “appeal to authority” argument??? completely violates rules of logic. asking her how she knows what she knows is legitimate, but really whether she happens to be an obstetrician is completely irrelevant, as irrelevant as amy’s having been retired an not seeing a living patient for years.

          • Amazed

            Coming from one of our most ridiculous trolls, that’s hilarious! Keep demonstrating that your ilk places so little value on education that you think everyone can understand “clinical evidence” without being educated in this field. Especially someone who doesn’t have the smarts to read the upper right margin of this very page and instead screams, “Are you licensed?”, insinuating that Dr Amy’s lapses license makes her as “educated” as herself, who never held a license to lapse in the first place.

            Please, kisarita, keep us amused. I am stunned by the brilliant logic of your arguments.

          • Wendy Hinds

            Ok – fair enough. If only medics are qualified to interpret clinical evidence then where does that leave lay persons like me when there seems to be a conflict of opinion? Whose analysis should the lay person rely on? A non-practicing medical blogger with the mother of all axes to grind, or the Royal College of Obstetricians and Gynaecologists, who support homebirth for low risk multiparous women as a safe option?

          • birthbuddy

            What axe does she have to grind?
            She is opposed to babies dying unnecessarily at the hands of lying uneducated practitioners.
            I grind that axe too.

          • Wendy Hinds

            Are you suggesting that the Royal College of Obstetricians are liars who don’t care if babies die?

          • birthbuddy

            No, Wendy, I am suggesting NCB idiots are liars who don’t care if babies die.
            I am also fascinated by your sudden support for Obstetricians when they happen to agree with your agenda.

          • Amy Tuteur, MD
          • sdsures

            The Royal College of Midwives is more interested in promoting themselves than whether or not their views mean that babies die needlessly.

          • Amazed

            Lay people like me as well, Wendy. And since I am not qualified to interpret clinical evidence either, beside the analysis of the people who are qualified to interpret it I rely on data that I can understand. Namely, whose analysis has data that can be understood by a lay person and supports their recommendations and whose analysis has data that contradicts their conclusion and recommendations.

            The UK healthcare recommends a course of action that contradicts the data everyone can understand. The data shows that midwife-led care as it is practiced in reality in the UK is less safer. The conclusion – let’s increase midwife-led care might be more cost effective but it isn’t safer.

          • Dr Kitty

            NICE also supports MRCS.
            You on board with that?

          • Wendy Hinds

            Medical organisations like the NHS, NICE, and the RCOG recognise that it’s extremely difficult for individuals, medically trained or otherwise, to keep abreast of the mass of new studies being published. This is why they have panels of doctors, epidemiologists, medical ethicists, and specialists from different disciplines whose role it is to analyse new research and provide an overview and recommendations. This is what NICE do, and the RCOG.

          • anh

            Wendy, I am an American living in the UK. You have the whitest population I’ve ever seen.

          • Wendy Hinds

            15% of Brits are non-white. In London and other large cities it’s much higher than this. There are only two white children in my son’s class of 30.

            Re: the ‘huge problems’ you foresee with an increase in the homebirth rate, I’d point out that the RCOG has released a statement supporting homebirth as a ‘safe’ option for low risk multiparous women and one with ‘significant benefits’. Midwives and doctors are required to advise primips of the poorer outcomes for the babies born at home, which is as it should be. In any case, homebirth has always been an option for low risk mothers having NHS care. Nothing much has changed. I very much doubt there will be a huge surge in women wanting homebirths.

          • Joy

            As an American living in the UK…..15% of the population being non-white is nothing. 15% is about the population of those identifying as African American in the US. The Hispanic population is much more. The UK, being an island, doesn’t have as much to worry about illegal immigrants coming over from border countries. Especially since the UK no longer grants citizenship based on being born in the country.

          • sdsures

            “The UK, being an island, doesn’t have as much to worry about illegal immigrants coming over from border countries.”

            Actually, with the Chunnel, the UK does still have a significant problem with illegal immigrants coming in by being stowaways on HGVs, according to the BBC series “Motorway Cops”. Not reading the Daily Mail here. I emigrated from Canada to England in 2008, passed my ILR test, and next up is the Citizenship application/ceremony. The amount of paperwork is astounding, as it should be.

          • Joy

            I’ve been here for 10 and taken the citizenship test and have my red passport. Yes, there are people who stowaway on trucks in the Chunnel. It is nothing like the Southern US border and as I have said, since children don’t automatically get citizenship it has less appeal than the US.

          • sdsures

            Having a shorter borderline helps. 😉

          • Rob C

            Homebirth is already reasonably popular here and growing. Homebirth in the UK is a ton safer than in the USA because all our midwives are very highly trained – I understand USA midwives who attend homebirths do not have a great deal of training.

          • Sarah

            Homebirth isn’t reasonably popular, it’s very much a fringe pursuit in the UK. It’s like 2 or 3 percent.

          • Sarah

            While Wendy is mainly talking caca, it’s true that the population of childbearing age women in the UK is now quite diverse. The white population overall is about 90%, but there isn’t an even spread by age. Younger age brackets are more multi-ethnic.

          • fiftyfifty1

            “Younger age brackets are more multi-ethnic than those who are past fertile age”
            Yes, but that is true in the US too. The UK is 87% white, while the US is 63% non-hispanic white.The US is 15% black/AA while the UK is 3%. This is important because of the genetic variant that predisposes to preterm rupture of the membranes which is so common in those of African heritage (add to that our shameful health insurance situation, racism and poverty and it is a recipe for disaster.)

          • Sarah

            Yes, I wasn’t disputing that. It’s just that looking at the percentage of the UK population who are White British doesn’t tell the whole story. Additionally, women from minority ethnic groups tend to have more babies too. I tried to dig up some figures but can’t seem to find any, but certainly the percentage of women giving birth who are WB is rather less than 15%.

          • fiftyfifty1

            Ah, so you’re admitting that you haven’t looked at the data and have no idea what they show. OK.

          • Wendy Hinds

            No, I have no idea why the maternal mortality rates in the US are double those of the UK.

            Do you?

          • birthbuddy

            Please provide a link to your data on maternal mortality.

          • Guesteleh

            Here is a presentation from the American College of Obstetricians and Gynecologists discussing the high U.S. maternal mortality rate. Factors they identified include:

            • Intermittent insurance coverage of some mothers with underlying medical conditions.

            • Increase in older mothers

            • Increases in obese and very obese mothers

            • Increases in requested caesarian births

            • Emerging infection (HIV/AIDS; H1N1 in 2009).

            • Racial disparities remain high

            It will be interesting to see if the increased coverage under Obamacare reduces the maternal mortality rate, particularly among black women.

          • Dr Kitty

            But birth in the UK (maternal mortality 8/100,000) is less safe than birth in Ireland (maternal mortality 5.7/100,000), where Homebirth is very rare and not encouraged and all women are seen by an obstetrician at least once during their pregnancy.

            I can play that game too.

          • GiddyUpGo123

            I am not answering this based on anything more than a guess, but in the US lots of people don’t have access to health care. We don’t have universal care like you have in the UK, and people who don’t have insurance don’t tend to get prenatal care. I would bet money that has a lot to do with higher rates of maternal mortality. Whether or not women use midwives or not doesn’t even factor into the equation.

        • Amy Tuteur, MD

          I appreciate that as someone who has worked for the Natural Childbirth Trust, had 2 homebirths with an independent midwife and appears all over the internet supporting homebirth, you are heavily invested in justifying your own choices.

          If you want to make an argument about maternal mortality, you MUST use numbers and demonstrate that you understand what you are talking about instead of merely parrotting propaganda that you have heard from other homebirth advocates.

          It takes very little time to challenge people like you since you obviously have very little idea of the depth and breadth of issues in contemporary maternity care.

          • Wendy Hinds

            Are you still a registered and practicing obstetrician?

            I am not a midwife or a doctor and make no case for my argument on the basis of my qualifications or personal experience.

            I have had a homebirth with a good outcome but I never refer to this in discussions with women because my personal experience is irrelevant – I don’t respect the use of anecdote as a replacement for clinical evidence.

            I suspect you have a very poor knowledge of UK maternity issues because you are not practicing here (or anywhere by the sound of it).

        • birthbuddy

          “Incidentally – are you still a registered and practicing obstetrician?”
          Relevance please?

        • Rob C

          Indeed… a medicalised model for midwifery is a step backwards. Having a baby is not a condition or illness that needs doctor intervention. A labouring mother is not a patient.

          • Dr Kitty

            Right up until the point where they are, which is currently well over 25% of pregnancies when you include PP, PPH, Emergency CS and instrumental deliveries, 3rd and 4th degree tears, AFE, Shoulder Dystocia, twins, HOM, prematurity, Pre-eclampsia and eclampsia, maternal cardiac disease, GDM, breech and malpositions,, clotting disorders, known foetal abnormality, maternal infection, underlying maternal morbidity, foetal distress, chorio-amnionitis, UR, GBS, APH….

            Pregnancy and childbirth are not illnesses, but they are physiological states with not insignificant risk of death and disability for both mother and child.
            Only a fool would think otherwise.

          • Rob C

            I think you are wholly missing the point of my post. The vast majority of pregnancies will not require intervention from a doctor. Even when intervention is required, a highly trained UK midwife can deal with a lot of these – referral to doctors and other multi-disciplinary team members is a rare exception rather than the norm.

            I dislike the american system of midwifery because being pregnant is treated more like an illness and managed like a medical problem. Speaking generically, it is not a medical problem and I think the USA has a lot to learn from other western cultures (such as the UK and New Zealand) on systems for midwifery led care, as opposed to Dr / OB led systems.

          • Dr Kitty

            Rob, I AM A DR IN THE UK and you are misinformed.
            A highly trained midwife cannot deal with “a lot of these” alone. In fact, EVERY SINGLE complication I mentioned above requires input from a Dr, because I specifically wrote the list to ensure it did.
            Not necessarily an OB, but always a Dr.

            Midwives can prescribe only limited medications, and rarely diagnose.
            I’m the one doing scripts for analgesics, antibiotics, clexane, insulin, thyroxine, antidepressants and aspirin. Not midwives.

          • Rob C

            There are many skilled midwives in the UK who can handle a shoulder dystocia, instrumental delivery, twins and others on your list. I am quite well informed to be fair.

            Again, I think you are missing the point of my post.

          • fiftyfifty1

            Midwives in the UK do instrumented births and manage twin pregnancy and delivery all without the input of MDs?!

          • Rob C

            Some midwives do assisted births and handle ventouse and forceps delivery, breech (including VBAC), twins… both at home birth and in a hospital setting. I say “some”…. not all have the training for ventouse / forceps for instance, but there are those who do, including some IM’s.

          • fiftyfifty1

            I can’t endorse a system that encourages midlevel providers to do high risk births, especially in a resource-poor setting such as the home. VBAC breech cared for by a midwife without requirement of MD oversight?! Very problematic. I guess the UK system of midwife-led care is far worse than I had originally believed. I had thought that perhaps Dr. Tuteur was over-zealous in criticizing the UK homebirth system, considering how much worse our own (USA) homebirth problem is. But after hearing your comments, I have come to agree with her.

          • Rob C

            Haha…. don’t get me wrong here…. it is not the norm for VBAC or breech to be done at home…. i’m only saying that there are specialist midwives who do this and with fantastic success. It’s not unheard of is all I am saying and our systems allow for it.

          • Amy Tuteur, MD

            Really? What peer review articles demonstrate that success? None, right?

          • fiftyfifty1

            So you claim they do very high risk births with “fantastic success” and in a home setting. Do you have anything to back this up?

          • Dr Kitty

            Actually, Rob, while the system allows MWs to attend high risk deliveries, NHS MWs are not supposed to remain the clinical lead for complicated pregnancies, and at the minimum are supposed to refer for an obstetric opinion any woman who is not low risk.
            You know that, right?

            Anyway, I vote mansplaining, ill-informed, borderline troll who isn’t worth any more pixels.

          • sdsures

            Citation please.

          • lilin

            It’s funny because you’re being told that you’re wrong, by someone far more informed than you are, but you’re still insisting you’re right.

            Also do you have any numbers for this? Of course not, because saying “fantastic success” is easy and numbers aren’t – especially if they indicate a higher death or injury rate.

          • Dr Kitty

            Rob, do you honestly believe the tripe you write?

            Do you really believe midwives do all these things alone, without the woman ever seeing an OB?
            If they do so it is because they are acting beyond their competency or because they have a patient who has refused to go to hospital.

            Nobody manages a high risk situation like a SD alone.
            The RCOG green top for OVD states clearly that a senior obstetrician should be present IN THE ROOM if a junior trainee is performing mid cavity forceps and that a theatre must be prepped and ready for immediate CS if the forceps fail, and that staff trained in neonatal resuscitation must be present.

            All twins are consultant led where I practice. No exceptions.

            But yet, apparently midwives are safely doing forceps right and left at home with just one back up midwife.

            I’ll tell you what happened in every single ventouse or forceps delivery I have been present at. No matter who performed it (and the MWs I worked with only ever did easy lift out ventouse deliveries) the Obstetric SPR and SHO were in the room, the paeds team were in the room, there was blood on standby and an OR ready to go.

            But sure, totally safe to do in your living room, why not!

          • birthbuddy

            Rob, I’m confused. I thought you said midwives are competent to deal with low risk pregnancies.
            In your delusional mind, are these low risk pregnancies. You are doing an excellent job of illustrating the problem most of us have with NCB and ‘scope creep’ or scope ‘distortion’.

          • Rob C

            I think the only distortion around here is of my comments. This place is pure poison.

          • Dr Kitty

            No distortions necessary.
            Simple reading comprehension.

            You’re the one who said natural childbirth was “better”.
            You’re the one who said ” (vaginal) birth is important for bonding”.

            Bye Felipe!
            Stick the flounce.

          • Elizabeth A

            Rob, do you have ANY direct experience of the US system of obstetrical care? Because you seem to be a guy, and you seem to not be in the United States, and those are two strong bases for the suspicion that you are talking out your hat about how the American system of midwifery works and how pregnant women are treated within it, and what the US should be learning from other cultures.

          • Young CC Prof

            And simply diagnosing those conditions requires using high technology on everyone. The basic bloodwork that should be done in all pregnancies, some of it requires quite a bit of medical technology, and we don’t even think about it. Ultrasound may be decades old, but even 10 years ago, we didn’t have the precision equipment or knowledge base to do some of the things ultrasounds can do now.

          • fiftyfifty1

            So you are a freebirth (UC) advocate then?

          • Rob C

            Absolutely…. where it is safe to do so and when that is the wish of the mother. It is the most natural way amongst all animal genuses, to which we also belong. The best thing a midwife can do with her hands is absolutely nothing! (unless really needed)

          • fiftyfifty1

            Why would anything be needed?

          • Rob C

            At the end of the day, if it is a mother’s wish to birth without pain-relief, or even without professional midwives or other professionals present then that is entirely up to her. If the mother is very well informed to the pro’s and cons of each birth decision then she can make an informed choice – it will not be the choice everyone makes but nonetheless it is HER choice.

          • fiftyfifty1

            “At the end of the day, if it is a mother’s wish to birth without pain-relief, or even without professional midwives or other professionals present then that is entirely up to her.”

            Absolutely. And medical ethics absolutely supports this principle. Dr. Tuteur has said time and again that she would never advocate that a woman lose the right to birth at home with (or without) whomever she chooses at her bedside. On the other hand, the right of a self-proclaimed “midwife” to call herself a medical professional and charge $ for her “services”, that is something that the government is well within its rights in eliminating.

            “it will not be the choice everyone makes but nonetheless it is HER choice”

            Exactly, just like the right of a woman to choose an epidural, induction, and/or elective c-section.

          • Rob C

            You are of course only referring to midwives in the USA. In the UK, independent midwives charge £ for their services but they are always educated to the same standard as any other midwife. Most independant midwives in the UK have vast experience and skills. I realise this is not the case in the USA.

          • fiftyfifty1

            Absolutely. The UK midwife system has its problems for sure, but they ain’t nothing like the problems of the American CPM/lay midwife system.

          • sdsures

            The UK also has CNMs who work in hospitals.

          • sdsures

            Except you insist that the only choice she ought to make in your view is to a natural and unmedicated vaginal birth.

          • Samantha06

            “Absolutely…. where it is safe to do so and when that is the wish of the mother.”

            How do you know “where it is safe to do so”? What criteria are you using to determine safety?

          • Rob C

            Well, thankfully that is not my job… phew! This is why we have qualified midwives at the forefront of care in the UK.

          • Samantha06

            So, you have no medical qualifications of any kind, you are a man, and you are trying to tell us what is “best” for women? And you expect us to take you seriously?

          • birthbuddy

            Thank you for confirming my suspicions. You are an idiot. I was worried I was becoming cynical.

          • sdsures

            As long as you’ll never have to do it (a unmedicated birth) yourself. Preach it! Oh wait, he can’t. Because it would be like me insisting that pain relief and prompt treatment for a testicular torsion is ridiculous and unnecessary.

            (My husband had testicular torsion when he was a teenager. You do NOT just wait and see if it will go away on its own. Prompt treatment saved the testes.)

          • Samantha06

            You are absolutely right! I had forgotten about good old testicular torsion. I learned about it when I got my ENPC- Emergency Nursing Pediatric Course certification a couple of years ago. And yes, it is a serious emergency! That’s a good example to use with these all-knowing guys like our friend Rob here! haha!

          • sdsures

            Husband had another scare a few months ago (turned out to be something less scary and less emergent, but still painful). We went to the ER immediately. Better safe than sorry. He still has pain, but ultrasound has confirmed that there’s no torsion. It may just be his fibromyalgia making him sensitive to the pain of the original scar tissue, which really sucks because surgery to fix the scar tissue will only create more scar tissue. It’s turtles all the way down.

          • Samantha06

            Awww, poor guy.. I hope he feels better soon..

          • sdsures

            He manages very well. He’s able to tell the difference between “normal fibro pain” and “we need to go to the ER right now!” pain. I’ll pass along the hugs.

          • Sue

            ” where it is safe to do so”

            And you can reliably predict this, can you, Rob?

          • Amy Tuteur, MD

            Medicalizing birth has saved literally millions of lives and would save millions more if we could only bring medicalization to the women who don’t have access to it.

            What’s wrong with medicalization beyond decreasing the employment opportunities for midwives since they don’t know how to provide it?

            Miwives have existed since the beginning of time and childbirth has been deadly since the beginning of time. Death rates of mothers and babies fell precipitously once we began to medicalize birth.

          • Rob C

            I’m sorry Amy, but comparing the mortality rates of the USA to countries where midwife led care is the norm would more than suggest otherwise.

          • Amy Tuteur, MD

            Really? Do tell. Which countries that don’t have liberal access to obstetricians have low mortality rates? Is there even a single one?

          • Rob C

            Liberal access to obs and obs led care are not the same. It’s like comparing apples to oranges.

          • Amy Tuteur, MD

            Not the same as what?

            A system that medicalizes childbirth is one that has liberal access to obstetricians and interventions. Midwives are great as obsterician extenders, but they don’t save any lives. Obstetricians are the ones who do that.

            Moreover, like most midwives and midwifery students, you are woefully ignorant of mortality rates. The Netherlands, the country that has a midwife led system of care has one of the highest perinatal mortality rates in Western Europe; it is considered a scandal in the Netherlands and the government is working to change the trend. Moreover, Dutch midwives caring for low risk women (home or hospital) have HIGHER perinatal mortality rates than Dutch obstetricians caring for HIGH risk patients.

            Bet they didn’t tell you that in midwifery school, did they? They’ve spent so much time making up lies and repeating them that they probably don’t even know.

          • Rob C

            Wow Amy… you are shockingly misinformed and alarming so!!! Midwives save many lives both in the western world and in the third world!! The UK has sent tons of midwives to Ghana, Sierra Leone and other third world areas and they save lives daily.

            Whats the difference between god and an obstetrician? God knows he isn’t an obstetrician.

          • fiftyfifty1

            Sure, midwives save lives…compared to no care at all. The point is that midwife care doesn’t save any lives compared to OB care. In other words, there do not exist patients that a midwife can save but an OB couldn’t, but there are plenty of patients that an OB can save but a midwife can’t.

            The main thing that midwives do that save lives is constantly screen for the many life-threatening complications of pregnancy and delivery that only an OB can fix and then refer promptly. The other thing they do that can save lives is screen for the subset of life-threatening complications of that have low-tech treatments (e.g. GBS positive/antibiotics) and employ these life-saving treatments. It is important to note, however, that even these low-tech treatments were invented, tested and implemented by doctors, not midwives.

          • Rob C

            I’m frowning upon the OBS led model of midwifery care in the USA, not frowning upon Obs themselves, or saying that they are not needed. They save many lives and should be the backup to a midwife led care model… such as the UK and NZ. This of course is my humble opinion.

          • fiftyfifty1

            So why are you frowning on an OB-led system of care? Cost, I suppose. Well that is true. Physician-extenders do cost less than physicians. In my opinion, there does need to be a compromise between ideal care (OBs for all) and cost. The best compromise, in my opinion, is one that makes excellent use of well-trained physician extenders e.g. midwives, but that is *led by the individuals with the most training* e.g. OBs. The problem as it stands in the UK is that care is being led by individuals with less than full training, e.g. midwives, and that the system is set up in such a way that they have perverse incentives at times not to refer. This is penny wise, pound foolish planning.

          • Rob C

            So, what is wrong with a case-loading midwife led model of care such as New Zealand… or even the model used in the UK? Most countries envy the systems in use in both these countries.

          • fiftyfifty1

            I have no problem with extensive use of midwives provided that:
            1. midwives are properly trained
            2. midwives are not the “gatekeepers” for more advanced care.
            3. the system does not contain incentives for midwives to keep patients rather than refer on.
            4. there are enough OBs
            5. women are not pressured into refusing pain relief so they can remain under midwife care.
            6. midwifery care is evidence based rather than based on an ideology that nature must be best.

          • birthbuddy

            Envy for the NZ system, really? You are delusional.
            Do yourself a favour and check out the HDC website in NZ to see what your NZ midwifery colleagues get up to.
            Envy, I don’t think so. Fear, more likely.

          • Amy Tuteur, MD

            I understand that midwives like midwife led care, but as I pointed out, it’s not necessarily safe for patients. Dutch midwives have higher perinatal mortality rates than Dutch obstetricians. That’s a stunning indictment of midwife led care.

          • Amazed

            Yeah, the glorious UK results. 17 stillbirths a day are something we should all awe at… not!

          • Rob C

            Only if your stillbirth rate is higher! Oh wait…. it is.

          • Young CC Prof

            Oh wait… It isn’t! The stillbirth rate in the UK is substantially HIGHER than the US, as per WHO data.

          • Amazed

            Ours? You think I am American? Earth to Rob C: the world (and this blog, in particular) isn’t populated by Americans and British alone. There’s a place for us, other people… and I’m telling you that the model I’d like to see here certainly isn’t the midwife-led one.

          • SporkParade

            I like the one here. Prenatal care is done by the woman’s gynecologist in low risk cases and by experts in high risk cases. The labor is attended by one of the midwives on call that shift. The midwife can summon the OB on call at the press of a button. Both the midwives and OBs are salaried employees of the hospital and have no financial incentive to provide or deny interventions. Given the horror stories I’ve heard in the UK, if I lived there, I would go for maternal request C-section. There are some sadistic, nature-worshipping midwives there.

          • Amazed

            The system here is a similar one. In fact, at my own birth the midwives caught the problem (the fact that my head wasn’t coming out) early enough to get the doctor with the vacuum, find out that the vacuum was, I kid you not, BROKEN and yes, as you might have gathered, there wasn’t another one anywhere near, so the doc took to work and REPAIRED it. All this in time to pull a baby with a sufficient number of brain cells left. My mom ended up with a broken tooth, though. Still better than the alternative.

          • Rob C

            Well we’ll agree to disagree then. I came here to advocate this model… not wrangle over natural birth, pain relief or anything else. Mum is in charge, it’s her show and she will have and should have what she wants. Medical systems SHOULD support that in home and in hospital. There is nothing wrong with pain relief, it’s the best advancement in medicine… who likes pain?

          • fiftyfifty1

            The US has a lower perinatal death rate than the UK, you know that right?

          • birthbuddy

            Wrong.
            Lift your game, Rob, you are not debating with your NCB colleagues here.

          • Elizabeth A

            What do you think midwifery care looks like the US? Because “the OBS led model of midwifery care” is not something I’ve run across. In particular, midwives in the US who provide homebirth services tend not to have supervising OBs, and professional associations of homebirth midwives have resisted any suggestion that they have professional partnerships with doctors.

          • birthbuddy

            You mean “midwifery care with Obstetric rescue”?
            Sorry, I didn’t sign up for that (yes, I am an Obstetrician- no I don’t play golf).

          • Samantha06

            “midwifery care with Obstetric rescue”

            That is great!!

          • birthbuddy

            Rob, if you ever want to be taken seriously, I would strongly suggest that you don’t use NZ as a model to aspire to.

          • Amy Tuteur, MD

            Really? Please present actual data from scientific papers. Otherwise, it’s just fabricated claims that you heard in midwifery school.

            I’m not holding my breath, Rob, since I know what the data shows even though you do not.

          • Amy Tuteur, MD

            What are midwives mortality rates if obstetricians aren’t there to save their patients’ lives? Hideous, right?

            Technology and interventions save lives; natural childbirth saves no one.

          • Rob C

            So, you hold a low opinion of natural childbirth?
            Obs do save lives, that really wasnt my point. I was simply putting over to you that it’s different in the UK. I can have an opinion without attending midwifery school can’t I?

          • Amy Tuteur, MD

            You are entitled to your own opinion; you aren’t entitled to your own facts. The data show that natural childbirth is not better, safer, healthier or superior in any way for women or babies. Of course, midwives consider it superior for themselves and that’s why they market it so aggressively.

          • Rob C

            Natural childbirth is better…. it is healthier, more empowering, superior and it’s far better for mum and baby. It may not be safer, but thankfully we have skilled midwives and behind those skilled OBS who are there as backup when complications do arise, or to manage high risk cases. I’m not saying it is right in each case, but natural birth should be the aim in each case generally. Now, if you have data to show natural birth is not better for women and babies (that doesn’t bias on interventions, because these get escalated to obs) then I’d like to see it. Breastfeeding is also a very natural thing… it’s only the media and formula companies who battle to make it not – it’s best for mum and baby in most cases (complications aside).

          • Young CC Prof

            Essentially you’re saying natural childbirth is better when nothing goes wrong, which is true but meaningless.

          • fiftyfifty1

            Uncomplicated births have fewer complications than complicated births, can you believe that?!

          • Amy Tuteur, MD

            It’s better? Show me data that shows it’s better.

            Find 5 peer review papers that demonstrate (not merely claim) that it is better in any way.

            You don’t seem to realize, Rob, that you are just recycling natural childbirth propaganda. It’s not true; it’s made up by those whose income depends on natural childbirth.

          • Rob C

            Of course natural childbirth is better generally when it can be done for low risk. Epidurals have risks and even kill people. Other pain-relief methods also have risks too. Maybe c-section is better too? Hey, maybe women will all evolve to have a zip… that would really help right?

          • Amazed

            Even then, Rob, sometimes the zip will malfunction. Fortunately, I believe doctors and CNMs will work on finding a way to ensure an optimal outcome, instead of let these defective women and/or babies die as nature intended.

          • sdsures

            *having visions of a guy’s junk caught in a zipper* Whose bright idea was it to evolve with zippers?

          • Amazed

            Robb’s. He knows it all!

          • The Bofa on the Sofa

            A natural childbirth is better when it is better than the alternative. The alternatives are better when they are better.

            The problem is, the whole reason women are choosing alternatives is because natural childbirth is not acceptable for them. Hence, they are using alternatives because they are better options TO THEM then NCB.

            No one is being forced to have epidurals or c-sections. They are choosing them. Why? Because they CAN!

          • fiftyfifty1

            “Maybe c-section is better too? Hey, maybe women will all evolve to have a zip… that would really help right?”

            Multiple studies do show that C-sections are safer for the fetus. The data indicate that they are slightly more risky for the mother however, and multiple (over 3) CS are without a doubt more risky for women.

          • Rob C

            Oh my gosh… Birth is an important part of the bonding process!! Why do so many Americans dehumanise birth! You’ll want routine csections as a norm next!

          • Kq

            Omigosh, the fact that you think my son’s beautiful, healthy, safe birth is dehumanized.

          • SporkParade

            No, birth really isn’t an important part of the bonding process. Is my husband less bonded to the baby because he didn’t give birth? Are adopted parents less bonded to their children because they weren’t even present for the birth? I know this will sound absolutely shocking, but it is very hard to bond with a tiny critter whose entire skillset consists of involuntary movements, crying, and trying to figure out how to eat while, at the same time, there’s a medical professional stitching up your genitalia.

          • Somewhereinthemiddle

            Hahaha! You are so full of shit. LOL!

          • Somewhereinthemiddle

            So, check it. I had a c-section, a medicated vaginal birth, and an unmedicated waterbirth. Are my births only partially dehumanized or are we all hopeless? Should I show you a picture of my three children and you take a stab at which one was born which way? Perhaps we should psychologically profile them to see which one of the suffered the ill effects of having their births “dehumanized”?

            You know what is dehumanizing? You coming on here, assuming you know what American women prefer, patronizing and belittling women who desire anything other than what you consider to be ideal, telling us all what would be best regarding *our* medical care, and pushing an agenda without any actual information supporting your claims. I don’t fucking think so. You probably think you are enlightened and “supporting women” or some such nonsense. It’s LAUGHABLE and you can shove your self righteous assumptions and opinions up your ass.

          • Samantha06

            Good one!!!

          • Ash

            Up the ass seems accurate. Rob C , sadly, could not share in the same pain as a woman in labor, so in the spirit of “pain shared is pain halved” as well as the necessity of pain for parental bonding and empowerment, rectal stretching seems like a great idea.

            Rob C could have a baby with a woman, and during labor, attach himself to electrodes, and go to town! Actually, some men in China and the Netherlands have tried this (you can see the videos online). They had electrodes attached to their abdomens to simulate labor contractions.

            As one participant reported, ” He described the treatment as creating a three-part sensation: hot steel balls dropping on his stomach and then a hook being gouged into him, followed by the ripping of his innards.”

            Unfortunately, men have no equivalent for a vagina for the so called “ring of fire.” As a poor substitute, rectal stretching would be an option.
            Fortunately, none of these proposed methods involve drugs, and can allow men and women to have an empowering birth experience–doubly so, since both are involved!

          • Samantha06

            Or he could try pooping a cactus out his ass.. it might be somewhat of a similar experience…

          • sdsures

            Nobody expects the Spanish Inquisition!

          • Kq

            *standing ovation*

          • Somewhereinthemiddle

            Thank you ma’am. *Curtsies* I am having a Julia Sugarbaker moment. 😉

          • wookie130

            I think this may be in the “Top 10 Comments of 2014”!!!

          • Dr Kitty

            Rob, my goodness, you mean you haven’t bonded properly with your own children because you didn’t personally push them out of your vagina? I’m so sorry for you.

            I mean…if a woman can’t properly bond because of a CS, there must be NO hope for fathers, parents who use surrogates, adoptive parents, people who aren’t in the delivery room when their child is born, step parents, non-biological parents in same sex relationships…

            You realise how offensive your statement is?

          • sdsures

            He probably doesn’t.

          • Sarah

            I would go for dimwitted above offensive, personally. The stupidity is bright and shining.

          • fiftyfifty1

            So are you saying that C-sections cause poor bonding? Citation please.

          • Samantha06

            You remind me of a father who wouldn’t “allow” his wife to have an epidural, in spite of the fact that she was screaming and begging for one. Her doctor was so incensed that he left the room and returned with a pair of towel clips, held them right up to the father’s face and said, “How about we clamp these to your balls every two minutes and see how long you last”. And since you have no medical education, let me explain what towel clips are. They are surgical instruments that look like crab claws… get the picture Rob?

          • An Actual Attorney

            I will assure you that every single woman who gives birth within the US, whether she is American or not, gives birth to a human.

            Occasionally, the Actual Kid to whom I gave birth acts like a complete monster, but I don’t think that has anything to do with how the birth went.

          • demodocus’ spouse

            Bond? No, I did not bond with my child through labor. Or pregnancy. Or breastfeeding. I don’t know about you but I’m not able to bond with someone who is hurting me (albeit innocently and without ability to do otherwise). My child had to wait until I could just hold him, sleepy, warm, and trusting, in my arms for me to fall in love with him.

          • Siri

            So in other words, as a man, if you have kids you’ve never managed to bond with them. I feel so sorry for them and you! No wonder you’re so bitter.

          • Dr Kitty

            I wonder if Rob is a father, or if he is an expectant father who has been doing some research to support his partner. Or if his partner, mother or sisters are midwives.

            Because he talks the talk, but I’m not at all convinced he’s actually held the hand of the love of his life while she screamed in pain, for hours, still convinced it was “better” for her.

            IME, most men are VERY supportive of epidurals, once they see the difference it makes to their partner. Few fathers actually enjoy the experience of NCB, because it means that they have to watch someone they love suffer, for hours, with little they can do to help.

          • Joy

            Italy has a higher c-section rate than the US. I often notice how people comment on how Italian mothers aren’t bonded to their children. It is just known as a cold, non-family oriented society.

          • MLE

            Maybe this explains that one Italian “family” that’s always getting into trouble.

          • Sue

            TOuche’! Joy wins the thread!

          • sdsures

            For some mothers, planned c-sections are the only option.

          • wookie130

            I think he may be on to something with his zipper idea. I would love that, personally. It would basically eliminate this whole issue entirely. LOL!

          • Ash

            @robcollyer:disqus , you have an excellent point. Pain is only pain, the acute pain of active labor does end. It saves money and risks of analgesia, so let’s just stop providing it. People don’t die from acute pain. It’s fine. Women, and only women, have endured this pain for centuries, right?

            Now, next time you get a colonoscopy, I really recommend you skip the sedation. It’s risky–people have died from it. The discomfort and embarassment lasts for way less time than active labor, so it should be all right.

            Maybe you know someone with sickle cell anemia? People with sickle cell anemia sometimes have acute pain attacks. It is transient. The narcotics they use have real risks–someone can overdose or become addicted to narcotics. But that’s all right, it’s temporary and it’ll all be over soon.

          • sdsures

            To say nothing of chronic pain.

          • Cobalt

            “Natural” childbirth is only “better” if it occurs in the absence of need for intervention. In any other circumstance it can be anywhere from traumatic to deadly.

            And pain that bothers the mother constitutes a NEED for intervention.

          • Dr Kitty

            One last thing Rob…
            PTSD, PTSS, PPD, all are more likely in women who have unmanaged or poorly managed labour pain or a traumatic labour.

            People die from PPD…some of them even take their children with them.

            So, logically, natural childbirth has killed someone who wouldn’t have suffered from PPD if her pain had been better treated. Based on sheer numbers affected, it is bound to have happened.

          • FormerPhysicist

            In other breaking news, not having medical problems is better than having them. The best way to heal a broken arm is not to break it in the first place.

            “When it can be done for low risk”. Hint, not even then. I take pain killers when I get a headache, and I want pain relief for childbirth.

          • wookie130

            Still waiting for you to actually back up your drunken Kool-Aid claims. And who has been killed by having an epidural? As a DIRECT RESULT of having an epidural, without other health issues that perhaps contributed to the said-person’s demise…I’m tapping my toe, waiting.

            I am one of your Americans who had a “dehumanizing” elective c-section. Oh, wait. I actually had 2 of them…17 months apart. And you know what? I FREAKIN’ LOVED THEM. I was delighted to skip the whole vagina thing, and have my babies lifted from the sunroof. Who are YOU to tell ME what is better for me? Both of my children, who are now 21 months, and 4 months of age, had no trouble bonding with me…and to add insult to injury, they’re both FORMULA FED (well, not the almost two year-old…she is now weaned, and eats real food)!!! THE HORROR!!!!!!!!!!!!!!! One day, I’m sure they’ll both look me in the eye, and say, “Mother, how DARE you choose to bypass vaginal birth, and feed me formula??? I’m so psychologically SCARRED!!!” Oh wait…that probably NEVER happen, because it doesn’t matter any more to them than the man on the moon.

          • Sue

            hey, maybe Rob C will evolve…(we can only hope)

          • fiftyfifty1

            “Healthier”– How can it be healthier if it is not safer?

            “More empowering”– How can bullying women into an intervention-free birth when they don’t want that be empowering? The vast majority of women WANT epidurals and are very happy with them.

            “Superior”– In what way?

            “Far better for mum and baby” —How so?

          • Rob C

            Most people want them? Haha… only in America 😉 I blame the media for that. Most people in the USA believe giving birth means lying down on their back in a hospital… that is simply wrong and not the way. Media and medicalised models have not helped. We’re coming at this from entirely different models of midwifery from two entirely separate countries but I know which I’d prefer to give birth in (if I were a woman of course).

          • Young CC Prof

            “Wanting epidurals is stupid!”

            Says Rob, secure in the knowledge that he will never give birth.

          • sdsures

            For any medical condition, in the literature, is there ever a case in which a male patient has had an epidural?

          • Amy M

            Yes. My mom (though not a male) had an epidural for knee surgery. I am sure that males having the same type of knee surgery are also offered epidurals for pain management.

            And though my mom had the epidural (and this was just a few years ago, she was around 58?ish), she was still able to bond with me. And she didn’t go out and seek street drugs. Maybe that was because she couldn’t walk really well for a while after the surgery, but for whatever reason, she managed to avoid drug addiction. Just in case Penny Simkin is conferring with Rob here.

          • The Bofa on the Sofa

            hey Rob, as a guy, it’s really hard for me to proclaim what I’d do as a woman.

            However, one thing I know. Childbirth was recognized 3000 years ago as being so painful that it was attributed to being a punishment from God. There is nothing that we, as guys, ever face that has been characterized that way, so I don’t think I really have the perspective to tell women what they should or should not be feeling during childbirth, nor how they should deal with it.

          • sdsures

            See my video response to Rob above.

          • fiftyfifty1

            “Most people want them? Haha… only in America”

            Not at all. Wherever epidurals are freely available, women choose them in overwhelmingly large numbers. Sure, many women say they plan to give birth all natural because of societal pressure to do so and propaganda that says that labor pain is nothing more than “intense rushes”, but once they experience the severe pain of labor, they realize that they have been fed nonsense, and request the epidural. Of course you, as a man, are in no danger of having to eat your words about choosing an all-natural birth, so keep right on with your assertions of why silly women are choosing what they are.

          • Amazed

            I blame your idiotic chuckle on the fact that you have a pendant down there and not a childbearing organ, so kindly shut up, will you? In exchange, I promise I won’t tell you how it’s all in your mind when someone kicks you down there, despite genuinely believing that it’s the mass culture of catering to macho pride that made men hysterical over such a minor thing as a kick between the legs.

            Deal?

          • SporkParade

            Okay, I’m not located in America. I did not give birth in America. My labor was attended by a midwife, as is the default here, and I had taken a natural childbirth course. Labor was absolute HELL until I got my epidural. I was crying for drugs by the time I was only 2 cm dilated, and I nearly vomited from the contractions several times before they would admit me to the delivery room. Once I had the epidural, the rest of the 1st stage of labor was serene and peaceful.

            By the way, my husband’s grandmother (gave birth in a different non-American country; doesn’t even speak English) was so traumatized by her unmedicated vaginal birth that she refused to have any more children. There was no effective birth control available in her home country. You can guess for yourself how she managed not to have more children.

          • Kq

            Right. Us stupid American women, brainwashed into wanting safe and effective relief from pain so epic it was considered punishment from god.

          • Samantha06

            Ah but you’re not a woman, are you? And you aren’t even a medical professional. So what gives you the right to spout off on what is “best, healthier, empowering or safe” for women’s healthcare? Come on, Rob, tell us. We’re anxiously awaiting your response…

          • Dr Kitty

            He’s a man.
            Therefore his opinion matters.
            Because he’s a MAN.
            LISTEN TO HIM LADIES.

            No, really, do yourself a favour and don’t.

          • Something From Nothing

            Here’s my wish for you, rob. I envision a good size kidney stone making its way down your urerter. It’s going to hurt like a son of a bitch on its way out, but don’t worry, once you pass it , the pain will go away. When those evil nurse offer you drugs, you stand strong and refuse. Be a man, and pass that stone naturally. Then come back and I’ll listen to your utter bullshit.

          • PrimaryCareDoc

            Yes! Rob, it’s much more empowering to pass a stone without pain relief.

            You’ll be so much better for it. Trust me. I’ve never had kidney stone, but I know. I just KNOW.

          • Sarah

            Also he needs someone to tell him what he should be doing with his nipples right afterwards as well.

          • sdsures

            Before or after the baby grows teeth?

          • Sarah

            Both. Don’t be a weaner.

          • Linden

            I’m in the UK. I asked for an epidural and got it. It was great. I could talk to my midwife and ob and discuss my medical care, instead of screaming and hyperventilating. That was empowering.

            Pain isn’t any different depending on country. What a loathsome person you are, that you would ignore a woman’s pain for you ncb dogma. I’m so happy none of my UK midwives shared your opinions.

          • Joy

            Ha ha. I’m in the UK as well. Almost every woman I have spoken to since wishes they had access to more pain relief. And guess what, most women in the US don’t think that labour means lying on your back. Although most UK people seem to think they do because they watch a lot of US shows.

          • sdsures

            How Men React to Labor Pain https://www.youtube.com/watch?v=qtR_-MINR1o

          • wookie130

            Hahaha! I’ve always loved this!

          • anotheramy

            I’m genuinely curious how u became interested in NCB, especially interested enough to come to this blog to argue the point. Most men I’m aware of leave the decision of pain meds up to their wife and don’t feel strongly about the medical model of care vs a more natural model.

          • Rob C

            A normal vaginal birth with or without pain relief is natural in my book. What I don’t see as natural is when a countries health systems limit the options available to women. Homebirth, elective c-sections, epidural, proper breastfeeding support, follow up post-natal care to name but a few things that all countries should make readily available to all women. Proper unbiased information with pro’s and con’s should ensure that women are accurately and reliably informed about the choices open to them. Women should be encouraged and supported to arrive at a birth plan they are happy with and health systems should not restrict their choices only to hospital. Health systems (and their staff) should support women regardless of their choices and not make them feel inferior regardless of their choice – some media and organisations do this pretty well which is bad enough.

            For the record, I am not anti-homebirth or anti-hospital birth – but I do subscribe to the fact a midwifery led team can lead to better outcomes… if women want pain relief, or even if they don’t then either is normal if it feels right to them.

          • birthbuddy

            I am anti-bullshit, Rob.
            Do yourself a favour and google Lisa Barret and the South Australian coroner.
            She was a UK midwife who took the NCB crap to its logical conclusion.
            What a role model.

          • Dr Kitty

            Nice flip flop Rob…

            You do know we can still read your original comments though?

            Particularly the ones in which you describe CS as dehumanising, detrimental to bonding and a bad idea all round, and a desire for epidurals as being misinformed…

            “Oh my gosh… Birth is an important part of the bonding process!! Why do so many Americans dehumanise birth! You’ll want routine csections as a norm next!”

            How exactly does that square with “elective c-sections, epidural… to name but a few things that all countries should make readily available to all women.”

            Yes Rob, those are direct quotes.

          • Rob C

            Peddling them as “normal”, without risk and even promoting elective CS’s I think is wrong. The way in which some TV and media portray birth I suspect is accountable for much tokophobia. Normalising elective cs (and to some extent epidurals) in the minds of the public just doesn’t feel right to me. I never said that CS was dehumanising… that would be you twisting my words which fittingly iconifies my entire experience on this website.

          • Anj Fabian

            Tokophobia is quite rational IMO.

            A woman facing what might be the most physically painful and exhausting experience she will know, with a significant chance of injury and the ever present risk of death?

            Being afraid of that is a logical response. Knowing that you have no control over what could be a lengthy process doesn’t help.

          • Dr Kitty

            Rob, why don’t you explain exactly what you meant?

            I directly quoted you. “Americans dehumanise birth”, according to you. If you DON’T mean that epidurals, CS are dehumanising, what exactly do you mean?

            Obviously, you think natural, unmedicated childbirth isn’t de-humanising, so you see, we are left to assume that you think it is the interventions that are dehumanising. If I mistook your intent, correct me. You’ve had plenty of opportunity to do so and as yet you haven’t clarified exactly what you meant.

            What is it that “Americans” are doing that is dehumanising? How are they doing it?

            Rob, an elective CS is only marginally riskier for a woman than a normal childbirth, and safer for her baby. It is more than possible over the next few years that they will become equivalent in terms of safety. Certainly NICE sees no reason why a woman who wants a CS can’t have one…

            “Normalising” CS and epidurals feels exactly right to me, if the alternative is denying access, lying to overstate the risks or shaming women who want or need epidurals or CS, which is what we have seen happening.
            Homebirth is much more likely to end in a dead baby than an elective CS, yet you see no problem “normalising” that.

            Anyway…weren’t you leaving?

          • Poogles

            “Peddling them as “normal”, without risk and even promoting elective CS’s I think is wrong.”

            Along the same lines, do you feel that peddling non-intervention vaginal birth as “healthier, more empowering, superior and far better for mum and baby,” without risk and even promoting elective pain (forgoing pain relief) is wrong?

          • moto_librarian

            Oh, just fuck off. Normalizing epidurals is problematic? Do you subscribe to the belief that women should suffer during childbirth for the sins of Eve? Epidurals are one of the greatest advances of modern medicine.

            And since you’re bashing on elective c-sections, tell me this: Do you routinely experience urine and bowel leakage due to pelvic floor problems? Have you ever experienced anal prolapse? Because these are things that happen to women as a direct result of vaginal birth.

          • sdsures

            I have urine and bowel leakage due to pelvic floor problems, I’m female and haven’t had kids yet. It’s soooo not fun. :'(

          • moto_librarian

            You have my deepest sympathies! I have done a stint in physiotherapy for the same thing, but mine was definitely caused by childbirth.

          • sdsures

            My doctor gave me some medication for the urinary problems, and a small diet change fixed up the rest of it: I now drink goat milk instead of cow milk. I still have the occasional accident, but far less often than before.

          • GiddyUpGo123

            Yep, that’s why I had two elective c-sections (previous 4th degree tearing). And I have occasional adhesion pain because of those c-sections but you know what, I’ll take that every day over not being able to hold my poop in public, thank you very much.

          • fiftyfifty1

            You claim that all you want is for women to have all the facts and then freedom to make up their own minds. But when I posted the simple fact that research shows that CS is safer for baby, but more risky for mom, you went into a fit and replied:

            “”Oh my gosh… Birth is an important part of the bonding process!! Why do so many Americans dehumanise birth! You’ll want routine csections as a norm next!””

            So basically, you want women to have all the facts, but you only want them to choose what you like to believe you would choose.

          • Sarah

            Nobody was ever scared of childbirth before the invention of TV. Fact.

          • lilin

            “that would be you twisting my words which fittingly iconifies my entire experience on this website.”

            Yeah. We’re so mean. We demand you tell us *why* natural childbirth is “superior” and “healthier” and “more empowering” despite not being “safer.” We demand you back your claims with actual studies, not your opinions. What awful, awful people we are, telling you that you need to figure out why something is superior before telling all women that it is and that they’re not empowered if they do something other than what you want them to do.

          • demodocus’ spouse

            What tv are you watching that has a lot of elective cs? Those don’t make good drama. A marine giving birth in the back of a car at a closed convenience store with only another marine to help her while their friend kills the assassins out to kill the pregnant marine and her baby is dramatic. Okay, that one was melodramatic.

          • Sue

            “iconifies”?

            You are made into an idol? I think NOT!

          • wookie130

            “but I do subscribe to the fact a midwifery led team can lead to better outcomes…” And, we are all still waiting for you to provide some real data, and some REAL facts that support why you’d support this theory.

          • lilin

            “A normal vaginal birth with or without pain relief is natural in my book.”

            It’s natural in my book, too. So what? Why is natural something to strive for? You’re typing on a computer – is that natural?

            “Health systems (and their staff) should support women regardless of their choices and not make them feel inferior regardless of their choice”

            How about you start that support by not telling women that natural birth is better and healthier and more empowering because you say so.

          • sdsures

            “A normal vaginal birth with or without pain relief is natural in my book.”

            So is polio. Should we stop vaccinating people?

          • Sarah

            Probably…

          • Sue

            Rob C – I guess you know that prostatic enlargement is fairly common with age in many men, and occurs naturally.

            If you ever get urinary obstruction from your benign enlarged prostate, which is not a disease, would you like any ”intervention”?

          • wookie130

            So, on that same basis, if you were to break your leg, or have a rectal prolapse, or shatter some ribs, you wouldn’t want pain medication…right? Because women really WANT to experience the suffering, and agony of delivering babies without pain meds…according to YOU. A man. Misogynistic much?

          • Amazed

            Natural childbirth is not safer but better anyway? Rob C, you seem to have come to the wrong blong. You’ll make great friends with Janet “My c-section was traumatic, my dead homebirthed baby was not” Fraser.

            You see, here we’re generally on the mind that a birth ending up with someone dead or disabled in any way is not better. From regular commenters to OBs, CNMs, doulas, lactation consultants, NICU nurses, loss mothers, mothers of children with lifelong birth injuries and mothers who were injured themselves during birth, we do believe it.

            ETA: In fact, we have former homebirth mothers here whose homebirths turned out just fine. Then, they discovered that homebirth was not safer, as they had been promised. Guess what? They decided homebirth was no better than, either. Hence, former homebirth mothers.

          • Dr Kitty

            Rob, when it is your uterus and pelvic floor and you suffering hours of pain, you get to make the call about what is “better” and “more empowering”, ok?

          • PrimaryCareDoc

            There was nothing, absolutely nothing that was “empowering” about labor pain for me. It was the opposite of empowering. Literally dropping to my knees ever 2 minutes, puking my guts up, amniotic fluid gushing out of me…it was one of the most out of control unempowering experiences of my life.

            You know what was empowering? Asking for an epidural and getting it.

            Piss off, Rob. When you grow a uterus and experience labor pains, then you can have an opinion on this.

          • birthbuddy

            Wow, Rob, your brain has been well and truly pickled in the Kool-Aid, hasn’t it?
            You keep regurgitating the same old NCB drivel without fail.
            If your UK NCB focus was so fantastic why are there so many reports of preventable disasters under their care?

          • moto_librarian

            No, no it is NOT “healthier, more empowering, super and far better for mum and baby.” I never felt more disempowered in my life than when I was giving birth “naturally.” The pain of pushing was an indescribable agony. I just wanted it to be over. This was with the support of a fabulous nurse-midwife and L&D nurse who urged me to push in different positions, drink between contractions, and only have intermittent EFM. It was still horrible because for the vast majority of women, labor is excruciatingly painful. You are lying when you claim that it is better in any way. Because I was unable to control my pushing, I suffered a cervical laceration, 2nd degree tear, and massive pph that almost resulted in a blood transfusion. My midwife called for help immediately, but I still had to endure the manual examination of my uterus without pain medication. Once I finally received from fentanyl, the worst was over and I was wheeled back to the OR so the attending OB could repair my cervix. He did a good job – I was able to carry a second child to term without any problems – but my recovery was long and painful. We almost didn’t have a second child because the birth experience was so terrifying and awful.

          • sdsures

            Is having a kidney stone roughly the same level of pain for both sexes?

          • moto_librarian

            I’m not sure, sdures. My mother had two unmedicated labors and several bouts of kidney stones. She said the pain was comparable.

          • sdsures

            I’ve only had a kidney stone once. I hope it never happens again.

          • sdsures

            Have a uterus and then come back and tell us how much better a lack of pain relief is.

          • anotheramy

            I’m glad someone called u out on you saying “it’s healthier”then later saying it’s not safer. That makes no sense.
            I just wanted to share my anedote: I had one natural childbirth in the hospital and it was great: not too painful, fast, and I would describe it as empowering, thanks to the endorphins. My second attempt at natural childbirth (3rd birth) was horrible, despite having an identical birth plan, preparing the same way, having a doula both times, having minimal “interventions” both times. I was in pain even b/w contractions and it was a much longer labor. I kept thinking “when are the fuckin’ endorphins gonna kick in?!” And “I hate this!”. Nothing me, my doula, or my husband did helped. I felt “empowered” only after I got the epi (and baby was born a half hour after I got the epi.)
            I’ve come to the conclusion NCB doesn’t MAKE labors easier or better or more empowering, but labors that are easier/ less complicated, there’s less NEED for pain meds or other “interventions”.
            There’s so much luck involved that I resent the idea that if you do things a certain way, you’ll have a better, more empowering, easier birth experience. In my case, that was complete BS.

          • lilin

            “Natural childbirth is better…. it is healthier, more empowering, superior and it’s far better for mum and baby. It may not be safer”

            What are you even talking about? It’s “healthier” but not “safer”? It’s “superior” but not “safer”?

            Why is it “superior”? Why is it “more empowering”? Do you even know? Or are you just empoweringly repeating the superior words that the healthier people said to you?

            “but natural birth should be the aim in each case generally”

            That doesn’t hold together as a sentence. “In each case generally.”

            You’re showing to me that people studying midwifery sometimes can’t even organize a thought, let alone a logical argument. I’d never entrust my health to you.

          • Amy M

            You’ve wrecked your own argument: how can it be better if it is not safer? What metric are you using? For most women the ideal outcome of childbirth is a healthy child and a healthy mother, with all their brain cells intact. Health for the mother includes mental health, not just physical.

            If interventions are reduced, morbidity and mortality increase. You said yourself that natural childbirth is less safe. How is that better? Why should it be the aim? Do you get points for every patient of yours that declines interventions? Do you get paid more if the patient delivers naturally? I can only imagine that the patient is concerned about the outcome first and foremost—you seem concerned about the process. What difference does it make to you if the patient NEEDS or WANTS (in the case of pain relief) some kind of medical intervention?

          • Young CC Prof

            A properly trained midwife with some basic supplies is better than nothing.

            A midwife with the support of an ultrasound technician, phlebotomist, full analysis laboratory, obstetrician, anesthesiologist, proper surgical suite, and anything else found in a modern hospital? Now you’re talking.

            To get first-world results, you need the whole first-world package.

          • Rob C

            I fully agree!! I just subscribe to this all being midwife led – they are fully trained practitioners here in the UK and the doctors and obs largely let them get on with things…. when they need multidisciplinary support they shout for that… they know their job well. I know the UK is really different to the USA and acknowledge that.

          • Young CC Prof

            Why do you want to change to a midwife-led system? What improvements do you expect to see? A reduction in interventions isn’t much of a goal, and I see no reason to think outcomes would improve.

          • Rob C
          • Young CC Prof

            That study does not mean what you think it means. It’s been frequently quoted as proving midwives are “better,” but what it actually demonstrates is the value of continuity of care, with a single provider taking primary responsibility for each patient from early pregnancy through the postpartum period.

          • Something From Nothing

            Great that your examples of midwives saving lives are in places where it’s them or nothing. excellent example. In say, Canada, midwives babysit low risk maternity patients, and when the shit hits the fan, or when their patients need pain relief, or when the midwife doesn’t know what to do, what happens? They call an obstetrician, who fixes it. That’s right, because an obstetrician has the skills and the training to do so, unlike a midwife. In my hospital, our midwives take care of vbacs. So when a rupture happens, what does the midwive do? I know, nothing. Nothing, that is, except call the obstetrician to come and make it all ok, because that is what we do! I’m so tired of people vilifying obstetricians as horrible people when we actually sacrifice a good portion of our own lives in order to better the lives of the women we care for. You joke is incredibly insulting. And you are ignorant.

          • Sue

            Rob C – do you put in your resume’ that you are a ”good team player”?

          • moto_librarian

            Have you ever looked at the population demographics of the United States vs those in the UK? Are you so dense that you can’t grasp the fact that women in the United States are, as a population, generally heavier, older, and more likely to have preexisting health conditions that used to preclude carrying a pregnancy to term? Cardiac problems are a leading cause of maternal mortality in the States. How would midwifery-led care help with that?

          • The Computer Ate My Nym

            Overall mortality rates can be quite misleading. There are a number of known confounders from differences in whether a 20 week GA fetus is considered a miscarriage or infant mortality case to the genetic makeup of people in the US versus Europe. A better comparison would be survival for babies born at similar GA and with similar risk factors born in the midwifery model versus the OB model. The data there are quite clear, as Dr. Tuteur’s posts on the Netherlands demonstrate.

          • Something From Nothing

            Rob, in all seriousness, do you actually stand by that statement? In areas of the world where there is limited access to medical assistance, do you have any clue what the wastage is in terms of human life, from childbirth? It most certainly is a condition that requires doctor intervention, if the outcome you desire is a live baby and mother. We provide this medical assistance to dogs having litters, and without it, many would die. Do you value the health and the lives of the women in your life? How can you make such a daft statement? Oh, wait, I know, you will NEVER have to push a baby out of your vagina, that’s how.

          • Box of Salt

            Rob C “A labouring mother is not a patient.”

            Wrong.

            That’s all that needs to be said.

            The mother of your children deserves your respect and compassion. The survival of your species depends on that.

            Your comment has neither.

          • Rob C

            Midwives in the UK do not generally refer to women as patients… that suggests they have something wrong with them and pregnancy is not an illness or ailment. The UK refers to women as service users, clients or informally ladies.

          • Dr Kitty

            And psychiatric patients are “service users” too.
            Semantics, Rob, semantics.

          • Life Tip

            What is wrong with the term “patient”? When I take my kids for their well child check ups, should I complain that I have to wait in a room with a sign that says “Patient Waiting Room”? They aren’t sick, but they are still the doctor’s patients. He is monitoring their health and is responsible for providing medical care if something goes wrong.

            If my OB referred to me as a “lady” I would be weirded out.

          • Joy

            Because our little lady brains would be too confused! The same reason I was told they don’t give out gowns in the UK to women in labour. Because it puts them in the wrong mindset. The only mindset I had was not wanting to do any laundry after giving birth.

          • Siri

            The vast majority of UK women prefer to bring a t-shirt or nightie to labour in; the very few that don’t are certainly very welcome to have any number of gowns.

          • Mishimoo

            Same over here in Australia. I took my comfy nighties in with me because they were soft and lovely. They also made the CNMs giggle because of the prints on the front – one had ‘Wild Child’ (teddy bear), the next had ‘I like to moooove it’, and the third had ‘Shake it, baby!’ (dancing cows for both). For the second, I ended up in a surprisingly comfy hospital gown because I wasn’t quick enough with the emesis bag. The third, I didn’t feel like getting changed into my nightie and wore my Betty Boop pajama top and a sheet. Honestly, no one cares as long as the mum is comfortable.

          • Joy

            Really? That’s not what I was told. I also slept on bloody sheets for three days before anyone actually got back to me and told me where to get new ones.

        • Susan

          A retired OB who is interested in these issues and willing to dig into the natural birth claims one by one is very threatening. She has the education and experience that gives her the excellent BS detection skills you find so threatening and worse, because she isn’t currently practicing she has the time to be intimately familiar with the research, the issues and she has the time and interest as well to engage with others interested in the issues. What is also unfathomable to people who start with a premise and then search for evidence to support it is that Dr amy will cite things that appear to be against her “agenda” because really, her agenda is just that women have accurate information and are not shamed to feel bad about things that really don’t matter that much anyway.

    • wookie130

      “Polarised birth culture”…*smacks myself in the forehead.* I don’t know why, but this phrase just sort of left a rather acidic pukey taste in my mouth.

    • Joy

      Idk. Lots of women in my area are concerned given that our hospital closes on average every three days because there isn’t enough room. My one friend was turned away from two local hospitals and had to go to a third over 45 minutes drive away. And lots of the women in my baby group felt they didn’t get good care at the birth, but what is the point of complaining? And there are plenty of hospitals that have bad reputations and deserve them. Furness General for one.

    • Sarah

      Speak for yourself. Breastfeeding support is of no interest to this pregnant British woman, where and how I have my baby is.

  • Amazed

    One of my top posts was the one when I went down on my knees to worship at the altar of Dr Amy, Birth Goddess. Pity that the NCBer infidels didn’t recognize you, Your Goddessness.

  • KarenJJ

    OT (but is it ever OT?):
    New mums and poor mental health. It is my opinion that we are increasingly treating new mums appallingly. Lack of sleep, increasing expectations over breastfeeding/bonding and telling women that we should be coping with circumstances that women in the past didn’t cope with (pumping through the night etc etc). We set women up to fail from the start and then tell them they are bad mums and that their children will suffer when they “fail”.

    Psychologically it is very distressing to be made to feel like a failure of a mum before you’ve found some confidence in what you are doing with your baby. And for what reasons? What are meant to be the expected improvements – especially in a well-off country like ours? We’re destroying a mum’s confidence in her ability to care for a new baby for miniscule benefits – whether it’s “normal birth”, “exclusive breastfeeding” or “attachment” – what was the problem that all this policy and handwringing was meant to solve?

    https://au.news.yahoo.com/thewest/lifestyle/a/25857632/worry-over-troubled-new-mums/

    • fiftyfifty1

      “what was the problem that all this policy and handwringing was meant to solve”

      That’s it exactly. It’s a draconian solution for a non-existent problem. In the end it’s nothing more than a hazing process to separate the in-group from the out-group and win status points. All dressed up in “concern” for the baby’s health.

  • Courtney84

    It’s not from this year, but my favorite this year was the Ode to C-section mothers. My fabulously wonderful little boy will celebrate his first birthday this weekend. He was born by c-section, and that’s not important. His birthday was one day. It was long and mostly unpleasant. I’ve had 363 days of joy as his mother, and expect that there are many years ahead of us.

    • Box of Salt

      Courtney84,
      you beat me to it.

    • sdsures

      Ah, the old escape-hatchday! 😉 Happy birthday, kiddo!

  • sdsures

    I love #4. 😀

  • SporkParade

    I’m not sure if it was this year, and I can’t find it using the search, but, if I remember correctly, there was an article where Dr. Amy proposed “There’s no need to suffer” as a mantra. That mantra got me through labor. Of course, my mantra until they would admit me to the labor room so I could get my epidural was, “I want drugs! Why won’t they give me drugs? 🙁 🙁 :(“

  • Bugsy

    I will have to check some of these out, thanks for including all of the links. My favourite was the toxicophobia post from a few months ago.

    Merry Christmas, Dr. Amy and fellow posters!

  • Thank you for all of these and the effort that went into the hundreds of other posts in the past year!

  • Mishimoo

    There was a Christmas miracle over here – I merely sat and laughed instead of saying “This is what science is for!” while watching my best friend’s family try to deal with a completely natural spider without nasty chemicals (because they have a chemical-free household).

    • Trixie

      Why would you need chemicals to deal with a spider? I don’t understand.

      • fiftyfifty1

        A gin and tonic for afterwards?

        • Trixie

          I’m not trying to sancti-spider anyone, but I really don’t get the big deal about spiders. Unless it’s a brown recluse or something (extremely rare), just relocate it outside. Spiders are our friends.

          • MLE

            Have you ever put on your slippers only to find a palm-sized wolf spider residing in one? If you had, you might be singing a different tune.

          • fiftyfifty1

            One Christmas my sister received an antique baby doll in an antique high chair from our grandma. She set it up in her room and within a few weeks the hollow head was taken over by a huge wolf spider that used it as its lair. It used the baby’s mouth as its door, and when you would walk in the room it would scramble across the baby’s face and dart back in. But then if you sat quietly it would creep back to the mouth and sit half out watching you with its many thick black legs hanging down onto the baby’s chin.

          • Siri

            Thank you so very much for that! I read your comment aloud to my mother, daughter and stepson. The (very large) bill for our therapy is in the mail.

          • Trixie

            That’s hilarious.

          • EastCoaster

            Sweet baby Jesus that is horrifying. HORRIFYING.

          • MLE

            I saw this comment in the sidebar and was 100% positive that it was about the doll spider.

          • Samantha06

            OH that is so gross!!!!!!!!

          • Somewhereinthemiddle

            OMFG, that’s crazy! I am not all that afraid of spiders but do respect the potential for damage. We get Black Widows in our garden and I make sure to teach the kids to stay clear of them. They like to live under our watermelons in the summer.

          • Samantha06

            OMG!!!!!!!!! I would probably have a heart attack!!!!!!!!!

          • Siri

            I know they are, and I approve of them in principle, but why do they have to look so horrid?

          • sdsures

            Maybe they think we look horrid!

          • Siri

            Good point. I’ll try sitting inside a spider’s dressing gown sleeve and see if I can make it yelp in horror.

          • Amazed

            Not mine! Spiders ARE a big deal. Cockroaches, not so much. But spiders are HORRIFYING! I hate it when I return after a holiday to find a huge, long-legged spider residing right under my shower. Hate, hate, hate!

          • Trixie

            Just think that it was there for a reason — something even grosser was lurking there and the spider ate it!

          • Mishimoo

            Wolf spiders are the ones that have to go. I’d love to keep them in my garden because they’re pretty awesome, but my dogs try to eat them. Apparently the venom can be fatal to dogs, but when Danny was bitten, it merely gave him a swollen face and a VERY upset stomach.

          • Trixie

            I think our wolf spiders here may not be as toxic. I got a load of wood chips for my garden that must have been full of eggs or babies because soon after I spread it the garden was teeming with them. It took care of my flea beetle problem but I did wear gloves because sticking a finger into one’s nest would be rather painful.

          • Mishimoo

            I was surprised when I heard how dangerous they can be to animals, because they’re relatively harmless to humans as long as you clean the bite well. I’m glad they cleared out the flea beetles for you, and I second the use of gloves. I need to get better at that as I recently managed to deeply embed a rosethorn in the tip of my ring finger. Luckily, I got my rings off before it started to swell, and avoided an infection. (Good thing I’m up to date on my DTaP too)

          • Medwife

            I had the same reaction at first, but now I see Mishimoo is Australian. If she says they needed science to protect themselves from a spider, I choose to believe her.

          • Trixie

            True

          • Who?

            Well it is widely known our country flows with venom and it’s a miracle anyone makes it to adulthood.

          • Sue

            We do also like to exaggerate to scare the tourists, though.

          • Box of Salt

            Trixie “sancti-spider”
            Three words.
            Tolkien.
            Mirkwood.
            She-lob.

            Enough said?

            Actually, I don’t think spiders are that big of a deal, but I can’t abide running into web (including the traveling lines they constant string across my yard).

            I am, however, raising a serious spider-phobe. My husband blames me, for discouraging the tasting of spider webs wiped up with fingers when this child was a toddler. I don’t see how that follows, however, since there weren’t any actually spiders around when when the webs were tasted.

            My younger child did not acquire the phobia, and has on occasion rescued the older sibling from them.

            And, yes, the spider-phobe appreciates Tolkien.

          • KarenJJ

            Redbacks.

            I’m in Australia. Spiders are not friends here and kids learn from a very early age not to stick your fingers into dark nooks and crannies. I’ve killed about a dozen redbacks over the past month (most of them hiding in dark corners of outside kids toys). They’re prolific here and normally I get pest controllers to spray for them but didn’t get around to it this year.

      • Mishimoo

        I don’t understand why they couldn’t just leave it alone as it was on the outside of a window, but my best friend’s sister-in-law was screaming about it being a white-tailed spider and “You’ll lose your hand if it bites you!!” hence the attempts to kill it. The resident bodybuilder put on some oven mitts, went outside, and started gently clapping at it…and flailing and shrieking. Being the terrible person I am, I nearly fell off the couch laughing at him. The spider managed to escape and hide, which is good as it turned out to be harmless.

        (White tails are the Aussie version of the brown recluse, this one was hanging from some silk so couldn’t have been a White-tailed spider)

        • Who?

          I’ve had the necrotising thingy they used to blame on that spider-I thought that was now debunked-and it is really nasty. You start with an itchy lump that looks like a mossie bite and a couple of days later you have a weeping sore which is gross. And hurts. Antibiotic cream clears it up. I still have the dent on my finger.

          Hope you are all having a happy christmas, or whatever it is where you are.

          • Mishimoo

            It has been debunked – it looks like it’s caused by something taking advantage of a puncture wound rather than the venom itself causing a problem. I’m glad that yours cleared up well despite being miserable and leaving a dent.

            Christmas was pretty good, despite the various dramas. I hope yours was lovely.

  • The Bofa on the Sofa

    Does the popularity of the “The best method for getting pregnant” post include all the “Dr Wonderful” spam comments?

    • Young CC Prof

      Yes, I would imagine so.

      • Box of Salt

        Maybe we should ask Dr Amy to have the list go to 11 . . . .

    • Siri

      Do not disrespect Dr Zabaza.

  • Somewhat OT: An excellent review of the current state of CNM midwifery in the US:

    http://www.medscape.com/viewarticle/833518

    • Young CC Prof

      So, there are over 13,000 CNMs in the USA. How many participated in MANA’s little statistics project? 44. Interesting factoids….

      • The Bofa on the Sofa

        But…but…but…there are CNMs that do homebirths, you know…

      • Medwife

        In the United States at least, it’s just irresponsible. It doesn’t look like a good idea in other countries, either, but here, it’s just… no.

      • To be honest, I’m surprised there were as many as 44. The very low number of CMs I found to be interesting — it seems the qualification doesn’t attract many applicants [?]

        13,000, given the size of the US population, is really not very many CNMs. Anyone know how many OB/GYNs there are in the States?

        • Ash

          Only ~3 states allow CMs to practice, so it’s not surprising to me.

        • Young CC Prof

          Only a few states recognize CMs, and there are only a few midwifery degrees that admit applicants without the nursing background.

          There are over 30,000 obstetricians. The USA could benefit from more advance practice RNs overall, in my humble opinion, and they’re easier to produce than more doctors.

  • Bombshellrisa

    My favorite is the one you wrote for your daughter on her birthday.

  • toofargone

    Oh and I found it. My all time favorite, The Mothers day post: Love Makes a Mother, Not Birth choices. THE BEST!

  • toofargone

    I have a few favorites for this year love your body as it is, love your birth as it is and also the one you wrote to your daughter for starters.

  • anotheramy

    My fave was “will pumping increase milk supply?” It was such a relief to read that primary lactogenesis failure is more common than previously thought, rather than the usual “almost all women can bf if they have the proper support”. I came to this blog to get birth info from another point of view, not just the woo that seems to predominate even Mainstream sources, and I got hooked on this blog b/c of the BFing posts, and the comments. The regulars here must be some of the smartest commentors on the Interwebz. 🙂

  • Trixie

    I see Vaginal Weight Lifting was a perineal favorite….

    • Roadstergal

      *rimshot*

      (ahem)

      • Trixie

        Hey, I’m a graduate of the Deb Puterbaugh Academy of Close Enough Spelling.
        Which reminds me, I’m kind of sad Social Morays didn’t make this list.

        • Young CC Prof

          It’s a less popular post because it’s sort of an inside joke, just for the groupers.

          • MLE

            You’re just angling for upvotes now.

          • Box of Salt

            I caught where you’re going with that . . . .

          • We shouldn’t carp on such an innocent spelling error.

          • SporkParade

            Oh, now you are all just fishing for additional puns.

          • The Bofa on the Sofa

            Oh, now you are all just fishing for additional puns.

            On porpoise

          • The Bofa on the Sofa

            I think this calls for the best set of fishing puns ever…

            It was April the 41st – it being a quadruple leap year – and I was driving in downtown Atlantis.
            My Barracuda was in the shop so I was driving a red Stingray, and it was overheating,
            so I pulled into a Shell station.
            They said I’d blown a seal.
            I said, “Fix the damn thing and leave my private life out of it, okay?”

            While they were doing that I went across the street to the Oyster Bar – real dive.
            But I knew the owner, Gill, ’cause he used to play ball the Dolphins.
            I said, “HI,GILL!” – you have to yell, he’s hard of herring.

            So I bellied up the sand bar, ordered a Rusty Snail, hold the grunion,
            with a peanut butter and jelly fish sandwich on the side, heavy on the maco.
            I was feeling good.
            I even dropped a sand dollar in the box for Jerry’s Squids, for the halibut.

            Well, the place was crowded.
            We were packed in like sardines.
            They were probably there to hear the Big Band sounds of Tommy Dorsil.
            He was rockin’ the place with a very popular tuna: Salmon-chanted Evening
            and the stage was surrounded by screaming groupers – probably there to see the bass player.

            Well, one of them was this cute little yellow tail, and she’s givin’ me the eye.
            So I figured this was my chance for a little fun – you know, piece of Pisces…
            but she said things I just couldn’t fathom, she was too deep – seemed to be under a lot of pressure.
            And boy could she drink.
            She drank like a… she drank a lot.

            And then she gives me that same old line, “Not tonight, I gotta haddock.”
            And she wasn’t kiddin’ either, ’cause in walked the biggest, meanest lookin’ haddock
            I’d ever seen come down the pike.
            He was covered with muscles.
            He said, “Hey, shrimp, don’t you come trollin’ around here.”
            I said, “Abalone, you’re just bein’ shelfish.”

            Well, I could tell there was gonna be trouble and so could Gill ’cause he was already
            on the phone to the cods.
            The haddock hit me with a sucker punch.
            I landed him with a left hook.
            He eeled over.
            It was a fluke, but there he was lying on the deck flat as a mackerel.

            I said, “Forget the cods, Gill, this guy’s gonna need a sturgeon.”
            Well, the yellow tail was pretty impressed with the way I landed her boyfriend.
            She said, “Hey, big buoy, you’re really a game fish.
            What’s your name?” I said…, “Marlin.”

            After that we had a whale of a time.
            I took her to dinner.
            I took her to dance.
            I even bought her a bouquet of flounders, on porpoise.
            And what did I get for my troubles?
            A case of the clams.

          • Samantha06

            That is great!! lol!

          • The Bofa on the Sofa

            I can’t take credit, of course. It’s Kip Adotta. But it’s nice that all that listening to Dr Demento in the 80s can be put to some use…

        • Sue

          (To the tune of “that’s amore”)

          “When the eel that you feel doesn’t feel like an eel…
          That’s – a moray!”

    • Cobalt

      That’s what SOB does to your autocorrect.

  • fiftyfifty1

    Well my least favorite was “Jan Tritten crowd sources a life or death decision and the baby ends up dead”. …
    But it was the most important.

    At first homebirth advocates claimed homebirth was “as safe or safer” than hospital birth. Now evidence proves that it is much more dangerous. But homebirth advocates want to continue promoting homebirth so they dismiss midwives who practice dangerously as bad apples or outliers. The death of Gavin Michael, and Jan Tritten’s role in his death, prove that dangerous practitioners are not fringe, but rather mainstream leaders within the homebirth community.

    • Bombshellrisa

      https://www.indiegogo.com/projects/help-katie-mccall-get-back-to-work#description
      One of the bad apples (the main Sister in Chains) won’t go away. She decided to crowd source getting her CPM renewed and get supplies so she can go back to being a dangerous, mediocre “expert in normal birth”.

      • Stacy48918

        Yea, that nut’s in my state. She was actually the subject of the straw-that-broke-the-camel’s-back argument that prompted my moving out, ha!

        • Bombshellrisa

          That woman is the poster child for the word dense.
          It’s very interesting your husband knows who she is.

          • Stacy48918

            Well he didn’t, really. He knew her as a Free Stater that ran a B&B…wanted to go stay in the B&B to support a Free Stater…then asked me about going…I said no because she’s a crackpot CPM (didn’t word it quite that way…) and he flipped out. That’s when I decided to move out. 😛

          • Bombshellrisa

            Oh ok. I know she is trying to build a birth center and is also teaching other CPMs.

          • Guesteleh

            So…this blog helped you leave your husband? AWESOME.

          • Stacy48918

            LOL, I never thought about it that way…but yes. The things I read here changed my mind on MANY different issues, helped me see the closed-minded verbal abuse of my husband if I ever dared to disagree with him and made me realize I deserve better than that. And my kids deserve better than that. And not just what Dr. Amy has written but many of the commenters as well (Trixie!). I LOVE this blog. 🙂

          • Trixie

            You rock, Stacy. Are things going okay?

          • Stacy48918

            Yes, they are. Thank you for asking. 🙂

            I am happier than I have been in YEARS, living the free life I have missed for so long. Things that I didn’t even realize I missed in some cases. Working on getting many things in my life back on track. I got my flu and TDaP shots too!

            Legally, it’s a quagmire…the ex is fighting to prevent me vaccinating the kids, prevent my son’s enrollment in public school, prevent him seeing a dentist that would use fluoride, prevent him seeing his therapist. I just hope the judge recognizes his brand of crazy. Our first court date is in 2 weeks…

          • The Bofa on the Sofa

            I would hope the court would recognize national health recommendations. It shouldn’t take much more than showing the AAP and CDC and ADA recommendations for pediatric care.

          • Trixie

            Wow, that is super nuts. So he didn’t allow fluoride either?
            I feel like I read a blog post by somebody — maybe Dorit Reiss? — about vaccination and custody issues.

          • Young CC Prof

            Dorit Reiss is probably a really good source for this sort of thing.

          • Amazed

            The judge has to recognize this. I am sure that’s what will happen. It’s so crazy that it’s unbelievable.

            Still, good luck to you, Stacy. So happy that you’re happy.

          • ArmyChick

            She gives us free staters a bad name. Some of us are actually sane…. I’m in NH by the way.

          • Stacy48918

            I am glad to live in the “Free State”, but I have no love for the Free State Project that would seek to eliminate many of the legal protections for the most vulnerable among us in the name of “freedom” and “liberty”. They seek to eliminate funding for public schools and health care. To privatize essential government services.

            http://www.npr.org/2014/03/09/288069880/libertarians-move-in-to-make-a-small-n-h-town-even-smaller

            All of that and my abusive husband besides…No, I am no fan of the Free State Project.

        • PrimaryCareDoc

          Oh, I’m in NH, also! Indiegogo to start a practice. Just like real medical professionals do it! /sarcasm/

          What’s wrong with a small business loan?

          • ArmyChick

            Where in NH?

    • Young CC Prof

      Did you guys see that AWFUL article on oligohydramos in Midwifery Today? The one allegedly written in response to what happened to Gavin Michael?

      It discusses the issues with low fluid in the second trimester, and then completely denies that low fluid at term is dangerous. So, still pretending it didn’t happen, eh?

      • Guest

        Link?

        • Young CC Prof

          Hmm. It’s not online, only in print. But trust me, it’s awful.

      • Trixie

        I’ve seen it too. It’s awful.

        • fiftyfifty1

          My goodness, do all of you subscribe?

          • SporkParade

            I’m starting to think I should subscribe. Just reading the online version is giving me my daily dose of rage. “Hi, I’m a student midwife, and I just saw a vaginal breech delivery at home. Therefore, it is safer than C-section, which will all know are evil and dangerous.”

          • Trixie

            Oh lord, no. As if I’d give Jan Tritten a dime.

      • Anj Fabian

        Wall of text.
        Cherry picked citations and excerpts from studies.
        Misrepresented studies.
        (One in particular happened to be one that I linked a decision tree graphic from, so I know what the REST of the study said – not just the two sentences they used.)
        Vague assurances that midwives are competent and able to handle any unspecified problems.

        Inductions are only mentioned as – you guessed it – unnecessary interventions.
        Cesarean not mentioned at all as an option, IIRC.

    • Kq

      Didn’t initially notice that Wanda Smith Midwife commented about baby with true knot and heavy mec – that “she stilled birthed vaginally” Is that a Freudian typo? Did that get discussed?