NYTimes asks: Homebirth is never safest, but can it be safe enough?

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Hallelujah!

I knew that it was only a matter of time, but sometimes it seemed as if it would take forever for the mainstream media to absorb the scientific evidence that has been around for decades: homebirth results in the deaths of babies who didn’t have to die.

The NYTimes, in its Room for Debate feature, acknowledges this increased risk in today’s featured question: Is Home Birth Ever a Safe Choice? The participants in the debate include Drs. Amos Grunebaum, Frank Chervenak and Aaron Caughey, as well ACOG representative Dr. John Jennings, Tekoa King, CNM and Marinah Valenzuela Farrell, CPM.

The pull quotes say it all.

Drs. Grunebaum and Chervenak: “In the United States, those who support home birth as safe are propagating junk science.”

Dr. Caughey: “Even in Europe, the fetal and neonatal risks are higher with home birth.”

Dr. Jennings: “The ability of a physician to rapidly provide care can be the difference between life or death for both mother and baby.”

In other words, homebirth leads to the preventable death of babies.

How do King and Farrell respond?

Tekoa King, CNM: “In Britain, women are actually advised to have children at home or in a birth center, rather than a hospital, when the pregnancy is low-risk.”

Marinah Valenzuela Farrell, CPM: “Certified professional midwives and certified nurse midwives should be licensed to practice independently in all 50 states.”

The contrast is striking. The obstetricians are concerned with babies’ lives; the midwives are concerned with money.

Here’s how I’d answer the question “is homebirth ever a safe choice?

Homebirth is NEVER the safest choice, so women contemplating homebirth need to ask themselves what risk to the baby’s life is acceptable to them.

The risk of death of a baby at homebirth is far higher than the risk of death of a baby in a car accident, so an appropriate analogy would be to ask “Is failing to buckle your infant into a carseat ever a safe choice?” The answer, of course is that it is never the safest choice, but apparently some parents believe that it is safe enough.

For me, personally the risk of not buckling a baby into a carseat, though tiny, it still too high. The risk of death of a baby at homebirth, which is much higher, is obviously completely unacceptable to me, but other women may feel differently.

Women have a right to make that choice for themselves provided that the choice is an INFORMED choice. That means understanding what homebirth midwives like King and Farrell were forced to acknowledge: homebirth increases the risk of death. Midwives who tell you otherwise are repeating the lies propagated by celebrity homebirth advocates and purveyors of junk science like the Midwives Alliance of North America (MANA), the organization that represents homebirth midwives. Their own data shows that homebirth increases the risk of death by 450%.

Most obstetricians believe that no increased risk to the baby is ever justified.

Most homebirth midwives believe that increasing THEIR income is an acceptable reason to risk the life of YOUR baby.

The obstetricians follow the Hippocratic injunction, Primum non nocere, first do no harm.

The midwives follow their own injunction, the experience of homebirth justifies putting babies at risk of death.

It may be ugly, but at least it’s honest.

  • Übermensch

    This article is so full of cherrypicking quotes and jumped conclusions that it’s funny, like “The obstetricians are concerned with babies’ lives; the midwives are concerned with money.” Uh, what? [citation needed]
    The only realistic bit is about the risk of death being raised 450% IN THE US, because it currently doesn’t seem to be supported or commonly practiced. Here in the UK, as you said, it has become actively encouraged (again) for babies to be birthed in a birthing centre or at home with a trained midwife on site, and that’s usually fine. Situations where hospitalisation is *needed* are actually turning out to be rare, and often obvious. Aftercare involves regular checkups at home and at clinics with midwives, health visitors and general practitioners. This is all part of the reduction and weeninf of unnecessary medical treatment in the UK, so the populace can actually wipe their own arse instead of going to the ER to get it done so as to reduce our dependency on our wonderful, world class socialist healthcare system.

    You say homebirthers hold a lot in common with antivaxers, what with their ‘feelings’, argument-from-nature and not liking medical mollycoddling. I say you’re like prohibitionists or pro-circumcisionists, pretending to have ideas in reality, with argument-from-status-quo and massaged stats, but really you’re just defending ‘traditionalism’ and small ‘c’ conservatism.

    • Nick Sanders

      So much presupposition…

      • Übermensch

        “I can parrot a word on a website without knowing what it really means. Anything that doesn’t fit with my fragile worldview dictated by skeptic blogs is morally inferior and automatically wrong.”

        • Nick Sanders

          Yes, please assume I don’t know what the words I say mean. Much like you assume that the people providing home birth in the US are trained the same as and act as professionally as the ones in the UK, assume there will be follow ups by GPs, assume “socialism” is inherently bad and everyone will agree with you, and assume Dr. Tuteur is just trying to defend the status-quo.

          • Übermensch

            Look, if you guys can’t train and manage your medical staff, that doesn’t make homebirth hokum like homeopathy or antivax… And I never said socialism is bad, you ninny, I’m thankful for it. If you’re massaging statistics and misrepresenting reality in order to avoid change, I’m pretty sure that’s maintaining the status-quo, however you dress it up and justify it.

          • Amazed

            Why the hell can’t YOU train and manage your medical staff? Namely, the midwives like the one from the article you chose not to comment on? As for massaging statistics, you try and massage the ones showing that the UK model of care you so praise amounts to effing 17 stillbirths a day… and the Birthplace study STILL doesn’t show a better homebirth rate anywhere else but in the false world researchers created for iyt.

          • Übermensch

            Stillbirths are rarely preventable by that point. Admittedly, if something like getting the umbilical chord tangled happened, it might not be easily treated at home. Still, that’s not what you said or what your figures imply.
            To counter, Mister Figures, what’s the number of stillbirths in the US per day.
            So the stats that disagree with you are fake, are they? Good to know.

          • Young CC Prof

            Stillbirths that happen at seven months due to a cord accident or out-of-hospital abruption are rarely preventable. Near-term, term, postdates and intrapartum stillbirths are preventable, and good care can prevent all postdates stillbirths (by inducing labor in a timely fashion) and most intrapartum stillbirths (by monitoring labor properly.)

          • Übermensch

            You’re right. Midwives monitor home births and hospital births alike. If a midwife fails to notice complications, that makes no difference, if there are complications that are spotted, the women tend to be taken to hospital or have a doctor brought to them, there is no evidence of this often causing deaths.
            If the pregnancy is predicted to be complicated, hospital is recommended.

          • Young CC Prof

            The US stillbirth rate is actually lower than the UK, at 4 per 1000 live births rather than the UK’s 5 per 1000. See http://whqlibdoc.who.int/publications/2006/9241563206_eng.pdf for details.

          • Übermensch

            Holy guacamole, a difference of one. Still, any evidence that this is thanks to homebirths? Besides, FREE HEALTHCARE LOL

          • Amazed

            Stats? I haven’t seen any stats in any of your posts. Perhaps you’ll show us those mythical stats you’re referring to?

            Stillbirths are absolutely preventable when a good monitoring shows a problem. Especially near term.

          • Übermensch

            Okay.

          • Guesteleh

            In the UK the same midwives are providing hospital and homebirth care, right? So what makes you think they’re doing a better job with mothers at home than in the hospital? The recent UK midwife scandal has to do with midwives delaying needed medical care and failing to risk out high-risk mothers. How is that situation improved by homebirth?

          • Übermensch

            No. That isn’t true. And the study has said nothing about home birth. You can’t just go “Well, there was a scandal in one hospital so all midwives in the UK everywhere must be shit”. That’s like me saying “Well, one school got shot up in the US, people must use schools as target practice there”.
            In other words, it’s not very evidence based and not very skeptical.

          • Übermensch

            It’s not worsened by it, and it was one hospital. Yeah, it’s awful, but it really only shows that one hospital is crap and nothing else.

        • moto_librarian

          So what do you have to say about the findings of the study to be announced today that reveal that up to 30 mothers and babies died due to poor care, mainly due to the fact that midwives are more concerned about turf wars with OBs than the well-being of their patients?

          • Übermensch

            Sorry, never saw your comment in the noise.
            That report is on hospital births, where mismanagement was rife and nurses and doctors had all kinds of ideas about what to do. Doctors were not being called and nurses were not assisting.
            If you’re in hospital, you’ve clearly elected to have hands-on medical assistance and this was not respected.
            This changes nothing about home birthing and almost makes you look silly for bringing it up.

    • moto_librarian
  • Red Ear Reviewer

    The problem I see in the future is that the CPMs, when confronted by their appalling PNMR, are just going to ask for more and more medical privileges from state legislators to “make home birthing safer.” (In my state of Colorado, DEMs are going to ask next year for suturing, IV antibiotics, IVs for hydration, ultrasounding, etc.) What can we do to stop this?

    • JFC. ):

      That’s ridiculous, and the worst part is that we have so many political figures as opposed to actual medical professionals making those decisions that they might just allow it.

    • Brackonfire

      My question is what’s the point of having all of that equipment if “you” want a natural hospital free comforts of home experience? These people make no sense. “I want a home birth because I hate being monitored and hooked up to IVs and ultrasounds cause autism”

      “Can we be afforded practically all equipment I’d find in a hospital so I can have a home birth?”
      At that point why not go to a hospital? Seems more inefficient and costly.
      All the comforts of modern science while squishing a baby out in a pool in the kitchen. Way for homebirthers to be “natural”

      And by the time midwives go through all this trouble they could just go to medical school if they want all the comforts and control a doctor has.

      (Yes I know someone who claims ultrasound technology causes autism)

  • Medwife

    Henci Goer responds: http://www.scienceandsensibility.org/nyt-home-birth-debate/

    She cites MANA stats! How can they keep on using that to SUPPORT their position?

    • Young CC Prof

      Ok, that post goes beyond motivated reasoning into pants-on-fire territory.

      Also, she argues safety by talking about single head-down babies in unscarred uteri, but refuses to call for safety standards. Oh, she claims, some of the CDC deaths must be unlicensed midwives! Call for proper licensing standards then.

    • Elaine

      “As can be seen by Jennings, Grunebaum, and Chervenak, people against home birth often fall into the category of “My mind is made up; don’t confuse me with the facts.””

      How funny, I was just going to say the same thing about her! smh.

  • Liz Leyden

    Is anyone else disappointed that all of the anti-homebirth writers are male, while all of the pro-homebirth writers are female? Most OB/GYNS are female, yet the New York Times couldn’t find a female OB-GYN to write about the hazards of home birth? It will only give more ammunition to the pro-homebirth crowd.

    • Amy Tuteur, MD

      If they had had a woman obstetrician homebirth advocates would have claimed that she was brainwashed by the patriarchy.

      The most powerful argument against homebirth is that the people who know the most about childbirth and newborns, obstetricians, neonatologists and pediatricians rarely have homebirths.

      • Elaine

        Disappointingly, there are some regular doctors, nurses, etc. who do. I’m surprised they didn’t find one of them to do the first-person homebirth mom piece, rather than someone in a completely unrelated field.

    • The Computer Ate My Nym

      If only there were a female OB who is known for her opposition to home birth, writes a popular blog on the issue, and is both knowledgable and a good writer. But where could we possibly find such a person? Oh, well, if she did exist she’d probably be mean. Unlike the tough male advocates that were actually interviewed.

  • carr528

    Sigh. I know the blog writer here, and she’s a really sweet girl, but she’s fallen hard into the woo. Her second birth was very traumatic, with the baby spending time in the NICU, and somehow that turned her into a NCB advocate. (She’s also a big follower of Dr. Sears, so there’s that.). But, ultimately, yes, it does matter where you have your baby. My third son was diagnosed with hypoglycemia shortly after birth. If I had had him at home (which since he also had craniosynostosis, that wouldn’t have happened), would a CPM have even checked? And what kind of damage would have occurred before it was treated?

    http://www.mommymadegreen.com/the-post-every-pregnant-mom-should-read/

    • Bugsy

      Wow. I took a brief look at the main post on that page. There were two things that jumped out at me: 1) the NCB/Attachment Parenting focus of her book list, and 2) her reference to pregnancy as being 10, not 9, months. (“during the 10 months (yep it’s 10 months, not 9) they are pregnant”)

      The statement of a 10-month pregnancy is ridiculously incorrect, as far as I know. I got pregnant with my son (IVF, so date is certain) on Jan 17th, and his due date was October 10th. Calculating his due date from his date of conception to due date yields 8 months, 3 weeks. Add in the first two weeks of a cycle prior to ovulation, and you come up with 9 months, 1 week.

      Still not exactly 10 months.

      • carr528

        I didn’t like the What to Expect books as much as the Week by Week books. I loved getting up every Monday and reading the new week.

        I had my third and fourth in the hospital where she had her second, and I thought they were TOO baby friendly. They didn’t take the babies during the night, so I was left trying to figure out a way to get them out of the bassinet while recovering from a c-section.

        • Bugsy

          Will check out the Week by Week books if blessed with another one.

          Ouch, that sounds like a challenge for nighttimes in the hospital. My hospital gave us the option to have the bassinet in the postpartum room or in the nursery. I was adamant that the little guy had to stay with me. In retrospect, I wish I’d let him go to the nursery so that I could sleep!

      • Paula

        It is 10 blocks of 28 days (4 weeks), I wonder if that is where that number comes from?

        • Bugsy

          That’s certainly a possibility – I can’t think of anything that makes more sense?

          • Karen in SC

            They don’t realize that a month = 4.33 weeks. That is the number used in any calculations, like cost of goods. Run a pump for 32 weeks, what is the cost per month? Things like that.

          • Bugsy

            Yeah, I’m pretty sure that beyond our current month, I don’t know of any that contain just 28 days. It was something they taught us in elementary school, but maybe I’m just bad at math! 😛

          • Roadstergal

            “The ten Februarys of pregnancy.” It does sound like a dramatic book title.

          • fiftyfifty1

            February. Dang. Shortest month and it always seems to stretch on forever.

          • Trixie

            Groundhog Day!

      • Wren

        I liked the “What to Expect When You’re Expecting” book that I read as a teen. I hated the version I had 10 years ago. I have heard that one was revised though, to be a little less scary. The one I had literally made everything seem like a huge risk in pregnancy.

      • Siri

        It’s based on the convention that pregnancy lasts for ten four-week months, as neither nine nor ten calendar months is correct.

  • Bugsy

    Completely and utterly OT: I finally did the deed and blocked crazy lactivist from my Facebook account. I’m glad to have finality, but it was a 25-year friendship, and she was one of my closest friends until she went crazy into the woo. It sucks, and I’m still feeling a bit sad.

    I realized that from the time I became pregnant, she saw her role as to mentor/guide me forward. It was at that point that we really ceased to have a friendship, and had much more of a teacher/student relationship. It was never the relationship I sought with her, particularly because she had zero experience with kids and my entire life has been spent working with kids. Frankly, I don’t think she particularly likes kids, and is not the sort of person from whom I would ever seek parenting advice.

    I finally stood up to her and to the info she was force-feeding me – over the summer; I let her know I wouldn’t allow my son to have a playdate with her unvax one (but could we have a mommy date instead?) – she cut me out entirely. After 25 f****** years. Pardon the French. It makes me so goddamn mad that the damn attachment parenting cult beliefs took over her life and our friendship.

    There was no point in trying to have a relationship beyond parenting. For her, parenting was everything. She wouldn’t allow herself anything else.

    After six months of watching her like & post comments to my friends’ walls, I’m tired of it. Never mind that I’m jacked up on another round of fertility drugs (that I’m sure is failing again). I’m not going to be a pretend Facebook “friend” to someone who has otherwise blatantly cut me out, someone whose new belief system condemns pretty much every decision I’ve made with respect to my own life.

    I miss my pre-AP friend. Hugs wanted. I need to move on.

    • Young CC Prof

      I am sorry it came to that, but it sounds like you made an effort to save the friendship and cutting her out was the only reasonable choice.

    • Cobalt

      That’s hard. I’m sorry she stopped being your friend.

      You have post-AP friends here, but that’s not the same as someone to sit with at the park while sharing life and watching the kids grow.

    • momofone

      I’m sorry. That’s really hard.

    • Kelly

      I am so sorry. I lost a good friend in an entirely different way and it hurts so much. It is a grieving process and it takes time.

    • Kq

      It’s a damned hard choice to make, finally backing out of those friendships. I’m sorry.

    • Roadstergal

      That’s such a shitty position to be in – watching an ideology pull away someone you really love and care for, and then to be in the position of actually having to, as it were, cut the cord yourself – it sucks sucks sucks massively. So sorry. 🙁

    • Daleth

      I’m so sorry. That really sucks. It’s like you lost your friend to a cult.

    • Poogles

      *hugs*

    • Amazed

      25 years of friendship lost on a cult. I’m sorry. It sucks.

    • Who?

      I’m sorry.

      Be kind to her as/when she reaches out to come back to you. Life goes on a long time.

    • KeeperOfTheBooks

      I’m sorry. That really sucks. Been there, done that over similar ideologies. Even though at the end you disagree with them so much, you really, really miss the person they used to be. ((Hugs))

    • {hug} Sorry your friend went insane and chose a cult instead.

      • Bugsy

        Thanks – me, too. I miss the kind and caring person she used to be.

  • pburg

    Some babies die from hospital related infection. In their case, home may have been the safer choice. How about women who die from complications of c sections?
    Why does this blog pay disproportionate attention to neonatal death when maternal death has been on the rise for decades (overuse of c sections being one of the primary factors)?

    • momofone

      Would you mind sharing your source for that assertion?

    • nomofear

      Keep reading past posts, and/or provide some sources for what you’re stating, because it’s flat wrong.

    • Young CC Prof

      Actually, it’s not entirely clear that maternal death is on the rise, due to changes in reporting method. Also, maternal deaths from bleeding and infection have stayed the same or dropped for decades. What appears to be going up is the rate of death from peripartum heart disease or hypertension, plus various preexisting health problems.

      Please tell me how home birth prevents or cures peripartum cardiomyopathy.

    • SporkParade

      By far the most common source of infections in newborns is their own mothers’ vaginas. For example, the top cause of fatal infections in newborns used to be Group B Strep, which is now prevented by swabbing mothers before they go into labor and providing IV antibiotics during labor for those who test positive. Hospitals usually do a very good job at keeping their maternity departments separated from anyone infectious (separate floors and/or buildings, separate laundry, etc.).
      You should stay here and read some more. It will teach you a lot.

    • lawyer jane

      Yikes. The term “disproportionate attention to neonatal death” sends chills up my spine.

    • Amy Tuteur, MD

      Your claims are regurgitated straight from homebirth websites and they’re not true.

      Haven’t you noticed that the only people who claim homebirth is safer than the hospital are those who make their money from homebirth?

    • Montserrat Blanco

      It seems really interesting what you claim. I know of preterm babies and babies with genetic issues that do die of infection. Most of them would not have survived after a homebirth. Please, give us the source (peer reviewed paper) that demonstrates that at term healthy babies die of hospital acquired infections. I would love to see the source (peer reviewed published paper) that shows that maternal deaths are on the rise due to hospital interventions. I really do not get how C-sections are getting more and more complicated when all the other surgeries have a decrease on mortality, so I would love to see the paper that demostrates that.

    • Elaine

      As for women who die of complications from c-sections, what would have happened to them and their babies without c-sections? This will vary, of course, depending on why the c/s was done, but in many/most cases it would not have gone well without the c/s either. It’s not like a c-section is done just for fun. Obviously we don’t want anyone to die of c-section complications and doctors and hospitals continue working to prevent those, but it’s not a simple matter of everything would have been hunky-dory without the c-section. I personally know at least one mom who would have died without a c/s (eclamptic seizure at 8 months pregnant).

    • The Computer Ate My Nym

      Have you actually read this blog? Attention is paid to maternal mortality. Overuse of c-section is NOT one of the primary factors for increased maternal mortality. Increased matenal age, obesity, and more women electing to complete pregnancies despite being high risk are major factors. Very few, if any, healthy women die from elective c-sections. C-sections do have their risks and the decision of how to give birth is one that every woman who is pregnant and planning to complete the pregnancy should consider carefully with the advice of her OB and any other support personnel or medical attendants she may have, but saying that c-section per se is a major player is misleading at the very least.

      Also, hospital acquired infection is a very rare cause of maternal or infant mortality. Nor is iatrogenic infection unique to hospitals. Remember the midwife who passed flesh eating bacteria to her patient by not washing or using gloves?

  • Allie

    “Women have a right to make that choice for themselves provided that the choice is an INFORMED choice.”
    I’m not sure I accept this premise 100%. In other medical contexts, the right to informed consent, including the right to decline lifesaving treatment, is absolute. However, in cases where the life, health and wellbeing of another (or others, in the case of vaccines) is at stake, the rights of the mother are not absolute. What should that look like in practice? That’s something we have to decide as a society, and it’s a question of balancing competing rights and interests. It’s hard, but not impossible, and its an ongoing conversation as knowledge and best practices evolve and change. Am I advocating forced confinement, in the literal sense of the term in relation to childbirth? Of course not, but I also think it is criminal to let a baby die needlessly.

    • SporkParade

      But it’s not a baby until it’s actually been born. Before then, it is a fetus and part of its mother’s body.

      • guest1

        ” Before then, it is a fetus and part of its mother’s body.” Actually the law isn’t universal on that point.

        • SporkParade

          Yes, I know, and I consider it a grave violation of my religious liberty and bodily autonomy.

          • guets

            I am sure you do but learned judges from around the world disagree with you.

          • SporkParade

            Of course they do. Christian privilege is common in much of the world, and male privilege, as far as I can tell, is universal.

          • guest1

            Can I predict some of the responses to follow?
            Siri will be popping up soon and she and others will accuse me of being pro life etc.
            Let me put that to rest by stating that I perform medical abortions.
            The legal arguments are not christian or male but based on legal reasoning.

          • SporkParade

            And I am grateful that you perform medical abortions (which, incidentally, are a violation of the Hippocratic oath). But any legal argument that does not start from the premise that a fetus is not a person and that granting it rights as if it were inherently strips pregnant women of their bodily autonomy is based either in religion or sexism, not justice.

          • guest1

            Many countries medical schools no longer subsrcibe to the hippocratic oath and the law provides a defence against the criminal act of performing abortions.

          • The Computer Ate My Nym

            The version of the Hippocratic oath that I took didn’t mention abortion. Nor did it forbid me from doing surgery. Nor even from administering poisons, which was fortunate since I turned out to be an oncologist. The oath’s changed over the years. We didn’t swear to Apollo either, though we might as well have as far as I was concerned.

          • guest1

            On the one hand you appear to be saying that I am breaking some law by performing abortions but on the other hand you are an advocate for maternal autonomy.
            Law and justice aren’t the same thing.

          • SporkParade

            Nah, I’m just joshing you about the Hippocratic oath thing. That’s exactly my point that law and justice aren’t the same thing. Laws that deny women absolute bodily autonomy because they are pregnant are unjust.

          • guest1

            Do you mind if I take you to the logical conclusion of your position?
            Is it OK for a mother to kill her baby in the name of performance art?

          • SporkParade

            I’m not sure how that’s the logical conclusion. We’re talking fetuses, not babies. I’ve already established that life begins at birth.

          • guest1

            So, the logical conclusion is that it is OK to kill your baby in the name of performance art.

          • SporkParade

            You are not good at forming logical conclusions. How did we go from abortions to killing babies?

          • guest1

            So,the logical conclusion is that it is OK to perform a late term abortion in the name of performance art?

          • guest1

            Clue: Lisa Barrett.(? Gloria Lemay)

          • guest1

            Ina May Gaskin?

          • SporkParade

            Ina May Gaskin is a tough nut to crack. She ought to be prosecuted for malpractice (hell, she ought to be prosecuted for not seeking medical assistance for her own preemie whom she allowed to die), but she has such a cult of personality about her that no one will sue her.

          • SporkParade

            A care provider does not have the right to perform a late-term abortion without the woman’s consent, so I would not say the situations are comparable. Unless both of them lost babies of their own at home births, in which case I question their priorities, but I certainly wouldn’t say they had no right to give birth in the location of their choosing.

          • guest1

            Right, so it is OK for them to kill the fetus in the name of performance art?

          • Cobalt

            Lesser of two evils. No, it’s not ok to risk a fetus so cavalierly, but restricting the rights of a pregnant woman creates a greater evil. There is no perfect answer, we have to do the best we can.

            Honestly and integrity demand we protect the right of women to choose what to do with their body, while demanding they get factual information on which to base their choice. It’s also consistent to call them selfish if they do decide that their experience is more valuable than the outcome.

          • guest1

            A well considered answer, thanks.
            It is unfortunate that some abuse the legitimate argument for autonomy in defence of their narcissistic stupidity.
            An example is the deliberate delay in transfer)(resulting in death) of homebirth complications because stillbirths avoid any legal scrutiny.

          • Cobalt

            If care providers delay transfer, that’s criminal. It’s an abuse of informed consent and duty to protect the patient by practicing beyond their scope.

            If the mother delays, knowing what the risks are, that’s a morally reprehensible but absolutely protected choice. I don’t think most homebirth mothers really understand the risks though, and the blame for that belongs on the homebirth provider that skipped the “informed” part of consent.

          • Young CC Prof

            Yes, that’s what some parachuters and NCB advocates fail to understand. Living in a free society means sometimes you have to say, “I hate your choice but will defend your legal right to make it.

          • Guesteleh

            Whenever abortion comes up I always counter with stem cell donations: an individual cannot be forced to donate stem cells to another person. Not even if they are related (siblings for example). Not even if the potential recipient will die without it. This is not hypothetical–as many as 30% of people in the bone marrow registry who match with a patient refuse to go through with the procedure.

            Bodily autonomy applies to everyone, whether they are pregnant or not.

            On a personal note, having a baby made me more pro choice than I’d been before. My pregnancy was very difficult and I can’t imagine forcing a woman to go through that without her consent.

          • Wren

            Personally, pregnancy had the same effect on my pro-choice beliefs.

          • Medwife

            Exactly.

          • fiftyfifty1

            There is a difference between killing something or someone and letting something or someone die. It’s the difference between euthanasia and allowing someone to say “no more” to chemotherapy or a vent. I don’t think we should ever prosecute women for homebirth. While the fetus is still in them, it’s bodily autonomy. (It won’t the Lisa Barretts of the world that get prosecuted anyway, it will be poor women who don’t have their acts together). Now I’m fine with prosecuting women who may deliver at home and then don’t seek CARE for their compromised babies afterwards. That’s in place already though.

          • Daleth

            I’m neither Christian nor male–I’m a Pagan feminist– but I agree with the Roe v. Wade principle that once the fetus is viable, it can be considered to have some rights. And I don’t think this is inconsistent with women’s rights, because we have six solid months in which to decide to abort it or not.

            That said, I am absolutely in favor of abortion on demand before viability, and after viability if the fetus or the mother have serious health problems (e.g. mom needs cancer treatment or the fetus will be severely disabled and the parents don’t feel they can handle raising it).

          • Cobalt

            I think it’s consistent to support fetal rights and abortion on demand. One only has to recognize the mother’s right to her own body takes unlimited precedence, and no one else can interfere with that choice.

          • guest1

            Autonomy is not absolute or unlimited.
            Various courts have reached different comclusions on the feto maternal configuration.
            Some said the fetus is part of the mother, others said seperate and others said neither part of or seperate but a “unique organism”.
            Interestingly. a British court said that whatever the fetus is “it is not nothing”.

          • The Computer Ate My Nym

            The fetus is not nothing, but if you say that at any point the fetus has the right to continue to live off the pregnant woman’s body against her will then you’re saying that it has or should have MORE rights than any born and living person has. McFall couldn’t live off Shimp, not even if he had no other choice. Children can’t force their parents to donate blood or tissue to them, even though the parents created those children and the child may have no other choice. Saying that a fetus has the right to be sustained by a pregnant woman against her will gives it more rights than any human being. Is that the way you want to go?

          • Guest

            There is a point at which the fetus doesn’t have to sustained by the mother at all anymore. At that point your autonomy declines.

          • The Computer Ate My Nym

            That point would be “birth”. Until then it is being sustained by the pregnant woman and any argument claiming otherwise is just ridiculous. I agree. At that point, the mother should not have the right to make certain decisions for the baby. Like, she should not be allowed to refuse to protect it against infectious diseases because she’s phobic of autism.

          • Guest1

            I think it has been made quite clear that the born alive rule is simply one of convenience and no longer justied.

          • Daleth

            Cobalt, how does such “recognition” mesh with supporting fetal rights?

          • Cobalt

            The mother’s right to her body comes first. She is the utmost arbiter of her own body, beyond any rights of the fetus within it.

            You can support fetal rights within that scope. For instance, pregnant women who are criminally assaulted or endangered should also have the fetus recognized as a victim if harmed. Or dangerous midwives who kill them with grossly negligent care being prosecuted for their deaths, especially with the level of uninformed consent involved.

          • Daleth

            In other words, if mom wants the baby then it has rights no matter how far along it is, and otherwise it has no rights, again no matter how far along it is? When does that end? What if she’s 9 months pregnant, actively in labor, and changes her mind–should she be able to kill the emerging baby? Why or why not?

          • The Computer Ate My Nym

            She should have the right to get the fetus out of her body in the way that is safest and most acceptable to her. In some extreme cases, yes, that might mean “kill[ing] the emerging baby”. Consider what happens in obstructed labor if a c-section isn’t available.

          • Cobalt

            That was one of my thoughts. Transverse lie, low resource environment. Like in the good old days.

          • Daleth

            Well, obviously, if continuing with labor is likely to kill her then she has the right to avoid death by killing the fetus. I thought we were talking about the supposed right to abortion on demand (for any reason the mother wants) up to the moment the child is born.

          • Cobalt

            Actually, once it’s established that a very clear case of preventing maternal death is an acceptable reason to allow the death of a fetus, the argument becomes “what other reasons are acceptable” and “how imminent does maternal death need to be?”.

            Those arguments kill women, result in their imprisonment, and limits their rights in all sorts of ways.

          • guest1

            The ‘slippery slope’ argument goes both ways

          • Cobalt

            Birth is a very bright line.

          • guest1

            It is actually quite a faded line drawn in 1601 based on the outdated and irrelevant born alive rule.

          • Cobalt

            Where does the slippery slope of allowing women control over their own bodies lead to that is so terrible? That is more terrible than deciding they do not, in fact, own themselves?

          • guest1

            Maternal autonomy has been the defence of crazy midwives for some time now.
            I have lost count of the times I have heard ‘I was just supporting the mother in her choice’ to escape any resposibility for homebirth disasters.
            The born alive rule was Lisa Barretts explanation to try to avoid the coroners court.

          • Cobalt

            One person’s right to own their own body does not give another person the right to pretend to be a medical professional or deny a patient informed consent.

            The protection of fetal rights in instances of deliberate misconduct is very compatible with respect of maternal autonomy.

          • Young CC Prof

            Indeed. My right to an abortion does not give anyone (even my partner) the right to sneak abortion drugs into my food. My right to reject medical care in pregnancy does not give anyone else the right to give me bad care. And the Barrett cases were particularly egregious, going beyond negligence or incompetence into the realm of deliberate harm.

          • guest1

            And the Barrett cases were particularly egregious, going beyond negligence or incompetence into the realm of deliberate harm.
            Perfectly illustrating the other side of the slippery slope.

          • It’s a little older than that. In Judaism, at least, baby isn’t a person until first breath. That means born, outside the body, etc. Why do you consider it outdated or irrelevant?

            And, to your point below, women do have the right to have homebirths. It’s an incredibly stupid and dangerous choice, but it shouldn’t be banned. However, no one has the right to pretend to be a healthcare professional or to attend births as a paid attendant. People are allowed to make stupid, dangerous choices, but other people aren’t allowed to lie about how dangerous those choices are nor present themselves as professionals when they are not. Bodily autonomy and informed consent are both preserved this way.

          • guest1

            The born alive rule, specifically, is a common law rule.
            It is oudated and irrelevant because it was justified at a time when medical care was so atrocious and the deathrate so high that all babies were presumed to be born dead.
            This is no longer justified with excellent medical care and an almost non existent deathrate of normal term babies in labour.
            It is not only me that considers it outdated but courts in the US and Australia.

          • Babies were never presumed to be born dead. The death rate was something like 9-10%, but that still means the vast majority of babies were born alive.

            The courts in the US and Australia presume that a fetus has the right to steal its mothers resources whether she is okay with this or not. It is a violent infringement of bodily autonomy that is only considered acceptable because women are still, in many ways, seen as not-quite-people but rather broodmares.

          • guest

            The law disagrees with you. In that time there was a rebuttable presumption of stillbirth.
            Today the law is dealing with the absolutely ridiculous notion that a normal term fetus in labour is nothing one second but something the next.
            There is a point at which wilful narcissistic negligent selfish stupidity needs to be called for what it is.

          • “Wilful narcissistic negligent selfish stupidity” is legal, though. That’s what you’re not getting here. It ought to be absolutely legal to abort a fetus (or at least terminate a pregnancy in the safest manner to the woman regardless of the effect on the fetus) at any point during the pregnancy.

            We aren’t talking about what is ethical here. Clearly it is unethical to abort a healthy 7 or 8 month fetus because one doesn’t want to be pregnant anymore. It’s also unethical and “wilful narcissistic negligent selfish stupidity” to have a homebirth. That’s irrelevant. It should be legal to do both. Why, you ask? Just look at the legal reasoning in McFall v. Shimp, linked above. If men don’t have to donate their bodies to keep someone else alive, neither do women. It’s that simple.

          • fiftyfifty1

            Exactly. That Shimp! A willful, narcissistic, negligent, selfish, stupid, unethical, asshole! They told him his cousin would die, and he was the only one who could save him, but he didn’t give a shit. He let him die a horrible death, and all he had to do to save him was donate marrow, which involves nothing more than a scary looking needle. Boo hoo a needle! Something 1/1000 as disruptive to your body as having a baby.

            There is only one thing more awful than Shimp himself. And that would be a law that allowed us to tie Shimp down and take his marrow. I’m glad that law didn’t pass. It would have made monsters of all of us, but instead Shimp is the only monster.

          • guest1

            Agreed, Shimp appears to be all of those things.
            Compltetly irrelevant to pregnancy care though as his cells were not capable of independent life.

          • Well, it was a court case and not a law, but I agree with you otherwise. What Shimp did is unethical, but it was and must remain legal.

          • The Computer Ate My Nym

            To be fair to Shimp, it’s not a needle, it’s about 50-100 needles into the bone marrow, which can’t be completely anesthetized* and it does feel pretty nasty afterwards. That being said, it’s literally orders of magnitude safer than pregnancy. Heck, kidney donation is safer than an average risk pregnancy at this point and it’s not average risk pregnancies that get aborted at 7 months.

            *Except by general anesthesia, which is given for marrow donation. Modern hematopoietic stem cell donation bypasses this issue altogether by using peripheral mobilized stem cells, which can be collected with a couple of IVs and is no more painful than giving blood, though somewhat more tedious because it’s a longer collection. End of lecture on bone marrow donation.

          • guest1

            The wilful killing of a normal term fetus in labour should be illegal.
            Shimp is irrelevant as his tissue was not capable of independent life.Courts have determined that the fetus is a unique organism.
            Men can’t get pregnant so I don’t understand the last bit.

          • McFall was a person. He needed Shimp’s tissue to survive. A fetus is questionably a person, but for the sake of argument lets pretend that it is unquestionably a person. It needs its mother’s tissue to survive.

            Just as McFall couldn’t take Shimp’s tissue without permission, nor can a fetus take a woman’s tissue without permission. The donation of bone marrow is significantly less intrusive, painful, and dangerous than pregnancy and labor, and the court wouldn’t order Shimp to give it. How, then, can any court or law order a woman to go through any amount of pregnancy or labor unless it acknowledges that it sees women as not-people, since we don’t allow people to take tissue from other people?

          • Guest1

            What about when the fetus no longer needs the mothers tissue to survive and is a viable entity in itself?

          • It’s still sucking blood and nutrients out of her, and she has every right to get it out of her body in the manner safest to her without regard to its well being.

            Why do you think that a fetus’s right to life trumps a woman’s right to bodily autonomy, exactly? You’ve only questioned my stance, but never laid out the reasoning for yours. What is your ethical and legal stance, and are you prepared to defend all the consequences thereof?

          • Guest1

            The fetus is a unique organism. There is no analogous situation. The rights of the fetus gradually increase up to the point where is capable of independent life and should have those rights protected.

          • fiftyfifty1

            McFall was a unique organism too. One of a kind (as we all are). Why not him too?

          • Guest1

            I think you are missing the point about unique.

          • Guest1

            Not unique at all. He didn’t live inside shimp at any time.

          • A fetus has exactly as many rights to my body as you do. It is being protected exactly as much as you are. Why do you think a fetus should have more rights than any person has ever had?

            There is an analogous situation to pregnancy. You need someone to donate organs or blood to you in order to survive. Do you think you should have the right to steal them from an unwilling person? Do you think someone has the right to steal them from you? If not, then neither does a fetus have that right.

            Why do you think a person should have access to another person’s body against hir will and without hir consent? What is your justification for forcing a person to donate blood and tissue against hir will to anyone for any reason?

          • Guest1

            Rubbish. I have no right to our organs or tissue at all.Your own fetus on the other hand absolutely depends on you up to a point and then trusts you to let it go and get on with its life.

          • The Computer Ate My Nym

            McFall was completely dependent on Shimp’s bone marrow to survive. No one else could donate to him. Furthermore, Shimp agreed to be tested, implying willingness to donate.

          • guest1

            So what?

          • The Computer Ate My Nym

            So McFall was as dependent on Shimp as any fetus is on the woman who is pregnant. The situations are pretty much identical. So why are you so determined to claim that it’s different?

          • Guest1

            Except that McCall is not capable of an independent life seperate from shimp, did originate directly from shimp’s genetic material and was not forced to live inside shimp. Apart from that it is Identical.

          • Who?

            I’ve been following this conversation, but resisting getting involved.

            In the end, you seem to not be comfortable with a woman having bodily autonomy while pregnant. You can parse that by reference to fetal rights, if you wish, but it doesn’t change the basic position.

            One of your criteria here is ‘originate directly from Shimp’s ie the mother’s genetic material’. So do you hold the same view where a woman is pregnant with a donor egg that is not her or a blood relative of her’s genetic material?

            Also, a fetus is not forced to live inside it’s host-that is where it is created, or comes to life, if you will, and where it must remain, at least for a while, if it is to survive. No volition there.

            You’re obviously passionate about this, as many of us are passionate about women not being used or treated as vessels, to be impregnated, cut open or otherwise used for the convenience of others, including unborn children.

            Ultimately, the rights of others stop at my skin, even when that other resides, for the time being, within it.

          • Guest1

            Donor egg question- yes.

            Living arrangements of the fetus- “Sui generis”

          • Who?

            Okay so your comment above about sharing genetic material with the host was a red herring.

            What do you mean, ‘sui generis’? I know what the expression means, but not what you intend to convey by its use.

          • Fetuses can’t trust. They don’t have brains with which to trust for most of their development, and even after brain development of sentience (28-32 weeks) the fetus is sedated and unconscious from low oxygen levels until birth.

            You have no right to my tissue. I have no right to your tissue. And a fetus has no right to either of our tissue. Why do you think pregnancy represents any sort of unique situation? Organ donation of any sort, including pregnancy, requires ongoing consent of the donor no matter the consequences to the donee of refusal.

          • Guest1

            The idea that the fetus does not exist as a person entitled to rights and protection immediately before birth is ridiculous and can no longer be justified . The fetus is a unique organism and there is no analogous situation.
            All these positions have been supported in various courts.
            Yes, I do support the consequences.

          • Oh. So you support the idea that life trumps bodily autonomy, then?

            I guess we have no more DNRs. No more beating heart cadaver organ donation. No more assisted suicide. People will be blood-typed by the government, and if anyone needs one of their organs, they will be mandated to provide it (no matter if it impacts their health negatively or could even kill them). You will be mandated to risk your life saving another in all situations- drowning, hanging off a cliff, live wire … even if doing so puts you at immense risk. It will become a crime to use deadly force to protect oneself against rape- after all, the life of the rapist takes priority over your bodily autonomy!

            No, these situations have not in fact been supported by the courts. McFall v. Shimp makes it perfectly apparent that only one person controls who uses your body, and that is you. You are not required to give any bit of your blood or tissue to another person. That includes your mother, brother, cousin, or fetus. Why do you think a fetus is more special than a 1-day-old infant in terms of rights over your body? I am giving a fetus every single right all persons have. I am just not giving it any more rights. Why do you think a fetus gets to enslave a woman’s whole body, but I can’t take so much as a drop of your blood from you?

          • guest1

            DNR’s, euthanasia and self defence are all very interesting but completely irrelevant to the unique situation of the mother and her own fetus.

          • Wren

            In what way are they completely irrelevant?
            If abortion is denied, the woman is being forced to donate her body and potentially her life for the duration of pregnancy and childbirth. The fetus is being prioritised above the woman herself.

          • There are two rights at stake here- right to bodily autonomy and right to life. The two clashing against each other is not unique at all. It comes into play in DNRs, euthanasia, self-defense, and pregnancy.

            I am consistent. I argue that bodily autonomy is flat-out more important than life. No person or fetus may take the body of another without consent. Period. Pregnancy is not unique, unless one wishes to argue that it is uniquely infringing on bodily autonomy due to its duration and dangers to the donor/host/mother.

            You still haven’t explained your view at all. Why do you think a fetus gets to enslave a woman’s whole body, but I can’t take so much as a drop of your blood from you? What makes a fetus more special than I am?

          • Daleth

            “Why do you think that a fetus’s right to life trumps a woman’s right to bodily autonomy, exactly?”

            I don’t think it does (although an easy answer to your question, if I were a pro-lifer, would be a rhetorical, “Well, why do we all think that murder is a more serious crime than assault? There’s your answer.”).

            But that’s not my argument. What I’ve been saying is simply that a woman’s interest in avoiding the difficulties, risks etc. of pregnancy and labor is HUGE in early pregnancy for the following reasons:
            – Almost all the difficulties and risks are in the future;
            – An abortion would be physically very easy on her, FAR more so than labor or a c-section; and
            – Giving birth instead of aborting is not an option because the embryo/fetus is completely incapable of surviving outside her. IOW there is no way to satisfy any interest in life that the baby may have without grossly violating the mother’s rights, i.e., forcing her to remain pregnant against her will for several months and then to undergo a delivery that is much harder on her body than an early abortion.

            But the situation is very different when she’s, say, 7-8 months along because:
            – She’s already experienced many of the risks and difficulties of pregnancy;
            – Aborting a baby that size is roughly as invasive and hard on her as giving birth to it; in other words,
            – The baby could be born alive right now with, at most (in most cases), just a little bit more trouble and risk to her than aborting it.

            I’m not debating what the law should be, by the way, because I agree that laws like this are likely to be abused by overzealous prosecutors. I’m just debating the ethics of it. As a pregnant woman–and I’ve been pregnant twice–I had no legal or ethical/moral interest in causing the death of my fetus. My interest, and the reason I have the right to an abortion, is in not having to continue being pregnant or give birth. It so happens that that protecting interest means the fetus will die, if you abort early.

            But once you’ve reached the stage where you’re massively pregnant and aborting is almost as difficult and risky as giving birth, if not equally so, what interest do you have in killing the baby? Why not cease being pregnant by letting it be born?

          • Ethically, it’s probably not a good call to abort a healthy 7- or 8- month fetus if you yourself are also healthy. I can see situations in which it makes sense and is ethically sound, though those would be few and far between.

            However, the decision to do such a thing must remain in the hands of the woman so affected. I can judge her unethical, but I cannot stop her, and that is as it must be. I honestly don’t have a ton of interest in debating why it might be ethical to abort a healthy late-term fetus. It probably isn’t. It just needs to remain legal. I just don’t find it an interesting question to talk about the ethics of such rare events when such ethical questions have no bearing on what real-world policies I support! I apologize if you want to go further with this, but I really don’t. It’s been a pleasure speaking with you and I hope you stick around.

          • Daleth

            No problem, I totally understand–no need to discuss this to death.

            Just so you know (this is not a debate point at all, just something that you might not know, given your reference to such decisions “remaining” in the hands of women), only seven countries in the world permit abortion on demand after 20 weeks, and generally speaking the countries that do don’t permit it after 24 weeks. Most countries prohibit it after 14 weeks. In other words this decision is not currently in the hands of pregnant women.

            By “abortion on demand” obviously I mean abortions for reasons other than to protect the mother’s health or life, or in some jurisdictions to remove a fetus with a disability that’s either incompatible with life or is otherwise extremely severe.

          • fiftyfifty1

            “What about when the fetus no longer needs the mothers tissue to survive and is a viable entity in itself?”

            You are right, there does come a time in pregnancy when the fetus no longer needs the mother’s tissue to survive and *could be* a viable entity in itself. But until a fetus is no longer in the mother’s body, it IS still relying 100% on the mother and is NOT YET a viable entity in itself. And we don’t yet have a way to “Beam me out Scotty”. Any way OUT involves THROUGH the tissues of the mother. And since the mother has bodily autonomy….

            The law has come down on the side of a woman’s bodily autonomy. Sometimes it ain’t pretty. But the alternative is uglier still.

          • The Computer Ate My Nym

            McFall wouldn’t have needed Shimp’s tissue after the one time.

          • guest1

            Irrelevant.

          • The Computer Ate My Nym

            Why is that irrelevant? Your argument (presuming I didn’t misunderstand it, in which case please correct me) was that pregnancy was different because the fetus didn’t need to keep depending on the pregnant woman forever. So how is this different from McFall who wouldn’t depend on continued marrow from Shimp, but would be able to make his own after the one donation?

          • Guest1

            Mcfall was not trapped inside shimp’s body fully capable of an independent existence.

          • The Computer Ate My Nym

            The wilful killing of a normal term fetus in labour should be illegal.

            Oh? So women in obstructed labor should just die? That is, in fact, the Catholic position, if I understand it correctly: that it is better to allow two people to die when you could have saved one rather than to commit one “murder”. Again, you may think you’re talking about the theoretical woman who suddenly in the middle of pushing demands an abortion instead, but the obstructed labor example is real and it kills. Which should the law respect more: the imaginary case or the real one?

          • Guest1

            Been there, done that. How about watching a normal term baby die in labour because the mother declines an episiotomy?

          • fiftyfifty1

            How about it? Super traumatic. Witnessing this would be incredibly disturbing for any normal person.

            The law has come down on the side of bodily autonomy for the woman. Sometimes the outcome is hideous. Hideous. But the alternative would be worse in my opinion.

          • Who?

            It’s not appropriate to take one person’s decision that leads to a hideous outcome as a signal to make blanket rules about how everyone of that class should in future be treated.

            Either mentally competent adult women can be treated as autonomous individuals, or the unborn can be. Not both.

            I don’t care for rights arguments, because with rights come responsibilities that in my world view aren’t discharged by allowing a child to die inside you for want of well-understood and comparatively straight-forward medical care.

            I also don’t care for a world view where a mentally competent adult can be cut into against their will to benefit another.

            So we compromise and sometimes aren’t happy with the outcome, which is the nature of compromise really.

          • The Computer Ate My Nym

            Yeah, been there, done that. Seen a Jehovah’s witness die because they refused blood. Seen a person go home with curable cancer to take woo and come back screaming in pain with incurable cancer. People are allowed to make bad decisions about their health. It’s horrible and traumatic on the providers but the law and ethics are clear: Consent is key and medical care without consent is assault. (And your patient, presuming you’re talking about a specific case, is a stupid and unethical jerk. But it’s her right to be a stupid and unethical jerk.)

          • Siri

            A quick google tells me that the ‘born alive’ rule states that while you cannot be prosecuted for the murder or manslaughter of an unborn person, if that fetus is born alive and later succumbs to injuries inflicted in utero, such a prosecution can take place. Nothing to do with a presumption of stillbirth, which is in any case a ridiculous suggestion. Not outdated or irrelevant either.

          • guest1

            Sorry,Siri, you will have to do more than google on this one.
            It’s all well documented in legal history.
            Brighter legal minds than yours consider the rule outdated and unjustified. US courts have overruled it and legislated against it.

          • fiftyfifty1

            Since it is so well documented, link to it.

          • Guest

            Ironically, you can start with Lisa Barretts high court casvce and research from there.

          • The Computer Ate My Nym

            What does perinatal mortality have to do with the issue? It’s about bodily autonomy: the fetus is, literally, parasitizing the mother. When it is born it is no longer doing so. That’s a bright line.

          • Guest

            I’m sorry that all the baby is is a parasite but you and the law have chosen birth as your bright line.perinatal mortality has defined that line since 1601.

          • The Computer Ate My Nym

            So when are you going to explain what has changed since 1601 that means that a fetus is no longer being supported by the woman’s body? Until you can do that all your rhetoric is just attempts at distraction and avoiding the point.

          • guest1

            What has changed since 1601? Apart from radical medical advances and changes in legal thinking, not much.

          • Daleth

            ” the fetus is, literally, parasitizing the mother. When it is born it is no longer doing so. That’s a bright line.”

            If you’re 7 months pregnant and don’t want to be parasitized anymore, give birth. If doctors should be able to perform abortions at that stage, surely they ought to be able to induce preterm labor (or do a c-section, per the mother’s preference) instead.

          • The Computer Ate My Nym

            If you’re 7 months pregnant and no longer want to be pregnant then you should end the pregnancy in the way that is best for you. In the vast majority of cases I would expect that to be delivery. In some cases, however, it may not be. Would you tell a woman in rural Sierra Leone who was 7 months pregnant with a transverse lie to “just deliver it”? What about the same woman living in the US with severe eclampsia and DIC? Just have a c-section and bleed to death? Just labor yourself into a stroke? Or maybe have a D and X and survive?

            Cases like that are extremely rare but agonizing for all involved when they do occur. Legal restrictions will only make it harder, physically and psychologically, on all involved. I don’t see the point unless you just want to put women at risk for no reason. Women and the providers who are going to be stuck watching women die and being legally unable to do anything about it. I did that once. Not a pregnancy, a Jehovah’s witness who refused blood. I had to watch him die knowing I could save him but that it would be illegal. That is the most horrible feeling. I wouldn’t wish it on anyone, but the “pro-life” movement would.

          • Daleth

            **Would you tell a woman in rural Sierra Leone who was 7 months pregnant with a transverse lie to “just deliver it”?**

            Of COURSE not. I’m not talking about Sierra Leone, I’m talking about places like the US where women have access to good medical care. By the way, do you think your hypothetical woman in Sierra Leone has access to a safe late-term abortion? No, she doesn’t–she probably has no safe options at all–which helps show why your hypothetical is totally irrelevant to this debate.

            **What about the same woman living in the US with severe eclampsia and DIC? Just have a c-section and bleed to death? Just labor yourself into a stroke? Or maybe have a D and X and survive?**

            As I’ve said in every post where the mother’s health came up, obviously if giving birth threatens her life and abortion doesn’t (or abortion threatens it just a tiny bit less), it would be insane to oppose abortion. I’m not arguing against late-term abortions where they are the only option or clearly the best option for preserving the mother’s life or health.

          • The Computer Ate My Nym

            By the way, do you think your hypothetical woman in Sierra Leone has access to a safe late-term abortion?

            Safe, no. Possibly survivable, yes. Women with obstructed labor in places where c-section is not available are sometimes saved by their attendants cutting up the fetus and removing it bit by bit. Is that gross and horrible? Yes. Is it better than dying? Also yes.

            These are the real cases that occur. Women don’t in general suddenly decide to have an abortion at 28 weeks because they’re bored with pregnancy. They do decide to have abortions because they’re too ill to complete pregnancy. Worrying about the theoretical case of a woman who does decide to abort at 28 weeks because it was there and making laws to prevent her from doing so endangers the women with pregnancy complications or a nonviable fetus. It’s not an intended consequence, but it is a consequence and putting your hands over your ears and saying “la, la,la, I can’t hear you!” won’t stop those deaths from occurring if you pass laws to limit late abortions.

          • Daleth

            I probably failed to make this clear in this exact part of the thread (though I’ve said it more than once in other parts of the thread), but I’m actually not arguing that we should have laws about this. Such laws would be abused by prosecutors and/or would scare doctors into not doing necessary medical procedures.

            All I’m debating is the ethics of it, not the law or what the law should be. (I’m not one of those people who think there should be laws prohibiting everything that’s ethically wrong.) And I can’t imagine saying it’s wrong for the hypothetical Sierra Leone woman with obstructed labor and no safe c-section options to get an abortion to save her life.

          • Daleth

            “women do have the right to have homebirths…. but other people aren’t allowed to lie about how dangerous those choices are nor present themselves as professionals when they are not.”

            That is a GREAT way to put it. That is really the key distinction, isn’t it. I completely agree.

          • The Computer Ate My Nym

            Alas, it’s not obvious. Catholic hospitals will not allow procedures that will kill the fetus, even if it is obviously doomed, to save the mother. See Ireland or El Salvador, for example.

          • Daleth

            Totally true, and totally insane. Apparently Ireland changed its rules in the wake of the death of that poor woman (Savita Halappanavar, http://www.telegraph.co.uk/news/worldnews/europe/ireland/9679840/Pregnant-woman-dies-in-Ireland-after-being-denied-an-abortion.html).

          • fiftyfifty1

            “Well, obviously, if continuing with labor is likely to kill her…[…]..”

            OK, how likely is likely enough? Should we do it like Northern Ireland and decide that the mother has to prove that her life is in “true” danger? That some mothers will die because of this, but that sorry, that’s the price of playing? That men have bodily autonomy no matter what, but that women have to give up their bodily autonomy card when they give up their virginity card?

          • Daleth

            “That men have bodily autonomy no matter what, but that women have to give up their bodily autonomy card when they give up their virginity card?”

            I’ve already said that in this discussion I’m using “a woman’s interest in bodily autonomy” as shorthand for her interest in avoiding the difficulties and risks of pregnancy. So obviously no, men don’t have “bodily autonomy” in that sense because they can’t get pregnant.

          • fiftyfifty1

            Huh? Are you seriously arguing that it is men who have LESS bodily autonomy because they can’t get pregnant? And so therefore it is somehow OK that women have to give up bodily autonomy where pregnancy is concerned.

          • Daleth

            Please pay attention to what I said. I just explained what I mean by “bodily autonomy.” It’s not what you think.

          • fiftyfifty1

            What you said where? Pull out the quote. Because I’m not seeing it in the thread I have before me.

          • Daleth

            In the post you were responding to, right above your post. Second paragraph, where I define what I meant by “a woman’s interest in bodily autonomy.”

          • fiftyfifty1

            Bodily autonomy is bodily autonomy. It is a person’s interest in making decisions about their own bodies. It ought to be equal for men and women. What you seem to be saying is that because only women can get pregnant, we ought to look at it as a special case, a time when the normal considerations of bodily autonomy can be put aside or greatly modified. Kind of like “Thou shalt not Kill” being put aside during war.
            People like yourself seem to be arguing that that is somehow inevitable that the principles of autonomy ought to be different for pregnant women because pregnancy is just naturally “different”. But I argue that the reason we see it as different is that society and religion have said it is different, and we are used to this way of thinking, so we believe it. Women are seen as signing away their right to normal bodily autonomy when they get pregnant. Actually even sooner by some– at the point of having sex. It’s “You made your bed, now go lie down in it” and “What did you expect?” and “You signed up for this, now put up with this”.

          • Daleth

            People like me? You mean pro-choice Pagan feminists who have had abortions?

            BTW as I’ve said a couple of times already on this thread, I would be very leery of laws about this, not just because virtually no one has a late-term abortion for anything but the most serious reasons, but because such laws would either be abused by prosecutors or would scare doctors into not doing what they should to preserve a woman’s life or health. All I’m debating is the ethical question.

            I’m going to stop using the term bodily autonomy as I defined it, and just say it the long way, so that we can get beyond the semantic quibble. What I said is just this: a woman’s interest in not continuing a pregnancy is at its strongest when two things are true: (1) most of the difficulties and risks of pregnancy are still in the future (so by ending it she could completely avoid them), and (2) an abortion is much easier on her body and safer for her health than childbirth.

            Do you see what I mean by “interest”? I’m using that legalistic term because I think it’s important to clarify that no woman actually has an interest in (i.e., something to gain from) her fetus being dead. What we have an interest in is not having to undergo continued pregnancy and childbirth. It so happens that the only way we can protect that interest is to have the fetus removed, which will kill it at any point in roughly the first two-thirds of pregnancy. But we don’t get abortions BECAUSE we want it dead, we get abortions because we don’t want to continue being pregnant or to undergo childbirth.

            I mean, can you think of any reason a pregnant woman would have something to gain by the child not just being out of her body, but actually being dead?

            And that perspective is what leads me to say that except in the most serious cases (e.g., the mother’s health or life is threatened by any of the options other than abortion), a woman’s “interest” in getting an abortion when she’s 7-8 months pregnant is virtually nil… because she has already lost the ability to avoid the risks, discomfort etc. of late pregnancy, and because it is no longer possible for her to avoid the risk, difficulty etc. of getting a large baby from the inside of her body to the outside.

          • Guest1

            I’m talking about when the section is available but declined.

          • Cobalt

            Not quite, but yes, the mother has the right to remove the fetus at any point. Even when in labor. You could argue where exactly the line is; ROM? Descent? Crowning? First shoulder? I would ask an OB and/or a perinatologist for input on where to draw it, they know better than I when one unit becomes two.

            And I don’t feel this way because I think killing a baby as it emerges is acceptable. I think it’s truly horrific. It’s also so incredibly rare for it to be done deliberately by the mother, so impossible to find a doctor that would agree to it without extremely extenuating circumstances, and the negative effects of legislation would be so common and so severe, that it cannot be legislated against without causing much greater harm.

          • Medwife

            There are babies with conditions that would be fatal with vaginal birth. These babies are unlikely to live long after birth anyway, but if the mother refused a c/s, that would be respected (hmm, maybe not at a catholic hospital. Unsure about that.)

          • Cobalt

            I wouldn’t trust a Catholic hospital to respect the mother’s rights. Too many instances of religious dogma trumping medical realities.

          • Medwife

            I work in one and I’d have to agree. If it came to the attention of the ethics committee, I’m pretty sure I’d know the verdict. The question, frankly, is how quiet it can be kept.

          • Daleth

            I disagree, because I don’t think the right to abortion is code for a supposed “right to kill a fetus so long as it’s inside you.” It’s a right to bodily autonomy; in other words, a right not to be forced to undergo the difficulties, risks and pain of pregnancy or childbirth against your will.

            No one has the right to force you to undergo any of that against your will. However, if you’re already undergoing labor, in what possible way could killing the fetus protect your bodily autonomy? You’re going to have to deliver it whether it’s alive or not. It’s too late for you to avoid any of the difficulties, risks or pain of pregnancy and birth.

            So I have to say, no, you don’t have the right to kill a fetus at any time until it’s actually fully outside of your body.

          • Young CC Prof

            How about the right NOT to consent to a c-section, even if the baby is injured or dies as a result?

          • Cobalt

            That reminds me of a case I read about here. An African woman in the U.S. was pregnant with triplets and was unwilling to have a cesarean to protect the babies because of her concerns about subsequent pregnancies and VBAC once she was back in Africa. Everything worked out fine with vaginal delivery, thank goodness, but putting fetal rights over maternal rights would have prevented her making that choice.

          • Cobalt

            I didn’t say you have the right to kill it. I said you have the right to do whatever you want with your body, even if that action results in a bad outcome for the fetus.

          • Guest1

            Surely that includes the right to kill it

          • guest1

            ” And I don’t feel this way because I think killing a baby as it emerges is acceptable. I think it’s truly horrific. It’s also so incredibly rare for it to be done deliberately by the mother…”
            This practise of killing babies during birth became so common in the 1800’s that ‘child destruction’ laws had to be introduced.

          • guest1

            This particular aspect of the law is slowly being taken off the books.
            The assumption is apparently that this simply doesn’t happen any more.

          • Cobalt

            In the 1800’s? Before birth control and early abortion were safe, reliable, and available?

          • guest1

            That’s correct and the ‘born alive rule’ was developed in 1601 when medical care was so bad and fetal deathrates so high, that the baby was presumed to be born dead unless it could be proven to have shown signs of life after being fully expelled from the mother.
            Hardly relevant today with our excellent medical care and almost non-existant deathrate of normal term babies in labour.

          • LibrarianSarah

            I am absolutely in favor of abortion on demand before before viability, and after viability if the fetus or the mother have
            serious health problems (e.g. mom needs cancer treatment or the fetus
            will be severely disabled and the parents don’t feel they can handle
            raising it
            ).

            But don’t you see how that would be ablest? Assuming of course, that by “severely disabled” you don’t mean “incompatible with life” because that would make no sense because if a disability were incompatible with life the whether the parents feel they can handle raising it would be inconsequential.

            If there is a particular point in time prior to birth that a “fetus” becomes a “baby,” you can’t say “but you can totally get an abortion if the kid terns out to be disabled and you don’t think you can handle that.” It is not legally or socially acceptable to smother a severely disabled baby because you don’t feel like you can handle raising it so I don’t see how disability becomes an acceptable “takie backsies” using your logic.

          • Daleth

            Yes, LibrarianSarah, I completely see how that is “ableist”–and perhaps I should mention that I learned this point of view at the knee of my severely handicapped mother, who was born handicapped and yet is 100% in favor of people having the right to abort a baby whose health situation is such that they don’t feel emotionally and financially able to deal with it.

            Her reasoning is basically that parents should not be forced into a situation they don’t feel remotely able or willing to handle, and unlike a healthy or mildly handicapped baby, severely handicapped ones are rarely adopted so that isn’t a realistic option for the parents.

            It’s not like she thinks being handicapped is a curse or that the lives of handicapped people are less valuable; for instance, she’s adamantly opposed to “right to die” laws because she feels they pressure handicapped adults who don’t really want to die to do so in order to stop being a burden on their families.

            It’s just that–and I agree with her–to force people to raise a child they don’t want to raise, or to put it in an institution where it’s basically guaranteed to have a miserable life, is a bad thing. Far better to be aborted than to be raised by parents who don’t want you or to spend your life in an institution.

          • LibrarianSarah

            But how does any of that justify not giving severely handicapped “people” the same amount of protection under the law that you would non-handicapped people. And how do we draw the line where a post-viable fetus is handicapped enough to be aborted? Who get’s to decide that? The parents? The courts? The legislature?

          • Medwife

            When people want an abortion, it’s usually because they don’t feel willing or capable of parenting, regardless of disability status. I think your reasoning is inconsistent.

          • The Computer Ate My Nym

            I don’t think it’s ableist or maybe it is but if it is I don’t really care. I have a disability. Actually, several interlinked disabilities. If these disabilities could have been detected in utero (they couldn’t have been) and my parents had decided that they didn’t want to put up with that crap when they could start fresh and get a healthy baby, I don’t see how that would have been my problem. Now if they’d decided to not vaccinate me to avoid making my social communication disorder worse once I was born and sentient that would have been my problem and that I might have grudged. But not ever being born? How is that different from not ever conceived? I don’t go around worrying that it would have been ableist for my parents to decide not to have sex the night I was conceived (even if they abstained to avoid my neurologically bizarre self). I’m also not that excited about people who abort for the “wrong” gender or whatever else. Yeah, it’s sexist. So what? The way to fight that is not to give women FEWER options.

          • LibrarianSarah

            My problem is that Dyleth said that she was against post-viability abortions with exception of severe disability. If she honestly believes that at some point in pregnancy the fetus becomes a “baby” and is subject to the same amount of legal protection as one, then saying it’s okay to have an abortion when it is disabled is ablest. I personally believe that women should be allowed the right to an abortion on demand but I don’t think it is right to provide special “protection” for post-viable fetuses but revoke it for ones that are “severely disabled.” Either everyone gets legal protection under the law or no one does.

          • The Computer Ate My Nym

            I see your point. Yeah, if you’re going to claim that late fetus=baby and it’s ok to abort a late fetus with a severe disablity then you’re saying that it’s ok to kill a kid or at least a baby with a severe disability.

          • LibrarianSarah

            Right. And the more I think about it you don’t even need to say that at a certain point fetus=baby. You just have to say at a certain point a fetus is entitled to legal protection. If a fetus is entitled to legal protection then said legal protection should apply to all fetuses regardless of their disability status. It is the same thing with people who are against abortion except in the case of rape or incest. If a fetus is entitled to legal protection the fact that it is the product of rape or incest does not void that right.

            The most logically consistent and moral view in my opinion that maternal bodily sovereignty should trump fetal “rights” period. I might find a 7 month abortion morally icky but I find the consequences of making it illegal more morally icky.

          • The Computer Ate My Nym

            I might find a 7 month abortion morally icky but I find the consequences of making it illegal more morally icky.

            I agree. I think Shimp was acting like a jerk, but it was his right to do so and the consequences of preventing him from doing so would be even worse. Same with the mythical or semi-mythical 7 month abortion for no good reasons: not something I’d find morally good, but banning it would have even more dire moral consequences so go for the greater good or at least lesser evil. And who knows what is really going on in situations where someone appears to have an abortion for “no good reason”? Shimp probably had his reasons too (whether I agree with them or not.)

          • Daleth

            LibrarianSarah, I think you may be seeing this in overly black and white terms. The choice is not between seeing the fetus as a baby/person with all the attendant rights, or seeing the fetus as having no rights.

            Or in other words, a woman’s right to an abortion is NOT a right to kill a fetus; it’s a right to bodily autonomy, i.e., the right to decide whether to go through the rigors of pregnancy and childbirth.

            So what there is, is a continuum. At one end–in early pregnancy–the mother has a major, major interest in being able to access an abortion, because the overwhelming majority of the difficulty, risks, and pain of pregnancy and childbirth is still in the future, and she can avoid it by having an abortion. At the same time, the fetus (or embryo if it’s early enough) has zero ability to survive on its own.

            At the other end–as you get later and later in pregnancy–the mother has less and less interest in being able to access an abortion, partly because more and more of the difficulty, risks etc. have already happened, and partly because by that point having an abortion is practically the same for her (in terms of risks, pain etc.) as giving birth. Either way she is basically going to have to deliver the child, alive or dead.

            So since she is going to have to effectively go through childbirth either way, and has already gone through most of pregnancy, what does she have to gain by having an abortion instead of simply giving birth to the kid and giving it up for adoption? Having gone through most of pregnancy, and having to go through a procedure that basically is childbirth, she has hardly any bodily autonomy interests left to protect.

            So by the time you reach that point, her interests are minimal but the fetus now has a major interest in being born (and getting out of her body like she wants it to), because it doesn’t really need to be inside her body anymore; it can live, and do pretty dang well, on its own.

            When the mother’s interest in her bodily autonomy is high and the fetus’s ability to survive outside her is low or nil, sure, abortion should absolutely be safe and legal. But when her interest in her bodily autonomy is minimal for the reasons above, and the fetus’s ability to live outside her is high… I just don’t see why she would still have the right to kill the fetus.

          • Cobalt

            A woman’s interest in bodily autonomy does not decrease on a continuum. It is as high at 40 weeks as it is at 40 days.

            Continuing a pregnancy can create potentially fatal outcome for the mother, even in late pregnancy. And once you allow that preventing maternal death is an acceptable reason to allow the death of a fetus, the question becomes “how imminent does maternal death need to be?” or “how much damage does the mother need to risk to herself before abortion (or any action not in the fetus’ best interests) is allowed?”. Is there a better person to answer these questions than the woman herself?

            Are women to be forced into unwanted surgery for fetal benefit? Should mothers of stillborn babies be investigated for homicide? At what point are women no longer in control of their own bodies, and instead reduced to incubators for the state?

            And exactly how common do you think “frivolous” late abortions are?

          • guest1

            The law implies that your autonomy decreases with increased gestation.

          • Cobalt

            Because of lobbying efforts of those who don’t believe women have bodily autonomy. The consequence ultimately being a loss of rights to medical care, including potentially life saving care, of pregnant women, pregnant women being incarcerated, birth choices being restricted, surgery without consent, etc. Down that road lies oppression of half the world’s population and other madness.

          • Daleth

            If you’re 7-8 months pregnant and continuing the pregnancy is in any way dangerous for the mother, you deliver, obviously. You end the pregnancy. Why is there any need to, in addition to ending the pregnancy, also kill the fetus which at that point could survive just fine on its own?

          • fiftyfifty1

            Yes, it would be rare to be in a situation where a woman would choose to end the pregnancy by having an abortion rather than by having a live birth, but it is possible she might find herself in a situation where that is the best course of action.

            One of my in-laws had an abortion past the point of viability. She developed a very, very severe case of pre-eclampsia very, very quickly. Despite being past the point of viability by dates, her fetus was found to have severe IUGR. She and her doctors discussed options. They could have induced and waited for her to deliver, but felt that taking that amount of time could very possibly kill her, and the fetus would be in grave condition. They could do an immediate CS, but felt that was also too unsafe because her liver, blood and clotting factors were already deteriorating, and a CS remote from term creates a type of uterine scar that is at much higher risk than a normal uterine scar of rupturing during the next pregnancy. So they decided on an abortion, a D&E.

            Why are people without medical training always so sure that they know better than a woman and her doctor what is the best course of action?

          • Cobalt

            The delivery that is safest for the mother is not necessarily safest for the fetus. Putting the fetus above the mother demands the safest delivery method for the fetus, which may kill the mother. This is why the mother comes first, full stop.

            A fetus at 32 to 34 weeks is frequently far from just fine on its own, especially if the mother was sick.

          • Kq

            YOU DO NOT KNOW WHAT IT IS LIKE TO HAVE A LATE TERM ABORTION. Your posturing about what YOU think is irrelevant until you have to walk a mile in those shoes.

          • Roadstergal

            “because we have six solid months in which to decide to abort it or not”

            The problem in the US is that there is a solid and effective lobby trying to make the route from decision to actual abortion so very difficult that viability is hit before the woman can actually have her abortion.

            In an ideal world, yes, a woman should have time to make her decision pre-viability, and to have that decision respected and fulfilled with expedience.

          • theNormalDistribution

            I’m curious. Let’s say a woman who, after six months, decides she does not want to be pregnant. Should she be allowed to deliver the fetus before reaching full term?

          • guest1

            I say yes.

          • Daleth

            In theory, yes, but she’ll be hard pressed to find a doctor willing to purposely make a baby be severely premature. Hippocratic Oath, and all that.

          • Young CC Prof

            Exactly. You have the right to do whatever to yourself, even if it’s harmful, but a doctor has the right and the moral obligation to refuse to help you, and I can’t see any above-board doctor deliberately aborting in the third trimester, or inducing very-early labor, on a normal pregnancy.

            However, outlawing deliberate early delivery opens the door to travesties like legal persecution of women who make any questionable decisions during pregnancy. Or women who go into spontaneous early delivery despite doing everything right.

          • Daleth

            Those are both good points. I think you’re right.

            So given that no ethical doctor would do this anyway, and given your very valid concerns about nutcase prosecutors harassing pregnant or until-recently-pregnant women, would you be opposed to a law that covered doctors rather than pregnant women? In other words, a law that said doctors can’t perform abortions after X point (say, 28 weeks–an important threshold for preemie health) unless ending the pregnancy is necessary to preserve the mother’s health (e.g., preeclampsia or a need for cancer treatment)?

            My guess is that virtually all doctors in that situation would induce or suggest a c-section rather than aborting, but either way the woman’s health would be preserved.

          • Cobalt

            Limiting abortion to only times when life or health of the mother is at stake has been tried, and women end up dead because of it. Doctors end up too afraid of judges, too well defended for erring on the side of not aborting. The law is not sensitive or timely enough to keep pace with individual medical needs in these situations, and women suffer because of it.

            ETA: survival at 28, 30 or even 34 weeks is far from assured, opening another complicated can of worms.

            “Frivolous” late abortions are so rare as to not be worth legislating against, especially considering the unavoidable negative ramifications of any legislation.

          • Daleth

            “”Frivolous” late abortions are so rare as to not be worth legislating against, especially considering the unavoidable negative ramifications of any legislation.”

            With that, I agree. I’m not actually saying anything I say ought to be the law–just debating the ethics of it.

          • SporkParade

            When is viability? The point at which survival is theoretically possible? The point at which nearly 100% of babies delivered can be expected to survive?
            What rights does a fetus have? If a woman wants an abortion (say, because she needs to undergo cancer treatment), will she have to lose precious time arguing her right to it in court? If the woman is a drug addict, will she be arrested for child endangerment? If she eats unpasteurized dairy, gets listeria, and has a miscarriage, will she be charged with manslaughter?
            See, life is much simpler if we go along with my 2,000+ year old legal tradition that says that fetuses are legally limbs of their mothers’ bodies, not people.

          • guest1

            I know it is simpler but legal tradition doesn’t say that universally.

          • SporkParade

            True. Some legal traditions say that personhood begins at conception. In those places, women are sentenced to prison if it is believed their miscarriage might have been purposely induced. Some women even die of sepsis because they cannot abort a fetus that is clearly on its way out. Fortunately, in the US, we only arrest pregnant women for child endangerment so that they can get substandard prenatal care in prison and give birth in shackles.

          • Medwife

            And in some legal traditions a woman can’t accuse a man of rape unless she has a male witness to vouch for her. Not relevant to our legal system in the west.

          • guest1

            I am talking about our legal system in the west.

          • Medwife

            Ah. There was another guest poster who referred to “learned judges around the world”.

          • guest1

            My bad – should have said western world common law countries.

          • Roadstergal

            Our legal system in the west doesn’t do all that stellar a job with rape either. It’s a long haul with little reward to carry a rape charge through, so me and the friends I know who have been raped just go to therapy and let the legal side go. :p

          • That’s pretty much what the law is right now in more liberal areas, and even places that have no restrictions whatsoever, that’s what winds up happening.

            The woman who aborts a healthy fetus at 7 or 8 months even though she’s had access to earlier abortion just doesn’t happen. Ever. It’s about as rare as seeing a unicorn. The only time you see abortion after viability (generally considered around 24 weeks gestation with modern medical care) is if a woman couldn’t access abortion earlier (note this is also illegal in the US) or there is a major medical issue with the woman or the fetus. Late-term abortions are dangerous to the woman, and doctors won’t generally do them without good reason simply because they are not medically advisable.

            That said, abortion on demand at any time (or at least termination of pregnancy) is absolutely critical to women’s rights. Pregnancy is basically a whole-body organ donation: uterus, blood and circulatory system, nutrients such as vitamins and calcium, kidneys to purify fetal waste products, immune system are all involved. We do not force anyone to donate organs or blood to another person, period. Ever. Even if the donee will die without them. Pregnancy is not more special than any other form of organ donation, and should thus legally and ethically be able to be terminated the moment consent to donate has ended.

          • Daleth

            Have you read the unexpurgated diaries of Anais Nin? She aborted a daughter at 7 months, and lied to her husband, saying the reason she went to the doctor (who performed the abortion, and would have performed it earlier if she’d asked) was because she was in labor and having a miscarriage.

            Part of the reason she aborted was because she didn’t know who the father was–she was far from monogamous–and part was because she felt that if she became a mother she would no longer be able to be artistically creative.

            I’m not saying this is even remotely common, but I highly doubt Anais Nin is the only woman who’s ever done it.

            And I do completely understand (and strongly object to) the fact that safe, early abortions are logistically very hard to come by in some parts of the US and in many countries around the world. That’s absolutely wrong, IMHO.

            But I don’t think the organ donation analogy is apt because you’re ALREADY “donating” when you’re pregnant, and changing your mind at 7-8 months is not akin to refusing to donate in the first place; it’s much more like killing the patient who has already received 80% of the stem cells she needs from you, and would survive even now if you simply cut off the supply (though she’d do better if you gave that last 20%).

            Or to look at it another way, abortion at 7-8 months is probably no less dangerous or uncomfortable to the mother than giving birth would be, so what exactly is the mother gaining by aborting then, rather than simply giving birth and giving the kid up for adoption? I just don’t see that she’s gaining anything valuable enough to justify aborting a child who, if she simply gave birth at that point, would almost certainly live and be healthy.

            It’s very different than aborting at 8 or 10 weeks when the real difficulties of pregnancy have barely begun, an abortion is far safer and easier than childbirth, and the fetus is completely incapable of survival outside.

          • The Computer Ate My Nym


            it’s much more like killing the patient who has already received 80% of
            the stem cells she needs from you, and would survive even now if you
            simply cut off the supply (though she’d do better if you gave that last
            20%).

            Know what would happen if you were in the midst of having your stem cells collected for donation and, 80% of the way through, you suddenly said, “I can’t do this any more. Stop it!” Here’s what would happen: The people running the machine would look at you for a minute, ask, “Are you SURE?” then, if you said, “yes” they’d stop it. The recipient does not have the right to your continued donation, no matter how close you are to complete.

            I don’t know what Nin’s situation was, but I doubt she would have gone 7 months and then aborted if she could have had the abortion earlier. The best way to prevent something like that from happening again (if the description is accurate) is to make early abortion readily available.

          • Medwife

            I’ve got an interesting take on that for you- why a woman would be better off aborting than giving the baby up for adoption. Say she’s a drug addict in one of the states with fetal protection laws. Even if she herself sobers up late in pregnancy, the baby’s mec will test positive, and that woman will go to prison. Plus, you’ve got a drug exposed baby who, if mom hasn’t gotten clean, will spend 30 days or so detoxing in a nicu, and then likely bounce around in foster care for years (because we all know how eager people are to adopt drug exposed babies).

            And a lot of those women don’t even figure out they’re pregnant until later, because who’s got time to track her period when she’s got a heroin habit to take care of?

          • EmbraceYourInnerCrone

            Sorry I am a lot more worried about the women who have been arrested for:
            Attempting suicide while pregnant, women survived but miscarried http://www.thegloss.com/2013/04/19/culture/bei-bei-shuai-charged-murder-commit-suicide-while-pregnant/
            Arrested and forcibly hospitalized for refusing bedrest for threatened miscarriage http://abcnews.go.com/Health/florida-court-orders-pregnant-woman-bed-rest-medical/story?id=9561460
            A drugfree woman forced to go to rehab :

            http://www.slate.com/blogs/xx_factor/2013/10/25/alicia_beltran_pregnant_and_drug_free_was_forced_into_a_drug_treatment_program.html

            “She was 14 weeks pregnant and thought she had done the right thing when, at a prenatal checkup, she described a pill addiction the previous year and said she had ended it on her own — something later verified by a urine test. But now an apparently skeptical doctor and a social worker accused her of endangering her unborn child because she had refused to accept their order to start on an anti-addiction drug.
            Ms. Beltran, 28, was taken in shackles before a family court commissioner who, she says, brushed aside her pleas for a lawyer. To her astonishment, the court had already appointed a legal guardian for the fetus.”

            Your rights do NOT end in favor of the fetus just because you are pregnant!

          • Yes. It is analogous to cutting off a donation at 80% done, which is something that is totally legally and ethically allowed. You can withdraw consent at any time.

          • Guest1

            Except that organ donation does not involve an organ that is capable of independent life.

          • I wasn’t aware that a person with blood and organs wasn’t capable of independent life … your comment is a complete non sequitur.

            Person A is a person.
            Person B is a person.
            Person A needs tissue from person B to survive.
            Person B has every legal right to refuse, even if Person A will die.

            It doesn’t matter if Person A is a fetus or a fully fledged human being. Person A has no right to any iota of Person B’s body- not their blood, bone marrow, kidney, liver, uterus, or lung. None of it. If Person B says no, that’s the end of it. At no point has any consideration been given to any organs. Your argument is absurd and makes no sense.

          • Guest1

            Except when person A no longer needs tissue from you to survive, is capable of independent life, but is now trapped in your body.

          • Guest1

            Doctors often refer to the ‘Feto-placental unit’ in a manner similar to an organ.

          • That’s entirely irrelevant.

          • guest

            Only to someone who doesn’t understand the concept.
            You do realise that you referred to the fetus as a person in your scenario don’t you?

          • For the sake of argument, I accept the premise that a fetus is a person. It doesn’t matter, honestly, whether it is or it isn’t. I put sentience as a critical marker of personhood so I do not consider fetii to be people, but whatever. What matters is regardless of whether a fetus is a person or not, it has no right to use the body of another without consent.

          • Guest1

            How should it go about getting the consent?

          • If the woman consents to remain pregnant, it can stay inside her body. Clearly. Obviously. If she doesn’t consent to remain pregnant, out the fetus goes. I don’t understand your question; non-sentient beings can’t ask permission (obviously!) so consent is based solely on the actions and motivations of the consentor.

          • Daleth

            “It doesn’t matter if Person A is a fetus or a fully fledged human being. Person A has no right to any iota of Person B’s body- not their blood, bone marrow, kidney, liver, uterus, or lung. None of it. If Person B says no, that’s the end of it.”

            You’re absolutely right. So if the baby is viable, get the baby out alive. I just don’t understand the argument that a healthy baby that’s, say, 6-8 weeks away from its due date can ethically be killed just because the mother doesn’t want to be pregnant anymore, given that by that point it’s roughly equally hard on the mother’s body to get it out alive vs. not alive, and either option gives her the desired result of not being pregnant anymore.

            Obviously in the rare situation where trying to get it out alive poses a risk to her health not posed by trying to get it out dead, of course her interests should trump the baby’s.

          • Siri

            You don’t know what ‘we’ have – you only know what YOU have. Not every pregnant female shares your privilege.

      • Doctyl

        Nonsense. A fetus is actually it’s own body, reliant on the mother. It’s simple intellectual dishonesty to support terminations-on-demand. The same kind of dishonesty when folks claim that there is a SIGNIFICANT number of terminations performed as a result of rape and incest. In 25 years as a physician, and 100s of pregnant college-age women, I can say it is misused as post-facto contraception, and for convenience, by middle-class kids, to an alarming extent. So, claim all you want, incorrectly, that a fetus is part of the mother (particularly “until it’s…been born,” given the viability after 32 weeks or so). It’s above your education level, but try an embryology text.

        • Medwife

          “Convenience”. Like pregnancy is a mere inconvenience. It’s a life altering, potentially life threatening condition, I don’t care what class the woman is a member of.

        • SW

          For a contrasting anecdote, every one of the abortions I knew of as a social worker for teens in foster care was due to rape or abuse, usually by a family member. The girls who got pregnant with boyfriends usually planned it and carried to term. Data is not the plural of anecdote.

        • Siri

          Well whoopee-doo, what a delightful doctor you must have been for all those pregnant young women! So open-minded and non-judgmental. Did you make sure to tell them they were misusing abortion for their own convenience? Or just try to put obstacles in their way? Those pesky middle-class ‘kids’ having all that dirty sex and then demanding abortions. Thank God for you, eh, Doctor?

        • fiftyfifty1

          So you are indignant that people discuss rape and incest as reasons for abortion, because you don’t believe they make up a “SIGNIFICANT number of terminations”. Instead you would have us believe that the real problem is the epidemic of women aborting near-term fetuses just for fun. Got it.

    • Guestll

      Competing interests, sure. But the rights of the mother are paramount, and a fetus is not a baby.

      • guest1

        You mean the fetus is legally not a “person.”

        • Guestll

          No, that’s not what I meant.

          • gueat1

            That is what the law decided in 1601.

    • CanaDoc

      Well said.

    • *Ahem* McFall v Shimp says otherwise. Your rights to control who uses your body, how, and when are absolute, even if the life, health, and wellbeing of another is at stake. McFall could not compel Shimp to donate bone marrow, even though McFall was going to die without it.

      Relevant quote: “For a society which respects the rights of one individual, to sink its teeth into the jugular vein or neck of one of its members and suck from it sustenance for another member, is revolting to our hard-wrought concepts of jurisprudence. Forceable extraction of living body tissue causes revulsion to the judicial mind. Such would raise the spectre of the swastika and the Inquisition, reminiscent of the horrors this portends.”

      • guest

        That’s a pretty old case, and only tangentially relevant to the rights of a pregnant woman. Not to mention, it’s out of a state common pleas court, meaning almost zero precedential value.

        Which isn’t to comment on the value on the words, but to say that there have been several other cases, directly relevant, and much more recent, that aren’t quite as stringent as to the rights of a woman during pregnancy.

        • It is an old case, but it is absolutely 100% related to the rights of a pregnant woman. If no one has the right “to sink its teeth into the jugular vein or neck of one of its members and suck from it sustenance for another member”, then no one has that right. Period. Fetuses included.

          All women have ever asked is the complete rights to control their bodies that men have been granted, even at the cost of the life of another.

  • Amy Tuteur, MD

    I saw this and thought readers might be interested in participating:

    “Attention women! Please take a few minutes to ensure your viewpoint is heard and counted regarding where you chose (or will choose) to give birth (home, hospital, or birth center). You are invited to participate in an anonymous nationwide survey (for research being conducted at Winthrop University) regarding “Mothers’ Views on Birthplace.” Please share with your friends and acquaintances. https://winthrop.qualtrics.com/SE/?SID=SV_88EWOAxThRoW8Xb

    • Paula

      Submitted, thanks. It will be interesting to see the results when they are collated.

    • Sue

      Leigh Fransen is a LM. Her supervisor is a psychology academic.

      • An Actual Attorney

        Those questions were such good examples of presupposing the answers. The midwifery equivalent of “when did you stop beating your wife?”

      • Trixie

        She was the founder of the Fort Mill SC birth center that’s been in the news lately, although she left before the deaths occurred.

    • Daleth

      Thank you! Done.

    • ersmom

      Done.

    • anon

      Can anyone find contact info about the Human Subjects Review Board at this university? Even this website does not have contact info. Most reputable studies require listing of full human subjects contact and approval info on the study itself. I clicked through to the study and could not find such info. Its very, very clear from the study that this study is deeply unethical so I will be contacting the president of this university to write complaint. Can someone post this on that Cornell guy’s social media?

  • Tosca

    They want licensing? I’d give it to them. Licenses have conditions, don’t they? Make it a condition of holding a license that ALL homebirth midwives (CNM and CPM):
    – have malpractice insurance
    – have written protocols for when to transfer (which must be disclosed to the clients in the first consultation)
    – have a transfer arrangement with an appropriate hospital
    – follow strict risking out protocols, which are set by an independent body with medical advice.
    – provide prospective clients with a document (set by the independent body) during the first consultation. This explains, in layman’s terms, the increased risk of fetal and maternal mortality and morbidity in homebirth.
    – are subject to the authority of the independent body. It deals with complaints and assesses negligence. It has the power to place midwives on probation, order they only work under supervision, suspend and disqualify licenses.
    – working as an unlicensed homebirth midwife (with or without fees) would be subject to criminal sanctions. I mean, can you imagine if untrained, unqualified people just walked around setting themselves up as medical professionals and charging for dangerous, incompetent services that kill babies?

    Oh, I’d give them licensing…

    • Elizabeth A

      …and that there is why CPMs so often *don’t* want licensing. They don’t want to adhere to any standards at all.

      • The Bofa on the Sofa

        Remember when the ACNM suggested creating some homebirth risk standards, based on the common minimum requirements from a bunch of international places – you know, the ones that homebirth midwives always point to for the safety of homebirths?

        And the membership balked at them? These were the CNMs – the supposed good midwives. And they wouldn’t accept risking out standards of their beloved international colleagues!

        • Medwife

          That is horrendous. Just to add- the cnms polled were attending homebirths. It’s telling in regards to CNMs who attend home birth, but not cnms in general.

          • Young CC Prof

            The CDC data clearly show that homebirth CNMs are just as bad as other midwives. They are just as likely to take on risky situations such as twins, prematurity or postmaturity, and they have just as many bad outcomes. It’s not a condemnation of CNMs, but of the small percentage of them who have chosen to do home births in a health system that doesn’t establish appropriate safety measures.

        • CrownedMedwife

          If I review my birth logs, from the last several months especially, I’m fairly certain the majority of births had a preexisting risk factor or later developed a risk factor precluding homebirth and isolated CNM care in general.

          As we’ve established previously, I’ve never attended a HB and have no desire to ever practice in a HB setting. If I were a HB CNM in my community setting, I’d have to risk practically everyone out. Perhaps that’s a portion of why ACNM HB CNMs balked at setting risk standards for HB. As CNMs they have the background to identify risk factors, but are too swept thru the woo to be able to acknowledge that those mothers are best managed with collaborative management and a hospital setting.

          • The Bofa on the Sofa

            If I were a HB CNM in my community setting, I’d have to risk practically everyone out.

            This is clearly hyperbolic, because we are only talking about the common minimum standards used internationally, and it doesn’t prevent those midwives from doing homebirths.

          • CrownedMedwife

            Perhaps I didn’t make it clear enough, as it seems you’ve missed my entire point. I am not as familiar with the precise standards accepted internationally and perhaps my definition of risk factors (and therefore risking out of HB) is more extensive than those minimum standards. However, there is nothing hyperbolic in my statement. The majority of my patients present with a preexisting risk of HTN, DM, Obesity, Twins, AMA, Grand Multiparity and previous CS or PPH. Add in a later diagnosis of Preeclampsia, GDM, IUGR or Oligohydramnios and it pretty much sums up my patient population.

            Not hyperbolic. Just a CNM identifying risk in an at-risk population. Perhaps you can correct the above risk factors I’ve provided if in your view it doesn’t meet international minimum standards. In the meantime, a risk is a risk.

          • The Bofa on the Sofa

            I don’t doubt that your personal standards are higher than the international minimum standards, but what does that have to do with your statement

            If I were a HB CNM in my community setting, I’d have to risk practically everyone out. Perhaps that’s a portion of why ACNM HB CNMs balked at setting risk standards for HB.

            If you have standards that exceed those of the proposed minimum, why balk? The proposed minimum would only apply to those who don’t have them, so have no bearing on people whose standards are higher.

          • CrownedMedwife

            I wouldn’t balk.I’m the last person who would balk. We’ve had this discussion before and you’ve mentioned your dislike of the term ‘collaboration’, but that collaborative practice environment is one in which midwifery exists best. I don’t have anything to prove and am not some rogue midwife who practices in isolation or uses naturopaths or chiropractors as colleagues.

            I would like nothing more than to see to explicit regulations regarding eligibility for HB CNMs. My original point to be made was that CNMs attending Homebirths and polled by ACNM would balk at establishing minimum standards. As CNMs they have a background education (unlike CPMs) that enables them to identify and diagnose the minimum risk factors used internationally. They do not want to use risks/minimum standards because they are swept into the woo of NCB, want to maintain their client base and, as we have seen time and time again, choose to ignore the risk factors in order to value experience over outcome. I WANT those patients risked out.

            Hyperbolic, no. Loquacious, yes.

          • The Bofa on the Sofa

            I still don’t understand your point.

            They do not want to use risks/minimum standards because they are swept
            into the woo of NCB, want to maintain their client base and, as we have
            seen time and time again, choose to ignore the risk factors

            I agree with this, but that is not what you said above,

            If I were a HB CNM in my community setting, I’d have to risk practically
            everyone out. Perhaps that’s a portion of why ACNM HB CNMs balked at
            setting risk standards for HB.

            which I interpret as suggesting that a reason why ACNM HB CNMs balked is because it would mean they would “risk practically everyone out.”

            As I noted, that clearly would not be the case, because international midwives who utilize those standards DON’T risk out “practically everyone.”

          • CrownedMedwife

            There are risk factors in pregnancy and birth that risk out women. In my practice, many to most pregnancies have risk factors. If I were a HB CNM, I would have to risk the majority out if standards existed. Agreed?

            My point is that US Homebirth CNMs would, of course, balk at minimum standards if that meant they couldn’t continue to practice Homebirth midwifery with a population laden with risk factors. I am not saying they should be able to practice without minimum standards, I am saying it’s obvious they would reject it.

            You’re going back to your initial complaint of hyperbole in concluding “practically everyone”. That point really seems to bother you, but it really has little to do with the fact that we are both agreeing there are no standards for CNMs attending Homebirths in the US and standards are necessary. We both agree CNMs balked at establishing guidelines. My contribution was that there are a lot women with risk factors, risk factors that should risk them out of Homebirth.

            Obviously there are midwives attending births internationally using minimum standards to risk out and while they may not risk “practically everyone” out, a significant portion of my population would be or should be risked out.

            If you can provide some direction as to where these ‘minimum standards’ exist, I would be interested as to how they compare to the earlier post with common risks factors in my particular population.

          • Back in 1975, it wasn’t easy, in the Cambridge area, which is quite large, to find enough women who were suitable for home birth for a class of 20 student midwives to achieve their necessary minimum of homebirths to satisfy the requirements for the Central Midwives Board to be allowed to proceed to the oral and written exams to become State Certified Midwives [the British equivalent of CNM]. During a year’s course, open to registered nurses only, we had to deliver 50 babies in hospital, and 10 at home.
            The reason was quite simple: among other criteria, ANY medical or obstetrical problem in the current or previous pregnancies ruled out home birth. One low hemoglobin in a blood count could disqualify a patient.

          • CrownedMedwife

            I can only imagine how difficult it would be now if a single low Hgb risked a patient out then. I have never seen so many women diagnosed and treated for DMII and Chronic HTN during the onset of prenatal care as I do now.

          • Medwife

            Well, I for one hear what you’re saying. I have a sadly unhealthy community. Many/most of the women of childbearing age have some major risk factor risking them out of homebirth, and the healthy, better off women are having their first child at 35 and older 🙂 which I don’t think risks them out of any local homebirth practice, of course. Why would it, they’re the ones most likely to afford it.

          • CrownedMedwife

            I’m glad my point was able to come across as I was beginning to wonder if my cold medicine was making me daft. It is a frustrating state of affairs, trying to balance a population with multiple risk factors who are more likely to be eligible for a perinatology consult than a homebirth. As you know, it is a careful balance attempting to maintain the normalcy of prenatal care, while addressing the risk factors without coming across as fearmongering.

          • fiftyfifty1

            I understand what you are saying. In the Netherlands, a country with an arguably healthier population than our own, about 50% of women who want homebirth are risked out. These are presumably women who thought themselves to be health conscious and “low risk”, but find out they are not.
            I think what you are saying is that some homebirth midwives practice in populations with a high risk profile and they would lose so much of their business if they had to rule out that they couldn’t make a living. So they let $$$ cloud their vision and corrupt their ethics.
            What worried me, however, is that the ACNM rejected even *minimal* standards (e.g. no breech, twins or VBAC) and that this rejection of standards was pretty universal. There are midwives out there in the US who have low-risk or normal-risk populations to work with (after all, the average homebirthing woman in the US is still lower risk than the average hospital birthing woman). But even the CNMs with low risk populations rejected standards. It’s not just the $$$ driving them to reject standards, more than that it’s the cult ideology.

          • CrownedMedwife

            Late to respond, it’s just been one of those weeks.

            Agreed HB midwives appear to be more driven by the cult ideology and seem to rationalize their actions or at-risk mothers by various mantras geared towards trusting birth and natural is safe.

            It does more than worry me, but little to surprise me, in that the ACNM has not only not established, but has even rejected the development of homebirth guidelines. Failing to identify even the most minimal risk out guidelines, as you have listed (breech, twins, VBACs) does little to reassure me of their priorities. A few weeks or months back, I believe you posted a suggested list to risk-out criteria for Minnesota. I had a few more criteria to add to the original list, but all in all it was a practical risk out guide for homebirth candidates. If it’s a simple enough task to identify women who are not homebirth candidates based on what conditions or factors encompass a higher risk, why wouldn’t a professional organization see it as their responsibility to provide that guidance to it’s members and to improve birth outcomes? The question is rhetorical as it is obviously ideologically driven. Ideology is the only logical conclusion when a professional organization claims it is committed to the health of women and infants, but can so easily ignore the vast amount of data available identifying risk factors and failing to establish such criteria.

        • MWguest

          No I don’t remember this.

          “The membership” of the ACNM?
          Really?

          I remember it being a small sample of CNMs who attended homebirths who held this opinion.

          Maybe we should cite this source and freshen up our memories before asserting that “the membership” of the ACNM (most of whom work in hospital-based practices and collaborate with physicians) rejects risking out standards for home birth.

    • Daleth

      I’d vote for that today, if it were possible.

    • That’s exactly it. They want to legitimize themselves without accepting legal culpability.

  • JJ

    This is why I am having my 4th baby at the hospital instead of at home like my last 3 babies, even though I am an extremely low-risk patient. If I had known the truth I would have NEVER had my children at home. I am so thankful nothing went wrong. This information must get out. Sure there will be mothers who still choose home but at least let’s have informed consent!

  • Guesteleh

    Did you notice that the only post that didn’t get a single comment was Grunebaum’s? He’s the lead author of the papers demonstrating drastically worse outcomes at homebirth so of course no one will address him directly.

    • Kq

      He’s not “safe” to engage with, because he will absolutely participate in the comments

      • Trixie

        Oh please oh please oh please I wanna watch that go down.

        • Guesteleh

          He’s commented in some of the other threads.

          • Trixie

            Darn, I need to clone myself just so I have time for everything on the internet.

  • SarahSD

    Once, when my baby was only a few weeks old, I forgot to buckle her into her infant seat (we had been walking around a shopping center with her in the stroller/infant seat, and I must have taken her out at several points to hold and nurse her). When we got home (after driving at high speeds on the freeway!) and I took her out, I was absolutely horrified at my mistake and the risk that we had taken. This was at exactly the same time that I was still feeling ruffled and pissed off about the interventions we had undergone during her hospital birth. It is so important to figure out why risk is perceived so differently in these two situations.

    • Elizabeth A

      I had a similar experience – both the forgetting to fasten the carseat straps, and the being furious at the hospital for interventions.

      I suspect that car accidents are just a more comprehensible risk to most of us than obstetrical injuries, and maternal and neonatal mortality. We can clearly see the preventive strategy that would make a difference in a car accident, but very few of us can as readily identify indicators of serious obstetrical danger (many of which require special monitoring equipment to even be aware of), or speak to how those dangers should most effectively be addressed. Additionally, for thousands of years, people had no choice but to accept that some babies and some mothers die during birth, and that attitude lingers – hideously – in some of the things that homebirth midwives and NCB proponents still say.

      • KarenJJ

        Plus car accidents are more frequent than birth deaths and injuries in our society, partly because car trips are more frequent (I’ve given birth twice in my life and drive a car typically at least twice a day). We probably all know someone that was injured or killed in a car accident.

        • Sue

          The difference, though, is that we don’t have a culture that values freedom to move around the vehicle while driving. There is no myth of naturalism that makes you an earth mother for risking your child’s death in traffic.

      • Elaine

        Also, it’s not such a big deal to buckle your baby into a car seat. It’s a routine thing that only takes a minute or two. A birth is a big life event that only occurs a few times and people understandably want to have it be as much to their satisfaction as possible.

        • Young CC Prof

          When your baby is a toddler who wants to hug instead and can dodge faster than you can buckle, trust me, it’s not such a small matter! (Still needs doing, though.)

    • fiftyfifty1

      “It is so important to figure out why risk is perceived so differently in these two situations.”
      The majority of mothers DON’T perceive these differently. Only the ones who have drank the NCB Koolaid.

      • SarahSD

        Having been one of those mothers, I don’t think the Kool-aid itself is the only important factor. Why did I drink it in the first place? What made its effects stick? There is something about birth in itself, and about birth in N. America in particular, which makes the Kool-Aid appealing. Part of it might be the control that it promises to give the mother in a scary and vulnerable situation.

        • EmbraceYourInnerCrone

          I think part of the problem is that we are victims of our own success, similar to what has happened with vaccines/antivax. As obstetric medicine got better, fewer people know anyone who lost a fullterm baby in childbirth and even fewer know of any (relatively healthy)mothers who died in childbirth.
          Most women in their 20’s that I know have no idea of all the things that can go wrong, REALLY quickly: My great grandmother died at home delivering her 2nd child(PPH) she was 20, my grandmother lost her 3rd child born at home in 1928, at birth due to RH incompatibility. My mother nearly bled to death delivering her 3rd child in 1966 (placenta previa/transverse lie) YAY emergency CS, I still have my mom and my baby brother). My sisters 3rd had a nuchal cord, but he was born in a university hospital L&D with expert OBs and LD nurses, so he’s fine.

          • Anyone who has an old family Bible of the sort which has space for the recording of births and deaths and has entries going back a number of generations will have noted that many of the men in the family married more than once, first and even second wives having died in childbirth or shortly thereafter. There will also be a surprising number of dead babies and children recorded. We forget so easily what life was like, especially for women, before anesthesia and antibiotics.

          • Daleth

            You’re right. I’m completely paranoid and even I didn’t know all that could go wrong.

            As it turned out I had two complications–hypovolemic shock during recovery, and a few days later an ileus that was misdiagnosed for a couple of days. In the past two-three weeks I’ve seen news stories about two women who DIED from those complications (one 36yo mom of quads who died of hypovolemic shock, and that 56-ish mom of twins who died of an undiagnosed intestinal blockage). Holy shit! I’m so lucky! Yay major medical institution where I gave birth!

  • Ash

    From the NYTimes comments section

    “(And increasingly obstetricians have *less* training now in techniques
    such as vaginal breech delivery, forceps delivery, VBAC . . .)”

    1) If there was a clinical trial conducted in which a physician discussed the potential risks and benefits of an attempt for vaginal breech delivery in a population of near-term women with breech presentation, how many women would REALLY be interested in a trial of labor with a breech presentation? Sure, the experience that OBGYNs have with piper forceps and Dührssen incisions have decreased because of the INCREASED safety of c-sections.

    2) Again, same issue with forceps deliveries. Forceps will always remain useful, but do women WANT to trade a c-section for forceps, especially considering the relatively small families of most USA women?

    3) VBAC. Probably the best predictor of successful VBACs are 1) carefully selected women 2) an operating room that is assured to be available within less than 5 minutes notice 3) anesthesiologist available and in house. That’s a lot of the “technique” right there.

    • toni

      I had to look up ‘Dührssen incision’. ermahgerd

      • Ash

        makes you reflexively cross your legs, doesn’t it?

        • Anj Fabian

          More like makes me afraid to stand up. That’s done way up in the pelvis.

      • Haelmoon

        I had to use them this week – never trained but understood the concept. A grand multiple showed up delivering a footling breech at term – not a lot of safe options. Head was entraped in the cervix. Baby and mom are well, but it was a stressful delivery. We don’t have to do lots of deliveries to know that breeches can be complicated. I am trained how to deliver them, I practice manouvers at each breech c-section and twins where the second one is breech. I don’t need to encourage more vaginal breechs to understand what needs to be done. I still recommend an elective cection, but we will always be ready for emergencies. The woo-types think this was aweseome, I think it was the lesser of two risks – mom would have needed a general aneasethisia for c-section and had four vaginal deliveries – proven pelvis, baby was two weeks earlier than previous and she always had rapid second stages. If she was a primip, I would have counselled her quickly for an emergency c-section. There is way more nuance to obstetrics than the lay-type midwives understand. It is never black and white, we, as obs individualize care way more than we are given credit for. Way more than they do!!

        • Medwife

          That is exactly what happened at my hospital a couple months ago. Our footling breach happened not to get entrapped but it’s so thoroughly luck of the draw. I wasn’t there but had a sympathetic weak knee response when I heard the story. The OB that day earned some street cred 🙂

          • Guestll

            My husband was a footling with a prolapsed cord (second twin). Birth mother showed up at the hospital pushing, was dropped off at the ER by the man who may or may not have been the biological father. Zero antenatal care, smoker, prematurity, previous classical incision. My husband was born without vital signs and his birth mother died, which is why my husband and his twin are adopted.

            My mother was an L+D nurse, beginning in 1963. Her least favourite delivery was vaginal breech, by far. And this was with “old-timers” who knew what they were doing.

          • Somewhereinthemiddle

            Wow, just WOW. Did you guys ever find out her cause of death?

          • Guestll

            Yes, PPH. My late father-in-law (pediatrician) actually worked at the hospital. Long story. She basically bled to death. 6 previous pregnancies, she was 42, in poor health, the list goes on. Sad story, but it ended well for my husband and brother-in-law.

          • Somewhereinthemiddle

            That is so sad… Gald it turned out well for your husband though.

          • Medwife

            Now that is a rough way to enter the world. They worked hard for your husband that night!

          • Guestll

            Yep. My mother looked at my husband’s hospital records (we keep them with his adoption papers) a few years back. She’s pretty blunt. “What a complete bollocks, but that was nice work.”

          • Guestll

            The amazing thing to me as a layperson is, the first baby came out, no drama, totally fine. The second was a disaster. It just goes to show (not that you don’t already know this firsthand) how quickly things can go bad during a birth.

        • Ash

          Many more tools at your disposal than a lay midwife. Plus you don’t lie about what you’re doing (“Calling to Courtroom”, hello!)

        • Somewhereinthemiddle

          Wow, that must have been super stressful! What is the prognosis for future pregnancies for a patient who has undergone a Duhrssen incision? I’m assuming there is a high probability of cervical incompetence but have zero basis for that assumption.

          • Haelmoon

            I felt like I had made a big cut, but once the baby was out, the cerivx just needed a figure of 8 stitich. It was just enough to let me get my hands in (same as the episiotomy) and flex the head. Things move forward after and I don’t think it would have a significant effect next time. Mind you, I would in a centre where we screen all pregnancies with a cervical length assessment at 18 weeks, so if there were concerns, hopefully we would be able to help save the pregnancy.
            For my complicated c-sections with cervical extensions (full thickness cervical damage, often in the setting of an obstructed labour), I examine them all at 6 weeks postpartum, 12 weeks in the next pregnancy and a cervical length ultrasound at 16 weeks, screening for trauma induced cervical incompetence.
            **edited for my poor typing post-call**

          • Somewhereinthemiddle

            Yeah, I would think it would be necessary to watch those with injuries to the cervix pretty closely in future pregnancies. I guess once the cervix and effacement are close to complete, the incision would end up being pretty small? I find this stuff so fascinating!

        • Wren

          My first was a surprise footling breech. He flipped at turn from head down to feet down. Luckily the midwife (UK hospital midwife) figured out he was not actually head down and a scan quickly confirmed he wanted to come out feet first.

          After my c-section I had a few lovely women on mothering.com (yeah, I was kinda into the woo then) tell me that I should never have given in to a c-section and I totally could have delivered him just fine vaginally. That was probably my first wake up call to the woo. Some woman actually berated me for choosing the obviously safer option. Just imagining what could have happened to my baby…hearing about any vaginal footling breech delivery scares me.

        • fiftyfifty1

          Nice work. Hats off to your quick thinking and decisive action. Glad all are well. I’m sure it scared the crap out of everybody.

    • jhr

      In the 1970s, after my membranes spontaneously ruptured, I delivered a 7 pound frank breech without anesthetic in a teaching hospital. There was no monitoring, but there was an x-ray to determine whether a vaginal birth was technically even possible–“pelvimentry”.
      At the time, I begged for a C-section but was not given the option, as my OB had trained to deliver breeches and all was proceeding medically. Nowadays I probably would be given a C-section without question. And hooray for that!

      • Mac Sherbert

        After I had my breech baby (by c-section) my neighbor told me about her experience giving birth to a breech baby in the late 60’s- early 70’s. She said it was horrible and that she begged them to just do a c-section and that nurse told her they didn’t do those for convenience. She thought my generation had it made now that they will do c-sections for that!

        • toni

          convenience?! yes head entrapment is so inconvenient..

      • momofone

        That sounds very much like my birth. My mother was told that she would not be able to have more children due to the damage my delivery caused. (She did, but said delivering my very large, head-first brother was much easier.) I wish she’d been able to have a c-section–mine was wonderful!

        • Mac Sherbert

          My MIL had a similar experience as your mom. Her first was breech and the doc told her husband during the delivery that if he didn’t get baby out in xyz they would both die. Anyway, her other two babies were nine pounders and she said they were easy compared to her 5 pound breech baby. She also said that years later a doc asked her who had done that to her when he saw the damage. (My baby was a surprise breech and she was clearly panicked at the hospital until she realized they were sending me to the OR.)

          • Young CC Prof

            5 pound breech. Now I’m imagining a long, skinny big headed baby, like my 5-pound breech. Skinny babies are at increased risk of head entrapment in breech birth, just like a fat body increases the risk of shoulder dystocia in vertex babies.

            I am really really glad we had a prelabor c-section. In those developed countries where vaginal breech is still done, measuring large or small is a contraindication.

          • Mac Sherbert

            I think the baby came early. So not a full-term breech baby at 5 lbs. No pictures so I can’t say for sure how big the head was…but my husband’s family does tend to have large heads. My breech baby did in fact have a large head and I’ve always thought a breech birth would have been very very bad with him.

      • Jen

        My MIL delivered twins vaginally in the early 90s – they were babies five and six for her. Twin #1 was breech and my MIL got to know the midwife caring for her *very* well as the midwife spent hours holding Twin #1 in (not sure of the exact reason why).

        It wasn’t even that long ago – and I’m still amazed that she wasn’t just given a c-section – but it was a small country hospital.

        • attitude devant

          Please don’t tell me that Twin A was breech and B was vertex. Please tell me the midwife was not foolish enough to try that one on.

        • Medwife

          Holding her in? Was this maybe waiting for an OB to come in? Maybe cord prolapse? Face presentation? I’m a little at a loss.

    • Elizabeth A

      A few years ago, I watched a woman on a message board cheerfully explain that she felt that she was better off at home, with a midwife well-versed in older techniques like symphisiotomy, than she would be in a hospital, with a cut-happy OB. I have no IDEA where this woman got her information about symphisiotomy – I would personally vastly prefer a c-section. Or several.

      My son was delivered by vacuum, after a prolonged pushing phase. I suffered rather unsurprising vaginal, labial, and perineal tearing as a result of delivery, but, at the time, I was grateful to have avoided a c-section. Years later, I was shocked to discover how much *less* I minded my small abdominal scar than the mess that my son’s birth made of some extremely sensitive and personally important parts.

      • Medwife

        SYMPHYSIOTOMY?!! Oh no. Surely she didn’t understand what that is?

        • Elizabeth A

          I can only imagine that she had no idea.

        • Nick Sanders

          I just looked them up. I am now horrified.

          • momofone

            I could hardly read past the first line. Give me a c-section any day.

          • Nick Sanders

            I skimmed the wikipedia article and just went into total “NOPE” mode. Not to be rude to all the women here, but I am beyond glad I don’t have to personally worry about all this stuff.

          • Elizabeth A

            I am pretty okay with not feeling insulted that other people are glad they don’t have to worry about awful obstetrical procedures. In a perfect world, none of us would have to worry about them.

        • Amazed

          Why should she? It sounds like a medical procedure. When I first tried to look it up, all I got was that it was barbarity, despite being a medical procedure. I didn’t try to look it up a second time. But I’m absolutely sure that if someone I’m supposed to trust, a medical professional, describes it as a medical procedure, I’ll take their word for it. I might later google-check it but at the moment, I’ll take their word. And if I don’t check? What then?

          Plus, it sounds a lot like symphony and nothing sounding like symphony can be this bad, in my mind, Totally stupid, I know.

          • Roadstergal

            If the midwife calmly and assuringly sold it as a medical procedure to be able to safely deliver vaginally and avoid the dreaded C-section, I could see the person who wants to believe the perfect C-section-avoidance procedure exists just rolling with it.

            I first came across it in the context of the ones that were forced on Irish women being cared for by Catholic providers, and it was one of the more deeply horrifying things I’ve read about.

          • Amazed

            I found it in the same book that first mentioned the Magdaline’s Laundries. The laundries, I got immediately. I remembered them for months later, details and all. But with symphosiotomy – that searched in Google – I couldn’t describe it adequately. I just got the general impression of butchery. I simply don’t have the knowledge base to undestand it fully, let alone memorize it. I can totally see why women who look up to their midwives wouldn’t understand it. It’s all in the context.

          • nomofear
          • Amy M

            Oh god, I remember reading one last year, where they interviewed victims of this and I was so nauseated I couldn’t finish it. I’m not clicking on that link, I know what it is…those poor women…

          • prudent planner

            In the cases where it’s really needed, with proper after-care, I am not sure it’s so barbaric. I know about the Irish cases (complete mis-use without necessary aftercare), but the supporting literature when the procedure was developed (like 1880’s or something) tells a moving story.

            I am not sure where/when a symphysiotomy would be needed in the first world, but it’s a tool that can still save a birth gone wrong (in the third world? maybe. In a woo soaked Oregon birth yurt – 50 miles from a hospital with an entrapped after coming fetal head… I don’t know).

          • Amazed

            But it isn’t the 1880s now. And as far as I can tell, it’s always barbaric. The thing is, it might be necessary barbarity in the third world. But to present it as an option that’s superior to C-section in a first world country, in 2010s… give me a break. That should be criminal. That’s UNinformed consent. Choice rape.

          • Prudent planner

            Yes. I completely agree that a planned c section is better in every way. I was so horrified when I first read about it. To cope with my horror, I spent some time reading about the development of the procedure and it’s uses when c section is not possible (“hospitals” without anesthesia/antibiotics) . And I felt at least a tiny bit better, understanding the circumstances when it might be used.

          • Amazed

            It was clearly invented out of need. But operating on patients who were unmedicated also arose out of need – to save their lives. Doesn’t make it a tiny bit better if someone presents unmedicated surgery as superior to medicated one nowadays.

            It might be a useful last resort. But the primary plan because home and homey… gag.

      • FEDUP MD

        Dear Lord. I had a bad diastasis symphisis pubis with my pregnancies and essentially self-separated it badly stepping off a curb late in my second pregnancy, turning it from just painful to excruciating. I couldn’t even walk and was crawling. I can’t imagine actually doing something worse than that on purpose. I had two c-sections and the OBs were always asking about my post op pain. Having my abdomen cut open was orders of magnitude less painful than the pain I was in from my diastasis.

    • KeeperOfTheBooks

      Exactly.
      1) My OB is *the* NCB/VBAC doc in my city. You know what? As soon as we saw that DD had flipped breech and wasn’t a candidate for an ECV, he immediately went to C-section. Period. And I, though I was fairly deep in the woo at the time, agreed 100%. I was never comfortable with the idea of vaginal breech birth.
      2) Yep. I want a bigger family by American standards–say, around 6-8 kids or thereabouts–but not so much as to take on the risks that come with forceps deliveries.
      3) Once more, yep. I’ll probably try for a VBAC with the next kid if the situation cooperates, but only in a hospital with those parameters. I have several friends who are deep into the NCB woo, and they keep telling me “but you’re more likely to get your VBAC if you birth at home!” Never mind that baby and I are also more likely to die, don’tyaknow–how I have the baby is so much more important than little details like that! *rolls eyes*

    • Sue

      Very pertinent point.

      In my practice, very few trainees are experienced in doing medical procedures “blindly”, because we now have ready access to bedside ultrasound.

      So, being de-skilled in something that has been superceded by something safer is actually a good thing.

    • Elaine

      I have definitely heard this “lost arts of midwifery” thing a lot from my woo-tastic friends. A lot of women really want to avoid a c/s. I feel like I can relate to this, even though intellectually I know that forceps and vacuum etc. can cause major problems, viscerally I don’t *feel* it while I *feel* resistant to the idea of being cut open. I think that may be part of the problem; women are having an emotional reaction to the idea of a c/s and they think anything is preferable–unassisted birth, prolonged labor sans epidural, forceps, shoulder dystocia which can be “easily” resolved by the Gaskin maneuver, etc. Patients acting out of emotion/instinct rather than reason/logic is a common phenomenon that medical professionals have to be trained to react properly to. The “c/s is no big deal” narrative alienates some people… what discussion of c/s would bring these people around?

      • Daleth

        I was steeped in the woo too. What brought me around was (1) my babies’ safety and (2) reading about the risks of vaginal birth in the book “Choosing Cesarean: A Natural Birth Plan.”*

        I actually asked one of my doctors, when he was explaining that the legal requirement of informed consent was why the other doctors kept trying to scare me by listing the risks of c-section, whether there was also a requirement that they inform us of the risks of vaginal birth. He said they didn’t, in a tone that suggested he agreed that describing the risks of option A but not the risks of option B wasn’t fair or honest.

        So long story short, I think a clear understanding of the risks of VB is important. Then you have something to weigh CS against. Without that, most people’s impression is that the options are either a long and painful but worthwhile and essentially risk-free natural labor, or quote-unquote “major surgery.” (I use air quotes there because a 30-minute procedure performed while you’re wide awake with only regional anesthesia is about as un-major as major surgery can be).

        * http://www.amazon.com/Choosing-Cesarean-Natural-Birth-Plan/dp/1616145110#

      • Daleth

        It’s funny, Elaine… those “lost arts of midwifery” must have been lost a really long time ago–as in a couple thousand years, before people started keeping written records describing childbirth–because otherwise there is a VERY STRANGE correlation between “the times when people practiced the lost arts of midwifery” and “the times when hordes of women and babies died in childbirth.”

    • The Computer Ate My Nym

      do women WANT to trade a c-section for forceps

      Ouch! No! Thanks, but no! N of 1 here, but ouch, ouch, ouch!

      • Medwife

        No, no, no. Unless it was maybe life saving outlet forceps. If I have a choice, c/s all the way.

      • Daleth

        Seriously! Not a chance! That’s one of the reasons I opted for a c-section, against my doctors’ almost coercive efforts to persuade me to do a TOL. As I told them, if someone comes near me with forceps while I’m in labor, I will kick them in the teeth, so let’s just schedule a c-section okay???

        • Dr Kitty

          It was a big reason for me to schedule the elective CS with my daughter.
          My OB told me from day one that he put my chances of a VB at around 10% and my chance of a non instrumental VB at less than 5%.
          In his words “we can try if you want to try, but I’d strongly advise an epidural on arrival and that you’re prepared for emergency CS or failed forceps AND an emergency CS as the most likely outcomes.” Way to sell it!

          Then my daughter’s EFW at 38w was 7lbs and we’d both agreed that 7lbs was the maximum size of baby my pelvis could handle. CS it was!
          She was 6lbs 3oz…but I had a nice calm experience rather than FUBAR delivery it could have been, so what’s not to like?

          This time round I’m team ERCS all the way.
          I think my birth plan will be “NO VBAC” in glitter pens!

  • Susan

    I’ve been to quite a few UCSF classes and I was upset this morning reading Tekoa King’s “as safe or safer” statement. She’s no dummy and I do think politics are winning out over facts in what she wrote. I believe the only intellectually honest stance with the evidence that we have is “not as safe for babies” may be safer for low risk moms with highly educated midwives. Saying “as safe or safer” without delineating that the baby is at increased risk is so misleading as to be unethical.

    • Susan

      In thinking about this I might add that what I mean by “may be safer for mom” means only that there is less morbidity ( specifically c/s and episiotomy ) I am not sure anyone has ever proven there is less matenal mortality even among lowest risk moms with best providers. Personally, it’s a no brainer to me that the worst maternal morbidity of all would be the emotional devastation of knowing you made a choice that resulted in the preventable death or serious disability of your baby.

      • Susan

        Forgive me for commenting under my comment again but, I reread King’s piece because she is someone I have seen speak and have had a good impression of. She talks about high risk conditions not belonging at home without specifically commenting on perinatal mortality of low risk babies with highly educated providers. I am reminded of the “if you don’t count Portland” comment. Why does Oregon ( as well as other states ) have a system that licenses providers who take on high risk births at home? If hospitals were to address our deficiencies by responding that some OBs and hospitals are horrible but If you take THEM out we’d have great stats…The idea is absurd. Yet the alternative birth crowd uses this argument over and over to defend home birth midwives.

        • Medwife

          I agree. Her politics are getting in the way here.

        • Mer

          We may as well argue that we have the best perinatal stats in the world . . . if you don’t count any of those pesky preterm babies. Makes US care look good and no different than what they’re doing!

      • Montserrat Blanco

        It is a no brainer for me as well.

    • Staceyjw

      I don’t think HB is safer for mom either, but it’s hard to saw for sure because maternal mortality is counted in 100,000.
      While it’s true mom is less likely to have a CS/instrumental delivery with a HB, the balance of that is more death and disability. Winning the odds of avoiding a Cs you didn’t need by staying home, doesn’t mean it’s safer. And women can say no to epistiotomies and it her things, so that doesn’t really make for a good argument of safety for mom. (as if epistotomies are common these days, and as if they are never done at home- they shouldn’t be done at home, but sometimes are!)

      • Young CC Prof

        Anecdotally, there have been a few deaths and a number of near-deaths from ordinary PPH at home birth. It sounded like saving them would probably have been routine in the hospital.

        This is one thing many home birth mothers don’t understand: Not only is it riskier for the baby, you are trading a somewhat lower risk of c-section for a significantly larger expected blood loss. (And of course the reduction in c-section risk is smaller than they think, it’s probably only 5-10 percentage points.)

        • Roadstergal

          What gets me about this ‘risk’ of C-section at a hospital… you can always refuse to have one at a hospital. Which means the increased ‘risk’ of a C-section is a health care provider telling you that they’ve detected something which increases the risk to the baby, and _you_ deciding it’s a risk you’re not willing to take. So the decreased ‘risk’ of C-section at home is actually intentionally choosing ignorance about what’s going on. I can’t even… I mean, it’s like saying driving with your eyes closed is safer, because it decreases the chances of having to use your ABS.

        • ersmom

          Got my 2014 stats at dept meeting last week. Our hospital has a 76% rate VBAC success. My personal primary CS rate is 11%. My vacuum rate is 2%. With the safety of monitoring and mutliple people available for help.

  • Amy M

    And there aren’t a lot of comments yet, but already the “The patriarchal medical establishment hates women and wants to remove their choices, make them uncomfortable (those tight monitoring belts!), and harm their babies with all those unnecessary interventions and Csections!!” Those people REALLY want to believe that.

    • Bugsy

      Lol, I loved my monitoring belt – it kept reassuring me that my little guy was doing well.

      • Mishimoo

        Same! There really is nothing more reassuring than that sweet little heartbeat.

        • Medwife

          I came out of my second stage pushing fog to demand what kind of decels I was hearing.

          • Mishimoo

            That’s both awesome and scary! It’s really cool that you noticed.

            I didn’t notice the decels with my last while I was pushing, I just had this overwhelming urge to get him out NOW which I didn’t have with my girls. My CNM said afterwards that before she could say anything about the decels, I’d gotten his head out and they were pretty busy (nuchal cord + mild shoulder dystocia).

          • Medwife

            It was a very strange moment- I didn’t have an epidural so I was pretty out of it, but suddenly my frontal lobe snapped back into action like I was going to start ordering fluid boluses and O2 and everything 🙂 then they said “early decels, early!” And just like that, frontal lobe went dormant again.

            I’ve seen it with patients, too, though- they get that awareness that something is wrong with the baby, and they are suddenly the most alert, cooperative people possible. They could have been screaming a second before, completely doesn’t matter.

        • Cobalt

          Best sound in the world! They kept turning the volume down on mine so it didn’t disturb me while I was dozing, and I’d have to wake up and tell them to turn it back up.

      • araikwao

        See, if you just trusted birth, you wouldn’t be so hung up on those evil MACHINEZ

        • Bugsy

          Ha, my kid was a test tube baby. Proof positive that my entire pregnancy with him was less-than-all-natural. 🙂

  • Amy M

    I like how the midwife compared apples to oranges: “Hospitals have a 30% C section rate, but at home there’s only a 5% rate of PRIMARY C-section.”

    I see what she did there. There’s no way she doesn’t know that 30% includes all of them, planned, emergent, repeat, etc.
    And of course, how can there be any Csections at a home birth? I suppose she means 5% first timers/no prior sections transfer and end up with Csections? I wonder if she cares to quantify the number of dead and damaged babies (and mothers for that matter) that should have been delivered by C-section. But at least they had a lovely homebirth, amirite?

    • Guesty

      The way people throw around the c-section rate always slays me. That number is irrelevant unless you compare it to the rate of damaged and dead babies AND permanently incontinent mothers or mothers who need significant surgical intervention as a result of vaginal deliveries. Um. That’s what c-sections are for, yo.

      • Kelly

        Also, that rate is different depending on so many factors. You have a healthy pregnancy and a proven pelvis, you have a much lower rate. You have a high risk pregnancy, that rate is higher.

        • Amy M

          The hospital too—a big teaching hospital in a city, with a Level 3 NICU is likely to have a higher Csection rate than a small suburban community hospital that doesn’t do so many births/year. Simply walking into a hospital with a high rate doesn’t increase your personal risk, like these idiots seem to believe.

    • Amazed

      Yeah, 30% c-section rate, oh, the horror! Including Gavin Michael. Homebirth didn’t get the primary c-section stat for this little boy.

  • Mel

    No. Home birth is never a safe choice.
    Look, I don’t honestly care what a person decides as long as they have full understanding of the potential risks of their choice.

    You want to see how safe home birth really is? Come to my farm.

    Our cows get a blood test for pregnancy and one dating ultrasound. We give them a set of vaccines at about 8.5 months gestation*. We move them to an area where we can keep a close eye on them three weeks before their due date.

    We have to guess when the cow is in 1st stage labor- prey animals don’t want to show pain. We identify 2nd stage by the appearance of the amniotic sac followed by fetal parts. We can’t provide any sort of effective pain relief because an epidural on a moving cow is dangerous. We can’t monitor the calf in any real way. (Sad but true: I was nervous about a calf I was helping deliver because it’s tongue/nose seemed too blue. All I could do to see that the calf was alive: gently pinch the tongue. As long as it retracted, the calf was at least mostly alive.) We lose around 5% of calves during delivery usually to first-calf heifers, but not always. About twice every 3 months, we have a calf that is born alive…well….the body is alive, but the frontal cortex is toast. So…about 8 brain-dead calves a year.

    Things that we can do better than NCB:
    We have one person at the farm around the clock who can perform instrumental deliveries plus 3 people who are on-call who live within 2 miles to assist.

    We call the vet promptly – in fact, it was the first number I programmed in my phone.
    Oh, our herdsmen…they have consciences. Those brain-dead calves? Those rip my husband up. He spends hours trying to figure out how to prevent those….and there is no way to prevent them in cattle. We have no fetal monitors….no OR….nothing but prayer and sheer dumb luck. Let’s not talk about what it’s like when a cow dies during labor or delivery…..

    Ladies, you have a choice on how you want to have a baby. Don’t give birth like a cow. It’s not pretty; it’s not empowering; it’s painful and risky.
    *We will not stop doing this to make our farm more like a NCB child-birth. Just…no.

  • Lisa C

    What I don’t understand about people who declare homebirth is safer is that common sense tells you it isn’t. I don’t need scientific studies to tell me that giving birth in a hospital which gives you immediate access to medical professionals that are trained to handle emergencies, a neonatal intensive care unit, an operating room, and a crash cart down the hall is safer than giving birth in your house.

    Also, I hate when people say a midwife will “transfer” a patient if complications arise because calling 911 or dropping them off at the emergency room is NOT the same as a transfer from one hospital to another. I used to work in a small emergency room and transferring a patient requires a lot more than just calling for an ambulance to do the physical transfer. This a lot of paperwork and a lot of phone calls between providers before, during, and after a transfer.

    • EmbraceYourInnerCrone

      I always wonder, do homebirth midwives tell that to their clients (“We’ll just transfer if there is a problem”) and the parents think that the midwife has an actual transfer plan/relationship with the hospital? Do any homebirth parents ever ask what the actual plan/protocol will be in case of transfer? Or do they just assume they will think positive and not worry about it, because of course it’s not going to happen to them? I wish life worked that way but it doesn’t…

      • The Bofa on the Sofa

        I think a lot of it is that CPMs will hide the fact that they don’t have hospital privileges in any way. So if you are at the family doctor and they want to transfer you to the hospital, they call ahead and say, “I’ve got a patient coming in with X, Y and Z and they need to be seen STAT.” People think this is what the midwife will do.

        And while there are midwives who are sufficiently well-known at the hospital where the staff will listen to their diagnoses, for the most part, no, a patient “transferred” to the hospital is coming in as if they are off the street, and have to go through triage and assessment in the ER first to establish their status.

        By calling it a “transfer” they give the impression that there is a relationship, when, in fact, all they are doing is calling the ambulance.

        The whole idea of a midwife dropping a patient off at the ER and leaving them there, which is something we hear about not uncommonly, is to me one of the most damning indications that these people have no ethics at all

        • nomofear

          When I needed follow up care (because who would think to examine a woman’s “area” post-delivery? Not a freestanding birth center midwife, apparently!) the people at the women’s hospital in town knew the midwives I’d used ALL TOO WELL. They were as nice as anyone could ever be to me, but the knowing glances and overheard heated phone calls to them were telling.

          I mean, no one’s perfect – my mom incurred a third degree tear with my younger brother that her OB missed until a day later, so the repair was much more difficult, but even there, I think there’s a big difference between the two – he looked and didn’t see it, while those midwives didn’t even look. Luckily my issue was much smaller and easier to fix, but still.

        • EmbraceYourInnerCrone

          I honestly think people are under the impression that their midwife (or they) can charge into an ER and say ” we need a C-Section NOW” Ummm no. and the ER staff is not going to take anything the midwife says as true, they are going to need to do an exam and booddraw probably type/cross match. And if there is a heart attack, multicar accident with injuries etc, the pregnant woman might have to wait. In some hospitals they might have to page the on-call OB resident, etc. There might not be an available OR, there might not be anyone available to do your CS because they are already doing C-sections on other people.

          Have these people never been to an ER before? ?
          I am reminded of the Johns Hopkins case where a family were awarded 55 million dollars for their son’s birth injury after their homebirth went wrong, they claim it’s all the hospitals fault for not doing a CS quick enough…

          http://articles.baltimoresun.com/2012-06-26/health/bs-md-ci-malpractice-award-20120626_1_malpractice-awards-in-state-history-gary-stephenson

          • Mel

            My twin and I were a vaginal birth that really, really should have been a CS but a multi-car accident + a previous emergency CS tied up every available OR in the hospital my mom was at 30-odd years ago. Mom remembers her OB on the phone in the hospital saying “I might be able to buy 5 more minutes, but the first baby is crowning and I don’t know how long it will stay in.” He hung up the phone, then swore when he turned back around. I was being born. Thankfully, they had anesthesia there and gave Mom lots of inhaled drugs before they had to manually reposition my (transverse) twin so she could be delivered feet-first.

          • The Bofa on the Sofa

            I honestly think people are under the impression that their midwife (or
            they) can charge into an ER and say ” we need a C-Section NOW” Ummm
            no.

            And the problem is, it’s not like midwives will do anything to correct that incorrect impression. They will be happy to let people go on thinking that, because if they actually knew the truth, they might think twice.

          • Sue

            AND because they want to convey the impression that THEY did the right thing, it was the hospital’s fault for not responding fast enough.

            This already happens when people are told to go to ED and “tell them you need to be seen straight away” – the patient assumes that the ED staff are negligent because their (trusted) provider told them it was URGENT.

          • Sue

            In reality, even if your GP calls and wants you seen in the ED ”STAT”, you still have to be triaged and compete with all the others who want to be seen “STAT”. That’s how triage works.

            Having said that, a person in labor with complications would be seen right away in our ED, but they wouldn’t go directly to the operating suite.

        • Ash

          I don’t think most ppl know that since CPMs have chosen to not be a part of the “system”, there is more inertia in transferring to a hospital. They don’t know that for an epidural or c-section, the CPM can’t authorize them to roll in and immediately get procedures in place. Most people would have no idea that even if your midwife has been drawing labs, the medical staff can’t go off of solely the CPM’s narrative in order to make a decision.

      • Amy M

        Well, I read one woman’s post, I think on mdc? where she said “they can just do a C-section in the ambulance if need be.” So based on that, at least some of these people are truly ignorant of what goes down during a medical emergency. Like who is actually a doctor, and so on.

        • The Bofa on the Sofa

          I really don’t know what you can do about this level of ignorance. I think calling it ignorance, while technically true, understates how far from reality this person operates. Totally clueless is probably a better way to describe it.

        • Cobalt

          Just do a cesarean in the ambulance?

          Wow. Just wow.

          • Roadstergal

            Again, it’s the disconnect. A C-section is OMG major abdominal surgery!! …but they can do it in an ambulance.

        • Cobalt

          “Had you been in a hospital they would have been calling a C section (GROSS, I know) It sounds as though she may have saved your birth experience. Maybe someone else will have a different opinion. But as a HUGE HB Advocate it sounds like your midwife rocked. Im glad your experience went well overall… Congrats on your lil bundle!”

          “she may have saved your birth experience”

          There it is, folks. There it is.

          • momofone

            That’s right. Screw the baby; it’s your birth experience that matters.

          • The Bofa on the Sofa

            Agreed. We got pregnant to have a baby, not for a “birth experience.”

          • theNormalDistribution

            We? lolno.

          • The Bofa on the Sofa

            It was a team effort, for sure

          • Poogles

            Well, “getting” pregnant is indeed (usually) a 2-person affair, so yeah, I think “we” works.

          • theNormalDistribution

            Well, “getting” beaten is (usually) a two-person affair, but I would bet you agree that the abuser doesn’t get to be a part of the victim’s “we”.

            The point is, pregnancy is a Really Big Deal. It carries significant risks and makes permanent changes to your body. I agree with the sentiment that Bofa was trying to express, but factoring oneself into the choice to get pregnant or the act of being pregnant when you will share little to none of the burden, shows a true lack of appreciation for the gravity of such a choice and the very real sacrifices that will be made.

            You wouldn’t tell people “we donated a kidney” just because your spouse did. Same goes for pregnancy. It’s just disrespectful.

          • Poogles

            Look, generally I agree with you – my husband and I have even got into heated “discussions” about how he doesn’t get to claim that “we’re pregnant” when it happens, for all the reasons you listed above.

            When talking about making the decision and then doing what needs to be done to get pregnant, I don’t feel it applies the same way. In healthy, committed relationships, making the decision and DTD are generally 2-person activities, even if the man cannot carry any of the physical burden or risks of actually being pregnant.

            Out of curiosity, do you object when a couple says “we’re trying to get pregnant” or “we’re TTC”? I feel those phrases and the phrase “we got pregnant” fall along the same line; to me, it’s just not the same as saying “we’re pregnant”. If you object to all of these phrases then we will just have to agree to disagree 😉

          • theNormalDistribution

            You may consider this pedantic and totally missing the point, but I think where we disagree is in how literally to take a statement. So, to clarify:

            No, I can’t see anything objectionable in “we’re trying to conceive”. S’truth.

            I’m less comfortable with “we’re trying to get pregnant” for the same reasons I don’t like “we’re pregnant”, but I think usually there’s an unspoken “obviously one of us is trying to get pregnant and the other is trying to impregnate them but that is really a mouthful so yeah,” so I would have a hard time complaining about someone saying that. But to be fair, that’s a generous interpretation, and not literally what was said. Whether or not two people are involved in the act of conception is beside the point.

            And finally: I don’t see any difference between saying “we got pregnant” and “we’re pregnant”. If you’re comfortable with one and not the other, I think that’s because that’s where you’ve drawn the line between the charitable interpretation (like the one above), and the literal one. I can’t see any other way you could take exception to “we’re pregnant” and not “we got pregnant”. They are literally the exact same things.

            So to conclude: say exactly what you mean because there’s always going to be some asshole like me who’s more literal than you and takes what you said the wrong (but right!) way. Hopefully we can agree on that.

          • Poogles

            “there’s always going to be some asshole like me who’s more literal than you ”

            LOL! I’m usually the one taking things too literally, so no worries there 🙂

            ” I can’t see any other way you could take exception to “we’re pregnant” and not “we got pregnant”. They are literally the exact same things.”

            Well, I see one as a state of being (being pregnant – which can only be experienced by the woman, of course) and the other as describing a past action (DTD – a 2 person experience), so I do not read them as being literally the same at all. But, yeah, I think we’re down to splitting hairs here, lol.

          • theNormalDistribution

            [I see] the other as describing a past action (DTD – a 2 person experience)

            That’s where you’re wrong. “I am pregnant” describes the state of being, “I got pregnant” describes the act of coming into that state of being – the becoming part. In this context, they’re pretty much interchangable; you can’t be pregnant without getting pregnant first, so it doesn’t really matter which one you say. The “past action” is going from not being pregnant, to being pregnant. The past action you’re describing is the act of conception, which is totally not the same thing (and yes, usually a two-person experience). You both “did the deed” but only one of you got pregnant.

            Just sayin. 😀

          • Roadstergal

            What an interesting conversation. I hear ‘we’re pregnant’ really infrequently, and it does rile me for all the reasons you go into. My male friends/relatives/colleagues generally have said “[wife/girlfriend/partner’s name] is pregnant (and we’re really excited/scared/etc.),” which seems concise and accurate. My brother’s phrase for trying to conceive was “we’re trying to have a baby.”

          • Cobalt

            Assuming a committed relationship, pregnancy does burden both partners. Not equally, and not in the same ways, but fathers don’t necessarily stop contributing between conception and birth.

            As a personal example, after I had preterm labor my physical activities were restricted in a way that seriously limited my ability to work on our farm as I normally did and keep our baby safe. My husband did a lot of extra stacking hay and hauling buckets, if he did it because he felt “we” were pregnant, and that the responsibilities of pregnancy were for both of us, I’m not going to argue differently.

          • theNormalDistribution

            The “burden” of pregnancy that a man faces is the shared burden of being in a committed relationship, caring for eachother, and choosing to have a family, not the burden of pregnancy in itself, which is what I was talking about.

            I mean, really. What if your husband nursed you back to health when you donated a kidney? Would that make him justified in claiming “we donated a kidney”? I certainly don’t think so.

          • Cobalt

            My kidneys don’t share my husband’s DNA, “we” didn’t put them there, and he has no intention of parenting them. It would be a shared experience though.

            If fathers want to invest themselves so deeply in their partner’s pregnancy, and the mother’s ok with that, I have no problem with “them” being pregnant. It’s an expression of partnership and shared responsibility.

          • theNormalDistribution

            It’s an expression of partnership and shared responsibility.

            I think I’ve been very clear on why I don’t see it that way. I actually wrote out a lengthy response and almost submitted it, but I just found an article that addresses a lot of the things you said way better than I would have. Here’s a small excerpt, but I strongly recommend you have a read.

            Support is great, but let’s not mince undercooked meat here. Saying “we’re pregnant” overshadows that there is a person doing life-threatening, body-changing work right beside you that is not you, work that you can’t feel, that you probably can’t understand, and that has real fucking consequences for only that body directly, and you indirectly. You care a lot, you’re affected, you’re invested, but so how about caring by constantly acknowledging the differentness of your woman’s experience and risk in pregnancy? THAT IS SUPPORT, GUY.

            http://jezebel.com/mila-kunis-is-right-dudes-stop-saying-were-pregnant-1590564625

        • Amy

          And these are the same people that go around crowing that doctors are “morons” because they get a limited amount of training in nutrition and natural healing techniques. As opposed to scouring the websites of Mercola and the Weston Price Foundation for articles that reinforce your world view.

        • Samantha06

          This one was the clincher for me:

          “Had you been in a hospital they would have been calling a C section (GROSS, I know) It sounds as though she may have saved your birth experience.”

          Saved your birth “experience”? I guess the baby’s life was just an afterthought…..

      • nomofear

        I assumed. My husband had actually confirmed that the closest hospital had an NICU, but I didn’t even know that he had done that. Never occurred to me to ask. But what we were blissfully unaware of was the potential for complications, and the lack of relationship had there been any – and, even on the neonatal resuscitation side of things, I think we were both totally unaware of the process and how intense it is if needed, and the fact that a midwife with an O2 tank, even in a freestanding birth center (which, to my current mindset, is really the same as homebirth), is in no way equal to a NICU team. It brings me to tears thinking about what COULD have gone wrong with my daughter’s birth. I thank the lucky stars that she was fine, but I also thank them that I found this site early in this second pregnancy of mine. Hospital and modern technology, here I come!

        • Montserrat Blanco

          I witnessed the difference myself. At my son´s birth there were three neonatologists ready. Everybody seemed calm and efficient. They performed resuscitation and they looked like a well rehearsed ballet, seriously. My son started breathing soon, his 5 min Apgar was 9, and everything went well from there on. He was born at 28 weeks.

          I had been at other births during my training, with a paediatrician and it was not so smooth, there is a difference.

          My son has a perfect neurological development so far, by the way.

          • nomofear

            Right – and then you read this idea that the cord will provide oxygen until you cut it, so neonatal resus isn’t really necessary…ugh

        • Amazed

          If you don’t mind me asking, how did you find us? You didn’t have a bad outcome, thanks God. You don’t mention being disappointed with your midwives. What made you click on a link that led to SOB and us socks? Just curious. You are in no way expected to indulge me if you don’t want to.

          • The Bofa on the Sofa

            “Come for the vaccines, stay for the vaginas”?

          • Amazed

            Love that!

          • The Bofa on the Sofa

            Credit to fiftyfifty1 of course…

          • Amazed

            Didn’t know. Thanks, fifty!

          • nomofear

            No worries! I was in about week sixteen of this pregnancy and had myself ALL twisted over being forced by default into a hospital birth, because it’s really the only option in my state, and I googled Ina May Gaskin because I was thinking it’s not THAT far from where I live, maybe I could go there…and someone posted a link to a post on this site from whatever it was I was reading…and for the next two weeks or so, I completely ignored my family and devoured this site, including the comments section. From woo to sense in two weeks of reading. Now, my biggest worry has switched from “hospital interventions” to “can they get me an epidural in time because family and personal history predicts a three-hour labor this time around and DUDE that hurt the first time”

            Really, I was floored when I realized how I’d been snookered by the woo. I prize myself as someone who trusts experts and science. I LOVE vaccines and couldn’t understand antivaccers. Yet on this one thing, I fell for it. Thanks to whoever was pasting links to here on Ina May Gaskin pieces across the net 🙂

          • Amazed

            Thanks for answering! I’m especially pleased when we have a mom like you join, first because no one was hurt or worse and second, because that proves what we know: that we DO change minds because not all homebirthers are deadly determined on homebirth and go in knowing the risks fully well. There are many, many normal women who just got sucked. Happens to the best of us in one thing or another. Plus, if it won’t harm anyone, why not follow the fad? The moment we know it might harm someone, we turn our backs on the fad. As true about homebirth as about everything else.

          • Daleth

            This site changed my mind too. I was woo-steeped. Despite having been born at home I never would have considered a home birth myself, out of sheer common sense (I want the emergency stuff close by in case it’s needed), but I just thought of that as a difference in overall approach to life between me and my even more woo friends who wanted home births. I had no idea how much more dangerous home birth was, or how uneducated most home-birth midwives are, or why all the tests and monitoring are so important.

            When I was pregnant last year I was going for the hospital-based birth center with CNM’s and no pain relief approach, and then I evolved all the way to an elective c-section.

          • CrownedMedwife

            Thank you for sharing, was so refreshing to read your story.

          • Sue

            Thanks for your candor, nomo. It takes insight and maturity to revise one’s opinion and discuss it openly.

            Ironically, many people do the first one in hospital (statistically the most difficult) and assume that it was hard because they were in hospital rather than because it was numero uno.

          • nomofear

            Further, to possibly demonstrate how cult-ish the natural birth movement is – I didn’t have a great experience with the midwives. There were two in the practice, and they would trade weeks of call, and both come in for clinicals during the day. So the one that was on call when I went into labor had been awake for almost two days. Maybe that’s why she didn’t think to examine me well afterward – she missed a small tear. They didn’t examine me at the two-day follow up, either. Luckily (ironic that this would be lucky) I came down with mastitis six days later and went to the women’s hospital where they gave me a full exam and put in a few stitches.

            Plus – and, these are things that I didn’t know about until this site – I don’t recall a GBS swab, and, for the GD test, they said you can either drink the sugar when you get here, or here’s a sandwich you can make and eat in the way. The sandwich, which I went for, included proteins, so that would have rendered the test ineffective. Then, when the sonograms were predicting a 10-lber, they said “meh, they can be off by two pounds.” I ran with it, and, fortunately, she was born at seven and a half. It only occurred to me recently that, wait, that was plus or minus two pounds – she could have been a 12-lber! I was measuring normally from the outside, so that last one was perhaps reasonable, but now that I know shoulder dystocia exists – no way!

            So, all of that, and this time I was still freaking out about having to be in a hospital! Until I found this place, anyway. I was sold in it all based on the idea that the “natural” way was safer for babies. To discover that it’s not is amazing. I can trust the hospital process, love fetal monitoring, be happy with a csection if that’s what happens, take an epidural and not worry that it will hurt the baby, etc.

      • The actual transfer — in terms of time, is hardly ever really thought through. The patient, and baby, are essentially in limbo for a considerable period of time. By the time a compromised baby is actually delivered, it can be much too late.

      • Ash

        Any discussion of transport on a CPM’s website usually emphasizes that transfers are rare and among those transfers, it’s even more rare that any sort of speed/urgency would be necessary (thus, the perpetual emphasis of transferring in a private vehicle rather than ambulance).

        Furthermore, since the CPM is a “professional”, the client assumes that they have a real, professional relationship with the staff.

    • The Bofa on the Sofa

      What I don’t understand about people who declare homebirth is safer is that common sense tells you it isn’t.

      The question I always ask is, what babies that die in a hospital would not have died in a homebirth?

      The ONLY answer anyone has ever given to that (and it is the standard answer) is MRSA.

      Of course, if you ask, so how many babies die from hospital acquired MRSA? You would think that will all those babies being born in hospitals, if MRSA were a serious risk, there should be lots and lots of examples of babies who died from MRSA. Yet, in all the anecdotes we’ve ever heard of bad hospital stories, nary a one has involved MRSA.

      And with maternal risk, although we don’t have exact numbers for MRSA, we know the number of mothers who have died due to “infection” to give us an upper limit. And it’s not all that big.

      So if you actually think about that question, who dies in a hospital that wouldn’t die at home, it’s clear that you can’t end up with homebirth being safer. Especially if you try to account for the 3fold increase in deaths.

      • Sue

        Even then, people pushing MRSA as a risk don’t understand the reality of hospital-acquired infection.

        MRSA is most common on surgical wards and ICU, where there are very sick people with wounds and prolonged antibiotic treatment – often the frail elderly. Labor and delivery staff don’t work across these other wards.

        Amongst healthy young women passing through labor and delivery wards for a couple of days, the risk of contracting a hospital-acquired infection is miniscule.

        • That is one of the reasons — but not the only one — why a dedicated OR next to the L&D suite is a good idea. Elective C/Ss are usually done as the first case in a standard OR, because they are much “cleaner” than following other surgery in the same room. OR schedules, when possible, go from “clean” to “dirty” for obvious reasons.

          The other big reason is that an OR used just for C/Ss can be equipped with all the necessary specialized equipment for infant resuscitation at all times.

        • FormerPhysicist

          I believe that (in general) you’re more likely to come into the hospital with community-acquired MRSA than get it at the hospital.

    • ModerateMom

      They are brainwashed into believing that being in the hospital causes the complications, so at home the risks of the complications are much lower. Which isn’t true, but I think that’s their logic.

      • Ash

        I think CPMs and clients know that the absolute risks are low; however, sometimes people (humans) can be terrible at assessing risk in terms of absolute risk vs bad outcomes if you are in the minority of those who are hurt. The apt comparison made by other commenters is that drunk driving is illegal. It’s illegal to not have an infant in a car seat. This is despite that the absolute risk is really low.

        • Roadstergal

          Low probability, high consequence.

          • The Bofa on the Sofa

            But compared to other activities in our lives that are considered “high risk”, that “low probability” is not all that low. We are talking 1000 times more likely than dying in a car accident while drunk driving.

            I think Ash’s point is that people don’t really understand how low of risks we accept in daily life. Climbing Mt Everest is about as risky as anything that you can do, but only has a death rate of about 2%. The death rate for having a heart attack is “only” 17%. In other words, most people who have heart attacks survive.

            99.9% sounds like a a pretty good success rate. But it’s nowhere close to acceptable when it comes to things we do in everyday life. If you had a 0.1% chance of dying on an average car trip, you’d never drive anywhere.

          • Roadstergal

            I suppose people tend to judge risk more socially than numerically, if that makes any sense? I know there are outliers, but generally speaking, it’s socially unacceptable in the US to drive your baby around in the car without a proper car seat. It’s definitely socially unacceptable to drive your baby around while you’re drunk. But it’s not socially unacceptable to homebirth, even though that’s more risky by the numbers…

          • toni

            I think homebirth is still generally frowned upon even if a lot of the anti-intervention ideas have filtered into the mainstream. It’s not *as* socially unacceptable though for sure

          • The Bofa on the Sofa

            To be fair, hospital birth is also more risky than most other things, too.

            But that is why a 3fold increase is so much worse, in an absolute since.

            A three-fold increase in the rate of death due to toothbrushing is not going to be anything to worry about. But a threefold increase in the rate of deaths in climbing Mt Everest is really serious.

            Childbirth is in-between these two, but closer to Mt Everest than even to drunk driving. So a threefold increase is very big.

    • anotheramy

      I totally agree about the “transfer” thing!

    • Melissa

      The saddest thing is that we’ve seen that the transfer thing is pointless since many midwives believe that all complications are just variations of normal. They claim that they’ll transfer for a complication, but since twins, breach, and unproductive labor are all seen as non-complications, then what do they actually transfer for?

    • jhr

      When a friend’s woo-infected daughter,r pushing 40 for her 1st delivery had a stalled and agonizing labor was transferred from the Birthing Center to the nearby local hospital by EMTs, it still took a solid 15 minutes., Thankfully, all ultimately went well, but my pediatrician SIL commented that this couple won the high risk lottery in these circumstances that the individual in “trouble” was the mother and not the baby. Because there could have been catastrophic brain damage to the little one, resulting from those 15 minutes…

    • Ash

      From NYTimes
      ” If a sudden and unexpected emergency of some other type does arise
      (very rare in a low-risk birth), then probably the doctor is at home
      sleeping, and takes at least 30 minutes to set up the surgery whether
      you are at home or in the hospital. If you can get to the hospital in
      less time than the doctor (typically 30 minutes) you are just as safe.”

      If midwives told the commenter that a half hour from recognizing a complication to getting to the hospital door is somehow an appropriate amount of time for treating all emergencies…NOPE

      • Cobalt

        Thirty minutes is long enough for a seven pound body to get cold.

      • Young CC Prof

        Yup. Because your local hospital will absolutely prep an OR on the midwife’s say-so, assuming she calls them at all. Never mind the fact that many hospitals have 24 hour coverage, or will keep the doctor around if you are there in labor.

      • Liz Leyden

        Because hospitals that do deliveries don’t have OBs on site 24/7 or dedicated ORs for C-sections.

  • Anj Fabian

    An entire article could be written about what the UK NHS thinks is safe for “low risk” women. Home birth is only one of the things the NHS thinks is safe.

    Routine screens in the US for GBS and gestational diabetes are reserved for “high risk” women in the UK.

    • Sarah

      And it’s not true that in Britain low risk women are advised to give birth at home or in a birth centre, either. One is given the option of homebirth, MLU or CLU, assuming all are available.

      • The Bofa on the Sofa

        Even if it were true that low-risk women are advised to give birth at home, it is done solely as a cost-cutting measure.

        • Christina Maxwell

          Not entirely, by any means, Bofa. The NHS uses some pretty arcane accounting strategies, for sure, for instance the cost of building offsite birthing centres and supplying two fully qualified midwives per homebirth never seems to be allowed for, let alone the life-long cost to the state of looking after children who are severely damaged at birth.. Unfortunately NCB woo is very strong in the UK, midwives are a very vocal lobby group and the results are all too predictable.

    • Roadstergal

      Wow, I did not know that. Are women who are considered at high-risk for GD by some metric screened, or women with high-risk pregnancies from any angle?

      • Anj Fabian

        I’d have to dredge through the NHS pages again.

        When you read them, the NHS presents itself as providing all needed testing…but…and suddenly there are preconditions. A woman who tested negative for GBS for her first birth isn’t rescreened for later births, but a woman who tested positive is.

        A woman who tests normal on a simple fasting glucose isn’t given a glucose tolerance test.

        The NHS says that other forms of screening like urine screens will be used to monitor women but either that doesn’t seem to work or women are missing prenatal visits.

        http://www.itv.com/news/wales/2015-02-02/cardiff-parents-stunned-after-mum-gives-birth-to-12lb-baby/

        Another huge baby that no one realized was macrosomic.
        George King was born over 15 pounds in the UK in 2013. Again, no one realized how big he was. How does that happen?

        • Medwife

          Simple fasting glucose- not a glucose challenge? The 50g type?

          • Anj Fabian

            “Every pregnant woman with one or more risk factors should be offered a screening test for gestational diabetes.”


            If any of these risk factors apply to you, you’ll be offered a blood test to check your glucose levels. This may also include a glucose tolerance test (GTT).”

            This is what drives me NUTS about the NHS. You can drive an aircraft carrier through those gaps! Here in the US it’s “You are pregnant. That’s your risk factor. You will be screened.”.
            http://www.nhs.uk/Conditions/gestational-diabetes/Pages/Diagnosis.aspx

        • toni

          If you’re overweight or have a family history you are tested for GD. I don’t think anyone is tested for GBS though(?) even for your first pregnancy. No one I’ve asked was at least but might depend on where you live. (most of the people I asked live in sussex.) and when I talked to a very non woo midwife who is a family friend she said it’s so rare that GBS would harm the baby that it’s not worth the cost of testing everyone.

          • araikwao

            One of my local hospital networks here in Aus was doing this when I had my second baby (which was a change from the previous pregnancy) – they didn’t screen for GBS but were supposed to just give penicillin intra-partum to those at high risk, e.g prem labour, previous baby with early-onset GBS infection. I think screening may be recommended now,as outcomes are slightly better with it.
            ETA I.e. screening recommended in Aus, I believe it’s been that way for awhile elsewhere

          • toni

            she didn’t mention that but yes now that I think about it I’m sure I’ve heard they give abx to everyone in premature labour because those babies would be most badly affected by GBS. I know France, Israel, USA and Kenya screen everybody

    • EmbraceYourInnerCrone

      How does only screening high-risk women work out ? I am not even sure how you would decide who is at “high-risk” for GBS, I assume for GD they are assuming only over-weight women get GD (not true!)

      Does this result in more women presenting with uncontrolled GD/macrosomic babies? And more babies hospitalized due to GBS in the UK than the US?

    • Ash

      Seems like GTT is only routinely offered for “high risk” women in the UK–what do the other women get–fasting glucose at the first antenatal appt?

      http://www.nhs.uk/Conditions/gestational-diabetes/Pages/Diagnosis.aspx