Charlotte Bevan’s death: an indictment of a breastfeeding culture that ignores the needs of women

Charlotte Bevan

Is breast still best when it leads to the murder-suicide of a baby and mother?

According to The Telegraph:

A mother who was found dead on a cliff face after wandering out of hospital with her newborn baby had been advised by doctors to stop taking an anti-psychotic medication so she could breastfeed.

Charlotte Bevan, 30, vanished from a Bristol maternity hospital with no coat or shoes, and with her four-day-old baby Zaani wrapped in a blanket in December 2014.

It is believed that she had suffered from schizophrenia and depression, and had been taking the drug risperidone.

The litany of failures in this case nearly defies belief, up to an including the fact that a shoeless woman was allowed to leave the hospital holding a newborn, and, of course, the inevitable stalling by the hospital representative who showed up to yesterday’s inquest into Bevan’s death without having taken statements from caregivers that he or she was supposed to present.

When it comes to caregivers, there is an enormous amount of blame to go around. Who tells a schizophrenic to go off her anti-psychotic meds to breastfeed? Use of risperidone, the medication that Bevan was taking, is compatible with both pregnancy and breastfeeding if the mother needs the medication. Who lets a schizophrenic go off her anti-psychotic medications without intensive monitoring? Who hands a baby to an unmedicated schizophrenic without continuous supervision to be sure that she does not harm her baby?

When it comes to philosophy, however, there is only one philosophy to blame: the philosophy of natural parenting that views women as nothing more than baby containers and feeders whose health, physical and mental, is irrelevant.

For most of human history, women have been reduced to three body parts: uterus, vagina and breasts. Their intellect was irrelevant; their talents were irrelevant; their wants and needs were irrelevant. For a while it appeared that we had moved beyond this deeply sexist and retrograde view of women, but now it’s back in a new guise: natural parenting, specifically natural childbirth, lactivism and attachment parenting. These movements place the (purported) needs of babies front and center. They ignore the needs of women.

In the case of breastfeeding, an industry has grown up around the assertion that “breast is best.” Best for whom? Best for babies, of course.

The benefits of breastfeeding have been grossly exaggerated, with lactivists referring to breast milk as “liquid gold.” The non-existent “risks” of bottle feeding are blared far and wide. In short, infant feeding has been thoroughly moralized into just another way to police women’s bodies and judge mothers as “good” or “bad.”

Is it best for mothers? Often it isn’t, but their needs — the need to sleep, the need to work, the need to share care giving with others, the need to own their own bodies —  are irrelevant.

Charlotte Bevan had schizophrenia. It’s an illness every bit as real as diabetes. Untreated it leads to severe compromise and even death.

Charlotte Bevan NEEDED risperidone. Why wasn’t she getting the medication that she needed, the medication that made the difference between her life and her death?

Why wasn’t Bevan encouraged to stay on her anti-psychotic medication? Because quite a few people believed that the purity of her breast milk was more important than her right to live without the torment of the voices she heard in her head.

How did we get to the point where women’s needs are viewed as irrelevant? How did we get to the point where health care providers (!!), weighed breast milk against Charlotte Bevan’s sanity and breast milk won?

We got here by way of a philosophy that renders women’s needs, even their need to be sane, invisible, routinely subordinated to fabricated “needs” of babies for parenting that recapitulates women’s subservient status in nature.

The death of Charlotte Bevan and her baby Zaani should be a wake up call to all of us, health care providers, feminists and anyone who cares about women, that women’s needs MATTER.

Women are people entitled to the best care we can provide for them, not baby containers and not milk machines. Moralizing infant feeding is wrong, not merely because the benefits of breastfeeding in industrialized countries are trivial. It is wrong because by pitting mothers against babies, everyone loses.

  • Tricia Wright

    This is not about breastfeeding and whether there is a moral problem with natural
    Feeding or parenting. This is a case of misinformation about mental health disorders and medication. Putting natural parenting practices and breastfeeding to blame in an obviously grossly negligent medical case is also unethical and wrong. True, women are not just a uterus, breasts and vaginas we are also MOTHERS. What is best for the tiny humans we welcome into this world is best for us. We have needs and we deserve respect and in a lot of arenas (including maternity care) we are not given that respect. BUT we have welcomed a defensless human into the world and our needs must be BALANCED with theirs. We have a responsibility to them. And if we are mentally ill or in need of extra support, the medical system and our caregivers have an increased responsibly to us and our babies. This is where the failure happened. Not because of breastfeeding. Natural parenting has been taken to the extreme in some cases but true “attachment” practices and conscious parenting insist that everyone’s needs be met and the parents seek balance in their health and those of their children. Attachment parenting has come to mean self sacrifice and martyrdom and it doesn’t have to be this way. Mom can still breastfeed, carry her baby, meet her tiny human’s needs for love, comfort, safety and life-sustaining food and still have her needs met. She needs good support and encouragement. Urging women to abandon their instincts and rage against the “natural parenting” machine isn’t serving anyone. It’s not good for babies and it’s certainly not good for mothers. They need support and encouragement to be women and be mothers at the same time. They can certainty do this while having a natural birth, breastfeeding, baby wearing and bed sharing. These experiences with their babies are intoxicatingly wonderful at times and if they’re not, mothers need to reach out for help or make other choices.

  • DelphiniumFalcon

    My mom had to finally shut my cousin up after she claimed that all her health problems stemmed from the fact that her mother didn’t breast feed her and therefore sabotogued her chances at a perfectly healthy life. My cousin is waaaaaaaay into the woo. You don’t want to see our arguments about Ebola and if a sugar free diet could kill her Strep-B colonization because “bacteria feeds on sugar.” Thank goodness she stopped short of home birthing…

    My mom pointed out that she breastfed me and I get sick every time a new bug crops up and I get sicker than most when I catch it. I have depression, anxiety, chronic pain, and am on the autistic spectrum. I throw kidney stones like they’re going out of style and all testing points to “Hell if we know why” despite cutting out soda. I push my body to excersize but it’s a pretty pathetic amount compared to others before my body gives out. Found out I’m severely vitamin D deficient so maybe when that clears up I’ll have less muscle pain. Where’s my perfect health I was supposed to have from breastfeeding?

    My (not so) little sister on the other hand wasn’t breastfed because after the horrific episodes of postpartum depression my mom had to the point of this kind of murder-suicide ideation (thank goodness we’re both still here) after going off Prozac to breastfeed me. The doctors and my parents didn’t want to take any chances with my sister.

    Well my sister may have Celiac’s but that’s about all she has. She’s taller than me, stronger, and healthier. She rarely gets sick and recovers quickly when she does. She has minor bouts of anxiety but no other mental problems. She does martial arts and dominates the completion. Her sport of choice right now is Brazilian Jujitsu where she routinely places silver and gold in tournaments despite being on the low end of her weight class. She can work out four hours a day every day and then go work her job. In high school she was on swim team doing the 500 meter endurance, practicing on weekends when swim team didn’t meet, and kept up on her martial arts. She is a machine!

    So without breastfeeding she literally can run circles around me when all these lactivists say she should be sickly and obese. Well she just dropped thirty pounds. I’m not even going to comment on my progress!

    My cousin didn’t have a comeback for mom and mom told her to stop shaming those who can’t breastfeed because chances are their kids will be just fine. Just like my sister.

  • Lancelot Gobbo

    I would tend to see this dreadful case as one where, yet again, psychiatric illness is regarded as unimportant, unreal (and possibly made up). The reality is plainly otherwise, but a narrow focus on one aspect of health – breastfeeding – excludes paying attention to the whole person. It’s bad enough when the public stigmatises mental illness, but it certainly happens from other branches of medicine too.
    The only excuse I can muster is that risperidone is far too widely prescribed these days, even for non-psychotic disorders. You’ll see it thrown around for ADHD, behavioural disorders of childhood, as augmentation for depression (and not just a psychotic depression), and for dementia-related behavioural problems. It was rather useful to understand a patient’s diagnosis by virtue of their medication, but risperidone is so widely used that only a minority of people on it will be schizophrenic. It still doesn’t excuse anyone who had access to her chart from not being aware of her true situation.
    English coroner’s courts are very gentle and rather kindly towards human weakness. This case will get a verdict of misadventure, and there will be no consequences from that. It will be up to the family of the deceased to see that the careless people who did this to Charlotte get what they deserve.

    • Roadstergal

      It’s fine to be gentle towards individuals, but the point is always to find a hole in the system and plug it. Like air crash investigations – yes, a pilot or ATC might have messed up in a given incident, but the important thing is to realize that humans mess up, and systems have to be in place to catch the errors. Like what Dr T says – this is a problem with the overall system, and _that_ is the problem needs to be addressed, even if you’re lenient on the doc/midwife/whatever who was hands-on at the time.

      Something went terribly wrong here, and it needs to be dug into.

    • Hannah

      Coronial inquests aren’t about apportioning blame in the same way that litigation or criminal proceedings are. The purposes of an inquest are to establish the identity of the deceased, cause of death and whether any advice needs to be given to prevent future deaths.

  • DiomedesV

    What I don’t understand about this case is… (well, one of the things)

    Even IF we assume that all nurses and doctors are trained to push breastfeeding whenever and on whomever…

    surely if anyone would be exempt from pressure to breastfeed, it would be a women who suffers from schizophrenia. I mean, we’re talking about 0.5-1% of the population. Who CARES whether the babies of these women are fed formula? I don’t understand how any health care provider doesn’t see DANGER! written all over a case like this and doesn’t feel concerned enough to make sure she takes all her meds all the time and has excellent followup. This dyad was high risk from the moment she got pregnant.

    • Amazed

      That’s why it’s so important for all healthcare providers of someone with such a problem to stay in touch. I’m going with my intuition alone (an excellent NCB material, aren’t I) but I suppose her labour and delivery team first saw her when she was on her meds, aka looked “normal”. Since schizophrenia isn’t the standard for pregnant women, I guess they didn’t have much experience with it and underestimated how serious a condition it is. Especially if they saw a “normal”, aka on her meds, woman.

      Perhaps they also fell prey to the standard delusion that because patients with such disorders look like everyone else, physically speaking, and not displaying any obvious signs of illness, there was an element of will involved. And the concept of maternal love being as strong as to beat everything is a wide-spread one. No one would except it to beat the constraint of being unable to walk, though.

      Collaboration. So needed. So important. Every psychiatrist could have told them this. Hell, I could have told them, with only having the anecdotal evidence of how a schizophrenic relative is like when not taking her meds. And how charming she used to be when in her “normalized” state. (No longer the case but I’m placing the blame on specific circumstances.)

      • Cobalt

        I think you’ve touched a major point.

        Like people with many other diseases and disorders, a schizophrenic with effective treatment generally does not show signs of illness.

        Also like many other diseases and disorders, if treatment stops, the symptoms come roaring back. Love, faith, will, anger, determination, hope, breastmilk, none of them change that.

      • Hannah

        “That’s why it’s so important for all healthcare providers of someone
        with such a problem to stay in touch. I’m going with my intuition alone
        (an excellent NCB material, aren’t I) but I suppose her labour and
        delivery team first saw her when she was on her meds, aka looked
        “normal”. Since schizophrenia isn’t the standard for pregnant women, I
        guess they didn’t have much experience with it and underestimated how
        serious a condition it is. Especially if they saw a “normal”, aka on her
        meds, woman.”

        I suspect you’ve hit the nail on the head here. I would be very surprised if her doctors directly told her to come off risperidone. That’s the take of at least one of the journalists present and has been propagated through other media, but the only direct quotes from the coroner we have are that Charlotte Bevan wasn’t taking her risperidone, she wanted to know what action was taken, and wanted to explore the breastfeeding advice given. What strikes me as more likely is that she may not have been given clear and authoritative advice on the matter. As you say, expertise is crucial, and the team managing her may not have had the expertise to cope with the complexity of managing a pregnant woman with severe mental illness.

        One possible hint in support of this is a case from last year in which the hospital were criticised by a judge for their slack management of another woman with schizophrenia:

        http://www.bailii.org/ew/cases/EWCOP/2014/3.html

        As I’ve said below, the inpatient Mother and Baby (mental health) Unit is attached to another hospital, at a different trust in Bristol, and presumably the complex perinatal mental health experts are based there, which makes me wonder why she wasn’t there instead.

        The broader background is that UBHT has something a history of large scale scandals, dating back to the child heart surgery scandal in the 90s (two of their surgeons were incompetent, one of whom managed to inveigle his way into management positions that meant he became unassailable, managers were repeatedly warned about this but did nothing, many children died and it became one of the all time great medical scandals), more recently problems with histopathology, and now this. This is in spite of the fact that it is an academic hospital, in a nice location, which should have no problem recruiting high quality staff, and indeed has many strong departments. Part of the problem may be a complacent and defensive management culture that refuses to acknowledge or deal with problems until they absolutely have to. It’s unclear whether there isn’t also an element of bad luck, with an unusual number of professionals with connections to the area prepared to blow the whistle publically. This case perhaps exemplifies this. Suicides of young mothers must happen from time to time but rarely a photogenic mother, prompting a major missing persons enquiry, followed 24 hours later by pictures of police abseillers crawling all over the gorge blasted across the national news.

        Either way, the histopathology enquiry might provide another hint regarding this case:

        http://www.uhbristol.nhs.uk/files/nhs-ubht/Histopathology%20report%20December%202010.pdf

        One of the findings was that UBHT regarded itself as the “kingpin” (paragraph 28) of the hospital trusts in Bristol (possibly because of it’s links to the University), and that:

        “It was evident that, in common with other cities that have more than one NHS Trust, there is an element of professional rivalry and professional jealousy between some of the departments and indeed between some of the clinicians in these Trusts. The effect of this disharmony was described succinctly by one of the witnesses:

        “That rivalry has been incredibly damaging to the sane and rational distribution of services.”
        ” (paragraph 35).

        This was in 2010, and I can’t say whether things have improved since then, but it’s certainly relevant when considering why the hospital might be reluctant to refer on to where there might be greater expertise or indeed acknowledge that more appropriate expertise might exist elsewhere.

  • Solhum

    This is more about an indictment on the mental health professionals involved in this woman’s care.

    • Sarah

      Absolutely. This took place within a climate of pushing breastfeeding for all women, and problematising formula. No great shock that Charlotte would imbibe that.

    • Michael Clark

      Absolutely! Active serious mental illnesses are by and of themselves teratogenic. That is, there are serious significant risks not only for mom, but for the baby too. And yet, far too many psychiatrists are more afraid of the effects of medications than the effects of the illness. During her pregnancy, my wife damn near ended up that way,

  • Zen

    What strikes me most about this whole thing is that this lady, wearing street clothes, so easily ABSCONDED WITH A NEWBORN and not a soul was there to stop her or even notice. At the hospital I work at (US), all units where infants or children are present are locked, and a unit coordinator or RN must buzz you both in AND out of the unit. We do hospital-wide “Code Pink” drills, where everyone, everywhere, in every department, stops what they are doing and goes to stairwells/hallways/etc. to look for a (fake) “suspicious individual” who is suspected of stealing a newborn or child. I could go on, but seriously–HOW are these hospitals operating in such a lax fashion when it comes to child security? I’m gobsmacked.

    • Who?

      When my daughter went through her run of UTIs she spent way more time than an 18 year old ought to in the maternity ward, which was thought to be a good spot for a young girl on a drip. The ward was often locked, needing buzzing in and out, and we were told-despite having no baby in our entourage-that babies were not to leave the ward until they were being discharged.

      There were lots of new mums doing circuits with the newborns, and the staff were generally more vigilant about movement than on any other ward but general medical, which was full of very old people, some of whom had dementia and tended to wander.

      So yes, not as strict as where you work but I doubt you would get far with a baby without being challenged, esp since there was no other ward on the same floor.

    • Jessica

      When I gave birth to my son in 2012, we were told that the bands on the baby’s ankle would set off an alarm if they got too close to an exit/out of a designated area without staff clearance, causing the whole unit to go on lockdown.

      • Amy M

        We had similar–each baby had two bands (wrist/ankle), my husband had two (one for each baby) and I had 3 (for myself, and both babies). They told me about their system, which included Code Pink, so they probably ran drills.

      • The Bofa on the Sofa

        See my comment below – in our hospital, the sensor is on the umbilical clamp, and so won’t come off until the baby is released. It triggers locks on the doors.

      • Sarah

        Same. The bands have to be removed before discharge, or half the local constabulary will rock up.

    • Phascogale

      Where I am and most places I know of there are no locked doors preventing people coming in and out (except at night) in the main maternity ward. There is also a level of complacency to the nursery that people are buzzed in. Even if it’s a parent you expect, anyone can follow them through the door. Also code pinks are obstetric emergencies and I’d be expecting a PPH rather than a suspicious person.

      • Amy M

        I think I asked if any babies had ever been taken, and they said “One or two”, but they got them back before the kidnapper could even get out of the hospital. If I remember correctly, the most likely person to try to steal a baby is an estranged family member.

      • Medwife

        I’m in the US. I work at a small hospital but our unit is locked and all babies get a sensor around the ankle that goes off if someone tries to take them out. That’s just basic safety here.

        • Mac Sherbert

          Yep. That does seem pretty standard in the US. Ankle alarm plus having to be buzzed in and out the unit. My hospital also requires the nurse to take you your car in a wheelchair. They no longer allow you put your baby in the car seat carrier before you leave. I’m thinking a lot of that has to do with safety.

          • Ash

            re: wheelchair. It’s a liability/safety thing. Every hospital is trying to reduce its number of patient falls.

            Reportable falls even include “unplanned descents” as they are called. This would include if you stand up and then decide you need to sit down, so you grab onto the chair and seat yourself.

          • An Actual Attorney

            When Actual Niece was born this year, the hospital checked my purse every time I left the unit. Granted, my work purse is big enough to hold several legal files / one good sized baby / all the random shit I don’t know why I carry around every day.

  • MichelleJo

    I’ll bet that no-one will be found guilty and we’ll have a statement like ‘this was a terrible tragedy and our thoughts are with the family, however rare things like this do happen even with the best of care.. women can be assured that our hospital has strict regulations in place to avoid such tragedies, and they are in safe hands when coming here to give birth.. women should not take this as an indictment against breast feeding, breast is best for you and your baby….” NO. This was entirely preventable, avoidable,d inexcusable, and there should be heads rolling. There was obviously no-one overseeing her care when she was a desperately high risk case. According to the Telegraph article, one of those under investigation is a porter! Talk about shifting the blame!

    When I gave birth after a particularly complicated and traumatic pregnancy which included HG and severe depression; unbeknown to me, the in house psychiatrist had instructed the staff not to allow me to be alone with the baby for a second, and to keep making excuses as to why the baby couldn’t be released, until she was a week old. He didn’t want to risk me taking her home to take care of her before that. When I later realized what had been going on, I felt very deceived and that it had been totally unjustified . I wasn’t psychotic, I was so thrilled that the pregnancy was over and my daughter was here, and there wasn’t a chance in the world that I would have hurt her or myself. But that’s what’s called having strict regulations in place. Most of the time it isn’t necessary, but it stops the one in a thousand tragedy. Charlotte and her baby would be alive today, if she had given birth where I did.

    • SporkParade

      Why couldn’t they just tell you ahead of time that they wanted you to be stay there for a week in light of your high risk status? Who thought it would be good for your mental health to be told that your baby had a problem serious enough to preclude being released from the hospital when she didn’t?

      • MichelleJo

        I don’t know that keeping a baby of a high risk mother in hospital for a week was a blanket rule that they could have told me ahead of time. But what was strict protocol was that the psychiatrist was called every time an at risk mother came in to give birth, being the correct professional to assess risk and advise care. How he came to his decision I have no idea, and he probably was over cautious, which is hardly a real problem. And the reasons given for delaying discharge were more technical than medical (we don’t do discharges on Yom Kippur, she needs the bili lamps for 12 hours etc,) So that while I found it frustrating, I wasn’t wracked with worry, which could have done more harm than good. Besides, telling a high risk mother ahead of time that she will be released without her baby is asking for the mother to skip the hospital and find another. Which is especially likely given the chances of her reasoning abilities being poor. Sometimes the rules of full disclosure and all that have to be bent simply to protect the patient, which is the reason she is in the hospital.

        • SporkParade

          Oh, you’re in Israel, too? Israeli maternity hospitals really need to work on informed consent when it comes to babies, in my experience.

          • MichelleJo

            Yes, I’m in Israel too, and jolly glad to be. Of course there needs to be boundaries set as to where doctor’s decisions end and patient’s choice takes over, but if we stick to them no matter what, patients are going to die (in cases where they don’t want to) because they are not well enough informed or don’t understand the danger. The patient is the one who ends up the winner and is usually grateful for it. In the UK for example, the government set a maximum waiting time at the ER (probably six hours or something), so in order to stay within it, some crowded hospitals were keeping patients waiting in the ambulances outside. So they kept within their target on paper, but it certainly wasn’t helping the patients. I agree that in Israel you do sometimes get walked over, and if I realize it, I tell them where to get off. Most doctors though are decent and do stick to the guidelines, but they ‘get away’ with saving patients because they are not likely to be penalized, and Israel does not have a ‘sueing culture’. I guess there’s good and bad in every system.

          • SporkParade

            Oh, I’ve generally been very happy with the care here. But your comment put me in mind of what happened after I gave birth, where the nurses tried to blindside me into accepting more risk for the sake of exclusive breastfeeding. I still can’t believe it’s okay for a nurse to say that she’s not allowed to discuss my baby’s care with me.

  • Anne Catherine

    I really don’t think that the ‘natural parenting’ movement is the only one to blame for this kind of behavior from health care workers. —

    Well respected sources like the AAP and
    HHS have information in their publications and websites that say that breastfeeding can reduce the risks of life threatening diseases like diabetes, asthma and cancers –in a dose response fashion. (below)

    AAP —-http://pediatrics.aappublications.org/content/129/3/e827/T2.expansion.html

    HHS—-http://www.ncbi.nlm.nih.gov/books/NBK52680/

    Unfortunately as readers of the blog know, the research
    behind these claims thin. The studies cited are old/inconclusive, associations are substituted for causal relationships and numbers are used before adjustment for variables.

    The AAP and HHS are trusted by MD’s and nurses; it is no wonder that co many healthcare professionals feel the need to push for exclusive breastfeeding at all costs, and in all circumstances.

    Until health professionals have good information and realize
    that formula does not put children at risk for chronic disease (as well as low
    IQ and everything else under the sun), we will continue to hear stories of women being bullied as well as a few
    really bad outcomes.

    • I always wondered how they were able to do those studies re: breastmilk and serious illnesses without using the parents of children who weren’t using any treatment BUT breastmilk.

    • KarenJJ

      This is one area of breastfeeding research that just doesn’t seem to have happened. How many women with a family history of diabetes, cancer, asthma, immune system diseases etc etc had a problem with breastfeeding? I’m one. Supply issues, delay in milk coming in etc etc. and had an undiagnosed immune system disease at the time. My kids have a 50/50 chance of inheriting the disease purely due to genetics. Nothing to do with their lack of breastmilk.

      It seems like researchers got the to stage where policy makers can moralise about feeding choices and bully women into breastfeeding and then people stopped looking. What is the real issue here? Is it the wrong food for babies or a genetic predisposition that is also causing some underlying issues in women that are trying to breastfeed?

      What would be a better way forward? Better screening for underlying conditions during pregnancy? Better awareness of things that can affect breastmilk supply? Lock women and babies into a room with no option but breastfeeding to force the issue?

      • Anne Catherine

        Actually, there are a lot of good studies out there that do factor in variables like family history of disease and other things that may make it more difficult (or might make women less likely) to breastfeed.

        These studies conclude that breastfeeding does not have an effect on chronic conditions like asthma, diabetes, and obesity, and they have been ignored by the AAP and HHS.
        HHS cites no research (on the benefits) post 2007 in their Call to Action- and the AAP isn’t much better.

        Below are a few such studies on asthma, obesity, diabetes-
        I could actually fill a few pages with studies like this…..
        http://researchnews.osu.edu/archive/sibbreast.htm http://www.ncbi.nlm.nih.gov/pubmed/25291239 http://jama.jamanetwork.com/article.aspx?articleid=1667089
        http://www.ncbi.nlm.nih.gov/pubmed/22837371
        http://www.ncbi.nlm.nih.gov/pubmed/22373843

        • KarenJJ

          Wow. That makes me.. um. furious.. So someone could be desperately breastfeeding around the clock and pumping etc, kid going hungry while mum is trying her best to prevent her kid suffering from the asthma/diabetes/immune system issues that plague her family. Getting exhausted, depressed that it’s not working, fearful for her kid’s future health… And it’s doing basically sod-all.

          What’s the harm, hey?

          • Anne Catherine

            Yep–this over-promotion is pretty harmful (as well as unfair and unethical).
            It makes me furious is well.

    • CharlotteB

      The whole dose thing confuses me. If you have a baby who is exclusively nursing, (no pumped milk at all) you have no idea how much they get. Or, if you EBF for 6 months, then switch to formula, does that give the same benefits as combo-feeding for the whole first year? As far as I know, nobody can say.

      OR, what if all the benefits of breastfeeding come from getting the colustrom?

      Not that it really matters since formula is great, but in the interest of making an “informed choice” it’d be nice to know.

  • Jeanette Santaliz Toledo McGur

    I had to get back on anti depression meds so no more breast feeding. I breastfeed for about (2) weeks I started getting the “blues” and doctors became concerned. It was decided my healthy was more important. I felt guilty and ashamed in the beginning Now my son is on formula and is healthy and I’m happier and we are bonding and making happy memories. My mental and physical health has improved and I so happy I feel more like my old self before baby. A baby turns your life upside down women need support, love and understanding from the medical world family and friends. We need to support moms and babies. I’m so lucky to have support.

    • lilin

      When you were breastfeeding, you looked at the circumstances and made the best possible choice.

      When you stopped breastfeeding and started formula feeding, you looked at the circumstances and made the best possible choice.

      There’s no difference between the situations. There’s just you figuring out a way for you and your child to be healthy and happy together. I’m glad that everything worked out well for both of you.

  • A

    I’m outraged. I just can’t find any words. What a senseless tragedy. Will those doctors be held accountable?

  • PeggySue

    I have had nurse practitioners immediately recommend I stop taking an antidepressant which “might” cause elevated blood pressure–with no seeming concern and, indeed, not even asking if I would be interested in doing so. Just, “OK, well, you’ll stop taking X…” and I say, “Oh no I won’t.” I guess they want me to use blue green algae or St John’s Wort or something. Re: Charlotte Bevan, my heart hurts to think how much she must have suffered before her death, and how much her baby suffered.

    • Guesty

      http://www.cnn.com/2015/03/06/living/feat-moods-antidepressants-new-book/

      The thesis of this conversation is that we are medicating women’s emotions away. Holy god. Don’t tell women they don’t need the drugs. If you’re in consistent pain and get relief from an anti-depressant TAKE IT. How many women need glasses, for crying out loud? Do we climb all over them for needing glasses?

  • Allie

    “Moralizing infant feeding is wrong” – ‘nough said.

  • Just the other day I commented on an idiot facebook story about “liquid gold”, and I mentioned the fact that mothers are committing murder-suicide over completely unnecessary guilt.

  • Jocelyn

    OT: Have you guys seen or read this today? Because if you haven’t, you really, really should: http://www.honestmidwife.com/wp-content/uploads/2015/04/High-Risk-FINAL1.pdf

    • Who?

      That’s quite a story-wasn’t sure where she was going but very moving and interesting to see how she reflects on her experiences.

    • Ash

      Really interesting article. The part about “the fruit” is terrifying.

    • Poogles

      After reading this, I really think it could be a great document to point people to for a decent summary of the overall literature on homebirth in the US, and that it comes from an ex-homebirth midwife is only better for those who immediately dismiss anyone who isn’t a midwife or HB advocate.

      • Wombat

        Unfortunately, as she called it, there’s still a good chance she would be dismissed.

        But always worth a try, and maybe at least slughtly less easy to dismiss, or more likely to cause doubt on the part of the dismisser c:

        And never a bad idea to give expecting Moms accurate statistics to allow unformed choices, whatever they may be.

        • Who?

          She told the story so well though-really understanding and speaking the language of the community she no longer participates in. Perhaps that authenticity would be of some value in those communications.

          The part that most caught my attention was when she said she wondered how she hadn’t ever got around to looking all this stuff up before she was so assured with home birth parents; and then her recount of the internal battle which eventually led to the loss of her business. She said she knew what to say, and when to say it, but in the end she couldn’t do it anymore. And standing watching those deliveries hoping each one wouldn’t be her one in a thousand. It is like inverse imposter syndrome-she came to realise she really shouldn’t be there.

          I came away with some admiration for her integrity, and for her tenacity in following where her studies-as opposed to her research-led her.

          • I found this statistic extremely important:
            When asked about the statement, “Having a safe and healthy mother and
            baby are the only things that truly matter in birth,” 68% of the women who had
            only had hospital births agreed with this statement. Of the women who planned
            nonhospital birth, only 36% agreed with this statement, and 50% disagreed
            (remainder neutral).

            Only 36% of women planning a homebirth put their baby’s safety above the mode of birth? Are these women psychopaths? One presumes that these children were conceived in love and are wanted, yet the possible death or damage is of less importance to 2/3 of the mothers bearing them than the place/type of birth?

          • Ash

            I don’t think they are less concerned with safety. I think that some people who subscribe to a NCB type philosophy think that danger during childbirth is so rare for carefully screened candidates (ie–themselves) that complications will not happen. In addition, tropes such as “pitcocin leads to distress which leads to emergency c-section” type of mantras, which leads them to think that hospital care is inadequate. Safety is a given so they want care that is sensitive to their desires as well, and NCB has convinced some people that hospitals are inadequate at best.

            It’s kind of like asking people “is a safe automobile the only thing that matters?” A lot of people think of driving as so safe that they would answer “No, I want a car that is safe and comfortable”

          • Amazed

            Still, the question said “the only things that TRULY matter in birth”. The inclusion of the word TRULY gave everyone the chance to explore their priorities without actually realizing that they were doing it. TRULY has the ring of, “When all is said and done, at the end, all niceties stripped aside”. And 2/3 of the mothers clung to their niceties as if they were being asked to spend the next 10 years in that dreaded hospital or at least giving birth. Not like the car example at all. Car is supposed to serve you a good number of years. Now, I know that mommy warriors find particular delight in bragging how long they suffered giving birth but I really, REALLY find it hard to believe that they would want their birth to last as long as the usage of their new car.

            It beggars belief that there are so many women who are so entitled that they cannot admit even the tinies chance of something bad happening and insist that the longterm outcome of a few days at most is not the only thing that truly matters. They see themselves as strong women fighting for womankind but they are anything but.

          • Amy M

            Yes, I agree, its because they are already convinced that safety is guaranteed (no one dies in childbirth in modern America!). And yes, its important that the woman be treated with respect by the caregivers, and mental health should be valued as highly as physical health—but first, start with getting everyone safely through the process.

          • Amazed

            Oh yes. But I find it disturbing that they cannot even pay lipservice to the fact that outcome should trump anything else. Sounds very brainwashed to me. It isn’t this hard to say, “Yes, everyone being alive and healthy is the only thing that truly matters but I have this and that concerns.” Still, they cannot even consider it, it seems. Very troubling.

          • Daleth

            That wasn’t the question (whether outcome should trump everything else). The question was whether safety was the only thing that “truly mattered.” You could reasonably answer no, it also truly matters that I not be completely psychologically traumatized. I chose a scheduled c-section and even I think that there are other things that “truly matter.”

          • Amazed

            That was the question. A safe and healthy mother and baby includes mental health. Especially to those tender flowers who can be so traumatized that the room they gave birth in didn’t have windows. If anyone is more likely to be more negligent in considering mothers’ mental state when answering, it’s probably the women who just want the baby, without the rite of passage that the process of becoming mothers is for THEM.

            Uneducated, OBs-trusting hospital birthers are more likely not to take mothers’ mental state into account because they haven’t learned that they can be so damaged by a birth experience. The mothers who filter everything through their experience, their rite, their low-risk pregnancy that simply cannot become a high-risk birth won’t forget about themselves and their mental state.

          • Sarah

            Safe and healthy does include mental health, but there are women treated badly in labour who don’t then experience mental health problems because of it. A woman denied an epidural because a midwife thought she shouldn’t have one might merely be pissed off. I can’t see how that would mean that, because she and baby were safe and healthy and not traumatised, her experience doesn’t really matter.

          • Amazed

            Experience matters but the context the question was asked in was glaringly clear. And it was not about disappointment, problems with bedside manners or someone usurping rights that were not theirs to usurp.

          • Daleth

            Amazed, you’ve got several people disagreeing with what it meant right here on this thread. Do you still think all 1000+ women who participated in the survey understood the question exactly as you do?

          • Amazed

            No. And you’re so sure they understand it exactly as you do? In particular, do you think the mother quoted in a post early this year who explained how she was left with a healthy baby but a broken soul and shattered heart because of her C-section would have considered herself safe and healthy? Mutilated apples doesn’t consider themselves healthy, after all.

          • Daleth

            Actually, I do think most of them probably understood it as I do, because only 68% of the women planning hospital births answered yes to that question.

            Do you really think that only two-thirds of (for lack of a better word) normal, mainstream mothers think safety trumps all other concerns? In other words do you really think almost 1/3 of normal, mainstream women think something other than their baby’s and their own safety matters most?

          • Amazed

            No. And I never said it was. You were the one who asked whether I was sure that ALL the + 100 women thought like I did. I think – and I wrote – that it’s incredibly privileged to consider yourself immune to all bad things that happened because birth is safe, you’ve been taking such a good care of yourself and so on. It’s like swearing falsely on your child’s life. None of the people I know would do that, even if they’re avowed atheists. It’s a gut response. Survival instinct. Whatever. A mother I know was SO grateful that she didn’t take the offered chance to have her child proclaimed autistic for financial benefit. Because he actually turned out to be autistic and she would have always wondered whether it wasn’t because of what she (a true unbeliever) did.

            Besides, I’ve written here before that it’s hard for me to say, “Homebirthing mothers didn’t have more information!” They now do. Studies are coming out. Word is coming out. They simply choose not to know. They choose to believe midwives. I really doubt they’re your average mainstream women. They’re in toxic environment that changes them. They might believe or not believe, act or not act – but if they want to stay in this communuty, they must talk the talk.

            And then, of course, there is the fact that for most of those mothers, both homebirthers and not, it’s done. The birth is over. It’s much easier to talk the talk when the experience, with both good and bad, is behind you and you’re not grading your priorities now.

          • Sarah

            Was it? I thought there was plenty of room for further clarification, personally.

          • Amazed

            It looked quite clear to me.

          • Daleth

            If two other clearly intelligent people read it as meaning something else, then it wasn’t clear. Case closed.

          • Sarah

            Well, there are evidently some of us who feel differently. Which would suggest it wasn’t.

          • Daleth

            No, that simply was not the question.

            Survey questions have to be phrased very carefully for this exact reason. It might “truly matter” to some women that they don’t get a c-section, so they would answer no to a question that asks whether a safe and healthy mom and baby is all that truly matters. But if you ask them whether having a living, healthy child “matters more than anything else,” the same women will answer yes.

            And I don’t think most people would read lack of pyschological trauma (not mental illness, but just trauma) into a question about a “safe and healthy” mother. Particularly because this is exactly the thing home birth enthusiasts complain of: “I was emotionally shattered, but everyone kept saying, ‘at least you’re both healthy’!”

            The concept of a birth everyone emerged from in perfect health, but with the mother’s disappointment/sadness/feeling of violation/etc. not acknowledged and even dismissed, is such a trope among NCB types that it verges on cliche. They’re going to read that question as reflecting that trope.

          • Amazed

            “They’re going to read that question as reflecting that trope.”

            Some of them will. Others might reply from the position of the injured parties they consider themselves to be. Especially if they had a C-section.

          • Sarah

            Exactly.

          • Busbus

            I think that the question did a good job teasing out underlying, emotional biases. Yes, even a person who does truly value safety over other concerns might read that question in a way that makes them answer no. And no, I don’t think that someone who answers no must be a terrible person. I think that the question simply does what it was meant to do—tease out what a person’s gut response is to someone who says that safety matters most. And, not surprisingly, that gut response differs greatly between people who choose hospital births and people who choose homebirths. That does tell us something, doesn’t it?

          • Amazed

            Perhaps. I am not sure what it tells us. But the teasing out the underlying biases part is clear. It’s like the sanatorium I came back from a few days ago. I was one of the youngest patients there, so many people were curious about me. The questions I got asked from people who were sent there for mild conditions and those whose bodies formed an upturned L were vastly different.

          • The Bofa on the Sofa

            Just look at the breakdown of the answers. Absolutely the question is telling something.

            Even if it is telling us about “how people read the question” it’s telling us something.

          • nomofear

            I was one of the ones convinced that hospital birth was less safe. Fortunately, nothing terrible happened with my firstborn, and I wizened up before the second and had an amazing time birthing her in an elective induction with an epidural. But they absolutely had their claws in me until someone linked one of Dr Amy’s pieces in one of their comments sections and I clicked it. Cognitive dissonance is a weird thing. In every other part of my life, I stick to trusting experts. I hated antivaccers. Yet, I believed the NCB cult. Only after obsessively reading this site for a few weeks did I fully snap out of it.

          • Daleth

            I don’t think only 36% of homebirthing women put their baby’s safety above the mode of birth. I think what generated that response is the phrasing of the question (“the only things that truly matter”). If it had been phrased as “are the most important things,” more people on both sides would have answered yes.

          • Sarah

            Yes, I agree. Obviously the term ‘safe and healthy’ is a very wide one, but it’s possible to feel that the mother’s experience is very important without meaning it in a prob NCB, unmedicated vaginal birth at all costs way. My first birth resulted in a healthy baby and mostly physically unscathed mother, but the epidural denial was also extremely important. As such, I don’t know that I could’ve answered ‘yes’ to that question without assurance that safety includes more than both coming out in one piece. If safe and healthy definitely includes being given adequate pain relief, sure.

          • fiftyfifty1

            It’s a difficult question because people will read it very differently depending on their backgrounds:
            -A woman in a developing country where dead babies and mothers happen routinely, may read the question differently than one from a country where neonatal and maternal deaths are rare.
            -A woman who has been taught that a vaginal birth is an essential rite of passage will read it differently than a woman who has been taught that birth is a way to get a baby.
            -A healthcare worker may read the question very differently than a layperson. (This was true in my case. I actually took the survey. I disagreed with the statement because ethical principles still truly matter, patient experience still truly matters. I am not allowed to force a woman to have a CS, or treat her rudely with the excuse that “having a safe and healthy mother and baby are the only things that truly matter”. And I would like to think I’m not a psychopath).

          • Guest

            I assume the wording of the question biases the responses. The use of the word “only” in this case. I don’t think that 32% of hospital birth women, for example, don’t care about safety, but that they see other factors as mattering in birth. “matter most” might have had very different results. Still appalling, but many people are very literal over how they read these sorts of questions.

      • Ash

        I think the article is VERY compelling, even without the studies. Some of the easy to understand parts

        1) the author went to a top midwifery school (not counting the CNM degree, of course). Some people argue “well you should do your research and choose a well trained midwife” She DID get what is considered high quality CPM quality among NCBers, but the school was completely corrupt. It wasn’t just her, it was from the top down.

        2) The comparison about car seat safety is apt.

        3) common practice of fudging among practicing CPMs due to lack of oversight

        I did find the description of how pain causes a person to be devoted to the cause to be interesting, but would be hard to swallow among NCBers.

    • Amazed

      I find it interesting that she’s a psychology student now. Given the fact that she started down the midwifery path because of her own experiences, I don’t think it’s too much of a stretch to presume that she recognized that something within this community was not right and that sparkled her interest in the things that were not right the way midwifery was.

      • Daleth

        Also, she clearly wants to help people. That’s what she thought she was doing as a midwife, until she had her awakening. As a psychologist, she can help people without endangering anyone–the stakes in psychology are much lower. (She’s not going into psychiatry, for instance, where she could be treating paranoid schizophrenics or psychotics who actually could be dangerous; she’s probably going into therapy, i.e., helping people with the normal dramas and difficulties of life).

    • Somewhereinthemiddle

      The paragraph at the end of page 51 going onto 52 is especially chilling. Applying a kiwi (illegally) without even the mothers knowledge or consent is fucking horrifying.

      • Sarah

        Yes! I mean, it’s one thing to perform the procedure illegally but with patient consent. But to not even ask! And ventouse is a procedure that potentially has long term effects. There may be women still living with the effects and not even knowing,

        • The Bofa on the Sofa

          Yes! I mean, it’s one thing to perform the procedure illegally but with patient consent. But to not even ask!

          To the point of locking the door to prevent someone from entering accidentally and covering the patient’s eyes with a washcloth so she can’t see it!!!!!

          I read that and my response was, holy shit that’s friggin slime!

          Wasn’t this something she experienced during training? You know, at the famous midwifery school?

          • Guesteleh

            Yes, and she didn’t run screaming. Credit to her for finally getting out and blowing the whistle but the fact that as a student she continued her training after seeing that is chilling. Look at posters like Dani and…woman from Oregon who was training to be a CPM but whose ‘nym is eluding me right now. After they started training and got a close-up look at what was going on, they were out of there.

          • The Bofa on the Sofa

            As I think about it, this is a pretty serious accusation being made against that program. If this piece found it’s way to the appropriate authority, what kind of consequences could result? If it were a med school, it would be shut down (1. Lose accreditation. 2. Serious sanctions from the state board)

            Is there anyone with oversight of that school?

          • Daleth

            Probably a bunch of CPM’s!

          • The Bofa on the Sofa

            I was going to say, “….aside from Ina May, of course”

            But yeah, this is the problem. If the accrediting agency, if there is one, is MANA or some other hack group, there isn’t much that can be done.

          • The Bofa on the Sofa

            I was going to say, “….aside from Ina May, of course”

            But yeah, this is the problem. If the accrediting agency, if there is one, is MANA or some other hack group, there isn’t much that can be done.

          • Ash

            the florida school of midwifery accepts federal financial aid. I wish that this school could be busted by the DOE for violations…Corinthian Colleges was busted by the DOE for falsification of records and lying about graduation rates.

            how about the DOE stopping funding for FSOM for violations as described by honestmidwife.com? That seems appropriate. I don’t think that would happen though.

            Someone rich and powerful would have to be egregiously injured to have a chance at change, sadly.

        • fiftyfifty1

          Empowering and natural if a CMP does it!

          Disempowering and unnatural if an OB does it!

        • Somewhereinthemiddle

          I can’t imagine being lied to about my care and end up with either me or my baby having effects from a procedure that I didn’t even know was being performed.

          I have a friend who did need a ventouse for her first and the resulting damage was not pretty at all. Of course her baby also had a shoulder dystocia and temporary erbs palsy so the damage to her lady bits didn’t rank at the top of things to be worried about at the time.

          • Sarah

            Additionally, ventouse without proper anaesthesia stings a bit, as I can personally attest. The women must surely have felt something when it was being performed. What on earth were they told?

          • Somewhereinthemiddle

            Yowza, yeah, I would guess that was pretty painful. A related question… Do you know if epidurals provide pain coverage for procedures like ventouse or forceps?

          • Ash
          • Amy M

            I had an epidural, which totally blocked contraction pain (I felt a little squeezing when they happened) but did nothing for the pushing pain, in the nether regions. They used the ventouse for my Twin A, and it hurt like a mofo, and that’s the only point I remember actually screaming. But it was fast, it did the job, and ultimately, I only ended up with a 1st degree tear that required less than 5 stitches.

          • toni

            maybe it would have been even worse without it? Or did you deliver without an epi before/since so you know it had no effect on your perineum.. cause if epidurals are that crap at reducing the pain down there they really need to work on that or do a pudenal (sp?) block as well. i think most women find the crowning the worst part (i did!)

          • Amy M

            No that was my first and only pregnancy, so maybe it WOULD have been worse without it, I don’t know. 🙂 Mostly it was the pressure (from pushing) which was very unpleasant, and if I did nothing, it didn’t hurt. So, I had to convince myself to just do it and get the babies out, and then I could stop.

          • Medwife

            I have seen some whose epidurals did not give sufficient anesthesia during instrumental delivery. I’ve seen others work very well for pain, but the woman still felt some serious pressure. Basically, they certainly can be effective for instrumental deliveries.

          • Jocelyn

            I had an epidural and forceps. I couldn’t feel my contractions, but I definitely felt the forceps. They hurt!

          • Sarah

            Not sure. For a ventouse, in the UK if you’ve not had an epidural and it’s too late, they do a local anaesthetic injection- pudendal block. It took the edge off, but is certainly inadequate. I believe they do a spinal for forceps?

          • SporkParade

            With me, there was a debate between the midwife and the OB about whether to use ventouse or episiotomy, and episiotomy won. I had already had an epidural and was not given local. The episiotomy itself didn’t hurt, but the baby coming out totally did. I got local anesthetic in the middle of being stitched up because the process kind of stung.

          • Somewhereinthemiddle

            You do have to wonder if they would have noticed. Maybe they were told some stretching was being done or something. I can’t imagine not feeling that thoug…

        • Aine

          I am a longterm lurker and huge admirer of this blog, especially the comments box. You all helped me realise that I wasn’t bonkers when my instincts screamed “but that’s nonsense” at a lot of the ncb guff I encountered while pregnant.

          I have an OT question though – in reference to the horrifying account of ventouse use in the excellent piece by the former midwife, some commentators have spoken of the potential long-term serious effects of ventouse delivery. My lovely son was born with ventouse and episiotomy (plus a whole lot of gratitude from me for my amazing ob and her team). I fully believe that this intervention was absolutely necessary in the circumstances but at no point in follow up care did anyone mention long-term risks. What are these please? Are they for the baby or for the mother? I did develop a DVT three weeks post partum, would this be in any way related to instrumental delivery? Thank you (back to lurking).

          • Amy M

            I’m not a doctor, but I imagine that if the mother tears badly (certainly a risk of ventouse), she can have pelvic floor issues later on (urinary incontinence to the point of surgery). I was told, while they were prepping the vacuum, that the baby might end up with a bruise on his head, but that was minor and short-term. (He didn’t, but his head was really weirdly shaped for a day or two there). My boys are 6 now and are healthy—no cognitive or developmental delays, but sometimes I have to cross my legs when I cough.

          • Sarah

            NHS info says greater risk of blood clots and incontinence.

            http://www.nhs.uk/conditions/pregnancy-and-baby/pages/ventouse-forceps-delivery.aspx#close

            I had SPD in my second pregnancy, and the physio told me previous instrumental delivery is associated with greater risk of developing the condition. I never researched that, but it would make sense. Like you, I’ve no argument with the use of instrument in my own delivery, the point is that you can only be aware of long term risks if you actually know you had the procedure!

          • The Computer Ate My Nym

            The first 6 weeks post-partum are the highest risk time period for development of a DVT. Higher risk than during pregnancy, higher risk than on OCP. In other words, it’s probably not related but you may be at higher than average risk for a repeat DVT during or after a subsequent pregnancy, since your body has demonstrated that it likes to form DVTs in that particular hormonal milieu. (Though it’s by no means certain that you’ll develop another DVT: your absolute risk is still quite low, just relatively higher than that of someone who has not had a pregnancy related DVT.)

          • Aine

            Thank you, yes my ob and haemotologist have already signalled I’ll be back on those horrid Clexane/Lovenox injections if I do get pregnant again from time implantation is confirmed to be non-ectopic to six weeks post partum. Interesting that NHS suggests ventouse is linked with dvt, does anybody know any research I could read about why this might be the case- as a non-medic, the mechanism of instrumental delivery lending to a clot seems very implausible to my (obviously limited) understanding.

            Thankfully the angry-looking bruise on my baby’s head healed very quickly and did not seem to cause him the slightest issue. I do have some mild stress-related incontinence now only when I run, so I am doing my pelvic floor exercises religiously, but I suppose this could equally have been the outcome of an unassisted vaginal birth.

            I remain horrified by the ventouse use by those midwifes in the paper, those poor mothers and babies, how dangerous for someone to seek to provide a treatment that they were untrained and unlicensed for, and what an unspeakable violation to do so without the mother’s knowledge. Surely this would be criminal?

          • The Computer Ate My Nym

            Off the top of my head guesses about why instrumental delivery might be related to DVT…
            1. You’re in more pain after an instrumental delivery so don’t move as much and inactivity is a DVT risk.
            2. A prothrombotic tendency might lead to both fetal distress (i.e. thromboses in the placenta) which might increase the risk of need for instrumental delivery and to an increased risk of DVT.
            3. Older mothers might be at increased risk of both complications and DVT due to the effects of aging.
            4. Some other correlation.
            I can’t think of any specific mechanism by which a vacuum or forceps could cause DVT apart from #1, but

            I could easily believe that I’m forgetting something too.

      • Dr Kitty

        Not to mention if one of your major selling points is that your clients will not have instrumental deliveries…and they do, but you don’t ask for consent or acknowledge that it happens…

        Can we trust the self reported levels of intervention of CPMs?
        Can we trust that all the tears were tears and not cuts?
        That all the spontaneous labours were really spontaneous?
        That all the normal deliveries were really not assisted with ventouse?

        Can we trust the self reported outcomes that can be fudged?
        What about the PPHs that were large enough to be transported but weren’t, and don’t have post partum Hb levels done?
        Or the second degree tears that are really third or fourth degree tears?
        Or the pre-eclamptics that have their BPs fudged and no formal diagnosis?
        Or the meconium that wasn’t really “light”?
        Or the APGAR of 8 that was really 6?

        FWIW, the UK guidelines on ventouse deliveries are clear that they should NOT be attempted at home or in stand alone birth centres.

        Part of the reasoning being is that you have a limit of two “pop offs” or three pulls. If the head isn’t delivered with that, you’re supposed to move immediately to forceps or CS.
        How can you do that in a stand alone BC or at home?

        If you’ve made a decision to use ventouse, you have already decided that the baby has to be born NOW. If you use it in a stand alone BC and you haven’t already arranged transport in the event that it fails (and ventouse does fail), you are acting irresponsibly at best, negligently at worst.

        • Somewhereinthemiddle

          Exactly. It casts doubt on *everything* in regards to not just the clinical skills (or lack there of), but honesty, integrity, medical ethics, and the humane treatment of their patients.

          To the authors credit, she is outing herself and others knowing that she is throwing away her career, her social security, and her source of personal income. I hope she comes out the other side very secure in the fact that she has done the only moral and ethical thing she could.

          I identify with her because I used to be “sold” on a lot of the birthy crap. I have lost friends and community because I started fighting back and while it is necessary, it can be a painful and lonely process to rebuild parts of your life. In her case to a much greater degree because of the depth of her involvement.

          • Guesteleh

            The big thing that midwives and the NCB industry are selling to women is bodily autonomy–having control of the birth process and what happens to them during labor (able to move, not confined to the bed, able to refuse interventions). Yet it’s all a lie. The midwife can do whatever she wants to you with no accountability or oversight. It’s so crazy.

          • Laura

            I applaud you for valuing your integrity and the safety and health of mothers and babies over your personal comfort. I can only imagine how painful those losses were.

          • Somewhereinthemiddle

            Well thanks! Those who bailed on friendship when I wasn’t part of the “club” anymore weren’t true friends but it took a minute to rebuild my friend network. Fortunately I’ve ended up with closer and more sincere friendships as a result. It’s been a win-win. Lonely in the short term, beneficial in the long term.

          • Medwife

            I’m ovary-ing up and getting more vocal about the lack of safety in homebirth and the deceptions of the homebirth community, especially those profiting from it as an industry. There are probably some bridges starting to smoulder but this ex-CPM’s blog is a good reminder that what’s at stake- lives- are more important than hurt feelings and getting snubbed. If you don’t have your integrity you don’t have anything.

          • Somewhereinthemiddle

            I would imagine that this sort of thing gets *way* more sticky when careers and “sisterhood” are involved. I’ve been super curious to question my CNMs about their opinions of DEMs or CPMs but haven’t has the right opportunity to do so. I can’t think that they would be too keen on the idea.

            Hope do you find your fellow midwives responding as you get more vocal? Is there agreement? Or do other CNMs support DEMs? How do hospital based midwives feel about homebirths?

          • Who?

            It’s the ‘sisterhood’ that’s the trouble. Professionals have objective standards and understand that upholding those is for the benefit of everyone.

            This crowd sounds more like a club or school reunion group, once you are in you are in regardless of what you do.

          • Medwife

            It’s mainly online stuff, the notorious world of Facebook, because there are so few CNMs here, and I haven’t gotten buddy-buddy with the CPMs. There haven’t been any direct confrontations, but I’m planning to start challenging things I’m seeing posted about studies supposedly supporting home birth. It’s especially weird because ACNM is pushing so hard to build bridges with CPMs and to get more cnms to do home births. I am going to look like the one not looking at the “evidence”. I mean I’m FB friends with Amy Romano! That’s not gonna be pretty.

          • Cobalt

            I have a ton of respect for you for this. Taking a big personal and professional risk to protect people, most of whom you’ll never know and many of whom who will fault you for it, is very brave. It’s also the way to make things change for the better.

        • MaineJen

          Did you catch the part where she admitted delivering a patient with dangerously high BP, which she fudged and reported as only slightly high? Playing. With people’s. Lives.

      • The Computer Ate My Nym

        Applying a kiwi

        I’m afraid my first thought on reading this was, “Do you mean a fruit, a bird, or a New Zealander?” The image of a midwife carrying a spare person from New Zealand in her bag in case of emergency amuses me.

        • Daleth

          If she were carrying both members of Flight of the Conchords, with their instruments, I might be tempted to have a home birth. Imagine: birthing while they stand in the hallway outside, playing…

          • momofone

            I’d love to have them there, but I’d rather have them scrubbed in for the c-section. My Kiwi husband would definitely go for that (but absolutely does not go for calling the fruit a kiwi–it drives him crazy that I don’t call them Chinese gooseberries or Zespris).

          • MaineJen

            I would have paid money for them to be playing in the room as I gave birth. 🙂

        • Roadstergal

          If they applied Rhys Darby, things could get surreal quickly.

        • An Actual Attorney

          Do you know the number of times I could have used a spare New Zealander?

      • MaineJen

        That part of the article left me deeply, deeply shocked. I had no idea the deception ran so deep, was so ingrained and so pervasive.

    • Ash

      From Navegazing Midwife’s Facebook post linking to honestmidwife.com
      A reader (Not NGM) writes
      “‘Im
      a student midwife. I had to stop reading. Midwives have been my heroes
      since I was a young girl. I’m not ready to have my illusions shattered.
      They little bit I read; I choose to believe, is a gross exaggeration.
      And I promise myself NOT to practice illegally or in a way that could
      potentially harm the families who put their trust in me.”

      • Amazed

        When I was a university student, the old generation of translators were my heroes. They still are. Their style is great; their vocabulary is so rich. But once I graduated and started working in the field, I realized that my heroes had their faults. They are still something I aspire to become one day. But now I realize that I used to see their works edited by other professionals, plural. I only saw the result of many people’s work. Now, I’ve had the chance to see some of their their works the way I see mine before I send them to the publishing houses and guess what? They were not perfect. Very good, indeed. Professional, for sure. Something to aspire to, yes. But not perfect. And frankly, I can now see mistakes even in the much lauded end products.

        It isn’t a bad thing to have heroes. But one should never think that their heroes are infallible. In her case, it’s much more important. In the worst case scenario, I’ll kill or mutilate a book, not a human being.

      • Daleth

        Wow. That article is fantastic. Her analysis (pp.41-45) of how women rationalize foregoing pain relief and how that affects their views about their birth process is REALLY insightful. I think she nailed it.

        • Jocelyn

          Yeah, I loved that part! It was like an epiphany.

      • The Computer Ate My Nym

        Kind of off topic, but something that occurred to me looking at one of the pictures in the blog linked: Waterbirth babies often seem to have their necks hyperextended in their pictures, whereas newborns usually have their necks flexed. Does this mean anything? I keep thinking that the babies look rigid. Maybe just my perspective or something, since I’d expect even a CPM to notice a baby that is as rigid as that one looks to me.

    • PrimaryCareDoc

      That was amazing. I especially appreciated her description of midwifery “peer review” and the supportive atmosphere they had to maintain. That’s not peer review, as she says. That’s therapy.

      Anyone who has ever sat through a medicine or surgery morbidity and mortality conference can see the difference in how doctors and midwives approach peer review.

    • Paloma

      I absolutely LOVED that piece. Her description of the whole process she went through from mother seeking info on birth options to retired midwife who changed her mind completely is just incredible. The best moment: “How many surgeries is a baby worth? A million”.
      This article should be shown to those mothers who are open to homebirth but not completely sure. It would absolutely change their minds.
      Also, I find interesting the fact that women who decided to have an OOHB consulted most with the midwife, leaving the husband/partner in second place, whilst the hospital group consulted with their partners the most. It says a lot about these women that they think somebody else’s opinion is more important than that of the baby’s father.

      • Daleth

        It probably means dad was leery of the risks of HB so mom looked to the midwife to reassure her that it was a good decision.

    • Laura

      This was the most thorough, intelligent, compelling and insightful indictment of homebirth midwifery in the US I have ever read. The imagery at the end of the burning fire, as well as this woman’s integrity, really affected me. My nursing classmate is a former CPM/DEM who left the community for the reasons this woman outlines. I hope the voices of warning and caution ring louder and louder as home birth has gained so much popularity recently. I wish the woman the very best in her career endeavors.

    • Susan

      Yes, agree with all this was so well written and compelling. It sort of reminds me of a well written true crime novel. I wonder if she’d think about turning it into a screenplay. HBO miniseries/docudrama.
      And the vacuum stuff… sickening and believable example of how crazy and off the deep end a zealot can get. Again, it’s like a cult where little by little one goes deeper and deeper into eroding morals for a cause. How does one rationalize shooing everyone from a room while the cover a mother’s face and apply the “fruit”…yet she explains it perfectly well. You start by lying just a little, a little more… until you are part of a big lie.
      Amazing woman, to lay it so bare. Real courage it took to write that.

      • Laura

        I think a movie is a great idea! It would make for very compelling drama. It could be called, “The Business of Being Truthful and Giving a D*%N About Mothers and Their Babies”!

    • Dr Kitty

      Fantastic piece, amazingly perceptive, really well written.
      She should be so proud of it.

    • Ash

      Navelgazing midwife posted this on her facebook. When describing some of the unethical things she has heard of /witnessed homebirth midwives doing, she said “Will they (USA homebirth midwife) shoot pit into the vagina to expel a baby so they don’t have to transfer care?”

      WTF??? never heard of that before!

      • Cobalt

        That sounds pretty nuts. Doesn’t mean someone won’t try it.

  • Keep it Anon

    This is OT, but given the context of the discussion, I thought I’d post my question here to get feedback from this group:

    Ever since weaning my second child (at my choice)– about 15 months ago– I’ve been dealing with a variety of depressive symptoms which have gotten especially acute and troubling over the last 6-8 months. Sometimes I am fine, sometimes I have rather terrifying, and serious suicidal thoughts. Often, I feel like an angry, short-tempered, grudge-harboring witch when I used to be kind and tolerant.

    For complicated reasons involving moving to a new and far away place, I do not have a current PCP or OBGYN. I have spoken with three different psychiatrists (with varying levels of pharmocologic management/psychotherapy balance in their practices), none of whom are willing to place me on medication without a substantial (many hours and $/week) commitment to do talk therapy. I understand that psychotherapy is helpful, and may be helpful to me, but a huge part of my problem is that I just can’t find several hours a week to do this (I already enlist as much third party paid and family help as I possibly can). I know it’s my fault that I am over-committed between job and family, but I cannot easily scale back either commitment. I get the feeling that what I want (some “bare minimum” psychiatric assistance while I get through an exhausting transition, with an opportunity to reassess down the line) just isn’t available.

    Family members have asked that I take a medical leave of absence, but I can’t–I’m not eligible for paid leave (and can’t afford unpaid leave), and the stigma of mental illness is so acute in my industry that such a leave would likely spell the end of my career.

    Am I doing something wrong in how I look for care? I’m rather shocked that the healthcare providers I’ve spoken with aren’t willing to take a patient who cannot magically produce 3-5 hours of clinic/transit time each week. Where do I go, who do I talk to, to better manage my mental health, while keeping my job and family afloat? Am I just stuck? The message I am getting is that if I cannot find time to see a doctor multiple times a week, I will simply not get better. Is that my reality?

    • Cobalt

      Part of the issue around wanting to physically see you several times a week might be to monitor your reaction to the meds. Relying purely on patient reports of mental effects can be very misleading, I could understand a doctor wanting to see you very regularly for monitoring until you know you have the right meds.

      Ask about it, and see if you could possibly do two weeks of close monitoring and start with an easier med to start and stop, like Welbutrin.

      I hope you get good help, and I understand the feeling of all the doors slamming shut. It’s hard, you’re doing the right thing, and you deserve treatment.

      On a totally personal note, what helps me in the immediate when I have super depressive onslaught is to remember that the crushing feeling isn’t ME, it’s my brain chemistry lying to me. I have no idea if that helps you at all, but it has made a difference for me.

      • Poogles

        “remember that the crushing feeling isn’t ME, it’s my brain chemistry lying to me.”

        Yes! I also find that idea helpful, I just keep telling myself “depression lies” over and over – it’s sort of a mantra in those times, I guess.

      • Keep it Anon

        Thanks for your comments. I’ve had a psychiatrist tell me that she didn’t want to start medication until several psychotherapy sessions, so I was under the impression that medication management wasn’t the issue. I could imagine that when starting a new med I might need several short check-ins to address the medication, but I would expect that these would be shorter (and cheaper) than hour long, $130 psychotherapy sessions.

        • demodocus’ spouse

          Not everyone with depression needs medication. You might, of course, but my husband doesn’t (he’s got anxiety and depression) and he sees a psychologist. Dario cannot prescribe meds, but did say he’d refer my husband to a psychiatrist if needed.

    • Have you had any blood tests done? You might have something hormonal going on.

      In addition to that, there are doctors and counselors who practice via skype. A friend with lupus uses such a service due to mobility issues and has nothing but good things to say as far as not having to drive out to an office and wait in the waiting room for ages with strangers, plus it will be private.

      You’re not stuck, though. You’re never stuck. “As long as you live, keep learning how to live.”

      Also,

      • Keep it Anon

        My last round of bloodwork was normal, but if I get a PCP I can have a new panel done. I don’t think I’d be able to find someone who practices via Skype, and finding the workday privacy for such a session would be challenging for me.

        • I’m glad that your levels were normal, though getting a second opinion when available would be prudent.

          While not available in all states, the upside of finding a doctor to talk to via phone or skype would be saving a ton in gas money as well as being able to chat in your car or at a restaurant during lunch. You might even be able to find a doctor who has evening or weekend hours.

          https://therapists.psychologytoday.com/rms/

          http://www.theravive.com/therapists/e-counseling.aspx

          http://psychcentral.com/find-help/

          Whatever path works for you, I hope you all the best and hope you know that this will always be a safe place for you to talk about what’s going on. It sounds like you’re going through a dark, scary time but it’s also abundantly clear that you’re an intelligent person who loves her child very, very much. You know that something isn’t right and you’re seeking help, which are two advantages on your side.

          You can do this and we’re here for you.

    • CharlotteB

      Oh man, that sounds rough. Is it possible to find a primary care provider? Mine prescribed anti-depressants (she was a nurse practioner) after I had a panic attack in her office when I tried to talk about my anxiety. (I’m in the U.S., so that’s what I’m familiar with.)

      Maybe that would be a place to start? I did eventually go to therapy and see a psychiatrist, but that was because I sought it out. I’d be honest with the dr about your time constraints–I think I did do a follow-up a month or two later.

      I hope you can find some help.

      • Keep it Anon

        I will work on getting a primary care provider. It might take me a while to get seen, but I’ll make that a first step.

    • Ash

      Since you don’t have a PCP right now, I do advise that you establish care with a PCP (I know that’s another chunk out of your work day so that sucks). Maybe they would have a referral to a psychiatry colleague who doesn’t require such a rigorous schedule to initiate treatment.

      • Keep it Anon

        I will definitely do this– I have prioritized finding a PCP for my kids, but will work on getting one for myself, too. Where I last lived the wait time to get a first appointment was around 4 months; hopefully that is not the case here.

        • momofone

          Does your employer have an Employee Assistance Plan (EAP)? That might be a quicker way to get in to see someone if it’s available.

        • DiomedesV

          Can you ask any friends or neighbors without telling them why you need to see one? In my experience, older women often have good recommendations for PCPs…. I hate to stereotype, but I feel like a PCP that is able to make time for the often complicated health problems of the elderly is a good PCP to talk to about… life’s problems.

    • Wadoc

      Have been lurking here for a few months. Found this site while pregnant with twins and am currently on parental leave. I’m a psychiatrist who practices in Washington and Oregon. Where I am, at least, it’s uncommon for psychiatrists to have a psychotherapy practice unless they are in private practice. Insurance companies don’t like to pay psychiatrists for psychotherapy because it’s too expensive, so I do medication management almost exclusively.

      I would never make psychotherapy a condition for treating a patient with medication, although I might encourage some therapy depending on the circumstances of the patient. It’s hard enough to convince people who need mental health treatment to engage in treatment without requiring a large outlay of time and money.

      Whether or not a given patient would benefit from medication is ultimately something that I would determine on examination. If I’m very worried about a patient, I might have them return a few days after starting a medication. If I’m not so worried, I might have them return in 3-4 weeks, depending on the situation. In my area, regular psychotherapy (if a patient wants to take this route) might last 1 hour per week. In some places, one is lucky to get 1 hour per month for therapy! I don’t know anyone who would provide several hours of treatment per week outside of a hospital or intensive outpatient program setting.

      Certainly, someone who was postpartum and having suicidal thoughts would warrant an urgent evaluation. Given the stigma toward mental illness, most psychiatrists want to make patients feel comfortable about coming in for treatment. If you found a PCP that you felt comfortable with–or your OB–they may be able to start you on a medication themselves or at least refer you to a psychiatrist that they know.

      • Keep it Anon

        Thanks very much for sharing your perspective. I have spoken exclusively to psychiatrists in private practice, and perhaps that is my issue. I’m in the U.S., and didn’t know how to get to a good psychiatrist without a PCP referral, and so landed, through recommendations, at the offices of a few different psychiatrists. I spoke with one on the phone who, after a discussion of my symptoms, told me that she would not take me as a patient because I needed 3x/week (!) psychotherapy and medication. I did an introductory psychotherapy session with another who did not want to start medication until I completed a few weeks of psychotherapy.

        Based on your comment, it sounds like perhaps I should look for a psychiatrist through my insurance company’s list of approved physicians.

        • Ash

          Where I live, PCPs do initiate antidepressant treatment on a regular basis. As for the psychiatrists here, to my knowledge it is not common for them to require psychotherapy. My insurance network includes both practices that work for the insurer as well as the private practices. The majority of psychiatrists are in private practice but the only ones who don’t accept insurance are of a psychoanalysis/Jungian philosophy.

          • momofone

            PCPs also initiate antidepressant treatment where I live, fortunately; it is a rural area, and the nearest private-practice psychiatrists are two hours away in any direction. There is a community mental health center with psychiatric nurse practitioners, but the wait is weeks-long (if not longer), and even helping someone get in for emergency evaluation can be difficult. None of the psychiatrists I know of do psychotherapy; they do only medication management and refer for therapy. In my experience, they tend to strongly recommend therapy as well, but I’ve never known of their refusing to see a patient who was not also seeing a therapist. Unfortunately, due to lack of resources (financial and other), there tends to be a band-aid approach to treating people in need of psychiatric care (ironically, sometimes that works for good in that PCPs are generally pretty willing to give it a try, and refer for psychiatric evaluation if they aren’t able to find a medication that works).

        • Amy M

          That sounds reasonable. When I had PPD, I found a psychiatrist that took my insurance and he worked with me to find the right medication. He encouraged me to speak with a therapist, but that was not his area. I did find a therapist also, through a recommendation from my OB. In general, I was very happy with the psychiatrist, because he didn’t push an agenda, he just helped figure out what worked for me. Something to keep in mind though–not all meds work for everyone, and some take weeks to months to really kick in, so be patient and if you don’t like a particular med, request a different one.

        • Wadoc

          If you decide to see a psychiatrist (versus your PCP) first, make sure you let the staff know that you have postpartum depression with suicidal thoughts. That will help them to prioritize your initial appointment. I have slots that are left open for last-minute urgent appointments–we just need to know who to give them to! There is a nationwide shortage of psychiatrists, so there tends to be a waitlist for new appointments. Postpartum depression would naturally take precedence over an ADHD eval.

          An SSRI or SNRI are the standard of care for initial treatment of depression with medication since they are effective and have the fewest side effects. Depending on the office you visit, they might give you samples of newer medications that could turn out to be quite expensive if you continue with them, depending on your prescription coverage. Don’t be afraid to tell your physician if money is an issue. I don’t want to bankrupt my patients when there is a less expensive alternative.

          The rub with these meds, though, is that although they start to work right away on your brain chemistry, it can take 1-6 weeks to start feeling improvement (and 1 week only if you’re lucky.) Unfortunately, there’s no good way to tell in advance if a medication will be a good fit for a patient. Obnoxious side effects tend to show up early, so if you know that a medication isn’t going to work for you, be sure to let the doctor know ASAP, so that you can be tried on a new medication without delay.

        • DiomedesV

          My experience as a patient has been two-fold. In one practice, I saw a psychiatrist for medication evaluation, which eventually became 15-minute appointments every few weeks. At the same time, I pursued therapy once every week or every other week. My therapist would often ask about my symptoms and side effects and recommend changes, or pass along her perspective, to my psychiatrist.

          Currently I see a psychiatrist who prescribes my meds but does occasional therapy, depending on what is going on in my life. I’m a pretty independent patient but when I have a rough spot I have found it helpful to see her more often.

          I think the first experience I have had is more typical.

          Please do take your symptoms seriously. I agree that next time you call an office, emphasize the severity. Mention being postpartum and the suicidal thoughts. I find it hard to believe that some office will not find an emergency slot or you. If not, go back to your PCP and tell them.

          Good luck.

    • fiftyfifty1

      I agree with Wadoc below. The only psychiatrists around here (midwest city) who do psychotherapy themselves are solo/private practice docs. And to be frank, I never recommend them. The ones around my area are weirdos and not the most skilled med prescribers either. In my experience they cater almost exclusively to rich people with plenty of time and money and without very serious mental illness. People sometimes end up with them because they are more likely to advertise and because they tend not to have very long wait lists. My advice would be to find a more typical psychiatrist, even though wait lists might be quite long I’m afraid.

      That said, I do think that therapy/counseling is valuable. If nothing else, it is traumatic to find yourself in a situation where your brain won’t work the way it always used to. Having somebody to support and encourage you during that time, and to remind you that *your needs matter* has a lot of value. And therapists sometimes offer evening hours.

    • Keep it Anon

      Wow– I didn’t expect so many thoughtful, helpful answers. Thank you everyone for your help. I had all but given up on getting any kind of clinical help, and now I feel like I can try a few different approaches for getting help. I will start with getting a PCP, and will reach out to my EAP to get some referrals for local healthcare providers who can help. And I now know that I shouldn’t be shy about describing what I’m going through to help prioritize my appointment. Thank you, thank you, for all of your responses here.

      A few specific responses to the comments below:

      – I agree that therapy would likely be helpful, and I’m willing to do it when I can order my life in a way to make it happen (but before I do that, I think I need to work on getting more sleep on a regular basis). But it also sounds like I haven’t found therapists that are a good fit for me.

      Fiftyfifty1– you’re comment that it’s helpful to have “somebody to support and encourage you” made me realize that I hadn’t found that person. You said about certain private practice psychotherapists that “The ones around my area are weirdos and not the most skilled med prescribers either. In my experience they cater almost exclusively to rich people with plenty of time and money and without very serious mental illness.” While I’m sure not all private practice psychotherapists are like this, the ones I spoke with fit this description. I think I’ve been looking for help in the wrong places….

      – DiomedesV– I can see myself being happy with a treatment approach like yours– shorter, more frequent appointments to manage medicine, with the ability to have psychotherapy sessions from time to time. I haven’t yet found a provider that is willing to do that out of the gates, but I think I have been looking in the wrong places.

      – Wadoc (and others)– Thanks for helping set expectations for how long these medications work, and for letting me know that I can be seen on an emergency basis.

      – momofone – My employer does have an EAP. I hadn’t actually thought to use it– thanks very much for the suggestion!

      – Annie (and others)- Thanks for the encouragement to post here. I was really hesitant to post about my personal troubles on this thread, but I literally felt like I had exhausted all other options. The information I’ve gotten here is so valuable– I finally feel like I have some options about what to do next.

      Although my symptoms started postpartum, I’m now about 2 years postpartum… Is this still considered “postpartum depression”? Does it matter that I identify it as such to clinicians?

      • Michele

        Let them know it started postpartum and is still ongoing. It won’t hurt anything to identify it that way but don’t get hung up on whether or not they consider it “postpartum depression.” Would you be willing to share a general location and maybe someone here is in your area and could give a recommendation for a dr? If you’re anywhere near Kansas City, for example, I’d be happy to send you the name of my psychiatrist and/or OBGYN if you want it.

      • Bombshellrisa

        Please don’t worry if you are textbook timeframe for postpartum depression. There is something going on that started postpartum. If your PCP tried to blow it off, find someone who WILL take you seriously. It can be so frustrating but don’t give up. I had a PA who refused to take my severe depression during pregnancy seriously on the grounds that since I took a shower and got dressed for my doctors appointments that my depression probably wasn’t too bad. If you go to an OB/GYN see if there is a psychiatrist who specializes in working with pregnant and postpartum mothers. There is one in the Seattle area who did both an OB and psych residency.

  • CharlotteB

    This story is so upsetting.

    I’ve been thinking that the info on the safety of medications and breastmilk is a double-edged sword. On the one hand, obviously, all women deserve accurate information, and if a medication IS breast-feeding compatible, they need to know that breastfeeding is an option.

    On the other hand, it takes away one of the “acceptable” reasons for not breastfeeding. Now, you might be interrogated about the medication and dose and why you’re taking it and is there another option? As anybody who’s taken anti-depressants knows, you often have to try a couple of different ones before you find the one(s) that work, and I wouldn’t want to get into that with say, extended family members. And the process of weaning off one and trying another can be hard, and seems like a terrible idea post-partum, especially if your medication and dose were working well. I wonder how many doctors have told women that their meds were not compatible with breastfeeding because they could see that mom’s mental health was suffering, but couldn’t just tell her to stop?

    Additionally, in my experience, NOBODY would actually tell me if my meds were safe for breastfeeding. While I was pregnant, I saw a genetic counselor who told me set my mind at ease about my anti-depressants and ADHD meds. However, after my son was born, the LC simply handed me a copy of the relevant pages from a book by a Dr. Thomas Hale (? I think), which basically said that based on a study of 4 infants the medication I took was probably ok. Besides the LC, the only other person who talked to me about the meds was my son’s doctor (who I think is wonderful), but she’s not MY doctor, so she couldn’t really tell me either. I tried to go off the ADHD meds after he was born, and that was…a terrible idea. Eventually, since I was combo-feeding anyway (and my life/home was falling down around my ears), I decided to go back on them.

    For some women, if the doctor says they’re unsure about the medication, mom will hear that it’s dangerous. Another woman will hear that since we don’t know, it can’t be that bad.

    Obviously, this whole problem could be solved by giving women accurate information, de-stigmitizing formula, and prioritizing a mentally healthy mom. That, to me, is as important as making sure baby has enough to eat.

  • MaineJen

    Failure. Failures all around. So, so sad…it is shocking to me that her health care providers were not familiar with the possible repercussions of her going off of her medication.

  • The Bofa on the Sofa

    Medical treatment aside, I will comment on the “mother took a 4 day old baby out of the hospital unknown to staff” part.

    In our hospital, the doors of the birth center had automatic looks, and they had sensors on the umbilical clamps. So if a baby with a clamp on came within 10 feet of the doors, they automatically locked.

    In order to take the baby out, the baby had to be discharged and the clamp removed by the staff.

    Nominally, it was a response to baby stealing threats, but it would have helped in this case, too.

    OBTW, part 2: With our kids, I got the impression that “liquid gold” referred to colostrum, and not the breast milk itself. Colostrum is precious because it is so nutrient rich (and it is a gold liquid). Every drop was precious.

    • Ash

      From the Bristol post:

      “A major internal inquiry was launched last week following
      Charlotte’s death and is expected to focus on monitoring of a mother who was known to have mental health problems.

      Provision of security doors and CCTV is also expected to be reviewed.”

      No mention of alert monitors such as an umbilical cord clamp or bracelet monitor. It looks like some NHS hospitals do this, but I’m not sure what percentage of NHS hospitals have this kind of security.

      • The Bofa on the Sofa

        To be fair, I don’t know what percentage of US hospitals have this, either.

    • Joy

      I gave birth in Nov. 2013 in a large hospital that is well respected. My baby had two bands around her ankles. They came off all the time. We were constantly told by the midwives that we would get in trouble because she didn’t have her bands on, but they literally came off in her clothes. My husband found them when he had to take her clothes home to wash them. After we were discharged we found at least one other baby’s bands in our bags. I guess they figure since there is no nursery, they don’t need to worry about it.

  • Hannah

    This case raises a great many issues, but I’d be inclined to wait for the full hearing before drawing conclusions about who said what exactly and when, which isn’t really clear from the direct quotes from the coroner. The Bristol Post and the Mail published yesterday, and the Telegraph published today, mainly material also present in the Mail article, iirc, without some of the caveats, suggesting that they are rehashing it without having actually been present at the hearing. This is very common (see Nick Davies on “churnalism”), but introduces an element of Chinese whispers.

  • Elizabeth Neely

    My Dr and Midwife encouraged me, well basically shamed me into trying to breastfeed and not take my psych meds, as soon as I left the Hospital I went and got some booboie dry up pills and a presciption for ma medication. I am very lucky that I am educated about my Illness and I am smart enough to fend for my self, on top of that, I had no privacy to relax and breastfeed without the prying eyes of my mother. So I basically went straight to the formula with my second baby, I have no regrets, My son and I are doing fine 21 years later..pooh pooh on breastfeeding Nazi’s.

    • sdsures

      I would have told that doctor and midwife to can it.

  • Angie

    Charlotte and Zaani appear to have been let down badly by the system. Mental health is not high priority in the UK, a casualty of the austerity measures. It does seem that pressure is on women from all angles, some would have us chasing our tails to satisfy their agendas. Once a baby is thrown in the mix they chuck in the guilt trip. Thirty years ago I had twins, I was pushed to breastfeed them, after two days of the most ridiculous carry on I said enough and reached for the bottle, they did very well. I had a further two babies who I breast fed, they also did very well. Choice is the keyword, what suits you in the present not what suits the drum bangers on a crusade.

  • Trixie

    So incredibly sad and unnecessary. My heart breaks for this family.

  • EW

    The issue I have with this article is the immediate conclusion that this mistake by the doctors is due to the culture of lactivism or of natural parenting putting the needs of the foetus/newborn before the mother. I’m not quite sure how that conclusion could be made from the evidence presented so far. Perhaps instead it highlights how little knowledge Drs may have of prescribed use of drugs in breastfeeding and it is education in this area that is needed rather than a blanket ban and advice to switch to formula instead.

    I was in the unfortunate position of ending up on an acute psychiatric ward after the birth of my first baby suffering from severe PND /possibly post natal psychosis. I desperately wanted to carry on breastfeeding and was pumping for my baby because I felt like it was the one thing I was doing well at and made me feel close to her. But the doctors wanted me on medication they said was incompatible with breastfeeding so of course wanting to get better I agreed to stop. Sadly the medication didn’t help and I had to change again, meanwhile I was away from my now formula fed baby for 3 weeks. Eventually I stabilised and went home and things slowly went back to normal but I was devastated to learn that in fact all the drugs I had been on were ok for breastfeeding! I felt betrayed, like the medics hadn’t known or cared how much it meant to me. Yes my daughter is a healthy 3.5 year old now, she was of course fine on the formula, and I’m sure the doctors thought they were doing the right thing, but it just showed to me how little knowledge there is of breastfeeding among psychiatrists.

    Thankfully after my second daughter was born I managed to be admitted to a mother and baby unit where the peri natal specialists were expert in medications for new mums and I was able to continue to feed my second daughter.

    Of course there is no need to breastfeed and I would always put the needs of medication above the desire to breastfeed but often these are not incompatible and actually maintaining a successful breastfeeding relationship can improve the outcomes of PND so maybe more education is needed to prevent the lack of knowledge that led to Charlotte being unmedicated.

    • Daleth

      I’m so sorry you went through that.

      I agree that part of the problem must be the doctors’ unfamiliarity with which drugs can be used while breastfeeding. That said, I would think any idiot off the street (much less a doctor) would know that schizophrenia is extremely serious and thus that the #1 priority for a schizophrenic new mother must be to stay on whatever medication is working for her.

      Thus, the only reasonable advice to such a mother would be either (a) don’t breastfeed, your daughter will do perfectly well on formula; or (b) let’s do a bit more research on the compatibility of this medication with breastfeeding, and in the meantime, feed her formula.

      NOT, NEVER, (c) stop your medication so that you can breastfeed!

      This poor woman could probably have gotten better medical advice on this issue from a random person at her nearest bus stop than she got from her doctors.

      • Roadstergal

        To me, it seems that the error is the doctor’s misunderstanding of the risk associated with BF on her meds, but the outcome of the error is the lactivist issue. Without a lactivist culture, the Dr tells the woman to use formula and stay on her meds. With a lactivist culture, the woman _has_ to BF, so she goes off of her meds. So the error would happen with or without the culture (and yes, it is an error and should absolutely be addressed) – but the death only happens with it. Just my feeling on the matter.

        • Daleth

          Yeah, I think you’re right. It’s because of lactivism that the doctor erred on the side of breastfeeding, instead of erring on the side of keeping a schizophrenic woman on her meds (!!!).

          • guest1

            Having worked with these doctors before,I think there is more to this case than meets the eye.
            Hopefully more facts will become available from the investigation.
            The Bristol team is internationally recognised for its work in Obstetric Risk Management e.g. virtually eliminating the incidence of Brachial Plexus Injury (BPI) in their unit.

          • KarenJJ

            I wondered that. It seems so odd for a doctor to make such a decision? I had an issue with meds and breastfeeding that I took to a children’s specialist who was able to research it for me and recommended that I don’t breastfeed. There was no potential outcome of death or serious injury in my case and maybe a slight chance baby would have a suppressed immune system.

            Once I gave birth and the lactation nurse started flipping through some massive tome and then tried to tell me it was OK to breastfeed I was fine to say “no thanks, I’m following the advice from a specialist”. I’m sure I became part of her story of “doctors being overly anxious and getting women to stop breastfeeding and women ‘not educating themselves’ about the risks”, but I don’t care. I trusted that doctor, who was very pro-breastfeeding but also someone very good at research and reading and interpreting scientific evidence.

      • PickAUserNameForDisqus

        Yes, there are resources for physicians: https://marcesociety.com/ is the international groups, and guess what? there is a regional groups for UK and Ireland: https://marcesociety.com/regional-groups/uk-ireland-marce-society/

    • Cobalt

      It should not be that breastfeeding is so important that mothers feel like it’s the “one thing” they are doing “right”. “Well, at least I’m breastfeeding” is not a healthy mind set, and it is a result of lactivism.

      You are doing just as well, just as right, just as good a job as a mother if you formula feed. Your baby loves you just as much.

      Lactivism sets women up to view breastfeeding as a measure of success at motherhood, which is not just false but dangerous.

      • jpow

        It may not be the lactivist culture that makes a mom feel like breastfeeding is the only thing she’s doing “right”. I also struggled with a flare-up of depressive symptoms and the decision to go back on medications while breastfeeding. I received little to no support from my family physician and he refused to refer me to anyone else who could help. I ultimately ended up NOT going back on my medications and continuing to breastfeed, not because I thought that breastfeeding was the be-all end-all of mothering, but because nursing my daughter was the one of the only times during the day that I felt connected to my infant daughter. Other times, I felt fearful of her, almost like she was someone else’s baby. Nursing provided an emotional connection that I wasn’t capable of feeling otherwise (thank you hormones, I guess!).

        • Cobalt

          I think the hormone connection needs a lot more study. For some women lactation is beneficial, and for some it promotes mental health issues. The who, how much, and why aren’t always clear though, and answers to those could improve treatment.

    • Amazed

      I’m sorry you encountered such difficulties for no reason at all. But youe case and Charlotte Bevan are nowhere near similar. Your doctors were overly cautious. Her doctors were neglectful. Your worse case scenario which did take place was losing your first weeks of breastfeeding but you’re alive to tell the story. Her worse case scenario which did take place was losing her life and her baby’s life because her doctors didn’t do what any normal lay person would do: place health before breastfeeding. I’ve sometimes speculated that the problem with mental deficiencies somehow is that those people look just like everyone else, so it’s easy to believe that their state is somehow more controlled by will than, say, an amputated limb. But there is no excuse for doctors to think this way and I cannot think of a single reason why they wouldn’t have told her just to stop breastfeeding. Nothing but what Dr Amy implies – that they thought breastfeeding was a more serious matter than mental health.

    • Hannah

      “Thankfully after my second daughter was born I managed to be admitted to a mother and baby unit where the peri natal specialists were expert in medications for new mums and I was able to continue to feed my second daughter.”

      There is just such a unit, in another hospital, quarter of an hour’s drive from the one where Charlotte Bevan gave birth. Why she wasn’t there instead is, imo, one of the bigger questions for the inquest.

      • Sarah

        Gross shortage of places.

        • Hannah

          Even if she wasn’t able to secure a bed at an MBU, I would have thought that it would have made sense for her to give birth at the hospital at which the perinatal mental health experts were located.

          • Sarah

            You would think. Although it’s possible she just turned up in established labour I guess.

  • Therese

    So what needs to be done to stop doctors from giving bad advice when it comes to breastfeeding and medications? The boob nazi approach is to emphasize how important breastfeeding is while educating doctors what meds can be safely taken while breastfeeding. Obviously, it doesn’t work if doctors only get the first half of the message but not the second! So what is the alternative? If doctors are not getting the message that “breastfeeding is best and most medications are fine to take while nursing, look up the med if you don’t know” are they going to do any better with the message “breastfeeding has no real benefits, but most medications are fine to take while, look up the med if you don’t know”? Or is it better for women who want to breastfed to be told unnecessarily to stop in order to err on the side of what happened to Bevan not happening to other women?

  • Heather

    Well this is a stretch. The physician is to blame for taking her off the med unnecessarily. Full stop. Natural birth and parenting groups are not to blame. Is it not possible for a woman to just want to breastfeed? People taking antipsychotics go off their meds for a litany of reasons…most commonly because of side effects. Sheesh.

    • KarenJJ

      It might be a stretch and that maybe breastfeeding did not weigh into the doctor’s decision to take her off her medication in this instance. It will be interesting to see what comes out.

      Are you saying that maybe it was the woman who wanted to breastfeed, for no particular reason, just because she enjoyed it and felt closer to her child from it and she went off her medication with her physician’s blessing – when her child was only 4 days old? Normally a successful breastfeeding relationship takes much more time to develop. Those first few days can be pretty rough. These decisions are rarely made in a vacuum and are part of a culture and moralising around motherhood that natural childbirth and parenting groups exist in, as well as pre-existing misogynist attitudes towards women and their bodies.

  • sarah

    Breastfeeding is good it is healthy for the baby and helps in bonding through the release of oxytocin. That being said it is not the only Choice or even the best choice. The keyword here is Choice. I breastfed for 3 months before ha ing to go back to work pumping is near impossible with a working family. But I felt guilty for stopping. I shouldn’t have. Noone should judge another person’s parenting choices unless it brings harm to the child, and bottle feeding can work just fine. So unless it’s your breasts doing the feeding then your mouth shouldn’t be talking.

  • You hit the nail on the head – and the current state is most distressing. There’s all kinds of assumptions that when, in the context of motherhood – women are finding do not hold. It’s your body – unless, you are a pregnant woman. It’s your choice – unless, you are a mother. It’s not the world I want my daughter to live in – it lacks compassion and humanity for the lives of women and mothers. Its why what you do is so important, the work you do is a wake-up call to the absurdity that has emerged.

    • Sarah

      It’s your choice, unless you want to use your body in a way I don’t approve of.

  • mabelcruet

    I like the comment about the hospital representative coming unprepared, but frankly its fairly common. If the usual ‘lose the most important document’ plan doesn’t work (remember the single document lost in the inquest of Baby Joshua Titcombe was the temperature chart about which a lot of the investigation hinged), then the next step is the ‘we need more time to prepare’, and finally, ‘lets not turn up at all’. I was giving evidence in one case (child neglect) where the hospital representative, the council representative, the social worker and the health visitor all failed to turn up despite being summonsed. The coroner asked the CID officer in charge to go and arrest them all and charge them with obstruction of justice. They all turned up about 3 hours later after the police rounded them up.

  • Dr Kitty

    Just…awful. I’m going to bet the Dr was either a GP or an Obstetrician. highly unlikely to have been a Psychiatrist and definitely not a Paediatrician.

    Thankfully, I have access to GREAT mental health services here.
    The legacy of the Troubles is that if someone is really mentally unwell I can get them seen at home, within hours, by very sensible people, who can visit them at home as often as needed, often on a daily basis.
    I mean, you do have to be very unwell for it to get quite that intensive, but really it is no issue.

    I’ve seen a PPP patient at 2pm, had them a home assessment with the Crisis Team and their first dose of antipsychotic before 5pm, same day, and this team frankly don’t care how the baby gets fed, as long as someone is feeding it.

    Case in point- recent severe PPD patient with recurrence following birth of new baby. Pt’s mother staying with the family to help out.
    Currently combo feeding.
    Treatment plan: antipsychotics, antidepressants, baby to sleep in maternal grandmother’s bedroom- granny to manage all night feeds with EBM or formula (depending on what is available), patient not to be disturbed while sleeping.

    My sister’s partner is a NHS CBT therapist in London. He has a six month waiting list to be seen. He nearly fell over when I told him I can get someone an appointment for CBT within 3 weeks, sooner if it is an emergency.

    • NoLongerCrunching

      I’m not even a doctor but even I can take two minutes to pick up a book about medications and breastfeeding. Unbelievable.

      • Cobalt

        I have the LactMed app on my phone…database of thousands of medications, with any supporting study conclusions attached, available in an instant.

      • Liz Leyden

        I’m a big fan of Medscape (app) and Medication and Mother’s Milk.

  • PickAUserNameForDisqus

    I successfully met with the chief nurse at my local L&D unit and had her to make sure to have the hospital pharmacy not add the “Do not breastfeed on this medication” sticker to Zoloft bottles. I happened to know enough that I totally ignored the sticker the hospital pharmacy had added. After severe PPD after my first-born, I knew that I was doing to take while pregnant if I had any symptoms during pregnancy, and even if I was symptom free I knew I would take right after the birth to hopefully not repeat the first postpartum experience. Whether is was the Zoloft, or just a different body and baby I did not have a repeat experience, thank goodness! And thank goodness that the L&D unit heard my complaint and have acted on it. (forehead slap because of the ridiculous pharmacist)

    • Dr. W

      Most psychiatric medication is safe in breast feeding. Many psychiatric medications are safer to stay on, rather than go off of, in pregnancy. It is a case by case risk/reward calculation. No lady should be on Depakote while pregnant ( it has a relatively high teratogen risk ). No lady should worry for a minute about taking Zoloft while breast feeding. The boob nazis make me so angry. This pack of evidence-averse ideologues who place their bullcrap ahead of actual life.

      • PickAUserNameForDisqus

        To stay on SOB topic, one thing that rally worries me about moms having non-OB care is that: I know that OB’s are not always up-to-date on mental health treatments in pregnant and postpartum moms, but the less education and increased dogmatic providers are highly likely to have even less knowledge, and less ability to network with mental health providers. And also, if bad things happen in the hospital they hopefully will be caught in time, and if they aren’t there is a high probability of accountability, but for out-of-hospital…well, who knows.

        • DiomedesV

          I have the same concerns. I know I would not feel comfortable being counseled on mental health by any nurse, including a midwife. In fact, I already felt judged by the NP at my OB’s practice.

  • Dr. W

    Beyond the stupidity of choosing breast feeding with a good risk of psychosis over formula and linear thought, the amount of medication that comes through in breast milk is tiny. Breast feeding while on Risperdal ( a damn fine anti-psychotic, by the way ) is much much safer than just stopping an anti-psychotic in a schizophrenic, who also happens to be a new mother.

    Medicine, like life, is a constant risk/reward calculation. What do I gain? What do I risk? There are very very few free lunches. Can you think of something more likely to destabilize a schizophrenic than staying up with a new born? I could name cocaine and a few other things, but new motherhood would stay pretty darn high on the list. Any rational thought about the risk and reward of the situation would conclude you want the lady on her darn meds. I am just offended.

  • Sarah

    Heads Should Roll. End of.

  • Hannah

    Wow… this was all over the news back when it happened, but there was NO indication that any of this was happening. She was mysteriously found by the cliff, and that was it. Not seen anything about it since. This should be all over the news as a complete outrage.

    • PeggySue

      actually, there was some talk about whether the patient had stopped taking medication.

  • Taryn

    I was only taking Zoloft, too.

  • Taryn

    I suffer from bipolar disorder. When I went into the hospital for my first delivery and ended up there for a week due to a complicated c-section (shout out to Dr. Susan Warner, who saved my baby’s life and my uterus), my nurse confiscated my psychiatric medication, which she judged too dangerous for the baby, and refused to administer it when the resident ordered her to do so. The resident finally snuck me some pills and told me to keep them hidden. The background to this was that the nurses were so hell-bent on my breastfeeding that they never told me my OB had warned them I wouldn’t be able to do so because of the severe physical trauma I had sustained. She explained it to me months later, seeming horrified at the deception and my consequent agonized attempts to nurse.

    A lot of women I know seem to have similar stories. A friend of mine who takes antipsychotics was even excoriated by a physician in a maternity ward for having children she knew she wouldn’t be able to nurse. And the doctor thought my friend was the crazy one…

    • Comrade X

      Bloody hell. Which country was this in?

      • Taryn Nelson Seawright

        Evanston, IL, USA. One of the better maternity wards in the country, too.

        • Comrade X

          That sounds like a horror story from one of the crazier maternity units in the UK, where the obstetricians are terrified of the midwives and basically hide shivering upstairs somewhere until they’re told they’re “allowed” to come on site.

        • Taryn Nelson Seawright

          I had a horrible experience. The doctors and nursing assistants were wonderful, and the RNs had god complexes.

          • Amy M

            Were you able to file an official complaint or something? I mean, that’s not just obnoxious, it was potentially dangerous.

          • Taryn Nelson Seawright

            You know, it honestly never occurred to me. I gave my doctor an earful, though, and as I recall, she had words with the hospital over the incident.

          • Guesteleh

            You can file a complaint with the national hospital accrediting agency (http://www.jointcommission.org/report_a_complaint.aspx) and the state nursing board (http://www.idph.state.il.us/pdf/CCR_ComplaintForm_Fields.pdf). A letter to the hospital CEO would be a good thing too. That hospital has a serious problem.

          • Medwife

            If I was the OB whose orders had been disregarded, I’d have that nurse disciplined. I would pursue the hell out of it.

        • Roadstergal

          Evanston Hospital? I was born there, I love that town. What a horrible experience they put you through. 🙁

          • Liz Leyden

            You would be amazed at how many nurses still buy into the Psych Med Stigma.

          • Roadstergal

            I sort of fell over when I found out how many of them were anti-vax, really. 🙁

          • Taryn Nelson Seawright

            Yeah, but a lot of them buy into therapeutic touch as well. I blame poor curriculum choices in some of their training programs.

          • Taryn Nelson Seawright

            Well, they did save my baby, which was no small task. When the kitchen staff found out that my hypoglycemic husband wouldn’t leave my bedside to eat, they started doubling the size of all my meals on the quiet. The ISCU staff were excellent, though the pediatric neurologist misdiagnosed a broken skull with minor bleeding as a stroke and kept the baby there several days longer than was necessary. On the up side, she provided really excellent pain management, which is not something all injured neonates get. And my second child’s birth there was lovely, easy, and without incident.

            They also have an excellent follow-up program for women at risk of PPD, ironically.

          • Roadstergal

            That’s good to know. My mom always spoke fondly of my birth there, although she never went into the details.

          • Taryn Nelson Seawright

            The maternity ward feels positively luxurious. Very comfy, yummy food, cable TV and Wifi.

    • demodocus’ spouse

      well, that makes as much sense as my 1 year old. edit to add: your nurses and that other doctor, I mean.

    • Kelly

      That is crazy. I had to go on Zoloft and the OBs I have met with have been supportive and up to date on what I can and cannot do while pregnant or nursing. I am wondering how I get my meds while I am in the hospital. I will be talking to my doctor about that.

      • Taryn Nelson Seawright

        Zoloft is the best SSRI for pregnancy and nursing, from what I’ve read. Very safe. Talk to your doctor, and talk to your maternity ward /before/ your admission. And if all else fails, ask your psychiatrist to talk to them. But also, don’t go borrowing trouble – your nurse may be (probably will be) kind and supportive.

        • Kelly

          Oh, I’m not. I have just wondered how it works. This will be the first pregnancy in which I am on meds and I just don’t want to miss a dose. This has just helped me remember to ask the doctor so that I can make sure I know the procedure. I am so incredible lucky and glad that Zoloft works for me and on a pretty low dose. When I called to get an appointment, they had me come in within twenty minutes. I am also glad I had someone who was able to take my kids right away as well. Overall, I have had a good experience and wish that everyone got the care that they needed. One of the big things that helped me see it was that both my husband and I knew what the warning signs were and I had the support to go in.

          • Michele

            I started on Zoloft part way through my last pregnancy. I took my prescription bottle to the hospital with me just in case anyone gave me crap, but didn’t need it as the nurses just asked what my preferred time for taking it was and brought it to me each day at that time. Now that I think about it I talked about it with the nurse when I did my pre-registration paperwork and she noted everything in my file then. Hopefully you will have an easy experience with the maternity ward as well.

      • CharlotteB

        I don’t know if this is true, but I heard somewhere that you should bring your own supply of medications, since the hospital will charge you more to bring them to you. I brought them with me.

        Then again, the nurses gave me bottles of Motrin, Tylenol, and a stool softener, and told me to be sure to take them every 6 hours, so not a lot of medication monitoring was happening.

        • DiomedesV

          Administering your own medications can be problematic from the staff’s point of view. They need to know what’s going on. I thought of doing this, but ultimately ended up being very persistent about making sure the nurses got me my meds. I didn’t have to try too hard, though. The hospital I delivered at took maternal mental health seriously.

    • Wombat

      This is so sad and unfortunate, I am sorry that it happened to you. Especially when the info -is- absolutely out there, and shows very little to no relatively conclusive risk. It is one thing to err on the side of caution, in the face of a total unknown (with the patient’s consent) and another entirely to ignore evidence that is available.

      Contrast your experience with mine, going in for my ankle surgery. Even if they carried a risk (which they thankfully really didn’t) it was made super clear and emphasised to me that my psych meds would absolutely not be discontinued unless there was a strong or absolute contraindication, abd even then I’d be likely appropriately tapered to something compatible instead. Even my birth control, that they didn’t want me taking due to clot risk (which I wasn’t crazy about but ultimately agreed with) it was essentially: we won’t administer it. We will help you with anything that comes of not administering it. We can’t actually confiscate it and keep it from you. Just like anything else (illegal drug history, etc) we’d rather know and be able to address it. I agreed to d/c it (and fortunately it was few enough days that my extreme menses didn’t rear their head too badly) but I felt like it was actually discussed and explained, even while being recommended against.

  • JJ

    As a PPD survivor and a mother hurt by NCB/BF ideology this makes me so sick. Dr. Amy summarized it well: “For most of human history, women have been reduced to three body parts: uterus, vagina and breasts.” Why did this poor woman’s mind not count as important! Women’s liberation is being trampled on by these zealots.

  • EW

    I’m only a Mum who has suffered PND very severely after both my births, not someone who has access to policy and procedures in the medical profession, but in both my journeys I have met other mums with mental health issues who were taken off their medication by their GP during pregnancy, or during breastfeeding, when I have heard of others being on the same medication during pregnancy and breastfeeding. I think some GPs and other doctors who are not specialists in peri-natal mental health are scared of potential side effects of prescribing anti depressants to pregnant or breastfeeding women, and don’t know of resources or knowledgeable colleagues to find out which drugs are considered safest in breastfeeding, I was lucky, my GP was able to provide me with information on the safety of the drugs she was recommending for me, as the breastfeeding relationship I had with my daughter was one of the only bright parts of the hideous PND I was suffering – not all of us dedicated breastfeeders are brainwashed by lactivists – for us it was simply easier, as a dyad we took to it straight away, and it was a positive thing for me.

    However in the case of Charlotte given she was previously diagnosed with schizophrenia you would have thought she would have specialist input throughout her pregnancy and after birth who were knowledgeable in terms of appropriate medication. It seems that was not the case and it should have been. Mental health is not a priority in the UK and peri-natal mental health resources are very scarce, there are very few mother & baby units throughout the UK for instance for specialist care, I think there were 17 last time I investigated, offering between 5-10 beds on average – that’s not much support for mums like Charlotte who seems to have been allowed to slip through the cracks. So terribly sad on all accounts.

    • Amy M

      And even if a doctor believes or knows that a particular drug is harmful to a fetus, so the women taking it should not if they become pregnant—that’s different than worrying about breastfeeding. I know of people whose doctors worked very closely with them to ensure their medical (mental or otherwise) needs were met while pregnant, but protecting the fetus as much as possible. After the baby is born however, and the woman should really be on the drugs, the answer is simple: formula. I hope that women see stories like this and if their doctors are lactivists, maybe they’ll go find new doctors.

      • EW

        But in addition and as the article states the drug Charlotte was taking is considered safe to breastfeed on anyway – so even supposing it was Charlotte’s choice to breastfeed – she could have done so and continued on her medication too. So it’s a even greater tragedy as Charlotte should never and had no need to have been unmedicated. No need in this case to even make the choice between breastfeeding and formula which makes it even worse!

        • Amy M

          Oh absolutely, but if the doctor doesn’t have the information, the safer thing to tell a patient is to use formula, not “go off your meds and breastfeed.”

    • PeggySue

      What was very upsetting to me at the time the story first came out was that it seemed as if Charlotte was showing some signs of emotional stress while in the hospital with the new baby (which was her first btw)–one might have had to read between the lines to see it, but in the way her partner spoke of their time together in the hospital it seemed as if she were quite stressed–not that there is anything abnormal about being stressed when one has had one’s first baby! but in her case I would have hoped that would be a red flag.

  • amazonmom

    My IUD failed and I got pregnant while taking small doses of Seroquel for depression. I didn’t want to risk a relapse so I stayed on it throughout pregnancy. I also breastfed my son for 6 months on it. It’s not the choice very many people would make. I’m so angry that women are told to go off medications that are essential to their health. We know what happens when people go without needed meds be it mental or physical illness. Formula is a wonderful choice and women should never be shamed into giving up their health to avoid using it.
    I don’t tell too many people I stayed on my medication,even though I did so on my doctors advice after she consulted national experts on the matter. The idea of accepting even the smallest risk for a child to benefit the mother brings so much judgement.

    • MegaMechaMeg

      I once had an awkward party conversation with a woman who absolutely could not understand why any woman would not want a giant family. She was going on and on about how as women we were built to be mothers and without children we were not fulfilling our destiny etc so to get her off my back I told her that I had severe depression and that going off the meds for a pregnancy was not an option so I was choosing to remain child free. She actually told me that once I became pregnant I would love my child so much that it would give me the strength to fight through the depression and get off the drugs.
      After that I just choose to get really drunk.

      • demodocus’ spouse

        Sounds like someone has been listening to medieval physicians again. That argument was used on Henry VIII’s daughters. Boy, what would Queen Elizabeth I have been able to do if only she’d had a baby!

      • JJ

        What is wrong with people. Having babies does not make fighting mental illness easier! I know firsthand.

        • MegaMechaMeg

          You know what my anxiety disorder needs? A tiny dependant human being that I am hormonally bound to love wholeheartedly that requires constant care and screams uncontrollably, sometimes for no damn reason!

          • The Computer Ate My Nym

            Oh, yeah. I remember those days. They were terrifying! The only thing that kept my anxiety based obsessive behaviors under any kind of control was knowing that if I obsessively checked the baby I’d wake her and that wouldn’t be good for her health. Well, that and 20 mg/day of citalopram (class C in pregnancy, but lower risk than PPD.)

          • MegaMechaMeg

            My actual pregnancy plan is to downgrade to the pregnancy safe pills and then go back to my current mix upon delivery and then formula feed. It seems like the best possible setup since post-partum is pretty much a foregone conclusion and with my life circumstances and physiology I am pretty sure breastfeeding would not work in the best of circumstances, but GOD am I not looking forward to the helpful commentary. My medical history is a private and emotional subject anyway and even with the good drugs I am sure to be thin skinned and emotional. The best I can hope for is that I can think of a few good one lines like “Well we were hoping with all the mercury and spiders eggs in this brand our baby would develop spiderman powers.”

          • The Computer Ate My Nym

            Make sure you get formula made with some Monsanto product. “Genetically altered” is the current catch phrase to explain completely nonsensical superpowers.

          • The Bofa on the Sofa

            Make sure you get formula made with some Monsanto product. “Genetically altered” is the current catch phrase to explain completely nonsensical superpowers.

            Yeah, “radioactive spider bite” never really caught on.

          • The Computer Ate My Nym

            I think the new Spiderman has him being bitten by a “genetically altered” spider. Though, of course, radioactive elements are mutagenic…

          • MegaMechaMeg

            I have four cats so I might have to tell people that I induced cat lactation to help with cat-baby bonding so we don’t have to pay for daycare.

          • The Computer Ate My Nym

            Hmm…perhaps the baby will have cat/spider superpowers from the combination of that and the formula.

          • MegaMechaMeg

            oh god, no cupboard would be safe.

          • Roadstergal

            “Don’t you want what’s best for your baby?”

            “Yes. Superpowers.”

            (Although, honestly, I think a yes and a smile is the only workable answer to that horrible question. A healthy mother is absolutely the best.)

          • MegaMechaMeg

            I prefer a deadpan “no” followed be a teenager style eye roll.
            I honestly have been thinking a lot about a story that my mother told me. She breastfed my brother until 18 months and meant to do the same with me, but at three months when she brought me to the doctor for a checkup and they asked her how things were going she burst into tears. She tells me that she just started wailing “I hate it” over and over. The doctor looked at her like she was nuts and told her to just quit if it wasn’t working and I became a formula baby. Nowadays that would probably be held up as an unsupportive doctor ruining her breastfeeding relationship, but really it was what my mother needed to stay sane and she has no regrets. I don’t understand why we can’t just calm down and let people do what works for them.

          • demodocus’ spouse

            My husband’s normal tendency to anxiety was completely eased by having a baby. Eased so much that he’s been seeing a therapist for a year and we’re wondering if having another would be a bad idea.

          • JJ

            I am going to have a bottle of formula and a bottle of xanax ready at home for the first sign for PPA. I am under no delusions that a baby will make me magically stable.

          • NoLongerCrunching

            Eased, or increased?

          • Box of Salt

            sarcasm

          • NoLongerCrunching

            Oh. Whoosh. 🙂

          • demodocus’ spouse

            lol

        • Amy M

          Right? Anyone with depression is at HUGE risk for PPD, I think its the biggest risk factor. I’m sorry that woman was a big jerk who doesn’t understand how depression works.

        • Somewhereinthemiddle

          If anything, it seems to make mental health situations worse in many cases.

      • The Bofa on the Sofa

        She was going on and on about how as women we were built to be mothers and without children we were not fulfilling our destiny

        Reminds of the (probably apocryphal) exchange between Grouch and the woman on You Bet Your Life.

        Groucho: Tell us about yourself.
        Woman: I am married and have 11 kids.
        Groucho: Eleven kids? Why so many?
        Woman: Well, Groucho, I love my husband.
        Groucho: I love my cigar, too, but I take it out of my mouth every once in a while.

        I wish that exchange were true.

      • RMY

        My wife’s in your boat, that’s why I was going to be the carrier (the plans for that are paused because I’m not very fertile apparently). I pretty much glare at anyone who suggests depression isn’t a serious illness.

    • Michael Clark

      Too many people generally and medical professionals in particular, fail to understand that active depression (and most other mental illnesses) is teratogenic.

  • demodocus’ spouse

    God, that’s such a tragedy, and one that probably would have been avoided if the poor woman had been allowed to stay on her extremely necessary medication. The supposed evils of formula are nothing compared to the voices in your mother’s head.
    Psychiatric problems *need* to be addressed. My grandmother had one, and when she was near-normal, she was fine, but when she got bad… They tried a lot of things, including electroshock when that was popular, and it was a long time before she was mostly okay most of the time. Don’t know if there were any medications for her or if she refused to take them or if age simply modified her imbalances a bit.

  • Cobalt

    What, exactly, did they think would happen when the newly postpartum schizophrenic suddenly stopped taking her meds after being told her value as a human was in her milk?

    Not sure how they could spin this as an accident, or an unpredictable tragedy. They killed her, as surely as if they had withheld treatment for any other life-threatening illness.

  • starstruck

    I was on certain meds for my health that could not be taken while breastfeeding. Witch nurse actually dared to ask me why I was taking them, because it made me selfish. I told her that she needed to get the hell out of my room now, because she obviously didn’t give a damn about me and MY health, and if I saw her again during my visit I was going to yell at her some more. She booked it. Luckily nurse #2 had brains and realized that me taking said meds were more important that breastfeeding. The doctor was pissed that she tried to usurp his authority, as he was the one to tell me to take the meds and to eschew breastfeeding. This poor woman…

    • JJ

      Way to stand up for yourself! The nurse should have been supporting you 100% though. When did mothers get reduced to breastfeeders only?!

  • dbistola

    This is awful. Are doctors actually on record as advising this person to stop taking anti psychosis meds?
    Did anyone actually think that unchecked mental illness would be good or safe for a baby?
    Better question-is a mother a pair of breasts? Or is it a woman who actively raises a child?

    • Ash

      Here’s the quote from the coroner. We don’t have additional information beyond the Mail and the Telegraph.

      At a pre-inquest hearing on Thursday, Avon senior coroner Maria Voisin
      said “breastfeeding advice given in relation to (Miss Bevan’s)
      risperidone” was an issue she wanted to explore in an effort to prevent
      future deaths, the Mail reported.

      • Hannah

        The full extended quote from the Mail:

        “At a pre-inquest hearing yesterday, Avon senior coroner Maria Voisin said ‘breastfeeding advice given in relation to (Miss Bevan’s) risperidone’ was an issue she wanted to explore in an effort to prevent future deaths.

        She said: ‘She was not taking risperidone – what action was being taken and what impact was that having on her mental health?’

        The coroner also said there were further questions for the hospital to answer, adding: ‘The ward she was on – was it appropriate for her to be on and were all the staff trained and able to deal with her needs?”

    • Amy M

      Remember those monkey trials, where the baby monkeys all went to the soft fuzzy monkey instead of the wire one with food-producing teat? I know those are often held up when someone is pushing AP, but its like they’ve gone right through and come out the other side. The baby doesn’t care where the food comes from, it just needs adequate food and lots of snuggles, which its more likely to get from a sane parent.

      • Roadstergal

        You know, I’ve thought that, too. I was taught those studies in random Intro To Things I Won’t Be Majoring In courses, and it just seems like it is a ‘bottles are just fine’ message. The animal needed sustenance and comfort, but they didn’t have to come from the same place.

  • Spamamander

    Wow. I’m beyond speechless. When I got pregnant with my son I attempted to go off of antidepressants to reduce any risks- but it became clear that the risks were much greater of me not properly caring for myself than would be caused by taking medication. I was followed every step of the way, adding a second medication after the first trimester was done. I was told I could breastfeed with the meds if I chose to, but if I didn’t feel comfortable with it that was totally fine too. I just cannot believe ANY health professional would take such risks with mother and baby. Beyond sick and sad.

  • Anj Fabian

    “It emerged at a pre-inquest hearing on Thursday that Miss Bevan had
    been advised by medics to stop taking her medication ahead of Zaani’s
    birth.

    NHS guidance says mothers should take risperidone during pregnancy only if their doctor says they need to.

    It adds: “If you take this medicine during the late stages of pregnancy
    or during labour, your baby may have some problems or withdrawal
    symptoms and may need to have some monitoring after birth.”

    Big whoop. The baby may need additional care after birth. I don’t see that as a crisis, more of a caution.

    • Stacy48918

      My thought as well – formula and monitor baby. Home healthy and happy. What a tragedy.

      • EW

        But even worse – if we assume that Charlotte wanted to breastfeed for her own reasons – she could have done on risperidone – Dr Tuteur says in the article that risperidone is compatible with breastfeeding, so it is a mistake that the doctors advised her to cease taking the drug in order to breastfeed as that wasn’t necessary. So it could have been fine all round – Charlotte well on risperidone and able to breastfeed too as seemingly this is how she chose to feed her baby.

    • demodocus’ spouse

      And “may” isn’t the same as “likely will”. ugh. Granted, they tell me withdrawal sucks, but I know which I’d rather go through between withdrawal and my mother killing me in a moment when she was not rational

      • Cobalt

        Risperdone withdrawal can be really awful, especially if it’s sudden. Most of the awful is sudden loss of symptom control causing worse than baseline symptoms, though, and the physical side effects are unlikely to be dangerous.

        The baby would be expected to be totally fine, but it’s a known massive risk for the schizophrenic.

        • demodocus’ spouse

          oh goody. makes it even better.