Jill Duggar Dillard risks her baby’s life at homebirth

Seaton Road Accident

Jill Duggar Dillard is giving us all a lesson in how planning a homebirth is like risking your baby’s life by not buckling him into a carseat.

The odds are in her favor that everything will turn out fine, but, of course, the odds would be in her favor that not buckling him into a carseat would turn out fine. That doesn’t make either one a good idea.

Dillard, one of the 19 and counting Duggar children, is a birth junkie.

Back a few years ago, I had the opportunity to attend 12 weeks of childbirth classes with my 14-year-old friend, who was a single mom. Through these classes, I learned how to coach her during the birth of her child. Although I had attended two of my siblings’ births, being able to work as an active part of my friend’s birth made me interested in learning more. I became friends with a doula/labor coach who worked in the area, and started going to home and hospital births with her. Soon, I became her assistant, and through that, I came into contact with other local midwives. Over the course of the next several years, these midwives would call on me periodically for help at home births.

Now Jill is studying to be a pretend “midwife” (CPM) and will be attended by an equally poorly educated, poorly trained pretend “midwife.”

What’s the difference between a CPM (certified professional midwife) and a real midwife? The CPM credential was made up by a bunch of women who wanted to be midwives but couldn’t be bothered to meet the internationally accepted requirements for midwifery. Real midwives, like those in the Netherlands, the UK, Canada, Australia and the US, must have a minimum of a university degree in midwifery. US certified nurse midwives (CNM) must have a nursing degree plus a masters in midwifery, making them the most highly educated midwives in the world. In contrast, CPMs are the least educated midwives in the industrialized world. They are required to have only a high school diploma, a course of unmonitored self-study that can be completed at home, and attend only 40 births (approximately the same number that I attended in my first week of residency training).

Jill could have trained to be a real midwife, but that involves college, and that, apparently was just too hard.

I had been considering attending nursing school for a while, but the timing of it all wasn’t working out … Eventually, through my work with the local midwives, the door opened for me to enter into a distance-learning midwifery training program in Texas. This program, after about 3 1/2 years of schooling, would give me the education I need to become a licensed, Certified Professional Midwife (CPM).

An “education” that is considered to be so poor that is unacceptable in the Netherlands, the UK, Canada and Australia. The training is as deficient as the education. All other midwives train within hospitals to learn to recognize, manage and prevent life threatening obstetrical complications. CPMs don’t bother with any of that because they are self-proclaimed “experts in normal birth,” which is about as useful a pretend meteorologist who is an expert in sunny weather and must call a real meteorologist to figure out if it might rain.

What do CPMs do when a life threatening complication occurs at homebirth?

They transfer the mother to the hospital where there are real medical professionals with the equipment and expertise to save lives. That, of course, is like transferring your baby to the hospital after the car crash that ejected the baby through the windshield because you couldn’t be bothered to buckle him into a carseat. We don’t think much of mothers who can’t be bothered to buckle their babies into carseats. That’s negligent or crazy or both. Now consider that the chance of a baby dying in childbirth is actually HIGHER than the chance of the same baby dying in a car accident.

Dillard is now nearly 2 weeks past her due date. We know that with every day that passes, the risk of stillbirth goes up. That’s because the placenta often has trouble meeting the oxygen and nutritional needs of a baby growing beyond full term. The baby could simply die spontaneously, or could die during labor, because contractions can stress a healthy baby, let alone one with a failing placenta. Insisting on homebirth at this point is like driving with a baby unbuckled, on an icy road, knowing that the road will get icier still with each passing day.

We all know mothers who have done that and everything has turned out fine. That’s why Jill Duggar Dillard’s son is likely to be fine, too, even though she is casually risking his life at homebirth.

1,352 Responses to “Jill Duggar Dillard risks her baby’s life at homebirth”

  1. AA
    February 15, 2017 at 2:15 pm #

    Jessa Duggar (not Jill as mentioned in this article) was transferred to the hospital for hemorrhage after a planned homebirth. Jessa required a blood transfusion in the hospital. Jessa has recently had her second child, and again, had a planned homebirth.

    http://people.com/tv/jessa-duggar-seewald-relaxed-delivery-baby-number-2-henry-wilberforce-seewald/

  2. Realitybites100
    April 25, 2015 at 2:58 pm #

    She cannot attend college. Her family rules.
    If anything she should be a doula. No need to pretend to be a midwife when plenty of people would hire her as a doula just to be near her celebrity. She would be highly in demand. Duggars and babies are seen as hand in hand.

    on another note..i am note sure if Jill was stunt birthing to the max or if the articles have been grossly amplified. Her social media did not match her timeline. I wonder if all this drama is just to make excuses to the HB communiyy on why she had the C-section. You know they arent “allowed” un;ess circumstances are mega dramatic.

    • Araebo
      April 29, 2015 at 2:47 pm #

      The preview for the birth episode is out and it totally contradicts what she has been saying. Nearly 50 hours at home, not twenty. She didn’t go to the hospital until 50 hours after her water broke even though she saw meconium. Not sure when she tested positive for strep B but it looks like there were no iv antibiotics at the house based on the preview anyway. FIFTY hours after her water broke and strep B positive followed by another twenty st the hospital before the c-section.

      Not to mention that the time line she talks about in interviews doesn’t match the episode.

      http://www.ibtimes.com/19-kids-counting-sneak-peek-jill-duggar-goes-labor-reveals-why-she-had-baby-israel-1901253

  3. Somewhereinthemiddle
    April 21, 2015 at 8:01 pm #

    I immediately thought of this post when I saw this on FB, lol! Looks like there will be more Duggar baby drama since another one of the Duggar kids is pregnant.

    http://www.msn.com/en-us/tv/celebrity/jessa-duggar-seewald-is-pregnant/ar-AAbsEVB

  4. holly patterson
    April 16, 2015 at 4:27 am #

    I am furious that she waited two weeks, I thought a few days maybe a week but two is terrible.
    That baby is blessed to be alive and thank God He didn’t die.
    I am against home births because I look at history and it tells me women who died in child birth before modern Technology was high,
    Also losing babies was very high,
    This is not the cause thanks to skilled doctors and a team of nurses that are the experts.
    Yes women still die, but it’s really rare,
    Doming it old school is ignoring history and having the baby natural is putting yourself and your baby at risk.
    Some women have a easy delivery others more risky. But I would never ever take a chance, sorry Ricky Lake, home birth doesn’t work.

  5. Bugsy
    April 15, 2015 at 12:46 pm #

    People magazine released more information on Jill’s c-section yesterday. (My apologies if someone’s already posted this!)

    -70-hr labor
    -Strep B positive w/ IV antibiotics
    -Meconium in fluid
    -Baby transverse breech
    -Baby not descended
    -Irregular fetal heart rates

    http://www.people.com/article/19-kids-counting-jill-derick-dillard-introduce-baby-israel?xid=socialflow_twitter_peoplemag

    • The Bofa on the Sofa
      April 16, 2015 at 8:43 am #

      Wow, how can the ACNM read that document and still consider the CPMs to be “sisters”?

  6. Andy
    April 12, 2015 at 11:44 am #

    Listen all pregnant women, your bodies are stupid and incapable of giving birth. Evolution got it wrong and you’re the only mammal on Earth who cannot give birth to her offspring without the safety of a hospital, its fancy equipment and drugs. You will induce at 40 weeks even though there is absolutely no scientific research to support that a vital organ for life such as the placenta begins to malfunction starting at 40 weeks and therefore you’re purposely risking your baby’s life. Induce, induce, induce even if your body isn’t ready! Then you will need an epidural because your artificial contractions are too much to cope with and your very instincts to move and change positions have been stripped away from you. Then you will “fail to progress” , your baby will get stressed and heart rate will begin to plummet and then infallible Dr. Amy will come save your baby’s life with an emergency c-section and tell you “see aren’t you glad you were in a hospital so I could save your baby’s life” because remember your body is stupid and don’t you dare think you can have a full-term baby without a hospital.

    Yes things can go wrong! That’s why there are hospitals for when things go wrong not to pretend “save” babies when it’s your medical interventions causing the MOST harm! I would never hire you as my provider.

    • April 12, 2015 at 11:56 am #

      Wow, I just got up and already I’ve seen the most ignorant comment of the day. Your ridiculous claims are debunked all over this site.

    • Montserrat Blanco
      April 12, 2015 at 12:41 pm #

      Evolution did not get it wrong. Evolution does not care about the survival of a particular woman and a particular baby. That is why a lot of mammals die in childbirth but the species continue to be alive. Nature does not care about a particular mother and baby too. Nature cares a lot about… Pretty much everything under the sun, incluiding vultures. Excuse me for not desiring to be vulture food and dying in childbirth.

      • sdsures
        April 12, 2015 at 1:51 pm #

        For some reason this reminds me of wildebeest in Africa. When they give birth, the new calf must be able to get up and run within 10 minutes or so of birth, or else, it gets to be a tasty snack. In other words, Nature doesn’t care.

      • SporkParade
        April 12, 2015 at 2:21 pm #

        Evolution is just throwing genetic peas at the wall to see what sticks. I read a really depressing article on Cracked today. Apparently, there is a species of coots (those are birds) that will lay, like, 10 eggs, and then they will gradually decide over and over again who is the runt of the litter and cast them out to starve until only 2-3 chicks remain.

    • fiftyfifty1
      April 12, 2015 at 1:24 pm #

      Studies show that inducing at 40 weeks rather than waiting DECREASES stillbirth, C-section rate and need for NICU. You have no idea what you are talking about.

    • fiftyfifty1
      April 12, 2015 at 1:30 pm #

      “Evolution got it wrong and you’re the only mammal on Earth who cannot give birth to her offspring without the safety of a hospital, its fancy equipment and drugs. ”

      Evolution can’t work without Natural Selection. Natural Selection involves making more offspring than a species needs, and killing off the unfit or unlucky. In places without modern obstetrics, even in this day and age, 1 out of every 7 women dies in childbirth. At least 1 in 4 babies doesn’t live to see one month of age. If you want those odds for yourself and your loved ones, be my guest.

    • Paloma
      April 12, 2015 at 2:52 pm #

      1º – Evolution doesn’t get things right or wrong. It doesn’t PLAN anything at all!! Certain mutations cause evolutionary advantages in a given situation and those same advantages can become disadvantages if the situation changes. And it is completely RANDOM. So really, you could trust chance and hope for the best, or you can actually hire a person who is trained, will plan what is best for you and your baby and try like hell to keep your child safe.
      2º – Yes, your body IS stupid, because it just knows how to solve things one way. That may cause to compensate a defect or make it worse, depending on the situation. For example, if blood pressure descends, your kidney compensates for the lack of blood supply by retaining fluid, so blood pressure goes back up. If you are bleeding, that helps compensate and keeps you alive. If you have heart failure, your heart doesn’t pump enough blood and blood pressure drops, so retaining fluid creates a buildup, putting a bigger strain on the heart, that fails even worse and the pressure keeps dropping, and it becomes a vicious cycle that eventually leads to death. If I went into heart failure I wouldn’t trust my body to solve the problem because evolution had to get right the organ that keeps me alive. The same applies to any other organ, including the uterus and the placenta.
      3º- I always like to illustrate with my grandmothers story. She was (still is, now is retired) a midwife, and when she practiced hospital births were not the norm in my country. She went from house to house on her own and saw many children and many mothers die despite her best efforts. She insisted to give birth in a hospital, with an OB and closely monitored, even though both of her sisters were midwives too. It says a lot that she knew the risk 50 years ago. That risk hasn’t decreased, it has gone up as obstetrics has evolved and morbidity and mortality keep getting lower in hospital settings.

    • The Computer Ate My Nym
      April 12, 2015 at 3:16 pm #

      Humans are by no means unique in having problems with reproduction. What is unique about humans* is that we have the ability to bypass our reproductive abilities using technology. Technology is, essentially, human’s evolutionary adaptation. And a highly successful adaptation it’s been. What kind of fools would we be to ignore it?

      *And any animals that we choose to share this technology with. Bulldogs, for example, usually give birth by c-section.

      • Mishimoo
        April 12, 2015 at 7:47 pm #

        Chihuahuas, Staffordshire Bull Terriers, and Corgis pretty commonly have caesareans too (if their owner/breeder cares, that is).

        My very own Hailie (weimaraner), had one for failure-to-progress, and a successful but unintentional HBAC.

        • The Computer Ate My Nym
          April 13, 2015 at 9:09 am #

          My chihuahua-who-know-what mix got a TAH/BSO instead. I didn’t realize that chihuahuas had so much trouble with delivery. Makes the excess of chihuahuas in shelters seem all the more disturbing.

          • Mishimoo
            April 14, 2015 at 6:09 pm #

            It really does! Also blows the idea that “Your body won’t grow a baby that’s too big to birth.” right out of the water because that’s what happens fairly, regardless of species.

      • D/
        April 12, 2015 at 9:46 pm #

        I actually began to develop my initial NICU nurse skills as a vet tech at those c-sections. Puppy assessments to divide into piles … the squeakers, the squeak-if-you-make-mes, and the please-save-me-if-you-cans and then get to work. Honestly it seemed like a treat to just have one baby to figure out once I got to the NICU.

        I already had the heart of a lactation consultant then too. I’d be the one back in the kennel well after time to close up trying to get the runt nursing … and was surprisingly a decent (non-human) LC even then 😉

        Decades ago and I still miss that job!

        • toni
          April 12, 2015 at 10:43 pm #

          this is my favourite comment today. how sweet!

    • The Computer Ate My Nym
      April 12, 2015 at 3:26 pm #

      absolutely no scientific research to support that a vital organ for life such as the placenta begins to malfunction starting at 40 weeks

      Classic mansplaining. This claim is presented entirely without evidence, despite being contrary to numerous publications on the risk of IUFD and neonatal mortality. We’re supposed to just accept it because a person with a male nym presented it.

      Sorry, cupcake, but the risk of neonatal mortality rises after 40 weeks gestation. By 46-47 weeks* the risk of neonatal mortality is doubled. This does not count the well known risks of intrauterine fetal demise, aka stillbirth. Numbers derived from the CDC Wonder website, calculated using no restrictions, display by gestational age.

      *Who the hell goes 47 weeks? Over 30,000 people in 2007-12 per the CDC.

    • momofone
      April 12, 2015 at 3:27 pm #

      Bullshit. My son’s placenta was almost completely calcified at 38 weeks. Thank goodness I didn’t hire you as my provider.

    • Fallow
      April 12, 2015 at 3:56 pm #

      I was induced for pre-eclampsia/HELLP, and that Pitocin didn’t cause me anything I’d consider unusual pain. Certainly not “too much to cope with”. It was about what I expected, honestly. Whoops!

      Severe pre-eclampsia and preterm labor run in my family. My grandmother and great-grandmother had some dangerous pregnancies, and some dead babies. My grandmother was the only surviving child of my great-grandparents. My grandmother also got sterilized as a young woman to prevent any future pregnancies from killing her. My uncle was a preemie in the 1950s, on top of all that! Sounds like evolution was doing a swell job, right? Sure, my great-grandmother had to bury numerous dead children before one of them stuck. But at least it was all natural!

      You ought to look up how
      hyenas give birth, if you’re so assured that evolution has good
      intentions (or any intentions). You know that hyenas are mammals, right? So, what the heck did hyenas do to deserve
      their birth process?

      You NCB people really sound like cult members, though. You recite BOBB like it’s scripture. Your diatribes are nearly word-for-word interchangeable. If you crossed your rhetoric with Scientology (which, of course, is on everyone’s mind lately), I bet you’d call non-NCB folks “SPs”.

      • Somewhereinthemiddle
        April 12, 2015 at 4:28 pm #

        I got curious about the hyena, googled and am sorry I did, lol. The thought of giving birth through pseudo penis is cringe worthy in addition to the obviously dangerous part. Yikes!

        • April 18, 2015 at 3:33 am #

          They mate through it also. I read a web comic called “Carry On”, about anthropomorphic hyenas. A lead character described her reproductive tract as being shaped like a saxophone. Her mother claimed you don’t know about motherhood until you’ve pushed a bowling ball through a P-trap.

          OW!

      • demodocus' spouse
        April 13, 2015 at 11:19 am #

        My grandma had several children in the late 30s and early 40s. None of them lived; Dad’s adopted.

    • Nick Sanders
      April 12, 2015 at 4:20 pm #

      “Evolution got it wrong and you’re the only mammal on Earth who cannot give birth to her offspring without the safety of a hospital,”

      Um, actually, yes.
      http://en.wikipedia.org/wiki/Obstetrical_dilemma
      http://www.americanscientist.org/issues/pub/why-is-human-childbirth-so-painful/

      • toni
        April 12, 2015 at 5:20 pm #

        ‘The prolonged period of breastfeeding needed by a human baby is the most energetically demanding period of a female’s life. A mother may even allocate her own brain during pregnancy, losing some 4 percent of its volume, to meet the energetic demands of her baby’s brain.’ I can believe that!! I’ve left the stove on and forgotten about it 3 times this week.. destroying a non-stick pan each time. I only do this when I’m pregnant

    • Who?
      April 12, 2015 at 6:27 pm #

      Hi Andy, you seem to have a lot of feelings there, directed variously at pregnant women, Dr T, and the medical profession.

      I don’t think it is helpful to cast women as victims as you do, if they choose professional care during their pregnancies and deliveries.

      My one question though: how does anyone know when something is going wrong unless a pregnancy and labour is being monitored and supervised? Or to put it another way, do you wait for a catastrophe like a serious bleed or a baby stuck in the birth canal before calling for help?

    • Dr Kitty
      April 12, 2015 at 7:03 pm #

      Andy,
      I have Spina Bifida Occulta (meaning bits of my backbone didn’t form properly, and didn’t properly protect my spinal cord), several sacralised vertebrae (meaning that bits of my backbone are attached to my pelvis when they shouldn’t be) and a pelvis that is best described as “wonky”.
      My Xrays look like someone has thrown a Meccano set in there.
      Of course, because modern medical treatment means that I can walk, and have normal bowel and bladder function, you wouldn’t know that to look at me.

      I’m one of the people who would be on the discard pile if natural selection was allowed to work unhindered by medicine and technology.
      I think that the fact I’m an intelligent, happy and productive member of society, who has saved lives in my day job shows that survival of the fittest is quite relative.

      Damn skippy I’m going to take a CSection over taking my chances that my body, which doesn’t know how to make symmetrical pubic rami and or ilia, or a spine with the components in the right places, will know how to deliver a baby.

      You assume that everyone has a healthy body, a functioning placenta and a healthy, typically formed baby that can tolerate labour.
      Your assumptions are wrong.

      They’re also ableist, and pretty insulting both to those of us who were made rather imperfectly and are incapable of giving birth and to the people who help us to have babies anyway.

    • FEDUP MD
      April 13, 2015 at 12:10 am #

      Umm, organs vital to life can fail at any time. Come to the hospital with me and see some kids with end stage renal, heart, or lung disease. Evolution doesn’t care, and nature can be pretty cruel.

    • demodocus' spouse
      April 13, 2015 at 11:13 am #

      Pff. I saw an ob for my prenatal care, had great blood pressure all pregnancy, actually gained only my child’s weight, went into spontaneous labor at 40 +5, was as calm as at a quilt guild meeting, and preceeded to develop pre-eclampsia 4 hours into labor *before* I got any medications. Also, I haven’t been able to sneeze without peeing since 7 months along and I’m ever so slightly incontinent. But my body was broken because I eventually got an epidural? Um, no..
      By the way, PBS showed a program on animal reproduction last summer, and the elephant they were profiling in one program died a couple weeks after she gave birth due to complications.
      PS, you did notice Dr. Tuteur is retired, yes? She won’t be at anyone’s delivery any time soon, except perhaps at a grandchild’s birth. I’ll take my own (certainly fallible, since he’s human) Dr. Escabedo, thanks. Especially when there’s a NICU down the hall.

      • The Bofa on the Sofa
        April 13, 2015 at 11:43 am #

        By the way, PBS showed a program on animal reproduction last summer, and the elephant they were profiling in one program died a couple weeks after she gave birth due to complications.

        “Sex in the Wild”

        A great show.

        There was another episode where an orangutan bonded immediately with her c-section baby, despite having GA.

        • demodocus' spouse
          April 13, 2015 at 12:07 pm #

          That’s the one; all I could think of was “Born in the Wild” but that’s a different show

          • The Bofa on the Sofa
            April 13, 2015 at 3:00 pm #

            My favorite one was on dolphins. I never knew how they did it.

            And considering that they only do it about 5 seconds, it makes me feel like a stud.

    • Daleth
      April 13, 2015 at 12:12 pm #

      Uh… how does induction at 40 weeks risk a baby’s life?

      That’s a rhetorical question.

    • Cobalt
      April 13, 2015 at 2:24 pm #

      People with these sorts of beliefs shouldn’t be allowed to use chairs. Perfectly functioning legs were made for standing and walking, and a chair is but the beginning of the cascade of sitterventions and before you know it you’ll end up with a nice couch set, complete with matching end tables.

      Tortoises, after all, NEVER use chairs, and their life expectancy is much longer than ours.

      • The Computer Ate My Nym
        April 13, 2015 at 2:34 pm #

        And there is evidence that sitting for long periods of time is bad for your health. Seriously. Chairs are an evil intervention and unnatural! If you must sit, use a rock. Much healthier.

        • Cobalt
          April 13, 2015 at 2:48 pm #

          And if you must leave your home, the only suitable solution is to bring your carefully selected, all natural, hand hewn, organically grown, runically mossed rock with you, so as to avoid contact with common benches. How to carry the rock? Why, in a sling, of course!

          • The Computer Ate My Nym
            April 14, 2015 at 12:27 pm #

            I love the image I get from this. A rock carefully cuddled in a sling…

          • D/
            April 14, 2015 at 8:47 pm #

            I need a new image. When the grand baby was a little sling lump, a teenager came over in a restaurant and left my daughter completely bewildered by asking ‘Is that a chinchilla?’ (Evidently that’s a thing for a pet outing around us?)

            Of course that question pops into my head now whenever I run into a well disguised little sling rider … along with inappropriate ‘WTH’s your problem’ snickering if I’m not very careful.

    • DaisyGrrl
      April 14, 2015 at 8:29 am #

      It’s kitten season in much of North America. A rescue I follow on Facebook had this rather sad story last week:

      ” On Saturday she went into labor and clearly did not know what was happening. She had her first kitten while she was standing on a cat tree; her second 2 hours later was found on the floor; a third was stillborn. She rejected all of them and was terrified about what was going on. A forth was born 8 hours later and she was clearly having difficulty, lots of bleeding. (yes, she and kittens were getting assistance); a fifth had to delivered for her as she was standing up and could not get it out; ditto for the sixth.”

      The cat subsequently hemorrhaged and required emergency veterinary care. She survived, and the rescue will make sure she never has another experience like that again (hooray for spay!). Unfortunately, another of her kittens has since died. If you have any spare time to give, volunteer to help nurse some kittens this year. For some strange reason, birth doesn’t always go smoothly and intervention is needed to save these babies.

      All this to say I’m glad I’m a human living in a resource-rich country. I get to give birth in a hospital with people watching over my safety, standing by to intervene if necessary. I bet the cat in my story would feel the same way if she could.

    • MaineJen
      April 14, 2015 at 10:24 am #

      That must be why my great-grandmother lost 4 of her nine children either during or shortly after her all-natural home births. No one told her, apparently, that it was supposed to be a perfect process that your body can handle naturally 99.999% of the time. Maybe the problem was that The Business of Being Born hadn’t been released yet, so she didn’t know how lucky she was to be avoiding all the modern interventions that could have saved her children’s lives.

      I would choose my two intervention-full hospital births, resulting in two healthy live babies and one still-living mother, over nine home births with no intervention where almost half of the babies ended up dead. Wouldn’t you?

  7. April 11, 2015 at 3:34 pm #

    I wonder if a big part of her taking a correspondence course and attending births with other women isn’t because her family won’t permit her to go to college and become a CNM or Ob/Gyn. This might be the closest she can get to a career that gives her any sort of autonomy, independence, and personal income.

    • Daleth
      April 12, 2015 at 10:30 am #

      Yeah, that makes sense. How sad.

  8. Dea
    April 11, 2015 at 12:10 pm #

    Poor Jill… I truly think she is a well intentioned girl, with good character. But I keep asking myself if she really knew what she was putting herself and her baby into by deciding to have a home birth. Midwifes usually are very sweet, receptive and armed with the most beautiful and convincing arguments, leding people to believe that home birth a magical experience and just as safe as a hospital birth. Giving the fact that Jill is a christian, I wonder if she has ever thought about the feminism influences on home birth (“my body, my choice, my birth”, “empowering women” etc). She would be surprised to discover that most of the home birth support comes from ideologies rather than from evidences (and yet, homebirth advocates LOVE to talk about evidences, numbers etc). I really admire her entire family and I think that protecting kids from certain things is important, but I also think that Jim Bob and Michelle shouldn’t impose so many restrictions when it comes to their kids education. I believe that her parents restrictions may have greatly influenced her choice for an “easier” way of delivering babies.

  9. D/
    April 10, 2015 at 9:07 pm #

    Related to NARM neonatal resuscitation education requirements:

    Just saw an interesting fb post by a NARM board member that they have received notice from AAP (American Academy of Pediatrics) that ‘Helping Babies Breathe’, a **ventilation only** neonatal resuscitation curriculum utilized in the resource-limited conditions of less developed countries, was not intended or approved for use in the US. NARM will be removing HBB as an option for neonatal resuscitation training and will have to require NRP certification/re-certification.

    • Karen in SC
      April 10, 2015 at 9:35 pm #

      How can lay midwives be certified to do a procedure that requires a team and special equipment?

      • D/
        April 10, 2015 at 10:40 pm #

        Technically speaking NRP is not a certification course and completion of the program does not imply that an individual has the competence to perform neonatal resuscitation. Each hospital (or in the case of CPMs, I suppose NARM?) is responsible for determining the level of competence and qualifications required for assuming clinical responsibility for neonatal resuscitation.

        Anyone can take an NRP course, but the target audience is those who care for newborns at the time of delivery. Depending on job responsibilities participants may complete Basic (non-intubated ventilations and chest compressions) or Advanced (intubation, umbilical line placement, emergency medication administration, etc) courses. With Basic providers being, at best, only a stop gap measure until the baby can get to the Advanced NRP team.

        I’ve been pretty flabbergasted to learn of the prevalence of mouth-to-mouth as a first choice ventilation method for home birth MWs, but I’m not even sure what adjective adequately describes them using the same training protocols intended for places like rural India and Africa here in the US. I’m glad AAP called them out on it.

  10. Poogles
    April 10, 2015 at 6:51 pm #

    Interesting tidbit: our CPM commenter, Heather Rische, is a fan of “From Calling to Courtroom”. I know you are all just shocked.

    “On 6/12/2004 Heather Rische, a midwife in New Mexico,
    wrote:
    “Thank you for doing this work. As I begin my homebirth practice, I
    feel more and more trepidation about the vulnerability of my position. I look
    forward to using this resource to move ahead in my practice with the best
    protective measures in place.””

    • The Bofa on the Sofa
      April 10, 2015 at 9:28 pm #

      She just wants to use Birth Art to illustrate it….

    • Amy
      April 11, 2015 at 12:27 pm #

      And Raymond Zakhari is a fan of all manner of paranoid right-wing conspiracy theorists, including many climate change deniers. His education, about which he brags on his website, is cobbled together from a variety of sources. His website emphasizes bedside manner over clinical competence. Shocking, I know.

    • momofone
      April 12, 2015 at 10:51 am #

      “Best protective measures” for her, that is.

  11. Nan
    April 9, 2015 at 7:45 pm #

    This rant is so full of ignorant and uneducated assumptions why bother with the US horrible hospital birth facts, high maternal death rates and despicable first day infant mortality rates. Go read a book before you spew nonsense

    • Who?
      April 9, 2015 at 8:59 pm #

      Hi Nan, so glad a visitor is engaging with some actual responses, I’m sure everyone here would be delighted to be educated. Please pass on the bases for your assertions about ‘hospital birth facts’ and death rates for mums and babies.

  12. Me24u
    April 8, 2015 at 8:51 pm #

    First child was born with a midwife seven miles down a country road in the mountains a good hour from a hospital. A few years later that marriage ended when she stepped out on me. Fortunately everything went O.K. with the birth. Eventually I met and married a person Ive been married to for 30 years and we have two of our own and raised the other one also. My second wife was a level III Neo Natal R.N. and after I learned why a hospital is important and what can happen, Im a believer in having your baby in a hospital,period. The standard line that we can position you in a safe way if something bad happens and drive to the hospital is a myth.

  13. pooOnyou
    April 8, 2015 at 5:42 pm #

    sounds like this was written by a menopausal bitch.. pure and simple.. a total asshole..

    • Stacy48918
      April 8, 2015 at 5:44 pm #

      And your reply wasn’t?

      • Who?
        April 8, 2015 at 6:39 pm #

        Always with the scatological (sp?, where is Jennifer when we need her?) references.

        • Cobalt
          April 8, 2015 at 7:46 pm #

          Hopefully, reviewing her 119 references to see if any of them are credible, relevant, and or current.

          If she actually checks them out, she *might* learn something.

          • Who?
            April 9, 2015 at 3:41 am #

            I really hope you are right.

    • moto_librarian
      April 8, 2015 at 5:50 pm #

      Yawn. If you can’t come up with anything other than an ad hominem, go away. You are boring.

      • Bombshellrisa
        April 8, 2015 at 5:55 pm #

        Yeah, at least be willing to take issue with the facts as they are presented. Name calling is so kindergarten

    • SporkParade
      April 9, 2015 at 3:30 am #

      Because nothing says “I respect women” like saying that their bodily functions make their thoughts unworthy of being taken seriously.

      • Medwife
        April 9, 2015 at 3:30 pm #

        Women should never feed into that. When you’re childbearing age, it’s PMS, or pregnancy. Once you’re past that, it’s menopause. There is never a point in a woman’s adult life where she can’t be blown off “because hormones”.

        • SuperGDZ
          April 16, 2015 at 5:40 am #

          While ironically men are far more influenced by their hormones on a day to day basis.

    • Medwife
      April 9, 2015 at 2:51 pm #

      Ooo. Menstruating, are we?

  14. KBCme
    April 8, 2015 at 4:44 pm #

    I saw the birth announcement. Baby was born on MOnday. From the photo that was sent out with the birth announcement, it looks like Jill did end up having the baby in the hospital. No word if she started there or ended up there due to problems. Baby was 9lb 10 oz.

  15. RJ
    April 8, 2015 at 11:52 am #

    Choosing to have a Homebirth is a perfectly responsible
    Health care decision and instead of shaming women,
    Maybe we ought to support women to do what they think is
    Best without judgement. Yes things can go wrong
    At home, but that is true for the hospital
    As well. Midwives have been helping women deliver
    Babies since our beginnings and are the original birth keepers.
    Yes thank God for hospitals, Dr’s, cesarians etc.. Nobody is disputing
    that. But let’s not act like women and midwives are incompetent Bc
    if they support home birth. The ideal model of care should be
    Mothers,Midwives and Dr.’s working together.

    • Nick Sanders
      April 8, 2015 at 11:57 am #

      “Yes things can go wrong
      At home, but that is true for the hospital”

      But what are the relative odds? And which is better equipped to do something meaningful when it happens?

      And midwives aren’t incompetent because they support home birth; supporting home birth is a symptom of their incompetence. Seriously read some more of this blog to see why they are so reviled.

    • The Bofa on the Sofa
      April 8, 2015 at 12:11 pm #

      Yes things can go wrongAt home, but that is true for the hospital

      And sober people die in car accidents, even when they are wearing seatbelts. That doesn’t make driving drunk without a seat belt a responsible choice.

    • Daleth
      April 8, 2015 at 12:12 pm #

      What makes it “perfectly responsible”?

      I guess what I have trouble with, logically, is that even low-risk home birth is almost five times more likely to end with a dead baby than hospital birth, and something like 18 times more likely to end with a brain-damaged baby.

      So, given those problematic facts, why do you think it is “perfectly responsible”?

    • NoLongerCrunching
      April 8, 2015 at 1:09 pm #

      I see a lot of lip service to doctors saving lives, but mostly a lot of disparagement of them (scalpel-happy, too impatient for moms to deliver, making decisions based on liability, money, or free gifts from formula companies, not familiar with natural birth, etc). One needs to give respect to get respect.

    • The Computer Ate My Nym
      April 8, 2015 at 1:31 pm #

      First off, I love the blank verse format. Second, things can go wrong at a hospital. Things can even go wrong because you were at a hospital. However, things are about 3-4x more likely to go wrong because you were at home with an incompetent or no attendant. That’s why I oppose home birth, or, rather, advocating home birth via deceptive means. If a woman wants to give birth at home and does so knowing the risks, that’s her decision. If she agrees to a home birth because someone lied to her and told her that it was perfectly safe, as safe as or safer than a hospital, that’s a completely different thing. Full disclosure and true informed consent are all I ask of home birth advocates.

    • sdsures
      April 14, 2015 at 7:08 am #

      “Midwives have been helping women deliverBabies since our beginnings and are the original birth keepers.”

      That explains their horrifically high infant mortality rate.

    • Stacy48918
      April 8, 2015 at 9:24 am #

      Getting home safely after driving drunk = WIN!

      Doesn’t mean it was a good idea.

      • EllenL
        April 8, 2015 at 9:28 am #

        I totally agree. I could have added “safe setting” to the list. For me, that goes without saying.

        I am happy for this couple. They apparently made a mature decision in moving the birth to a hospital.

        • Stacy48918
          April 8, 2015 at 9:31 am #

          Love that they “turned to the Bible”…too little too late I guess.

          • EllenL
            April 8, 2015 at 9:37 am #

            I really hope that this is a learning experience for Jill and for the whole family. We shall see. It would be easy for them to spin this as “There is no danger in a home birth, because your midwife will send you to the hospital when necessary.”

            If only that were true! We’ve seen too many cases where midwives were unable to recognize trouble in the making, and unwilling to surrender control to the experts who could have saved baby and/or mother.

            The bottom line is that home birth is inherently riskier than hospital birth. And taking any unnecessary risk with your baby is unthinkable to me.

          • Stacy48918
            April 8, 2015 at 9:42 am #

            I think that’s exactly how they will spin it.

          • Karen in SC
            April 8, 2015 at 10:09 am #

            sadly, I agree

          • Mattie
            April 9, 2015 at 6:58 am #

            probably more of a ‘if you happen to be the star of a tv show on TLC and the cameras are there then your midwife will send you to the hospital because otherwise the film could be used as evidence for her malpractice and she can’t just lie her way out of it’

          • Cobalt
            April 9, 2015 at 7:26 am #

            This is, I think, a really big part of it. And it’s a shame that it takes a million people watching to get midwives to do the right thing.

            Medical decisions should be based on medical realities, not concerns about “brand” or what plays well on TV.

          • EllenL
            April 9, 2015 at 9:49 am #

            I wouldn’t be surprised if that had a role in it.

            Sadly, most midwifery disasters take place out of public view – and accountability.

          • Mattie
            April 9, 2015 at 10:08 am #

            true, and it makes tv shows like ‘born in the wild’ or whatever it is even more dangerous, because people watch and things will go fine, and then those who are already leaning that way will think it’s totally risk-free to go and do that, when the cameras and tv show change the situation so much that they might as well be comparing chalk and cheese.

    • toni
      April 12, 2015 at 12:32 pm #

      aw they look thrilled, I’m glad they finally did the sensible thing.
      Also that baby looks enormous! And she’s so slight. :/ I honestly think I would die pushing out a baby that size.

  16. April 8, 2015 at 7:34 am #

    You conflate Home birth as the same as not having the birth attended by a qualified professional. There are CNM (the highest trained ones) that do attend home births. As for the CPMs 3.5 years of being educated to only do normal deliveries is really not that brief. If they spend that long seeing the wide variety of normal then I expect they are very attuned to what is abnormal.

    Likely the person using a CPM has been planning for pregnancy, likely received excellent prenatal care, attended every class and has educated herself to prepare for what is usually a very normal process.

    Why is it that in terms of reproductive rights only those endorsed by the medical association are acceptable and anything else is mocked, marginalized and intolerable?
    How much of medicine is practiced for the benefit of malpractice prevention rather than well-being of the patient. Do we honestly think that a CPM is telling moms that “nothing can and will go wrong” as in every birth complications can occur.
    It is not a fair comparison to make between all the high risk births that OBs attend to the well planned normal births that everyone midwives do.

    In my private medical and psychiatric house calls practice in Manhattan (www.MetroMedicalDirect.com) I have an egalitarian discussion with my patients and their loved ones to help implement a plan of care that is mutually agreeable and we both understand the risks and benefits and perceptions of what is being offered.

    • KarenJJ
      April 8, 2015 at 7:38 am #

      NP?

      • Stacy48918
        April 8, 2015 at 8:14 am #

        Naturopath?

        • KarenJJ
          April 8, 2015 at 8:27 am #

          Ah, OK maybe he edited or maybe disqus is being buggy but there’s a link now to a Nurse Practitioner’s website. So I presume that’s the NP.

          • Sue
            April 10, 2015 at 3:45 am #

            A Nurse Practitioner who calls himself MetroMedical Direct and does housecalls in Manhattan in “primary care, Geriatrics, Mens Health and telemedicine” to “Take the hassle out of seeing a doctor”, and pronounces on how much obstetics exposure is enough. So much wrong with all that.

        • Mattie
          April 9, 2015 at 6:48 am #

          nutty professor =P

          • Daleth
            April 13, 2015 at 12:14 pm #

            I shouldn’t say this, since I’ve seen naturopaths myself, but today I wondered if “ND” stands for “Not a Doctor.”

      • Bombshellrisa
        April 8, 2015 at 5:50 pm #

        http://m.metromedicaldirect.com/OurServices
        A nurse practitioner

    • Somewhereinthemiddle
      April 8, 2015 at 7:59 am #

      Actually, I was told by a CPM that serious complications are be prevented by diet and supplements. And when questioned about what would happen if we needed to transfer that “That won’t happen.”

      • Bugsy
        April 15, 2015 at 12:51 pm #

        Reminds me of the crazy doula we interviewed (and thankfully never hired…).

    • Stacy48918
      April 8, 2015 at 8:16 am #

      Even “best-case” CNM homebirth is twice as likely as comparable risk hospital birth to end in a dead baby.

      “Why is it that in terms of reproductive rights only those endorsed by the medical association are acceptable and anything else is mocked, marginalized and intolerable?”

      Ummmm….because the alternatives swindle people out of their money with grandiose claims for products and services with no verifiable efficacy? Oh yea, and homebirth midwives kill babies. We really have a problem with dead babies here. Why don’t you?

      • Amy
        April 8, 2015 at 7:56 pm #

        Again, replying here becuase Disqus isn’t allowing replies directly to Raymond.

        Further, unlike those who are actually anti-choice and want to criminalize abortion and severely restrict access to reproductive care, the only thing Dr. Amy and most of the posters here want to restrict is the ability of ill-trained birth junkies to present themselves as competent professionals. I challenge you to find a post where Dr. Amy advocated for the prosecution of women who gave birth at home, while the anti-choice folks are happy to pass laws that land women in jail after a miscarriage.

    • DaisyGrrl
      April 8, 2015 at 8:18 am #

      “As for the CPMs 3.5 years of being educated to only do normal deliveries is really not that brief.” And yet every other industrialized nation thinks the CPM credential is inadequate. Maybe there’s something to that.

      • Daleth
        April 8, 2015 at 10:13 am #

        And where does “3.5 years” come in? There is no requirement that you get any length of education to qualify as a CPM, much less 3.5 years.

        • The Bofa on the Sofa
          April 8, 2015 at 12:13 pm #

          It takes 3.5 years as a correspondence course?

          • Heather Rische
            April 8, 2015 at 3:19 pm #

            3.5 of clinical time.

          • The Bofa on the Sofa
            April 8, 2015 at 3:36 pm #

            “Houston, we have a failure to disengage”

          • Stacy48918
            April 8, 2015 at 5:23 pm #

            The flounce is hard to stick.

          • Daleth
            April 9, 2015 at 9:55 am #

            Heather… that is just not true. Here are the California requirements:

            http://www.mbc.ca.gov/Applicants/Midwives/

            They require 3 years of study at a recognized midwifery school. That’s not 3.5 years (though the difference there is minimal), and more importantly it’s not 3 years “of clinical time,” as you claimed.

            But MOST importantly… that is CALIFORNIA’S requirement for licensed midwives. It is NOT a requirement for the CPM “qualification.” The CPM has zero educational requirements, unless you count reading stuff at your house without supervision, and then putting together a “portfolio” about what you read, as an educational requirement. Personally I call that a book report, not an education.

          • Heather Rische
            April 9, 2015 at 12:20 pm #

            Yeah, I’m not in CA, so I only know what I have heard. I only echoed what one of you said above (re: 3.5). I am really shocked that a group of people so set on undermining homebirth and/or the CPM credential (which can be 2 very different things) by using peer reviewed science have actually not done the research on things like our ability to administer meds properly, run an IV, or resuscitate a baby; our required studies and the 8 hour exam we have to pass. Every midwifery school that I know of (or have gone to) *is* a clinical setting. When not in classroom, aspiring midwives are in prenatal and postpartum clinic and in birth , usually for 24 hour shifts. This is what CA requires, as much as I can claim understanding based on a nearby midwifery school in which the women from CA (and other states) stay on for 3 years, in clinic, as well as doing didactic during their extended stay. We also work out of the same texts as CNM’s (for example, Varney’s) and OB’s. If you want more real info, and not just Amy’s made up stuff about CPM’s (whom I will readily admit are not all created equal any more than CNM’s or OB’s) please do the research, folks, lest everything you say be dismissed as trollery. Unfortunately, this is not the forum in which I (or my much smarter peers who haven’t fallen prey)will attempt to educate those actually wanting to know. I absolutely support the positive intention of those of you wanting birth to be safe for mothers and babies. I have seen how the NCB community can be ignorant and shunning to women who do not fit their assumptions about birth. Rest assured I fight against this.

            So that I can reliably say I am not “failing to disengage”, I am cancelling my Disqus account (or notifications from here) today, because i can’t continue to give clicks to this misinformation site.

          • Amy Tuteur, MD
            April 9, 2015 at 12:25 pm #

            We get it; you’re running away because you have demonstrated youself to be a dangerous fool.

          • KarenJJ
            April 9, 2015 at 12:39 pm #

            Why come here to tell us that we are wrong but you’re not going to educate us and tell us why? You seem like a well-intentioned person in this reply and admit to issues with the standards across the board of CPMs but want to say that it’s #notallCPMs. Do you not see a problem with that sort of thinking? Do you not think that CPMs need to meet much stricter standards of practice in order to provide a safe maternity service to women?

          • Medwife
            April 9, 2015 at 2:48 pm #

            It is impossible that you have been a midwife for as long as you say you have and not be aware of the HUGE spectrum of requirements and competences among different educational programs. It’s like medicine in the 1800s. Medicine got it straightened out and now when someone says they are an MD, you can be confident of a basic level of training. Midwifery, as in CPMs, are not there yet. You think all CPMs can start and run an IV, and know how to suture competently, and identify pre-e, and bother to test, REALLY test, for GDM? You are dreaming!

            Edit: I’m in Cali and not everyone practicing here is a licensed LM, not by a long shot. The CPM portfolio process, by the way, is a joke, too. It is SCARY, the shit that goes on.

          • Montserrat Blanco
            April 12, 2015 at 12:42 pm #

            Heather, how many attendants go to a birth with you? Because for me it would be impossible to perform a good (not excellent, just average good) CPR being alone with the patient.

          • Anj Fabian
            April 12, 2015 at 1:14 pm #

            “or resuscitate a baby”

            The one thing I have seen midwives do poorly time and time again is neonatal resuscitation. They usually fall down on the first step – accurate and timely assessment of the apgar scores. Then if the baby needs help, they often (because of poor assessment) intervene incorrectly.

            This happens even when the birth has gone badly and there is every reason to expect the baby will be compromised. This should be a reason for the team to be readying themselves to intervene. (Including calling for an ambulance.)

            If you want to know where I’ve seen this – thank the internet and the growing quantities of videos and still images that document home births.

          • D/
            April 12, 2015 at 9:00 pm #

            I’ve seen more than a few of those on-line home birth “resuscitation” video/ images too … or actually more like non-resuscitations with obviously unresponsive babies being only verbally coached back from the jaws of death. They never fail to make me cringe and wish I could reach through the screen and intervene.

            Just to clarify the Apgar score provides a useful, objective picture of the newborn’s status (and response to resuscitation), but it is actually not used to determine the need for resuscitation, which steps are necessary or when to use them. By the time the first Apgar is assigned at one minute the baby should have received the initial steps in stabilization- provide warmth, clear airway if necessary, dry, stimulate, assessment of respirations and heart rate, and initiation of positive pressure ventilations when needed.

            If PPV is initiated the baby should be immediately put on pulse oximetry and after 30 seconds of PPV the decision of whether to initiate chest compression is being made … This point in resuscitation could be reached within 1-1.5 minutes of delivery in an anticipated and well executed resuscitation.

            For fun I attached the list (from the NRP textbook) of risk factors associated with the increased likelihood of needing neonatal resuscitation. How many of those do you hear about as variations of normal?

          • sdsures
            April 14, 2015 at 7:13 am #

            Remember the Rixa Frieze (sp?) waterbirth video? The baby was blue. IIRC, the baby was eventually revived after a heart-stopping few minutes. I wanted to reach through the screen, too.

            I don’t know what its status is now – does anyone know?

          • D/
            April 14, 2015 at 11:20 pm #

            Yep, definitely one of those chip your nails on the screen reactions for me. Initially only weak, brief respiratory effort (really needed her airway cleared and some stimulation at this point that she didn’t get). Then quickly became cyanotic, apneic, completely limp and unresponsive.

            Really glad Rixa had the wherewithal to finally do mouth to mouth at that point. That baby was going nowhere except down the tubes on her own!

            She’s four now. There was a birthday update a month or two ago on Rixa’s blog.

          • sdsures
            April 16, 2015 at 4:26 pm #

            What if she comes across her own birth on Youtube 20 years from now?

          • MaineJen
            April 14, 2015 at 10:03 am #

            …yeah, you’ve proven me wrong, so I’m going to go on another tangent now. Otherwise known as Reframing the Argument.

        • Heather Rische
          April 8, 2015 at 1:03 pm #

          For several states, including California, 3.5 years is required.

          • Daleth
            April 8, 2015 at 2:14 pm #

            That would be a California requirement for midwives. Not a requirement of the CPM “qualification.” Absolutely no education requirements exist–unless you consider sitting at home reading stuff to be “education”–for CPMs.

      • Paloma
        April 12, 2015 at 2:31 pm #

        I don’t know why it doesn’t let me answer the main thread, so I’ll post here.
        3.5 years is not a long time. To put it into perspective, in my country (Spain) a midwife needs to go through 4 years of college to earn a nursing degree, pass a national exam where 14,000 people try for less than 400 spots of training for midwifery, and then do 2 years of training, in a hospital that has to be credited with a certain amount of births per year to be able to have a midwife resident. That is 6 years of training, all in college or a hospital, where they have to go through evaluations constantly. 3.5 years of self-taught with a portfolio and control by another midwife of similar training, none of it requiring college education, is NOT enough.
        And they don’t spend that much time seeing a “wide variety of normal” unless they spend those 3 years seeing multiple births per day, and that doesn’t happen. Since most births are at the hospital to begin with you are left with 1 each day if you are very lucky. Not that wide variety you would expect to learn to identify and manage complications.

    • KarenJJ
      April 8, 2015 at 8:31 am #

      “If they spend that long seeing the wide variety of normal then I expect they are very attuned to what is abnormal.”

      You expect wrong.

      If you’d read here a few months ago you’d have been able to watch CPMs and other lay midwives (and I think there was an Australian trained midwife in there too from memory?) try their very best to ignore issues that led to a baby’s death. Keep reading. You’re just skimming the tip of the iceberg with this case.

      http://www.skepticalob.com/2014/02/jan-tritten-crowd-sources-a-life-or-death-decision-and-the-baby-ends-up-dead.html

    • Siri
      April 8, 2015 at 8:48 am #

      Why do you feel that malpractice prevention and patient wellbeing are mutually exclusive?

      • NoLongerCrunching
        April 8, 2015 at 12:46 pm #

        Sorry to reply to this instead of the OP, but for some reason Disqus isn’t letting me. Anyway, Raymond, as a nurse practitioner, how would you feel if a lay person did a correspondence course in your field, apprenticed with another person who had been through the same program, took an exam after seeing maybe 50 patients, then opened their own office? What’s more, they cast aspersions on you as overly medicalized and advertise to your patients that they can provide more evidence-based care?

        • Amy
          April 8, 2015 at 7:52 pm #

          Same– I don’t understand why Raymond’s post alone doesn’t allow replies. But I’m trying to think of another profession (profession– not just “job”) where we consider 3.5 years adequate training. An undergraduate degree is the equivalent of 4 years of full-time study. An MD is another four years on top of that; an MSN or CNM is another two years on top of that. Lawyers and teachers need that four-year degree plus an additional 2-3 years of training, and they’re (I guess we’re– I’m a teacher) not expected to deal with emergency situations.

          • Mattie
            April 9, 2015 at 6:07 am #

            I mean, an undergrad degree is 4 years in the US, it’s 3 in the UK. So UK nurses and midwives (and many other professions) have 3 years of training, but then UK midwives are way better trained than CPMs so that doesn’t really relate, something isn’t going right. CPMs could be sufficiently qualified to practice as a UK midwife in 3 years, they are clearly not.

          • Wren
            April 9, 2015 at 6:35 am #

            An undergrad degree is shorter in the UK because it lacks the general ed requirements. A UK undergrad usually has more work in the degree field (major for the US) than a US undergrad degree.

            I have a US undergrad degree in biological sciences with a minor in chemistry, but spent 1 1/2 years of that studying in the UK. When I came to the UK in my junior year, I did not have the prerequisites for most of the third year classes, and not all of the 2nd year ones. I did take a few third year classes the second time I studied in the UK (2nd half of my senior year), but by then I could have graduated from my US university had I not wanted the extra semester abroad.

          • Mattie
            April 9, 2015 at 6:42 am #

            Yeh that makes sense, I also think grad school is a lot more common (a lot more professions require it) in the US, and potentially general 12th grade high school education requirements in the US (non-AP programs) are at a slightly lower level than UK year 13. But I think it all balances out in the end haha

          • Wren
            April 9, 2015 at 7:17 am #

            From my experience, and comparing my high school to that of friends and family in the UK, the U.S. has a much broader high school education while the UK generally focuses on 3 subjects for A-levels, the last 2 years before university, and those are optional years. Leaving at 16 is perfectly acceptable (though does rule out jobs requiring higher education). That narrower focus continues into undergrad degrees, and due to that a masters is often shorter here. I know my husband took 4 years to get a combined degree equivalent to a BS and MS in physics. Back then UK students paid no tuition fees for undergrad and received a grant for living expenses, so it was entirely worthwhile to do the combined program. Unfortunately, those days are long gone and my kids won’t get that free education. Boo.

            Unlike the US, law school and med school do not require an undergrad degree. I think it’s 5 years for medicine, as opposed to 8 (4 and 4) in the US. New doctors really are young here.

          • Mattie
            April 9, 2015 at 8:13 am #

            I can’t remember exactly how many years ago it was but children are required to remain in some form of education until 18 now, this can be A-Levels, IB, a vocational college course or an apprenticeship. I think the options allow for those who are less academic to achieve in other ways, and hopefully find careers that are meaningful to them as well as provide an income one can live on.

            Tuition fees at most universities are £9000 per year, with loans from the government for UK and EU students, international fees are higher and set by the university I think. Loans and grants are available for living costs, and students can also work during term time if they wish. UK student loans are different from US loans I think in that the repayments are tied to your income (you don’t pay until your earnings reach £25k per year and stop if they fall below that) and repayments rise when you earn more money etc… Also the loans do not effect credit rating, and are written off after 30 years (or if you die) so are not passed on to children/other family.

            Yes, med school and law school (and also some teacher education, nursing school, midwifery school, paramedic training, ODP training and many other health professions) are undergrad programs, varying in length from 2-5 years+. Doctors really are young here 🙂 but also we have more mature students I think so that kind of balances the ages.

          • Dr Kitty
            April 10, 2015 at 5:54 am #

            Yep! 5years for medicine, but A-level chemistry, biology and physics are common entry requirements, so they can basically jump straight into biochem, physiology and anatomy in the first year.

            I had a six year medical degree- first year was basic maths, physics, biology and chemistry to ensure that the Irish students were all up to speed, because some would only have taken two sciences at Leaving Cert, and Leaving Cert is less than A-Level.

            Second and third year were biochem, anatomy, physiology, fourth was pathology, pharmacology, microbiology and clinical placements in medicine, surgery and GP. Fifth year was more pharm and path and micro and placements in ObGyn, paeds and psych and sixth year was finishing up all the theoretical stuff, clinical placements in ENT and Opthalmology and things like cardiology, neurology and endocrinology, with some leeway to arrange placements to suit your own learning needs/ future career plans.

            UK medical schools can get away with squeezing things down into five years because the basic science grounding is stronger to start with, and there aren’t required humanities or arts courses apart from some mandatory comminication skills and ethics courses. Also it takes at least 5 years after graduation to be a GP and 8-10 to be a fully qualified consultant specialist.
            Which is longer than the USA.

          • Amy
            April 9, 2015 at 11:23 am #

            Well, yes, it is only three in the UK; however, from what I understand having gone to university in Canada, GCSEs and A-levels before that were about the academic equivalent of the first year of university in the US. When you add to that that the CPM credential barely requires a high school diploma, it makes it even worse.

          • Mattie
            April 9, 2015 at 2:22 pm #

            yeh definitely not enough, also midwifery (and nurse) training in the UK is so so hard, lots of people who start do not finish (including me).

      • Daleth
        April 8, 2015 at 2:36 pm #

        “Medical malpractice” means doctors, nurses etc. making mistakes that hurt or kill their patients. So, “malpractice prevention” means “preventing doctors, nurses, etc. from making mistakes that hurt or kill their patients.”

        Why would anyone think that was somehow inconsistent with patient well-being?

        • Stacy48918
          April 8, 2015 at 2:41 pm #

          Unfortunately, a large number of “malpractice” suits are just bad outcomes, complications, etc…not necessarily mistakes.

          • Daleth
            April 8, 2015 at 2:45 pm #

            I’m a lawyer, but I was trying to speak in plain English, using the word “mistake” to stand in for “something a reasonable doctor/nurse/etc. would not have done in such circumstances.”

            But even setting aside the technical legal definition of medical malpractice, you mention “bad outcomes, complications etc.” Isn’t preventing bad outcomes and complications, whenever it’s possible to prevent them, totally consistent with patient well-being? In other words I’m still not seeing why or how “malpractice prevention” is inconsistent with patient well-being.

          • The Computer Ate My Nym
            April 8, 2015 at 4:08 pm #

            Do you do malpractice law? Can I ask you your impression about the frequency of justified versus unjustified lawsuits? I don’t like malpractice lawsuits as a way of preventing malpractice because there seem to me too many opportunities for both unjustified lawsuits (an unavoidable bad outcome or a case where there was a risk no matter what course was taken and things happened to go wrong) and suits not occuring that should have because medicine is so esoteric that it’s hard for patients to know whether the right thing was done or not. That being said, it’s sure a lot better to have people sue than to have them have no option to sue as the CPMs who don’t have malpractice insurance and therefore shrug off lawsuits clearly show.

          • The Bofa on the Sofa
            April 9, 2015 at 8:44 am #

            Can I ask you your impression about the frequency of justified versus unjustified lawsuits?

            While there are some clearly frivolous lawsuits that can be thrown out immediately, isn’t the question of “justified” vs “unjustified” really a question for the jury?

            It’s easy to say that all the lawsuits that didn’t win were “unjustified” but then again, shouldn’t they also have their day in court to make their argument that they were justified? If you knew ahead of time which lawsuits would win and which would not we would not need a jury system.

          • Daleth
            April 9, 2015 at 9:47 am #

            You pretty much nailed it, Bofa. Also, FYI it is against the ethical rules lawyers are required to follow for a lawyer to bring a suit that they know is frivolous.

          • sdsures
            April 14, 2015 at 7:10 am #

            Could te TFB fiasco be an example of that?

          • Daleth
            April 14, 2015 at 8:55 am #

            What’s the TFB fiasco?

          • sdsures
            April 16, 2015 at 4:31 pm #

            The case is summed up here: http://getoffmyinternets.net/blogger-flamewar-escalates-into-legal-battle/

          • The Computer Ate My Nym
            April 9, 2015 at 10:42 am #

            The problem, from my point of view, is that it’s hard for a patient to know what is malpractice and what is simply a bad outcome or a bad decision. For example, patient has a blood clot and gets started on anticoagulation. They slip on the ice and have a head bleed. That is not, IMHO, malpractice but just bad luck*, but it is a bad outcome and there’s a reasonable chance that it wouldn’t have happened if the patient hadn’t been on anticoagulation. So it might look like malpractice to the patient and the lawyer–after all, they bled or bled worse because of the anticoagulant. That could result in a lawsuit just because how is anyone not trained in medicine supposed to know whether it was malpractice or not? Juries have the same problem. How are they supposed to know what is or is not accepted standard of care? There is so much expert knowledge needed that I don’t see how a nonspecialist can evaluate whether a malpractice suit is justified or not.

            *There is an increased risk of bleeding when you take an anticoagulant. We don’t have the drug that prevents clots but doesn’t cause bleeding. Sorry.

          • The Bofa on the Sofa
            April 9, 2015 at 2:04 pm #

            How are they supposed to know what is or is not accepted standard of care?

            They ask doctors, of course. Well, the lawyers ask doctors, and the doctors testify.

          • Daleth
            April 10, 2015 at 10:07 am #

            **” That could result in a lawsuit just because how is anyone not trained in medicine supposed to know whether it was malpractice or not? Juries have the same problem. How are they supposed to know what is or is not accepted standard of care?”**

            A malpractice lawyer is supposed to be able to evaluate, either from experience or with the assistance of an expert, whether it’s malpractice (i.e., whether it falls below the standard of care). Malpractice lawyers are the first gatekeepers against frivolous suits–which sounds like a conflict of interest, but isn’t, because malpractice lawyers most often work on contingency, so they make no money unless they win.

            And the jury is supposed to figure it out by listening to the experts. That’s why you have to have expert witnesses in a malpractice case–you need doctors to explain to the jury what the standard of care is.

          • Roadstergal
            April 14, 2015 at 6:47 pm #

            I go back and forth on these things. There are some high-profile cases where juries decided cases against the science – eg, silicone breast implants.

          • sdsures
            April 14, 2015 at 7:08 am #

            Agreed.

  17. Lea
    April 8, 2015 at 6:53 am #

    I am happy to see she was open to advice and went to the hospital where she could be safely delivered of this very big boy. Looks like it was a possible cesarean delivery as well but all that matters is that everyone is fine. As for Jill, if she wants to take midwifery seriously and train to be a proper one it is good she had a delivery like this to show her that things sometimes don’t follow a birth plan.

  18. KarenJJ
    April 8, 2015 at 3:46 am #

    A few things to consider for posters below:

    1. If you believe that women are intelligent and autonomous human beings, you will need to accept that other women will choose differently from you. They might discuss c-section risks or epidurals with their doctors and midwives and decide that a c-section/epidural is the best decision for them.

    2. Not all women believe that their bodies were designed with a certain purpose in mind. Many women have bodies with their own quirks. Telling my body that it is getting life wrong doesn’t make it more able-bodied and is a form of “magical thinking”.

    3. What you believe to be “well researched” and “educated” is mostly made up crap read on the internet. Just because someone says they are a “Doctor” and shows a massive list of impressive sounding “references” doesn’t mean that they get a free pass. You need to examine EVERYTHING that you read on the internet with the idea that maybe the person saying it is full of crap and/or a 16yo kid with no idea what they’re talking about. This includes this website. Take what you read with a grain of salt and discuss with your doctor/s or read the source material (eg journals, studies, CDC info).

    4. It’s OK to change your mind. Have a read around here and elsewhere and see what different people say about things. We’re generally a reasonable bunch on here. Hardly “minions” (unfortunately). If you find Dr Amy’s tone a bit too much there are also some great blogs on the blog roll.

    5. CPMs cannot practice anywhere else in the developed world precisely because they lack skills, training and experience. Homebirth is not hugely common in other countries and in many is actually declining. Sure they are lovely people, but are you falling for charisma – an illusion and good advertising? Don’t confuse image with substance.

    • Who?
      April 8, 2015 at 3:54 am #

      Well put, thanks.

      Not that it’s likely to slow anyone down though.

      Can we add a

      4. In the end what matters is healthy mum and healthy baby. Neither of you are defined by how that is achieved. Life is long, parenting can be challenging work, and how a pregnancy ends doesn’t make you a better or more loving parent.

      • KarenJJ
        April 8, 2015 at 4:20 am #

        “Not that it’s likely to slow anyone down though.”

        I wish it would. Some outrageous things have been said below. I was hoping a more generalised post at the top might give the more reasonable posters pause for thought before they posted.

        • Who?
          April 8, 2015 at 4:38 am #

          Agree completely.

          I didn’t mean to suggest the list isn’t valuable, or important, or useful. Some posters feel like a vacuum into which good intentions and knowledge and facts get sucked, then spat out twisted and broken.

          • KarenJJ
            April 8, 2015 at 5:36 am #

            I was worried it would sound condescending putting that list up, but I really felt like I was following a “stream of conscious” defensiveness rather than a disagreement of fundamentals.

          • Who?
            April 8, 2015 at 6:06 am #

            That’s true. It’s a good list, and a great point for starting a conversation.

            One of the challenges is receptivity to disagreement. People and I disagree all day long. I’m used to it, don’t find it challenging. Sometimes I get what I want, sometimes others do, more often we find a way to compromise and get the job done. Some compromises are strategic, some are actual changes of view by me or others. And no one dies, and the work of the world inches forward.

            If you’re not used to it though, it must be hard. And if you’ve built a whole value system around a particular thing, hearing it robustly attacked would be really difficult.

            The fence sitters are the target, and a list of talking points as you suggest would surely help to reach them.

    • Heather Rische
      April 8, 2015 at 1:32 pm #

      It’s interesting that Medecins Sans Frontieres (Doctors without Borders) do wholeheartedly accept CPM credentials; in response to your “nowhere else in the developed world” comment. I understand the MSF operates in the 3rd world, primarily, however, this doctor-run organization respects the credential. Perhaps the reason that CPM isn’t accepted worldwide is that there are already established credentials in those developed countries. Likewise, a British CM can’t practice in the US, in most cases. Even doctors trained in other countries have a hard time getting licensed to practice here.

      • Medwife
        April 8, 2015 at 2:15 pm #

        I am hoping that there is a misunderstanding and that it’s not true that MSF accepts CPMs. If they do I am deeply disappointed and as a regular donor I’m writing a letter, for what that’s worth.

        And yeah. Third-world. Desperate poor people who take what they can get.

        • attitude devant
          April 8, 2015 at 2:19 pm #

          Does the phrase ‘warm body’ mean anything to you? Even Ensign Pulver was allowed to do an appendectomy.

          • Daleth
            April 8, 2015 at 2:57 pm #

            Exactly. In the middle of a war zone or the Ebola quarantine zone, a CPM is better than nobody. At least she won’t freak out when someone goes into labor; at least she’ll probably know how to cut the cord properly; at least she’ll know to use soap and water; at least she’s not pregnant and/or starving and/or frantically searching for her missing family and/or horribly ill herself.

            But we’re talking third-world war zone/epidemic conditions. Is that really the standard we want to use for our own births, here in the US?

          • Medwife
            April 8, 2015 at 3:23 pm #

            Hell no she wouldn’t be! In an Ebola zone? They’re not used to PPE and any real, full scale sterile technique. They rarely give IM injections. They’d get themselves infected and/or infect somebody else on their first day.

          • EmbraceYourInnerCrone
            April 8, 2015 at 4:59 pm #

            NO thank you. I understand what you are trying to say but we do not need to be exporting our poorly trained birth junkies and letting them inflict themselves on resource poor countries. Just no. These people (CPMs) often miss signs of PPH, retained placenta, GD,etc. People deserve real Health Care professionals. I would prefer donating to legitimate agencies that work on training local people in science based midwifery techniques rather than encouraging the “mostly untrained volunteer wants to swoop in and rescue the poor third world unfortunate” model

          • EmbraceYourInnerCrone
            April 8, 2015 at 5:11 pm #

            This is the sort of train local people as birth attendants program I mean:
            http://www.globalgiving.org/projects/training-women-to-become-birth-attendants/

            from the website:

            “Trained birth attendants will provide health education in isolated villages(family planning, breastfeeding, nutrition, maternal and infant care). Mothers and children receive adequate care with recognition and referral of early signs of complications”

          • Bombshellrisa
            April 8, 2015 at 5:22 pm #

            http://www.doctorswithoutborders.org/work-us/work-field/who-we-need/nurse-midwives-certified-midwives
            There is no mention of CPMs.
            http://prontointernational.org/about-us/mission-vision-and-values/
            My favorite organization, they do emergency simulations and teach in low resource areas. No woo, but they really try to help improve outcomes

          • SuperGDZ
            April 16, 2015 at 5:43 am #

            Yup, those dumb Africans haven’t even figured out how to use soap and water yet

          • Daleth
            April 16, 2015 at 8:53 am #

            I’m not sure what you’re trying to say. “War zones” are hardly exclusive to Africa, and the problems I envisioned existing inside the Ebola quarantine zone were not because it happened to be in Africa, but because it was the Ebola quarantine zone.

          • SuperGDZ
            April 20, 2015 at 8:28 am #

            Do people in war zones forget how to use soap and water?

          • Daleth
            April 20, 2015 at 11:04 am #

            Did I mention soap and water somewhere? I believe you may be arguing with yourself.

          • SuperGDZ
            April 21, 2015 at 4:35 am #

            “In the middle of a war zone or the Ebola quarantine zone, a CPM is better than nobody…at least she’ll know to use soap and water”

        • Daleth
          April 8, 2015 at 2:27 pm #

          My google search brought up a bunch of midwives on LinkedIn who have Medecins Sans Frontieres on their resume. With only one exception, the CPMs were either:

          (1) not working as midwives (two of them worked for MSF as “Sexual Violence Program” coordinators or consultants), or

          (2) were actual midwives from foreign countries (i.e., with midwifery degrees from universities, and in most cases experience in hospitals in those countries), who now live in the US and apparently decided to become CPMs on top of their real qualification.

          The only *possible* exception on the entire list is a woman in Portland who, though clearly pretty woo-intensive, did at least spend 4 years at a “college of midwifery” in Oregon. And even she lists herself as both a midwife and a “Sexual Violence Program Consultant,” so it’s not entirely clear to me what she does at MSF.

          Here’s a link:
          https://www.linkedin.com/title/midwife-at-m%C3%A9decins-sans-fronti%C3%A8res-(msf)

          • Medwife
            April 8, 2015 at 2:42 pm #

            What use could they be as midwives? I have a CNM friend who worked with them in Sudan. She first assisted a lot for c/s. Her patients were often very complicated. How could a CPM have any experience whatsoever with sick women, since they only attend low- risk home births with appropriate backup quickly available?

            That last sentence gets a /s

        • Heather Rische
          April 8, 2015 at 2:36 pm #

          Nope, true story. I have several friends who are CPM/MSF. Only one of them is also a nurse. One has been featured heavily in their blog posts regarding Ebola and pregnancy.

        • Bombshellrisa
          April 8, 2015 at 3:14 pm #

          Amos Grunebaum stated that only CM/CNMs are being recruited, not CPMs. There was a notice for recruiting on Facebook and he commented on it https://m.facebook.com/MidwiferyToday/posts/10152328336530266
          “Amos Grunebaum
          Hi. Just to clarify the requirements. Only CNM or CM can apply and not CPMs or others. So 2/3 homebirth midwives cannot even apply to work for DWB. That should give a clear indication whom DWB considers a real midwife.”

      • KarenJJ
        April 9, 2015 at 4:28 am #

        “wholeheartedly accept CPM credentials”
        They do? Can you provide info on how MSF wholeheartedly accept the CPM credential? There are midwives that work in other countries (eg Carol Perks, an Australian midwife that worked for Save the Children in Laos) and had great results, but I’ve not heard of a CPM being able to set up the health infrastructure that she set up and be able to show the evidence of improvement on key statistics that a midwife like Carol was able the achieve.

      • Amy
        April 11, 2015 at 12:49 pm #

        I suppose you weren’t expecting people not to just accept everything you put forward without question?

  19. Pdoh
    April 8, 2015 at 2:55 am #

    Bottom line. It’s no ones business but theirs!!!!!

    • Cobalt
      April 8, 2015 at 2:59 am #

      Unless they are selling it to the public.

    • Stacy48918
      April 8, 2015 at 8:17 am #

      What exactly is the baby’s business?

      Seems he had difficulty getting from the inside to the outside, why didn’t he get a say before the birth?

  20. Wombat
    April 8, 2015 at 1:44 am #

    These comments are funny as sin. Glad the baby is healthy. Fortunate he’s a boy so he probably won’t have to be (as much of) an indentured servant either!

    • Stacy48918
      April 8, 2015 at 8:18 am #

      No, he’ll just be the one perpetuating the verbal, emotional, reproductive and spiritual abuse.

      • Mishimoo
        April 8, 2015 at 8:58 am #

        There is hope – my brother has turned into a wonderful person who does his best to be fair and kind despite being raised in that lifestyle.

      • Wombat
        April 11, 2015 at 4:53 pm #

        Unfortunately, probably. But I’d say the boys have a slightly better chance to eacape just because them having their own control of their future is slightly more accepted, and they are less guilted, trapped, and indoctrinated by essentially becoming mothers at 9, 10, 11, 12 (if they even wait that long).

        I wish all children of these movements their chance to -truly- make their own choice, free of indoctrination and the threat of shunning, but I also know that is extremely unlikely to happen, so I take the small victories where I can.

  21. moms2cool
    April 8, 2015 at 12:45 am #

    Wow this a really biased article. As a registered nurse, a four year bachelors degree program , I have been a nurse for 33 years. I have actually recently looked into the different ways to become a nurse midwife and you are correct there are two routes. However every state has different qualification requirements. England has just announced after a huge study that low risk births are safer at home. I totally understand that study. Unfortunately too many babies are born by c-section in the USA in the hospital. Many women that could give birth successfully vaginally are rushed to sections or frankly there is the whole growing host of women who schedule sections so it is convenient for them. That is just irresponsible. Now before all of you start yelling at me, I was a section baby as were all my siblings because we were all frank breach. Guess what all of my babies were section babies because all were frank breach. As a NICU nurse I saw the horrors of women who had unqualified obstetricians who did a vaginally delivery with breach babies. Cerebral Palsy , broncho pulmonary dysplasia due to meconium aspiration because baby was too stressed during labor and no one recognized it and because mom wanted vaginal birth they got it. With a severely sick and eventually disabled child. The best birth for a baby is when the baby is HEALTHY. That is the bottom line. My hubby is a board certified family physician who used to deliver babies all the time however stopped due to high malpractice rates. The realization is pretty soon there will not be enough Ob’s to deliver babies in the US. So nurse midwives are a great thing. I just experienced 9 months of prenatal care and delivery with my daughters best friend and attended her birth. The nurse midwives were totally professional and were as good as any OB I knew. They also knew their limitations and had a hospital plan in place. Like I said the best delivery is where the baby is healthy.

    • Nick Sanders
      April 8, 2015 at 12:47 am #

      Safer or less expensive? Last I heard, it was a cost cutting measure.

      • Cobalt
        April 8, 2015 at 12:59 am #

        Yup. Cheaper for the government (short term, at least), and more money for midwives, who lobbied hard for years for the declared conclusions (psst…the headlines don’t clearly reflect the data).

        • Bombshellrisa
          April 8, 2015 at 1:04 am #

          Not that UK midwives should be held as great models to follow right now. Between the comments the student midwives make about withholding pain medicine and how the midwives have conducted themselves lately on Twitter and, as you mentioned, the latest headlines regarding midwifery care.

          • Cobalt
            April 8, 2015 at 1:11 am #

            They have a horrible track record even in hospital…what good is the technology if you don’t use it? It’s like giving birth in the hospital parking lot.

          • Bombshellrisa
            April 8, 2015 at 2:14 am #

            OMG don’t get me started. A friend’s mother told me that the midwives left her room while she was in labor, telling her “we are going to go and have our tea, when we get done it will be just about time for that baby to be born”. And that isn’t even anything compared to what has been published lately

    • Jennifer
      April 8, 2015 at 12:48 am #

      SO GLAD you referenced the study from England! I was wondering if anyone here knew it even existed.

      • Cobalt
        April 8, 2015 at 12:54 am #

        The Birthplace study? We went over that several times here. Do me a favor and put up a graph of the death rates in the various groups.

        • Dr Kitty
          April 8, 2015 at 3:44 am #

          Like this one?

          Table 4 Outcomes for the baby for each planned place of birth: low‑risk nulliparous women (source: Birthplace 2011 )

          Number of babies per 1000 births

          Babies without serious medical problems

          Home 991

          Freestanding midwifery unit 995

          Alongside midwifery unit 995

          Obstetric unit 995

          Babies with serious medical problems*

          Home 9

          Freestanding midwifery unit 5

          Alongside midwifery unit 5

          Obstetric unit 5

          * Serious medical problems were combined in the study: neonatal encephalopathy and meconium aspiration syndrome were the most common adverse events, together accounting for 75% of the total. Stillbirths after the start of care in labour and death of the baby in the first week of life accounted for 13% of the events. Fractured humerus and clavicle were uncommon outcomes – less than 4% of adverse events.

          Like this table from the December 2014 NICE Intrapartum Guidance, which shows that planned Homebirth in low risk nulliparous women, even with a high transfer rate (450/1000!), almost doubles the risk of a serious adverse outcome for the baby, from 5/1000 to 9/1000, or from 1 in 200 to almost 1 in 100.

          Source: http://www.nice.org.uk/guidance/cg190/chapter/1-recommendations#general-principles-for-transfer-of-care

          So, for low risk nulliparous women (like Jill Dillard) giving birth at home home, with two graduate level NHS midwives who carry drugs and oxygen is twice as dangerous for the baby as hospital, even using the Birthplace study.

          Considering that a CPM in the USA usually has less equipment and less training, often attends labours alone, with longer distances to get to hospitals than the UK and without the seamless transfers and direct admissions to L&D possible in the NHS, it is unsurprising that Homebirth in the USA is even less safe.
          Source: http://weill.cornell.edu/news/pr/2013/09/birth-setting-study-signals-significant-risks-in-planned-home-birth.html

          But hey! Let’s not let pesky facts get in the way of the nice fluffy idea that Homebirth is as safe as hospital!

          • Roadstergal
            April 9, 2015 at 2:50 pm #

            Wow, almost half of all low-risk nulliparous women transfer? I know that stat isn’t getting a lot of play on the ground…

            Telling that none of the parachuters touting the Birthplace Study has replied. It’s one thing to read the abstract, another to actually look at the data.

            It looks like risk of C-section and blood transfusion is higher at HB than at an MLU…? I wonder about that, as my NCB friend inquired about an MLU (which surprised me, given how much she hates health care professionals, but she does love her the midwives) but noted that if she were risked out of an MLU and referred to an OB unit, she’d just give birth at home instead.

          • Medwife
            April 11, 2015 at 1:36 pm #

            If she was RISKED OUT she’d “just give birth at home”? D:

          • Roadstergal
            April 13, 2015 at 1:23 pm #

            I’ve been trying to parse out the reasoning, and it’s been a lot of difficult and painful conversations, and I’ve actually had to move away from being as close a friend because it was all getting too much. : But from what I could find out – the Birthplace study was, among a lot of folk on the ground, taken as read as a blanket statement of fact that ‘home is always safer than hospitals,’ and they hang hard onto that as a truism.

            There’s also a big dose of distrust of hospitals and doctors (not helped by GPs that were hesitant to provide drugs for HG), and having had an emergency C-section after a failed version that she found a traumatic experience, and a friend who had a midwife-supported HBAC that apparently went well.

            I gave up, I really did, and I feel that every day. I know that even with an HBAC, there’s still better odds than not that everything will be OK, so I can at least feel moderately OK that it won’t be a disaster.

            It’s like knowing your friend is going drunk driving with her kid. I know she’ll probably be okay, but… I feel strange and sad and off about the whole thing.

          • Sarah
            April 17, 2015 at 4:26 pm #

            Fascinating. Thanks for copying the relevant extract.

      • Dr Kitty
        April 8, 2015 at 5:12 am #

        Jennifer, I find it interesting you assume that we don’t read the research.

        I wonder if you had any comments on any of these papers?
        I assume you’ve read them already, but I’ll link, just in case you need to remind yourself of the conclusions.

        Grunebaum et al 2014
        http://www.ajog.org/article/S0002-9378%2814%2900275-0/abstract

        Grunebaum et al 2013
        http://www.ajog.org/article/S0002-9378%2813%2900641-8/abstract

        Wax et al 2010
        http://www.ncbi.nlm.nih.gov/pubmed/20598284

        Evers et al 2010
        http://www.bmj.com/content/341/bmj.c5639

        Kennare et al 2010
        http://www.ncbi.nlm.nih.gov/pubmed/20078406

    • Cobalt
      April 8, 2015 at 12:48 am #

      It is very biased against CPMs, and the more you know about CPMs the more you understand the bias.

    • KarenJJ
      April 8, 2015 at 1:16 am #

      “The best birth for a baby is when the baby is HEALTHY. That is the bottom line.”

      Nobody is going to disagree with that here. Have a read around the archives for some interesting discussions and articles. Sounds like you’d be more in agreement with everyone here. There’s some horrifying stories of midwifery incompetence and bullying catalogued here that get deleted on other websites in order to preserve the illusion that untrained lay people that don’t even have nursing training are also as good as obs.

    • jricord
      April 8, 2015 at 3:18 am #

      Thank you for your educated input moms2cool!! I am a mommy who has given birth 5 times. 3 at a hospital under care of different OB’s and hospital staff, and 2 at home under the qualified care of a CPM. So while I have no medical background, merely personal experience, any day of the week I choose birth at home with a CPM!! My only complicated deliveries occurred in hospital due to uneccesary interventions which just snow balled. Think of the outrageous c section rates in many hospitals)…MANY MANY low risk women are MUCH better off at home allowing their bodies to do what a woman’s body is created to do in a safe, loving environment in which they are relaxed and at ease (as moms give birth most effectively under these circumstances). Not lying flat on a bed in a L & d room full of medical technology so many doctors and nurses seem so overly eager to use at times. More and more moms are turning to home birth NOT as a last resort, but a first option. The majority of these moms are well educated and informed on their decision. Wish I chose home birth with a skilled and experienced CPM from the first!!

      • KarenJJ
        April 8, 2015 at 3:24 am #

        I like how your idea of a “skilled and experienced” midwife would be ineligible to be a midwife in my country due to the lack of skills and experience.

      • Cobalt
        April 8, 2015 at 3:25 am #

        Then why is the death rate at homebirth 450% higher than hospital birth, according to MANA?

      • Nick Sanders
        April 8, 2015 at 4:13 am #

        What makes the c-section rates outrageous?

      • Julie
        April 8, 2015 at 9:49 am #

        I would have considered a home birth for my 3rd, but I was considered high risk. All 3 were hospital births, my first two I had IV pain meds, last one zero pain meds. Guess what? My last one was the easiest! I went in hell bent on no pain meds (because it was my last). I notice hospitals want epidurals because it makes their jobs easier (i.e. they can take their time once the woman is at 10 cm). I went from 8-10 in about 3 min so there was no time for the Dr to wait (once I felt the urge, I was pushing). I lucked out and had a wonderful nurse who allowed me to make the decision to not get an epidural when I was about to give in. My husband was very supportive of my decision. I educated myself a ton on how to get the birth you want. Plus sometimes interventions (epidurals, pitocin, etc) cause the need for c-sections. I wish I would have done all 3 pain med free. My 2nd was a nightmare. The hospital staff was horrible. I was fully dilated and the Dr wasn’t there. They made me breathe thru my pushes for about 30 min while I’m screaming in pain. Finally I gave up and the intern delivered my son, because I couldn’t keep him in any longer…one of us could have been injured). I’m glad I didn’t wait, the Dr showed up 20 min after my son was born! He was 5 weeks early and got sent to the NICU. I think laboring on your own is the best for sure, with as little interventions as possible. It’s best for baby and your body knows what to do!

        • moto_librarian
          April 8, 2015 at 9:57 am #

          I feel so sorry for women like you who can’t get it right the first time. I had my first child totally naturally. It really is too bad that you weren’t prepared enough to not cave in and have medication with your first two. I guess you only warrant a bronze medal.

          /sarcasm

          • Julie
            April 8, 2015 at 2:05 pm #

            I’m hoping that’s sarcasm. I had for first one at 18 and didn’t have very much support and didn’t educate myself enough, but I went almost all of labor before asking for anything

          • Daleth
            April 8, 2015 at 2:08 pm #

            It is sarcasm–that’s why it says “/sarcasm” at the end. The slash means “end of” (as in “end of sarcasm,” since its the end of the post).

          • Busbus
            April 8, 2015 at 3:52 pm #

            Julie, it’s great that you feel good about your last birth; apparently a lot of things turned out the way you wanted them and that’s wonderful!

            However, I still feel that the insistence on doing it natural being somehow “better” that you encounter in lots of natural birth circles, and even in mainstream culture, is quite problematic. Women in labor are the only ones who are frequently told by others that they ought to tolerate major, often excruciating, pain despite having the ability to relieve it, and that if they do happen to choose to relieve that pain, they have “given in” or “failed.” This attitude is both inhumane and misogynous. No one would talk like that to people about to undergo root canal surgery. Let’s cut it out of our discourse about birth, and let’s cut it out when it comes to our self-talk” and our own feelings about birth. There is no right or wrong way to give birth, and there is absolutely no reason that having chosen an epidural or any other medical procedure (that we are lucky to have access to) should make us even one iota less proud about the momentous day we gave birth to our much-loved child.

          • Julie
            April 8, 2015 at 4:27 pm #

            I guess I want to say that it was empowering for me to have the birth experience I wanted. After 9 weeks of bed rest it was a way for me to relinquish control of my pregnancy again! Women have been having babies alone, in the fields, etc with no pain management so I knew it could be done. Main thing is healthy mommy, healthy baby! They sure are worth any amount of pain

          • The Bofa on the Sofa
            April 9, 2015 at 9:21 am #

            Women have been having babies alone, in the fields, etc with no pain management so I knew it could be done.

            So wait – if it’s so common and women can have babies in the field alone without pain relief etc, why are you proud that you can do it?

            Or is it more that you feel that if you didn’t, you would have been a failure? You would have thought, “There are women who have babies in the fields working alone without pain medication and I can’t! I can’t even be as good as them!”

            Of course, keep in mind that the reason that women in the fields gave birth without pain medication is that THEY DIDN’T HAVE ANY CHOICE!!!!! You think natural childbirth was empowering for them? God no. They had no control at all. Do you think that maybe if they had an alternative, they would have opted out?

            You had options. So how is not choosing to have an epidural less empowering than choosing to have an epidural? I would think that “I had an option to get an epidural and damn it, I made the decision to do it” would be just as empowering as saying no. Empowerment is manifested in the ability to have control and make decisions, not in the decisions that are made.

            However, in the end, whether it CAN be done or not, or even whether you wanted to or not is not the point of my question.

            I am trying to figure out why, if the pain had gotten so bad that you had chosen to go with pain relief and an epidural, why you would have been “furious” with yourself? You wanted to do it without, fine. However, if you had given in (considering the pain was unbearable, you have said), what would have been wrong with that that you would have been mad at yourself?

            You didn’t cause the pain. You would have just found it unbearable and chosen to get rid of it. That’s not a failure, that’s taking advantages of your options.

          • Daleth
            April 9, 2015 at 9:58 am #

            Relinquish?

            You might want to look up the word “relinquish.”

          • momofone
            April 10, 2015 at 11:18 am #

            The only “birth experience” I wanted was one that ended with both of us healthy. How that happened was way down the list. No extra credit for unnecessary pain.

        • The Bofa on the Sofa
          April 8, 2015 at 10:10 am #

          I lucked out and had a wonderful nurse who allowed me to make the decision to not get an epidural when I was about to give in.

          I fail to see how that was lucky.

          Actually, I don’t even understand the point. How can you be allowed to make the decision to get an epidural? Epidurals aren’t given unless you make the decision to do it. If you don’t ask for an epidural, you don’t get one. And if you do ask for an epidural, it’s because you want one, so you should get it.

          You were about to ask for an epidural. Why? Because the pain was getting to be too much for you? Why else would you “give in”?

          • Julie
            April 8, 2015 at 2:07 pm #

            Sorry for the confusion. I meant that she respected my birth plan of not having an epidural, she wasn’t pushy. She allowed me to take as long as I needed to decide. I would have be furious at myself if I’d given in to the pain.

          • The Bofa on the Sofa
            April 8, 2015 at 2:55 pm #

            She allowed me to take as long as I needed to decide.

            What else can she do? She can’t do an epidural until you decide to do it, so it’s always on your time frame.

            I know, asking you if you want an epidural is really offensive. Of course, you yourself ADMIT that you were about ready to want one, so the fact that she would ask you is actually a pretty good thing.

            I would have be furious at myself if I’d given in to the pain.

            Why? Why do you think it is better to not get relief from the pain? I don’t understand.

          • Julie
            April 8, 2015 at 3:04 pm #

            I was at 8 cm when I was starting to 2nd guess my ability to have the baby with no pain medication. It was my last baby and I’d had 2 others without an epidural so to me it was a pride thing. I knew I wouldn’t need one if I didn’t need one before, but when it was starting to become unbearable I was too close to delivery for anything but an epidural (IV drugs would cause a low apgar in baby). So instead of me saying “sure” I took a few more contractions to think about it, then “wham” I was at 10! I thank God that I didn’t jump to an answer….so basically because of my perfectly timed procrastination I got the exact birth I wanted! And I would have been mad at myself, because I really wanted a natural delivery and that was my last chance. No more babies for me! I did the same thing with my other two, I waited until I couldn’t breathe between contractions (hyperventilated from the pain) before I asked for meds, but they didn’t push epidurals back then. They offered IV meds and I said sure. But in the end I had the birth I wanted for my last child and it was the best experience of all 3. I felt so euphoric after! And I’d do it natural all over again if I had to 🙂

          • The Bofa on the Sofa
            April 8, 2015 at 3:08 pm #

            It was my last baby and I’d had 2 others without an epidural so to me it was a pride thing.

            Why? What is there to be proud of?

            but when it was starting to become unbearable I was too close to delivery for anything but an epidural

            Sounds like a good time to get pain relief, to me. The pain was “unbearable”? That sucks.

            And I would have been mad at myself, because I really wanted a natural delivery

            But why? You keep saying you would have been mad (or furious) at yourself for getting pain relief, but I don’t understand why.

            You already had 2 “natural delieveries” without epidurals, so why were you so bent on having a third?

          • Julie
            April 8, 2015 at 3:16 pm #

            Well I’ve been told that IV meds is not “natural”. I’m very proud of myself. I guess I’m confused on why you’re confused. It was something I wanted to do for myself! All natural – no drugs! I knew I was strong enough to do it, but felt I needed to prove it to myself. Please don’t question my motive. It was just something I WANTED TO DO! And I’m extremely proud that I did it and that it turned out better than the 2 with drugs! That’s all…I think I enjoyed the actual delivery more without the drugs.

          • The Bofa on the Sofa
            April 8, 2015 at 3:35 pm #

            You were the one making the big deal of out it (you claimed you would have been furious at yourself), I’m just trying to understand why.

            If it hurt so bad that you had “given in” to having pain medications, why would that have been bad to do so?

            When things hurt so bad that you would opt for pain relief despite your initial desire not to do so, my response is “wow, that must have hurt a lot.” You, otoh, consider a personal failing?

          • Barbie B.
            April 8, 2015 at 7:33 pm #

            All four of my children were born without pain meds, or any other type of pain relief. They were born beginning in 1975 and ending in 1980. It was very “trendy” then to have “natural” childbirth, and almost all of my friends and I who were pregnant at the same time took the also “trendy” childbirth class of the day – Lamaze – to help you through the birthing process through breathing techniques and relaxation methods with the help of your birth coach, who was usually the husband.
            My first child was 16 days overdue, and my incompetent OB disregarded my concern when I told him, one week after my due date, that I felt my baby had turned to the side and my belly looked lopsided.
            When I started labor, it was difficult from the beginning, with a whole lot of bleeding initially. I had no more than five seconds between contractions the entire time I was in the hospital following the time my water broke, and the pain was unbearable. Still – no pain meds.
            When the baby was finally ready to be born and I started pushing, the OB said to the nurses, “the shoulder is presenting, we have to pull the baby over.” My baby was then born, a beautiful little girl weighing 9lbs. 2oz. and 21-3/4 in. Early the next morning, a neurologist came in to see me. He said they had noticed that my daughter’s left arm was not “working,” and he had determined she had some type of nerve damage, and that either her arm would “work” or it would hang at her side – he didn’t know – and all I could do is take her home and “give her a lot of love.” He then walked out of the room. Never gave me time for questions – nothing! He was in and out in 5 mins. and his bill was $50. For 1975, that was a whole lot of money considering my OB and hospital stay together was $800. Luckily, my husband came in my room immediately afterwards and I was able to come unglued at the seams with him to comfort me.
            My point is, I was a young 18 year old mother who knew very little about childbirth and certainly didn’t think about complications. I just went with the trend of the day because that’s what everyone was doing. I’m glad that women are more vocal about how they want to give birth, and make the choices THEY want to make. But that being said, I am thankful I was in the hospital when my baby was born because what on earth would have happened at home, with a midwife and a shoulder presenting.
            It turned out that I paid very close attention to my baby’s arm, and noticed that it did move from the wrist down, so I knew the nerves were not severed and the damage was probably in the upper arm. I worked with her arm every day and at about 3 mos. old, she finally began to raise her arm, and bring it across her tummy. My pediatrician said that was a miracle and that usually if a baby’s arm is not moving in that way by 3 weeks, it will never move – so I do thank the good Lord above for that miracle. Her arm is not perfect, but if you really didn’t know the story, you probably would not notice her shoulder and elbow are a little different. The pediatrician (who was also MY pediatrician) said my baby should have been taken by C-section as she was way to big for me to give birth to, which is why she “turned” a week past my due date.
            I was very fortunate there were not more dire consequences of having an inept OB, who chose not to listen to his patient, which proves there are OB’s out there that could be much worse than a midwife without all the proper training. I later learned this OB had been sued multiple times for birthing “accidents.”
            I know this is a VERY long story, and for that, I apologize, but the lesson in all of this ladies – do your research – a whole lot of research – and make sure you choose the right person/people (with the right experience, and great reviews from other women who have used them), to help you deliver your baby, and don’t do something just because it’s “trendy.” Looking back, I probably would have chosen an epidural if I would have had the option back then because the only birth that I felt was even remotely “easy” was my 4th child. Of course, my husband wasn’t very interested in that birth and spent most of his time out of my room, so maybe HE was the problem causing most of my pain – lol.

          • SporkParade
            April 9, 2015 at 3:42 am #

            Because when you say that you are “proud” that you were “strong” enough to do it all natural, then you are implicitly saying that women who are not physically able or just not interested in having an unmedicated vaginal delivery should be ashamed for being weak.

          • Medwife
            April 8, 2015 at 3:18 pm #

            You know, she was in a hospital, she wasn’t doing anything dangerous. She wasn’t refusing life saving care. Details beyond that are unimportant.

          • The Bofa on the Sofa
            April 8, 2015 at 3:38 pm #

            She felt the need to share, so apparently, to her, the details ARE important.

          • CharlotteB
            April 8, 2015 at 5:47 pm #

            Having an un-medicated birth is nothing to be proud of–billions of women have done it. I’ve done it. It’s not special. Assuming everything is going well, the pain, by itself, won’t damage you physically. But seriously? Being proud of yourself for enduring “natural” childbirth is like being proud that you can poop by yourself. Slow clap. Would you like a gold star?

          • Julie
            April 8, 2015 at 6:42 pm #

            Geez…No need to get your panties in a bunch. I’m proud enough said. You raising a type 1 diabetic? I am! Where’s your cape super mom.

          • Amy
            April 11, 2015 at 12:55 pm #

            Nobody’s getting anyone’s “panties” in a bunch. Motherhood isn’t a competition. Am I supposed to feel bad or less of a mother because neither of my children have diabetes, for example? And stop moving the goal posts. The original discussion was about whether or not forgoing an epidural is something to be commended– that has absolutely NOTHING to do with one’s children’s medical conditions or anything else that might make parenting a challenge.

          • April 12, 2015 at 12:52 am #

            Fuck you

            – a mother who had pain relief and a baby saving c section and is tired of bullshit like you have spewed

          • FEDUP MD
            April 13, 2015 at 12:19 am #

            Fine, you want to move the goalposts? I had an emergency c-section and my spinal failed, so for several minutes until they got me under general anesthesia, I felt them opening my abdomen and moving my organs around without any anesthetic. That’s right, major surgery with no anesthesia! I don’t take any special pride in it, it really sucked. I really wish it hadn’t happened, and I really hope no woman has to endure it either.

          • Julie
            April 8, 2015 at 3:06 pm #

            ” you were about ready to want one”….No not at all. I’ve never wanted an epidural. I’m too afraid of the teeny tiny chance they could hit the wrong spot and I’d become paralyzed. I’d rather take the pain!

          • The Bofa on the Sofa
            April 8, 2015 at 3:09 pm #

            No not at all. I’ve never wanted an epidural.

            You said you are about to give in. Why would you give in if you didn’t want an epidural?

            By the way, you are changing your story. Now you say it was because you didn’t want the risk of the wrong spot, but below you said it was about “pride.” Those are not the same thing.

          • Julie
            April 8, 2015 at 3:20 pm #

            Ok if you’re getting nit-picking. My original fear was hitting the wrong spot. That’s why I didn’t get one with my first child, then for my 2nd I thought why get one now if I didn’t need one in the first place. With my 3rd it was a pride thing. That’s also why I didn’t immediately say yes when she asked if I wanted an epidural. When she said it was too late for IV drugs I thought “WTH I only have 2 cm to go, you’d be stupid to get one now” Then boom…10 cm! This all literally happened in a matter of 2 min…I was at 8. She said only epidural. I thought for a second about getting one then felt the urge to push. I’m glad it happened the way it did.

          • EllenL
            April 9, 2015 at 9:24 am #

            It isn’t nit-picking to point out that epidurals don’t lead to an increase in C sections.

            Women may be denying themselves effective pain relief – or their caregivers may deny it to them – based on an erroneous assumption.

            Perpetuating myths about epidurals is a disservice to women.

          • Julie
            April 8, 2015 at 3:24 pm #

            Plus, I’d been to nursing school and have my license so i was aware of the risk factors that go into play when epidurals are involved. The risk of c-section go up. Don’t say it doesn’t…it was something my OB and I discussed at a prenatal visit

          • Stacy48918
            April 8, 2015 at 6:27 pm #

            No, an epidural does not increase the risk of a C-section. Even if given in early labor (<4cm).

          • Jocelyn
            April 8, 2015 at 7:22 pm #

            I know you just said “don’t say it doesn’t,” but um, it doesn’t.

            “Since the last Committee Opinion on analgesia and cesarean delivery, additional studies have addressed the issue of neuraxial analgesia and its association with cesarean delivery. Three recent meta-analyses systematically and independently reviewed the previous literature, and all concluded that epidural analgesia does not increase the rates of cesarean delivery (odds ratio 1.00–1.04; 95% confidence interval, 0.71–1.48) (11–13). In addition, three recent randomized controlled trials clearly demonstrated no difference in rate of cesarean deliveries between women who had received epidurals and women who had received only intravenous analgesia (5–7). Furthermore, a randomized trial comparing epidurals done early in labor versus epidurals done later in labor demonstrated no difference in the incidence of cesarean delivery (17.8% versus 20.7%) (5). The use of intrathecal analgesia and the concentration of the local anesthetic used in an epidural also have no impact on the rate of cesarean delivery (5, 13–15).”

            TL;DR: Epidurals don’t increase your chance of a c-section. Tons of studies have proven it.

            All of the studies referenced can be found here: http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Analgesia-and-Cesarean-Delivery-Rates

          • Nick Sanders
            April 9, 2015 at 12:46 am #

            “The risk of c-section go up.”

            Do you mean that c-sections become riskier if performed on women who have had an epidural, or that women that take an epidural are more likely to have ac-section? If the former, can you cite some statistics? If the latter, what makes that a “risk”?

        • Cobalt
          April 8, 2015 at 10:51 am #

          My third was my easiest, too. Oddly enough, that’s a really typical experience, regardless of pain management choices.

        • Roadstergal
          April 8, 2015 at 11:22 am #

          “I lucked out and had a wonderful nurse who allowed me to make the decision to not get an epidural when I was about to give in.”

          That’s a lot of disturbing to fit into one sentence.

          • Julie
            April 8, 2015 at 2:09 pm #

            How is this disturbing? It may sound confusing, but it’s not meant to

        • momofone
          April 8, 2015 at 9:19 pm #

          Unless it doesn’t.

        • araikwao
          April 9, 2015 at 6:36 am #

          Hospitals want epidurals? Funny, because I’ve heard plenty of hospital MWs complain about all the extra paperwork they have to do when women choose an epidural. Maybe that’s part of why they try to talk women out of them, or just deny them..

        • Stacy48918
          April 9, 2015 at 7:17 am #

          Do you have a single paper citation demonstrating that epidurals increase the rate of C-sections?

          I think your ending comment about “your body knows what to do” is particularly funny on a post about Jill Duggar Dillard…whose body clearly DIDN’T know what to do, which is why she transferred to the hospital. If our body’s “know what to do” – why bother with doctors or midwives at all?

        • April 12, 2015 at 9:08 am #

          Interventions aren’t done for shits and giggles. It’s because while your body surely knows what to do, that knowledge doesn’t translate to correct bone structure, fetal weight and position, unforeseen medical problems requiring prompt emergency care, organs that insist upon rupturing, meconium inhalation…

          Your refusal to have a home birth when the possibility of complications arose makes me believe that you know this, despite everyone’s talk of trusting birth.

          You, knowing your body, knew commonsensically that so many things went wrong with our foremothers birthing in the fields that something requiring our miracle of modern science could happen. When it saves the baby’s life, that knowledge is what’s best, not a blind refusal of interventions.

          Your son had to spend time in the NICU; thank god you were able to have those interventions and didn’t have to labor on your own at home.

    • Dr Kitty
      April 8, 2015 at 5:52 am #

      Actually no, England has announced that homebirth may be safer for MOTHERS than hospital birth, while possibly increasing the risks to babies, which is not quite the same thing.

      • SuperGDZ
        April 16, 2015 at 5:45 am #

        And even then, only for CERTAIN mothers

    • The Computer Ate My Nym
      April 8, 2015 at 3:11 pm #


      there is the whole growing host of women who schedule sections so it is convenient for them

      And this is bad…why? Because birth should be painful, awkward and inconvenient and it’s cheating to make it not so?

  22. angelita
    April 7, 2015 at 10:22 pm #

    wow i think you need to research your ideas before you just go out and post whatever you “think” are the correct facts. first of all, many women choose home birth and a large percentage of them give birth at home successfully. if there is a problem, the midwife will ensure the mother to be gets to the hospital in a timely fashion, if one lives more than twenty minutes away from a hospital, emergency personnel such as fire department, etc. are notified in advance that a home birth is in progress so they are aware and ready if they are needed. second, i had a certified midwife as my caregiver during my first pregnancy, and she was AMAZING! yes i gave birth in a hospital (my choice) but she was so much more supportive and kind and more involved in my pregnancy and birth than my second and third children’s providers (and they were wonderful doctors! i would have had the same midwife but my insurance changed and i was in a different locale). and by the way, in the netherlands, the UK, and australia, home births are more common than in the US. don’t know where you got your info from but it is NOT the truth, so get over yourself and stop trying to degrade jill’s choices.

    • Stacy48918
      April 7, 2015 at 10:23 pm #

      Glad to hear that “A large percentage of them give birth at home successfully”.

      Too bad about the ones that don’t I guess. You’re must be more comfortable with tiny coffins than we are.

      • Who?
        April 7, 2015 at 10:27 pm #

        Perhaps they are all in the tiny coffin business? Honestly, can these people hear themselves?

      • Deborah Starrett
        April 7, 2015 at 11:04 pm #

        My sister was at a hospital when she gave birth to a daughter that was still born, as are a lot of women. So the comment about tiny coffins is very insensitive in any conversation. I am sure there are a lot of mothers that are reading this and just like me as an aunt would love to show you what a tiny coffin really looks like.

        • Cobalt
          April 7, 2015 at 11:11 pm #

          I understand your sensitivity, but there really are babies dying in the hands of unqualified midwives. It’s not graceless hyperbole, or thoughtless exaggeration.

          I’m sorry for your family’s loss, there is nothing on this earth that can repair a child-shaped hole in a family.

          • Deborah Starrett
            April 8, 2015 at 8:52 pm #

            I agree that home birth is not a good idea, my water broke in the middle of the night. I lived 25 or more miles from the hospital. IF I had given birth at home my daughter would have joined her little cousin up in the sky. She was breech, footling position so a midwife would not have been able to safely deliver my daughter. As it was I had an emergency C-section. You were one of three to reply to my comment. You did not repeat the “phrase” I thought was insensitive. Thank you for your understanding, my sister lost her daughter in Feb. 1982, my daughter was born in May of the same year. 33 years ago but my sister still grieves the loss of her daughter.

          • Cobalt
            April 8, 2015 at 9:42 pm #

            Grief, like love, has no time limits.

            Again, I am very sorry for your family’s loss. Every lost child is a tragedy, every single one.

        • Stacy48918
          April 7, 2015 at 11:19 pm #

          I am very sorry for your family’s loss. My comment was not meant to be insensitive but is in fact 100% relevant. Down thread Angelita states she is ok with babies dying at home because maybe they weren’t meant to live anyway. HER view is the insensitive one. Her views and those of other homebirth supporters do in fact lead to unnecessary death and tiny coffins. It’s not hyperbole but a fact that must be addressed so others lives can be spared.

          Again, my condolences.

        • Who?
          April 7, 2015 at 11:41 pm #

          I’m sorry that happened in your famiy. There certainly are loss parents and other family members here, some of whom come out of the homebirth environment that shrugs and says ‘some babies aren’t meant to live’.

          That community shuns and punish people who raise concerns about babies’ deaths, and are very comfortable with tiny coffins, seeing them as a normal and inevitable fact of life.

    • Who?
      April 7, 2015 at 10:24 pm #

      To our comments below, regulars, I offer you this post as further fodder.

      Jill chose hospital. Smart Jill.

      • Stacy48918
        April 7, 2015 at 10:25 pm #

        No kidding. Angelita didn’t even bother to read the first comment below hers!

    • Cobalt
      April 7, 2015 at 10:39 pm #

      Please, share your sources for the “correct” facts.

      MANA itself admits your baby is 450% more likely to die under the care of its midwives compared to hospital birth.

      • angelita
        April 7, 2015 at 10:52 pm #

        Here’s your MANA information: http://mana.org/blog/home-birth-safety-outcomes

        • Stacy48918
          April 7, 2015 at 11:04 pm #

          Cobalt has read it. You clearly haven’t. But prove me wrong. Please tell us in your own words what it says and how their findings compare to CDC statistics.

        • Cobalt
          April 7, 2015 at 11:04 pm #

          Does that link to their safety study? The one that showed low risk homebirth is much more dangerous than high risk hospital birth?

        • Bugsy
          April 8, 2015 at 11:50 am #

          That’s a bogus link, FWIW. “This page doesn’t exist.”

    • momofone
      April 7, 2015 at 10:48 pm #

      So are you saying that if you’re aware a home birth is in progress, you are on standby, meaning that you wouldn’t respond to, say, an accident call during that time, just in case you were needed at the birth?

      • angelita
        April 7, 2015 at 10:49 pm #

        umm you do understand there are more firefighters/emt’s available than are needed for just one emergency? what do you think they do if there are more than one fires in the vicinity?

        • Cobalt
          April 7, 2015 at 10:53 pm #

          In some areas it’s a major problem. There aren’t unlimited emergency services, and it reduces strain on the emergency response system when people don’t deliberately create additional emergencies.

          • angelita
            April 7, 2015 at 11:06 pm #

            In our area, the hospital is 45 minutes away. There are firefighters and EMTs on duty at all times, for five 4th alarm assignments total.

          • Cobalt
            April 7, 2015 at 11:14 pm #

            So many! I guess it’s fine to waste their services on a midwife’s vanity then. It’s not like unplanned, unpredictable, unavoidable emergencies will occur in those hours.

          • NoLongerCrunching
            April 8, 2015 at 4:59 am #

            Was a post deleted by the author? I see no reference to E

          • momofone
            April 8, 2015 at 7:09 am #

            I think several posts were deleted.

          • Stacy48918
            April 7, 2015 at 11:21 pm #

            Selfish selfish selfish. “come park in my driveway for hours on end because hospitals are scary.”

          • Bombshellrisa
            April 7, 2015 at 11:23 pm #

            In this area last week, there was a fire call, a call for
            Medics because a four year old fell from a second story window onto cement, a chest pain call from the assisted living and another chest pain call from the senior community all at the same time. The four year old was airlifted. A home birth in trouble call during that time would probably not have turned out well

          • Bugsy
            April 8, 2015 at 11:46 am #

            …and who pays for the cost of the emergency response system? My father went to the hospital by ambulance last year, and they’re still dealing w/ the costs. Is this something we all end up covering through insurance premiums? Does insurance even cover an emergency hospital transfer from home birth? (If I were an insurance company, I sure as heck would not want to cover home births and related complications…)

        • momofone
          April 7, 2015 at 10:53 pm #

          I’m supposing that if you’re in a rural area, as I am, there would definitely be limited resources. However, I’d love for you to educate me.

          Just for clarity, in my area, if there were more than one fire, something would burn.

          • Bombshellrisa
            April 7, 2015 at 11:17 pm #

            Even in a metropolitan area. We have many many fire stations in my small area and if there was more than one fire, someone would have to wait.

          • moto_librarian
            April 8, 2015 at 9:49 am #

            And don’t forget traffic in a metropolitan area! A mother at my children’s daycare is planning a home birth with her third. On a good day, we are 30 minutes from the closest hospital with a L&D, but 45 minutes is average. Traffic impacts the ability of EMS to get to you and transfer you. At rush hour, there is no way to pull over for them, and they weave between the right and left lanes. I am very worried for her.

        • Bombshellrisa
          April 7, 2015 at 11:13 pm #

          What can an EMT do besides stabilize and transport during an emergency? I couldn’t do much beyond slap on some oxygen and give herbs waiting for an ambulance to show up when I attended home births.

          • Cobalt
            April 8, 2015 at 1:13 am #

            Then can probably get the mother to the hospital in time. Not so much the baby. There’s just too narrow a margin.

          • Montserrat Blanco
            April 8, 2015 at 1:18 am #

            They usually do not carry pitocin, so in case of a bleeding….apart from that, have you ever tried to get an IV on someone that is bleeding out???? It is extremely difficult because veins collapse when there is an important bleeding.

          • Bombshellrisa
            April 8, 2015 at 3:35 am #

            And some people (like me) have veins that don’t cooperate even when I am hydrated and not bleeding out. It took four attempts to get an IV in me during my last labor.

          • Montserrat Blanco
            April 8, 2015 at 6:11 pm #

            I know. I wish I did not know but I know… Too many patients with difficult veins…

          • Heather Rische
            April 8, 2015 at 1:47 pm #

            ummm, CPM’s carry pitocin, methergine and in some states, Cytotec, for bleeding.

          • The Computer Ate My Nym
            April 8, 2015 at 1:51 pm #

            But do they know how to use them? These drugs can be dangerous if misused or used without proper monitoring. Who ensures that the dose is correct, the monitoring adequate, and the administration performed correctly?

          • Heather Rische
            April 8, 2015 at 1:58 pm #

            CPM’s are also trained in dosage, dangers, use, monitoring, administration, etc… of course. Obviously they couldn’t legally carry them without proper training.

          • Amy Tuteur, MD
            April 8, 2015 at 2:03 pm #

            They’re trained? Really? How many times does the average CPM use Pitocin during her training? Zero? How many times does the average CPM use methergine during her training? Zero? How about Cytotec? Zero?

            Carrying those medications is like carrying a diaphragm for birth control. It won’t work if you don’t wear it, or if you’ve never had the experience of inserting it.

          • Heather Rische
            April 8, 2015 at 2:10 pm #

            That’s your impression? Whacky. They are used frequently at the birth centers where most CPM’s trained, and in home birth practices during apprenticeship. That’s odd that you believe they are not used. Sounds like you really haven’t done the research on this subject on which you claim to be an expert. Trust me, we all learn how to give an IM injection, and get lots of practice. Because some midwives also use herbs, you must have gotten the ill-researched opinion that they don’t use the meds as well.

          • Amy Tuteur, MD
            April 8, 2015 at 2:12 pm #

            You’ve never used them, right? Not even a single time, right?

          • Daleth
            April 8, 2015 at 2:29 pm #

            She certainly would have said so by now, if she had. So you’re undoubtedly right.

          • Daleth
            April 8, 2015 at 2:11 pm #

            CPMs are trained in dosage, etc…. by WHOM?

          • Heather Rische
            April 8, 2015 at 2:33 pm #

            By the midwives who train them, who operate under the state guidelines which usually fall under the department of health, including a midwifery board staffed by OB’s, CNM’s, Family Practitioners, Consumers, CPM’s. The dosages are set in the training and practice guidelines and are approved and changed as new research comes to light. The prescriptions and/or standing orders by the collaborating doctors also specify dose. Who trained the first modern midwives to give an IM injection? (or phlebotomy, or to run an IV) I don’t know. Probably nurses and doctors. We are still trained by doctors and nurses for NRP and IV certification. Anyways, I appreciate your honest questions versus flat out insanity but I do have to get on with my day.

          • Heather Rische
            April 8, 2015 at 2:01 pm #

            (and I’d like to add here that cytotec, used off-label by impatient OB’s has caused several maternal deaths)

          • Amy Tuteur, MD
            April 8, 2015 at 2:05 pm #

            Yet CPMs have been responsible for more deaths than Cytotec yet you think they’re safe. How can that be?

          • The Computer Ate My Nym
            April 8, 2015 at 3:02 pm #

            Yep. And how do you know this? Because the deaths were reported, root cause analyses performed, and common features defined. And as a result changes in protocol were instituted.

            What happens when a CPM loses a baby? She says “so sad” and goes back to doing exactly what she was doing before. No one stops her, no one demands that she examine her protocols and consider whether any of them are doing more harm than good, no one stops her from practicing in an unsafe manner.

            There are definitely bad OBs out there. There are hospital administrators, other doctors, nurses, pharmacists and lawyers looking over their shoulders. And when they do the wrong thing things change. Where is that control for CPMs?

          • The Computer Ate My Nym
            April 8, 2015 at 3:07 pm #

            Also, earlier you said, “CPM’s carry pitocin, methergine and in some states, Cytotec, for bleeding.” Use of Cytotec in labor is no more on label when CPMs do it than when OBs do.

          • Heather Rische
            April 8, 2015 at 3:12 pm #

            It has been shown to be safe for hemorrhage (benefits outweighing risks). We don’t use it to induce. As I said above (or somewhere), I’m extracting myself from this page, because I somehow had the impression that Amy had done her research before assuming things about the CPM credential that are untrue and then acting legit crazy when challenged. Your comment is a reasonable one. However, I’m out of here.

          • The Computer Ate My Nym
            April 8, 2015 at 3:14 pm #

            It has been shown to be safe for hemorrhage (benefits outweighing risks).

            What’s the data on that? It’s not an area I’m all that familiar with.

          • Medwife
            April 8, 2015 at 5:49 pm #

            Cytotec is awesome for PPH. It’s my next drug after pitocin.

          • Daleth
            April 8, 2015 at 2:09 pm #

            Exactly. That knowledge is exactly what a MEDICAL EDUCATION is for. And there are no educational requirements of CPMs, much less medical education requirements.

          • Amy Tuteur, MD
            April 8, 2015 at 1:57 pm #

            Do you carry them, Heather? How many times have you used them? What would they do for a piece of retained placenta? What do you do when they don’t stop the bleeding?

            Seeing as you’re a CPM, perhaps you can tell me how much blood loss will lead to hemorrhagic shock and death, and how fast that could happen.

          • Heather Rische
            April 8, 2015 at 2:05 pm #

            Oh sweetheart, I think we both know the metrics and the individuality from patient to patient in regards to the meds, the metrics and the well-established fact that mothers at home birth die less than in hospital. Of course I carry them. And I transfer when needed for bleeding. Twice last year. All good.

          • Amy Tuteur, MD
            April 8, 2015 at 2:11 pm #

            Bullshit. You, like most CPMs are utterly clueless and no amount of calling me “sweetheart” will divert attention from that fact.

            You’ve never used these medications even a single time and you’re boasting that you CARRY them? Do you have an idea how stupid and dangerous that is? Obviously not.

            Your ignorance and hubris are appalling. YOU are unqualified to care for pregnant women.

            There’s no evidence that the maternal death rate is lower at homebirth since no one has ever done a large enough study. I know of 2 maternal homebirth deaths that occurred within days of each other in December. That doesn’t sound like a low death rate to me.

          • Heather Rische
            April 8, 2015 at 2:22 pm #

            LOL, Ok, bored now. I wonder what I was doing all of those times that I administered them? It was a dream? Or all of the times I observed them being given, then graduated to being allowed to administer in training… Some weird delusion, I guess. Didn’t realize how unreasonable you actually are… I’ve heard tell, but, wow. Lesson learned. I gotta’ go restock my imaginary meds kit. With the fairies. LOL. i just had no idea how little you actually knew about our qualifications and training. I figured you’d done the research.

          • Amy Tuteur, MD
            April 8, 2015 at 2:26 pm #

            Don’t waste our time, Heather. We know you are lying. And you haven’t answered my question about what volume loss leads to hemorrhagic shock and death and how fast that can happen. Don’t know or won’t say?

          • attitude devant
            April 8, 2015 at 2:29 pm #

            How dare you question Heather’s credentials? I looked her up! She has completed a Birth art course at Birthing from Within!

          • The Bofa on the Sofa
            April 8, 2015 at 3:00 pm #

            Are you serious?

          • KarenJJ
            April 8, 2015 at 8:21 pm #

            Doubt it 🙂

            WTF is Birth art?

          • Bombshellrisa
            April 9, 2015 at 11:12 pm #

            Please don’t let it be the “painting with a placenta” class. I just can’t….

          • attitude devant
            April 8, 2015 at 9:50 pm #

            Absolutely! Her website is entertaining, to say the least. She includes teaching a children’s art class among her relevant jobs

          • The Bofa on the Sofa
            April 9, 2015 at 9:29 am #

            Wow, we do attract the serious loons here, don’t we?

            This seems to happen a lot. We have vocal participants, and when you find out who they are you discover that they have a lot of, um, entertaining aspects in their lives.

          • Daleth
            April 9, 2015 at 10:05 am #

            She charges $3000 cash to be someone’s midwife, and then there are other fees on top of that (patients have to pay for Rhogam testing, ultrasounds etc.).
            http://www.mymidwifeheather.com/fees.html
            Good lord. There are so many Obamacare and private insurance plans with deductibles on the order of $1500, $1000, $500…. so birthing with her apparently costs several times more than birthing in the hospital. Way to serve the working poor of New Mexico, Heather!

          • Kelly
            April 11, 2015 at 9:14 pm #

            They pay that and if they do end up going to a hospital they have to pay that too. You know the nice thing about paying medical bills is that you can pay monthly with no interest? They will also work with you sometimes on the cost. Do midwives do that? I am on a monthly plan to pay my OB ahead of time for prenatal visits and tests and the delivery. If for some reason I don’t end up delivering with them, guess what, I get my money back. Do midwives give money back if they don’t make it and/or don’t deliver the baby? I know that medical expenses are ridiculous here but paying a midwife is not the answer to saving you money at all.

          • Daleth
            April 8, 2015 at 2:42 pm #

            Ooh, me me!!! (Waves hand). I can tell you what volume of blood loss causes hemorrhagic shock, a.k.a. hypovolemic shock, because it happened to me! In a hospital, which is why I’m still here to tell you about it!

          • Heather Rische
            April 8, 2015 at 2:59 pm #

            The crazy train has left the station. The research lady has not done her research (very curious where you get your info, really) and I am crazy for continuing to engage. However, 20% of blood volume causes hypovolemic shock… Gotta’ go, folks. It’s been real. I am so glad that you have shown me that my reality and the reality of the >100 midwives I have known, worked with and trained with are all imagining the anti-hemorrhagic medications we both CARRY and ADMINISTER. Good day. I’m out. Lesson learned.

          • Amy Tuteur, MD
            April 8, 2015 at 3:14 pm #

            Be sure to stick the flounce!

            And thanks ever so much for demonstrating the deadly lack of experience of homebirth midwives. A homebirth midwife as just as useful as a woman who offers to hold your infant in place of buckling him in a carseat, proclaiming herself an expert in normal car rides, and promising to transfer to the hospital in the event of a crash.

          • Stacy48918
            April 8, 2015 at 2:47 pm #

            She ain’t your “sweetheart”. Stop being such a paternalist.

            And you seriously can’t answer the question? It’s a simple numbers game. 2% of blood volume? 5%? 10%? 20%? I know the number for a dog off the top of my head. Why can’t you answer such a simple question?

          • momofone
            April 8, 2015 at 9:43 pm #

            Oh, “sweetheart”, it’s crystal clear that you’re attempting to divert attention by being condescending so you don’t have to address her questions in full. And when someone pushes you, it’s suddenly time to “disengage” again (though you’re a pretty safe bet to return).

          • Montserrat Blanco
            April 8, 2015 at 2:04 pm #

            I have read in various CPMs blogs and FB pages that it is forbidden for them to administer those drugs. It makes sense as they are not doctors or nurses, if you have different information from a more reliable source, please post the link.

          • Ash
            April 8, 2015 at 2:14 pm #

            It’s actually a state by state thing.

            Some states allow CPMs to carry certain medications.

            For example, see Wisconsin

            https://wisconsinguildofmidwives.files.wordpress.com/2013/06/standardsofpractice.pdf

          • Heather Rische
            April 8, 2015 at 2:16 pm #

            http://www.newmexicomidwifery.org/images/uploads/NMMA_2008_practice_guidelines.pdf

            Should be in there. ^^^ I think in states that the CPM or LM credential isn’t accepted, you may be correct. It varies from state to state, but many of us need standing orders/prescriptions from an MD to carry all of the meds we do, including oxygen, Vitamin K, etc. I think many midwives in illegal states still carry the meds, because it would be stupid not to.

          • Daleth
            April 10, 2015 at 10:31 am #

            I’m glad to see that New Mexico prohibits home-birth midwives from attending the births of multiples, babies in any position other than head down, and births before 37 weeks. Unfortunately I wouldn’t be surprised if there are NM HB midwives who purposely flout those requirements by, for instance, accepting women who have refused all ultrasounds (so there’s no way to be sure how many are in there and, unless ultrasounds were done very early, no way to know the exact gestational age), writing in her notes that the baby was vertex at labor onset when it wasn’t or she doesn’t know what position it was in, etc.

          • Daleth
            April 8, 2015 at 2:30 pm #

            Pitocin wasn’t enough to stop my hemorrhage–I needed IV fluids. Fortunately, I was in the hospital. Sadly for her and her family, Caroline Lovell wasn’t. She bled to death:

            http://www.theage.com.au/victoria/home-birth-mother-caroline-lovell-pleaded-for-help-before-her-death-20150317-1m17lo.html

          • Heather Rische
            April 8, 2015 at 2:43 pm #

            Yes, we are IV certified as well, but would transfer if the need for IV was indicated anyways, as prolonged care would be required.

          • Daleth
            April 8, 2015 at 2:52 pm #

            If a midwife had transferred me from my house, by the time I got to the hospital I would have already bled to death. And I live in a major metropolitan area, it’s not like the hospital is all that far away. The reason I’m alive is that I was in the hospital.

            Like most if not all US hospitals this one required heplocks, and there was an IV bag of fluids hanging next to me in recovery just in case, and I was hooked up to monitors despite an uncomplicated delivery so that they would immediately see if my blood pressure was dropping. (My bleeding was almost entirely internal–without monitors they would not have noticed what was happening). Because of all that, there was no delay in getting the fluids into me.

          • Bombshellrisa
            April 8, 2015 at 2:52 pm #

            What about in the case of GBS positive patients? In my state, CPMs still attend those births and give IV antibiotics.

          • Amy Tuteur, MD
            April 8, 2015 at 2:53 pm #

            Okay, now that we have established that you’ve never administered any of the IM medications that you boast of carrying, let find out a bit more. When was the last time you successfully started an IV on a patient? Never? And how many times have you performed infant CPR on a patient? Was it successful?

          • Daleth
            April 8, 2015 at 3:00 pm #

            PS what’s your definition of prolonged care?

          • Heather Rische
            April 8, 2015 at 3:07 pm #

            Sorry, I’m going to respectfully disengage. I am replying to you because your questions and comments have been sane and reasonable. Not so much elsewhere on this page, and I had no idea that Amy has actually not done her research on CPM training…somehow thought she had. I’m extracting myself. It’s getting crazy up in here! I respect your concern for women and babies. best of luck.

          • The Bofa on the Sofa
            April 8, 2015 at 3:12 pm #

            am replying to you because your questions and comments have been sane and reasonable.

            …and then you didn’t reply to her question.

            Just like you avoided everyone else’s questions that have been asked of you.

          • Heather Rische
            April 8, 2015 at 3:18 pm #

            Untrue, but the definition of disengage is pretty clear. good day.

          • Daleth
            April 10, 2015 at 10:23 am #

            It’s too bad that you’re choosing to disengage. Unlike a number of other non-CNM midwives or other homebirth advocates who have come to this site, you’ve discussed things reasonably and mostly respectfully (calling a woman you don’t know “sweetheart” in a sarcastic way, as in “sweetheart, you have no clue,” is not respectful, but mostly you have been).

            I’m still confused by your belief that (if I’m understanding your post correctly) Dr. Tuteur is mistaken about what training is required to get CPM status. Most of us here have already (long ago) gone to the NARM website to look up what is required to become a CPM. It’s right here:
            http://narm.org/certification/how-to-become-a-cpm/

            …and it’s just true, unfortunately, that there are absolutely zero educational requirements (unless, as I said, you count reading stuff at your house without supervision as “education”) and the clinical requirements are scanty (40-50 births is VERY few).

            And I don’t think anybody is saying CPMs can’t catch babies safely most of the time–of course they can, because statistically most births go fine. Home births without a midwife in attendance have a neonatal death rate of 18.2/10,000; in other words even without a midwife babies very rarely die. I’m one of those 10,000 who was just fine–the midwife went home, telling my mother (incorrectly as it happened) that I wouldn’t be there until morning, and my dad caught me.

            And I for one do not discount the emotional support you can offer a birthing mama.

            HOWEVER, most home birth midwives cannot handle true emergencies; that’s why you typically transfer when such emergencies arise. For instance, PPH? You just can’t, unless you monitor carefully enough and long enough to detect internal bleeding, carry pitocin, know how to use it AND it works (which it doesn’t always). Hospitals have heplocks, IV fluids and matched blood on hand. You don’t; you just don’t.

            And the reason people here have a problem with home birth is because–well, two reasons: first, there’s no way to know in advance how someone’s labor is going to go; and second (and probably more important), in America most home-birth midwives reject any call for them to operate under standards that would require them to risk out high-risk patients. There are HB midwives who accept mono-di twins, for god’s sake–which is crazy because in addition to the fact that most twins come prematurely, mono-di is so high risk that moms who labor in the hospital are required to labor in the OR. It’s just so bizarre, don’t you think, for HB midwives to be saying on the one hand, “Home birth is safe for low risk moms,” and on the other hand… to accept patients who are NOT low risk!

          • Daleth
            April 8, 2015 at 3:03 pm #

            If a midwife had transferred me from my house when she realized that “the need for IV was indicated,” I would have been dead by the time I got there. And I live in a major metropolitan area–it’s not because the hospital is far away that I would’ve been dead. It’s because postpartum hemorrhage can kill within 20 minutes, easily.

            So here’s what saved me: being in a hospital. And here’s why it saved me:

            – They required heplocks for all delivering women, so there was no delay getting the IV fluids into my deflating veins.

            – In recovery they had an IV bag of fluids hanging next to me “just in case,” as they do with all new moms, so again, no delay.

            – They were monitoring my vitals as I rested in recovery, so although my hemorrhage was entirely internal (and thus could have gone unnoticed for a while), they spotted it immediately and suddenly three doctors burst into the room and went to work on me.

          • moto_librarian
            April 8, 2015 at 3:45 pm #

            You also probably aren’t very good at it if you don’t do them routinely. Same with NRP. Color me unimpressed.

          • moto_librarian
            April 8, 2015 at 3:45 pm #

            And what would you do for a cervical laceration? Pit and cytototec do nothing for that. Can you do a manual exam of the uterus without assistance? Do you carry the tools to do that? How long do you wait to call for help?

            These are not academic questions. I had this exact complication, fortunately, in a hospital after a natural birth. I still almost got a blood transfusion, despite prompt diagnosis and treatment in the OR. I have had several CPMs tell me that it could have been manages at home, but at least one admitted that LifeFlight would be my best chance.

          • Roadstergal
            April 8, 2015 at 4:08 pm #

            LifeFlight and the like aren’t cheap, and aren’t covered under a lot of insurance plans. I’ve known people who were helicoptered to the hospital after motorcycle accidents, and it was $50,000+ out-of-pocket despite them having medical insurance. Aside from the risk to mom and baby, add the risk of bankruptcy…

          • demodocus' spouse
            April 14, 2015 at 11:42 am #

            Not to mention it could take the helicopter 30 minutes to get to the hospital.

        • Montserrat Blanco
          April 8, 2015 at 1:15 am #

          You know what? A firefighter has ZERO training on how to resuscitate a newborn. If your baby needs resuscitation you’d better get someone that does it regularly. And no, someone with 40 births a year is not well versed on that.

          • Who?
            April 8, 2015 at 1:16 am #

            At least the firies wouldn’t be blowing cinamon around and simultaneously covering their arses-they are probably the better bet in that case.

          • Montserrat Blanco
            April 8, 2015 at 1:28 am #

            That is SO true!!!!

            Or saying to the woman: “Stop bleeding!!!”

          • Who?
            April 8, 2015 at 1:31 am #

            Or not noticing she is bleedng, or ‘losing’ whatever pathetic excuses they had for notes, or making some up, or going to crowdsource what to do next…

            The options are endless.

          • Karen in SC
            April 8, 2015 at 10:15 am #

            Most lay people don’t even realize that neonatal resuscitation is a specific skill that nurses and other medical personnel train on and re-certify after a few years!! Not only the skill, but specialized equipment.

            Some homebirth midwives have an adult oxygen mask only, if that, and may not even have a full tank of O2 at the ready.

          • Bugsy
            April 8, 2015 at 11:43 am #

            It was really reassuring to me that when my son was being born (low-risk OB-attended hospital birth), that the neonatal team was literally right there in case things went wrong. Why on earth would anyone want to give birth without such a safety net?

          • Heather Rische
            April 8, 2015 at 1:45 pm #

            CPM’s must carry PPV equipment for newborns and must recert in NRP as often as everyone else.

          • Medwife
            April 8, 2015 at 3:12 pm #

            They often don’t have pulse oxes for the baby (now standard of care in NRP), deep suction, or an O2 mixer, let alone a team at hand. If you’re at a birth with one assistant, someone needs to be on mom. What if you just had a shoulder dystocia, with a baby now in need of resuscitation, and a hemorrhaging mom- happens a lot after SD. Someone is resuscitating the baby by herself while the other, probably the assistant with god knows what training, managing a PPH. You’re telling me that doesn’t worry you?

          • Montserrat Blanco
            April 8, 2015 at 6:03 pm #

            Heather, with all due respect, how many people have you resuscitated in your life? Have you got any idea of the amount of training and re-training that it takes?

            I have to re-train every 2 years in order to be in good shape for it just in case. I have performed CPR more times than I would like already and if you are not used to do it and well trained the person has ZERO chances. ZERO. It is pretty different to perform CPR on a model than on a real person. A neonate… Without a team with a lot of experience a neonate has no chances at all.

          • D/
            April 8, 2015 at 9:44 pm #

            “CPM’s must carry PPV equipment for newborns and must recert in NRP as often as everyone else.”

            So how often would you estimate that CPMs engage in resuscitation simulations?

            Here’s the thing about competencies, the more infrequent a critical event that requires technical skills happens the more important it is that it be regularly practiced. Even in the hospital setting most health care staff don’t maintain their skills of resuscitation by simply re-certifying every 2 years, stuffing equipment in a drawer and then waiting for an actual emergency. The ones who can do that are in trauma centers, (neonatal) intensive care units, etc. And they can do that because they get all the “practice” that makes them not just proficient, but rather experts. For the rest of us (which should certainly include CPMs at home births) frequent review and periodic simulation is necessary.

            In addition to required 2 year re-certifications in CPR and NRP, plus the real life practice that NICU and L&D staff members get in actual emergencies and resuscitations, both of the hospitals I work at require participation in neonatal mock codes (and post-partum maternal hemorrhage scenarios). These events come complete with mannequin simulators and video debriefings are scheduled 1-2 times (or more) per year, pull in everyone from all of the Maternal-Child units and focus not just on the equipment skills but also on the necessary teamwork aspect of these emergencies

            Now imagine a CPM who is “carrying PPV equipment for newborns and re-certifying in NRP as often as everyone else” trying to use equipment she may not have touched or thought about in up to 2 years to resuscitate a unresponsive baby. This is why so many CPMs will use mouth-to-mouth as their primary resuscitation plan for ventilation. They are unwilling or unable to become skilled and remain proficient in the use of PPV equipment … and being under equipped, under skilled and overly confident in trusting birth to the point that risk factor after risk factor become just variations of normal is why “valuing the art of letting go and acknowledging death and loss as possible outcomes of pregnancy and birth” becomes a necessary philosophy!

          • The Bofa on the Sofa
            April 9, 2015 at 9:24 am #

            Here’s the thing about competencies, the more infrequent a critical event that requires technical skills happens the more important it is that it be regularly practiced.

            I had CPR training in high school. Who needs EMTs?

          • D/
            April 9, 2015 at 9:48 am #

            Or even I had “medical” training in high school. Who needs OBs?

            From a birth professional forum:

            “well a lay midwife- is by definition a person who assists but does not have any formal training. But it is quite a stretch in modern America for just about anyone in mainstream culture to not have had some level of “medical” training- in order for me to graduate high school I had to pass a first aid class and that involved a whole list of things- including rescue breathing, bandaging , heart and respiration assessment, life saving in many situations … and beyond that we all have medical experiences and influences”

        • DaisyGrrl
          April 8, 2015 at 7:48 am #

          There is only one firefighter/emt unit within a 20 minute drive from my house. I live very close to a large urban center. If there’s more than one fire/car crash in the area, you just have to wait the 20-30 minutes for backup. Can you hold your breath that long? A baby can’t.

          Women in rural areas almost certainly don’t have multiple emergency responders on standby for when they’re in labor. Take that 20-30 minute wait and stretch it to an hour.

        • Mac Sherbert
          April 8, 2015 at 9:30 am #

          Have you talked to any emergency responders? Some days they do nothing some days they never return to the firehouse. Just because they are lots of emergency responders in your area doesn’t mean that’s true for everyone. My small town has had trouble keeping an Ambulance service in town because they can’t make money.

          • Dr Kitty
            April 9, 2015 at 3:35 am #

            My city of 500,000 people has 7-9 ambulances at any one time, involved in everything from 999 response to RTC to transporting patients between hospitals for procedures.

            If an elderly, confused patient of mine who lives alone has to wait 2-4 hrs for transport to hospital for treatment of her UTI, as it is, if even10% of the 40-50 women giving birth in the city every day decided to Homebirth it would put a significant drain on ambulance resources.

            There is no way 50% of the vehicles could be “put on standby” just in case.
            That is nonsensical.
            You’d get 8-15 minute target response to a 999 call, with first available vehicle diverted ASAP like everyone else.
            So…still 20-30 minutes before you got to hospital from when you make the call.

            I’ve called ambulances services for enough strokes, MIs and collapses to know how it goes.

          • Who?
            April 9, 2015 at 3:48 am #

            It’s hard to know sometimes when to call. We’ve been talking a bit about snakebite what with all the snakes around at the moment. Do you call the ambulance if you’re sure it was ‘just’ a python, or do you apply first aid and head off to the hospital? A number of the world’s most venomous snakes routinely shed skins in our corner of the suburbs.

            I rang the museum once to speak to a herpetologist to identify a snake-the receptionist wouldn’t put me through until I’d assured her no one was bitten.

            The first aid is pretty good, and will probably hold the bitee for a while even if the snake recognition scores an E for effort. My view is call the ambos, particularly if the victim has to move much to get out-since moving is the bad thing to do-but I don’t know.

          • Dr Kitty
            April 9, 2015 at 6:04 am #

            Snakebite- fine- call 999!
            The bane of my life are phone calls with presenting complaint of “just don’t feel right”, “funny turn”, “not quite at myself” calls from older people, who don’t want to go to hospital, and just want a Dr out to see them.

            Those can mean everything from massive MI or dense hemiplegic stroke to mild indigestion or just being lonely and wanting a chat.

            Sometimes, if I can get a good history, I’ll advise them to call 999, but most of the time it ends up being a house call to assess, and I’m never really sure what I’ll see when I get there…

            One of my colleagues had a “she’s just very low and not very talkative” turn out to mean “dead with rigor mortis well set in” when he got to the house.

          • Medwife
            April 11, 2015 at 2:10 pm #

            You know, as an American, that’s something I’ve taken for granted when doing phone triage. I’m either telling them to take a bath and some Tylenol, or to come in to be evaluated, or to call 911. Never do I have to make home visits.

          • Dr Kitty
            April 11, 2015 at 2:58 pm #

            Home visits, to be clear are for the elderly and housebound, palliative (hospice) patients, the severely mentally unwell who may require hospitalisation against their wishes and people in residential or nursing homes.

            I don’t do house calls for kids who usually come to the practice (if you think your child needs to be seen immediately by a doctor, and you can’t physically drive them, put them in a pram and walk here with them, get a lift from a neighbour or call a taxi, you need to call an ambulance, because if they get sicker you won’t be able to cope, and you already think they are very sick).

            I also do not do housecalls for usually well adults. Again, if you’re normally able to come and see me, and you are currently unable to get out of bed, you need a hospital, not me with a BP cuff and stethoscope and very little else in terms of diagnostic or treatment options.

            Our practice of 6000 patients has, on average, 3-5 house call requests a day, with 2 or 3 doctors to do them, sometime over the lunch period.
            Not my favourite thing, especially the complex social care ones that take ages to sort out, and involve phone calls to multiple relatives and agencies.

          • Nick Sanders
            April 11, 2015 at 4:29 pm #

            I’ve heard of British understatement, but… wow.

          • Dr Kitty
            April 11, 2015 at 7:09 pm #

            Elderly people with poor vision, hearing and memory are not the most accurate historians, nor are they very good at assessing the health of their spouses.

            They also like to call the GP out without running it by the actual patient first. Nothing like a house call to an irate pensioner who denies any symptoms and is adamant they don’t need a doctor, while their spouse offers you tea and biscuits that they bought “specially for your visit, I had to get you out because he refuses to go and see you”.

      • NoLongerCrunching
        April 8, 2015 at 5:01 am #

        Was a post deleted by the author? I see no reference to someone being an EMT on standby above…

        • Nick Sanders
          April 8, 2015 at 5:02 am #

          “if one lives more than twenty minutes away from a hospital, emergency personnel such as fire department, etc. are notified in advance that a home birth is in progress so they are aware and ready if they are needed.”

          • Bugsy
            April 8, 2015 at 11:49 am #

            Heck no! My dad had a seizure unexpectedly last year and was rushed to the hospital. Thankfully, he recovered and is doing great. To know that the EMT staff could have been too busy for him due to being on stand-by for someone else’s poor choice is INFURIATING.

          • Daleth
            April 8, 2015 at 12:19 pm #

            Well, to be fair, isn’t a lot of what EMTs have to deal with the result of someone’s poor choices? They attend drunk-driving accidents, crime scenes, frat houses where some idiot did something on a dare, etc. I don’t think people who choose to home birth are any less deserving of EMTs’ time than a drunk frat boy who jumped off a balcony.

          • Roadstergal
            April 8, 2015 at 12:21 pm #

            No, but you can condemn drunken frat parties and call for action to reduce the preventable emergencies that arise from them.

          • Bugsy
            April 8, 2015 at 1:11 pm #

            If it’s a matter that they’re standing by waiting for this poor decision, then yes, I think there’s a big difference. We know that drunk-driving accidents can occur, and also that crimes happen. The difference is that generally speaking, people don’t call the EMTs and state “I might be driving drunk tonight and want you on stand-by in case I need your assistance.”

            I don’t think it’s fair to have everyone’s shared resources on stand-by for people who know that their poor decisions may necessitate them.

          • Daleth
            April 8, 2015 at 2:07 pm #

            I completely agree. There is no evidence that EMT’s do this at all–one random stranger on the internet coming to this forum and *claiming* that home births are somehow safe because EMTs know about them in advance and stand around on call does not make it *true* that EMTs do that.

            And I can’t imagine that they do, for the exact reason you and others state: it would be unfair (indeed, unethical) to everyone else in the community if EMTs stood around waiting, refusing to answer other calls, just in case a particular home-birth mom gets into trouble. It would be a complete waste of resources, too. EMTs are emergency responders–they respond to emergencies in progress–not babysitters paid to help prevent emergencies from happening.

          • The Bofa on the Sofa
            April 8, 2015 at 2:58 pm #

            There is no evidence that EMT’s do this at all–one random stranger on the internet coming to this forum and *claiming* that home births are somehow safe because EMTs know about them in advance and stand around on call does not make it *true* that EMTs do that.

            It’s like the claim a few weeks back that the “ER is prepared for an emergency transfer.” Um, yeah, that’s what ERs do. They are ALWAYS prepared for an emergency transfer.

        • Heather Rische
          April 8, 2015 at 1:43 pm #

          Meh, have had some EMT’s really not be much help. For example, a mom in very early (pretty much prodromal) labor with very nonreassuring fetal heart rate. (could happen easily to a woman planning a hospital birth as well, with no professional visiting her home to monitor baby) EMT’s are called for fastest passage to hospital, only to have them spend 20 minutes trying to get an IV in and not even registering the repeated pleas that MOM is fine, BABY needs to get out, now!

          • Daleth
            April 8, 2015 at 2:13 pm #

            Hi Heather, that sounds like an incredibly stressful, not to mention dangerous (for the baby), situation. But um… isn’t it an example of why home birth is more dangerous than hospital birth?

          • Heather Rische
            April 8, 2015 at 2:25 pm #

            As I said, most moms spend that portion of labor at home when planning to birth in hospital, so no. (considering no hospital staff drops by to monitor in early or prodromal labor)

          • Daleth
            April 8, 2015 at 2:28 pm #

            Uh, I don’t think the point is what phase of labor she was in. The point is that the EMTs spent 20 minutes ignoring repeated pleas that mom was fine but the baby wasn’t. Think that would happen in a hospital?

          • Heather Rische
            April 8, 2015 at 2:35 pm #

            I see what you mean, and I don’t think that exactly proves your point, as most women would not BE in the hospital yet… This happened to be a situation in which mom and baby were lucky that they chose home birth.

          • Daleth
            April 8, 2015 at 2:39 pm #

            Let me put it another way so it’s more clear. If she had been in a later phase of labor–say, whatever the first phase is that most women present to the hospital in–do you think the EMTs would have behaved any differently?

            What I’m trying to say is that it’s not because it was early labor that the EMTs were focused on her and ignoring the baby. It’s because they were EMTs. They can’t do much for fetuses. All they can do is provide medical care to the person in front of them–not the person inside her.

            So if people are planning a home birth with the hope that paramedics will come save their baby if things start going wrong, that hope is sadly misplaced.

          • Heather Rische
            April 8, 2015 at 2:46 pm #

            I agree. That hope is misplaced. There are several levels of EMT/paramedic and they are not all created equal. Some are great at neonatal resus, others, not so much. I haven’t personally had experience with home birth plans relying on EMT for anything but transfer. The midwives in a nearby town trained the paramedics in emergency birth at the community college for years.

          • moto_librarian
            April 9, 2015 at 12:40 pm #

            “There are several levels of EMT/paramedic and they are not all created equal.”

            Huh. What other profession do we know of that works this way?

          • Medwife
            April 8, 2015 at 3:06 pm #

            But you were already there. She had called for support, thinking she was in labor or about to be, right? A mom not planning a homebirth goes to the hospital when she feels she needs professional support. She would have spent a minimum 20 minutes on the monitor shortly after she walked in the door. There you go.

          • Heather Rische
            April 8, 2015 at 3:16 pm #

            It was actually a colleague, but yes, she came to check on them. Of course we can’t know what would have happened otherwise but one possibility is an IUFD at home if they didn’t go in because most women stay home in early labor (and are sent home at <3cm, which she was). Thanks for respectful communication, Amy apparently hasn't done her research on the CPM credential and is acting certifiably insane when challenged, so I gotta go.

          • Medwife
            April 8, 2015 at 3:29 pm #

            I know you’ve “disengaged” but any woman who comes in for almost any reason whatsoever is getting an NST. For rule out labor my patients are there for at least 1-2 hours, to determine if there’s cervical change happening. Monitoring obviously takes place. And if she goes from 2 to 3, I’d probably keep her, assuming she was amenable. This lady probably would have gotten proper care much more quickly had she not been planning a homebirth.

    • KarenJJ
      April 7, 2015 at 10:51 pm #

      I’m Australian. Homebirths are not common, even though they’re free if you meet the criteria and live close enough to the hospital. Most people want the reassurance of being much closer to medical care.

    • Bombshellrisa
      April 7, 2015 at 11:04 pm #

      In the UK, Australia and the Netherlands, Jill Duggar’s midwife would be unable to qualify to be a midwife. Midwives there do not learn by following a midwife around to people’s living rooms to watch a birth happen and call it midwifery training. The Netherlands has the worst perinatal mortality rates in Western Europe btw.

  23. ArmyChick
    April 7, 2015 at 10:00 pm #

    Home birth / Jill Duggar defenders…. I know you are all angry and butt hurt but I guarantee you that your anecdotal nonsense doesn’t stand a chance against science.

    Oh and one more thing: try checking your spelling before posting. It is very hard to take you seriously when half of your posts consists of misspellings and the other half consists of name calling.

    • Who?
      April 7, 2015 at 10:04 pm #

      All that.

      We’re missing FODBA today, don’t know where he/she is, perhaps girding the loins for a final, magnificent strike?

    • dbistola
      April 7, 2015 at 10:04 pm #

      I hate to get nasty but why, why oh why are most of these responses written SO poorly? I mean these commenters who are claiming to have an equal or better knowledge of birth than an ob, yet are fundamentally unable to type out a coherent thought. What’s annoying is not the fact that they write poorly (a lot of people do, due to a myriad of reasons, some very well could be out of their control), but the fact that they believe they possess so much knowledge, despite the fact that they write so poorly, or don’t seem to notice or care that they write poorly, are unable to spot their own deficiencies, and find it all so trivial.

      • dbistola
        April 7, 2015 at 10:07 pm #

        and the sad reality is, many people (not all) who cannot write well do not read well either. Yet a lot of these commenters consider themselves as well versed in complex medical literature that would fly over the heads of most people.

        • Mac Sherbert
          April 8, 2015 at 9:52 am #

          The saying in education is “writing follows reading.”

      • Cobalt
        April 7, 2015 at 10:09 pm #

        It’s almost as if they all had the same poor curriculum in school…

        • dbistola
          April 7, 2015 at 10:10 pm #

          or all responded in a similar manner toward their coursework (what? no, I don’t need to do that…)

        • Stacy48918
          April 7, 2015 at 10:13 pm #

          Maybe they also attended the SOTDRT (School of the Dining Room Table) like the Duggar kids….

          • ArmyChick
            April 7, 2015 at 10:15 pm #

            LOL I have no words.

          • Stacy48918
            April 7, 2015 at 10:17 pm #

            Glad you laughed, wish I could say it was original – It’s an inside joke from a Duggar snark site called Free Jinger.

      • ArmyChick
        April 7, 2015 at 10:14 pm #

        I came across someone calling this blog “rediculous”.

        My head spun.

        PS: English is my second language and I am cringing over here.

        • dbistola
          April 7, 2015 at 10:15 pm #

          Mine too! (admittedly, I was four or five when I learned English so that probably doesn’t count)

          • ArmyChick
            April 7, 2015 at 10:19 pm #

            Haha I was 15 🙂 I was born here but raised overseas after my parents divorce. I lived in a third world country for almost 15 years and when I see people arguing about home birth and how superior it is while demonizing c-sections and modern medicine I get angry. My youngest uncle died during a home birth in the boonies in Brazil. My grandparents couldn’t afford to go to the hospital to deliver him.

            I am so thankful for modern medicine for saving me and my daughter.

          • dbistola
            April 7, 2015 at 10:20 pm #

            Me too. I almost think that it is evil to make people suspicious of C-sections. We have the C-section to thank for so many people in our lives.

          • Stacy48918
            April 7, 2015 at 10:21 pm #

            Just like the anti-vaxxers…they have no experience with vaccine preventable diseases, so they don’t see the big deal. Go to the Philippines and see kids with measles and come back and say its no big deal.

          • KeeperOfTheBooks
            April 7, 2015 at 11:28 pm #

            Yup. As I’ve mentioned on here before, DH works in Africa for part of the year. He’s quite certain that if someone knew you were carrying the MMR vaccine through some areas of the country he works in, you’d get mugged for it. Everyone knows kids who died of measles there; it’s an epidemic.

          • Bugsy
            April 8, 2015 at 11:58 am #

            Crazy Lactivist told me last year that her husband wanted to move to the South Pacific for the _sole_ purpose of escaping toxins. I told her it wasn’t the best of ideas (although my gut response was much less PC). In retrospect, I should have encouraged them.

          • KarenJJ
            April 9, 2015 at 3:49 am #

            This was what first came to mind when talking about South Pacific and toxins. http://en.wikipedia.org/wiki/Moruroa

          • Bugsy
            April 9, 2015 at 11:21 am #

            I should’ve recommended it to them. The whole thing seemed odd to me…considering how paranoid they are about toxins, why would they want to move to the same ocean that has Fukushima spillage?

            (Heck, I live on the Pacific myself and realize how ridiculous it sounds…but that’s their world.)

          • SporkParade
            April 9, 2015 at 11:36 am #

            And now most people who can afford to in Brazil give birth by maternal request C-section. But let us listen to the natural birth advocates talk about how “native” women learn not to fear birth. ::eye roll::

        • dbistola
          April 7, 2015 at 10:17 pm #

          the most depressing one to me was the one someone referred to as a “self parody.” What a sad, confused individual, who seemed to have some hazy idea he/she was wrong but was unable to articulate on what or how
          : (

      • Who?
        April 7, 2015 at 10:19 pm #

        Are we talking about poor education or general sloppiness though?

        I think it is interesting that they think it is petty or doesn’t matter. So who cares about detail, so long as the big picture suits? This may give some insight into the attitude to medical things-don’t bore them with details, big picture it’s likely to be fine.

        Court cases are fought over the placement of a comma, and people die when details are not attended to.

        • dbistola
          April 7, 2015 at 10:24 pm #

          It is mostly the poor education, not the typos that most of us do. I would wager that most of them may believe that while their writing is far from perfect, that it is still understandable and coherent. I am sure that most are blissfully unaware of at least some of their shortcomings, and believe they are showcasing their strengths.

          • Who?
            April 7, 2015 at 10:25 pm #

            Now that is really depressing.

          • Jennifer
            April 8, 2015 at 1:01 am #

            And as you both are touting your obvious superiority in terms of English and proper grammar, I feel the need to point out that you BOTH ended sentences with prepositions. Tisk, tisk. Any high school English teacher would have a FIT over that one. Awful high and mighty, aren’t we? Yet, look how the mighty have fallen.

          • momofone
            April 8, 2015 at 1:02 am #

            I understand. I’d probably start focusing on prepositions too if I couldn’t produce any studies that show what I believed they did.

          • Jennifer
            April 8, 2015 at 1:07 am #

            I have produced many references; sadly, those in this thread immediately dismissive of them are also the ones showing their own ignorance while belittling others. Humorous, indeed, and quite ironic that you have no problem pointing out the lack of grammar skills of many who post here; yet you lack the basic grammar knowledge necessary to observe when you have ended a sentence improperly. Hypocrisy comes in many forms.

          • momofone
            April 8, 2015 at 1:07 am #

            So in other words, you couldn’t find any.

            Producing references is not the same thing as producing credible references.

          • Cobalt
            April 8, 2015 at 2:46 am #

            Well, the one was credible. Completely irrelevant, but credible.

          • KarenJJ
            April 8, 2015 at 2:16 am #

            And yet we still don’t understand how those references back up your claims? A hint here would be to go to those studies and read them and let us know how they back up your claims. Many people here do know their information very well and you are getting dismissed because it is obvious that you don’t.

            I recommend reading The Adequate Mother’s blog on the side bar for up to date and relevant information on epidurals (she’s a practising Anaesthetist).

          • Cobalt
            April 8, 2015 at 3:39 am #

            Oddly enough, your references were out of date, irrelevant, or lacked credibility. You show your ignorance of the negative ramifications of promoting natural birth, belittling those who use facts to make decisions about their babies and bodies.

            And yes, it is humorous and ironic that you are clinging to a GRAMMAR rule that doesn’t exist to try claim intellectual superiority.

            Define “hypocrisy”.

          • Stacy48918
            April 8, 2015 at 8:26 am #

            Hitting “copy – paste” doesn’t mean you understand what’s written in the link.

          • Who?
            April 8, 2015 at 1:04 am #

            What became of those studies?

          • Cobalt
            April 8, 2015 at 3:14 am #

            Waiting on the analysis of the death rate in the Birthplace study, too.

          • Cobalt
            April 8, 2015 at 3:18 am #

            I have more bad news for you.

            http://blog.oxforddictionaries.com/2011/11/grammar-myths-prepositions/

            From Oxford Dictionaries, on ending sentences with prepositions.

          • Who?
            April 8, 2015 at 3:57 am #

            But is that an approved textbook?

          • Ruby
            April 12, 2015 at 8:24 pm #

            It’s actually a myth that you shouldn’t end a sentence with a preposition.

            http://blog.oxforddictionaries.com/2011/11/grammar-myths-prepositions/

      • Medwife
        April 7, 2015 at 10:21 pm #

        The average American reads at about a 4th grade level, I’ve been taught.

        • dbistola
          April 7, 2015 at 10:27 pm #

          I taught Language Arts for years, and it does seem like a lot of people’s reading abilities get stagnant somewhere after reaching an elementary level.

          • Mac Sherbert
            April 8, 2015 at 9:47 am #

            Which why I in High School I read the entire Lit book during class then started bringing my own books. Thankfully, my teachers just let me be as long as I turned in assignments. I just don’t get why the reading level falls off.

  24. Ducky
    April 7, 2015 at 9:42 pm #

    I, unfortunately, got into a debate that I’m, frankly, on the fence about. I’m in Australia and I’m guessing we do this a bit different here. We have the option of a home birth experience within the hospital environment. Most hospitals here have suites set up like a home, and the parents have contact with the midwife during the pregnancy and birth. But should anything go wrong, the hospital facilities are down the corridor. This option is a choice, and the parents are informed and in total control of the experience.

    • The Bofa on the Sofa
      April 7, 2015 at 9:44 pm #

      And that isn’t bad, although you have worry about the ideology of the midwives, as the situation in the UK has shown.

    • Who?
      April 7, 2015 at 9:45 pm #

      So not a home birth at all then. Home birth lite.

      And why would you want to be in control of something you don’t know anything about. I’d be scared to death if I had to fly a plane or manage a birth, and any others involved would be smart to be scared.

      Leave it to people who know all about it, I say.

    • dbistola
      April 7, 2015 at 9:46 pm #

      even as it is, even with a hospital right near by, even with a perfectly healthy and strong mother, there is still a higher risk. Yes it is a choice, and this site does not advocate it being taken away, but that being said, I just don’t know why anyone (personally) would purposely elect a less safe option in something so important.

    • Cobalt
      April 7, 2015 at 9:50 pm #

      The problem is that the most important part of the experience (the healthy mom and baby) is beyond your ability to control. You don’t get to decide if you’re going to hemorrhage, or have a prolapse, or if your baby will tolerate labor well or fit through your pelvis.

    • Bombshellrisa
      April 7, 2015 at 10:27 pm #

      From what I understand about Australia, there are areas where homebirth is an option with trained midwives as long as you fit the criteria and it’s free. I don’t know anyone who has been able to do it because they were risked out.

      • Klain
        April 7, 2015 at 11:24 pm #

        A friend just posted on Facebook that a homebirth in Australia would cost them $6000.

        • Who?
          April 7, 2015 at 11:27 pm #

          Yes there are plenty of high charging cowboys everywhere. In cash, up front, no refunds, I’m guessing.

        • KarenJJ
          April 7, 2015 at 11:47 pm #

          That’s because they are going privately because they either:
          a) don’t live near a public maternity hospital that has a home birth program
          b) have been “risked out” of the public hospital home birth program.

          Homebirth programs are fairly rare, have strict criteria and are constrained to the local area around one of the big maternity hospitals.

          But they’re free, if you qualify and want to do it. Otherwise you can spend several thousand dollars on a private midwife.

          • Who?
            April 7, 2015 at 11:49 pm #

            I think that’s right-so they are either miles from anywhere or in unsuitable shape.

            What could possibly go wrong?

          • KarenJJ
            April 8, 2015 at 12:47 am #

            To be honest you don’t have to be miles from anywhere – just being 30 minutes from KEMH will risk you out of a homebirth so outer suburbs are out of range. I’m not sure of St George’s boundaries, but that would cover a small geographical area of Sydney.

          • Klain
            April 8, 2015 at 12:25 am #

            Tbh I was quite surprised there were any hospitals that had a homebirth program in Sydney. Apparently St George does.

          • KarenJJ
            April 8, 2015 at 12:43 am #

            Yeah, St George is one. On the other side of the country, KEMH does one in Perth.

          • Phascogale
            April 8, 2015 at 5:12 am #

            Melbourne has two. Sunshine in the West and Casey in the South East.

        • Bombshellrisa
          April 7, 2015 at 11:47 pm #

          Through the public system?

          • Klain
            April 8, 2015 at 12:24 am #

            No – that is if she went with a private midwife. She doesn’t live near a hospital that does the homebirth program.

          • Bombshellrisa
            April 8, 2015 at 12:26 am #

            Got it. I know that it’s hard to have access to the program if you are outside WA.

  25. Elizabeth
    April 7, 2015 at 9:31 pm #

    Wow. You obviously don’t know what CPMs do. They are highly trained. They are experts in natural birth. They are trained to recognize warning signs of complications. Doctors are extremely uneducated when it comes to natural birth. Sure, there are bad midwives out there, but there are also really good ones. For a normal, low risk mother, you and your baby are FAR more safe at home. Your chances of having a completely natural childbirth in a hospital are slim.

    • Nick Sanders
      April 7, 2015 at 9:31 pm #

      Go read some of her other entries then come back and say that again.

    • Stacy48918
      April 7, 2015 at 9:33 pm #

      So when a midwife “recognizes warning signs”, what then? They go running to the hospital because they don’t know what to do. Because they don’t have the training or the equipment. Because they are an inferior class of midwife.

      Have a SINGLE citation for your claim that homebirth is “FAR more safe”? Just one. Please?

    • Cobalt
      April 7, 2015 at 9:34 pm #

      What good is a midwife if they can’t help when you actually NEED help? Why not have someone useful in attendance?

      • Daleth
        April 8, 2015 at 10:57 am #

        Right!!! It’s not reassuring to hear, “If you need help, I and my ample training can pick up the phone and call 911.” A six-year-old can call 911.

    • Who?
      April 7, 2015 at 9:35 pm #

      Why would I want a completely natural childbirth? What is the benefit gained or the risk avoided?

      • Stacy48918
        April 7, 2015 at 9:37 pm #

        No kidding. Natural birth f-ing SUCKS!!!

        • Who?
          April 7, 2015 at 9:39 pm #

          Did it twice, went fine, but it did really hurt. I just don’t see why it is ‘better’, let alone so much better that I’d run any kind of risk at all to achieve it.

          • Stacy48918
            April 7, 2015 at 9:41 pm #

            Twice here too, hopefully never again. No thanks.

          • Who
            April 7, 2015 at 9:43 pm #

            Oh I think it would take a miracle for me to have another at this late stage, but I agree completely. Mine were when epidurals weren’t so developed, I’d have one as I walked in were things to ever go that way.

          • Stacy48918
            April 7, 2015 at 9:44 pm #

            I’d be open to another baby…but I’m getting a divorce now so I’d need another interested party first, haha. But yea, epidural the moment I walked in. That’s the way to go.

          • Who?
            April 7, 2015 at 9:46 pm #

            Get the pup sorted first!

            Epidural totally.

          • Stacy48918
            April 7, 2015 at 9:47 pm #

            Ha!

            Though I am dreading possibly potty training and house training at the same time….

          • Who?
            April 7, 2015 at 9:50 pm #

            Don’t go there. You are in charge. And would need way more than an epidural to get through that!

          • Cobalt
            April 8, 2015 at 12:12 am #

            Well, you’re already going to be going through a lot of towels…

          • momofone
            April 7, 2015 at 10:13 pm #

            If I had another, I’d see your epidural (spinal) and raise you a c-section.

          • Stacy48918
            April 7, 2015 at 10:16 pm #

            My problem would be timing/scheduling. My first came at 39.4, my second at 38.3. Second labor I went from 5cm to baby in 2 hours. I’d be worried either way – doubt I could schedule a C early enough to be confident I wouldn’t go into labor…and I’d worry I wouldn’t have time for an epi if I did!

          • momofone
            April 7, 2015 at 10:28 pm #

            I’ve only had one, and was never in labor (which was definitely not the plan, but in retrospect I highly recommend it!). I would schedule another in a heartbeat–but I can definitely understand your concern. My mother insisted that she was about to have my brother when she arrived at the hospital in labor, only to be put off by a nurse who assured her second babies didn’t come that quickly. Nineteen minutes later he was born and my mother had a new nurse.

          • Who?
            April 7, 2015 at 10:30 pm #

            Same happened to my mum.

            Except the doctor stitching mum up made the nurse stay while he told her off and talked through what he was doing and how things might have been done better, perhaps to make it clear to her that when a second time mum says ‘baby’s coming’ she had better believe it.

          • Who?
            April 7, 2015 at 10:22 pm #

            It’s funny that never crossed my mind. Knowing everything went really well, I wouldn’t choose surgery. But not knowing the outcome, and knowing I wanted a small family, a cs might well be a sensible choice.

          • momofone
            April 7, 2015 at 10:42 pm #

            I didn’t want surgery. I hate to think how close to woo-ish I might have been in terms of wanting natural all the way, but a BPP at just over 38 weeks showed a lot of placental calcification, and I was nowhere near dilating, so we opted for the surgery. It gives me chills to think what could have happened if I had insisted on waiting; after my son was born, the doctor said the placenta was much worse than he’d expected. If we’d had another, I’d have needed another c-section (I had a classical incision), but I had a great experience and would have been glad to schedule it.

        • Cobalt
          April 7, 2015 at 9:43 pm #

          I liked mine. Had three, each in a different hospital. Everything went fine till the placenta wouldn’t come out at the last one, at which point the medical team stepped in and resolved the issue before I had the chance to really hemorrhage.

          At home, I may well have died.

        • Bombshellrisa
          April 8, 2015 at 12:24 am #

          Now now, you just didn’t trust birth enough! (Good to see you Stacy, I was starting to get worried when I didn’t see you here)

          • Stacy48918
            April 8, 2015 at 8:21 am #

            Thanks for the concern. Life’s been good but crazy. Also, I’ve been reading and more active over on some of the FB groups. Been missing things over here. 🙂

          • Bombshellrisa
            April 8, 2015 at 12:21 pm #

            I have been on the FB pages too-the Real Birth group has really been active

        • CharlotteB
          April 8, 2015 at 1:55 am #

          If I have another baby, I’m going to handcuff myself to an anesthesiologist at week 35.

        • NoLongerCrunching
          April 8, 2015 at 5:53 am #

          Personally, I liked my natural births. But I respect that different people like different things. I used to judge women who chose c-sections simply because they wanted to. But then I realized that given that I am pro-choice about pregnancy, it would be pretty hypocritical to pressure women into vaginal births if they didn’t want them.

      • Jennifer
        April 7, 2015 at 11:07 pm #

        Why would you want a completely natural childbirth? Because it is the BEST OPTION for you and for your baby! Because of the pain of labor, your body produces certain hormones which cross the placental blood barrier into the baby and actually help PREPARE the baby for the grueling task of descending into and through the birth canal. The baby’s body CANNOT produce those hormones by itself; it relies on the mother’s body to give produce them. No hormones, harder birth on the baby. If you have an epidural, you don’t produce those hormones, because your pain receptors are “turned off” [drugged], and your brain receives no “instruction” from them to produce the hormones in question. Not to mention the inherent risks of spinal epidural and other types of pain medication during labor and delivery to both mother and baby; look up the statistics of how many children and birthing mothers have DIED from that alone. If you’re SO SURE that science is on your side, why not listen with open ears [and an open mind] to the research from those saying natural birth is better? Or are you afraid – deep down – they are right??? Watch “The Business of Being Born” [or its sequel], or any similar documentary, and then reconsider your “science”. If you’re right, no harm done; at most, you’ve lost an hour or two watching those documentaries. But if there ARE scientific studies – if there IS scientifically valid evidence you could consider, perhaps you should do so?

        • momofone
          April 7, 2015 at 11:10 pm #

          Are you seriously coming here and suggesting that The Business of Being Born is a legitimate scientific tool?

          • dbistola
            April 7, 2015 at 11:12 pm #

            My God yes. It happened.

        • dbistola
          April 7, 2015 at 11:11 pm #

          I would say that at the very, very, very least, your sources are deeply flawed. You are clearly in over your head here. Please spend the next few hours looking over this site. All of the information you bring up is addressed in layman’s terms for you and for me to understand, and you will find quite a different story from what you’ve been told about hormones, epidural risk, etc.

        • momofone
          April 7, 2015 at 11:22 pm #

          Interestingly, the magic failed somehow for us, and my body was actually not the best thing for my son. The placenta had already broken down significantly long before I ever started to dilate. Are you saying it would have been better for me to let him slowly suffocate in order to have a “completely natural birth,” which would have been followed by a completely natural funeral?

        • Stacy48918
          April 7, 2015 at 11:24 pm #

          Please name one specific hormone to which you reference.

        • Stacy48918
          April 7, 2015 at 11:25 pm #

          And what specifically are the stats for epidural deaths? Clearly if you’ve done your research it should be easy for you to cite that for us.

        • Who?
          April 7, 2015 at 11:26 pm #

          Until the baby is too big; until mum’s blood pressure goes through the roof, until who knows what else.

          Show me the numbers of dead mums and babies from epidurals and sections.

          I had two natural deliveries, both went well. Neither I nor my children are defined by those experiences.

          Fetishising something over which you have no control is grotesque.

        • Cobalt
          April 7, 2015 at 11:29 pm #

          What if my labor is naturally painless and orgasmic? Do the hormones still work?

          • Jennifer
            April 7, 2015 at 11:53 pm #

            I assume you are referencing the “orgasmic birth” movement? It’s a fascinating concept, granted, but one with which most women will never have any experience. The ability to achieve such a birth is directly proportional to the ability a woman has to attain [and RETAIN] a sense of profound calm during labor. An interesting thing happens here: the calmer the laboring mother, the more her body produces endorphins [our body’s natural pain-killers, as I’m sure you know]. Our biggest “endorphin high” is often orgasm – hence “orgasmic birth”. The curious thing, however, is that the hormones I referenced above are STILL produced – because the nerves are STILL “firing” and sending messages [“cue production of hormone cocktail – STAT!”] to the brain; the trick is, the mother is on such an endorphin high, she doesn’t REGISTER the pain as much in her conscious mind. As I said – a fascinating concept, and one which I feel warrants further study. Although I have a sneaking suspicion you might not find many women who can actually achieve the level of calm necessary for this kind of birth WHILE being “studied”! LOL

          • Cobalt
            April 8, 2015 at 12:04 am #

            Actually I think “orgasmic birth” is merely a misunderstanding of the sudden decrease in pain and pressure when the baby is finally out. It feels (relatively) very good compared to the moment before.

            Midwives, doulas, and childbirth educators have since tried to establish it as a marketing tool, but it’s basically just like finally taking off a shoe that’s 3 sizes too small, after running a marathon.

          • Jennifer
            April 8, 2015 at 12:21 am #

            In actual fact, the “orgasmic birth” movement speaks to the concept of having a totally enjoyable labor and birthing experience – from the first contraction to the cutting of the umbilical cord. Anyone who says “orgasmic birth” is about the moment of “release” when the baby is actually out [completely] of the birth canal is sadly misinformed as to the meaning of the idea, as a concept. Interestingly, this concept was initially developed overseas in Russia and neighboring countries; it is not the product of the overactive imaginations of United States midwives, doulas, etc. Neither my midwife nor my doula attempted to make me think an “orgasmic birth” was possible; quite the contrary! They each did their best to establish firmly in my mind the reality of the pain I would endure, and to give me the best possible mental and physical techniques for processing that pain during labor and delivery. My son’s birth last October was not “orgasmic”, by any means; I remember every twinge, jolt and rip of pain – EVERY. SINGLE. ONE. That said, I somehow kept it in perspective, with the goal of his birth in my sights. Mental and physical preparation before the event made the endurance of the pain much more manageable. Of course, this is my own personal experience, and merely anecdotal.

          • Cobalt
            April 8, 2015 at 12:25 am #

            The USSR was big on going without pain relief, they had to sell it somehow.

            Epidurals allow almost everyone to have a totally enjoyable labor and birthing experience, no gimmicks or Jedi mind tricks required.

          • Jennifer
            April 8, 2015 at 12:31 am #

            Hope you take the time to review the link I just posted – and all its 119 references. Perhaps it will answer some of your objections better than I am able. In case it got buried in the thread, I’ll post it again here: http://sarahbuckley.com/epidurals-risks-and-concerns-for-mother-and-baby

          • Cobalt
            April 8, 2015 at 12:33 am #

            See above.

          • Bombshellrisa
            April 8, 2015 at 12:34 am #

            Sarah Buckley? Edited: Sarah Buckley is not an OB, CNM or anesthesiologist, so I cannot accept her as an authority. Also, meant this for Jennifer and not Cobalt

          • Who?
            April 8, 2015 at 12:34 am #

            Answering that in this context could be construed as unkindness.

          • Jennifer
            April 8, 2015 at 12:38 am #

            If you take umbrage with the reference to Dr. Buckley, you most certainly cannot take umbrage with EVERY one of the 119 references she uses. Have you checked ALL of those references to be sure they are ill-advised and scientifically inaccurate? I would sincerely like to know if you have done so, as it would show your own sincerity in saying you are open to the truth.

          • Cobalt
            April 8, 2015 at 12:40 am #

            I would rather get a list of references from a trusted source and spend a lot less time having to start over because their references were total crap.

          • Nick Sanders
            April 8, 2015 at 12:41 am #

            Yeah, the Gish Gallop is super annoying.

          • Cobalt
            April 8, 2015 at 1:20 am #

            She’s trying to send me hunting oranges in an apple tree while I’m busy shooting fish in a barrel.

          • Jennifer
            April 8, 2015 at 12:41 am #

            So, in your estimation, studies published in peer-reviewed medical journals are “total crap”? I ask as there are many listed in those 119 references.

          • Cobalt
            April 8, 2015 at 12:46 am #

            If a 30 year old study on which hormones trigger labor is used as a reference for epidurals having a negative effect on fetal heart rate, then yes.

            Even if the data is good, if it is mislabeled, misapplied, misconstrued, or just plain irrelevant, I’m not sorting through all of it to try to prove someone else’s (false) premise.

          • theadequatemother
            April 8, 2015 at 12:42 am #

            Since you are so well versed in the research how about you reference the specific study that you feel supports your view that pain protects the fetus from stress during labour. And you could also enlighten us as to why the study’s methodology controls for various forms of bias and what the statistical and clinical significance of the results is. Afterall you claimed to be educatd in this area. I am hoping to be educated too. Please teach us.

          • Daleth
            April 8, 2015 at 10:54 am #

            The main form of birth control in the USSR, aside from abortions, was diaphragms made of METAL. Is this seriously the country from which we’re going to take childbearing advice?

          • Who?
            April 8, 2015 at 12:31 am #

            I think you are underestimating the overwhelming effect a good outcome has on your outlook.

            My birth plan was one line-baby healthy, me healthy. I had two natural, normal deliveries, hurt like the Dickens, well supported by hospital midwives, go to whoa in six hours. Babies were great, I was great. Our of hospital inside 12 hours both times. I was lucky it went well.

            Out of my pregnant friends, one had a similar experience to me with a much smaller baby, one had a massive complication at the moment of delivery requiring surgery, one had a 36 hour labour, failed epidural (this was back in the day), and there were two pretty emergency sections.

            I was lucky. Not better prepared, not healthier, not younger, not better at coping with pain, just luckier.

            You don’t see it, but you were lucky. You did what you thought was the prep, and you are gloating over the reward, your normal delivery.

            Confusing luck with good management is a particularly unattractive form of hubris.

          • Jennifer
            April 8, 2015 at 12:36 am #

            “A particularly unattractive form of hubris”? Whew! So glad I don’t have to worry over whether or not any facet of my life or person is “attractive” to YOU! Lucky, eh? Hmm. Ok. Like athletes who train for the Olympics are “lucky”when they win gold. Right. My OB [yes, I had an OB, as well as a midwife] actually told me the SAME THINGS my midwife did in regard to preparation for labor. Funny how you’d likely accept the advice if it came from her, [female OB], but NOT from my midwife or doula?

          • Cobalt
            April 8, 2015 at 12:42 am #

            Here’s the thing. It doesn’t really matter if you prepare for labor. It’s going to do what it’s going to do, no matter what you do.

            THAT is surrendering your ego to nature.

          • Who?
            April 8, 2015 at 12:44 am #

            Yes, lucky. You don’t see it, that’s okay, you haven’t lived long enough yet to experience doing everything right and things still going wrong.

            Where’s the choice if they were telling you the same thing?

          • Jennifer
            April 8, 2015 at 12:51 am #

            I haven’t lived long enough? Who are you to assume you know how old I am, or what life experience I have had? NOW who is exhibiting a “particularly unattractive form of hubris”? I have, in fact, been in just that situation: one in which you do everything right, and things still go wrong. It was still my choice to prepare as advised, or not to prepare; just as it is the choice of the athlete to practice their sport before the Olympic games or not. I’d wager no one would be telling the athlete NOT to practice, but to rely simply on luck.

          • Who?
            April 8, 2015 at 1:30 am #

            No, Jennifer, that was arrogance on my part, not hubris, but thanks for playing. Perhaps pull out that textbook you were using for definitions and study it a little more closely.

            And the athlete analogy is wrong. In a test of speed, strength or skiil, practice and training can make a difference.

            Labour is not about mum’s speed, strength or skill. The skill of her attendants can be critical, but labour is happening regardless of her preparation, and won’t go decisively better or worse on a given day based on that preparation. Like you, mum may feel proud of what she achieved, but it’s actually pretty hollow when you break it down.

            If you and baby were well, the rest is window dressing.

          • Jennifer
            April 8, 2015 at 1:38 am #

            I actually mis-used the word intentionally, as you did. Interesting that you apparently wear the badge of arrogance with pr