What has the natural childbirth industry done to reduce mortality rates? Absolutely nothing.

ZERO written on chalkboard

I’ve often written that the natural childbirth industry (midwives, doulas, childbirth educators, businesses like Lamaze, and lobbying organizations like the Childbirth Connection) is obsessed with process, in contrast to modern obstetrics, which focuses on outcomes.

Simply put, how your baby is born is more important to the natural childbirth industry than whether your baby is born healthy and whether you are healthy.

There are several reasons for this:

  1. The natural childbirth industry makes money from a specific mode of childbirth (unmedicated vaginal birth), so profits depend completely on promoting that mode as superior.
  2. The natural childbirth industry is profoundly ahistorical and lacks basic knowledge of medicine. Childbirth is and has always been, in every time, place and culture, a leading cause of death of young women and the leading cause of death of babies. Most members of the natural childbirth industry appear to be utterly unaware of this basic reality. They labor under the misapprehension that birth is inherently safe and always has been.
  3. The natural childbirth industry bears no responsibility for birth outcomes. If you refuse interventions because your doula told you to do so, and your baby dies as a result, the doula is never held accountable, legally or financially, for the tragic outcome.

These reasons explain the most critical difference between modern obstetrics and the natural childbirth industry: Modern obstetrics is always seeking to lower the maternal and perinatal mortality rates, and the natural childbirth industry thinks the current level of maternal and neonatal mortality is low enough.

Obstetricians seek to lower the maternal and perinatal mortality rates; the natural childbirth industry thinks they’re low enough.

It’s not that the natural childbirth industry is unaware of contemporary maternal and perinatal mortality rates. They follow them assiduously and are quick to exploit the tragedies of maternal and perinatal mortality (particularly among women of color who suffer disproportionately) in order to promote natural childbirth. The “reasoning” seems to go something like this: if modern obstetrics can’t guarantee the lowest possible mortality rates then you might as well pay for the goods and services of the natural childbirth industry who couldn’t care less about ensuring the lowest possible mortality rates.

Don’t believe me? Ask yourself this: What has the natural childbirth industry done to lower mortality rates?

Absolutely, positively nothing!

They spend a lot of time prattling about maternal satisfaction and the birth experience, but I’m not aware of any action they have undertaken in the past 50 years to improve outcomes. They imply, and possibly believe (despite a complete lack of scientific evidence) that unmedicated vaginal birth is somehow safer than birth with interventions, and that’s good enough. They don’t look at mortality rates among their customers; they don’t care about mortality rates among consumers of their goods and services; and they certainly aren’t going to let a little thing like dead babies interfere with making money from their philosophy.

Where is the natural childbirth industry research funding for efforts to lower mortality rates?

There isn’t any.

Where are the techniques created and promoted by the natural childbirth to save lives?

There aren’t any.

Where are the drills practicing life saving maneuvers specifically designed for the service providers of the natural childbirth industry?

They don’t exist.

Where are the goals for lowering maternal and perinatal mortality?

Surely, you are joking. As far as the natural childbirth industry is concerned profits are derived from healthy women; women who have complications can be dumped on obstetricians and forgotten.

Don’t get me wrong. There is plenty of room for improvement in modern obstetrics, BUT (and this is the critical point) obstetricians are working EVERY day and in EVERY way to do better than they’ve ever done in the past, both in terms of the provision of services and perinatal and maternal outcomes.

The natural childbirth industry is doing NOTHING to improve perinatal and maternal outcomes because they don’t care about outcomes. They profit from process and that’s all they care about.

The natural childbirth industry thinks current levels of mortality are good enough and that is a scathing indictment of their business model.

They want your money. They want your choices about birth to mirror their own choices back to them. They want you to hire them and buy their goods and services.

But if your baby dies, or you die, they couldn’t care less. They won’t lift a finger or forgo a penny of profit to prevent it.

  • Aaron Baker

    Totally do not understand what to say something
    ______________________________________________
    I’ll give you recommend a game: FIFA Münzen

  • JellyCat

    My friend is under impression that if she didn’t have a doula attending her hospital birth, her baby would die, because she would require emergency c-section. With doula help she was able to have an operative vaginal delivery. This sounds so crazy to me that I don’t know how to react to this. This makes me sick and sad.

    • The Bofa on the Sofa

      Yeah, and who taught her all this bullshit?

      • JellyCat

        I’m assuming both, midwifes and doulas. She is a rational person and wanted to have a hospital birth as it is safer. This was a great decision of course except that health care providers were not ideal.

        • The Bofa on the Sofa

          She is a rational person

          My friend is under impression that if she didn’t have a doula attending her hospital birth, her baby would die, because she would require emergency c-section.

          Sorry, those two sentences are not compatible. The second statement is not rational at all.

          • JellyCat

            I agree, but they worked to convince her real good I’m assuming. She is educated and rational in other aspects 🙂

      • JellyCat

        My friends story is exactly what they natural childbirth industry has done. They convince their clients that without them the baby would be dead. When in reality, the baby was delivered by the OB without any complications and need of resuscitation.

    • sdsures

      If it was the idea of havig a second support, non-medical person there who could attend to her psychological needs, that might make sense. It would free up the L&D nurses for any medical issues.

      • JellyCat

        The idea might be good, but the execution isn’t.

        • sdsures

          How come?

      • JellyCat

        Actually, we have people in the hospital who assist patient and are not nurses. They are called health care assistants 🙂 so if L&D ward would have some of them available at all times, it would achieve axactly that.

    • Anna

      Sounds so absurd indeed… Operative vaginal delivery, isn’t that a lot more traumatic both for mother and baby? I read about a woman whose bladder was injured by forceps so badly she had to go around with a catheter for months. However, for some it’s vaginal delivery at all costs and that’s all that matters.

      • JellyCat

        I think she was under impression that c section is very traumatic and dangerous and that they wouldn’t have the time to do it, so baby could end up with anoxic brain injury.

        • Anna

          Maybe she thought c-section was like in the old days from chest to bottom with crude stitches and under general anesthesia… Wouldn’t be surprised, some people DO still think so.

          • Roadstergal

            And it’s a good thing those doulas and midwives she was getting her information from disabused her of that notion, and gave her more accurate information about what to expect if a C-section starts to look like an option…

            …right before the pigs flew out of their rears…

          • JellyCat

            I’m a health care professional, but I have nothing to do wit L&D. I was present during vacuum assisted delivery once and that looked incredibly traumatic to me. I would personally rather consent to the c-section. I’m not sure if that was an option, but it is just my opinion.

      • JellyCat

        Thankfully she didn’t need forceps. It looks like the use of for forceps is relatively rare in that hospital and vacuum is a lot more common.

  • Anna

    I have read a really absurd article from the NCB lately. They claim that as long as approximately a third of today’s younger population are c-section babies, the world is dealing with so many problems, i. e. incapacity to love, perverted relationships, etc. They then go on to claim that people who came into the world straight out of their mother’s belly are more aggressive, lack empathy and are basically selfish because they avoided difficulties in transiting vagina and therefore think that the whole world is there to please them and fulfill their desires. Bingo! The cause of major wars, terrorism and all sorts of human-inflicted cataclysms has been detected! The evil c-sections! Indeed, there have been no World Wars before the twentieth century, when c-sections began to be practiced on live mothers! So now we know what this evil derives from! (sarcasm) No wonder these nutties couldn’t care less for babies’ lifes. They truly believe (or persuade their customers to believe) that by performing a c-section they are letting out a new potential Hitler or something. So yes, little do they care about infant mortality! Their target is only for those babies to live, who can be born the “correct” way, because according to them being born vaginally is the only chance to become a normal person in future.

    • Amazed

      But Hitler was born vaginally! Most dictators in history were born this way. I’m quite sure that was even the case of Attila the Hun!

      We’ve determined the cause of wars: natural birth leads to wars.

      • Anna

        Perhaps their mothers failed to breastfeed them properly, that’s another major cause of all evil, ahahah) However, there was no formula back then… Oh, I got it! Their mothers did not co-sleep with them, that’s why they grew up such evil people, being deprived of maternal warmth as infants. Genes, upbringing, relationship between parents, environment, financial status have no impact on what sort of person you grow up. It’s just the way you are born/nursed/nourished (sarcastic)

        • Amazed

          Well, let’s not flatter ourselves unduly. It isn’t as if it was some great secret. Breastfeeding bullies aren’t exactly discreet about it. Look at how they define themselves: mommy WARRIORS, breast WARRIORS, FIGHTERS for their births (funny, I thought it was their children’s births but I’m just naive this way). What would you expect but warlike offspring?

          Natcherels are like that stale joke: A man was walking through a desert. Dragging himself through a desert. Dying in a desert, you get the gist. And then – oh joy! A well! He geared himself up and headed to it. But alas, there was a dragon nearby, sitting comfortably and cleaning his scales. The fellow summoned the last bit of his energy and started fighting the dragon. They fought for hours, to no end. And then, the dragon asked, “Well, WHAT do you want?”

          “I want to have some water!” the fellow said, and the dragon gave him a look of surprise.

          “Well, then have it! Why are you fighting instead?!”

          Doesn’t it sound like a NCB in a hospital, ready to fight evil enemas and vile shaving?

          • Anna

            I rather wonder why they are so upset the shaving (or requirement to be shaved). It seems they see everything as an assault to their dignity. I wonder if they have some profound issues with self-confidence and being assaulted, like former targets of bullying at school or victimes of home violence? They are so defensive when noone means to offend them.

          • Amazed

            I am curious. I want to know if they’re this dumb for real. A third of the young generation is being born by a c-section… lovely. The USA is not the world. Do you think they know it? Because I can name a dozen countries where a good deal of the young generation dies before being born… for the lack of ability to do a c-section.

          • Anna

            It’s not just the US. I leave in Eastern Europe, the same here. About 40-60% of c-sections, because doctors prefer them to instrumental vaginal deliveries.

          • Amazed

            I knew from one of your previous posts that we were neighbours – you, I, and yugaya here.

            It isn’t this terrible here, compared to the people who have it really, really bad. There are many countries that don’t do c-sections to all women who need them – and usually, they don’t do instrumentaI vaginal deliveries there either, for the same reasons. Jeevan’s blog here, on the blogroll, is telling. I, for one, am quite happy that my friends (I do not have children yet) can have their babies via c-sections, instead of more risky instrumental vaginal deliveries (I was one such, by the way. Yay for vacuum!) when needed or worse, being left to die under a tree because they weren’t fit enough for nature.

          • KeeperOfTheBooks

            Vaginal births in the US haven’t required shaving for, well, decades. C-sections, it’s going to depend on the incision type and the mom’s pubic hair line; I had to have some shaving to keep the field clear, and itchy/annoying as the regrowth was, I’ll take itchy/annoying over infection due to a less-than-sterile surgical field any day, thankyouverymuch.
            It’s rather pointless for vaginal births, and just leads to the aforementioned itchiness with the potential for ingrown hairs–therefore, as I said, it hasn’t been used in decades.
            In a recent comment in another thread, someone mentioned that there’s an increased push for the medical establishment to re-evaluate their current model of practice and see what can give without compromising mom and baby’s health. For example, having comfortable, homey rooms for mom and baby to stay in aren’t going to have an adverse effect, and they make everyone happier, so hospital rooms are looking more like comfy bedrooms than before, but with life-saving equipment (oxygen, suction, etc) behind panels behind the bed, easily accessible in case of emergency. Before it became evident that I’d need a c-section, I wanted to labor while wearing my own clothes. My OB was fine with that as long as I understood that they’d probably be pretty messy at the end, and in case of an emergency might have to be cut off. I understood that, and accepted it. Etc. There’s nothing wrong with compromising on the non-essentials, and I think it’s a good thing that the medical establishment is willing to do so. Now, if the NCB types could just follow their lead…

          • Ash

            Also, now they are using clippers rather than a safety razor .

          • Roadstergal

            “I’ll take itchy/annoying over infection due to a less-than-sterile surgical field any day”

            Okay, so now you’re making me think. When I had my surgeries, I rinsed with chlorhexidine the mornings of (I know the data is iffy, but I think noncompliance is a big issue, and I was compliant). Do they do something similar for C-sections? There are so many reasons I can see a planned prelabor C-section having better outcomes than an emergency/crash one, and now I’m adding ‘sterility’ to that list – getting a sweaty, exhausted woman cut open in a hurry to save a dying baby, vs a leisurely prep of a rested, clean woman…

          • Michele

            For my planned C-section, they gave me a surgical rinse to shower with the morning before, evening before, and morning of. I only ended up using it once though since I went into labor and my C-section ended up being a day earlier than planned. I can’t remember if it was chlorhexidine but I think it was. They also clipped the hair rather than shaving.

          • Dr Kitty

            The patient leaflet here advises women not to shave their pubic hair, and that the nursing auxiliaries will clip it for you prior to a planned CS.

            However, I do not enjoy itchy re growth, and rarely get ingrown hairs, so I epilated my bikini line, which is what I usually do.

            From the way the auxiliary asked “do you need me to do a wee trim, or did you sort it out yourself love?” I get the feeling that most women here ignore the leaflet and arrange a bikini wax prior to their elective sections.

            Since my old scar was excised completely and I have sub-cut sutures and steristrips, I’m pretty happy I opted against the clippers. Stubble and steristrips is not a good combo.

            I’m allergic to chlorhexidine, so i don’t do any pre-op prep other than soap and water, and they use iodine for me in the OR.

          • An Actual Attorney

            For my planned CS, I didn’t get any rinse. I went to the spa the day before and got a brazillian and a pedicure. From both what the waxer said and the nurse at the hospital, I think the spa trips were pretty common before a CS, or even a vaginal birth for women who just wanted to be “neat.”

          • KeeperOfTheBooks

            I don’t know how all docs handle it, but mine had me shower with Hibiclens, which I think it chlorhexidine, for three days pre-surgery. I imagine that’s fairly mainstream.

          • sdsures

            I thought hibiclens is woo? I’ve seen it discussed on NCB pages.

          • Mishimoo

            Its only woo when used for things it shouldn’t be (like vaginally, for GBS colonisation). It’s a pretty useful antiseptic/antimicrobial when used correctly.

          • KeeperOfTheBooks

            Not woo-y at all; it’s used as a pre-surgical scrub for surgery staff in some hospitals. Here’s the PDR article on it: http://www.pdr.net/drug-summary/hibiclens?druglabelid=2708
            Where you might be associating it with woo is that some NCB types will insist on using it rather than antibiotics in the case of, say, Group B Strep or ruptured membranes. Because anything, of course, is better than the eeeeeeevil antibiotics or Pitocin or IVs.

          • Anna

            In my country shaving is obligatory and so is the absence of nail polish on hands and feet. And I completely understand why. Any perfectly normal, beatifully progressing labour may turn into c-section any moment as soon as the baby or the mother is in distress. So if a woman has pubic hair, I wonder what are they supposed to do if the operation needs to start NOW? Shave in haste? Cut above the pubic line? Now, I totally understand that a woman does not feel at ease when giving birth, but these requirements are not the whims of the OBs, they contribute to safety and sterility.

          • KeeperOfTheBooks

            Here, at least in the hospital where I volunteered, acetone (nail polish remover) wipes are standard cart supplies. We’d have women come in with nail polish, and we’d swipe it off one finger/toe to get a good pulse ox reading. Took a couple of seconds, no issue.
            Similarly, shaving can take seconds. It’s probably partly a cultural thing here, too. I mean, we don’t make guys shave their chests before going in for surgery, either, though of course we do for planned open-heart stuff. Also, shaving does contribute to a minor increase in certain types of infections when women birth vaginally. Lastly, as it used to be practiced, the whole genital area was shaved, which is both unnecessary and can lead, as I said, to more infections while having no affect on C-sections (I mean, why would the labia majora need to be shaved for a C-section? That’s one odd section, if so…); for even those of us who are fairly *ahem* fuzzy, an inch or two down from the bikini line is really all that is required even for a planned C-section.

          • KeeperOfTheBooks

            I just realized you aren’t in the US, so I’ve no idea how hospitals handle births in your country.
            One thing I will say about women in labor is that they are rather emotionally vulnerable at that point, and understandably so. Women in labor often aren’t quite sure what to expect, and their body is doing just plain weird and sometimes frightening stuff. Having rude, abrupt, or uncaring staff during, say, a mole removal is irritating. Having the same treatment during labor, especially since labor inevitably involves very personal areas of the body, can be traumatizing. Vaginal exams by someone who is rude and not at all gentle are unpleasant at best when you aren’t in labor; when you are, they not only hurt a lot, but they add that layer of violation to the whole business even though such exams are quite necessary.
            In short, relatively small things can become a much bigger deal when you’re in labor, and understandably so. Shaving could be seen as being a sort of final indignity: you’ve shoved your hands up my vagina while being rude about it, you’ve treated me dismissively while I’m scared and in pain, and now you’re changing the way my genital area looks, often for little reason.
            Mind you, I’m anything but a NCB apologist, but they do have a few things right. Problem is, at least in the US, that they’re basing all their decisions on things that mostly just don’t occur here anymore. L&D staff are usually hand-picked to be good at their jobs and supportive of families; OBs generally don’t go into that line unless they genuinely like dealing with moms and babies; and hospitals are becoming warmer, more friendly places overall. Practices that used to be common (shaving, forced enemas, required lying on one’s back, etc) are nonexistent now. You wouldn’t know it to listen to an NCB type, though.

          • Daleth

            In perhaps more cases than you might think, they are past victims of sexual assault or rape. It’s horrifyingly common. Of course, many women who have that trauma in their past elect to give birth by cesarean, precisely so that childbirth won’t trigger those emotional wounds.

          • sdsures

            BT;DT. Because of sexual abuse when I was a kid, I am unable to have a regular Pap smear; not only because of the psychological distress, but also the physical component. I have primary vaginismus. There’s just no getting any kind of speculum in there. When I had some abnormal bleeding last year and my GP recommended a Pap, I suggested putting me under general anesthetic and getting it done that way. I know it’s extreme, but I believe the situation warranted it, and eventually I made my case to an OBGYN successfully. Everything checked out fine, except that now I have a dx of PCOS.

          • Daleth

            I’m sorry you went through that! Wishing you healing. And good luck with getting the PCOS taken care of.

          • sdsures

            Thanks. It’s not causing me any bothersome symptoms at this time, so I guess we just go along as normal.

      • Daleth

        Not only was Hitler born vaginally, he was even breastfed. (So we can assume, since otherwise he wouldn’t have survived.) The same is true of Goebels, Goering and every other Nazi. Not to mention Jack the Ripper.

        • Roadstergal

          He can’t have been breastfed. His mom died of breast cancer, and everyone knows that breastfeeding is 100% protective.

        • DelphiniumFalcon

          Funny thing about Hitler. He definitely didn’t lack for bonding with his mother. If he could have elevated her to the station of Goddess of Germany he probably would have.

          How much did her love her? When she diagnosed with terminal breast cancer and there were no other treatment options, Klara’s Jewish doctor offered a very primitive, very painful chemotherapy treatment. She died anyways. He should have been first on Hitler’s “kill all Jews!” list, right? Wrong. Hitler was so grateful to the doctor for even attempting to save his beloved mother that he allowed the doctor to immigrate to Amercia and escape the Holocaust. Hitler also had portraits of his mother in his private rooms in his bases.

          News flash to the natural nutters: Even vaginally born, breastfeed bad guys love their mamas.

          • sdsures

            Have you seen a movie starring Robert Carlisle called “Hitler: The Rise of Evil”? It has the story of what happeed to Adolf’s mother, who is played by Stockard Channing. Carlisle is spot-on.

          • DelphiniumFalcon

            Ooo that does look good! I’ll have to go find it.

            To be honest at the risk of sounding really weird, Hitler as a person fascinates me.

            It’s easy to paint his as a caricature of all evil but that is what allows those that come after Hitler that could be equally as dangerous to rise to power the same way he did if that’s all you know of Hitler’s life.

            He wasn’t completely evil as to reduce people to good or evil leaves out the human element. He wanted to be an artist. Not just a painter but he loved opera as well especially Wagner. The pagentry you see in the Nazi paraded and films are a great example of him applying themes from opera and theater to gather and then keep the attention of potential supporters.

            He loved animals probably more than people. Eva was actually jealous of how well Hitler treated Blondi, his German Shepard dog, and used to kick her when she could get away with it. I don’t think it’d be a stretch to say that Hitler probably loved Blondi more than Eva. With the footage that’s being found if you didn’t know what Hitler looked like, you’d see a man who lavishes attention on this very well cared for dog like many today dote on their “fur babies.”

            His speeches lose something when we can’t understand him so we see him as a raving lunatic. But if you read the translations of his early speeches when he was trying to amass support, he’s a patriot, a man who wants to provide for the people of Germany, and man with so much love for his country that it bursts forth from him in shouting and gestures. It’s brilliant theatrics and Hitler knew his theatrics.

            As mentioned he loved his mother dearly. The doctor said that when his mother died he didn’t think he’d ever seen a man so broken hearted in his life.

            Hitler was a human being with human thought processes. Did he have kind of pathological process going on? Possibly. More probable than not. But he didn’t come out of the womb set on being the poster child of evil dictators. He became that somehow. How he did it and what this man was is important if we hope to ever prevent another like him from rising up.

            I don’t feel sorry for him but I do see how he was able to captivate his core party members into believing he could achieve what he did and more.

        • sdsures

          And Ted Bundy.

      • Roadstergal

        Macbeth was born vaginally, and a C-section baby ended his killing spree.

      • Young CC Prof

        In fact, I might be able to “prove” it. Let’s look at the violent death rate of various countries and the cesarean birth rate 20-30 years earlier. We will almost certainly find a strong negative correlation, and we will also find that most current war zones have very low cesarean rates.

        Yes, this is not how you science, but the point is you could make it work and look good.

        • The Bofa on the Sofa

          Let’s look at the violent death rate of various countries and the cesarean birth rate 20-30 years earlier. We will almost certainly find a strong negative correlation,

          You could just do that using the US data alone. Given that violent crime has steadily decreased for the last 40 years or so, it has coincided with the increase in c-section rate. The changes as determined by the endpoints are significant for both, and so the correlation will be very strong.

          Indeedy do.

          Using the data from 2000 – 2012. The C-section rate has increased from 21.2 to 32.8, whereas violent crime per 100K has dropped from 568 to 387. The r^2 correlation between the two is 0.77, which is pretty crazily good. The correlation with aggravated assault is 0.85.

          These attempts to claim how X is the cause of all our problems really beg the question of, what problems? The Donald thinks illegal immigrants are turning the US into a criminal wasteland. Yet, with all the illegal immigration going on, crime is going down. How is the US turning into a criminal wasteland? It’s nothing like it was during the 80s, not even close.

        • Sarah

          Well, there are people who think it’s significant that autism rates are rather lower in Somalia than in ethnic Somali communities in the diaspora.

          • demodocus

            Wouldn’t a Somali kid in Europe or North America or even Egypt be more likely to be diagnosed than back home in Somalia? Somalia has some really big problems right now and diagnosing people with ASD is probably low on the list

          • Daleth

            And it’s Demodocus for the win. I’m going to hazard a guess here and say that diagnosing ASD is right down there in the Somali priority list with choosing the right color upholstery for your child’s car seat or deciding whether Pepsi is better than Coke.

          • Sarah

            Yes, exactly. There are vast swathes of Somalia where even basic medical care is hard to access, especially the southern and central regions. You aren’t getting autism diagnosed in a DP camp.

          • sdsures

            Methinks they have higher priorities at the moment.

        • Amazed

          Let’s look at the Hundred Years War. And the reconquest of Normandy and Anjou. And the Thirty Years War. Since c-section has become the vogue, the most remarkable wars of the centuries had dwindled in longevity about freaking 20 times! Or even 25 times! Or at least 5 times!

      • FrequentFlyer

        Yes! And I thought my c-sections were just the best thing for my children and myself. I didn’t realize I was serving humanity by having surgery. Do I get to feel superior to everyone who so thoughtlessly pushed their babies out of their vaginas?:p

        • Sarah

          It sounds that way. I’m wondering how those of us who’ve had even numbers of VBs and sections are supposed to feel, though…

        • Amazed

          Zing! Zing! Zing!

          That was the nice sound of your Service to Humanity Medal.

          • FrequentFlyer

            Thank you. I guess I’ll post it on Facebook so I can lord it over everyone.

    • sdsures

      Oh for ****’s sake.

      • Who?

        Upvote that!

    • Tiffany Aching

      “Indeed, there have been no World Wars before the twentieth century, when c-sections began to be practiced on live mothers!”

      Because, you know, European wars of religion were so nice and cozy, and the colonization of America was all hugs and pugs

      These people are SO ignorant and think they’re entitled to talk about any subject even if they don’t know the first thing about it. Talk about spoiled, privileged brats.

      • Roadstergal

        The massacre of the Pequot, where babies and mothers were burnt alive, was done by the Massachusetts Bay colony, where they had naught but midwives.

        Were they doing a bunch of C-sections at Drogheda in the 1600s? Was Pedro de Alvarado not squeezed all-naturally out of a vagina?

  • Ellen Mary

    In Oregon I had my first experience with female OBs & finally I had someone who was interested in discussing research & not threatened by me having read it. Just saying.

  • Sue

    I’ve always found the engagement of a lay midwife really strange. Why would you pay for someone to not interfere with your birth process?

    • SporkParade

      Yes, that is the reasoning of freebirthers.

      • Sue

        Probably safer to freebirth – at least there’s nobody to talk you out of going to the hospital.

    • Who?

      To defend you in case of your own ‘weakness’ in wanting medical attention, or interference from others, up to and including the father of the baby? To tell you why you don’t need all those tests the control freak doctors want to fill up their idle days? To affirm (and hide behind) your every ill-informed decision?

      I just don’t understand the mentality or morality or ethics of selling a useless product-they are either delusional themselves or stone-cold exploiters of fear. Not good either way.

    • Therese

      Because you think that if something were to go wrong, that the midwife would know enough to know how to save your baby.

      • Who?

        Which is unfortunately a potentially fatal misapprehension, created in the mind of the mother by the midwife, or not dispelled by the midwife if the mother does ask questions.

  • Chi

    And it’s not just the deaths either. It’s all the children who are brain damaged from lack of oxygen in labour. The ones whose shoulders are never right because of shoulder dystocia. What about all the children who live through a home birth, but with lifelong repercussions? Natural Birth Advocates don’t give a shit about them either, even though their damage is the DIRECT result of the process they so revere.

    • Daleth

      Next time an NCB advocate gets mad at you for “playing the dead baby/brain damaged baby card,” tell them, “I may be playing it, but YOU dealt it.” Since they’re the ones advocating the only method of birth that carries a direct risk of killing or brain damaging babies.

  • Red Ear Reviewer

    What is the response of Colorado’s registered lay midwives to their high PNMR? They are going to ask state legislators in 2016 to stop requiring the state to collect statistics on deaths, transfers, etc.

    • Megan

      Disgusting…But not surprising. Their answer to any information they don’t like is to sweep it under the rug. I hope the state legislature is smart enough to say no to their plan.

      • Red Ear Reviewer

        Unfortunately, the Colorado Dept. of Regulatory Agencies — the people who have been charged by the legislature to collect data on the “direct entry midwives” (DEMs) — has been shielding these quacks. DORA claims that the data they collect is not accurate since more than one midwife might be involved with a fetal or newborn demise (which would be reported as two deaths). Of course, DORA isn’t acknowledging that the presence of more than one DEM at uncomplicated births could just as well skew the data in the other direction. Instead of taking steps to insure accurate figures, DORA is undoubtedly going to urge the legislators to drop record keeping, as well.

        By the way, Colorado has a transparency act that requires DORA to post online the education and disciplinary backgrounds of all registered and licensed health care workers. Most of the DEMs’ educational background is listed as “other.” That’s not exactly what most people would call transparency.

  • Maya Manship

    “They labor under the misapprehension that birth is inherently safe and always has been.” Dr. Amy, I believe the word your looking for is misrepresentation.

    • Maya Manship

      And that’s “you’re”, not “your” for me. My grammar is usually much better.

    • sdsures

      I vote for “misapprehension”. http://www.yourdictionary.com/misapprehension

      • Daleth

        Yes, it’s misapprehension. A misrepresentation is something you do to someone else. A misapprehension is something you have yourself. Synonym: misunderstanding about something; false belief.

        • Maya Manship

          Fair enough…my bad. 🙂

        • Young CC Prof

          I would say many women who choose the natural childbirth industry ARE laboring under a misrepresentation.

          • Roadstergal

            They have had the risks of pregnancy and childbirth and the value of ‘interventions’ misrepresented to them, and are therefore laboring under a misapprehension?

    • SporkParade

      I just want to know whether or not the pun was intended.

  • Mel

    A casual acquaintance of mine recently had a healthy baby boy who was her first!

    The baby’s grandma mentioned that “unfortunately, she had to have a CS.” Without missing a beat – or thinking, actually – I blurted out in the middle of a church “Shit, all that matters is that he got out” and turned beet-red.

    The grandma replied “That’s a good way to look at it, isn’t it?” I said “Yup. Do you have any new pictures?”

    For some reason, this birth really drove home the miracles of modern obstetrics for me. Little Guy wasn’t particularly large; his mom was young, healthy and had access to excellent prenatal care. But if LG had been delivered 100 years ago, I doubt he would have survived the labor and we may well have lost his mom, too.

    I’m so glad we’re planning a baptism rather than two funerals.

    • I have absolutely no doubt that I would have died in labor, or possibly have a vegetable for a son, if I had labored anywhere where I could not have had a C/S with my first birth. Probably the former. 48 hours of strong contractions, ruptured membranes, no cervical dilatation at all, baby weighing 4.2 kilo.

      • Outi

        Me too. After 24 hours of contractions and my son’s heart beat fading I went through emergency C/S. He wasn’t big and the doctors can’t explain why the delivery stopped at 4 cm, but I’m sure the crunchies would explain it with the epidural I asked for.

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    • FEDUP MD

      I wouldn’t have even made it to have my own babies, my mother and I would likely have died almost 40 years ago without a c-section.

  • fiftyfifty1

    “Don’t get me wrong. There is plenty of room for improvement in modern obstetrics,”

    Dr. Tuteur, I would be interested to hear what you think are the areas with room for improvement.

    My personal opinion is that having walk-in capability in OB offices could make a huge difference. The groups with the worst outcomes are those that have difficulty making and keeping appointments. It’s not that they don’t want to go to prenatal visits, it’s that the process of 1)getting on insurance 2)making an appointment 3) getting there on the day they had scheduled, is next to impossible for the highest risk women living in poverty. If they could just walk in whenever and get care right then, insurance or not (and be able to meet with a social worker to get on insurance after seeing the doctor), it would reduce barriers.

    • attitude devant

      Germany does (or did) this very nicely. Every woman has a ‘mutterpass’ which not only entitles her to get care all over the country but contains her obstetrical record. So she has access AND her healthcare record wherever she goes.

      • Roadstergal

        This sounds like a great idea, as long as it’s straightforward, easy, and quick to get a ‘mutterpass.’ (Ja, sicher.) It sounds like the sort of thing that an organization that does a lot of reproductive health work with poor/at-risk women could handle, and IMO the US government should fund and support such an organization, rather than slash its funding in a politically motivated witch-hunt.

        • attitude devant

          Thank you for that! I work for that organization as a community service.

        • Young CC Prof

          When I was young and broke and needed birth control, they set me up with some, and did the paperwork for me, I didn’t have to pay a thing. (At that time my state had a special program providing free reproductive healthcare for the poor.)

      • KeeperOfTheBooks

        One problem in the US is just that we’re so freaking big/spread out, and even in big cities our public transportation systems range from quite good (say, San Francisco) to a standing and very poor joke (much of the rest of the country). For example, I lived for a while in one of the top 10 biggest cities in the US. I considered riding mass transit to save money/not contribute to pollution and traffic congestion. I understood that of course mass transit was liable to take me longer than driving, but figured I could spend the time reading, so win-win. As it turned out, it would have taken me over three hours to get from home to work, and again from work to home–all of that a drive that took perhaps 20-25 minutes during rush hour.
        Which was totally unreasonable, so I kept driving. I, however, had that option, and a lot of people don’t.
        The cities here are spread out, too. I remember you could get from one end of Paris to another on the train in not very much time at all, but doing that in, say, Houston, or Chicago? They’re just so BIG. And that’s leaving out all the rural poor/underserved populations with no access to mass transit because, reasonably enough, why fund a bus line that five people in as many a mile radius would use?
        All of that having been said, something like a mutterpass would be quite useful, I should think, in the bigger cities here, or at least those with an acceptable mass transit system.

        • sdsures

          Canadian cities (particularly the provincial capitals) are also very spread out. The best thing that has been done to combat this in terms of medical care is when children from remote communities in a particularly large province (which most of them are, except for the Maritime provinces) need cancer care, and have to travel with their families to the capital city, the city with the province’s largest PedOnc units. Ronald McDonald Houses have made this ordeal easier, where before kids might have to be away from their families for weeks of treatment. Winnipeg is a particular example I’m familiar with, since that’s where I received my neurosurgical and physiotherapy care as a kid growing up on a farm outside the city. Anyone living in the middle to northern parts of the province has to deal with not only a very sick child, but often the cost of travel, loss of work, etc.

          • KeeperOfTheBooks

            We have RM houses here, too, which do wonderful work. I believe they’ll also house parents of early preemies, if the parents aren’t local.

          • It depends on how “local” you are usually. I had a friend who lived around 20-25 miles from the level 1 NICU and wasn’t allowed to stay there: too close. More than an hour round trip with other kids and when she was planning to breastfeed? (the baby was a term homebirth, but had breathing trouble: child is fine now)

          • sdsures

            Do they help out families whose kids have other diagnoses besides cancer?

          • KeeperOfTheBooks

            I know they’ll house preemies’ parents, and also parents of kids with heart issues requiring surgery. I imagine that their parameters are that the kids have to be fairly ill/require long-term hospitalization.

      • Israel has much the same.

    • Lawyer jane

      Great question. It haunts me that there is such a huge disparity in infant mortality in my city (DC). On the one end we have hyper educated moms obsessing over the choice between the Bradley Method or hypno babies; on the other end we have poor babies dying.

    • Young CC Prof

      Definitely, I think logistical barriers to care can be just as serious as financial barriers.

      And how much avoidable morbidity and mortality is caused by lack of access to care before pregnancy, I wonder?

      • Cobalt

        I’ve seen pregnant women be unable to get any prenatal care until well into their second trimester if they are poor and uninsured. Medicaid applications can take 6 weeks to process, can require difficult to get documentation (the most difficult income amount or address to prove is “none”), and you can’t apply until you can prove you’re pregnant- and the verification must be done by a doctor (expensive up front cost) or pregnancy center (who wants to delay you until abortion is more expensive- even if it compromises care for the fetus that you have no desire to abort).

        It’s nuts.

        • DelphiniumFalcon

          The no address thing is always so sad because so many newly homeless people are so embarrassed to come to get health care until they can’t bear it anymore.

          I’m just happy that we have an option in our computer system where if we put in “No Address” in the address field it automatically flags it to our billers to write off all charges as charity. Usually encourages these patients to come back and talk with one of the social workers to help them get the resources we need.

          It means just about everything to them. A newly homeless woman and her son fled three states over to escape the abuse of her husband and she was so nervous to ask for care at the ER until I said that legally I can’t turn her away, even if she doesn’t have a penny to her name and we’ll figure it out after the doctor had seen her. EMTALA and all that.

          After the ER doc assessed her I went to get her demographic info to finish her new profile (we just get name, birth date, and an ID scan at initial presentation if they’re not in our system so we can generate a chart for them) and when I asked her for an address she said she was at the shelter so quieitly I could barely hear. I felt bad but I needed to clarify so I asked if she had a permanent residence and she said no. I think she was afraid I was going to give her one of those nasty looks because she want meeting my eye. When I told her we have a special program for displaced persons and to come talk to one of our specialists when they were in the next morning if she was able she was pretty shocked. When she asked how much the visit was going to be I said since she was displaced we write the whole thing off and she didn’t owe us anything she just burst into tears.

          I guess the hospital staff’s care and treatment of her like a “normal” person and the bill write off was basically the first bit if kindness anyone had shown her since she started running from her ex. How sad is that? I almost started crying with her to be honest. She just couldn’t stop thanking the staff and praising how she had managed to stop in the right town.

          Just.. Sucks how some people treat the most vulnerable of us. Kind of changed my entire understanding of the homeless situation after that. I’d always felt bad for them but that just drove it home.

          • KeeperOfTheBooks

            I volunteered in an emergency department for two years while in high school. It was one of the more life-altering experiences I’ve ever had, and one I’ll always be grateful for. I had a pretty crappy child/teenager-hood, but I learned to be grateful for what I did have, to appreciate that a lot of other people had it a lot worse, and to sort out my priorities a lot better than I had before then. Perhaps most importantly, I had the blinders rather effectively ripped off my eyes about situations like the one you described. (Until then, I, thanks to my upbringing, would probably have made some disgusted noises about how that woman was “freeloading” or something. Sigh.)
            Once DD is a teenager, I’ll give serious thought to encouraging her to volunteer at an ER, too. While I want very much for her to be sheltered from a lot of the stuff she’d see on a personal level, I also want her to see firsthand what it can be like to want for the basic necessities of life.

          • DelphiniumFalcon

            I think that’s a fantastic idea for your daughter and I wish more parents thought like you. It really makes the scales fall from your eyes when you see first hand what these people go through. Abscessed teeth they can’t afford to have treat, celluitis from an injury they thought they could treat themselves, osteomyelitis, and so many other horrible, painful things that the average middle class American could pop into a clinic to get checked out before teeth have to pulled or toes amputated.

            Working/volunteering in an Emergency Room also gives you this great appreciation for seatbelts. I’ve always buckled up but I’m more insistent on making sure everyone’s buckled up or we’re not going anywhere. The injuries I’ve seen on people…

            Saw one that was a two car crash with two teenagers in one car and a woman and her older mother in the other. The woman and her mother had their seatbelts on. They walked out that night with the mom having a rash where her seatbelt was and nothing else. The two teenagers were in bad shape. One immobilized in a back and neck brace being questioned by the police that if she was wearing her seatbelt as she claimed she was, why was there a spider web crack pattern on the windshield that matches the bruise and wounds on her forehead. She had to come clean after that. The other one was crying her eyes out and I don’t blame her. Her ribs were all bruised from the steering wheel and she was pretty bloodied up.

          • KeeperOfTheBooks

            Believe you me, I wasn’t particularly inclined to try drunk driving before I started volunteering at that ER, but as it was also the local trauma center, you can bet any portion of your anatomy you might wish on the fact that there was no way in hell I’d try it after spending a few Friday/Saturday nights there. Nopity nopity nope nope nope.
            Long story, but I ended up not having health insurance or proper access to health care for several years in my late teens/early 20s. Worked three jobs while going to school full-time; couldn’t afford health insurance, but made too much to be eligible for state-funded insurance. Insanity, but I digress. I’m glad that, barring really out-there circumstances, our daughter will never be threatened with homelessness because of a $250 bill for strep throat (I waited for ten days before going to get seen…), but I also want her to appreciate just how lucky she is in that regard.

          • demodocus

            My dad is occasionally…descriptive…about his emt days.

          • Kelly

            After I started teaching in a low income area, I called my parents and thanked them for the life that they have given me. My eyes were opened to how awful other people had it. I thought that my parents were crazy and I criticized them for mistakes they made. I know now that I was given a great life. I think it is a great idea to expose your daughter to that. It will give her compassion and an understanding for those less fortunate.

          • This is one of the reasons the U.S. Needs a government-sponsored universal health program.

          • DelphiniumFalcon

            Since the US has been shown to be completely against that so far (not that I’m saying give up we just need a stop gap in the mean time) the rest of the US should do what Salt Lake City has done for their chronic homeless populations.

            Contrary to what the farthest Right believes, it’s actually cheaper to house and provide free counseling and medical care plus nutrition and basic needs classes to the homeless than to let them sit outside. I don’t know how many homeless people I’ve seen come in to the ER citing nebulous pain symptoms just to get out of the elements. And ER stays are expensive.

            http://www.newyorker.com/magazine/2014/09/22/home-free

            There still needs to be a solution for the non-chronic homeless but it’s a start.

        • Stacey

          I would have lost DD for this reason had I stayed in TX. Just getting the state coverage takes forever, then finding a doc that takes it…. You are well into trimester 2 before this happens, and thats if you know you’re pregnant right away and get on the paperwork ASAP.
          I would never have gotten my 19 week scan, and corrective cerage and treatment ASAP. I would have still been waiting.
          Thank you Oregon.

          • Cobalt

            Glad you and your daughter were somewhere safer than TX for your pregnancy! How policy can be so anti-abortion and so willing to deny basic prenatal care is a sign of where policymakers true goals lie.

          • KeeperOfTheBooks

            From what I understand, it’s partly that the reimbursement an OB receives from TX is so low that they end up losing money by taking on state insurance patients. Some OBs will take on a few at a time and consider it charity. Good on them, but there should be a better way of making OB care available to pregnant women of lower/no income without making OBs take serious hits by doing so.
            ETA: this situation is not helped at all by the fact that TX is one of the worst states there is for malpractice litigation, meaning that malpractice insurance rates, even for those OBs without claims filed against it, are through the roof. A lot of OBs here are leaving obstetrics for that very reason, meaning that there are ever-fewer of them to serve the general population, much less those with income issues. It’s a mess, and I say that as someone who loves my state.

          • Liz Leyden

            Texas also rejected Medicaid expansion, so there’s not much money to go around in the first place.

          • KeeperOfTheBooks

            It’s a mess, no arguments there. I’m not sure what the solution is, either.

      • KeeperOfTheBooks

        Just look at, say, a 3-hour-long test for gestational diabetes. You have to get to the lab (transportation) without having eaten anything earlier that day (never mind if your job needs you on your feet the whole time, and you can’t get to the lab until the afternoon), and then spend three hours just sitting there, possibly with other kids underfoot to corral. Then you have transportation back, too. Egads. And that’s not even factoring in how much the whole business would cost! Yet undiagnosed/untreated GD can be very, very unpleasant for both mom and baby.

    • DelphiniumFalcon

      Almost any woman who’s pregnant is eligible for the Baby Your Baby Medicaid in my neck of the woods.

      But we also have special eligibility counselors that help patients apply with various assistance programs and if they don’t qualify for any of that then if a patient provides their proof of income they come to an agreement on how much, if any, the patient will pay in labs and procedures.

      Anyone who’s uninsured automatically gets a 20% discount on their services anyways and if they pay the estimated price at the time of service we’ll chop off another 15% for a total of 40% off. It’s not perfect and we always send them to the eligibility counselors if they have time or at least give them a financial assistance packet and tell them it doesn’t hurt to fill it out and turn it in. Worst they can say is no. And they rarely say no when it comes down to it.

      The hospital chain also does free health fairs several times a year with counselors to teach about the importance of preventative care. Also handing out things like mammogram vouchers from Utah Cancer Control or the Komen foundation for people that don’t have insurance or whose insurance won’t pay for it.

      The hospital chain sees it as the best way to lower health care costs and allocate resources smarter is to get the population on board with preventative care. So for example a doctor is removing a small tumor that hasn’t spread vs radiation, chemo, surgery and multiple doctors involved over a long, expensive treatment course with a cancer that could have been easily screened for and treated with less invasive measures.

      • fiftyfifty1

        My state is the same. Almost every pregnant woman qualifies for MA, and if not, there are a number of charities that cover her care.

        Even so, the barriers are huge. The simple acts of phoning for an appointment (do you have a phone? does it have any minutes?) writing down the appointment (do you have a pen and paper? Can you write?) finding transportation to the appointment (who can you ask? will the car be working on that date? how much will they ask you for gas money? who will take care of your other kids?) is all just too overwhelming.

        Maternity care ought to be available on a walk-in basis similar to the way you can go to urgent care when you are sick.

        • Young CC Prof

          Do you have any idea what hours you’ll be working two weeks from now? This is a big one for many low-income women.

          • fiftyfifty1

            Oh yes. That one is huge! “I can’t make that appointment yet because I don’t know what hours I will be working in 2 weeks”. Then that week comes, and they try to make an appointment and it’s “Sorry, all the appointments are booked for this week, how about a slot 2 weeks from now?”

          • KeeperOfTheBooks

            2 weeks? *laughs mirthlessly* Lucky them! My OB’s office will get you in within hours for an urgent/emergency situation, but for a regular prenatal visit, you have to book a month in advance until you hit 36 weeks.

        • DelphiniumFalcon

          Those are the big barriers and they are hard to find solutions to.

          It’s not perfect but for women with very unpredictable job schedules or unreliable transportation, most of the OBs will give them several lab sheets at once with a date range on each for when it needs to be done and fax copies to the lab in case they get lost/too damaged to read. They can use the hospital lab to get those done since they have much longer hours than the doctor’s office. Even outside of regular registration hours, if they’re willing to wait for a phlebotomist to come down from Med/Surg they could get them done by having an ER registrar put the order in and page the tech at 3:00 AM. We don’t recommend it but the option is there. We also have limited weekend hours with the same unofficial hours.

          Ultrasounds are much harder because being in Utah, the maternity ultrasound techs are constantly booked back to back. We’re trying to work on a better solution to that one but as of right now we haven’t been able to find that magic bullet. There is a taxi service in town that’s set up to accept payments from the hospital if a patient really needs to be seen but really can’t afford it. Again, not ideal, but it does help.

          For patients who don’t speak English we recently got a new translation system that they seem to be more comfortable with when we don’t have a registrar that’s bilingual in their language. It’s goofy looking at first but the non-English speaking patients seem to like it much better than telephone translation services. We have an iPad on a rolling base that can be adjusted in height to the patient’s eye level and we press the button for which language we need and it pops up a live translator on the screen that they can speak to and actually interact with. The translator can also ask us to rephrase something if they can’t relay it in a way they’re sure the patient understands. The patients definitely prefer seeing who’s translating for them and reading their body language.

          Since it’s video we can reach a lot more of the deaf population as we have a translation services for sign language. That’s been a major boon since people who haven’t been around signing deaf people don’t know that ASL uses a different syntax than English so communicating by writing may end up being more frustrating for both parties. Definitely had a lot more satisfied ASL speakers.

          Patients that can’t read or write we usually grab someone from the volunteer desk or a free secretary to sit with them and fill it out based on the patient’s answers from reading the form out loud. A medical assistant at our Spine and Pain clinic actually did that last Thursday for an older man with failing eye sight and shaking hands so he could get set up for treatment.

          Just wish more places like where I grew up were willing to try working outside the 9-5, English only box.

        • demodocus

          Transportation is an issue for me; our insurance demands that women see the obs in their main building in a town 30 minutes away by car, except that it’s an hour trip by bus and feet, and one of the buses runs only hourly. And who wants to take their child into the exam room? If you live further afield, the trip would be much more difficult. I’m fortunate that a retired friend will often take me and watch my toddler while I’m there

          • Staceyjw

            Our state Medicaid also covers transport to any appointment that they cover. So you do not need a car.
            You do need a way to make a call, but even those without phones can usually use someone else’s.

            I think the biggest barrier is lack of time off of work to go to these appointments. Lack of childcare is another one, but you can bring your kids with you. Might not be ideal, but it can be done. Working 2 jobs may not leave a lot of time for anything else.

            But as always, if there is no safety net, no assistance to help the impoverished or disabled, there will always be issues with women’s care. And that’s not even considering the misogynist culture we live in- another post altogether.

          • demodocus

            yup

    • That was exactly the arrangement we had in my last job, at the Women’s Health Center in a health fund. There was always one doctor present for unscheduled patients who arrived with either an emergency or an antenatal check. Nurses did the standard weight, BP, urine and FH checks before sending the woman to the doctor. Sometimes the waiting time for the doctor could be a bit long, but usually it wasn’t. There was also ultrasound and EFM facilities available on site.

    • Ellen Mary

      Even though I had insurance & I am medical system literate, making & keeping appointments with one car, 3 kids & ADD was my biggest challenge getting mainstream care. One of my friends has 5 kids, no car & an alcoholic husband (so no childcare). Her CPM comes to her & that is a huge reason she chooses non-mainstream care.

      • Roadstergal

        “Her CPM comes to her”

        One thing we are using more and more – mobile nursing services. I use it for prospective collections a lot, but it’s seeing a lot of mainstream use. Nurses in vans with a solid set of equipment, going to patients.

        Maybe a CNM-Medwife could be drafted to drive a Sprinter around to patients to provide basic antenatal care?

        • KeeperOfTheBooks

          This isn’t a bad idea at all, especially in rural/underserved areas. In thinking about it, most of my OB appointments needed no specialized equipment beyond my OB’s mind 😉 : Doppler for heartbeat, BP machine/thermometer for me, a cup for me to provide a urine sample, etc. There’s no reason a CNM couldn’t have all of this, plus test dip strips for UTIs (if that’s what you use for diagnosis)/sugar/protein. Then, when more advanced care was needed (ultrasound, OB consult, etc), moms could be referred to an OB practice. Of course, they’d still need a way to get to the OB, but it would at least be fewer trips.

  • Sarah

    The point isn’t safety! Mothers need to have a CHOICE… to make the right decision which is obviously to give birth in a yurt and eat your placenta immediately afterward.