Jill Duggar Dillard is not a real midwife; she’s a CPM, a counterfeit professional midwife

Rooks quote

Cosmopolitan Magazine reports Jill Duggar Adds an Impressive New Job to Her Résumé.

According to her husband, Derrick Dillard:

It’s official; my wife is a midwife!

Not exactly.

Jill Duggar Dillard did not become a midwife. She became a counterfeit midwife. She was awarded an ersatz credential (CPM, certified professional midwife) designed to fool the public into believing that lay people who can’t be bothered (or can’t hack) the education and training needed to become a real midwife are “midwives” nonetheless. The CPM really means “counterfeit professional midwife.”

The CPM credential is a public relations ploy, not a medical credential and it is a testament to its effectiveness as a public relations ploy that most Americans don’t realize it is a counterfeit midwifery degree. It is not recognized by the UK, the Netherlands, Canada or Australia because it doesn’t meet the international standards for midwifery education and training. Indeed, the US is the only country in the industrialized world that has a second class of counterfeit midwives in addition to real midwives (certified nurse midwives).

Consider:

Why are the minimum standards so low, especially in comparison to counterparts around the world?

It’s hard to become a doctor.

It takes four years of college, followed by four years of medical school, followed by 3-5 years of internship and residency. That’s challenging.

Imagine if you couldn’t be bothered (or couldn’t handle) the necessary preparation but wanted to masquerade as a doctor anyway. I don’t mean simply pretending that you are a doctor when you are not, but rather awarding yourself a counterfeit MD degree (CMD) that involved only a correspondence course and trailing around after another counterfeit MD for a while. Would a CMD be a real medical doctor? Of course not; but with a “CMD” after your name, you might be able to fool the gullible and less knowledgeable into thinking that you were a real doctor and into paying you as if you were.

It’s hard to become a certified nurse midwife. CNMs are the best educated, best trained midwives in the world. They have an undergraduate degree in nursing, a master’s degree in midwifery, and extensive hospital training in diagnosing and managing birth complications. European, Canadian and Australian midwives are also well educated and well trained; they have an undergraduate degree in midwifery and extensive hospital training in diagnosing and managing birth complications.

Imagine that you couldn’t be bothered (or couldn’t handle) the necessary preparation but wanted to masquerade as a midwife anyway. You could simply take a correspondence course, attend a few dozen deliveries outside the hospital, pay money for an exam and voila: you are a CPM. Actually, you don’t even have to complete even those minimal requirements. You can simply submit a “portfolio” of births that you have attended, pay the money and take the exam, and voila, you too are a CPM.

The CPM (any similarity to CNM is unlikely to be coincidental) was created by a group of lay midwives who promptly awarded it to themselves. How do they justify calling themselves midwives, and charging thousands of dollars for their services, when they have no midwifery training? They insist that they don’t need real midwifery training because they are “experts in normal birth.”

That makes as much sense as a meteorologist who’s an “expert in sunny weather.”

No one needs an expert in normal birth; if the birth is uncomplicated a taxi driver can do it and legions of taxi drivers have done it successfully and for free. The only reason to have a professional birth attendant is to prevent, diagnose and manage complications. CPMs cannot do that because they aren’t real midwives, they’re counterfeit.

Judith Rooks, CNM MPH, a highly respected leader in the world of real midwifery was interviewed in 2013 about the CPM credential.

She noted that the CPM is a way to avoid the rigorous midwifery training required everywhere else:

…[M]any young women who want to become midwives seem to think it is too much bother, time or money to complete an actual midwifery curriculum and think it is enough to just apprentice themselves to someone for a minimal number of births, study to pass a few tests, and become a CPM that way.

Rooks gets to the heart of the matter:

The lingering questions then become why are the minimum standards so low, especially in comparison to counterparts around the world? Why is it acceptable for midwives to aim for the cheapest, quickest route instead of striving to be their best? Why are the “certifying” bodies (ie NARM/MANA) keeping the bar so low…as in only requiring a high school diploma as of 2012 instead of requiring a college level education to deliver our babies?

Why are the minimum standards so low? Because the CPM isn’t an academic credential; it’s a public relations ploy designed to falsely reassure women that CPMs meet the same international standards as midwives in the Netherlands, the UK, Canada, Australia and all other first world countries. It’s been an incredible success as a public relations ploy, but it is been a horrific failure by the measure that really counts: safety.

EVERY study conducted on American homebirth (including studies by homebirth midwives themselves) has shown that homebirth (planned, with a licensed midwife) has a death toll up to 800% higher than comparable risk hospital birth.

That’s just what we would expect if we were to replace real midwives with counterfeit midwives.

The CPM ought to be abolished, but until it is, it is literally a matter of life and death that women understand that CPMs like Jill Duggar Dillard aren’t real midwives, they are counterfeit midwives. They are women who couldn’t be bothered (or could not manage) to meet the international standards for midwives.

If some women want to hire counterfeit midwives, they are free to do so, but they must never forget they are hiring lay people masquerading as midwives, not real midwives and their babies may pay the price.

  • kmeinig

    I don’t know where you are getting your information from, or if you have been burned by an incompetent CPM somewhere along the way, but your statements are derogatory and your statistics are incorrect by a long shot.

    CPM’s must undergo quite extensive training to become eligible to sit for the national exam. They can’t just make up their “portfolio” and submit it. Stating that these women chose the CPM route over becoming a CNM because they “couldn’t be bothered” in today’s world of skyrocketing secondary education costs is downright classist. Many CPM’s serve lower-income communities, and several do so because they came from those very communities themselves. Telling those women that their credential sucks because they could not afford 4-5 years for a bachelor’s in nursing and then another 2-3 years of graduate school just showcases your privilege and elitism.

    I am proud to work for a large birthing center that employs both CNM’s and CPM’s. I have seen these women save lives based on the personal relationship they develop with clients – my old GYN never even got my name right from appointment to appointment. Sure, there are bad CPM’s out there, just like there are bad doctors, bad nurses, bad attorneys, etc.

    I would also like to point out that abolishing midwifery would work quite a bit in your favor financially as an OBGYN…but surely that didn’t influence this article at all…

    • Dr. Tuteur is retired and has no financial interest in birth attendants.

      Really? They saved lives with personal relationships? Do tell more. Glad you have some CNMs on staff, but if a birth goes south about all a competent provider can do is transfer to the hospital, where there’s lifesaving equipment and trained personnel.

      You can toss terms like “privilege” and “elitism” around all day long, but providers who are literally responsible for the lives of laboring women and babies had better be properly trained and equipped–otherwise, they are screwing over the population they’re supposedly serving.

      Lower-income women should not have to put up with a pretend midwife who will charge them thousands out of pocket, be unable to do squat in case of emergency, and carry no insurance and take no respnsibility in case of screwups that lead to death or disability. Saying otherwise is a disservice to these families.

      There are bad obs. But look who saves lives–it ain’t the CPMs.

    • LaMont

      Save lives based on relationships? So, if one of my best friends is a doctor (and she is!), does the fact that she has an education cancel out our relationship, should she need to advise me in an emergency? I’m curious…

      Also, why do you want women to put their lives in the hands of laypeople during the most medically dangerous thing a young woman is likely to do?

    • swbarnes2

      I have seen these women save lives based on the personal relationship they develop with clients

      So you are claiming that your colleges are incapable of properly practicing on patients they don’t know well? That they literally can’t diagnose problems if they aren’t bosom buddies with their patients?

      We all read about Caroline Lovell’s CPM, who discouraged her client from calling 911 as she was bleeding to death in a birthing pool. Lovell likely would have survived if she had had no attendant, because she likely would have called 911.

      Sure, there are bad CPM’s out there, just like there are bad doctors, bad nurses, bad attorneys, etc.

      Bad nurses and doctors get fired and lose their licences. Bad CPMs brainwash their clients into covering up for them. We know this, because they write about how to do it. Worst case, they just slide into another state and start up again. We know this because that’s just the kind of practitioner who taught Jill Duggar, and her training from a woman that incompetent was considered by CPMs to be a good and solid foundation for her to be a CPM herself.

    • Empress of the Iguana People

      I’m sorry your ob couldn’t get your name right. Mine knows my name, my spouse’s name, and both my kids’ names. I wouldn’t trade him for the best cpm in the world. He has the skills to deal with my pre-eclampsia

    • Who?

      So selling rubbish training to poor people is ‘giving them an opportunity’?

      Rubbish. These cpm students are getting ripped off by their ‘trainers’. It’s shameful to sell crap masquerading as gold to people who through no fault of their own know no better.

      You are the elitist, thinking people who can’t afford a proper education deserve to be sold a junk one.

  • QuiteContrary

    It undermines your argument to say “Consider: It’s hard to become a doctor.” It *is* hard to become a doctor, but then are CNM’s also counterfeit doctors?

    She’s pretending to be a nurse.

    Then this:
    “EVERY study conducted…home birth…has a death toll up to 800% higher than comparable risk hospital birth. That’s just what we would expect if we were to replace real midwives with counterfeit midwives.”

    What? Those are the statistics *including* “real midwives.”

    You can’t make the point that all midwives are shit medical professionals, AND ALSO that it matters if Jill Duggar is a real or counterfeit version.

    Pick. Is a CNM a worthwhile profession and credential, or isn’t is?

    • MaineJen

      CNMs ARE nurses.

  • Andrea

    You are being ridiculous. She is a real midwife . You mean that she is not also a nurse. She has full training in midwifery. Furthermore no one thinks a darn things about the thousands of babies that die evert year in hospital! Study Ina May Gaskins. Delivered over 1009 lbabies at home.97% success rate. A woman is far more likely to have Complications dang it from all the interventions in hospitals. The US has a terrible track record.

    • Amy Tuteur, MD

      No she is not a real midwife. Certified professional midwives (CPMs) do not meet the international standards for midwives in ALL other industrialized countries. They would not be eligible to practice in the UK, the Netherlands, Canada, Australia or anywhere else.

    • thejungle137

      She is NOT being ridiculous. She is being truthful and factual. Jesus, NOTHING the Duggars do is genuine. You don’t know this? They’re not real anything, not even real missionaries.

  • Liza

    http://www.bmj.com/content/330/7505/1416
    What’s sad is the misinformation given in this article. Wake up people, smh.

  • Erica Lea

    Actually, did you know in the state of FL, LICENSED midwives have the
    SAME level of education as any CNM? In fact, we Licensed Midwifery
    students receive more hands on training (in the form of clinical hours
    with a CNM or LM) than a CNM student when it comes to midwifery,
    pregnancy, birth, postpartum and newborn care. Did you know that we
    have to attend more births in order sit for our STATE BOARDS than a CNM
    is required to? Did you know that we are REQUIRED by the state of FL to
    carry malpractice insurance? Did you know that our protocols are
    directly written into our governing LAW? I think Women on this board
    need to do a *bit* more research if they are going to attack a fellow
    woman. No wonder you people talk the way you do… You’re just as
    uneducated as you are projecting LICENSED midwives to be. And just so
    we’re clear, I attended clinic under a very respected CNM in FL… who
    practices out of hospital births. I also attended clinic alongside
    several other midwives (one with over 35 years in the field) *while*
    completing my didactic work as well… CNM’s finish their didactic work
    before going to clinicals, a time where they are cramming so much
    information it’s hard to actually remember the material. And then they
    are sent off to clinic where they then have to learn what real-life
    midwifery is all about. Licensed Midwives in the state of FL have to
    attend over 1200 clinical hours, 80 births with a preceptor who has been
    licensed for at least 3 years and manage an exponential amount of
    prenatals, births and newborn exams. Please stop staying that we are
    uneducated.

    • Megan

      80 births is nothing. It’s telling that you think that’s adequate training given that complications of birth are measured per 1000 births. And when the shit hits the fan at home, none of your training matters at all when you have minutes to save a baby’s brain function or prevent mom from bleeding out and lack the resources to do so. Even if I were willing to take the time to check your assertions of CNM vs. CPM training int he state of FL, it wouldn’t change my mind because home birth with a US home birth midwife is less safe than a hospital birth.

      • Bombshellrisa

        There is no minimum listed in the CNM curriculum because a student will easily see more than that at a teaching hospital, especially since a CNM will have already done L&D as an RN student.

        • Dr Kitty

          Yup.
          I saw 20 births as a student in the single week I was on L&D. There were also midwifery students there, doing 8 week placements. Every year of their four year degree…

          Even if they saw fewer births because they were with women from start to finish of labour, they would still see 5-7 births/week.

          80 over 3 years is NOTHING.

          I’ve probably been at well over 100 deliveries, and I still wouldn’t have the necessary skills or experience if it all went pear shaped, which is one of the many reasons I don’t attend births.

    • Dr Kitty

      You have a nursing degree like a CNM?

      You think it is a good idea to do the didactic alongside the practical. It isn’t.
      Far better to learn the theory underpinning the practice and then learn how to put that into practice rather than spend hours in a clinic not understanding what is going on around you, because you haven’t got to that chapter in the book yet. I’ve done clinical rotations as a medical student both ways. The one where you already know what is going on and why and where you don’t waste time with stupid questions or misconceptions is better.

      Midwifery isn’t rocket scuence, but the reason Florida wants you to have more hours and more births is because your knowledge base isn’t as broad or as deep as someone who has already done a nursing degree and spent hours on hospital wards before she starts her midwifery training.

      I attended 20 births in a WEEK as a medical student. 80 births over many months doesn’t impress me.

      • Bombshellrisa

        They are attending 80 births in 3 years, that is how long the program is. I would think that attending only 3 births a months would leave a midwife quite rusty but I guess “trust birth”.

    • demodocus

      They have both a bachelors and a masters in a biology related field?

      • yugaya

        Methinks this is either Abby with a vengeance or one of her equally butthurt ( and ignorant) classmates.

        • demodocus

          I suspected as much

    • yugaya

      “Actually, did you know in the state of FL, LICENSED midwives have the SAME level of education as any CNM.” No they don’t.

      And if you really want to learn about the abysmal education and training that Florida CPMs are getting, check out Leigh Fransen’s blog: http://www.honestmidwife.com/ She’s a former Florida-educated CPM.

      Let me know if you need help navigating it in order to read about how she was trained to illegally administer cytotec without consent or informing the clients, or the one about illegal use of vacuum and how (usually first time) mothers were separated from everyone else, locked in a room and blindfolded to enable that illegal practice.

      • yugaya

        ” Did you know that our protocols are
        directly written into our governing LAW?”

        Yes I know there is regulation in place. I also know that the OBs in Florida are nowadays after per regulation required consultations about risks writing in medical records “valid for hospital birth only” to prevent widespread abuse by homebirth LMs of their credentials and that regulation in order to take on insanely high risk homebirth clients.

        I can name a dozen LMs who have taken on clients they should have risked out. I can also tell you which CPM who is banned for life from practicing midwifery in the state of Florida was earlier this year “catching babies” pretending to be just a doula in an unregistered birth center. I can also tell you which Florida midwife currently under investigation boasts on her website about accepting HBA3C clients, and which one advises women with recent surgery and a bunch of other automatic risking out factors that she is an acceptable client for a homebirth in her center. And so on and so on….

        I wish that this excellent protocols of care regulation written into the law in Florida was enforced more often.

    • Daleth

      I’m actually really sad for you that you have been fed such ignorance by people who were supposed to be giving you an education.

      There is no state in which CPMs are required to have even close to the same level of education as CNMs. Here is a handy chart–what it says is true in every state:

      http://www.midwife.org/acnm/files/cclibraryfiles/filename/000000001031/cnm%20cm%20cpm%20comparison%20chart%20march%202011.pdf

      If you can point me to a link that shows the situation is different in Florida, I’d be glad to look at it. The problem is, though, that you can’t–you’ll find that out when you start looking for such links–because the situation in Florida is as bad as it is in the other 28 states where CPMs are allowed to practice.

    • Bombshellrisa

      https://nursing.uw.edu/sites/prod/files/wysiwyg/NM-DNP-Grid.pdf
      Education required for a CNM. Since the University of Florida no longer offers the CNM program, I had to go with the curriculum from another school. The prerequisites for entering a CNM program would be to already have a bachelors in nursing.

      http://midwiferyschool.org/admissions/prerequisites/
      The requisites for entering midwifery school include a high school diploma, doula training and being a child birth educator. Having college level biology is not required.
      http://midwiferyschool.org/pdfs/curriculum-glance-2015.pdf
      Compare the two curriculum side by side, there is no comparison.

    • PrimaryCareDoc

      80 whole births! Wow! That’s amazing!!

      Oh, sorry. The word I was looking for was pathetic, not amazing.

      The risk of severe PPH in a low-risk woman is 1.3%. That means that you likely will not see it in your 80 births. The risk of shoulder dystocia in a low-risk woman is 0.5%. You almost definitely won’t see that in 80 births. Risk of cord prolapse in low risk women is 1 in 1000. Definitely won’t see that.

      Tell me again about how educated a prepared you are.

      • Life Tip

        But she’s a fellow woman and making such a compelling use of ALL CAPS. Maybe we should just all be supportive, mkay? School is hard.

        • PrimaryCareDoc

          Does she think she gets brownie points for being a “fellow woman”? Incompetent practitioners don’t get a pass from me, no matter their gender.

          • demodocus

            As a doc, you, like Dr. T, automatically belong to the boys’ club that is modern medicine. You’ve probably lost touch with your own inner ancient wisdom or something. Natch.

          • Roadstergal

            A naturalwisdomectomy is a requirement for any modern medical program, you know.

      • yugaya

        And she thought she made such a solid point by smugly advising people on this blog ” to do a *bit* more research if they are going to attack a fellow woman”.

        Burnnnnnnnnnnnn stupid!

      • Annitte

        Well a bit more likely than you would see it in the 20 births you observe in the CPM course. I would further add that That is in addition to being a registered nurse.
        A normal birth, anyone can deliver. 6 year old children have delivered their siblings, women have given birth alone. To be a person who has watched 20 births is no training especially when you consider that they have no other medical training,

        If I and hiring a midwife I am hiring her to know when something goes wrong and what to do about it.

      • s pag

        I’ve managed all of the above complications as a student midwife. Under the supervision of senior licensed midwives, as per our state law.

        • Amazed

          Really? Let me doubt it. It’s statistically very unlikely that you have encountered all of the abovementioned complications. You didn’t even know that cord prolapse in non-hospital environment means an almost certain death, or else you would not have bragged about it. But please keep enlightening us at how well they teach you to blow air off your rear end. Hint: they aren’t doing a very good job.

          • PrimaryCareDoc

            Oh, man, I forgot about this thread. I’m gonna re-read it. It’s better than sex.

          • Amazed

            That’s because you’re a doctor. I guess I would have thought it better than sex if it had something to do with literature and translations.

            It’s amazing anyway.

          • Valerie

            The odds of seeing at least one of each PPH, shoulder dystocia, and cord prolapse in 80 births is about 1.6%, by my calculations. Not reassuring.

    • Bombshellrisa

      http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000076/Mandatory%20Degree%20Requirements%20Position%20Statement%20June%202012.pdf
      As of 2010, completion of a graduate degree program became a requirement for certification and entry into clinical practice as a Certified Nurse Midwife

  • SweetBabyJesus

    The part where Dr. Amy Tuteur says that I am WRONG with my stats, then gives me the very same figure that I have already given her. She just doesn’t want me to apply it to any real case and see how women are ACTUALLY affected by childbirth. But I did it anyway and I’ve gotta say guys, it’s a good day for educated homebirth midwives everywhere.

    And just to go on record, she is backing up my calculations so any of you who told me I was wrong or came up with your own bobo figures–SUCK IIIIIT! And to anyone that I brought the word “fuck” out of–way to lose your cool dude. That’s what happens when an egomaniac has their shit thrown up in their face. All the fucks in the world can’t salvage your erroneous blabber.
    —————————–
    (Here’s the rest of my response too:)
    So anyway it’s all about applying that relative risk to the case at
    hand. Saying that something is 1.2 times more likely to cause neonatal
    death is relative to the baseline risk of the person you are So if we
    have a mother who is (just going to make up a number here) at a 10% risk
    level for giving birth because of her complicated medical and
    obstetrical history, we are going to multiply the relative risk of
    homebirth (1.22) to her risk level and get the figure 0.122 or 12%. Now
    this woman’s risk level has gone from 10% to 12% based on the decision
    to have a homebirth. A 2% increase is quite a jump and of definite
    statistical significance!

    Of course this is all
    hypothetical–someone at an initial risk level of 10% would not qualify
    for safe homebirth anyway–I just wanted to show the significance of how
    when someone’s baseline risk is higher then that added risk of
    homebirth is going to increase exponentially. Conversely, if a woman is
    considered uncomplicated/low-risk and only has a 0.13% baseline risk of
    giving vaginal birth then they move to a 0.16% increased risk when
    choosing homebirth. That’s a mere 0.03% increase in risk by choosing
    homebirth. If you apply the risks of having unnecessary medical
    interventions that might come from being managed by OBs that practice
    the way you think, then she might just decide that it’s worth bumping
    her risk 0.03% to avoid all of the things that come with those
    interventions.

    This is why I have said that homebirth
    should only occur with LOW RISK WOMEN and should utilize OB BACK-UP.
    Once they risk out of care (and we have a stringent risk screen in the
    state of Florida midwifery law CH 64B24) then it is safe to say they
    need to have their baby in the hospital. And I am ok with that, Dr. Amy.
    The hospital is for people who need it–just not the ones who decide to
    accept the fractional risk of homebirth and choose another route.

    Again,
    please feel free to check my math on this, or provide another argument
    such as I have that utilizes scientific facts and figures, not an Ad
    Hominem arguement where you try to discredit my intelligence. You know I
    am proving myself.

    • PrimaryCareDoc

      Again…you’re not using the right formula. You’re not interpreting anything right.

      I think we’re all pretty much done with you, Abby Reichardt. You have demonstrated that you’re incapable of understanding, and your response to being told that you are wrong is to dig your heels in, put your hands over your ears, and say, “LaLaLa I can’t hear you!!”

      In other words, you’ll make an excellent home birth midwife.

      • yugaya

        Abby Reichart? Jesus fucking Christ, apparently she is an edmucator in the cesspool of ignorance that is Florida School of Traditional Midwifery ( how appropriate). Also:

        “$158USD
        Name Abby’s baby
        Abby Reichart, our Academic Director, is expecting her first child mid-October. For $158, Abby will consider naming her baby after one of the donors- unless the name is too crazy- in which case she will have to check with her husband.”

        http://webcache.googleusercontent.com/search?q=cache:HosdvaSJBfsJ:https://www.indiegogo.com/projects/midwifery-is-catching+&cd=4&hl=en&ct=clnk&gl=hu#/

        • PrimaryCareDoc

          I wonder how Abby Reichardt’s school feels about her using her real name and school/workplace email to demonstrate her ignorance.

          • yugaya

            Given what a lot of idiots they are, they will think this is good marketing. I mean, she thinks this exchange makes her look smart. :)))

          • MaineJen

            Is she going to include the “fuzzy math” part of the conversation?

        • MaineJen

          WTF? Really?

        • Megan

          Academic Director? I don’t know whether to laugh or barf.

          • yugaya

            In a village full of idiots, it is to be expected that the idiot of her size gets to play teacher.

          • Squillo

            I doubt “Academic Director” is a teaching position. In most schools, it’s purely administrative.

          • yugaya

            She is in charge of evaluating course materials, curriculum, faculty members and students: http://www.midwiferyschool.org/pdfs/faculty-handbook.pdf

            God help those who end up giving birth with Florida School of Traditional Midwifery fake midwives in attendance.

          • Squillo

            Well, that’s kind of frightening.

          • yugaya

            Agreed.

          • PrimaryCareDoc

            From the linked document:

            Use of a FSTM e-mail or IP address to engage in conduct that violates FSTM policies or
            guidelines. Posting to a public newsgroup, bulletin board, or listserv with a FSTM e-mail or
            IP address represents FSTM to the public; therefore, you must exercise good judgment to
            avoid misrepresenting or exceeding your authority in representing the opinion of the
            company.

            Uh oh.

          • Roadstergal

            She was insulting OBs and denying that there are any risks to homebirth or vaginal birth. I’m thinking that they consider that to be good judgment.

          • yugaya

            Ouch.

          • Bombshellrisa

            It says she is the coordinator not director.

          • Squillo

            Even more likely to be administrative, I imagine.

          • Charybdis

            Both. You could larf.:P

        • Roadstergal

          Is ‘Innumeracy’ worth $158?

          • Who?

            Harsh.

            But funny,

        • The Computer Ate My Nym

          All she actually promised was that she’d consider naming the baby after the donor. She never said she would name the baby after the donor. For $158 I’ll consider changing my name yours. I won’t do it, but I’ll consider it.

      • Amazed

        How did you find out her real name? Did she give it?

        • PrimaryCareDoc

          The idiot posted a screenshot of her email convo with Dr. T. Her real name is on it. I’d never dox someone. The fool did it herself.

          • Amazed

            Oh I didn’t mean that you would. And Dr Tuteur never gives up names. I figured it would have been her. I was just curious how.

          • yugaya

            She is the gift that just keeps on giving. Hopefully all of her potential clients will end up reading this blog before they run in the opposite direction.

          • PrimaryCareDoc

            Well, it’s too bad for Abby Reichardt that Dr. T’s blog ranks so high in search engines. It’s sure to come up.

        • yugaya

          She posted on this public forum of her own accord this SS at the end of that long comment of hers on top ( I’m repeating it in case she manages to somehow come to conclusion that at his point she can just limit further damage by deleting her entire account):

      • Megan

        This would all be funny if it wasn’t so sad.

      • Barbara Delaney

        From The Florida School of Traditional Midwifery’s most recent catalogue;

        “Professionalism: Students should act professionally in dress, speech, and demeanor (see Appendix for specific information). Public opinion of midwifery and related professions is shaped through impressions of individual practitioners and students. Common sense standards of behavior and appearance are expected of FSTM students. Care providers are sensitive to the impression clients receive from students associated with their practices. A student’s failure to meet behavioral expectations could result in dismissal from a preceptor site or from the program.”

        How do you suppose her colleagues would asses Abby Reichardt’s professionalism based on her comments on this site over the past several days? Would her attacks on physicians meet with their approval? Would her use of language including “STFU”, “stuff it”, addressing other people as “dude”, “bucko”, her braggadocio and demonstrable mathematical errors concern them?

        • monojo

          “Braggadocio”, that’s EXACTLY the word. Thank you!

        • Bombshellrisa

          One can only hope screen shots were sent. The only thing is I don’t think that anyone there would do anything but praise her for her antics here.

    • yentavegan

      The average mother contemplating a homebirth trusts ( because she has been socially conditioned to trust) the midwife she hires. Here in the USA homebirth midwives practice their profession without liability insurance and homebirth midwives often lack the university level education to recognize when they are practicing outside their scope of expertise. Yes in the perfect world midwives would work collaboratively with medical professionals. MIdwives would be legally permitted to transfer her patients to a hospital/ob/gyn seamlessly if need be. But this is not the case so all the risk statistics are useless.

    • Daleth

      Abby Reichert, oops, Abby Reichardt–sorry for the misspelling–you’re doing the math wrong, as multiple people have explained.

      If you can’t even accept that you have made a mathematical mistake when people point it out to you, it’s no wonder you believe yourself incapable of making a medical mistake.

      As a midwife, you’re going to kill someone someday.

      • Roadstergal

        When it comes to her clients, they probably haven’t had enough math to prevent her from baffling them with bullshit. The way she falls back on Attack Mode when corrected is all you need to know about her ‘education’ when it comes to pregnancy and birth.

        With all of her comments about being a Proper Medical Professional, however, I can’t help thinking what a hoot she would be at Grand Rounds.

      • Sue

        And with logic like that, how could she manage to schedule ANYTHING?
        http://midwiferyschool.org/pdfs/student-handbook.pdf

        • Daleth

          I bet everyone there has an AMAZING GPA, if she calculates it…

    • Cartman36

      Dear Abby,

      Lay midwives are the dangerous equivalent to what a lay pilot would be. Imagine if you had to get in a commercial aircraft with a pilot and co-pilot who had only ever trained in a simulator in “normal weather conditions”. You wouldn’t do that right. But now imagine that the airline went to great lengths to ensure you were fooled into thinking that they had as much experience as a pilot who had actually flown this type of aircraft. You would feel deceived and angry. If the flight (flown by lay pilots) crashed and the airline said some people are meant to die in aviation accidents or this crash isn’t even “a blip” on their radar you would be outraged.

      That is what the regulars here at SOB understand about lay midwives. NOTHING that you say and no “evidence” you present will convince us that ANY lay midwife could POSSIBLY be a safe choice for pregnant women and babies.

  • SweetBabyJesus

    It’s been fun kids. Feel free to math-check me on the stats. I sent it over to Dr. Amy too. I’m sure she’ll just tell me something insulting and explain that having an 8-year degree means that she is a better human being. Or whatever. See you soon! I’ll be around–this is just too good to pass up.

    • Amazed

      Big girl! Don’t go away! I’ve been waiting breathlessly for your mighty brain to make the research on baby Gavin Michael’s death! You promised you’d look it up since you were so open to the truth about unqualified CPMs.

      What are you going to say about this baby and the droves of CPMs, you great human being?

    • PrimaryCareDoc

      In case you missed my calculation downstream, your decimals are off. I get that there is a 10% increased risk for home birth in our theoretical woman.

      That risk is enough to make me go running to the nearest hospital.

      Now, my numbers might be off. Let’s say I’m off by a factor of 10. Even a 1% increased risk would make me run to the hospital. That’s 1/100.

  • SweetBabyJesus

    Best yet?

    Midwife? Burrrrrn herrrrr! BURRRRN HERRRR!

    • Bombshellrisa

      Katie, is that you? If not, you aren’t the first person to say it but the only people who have ever said it here have been CPMs.

      • yugaya

        No, she’s not Katie dearest. Katie is a sociopath, not an idiot.

      • SweetBabyJesus

        Don’t memes make it so much funnier?!

        • Bombshellrisa

          You just insulted yourself. You have stated that we have had the experience of dealing with isolated cases of bad behavior by CPMs. That might be true, but you haven’t made a case for being the exception. I would like you to think about this very hard: you are aspiring to provide healthcare to women. In that capacity, you will be in the position to have to be the bearer of bad news and also inform women about things they may not want to hear. You have said you are going to adhere to a very strict risking out process and so there will be women seeking your care who are going to disagree with you, who are going to hurl insults at you and who are going to have unhappy family members too. Are you going to react in the same fashion you have to the people on this board? It only gets harder from here.

          • SweetBabyJesus

            How can I make my case to a brick wall mortared with hate-filled zealots like you all? HOW? What else can I say?

            I am willing to take on the responsibility of caring for women and family because I know how to stay in my lane, practice within my scope and receive advisement from backing physicians who we work with DAILY. I will see heartbreak and death at some point–all birth workers inevitably do–but it will not happen as a result of my own ignorance or poor practice.

            You won’t believe a word I am saying–you don’t have to. You will watch it play out year after year as more states legalize midwifery and make stringent standards that keep the Duggar idiots out of practice. And I will smirk and think back to this time we’ve all had together.

            Oh and I kinda just want to say to you personally: STUFF IT.

          • KeeperOfTheBooks

            Will you say the same thing to a mother who wants to know what you have to say to the fact that her baby died in your care, but would have survived in a hospital? A mother who’s angry and hurting and wanting to know why you didn’t tell her that her risk of losing her baby was twice as high in your care as it would be in a hospital?
            Because from what I’ve seen, that would be standard CPM practice. I genuinely hope that won’t be yours, but if this is how you respond to one of the more courteous people here, I can just imagine how you’ll handle a tearful, hysterical woman who wants to know why you killed her baby.

          • SweetBabyJesus

            The mother’s informed choice involves her assuming the risks that I will clearly lay out from the start. She will know that her choice comes with risks and that as long as I have done my due diligence then I am not the one at fault. And I will not dump her off or abandon her, I will stand by her side and process the grief with her.

            I apologize if I was rude. If you’re associated with this crew then I assumed you were full of acid like everyone else here. For two days I have been fighting off these wolves, and even when I admit fault they make fun of me.

            I did not mean to hurt your feelings. I am sorry for that @keeperofthebooks:disqus .

          • fiftyfifty1

            “as long as I have done my due diligence then I am not the one at fault”

            You don’t think it’s possible you could make a mistake?

          • DaisyGrrl

            She’s setting her patients up for the classic “she knew the risks” gambit.

            Classy.

          • PrimaryCareDoc

            Impossible, fiftyfifty! She never makes mistakes. No CPMs do.

          • Daleth

            The mother’s informed choice involves her assuming the risks that I will clearly lay out from the start.

            Will you really? So that means you’ll show her the Cornell study, for instance, that looked at all low-risk full-term babies born in the US over a three-year period (almost 10.5 million babies) and found that they were four times as likely to die in a midwife-attended home birth (which almost always means a CPM) as in a midwife-attended hospital birth (which always means a CNM)?

          • Bombshellrisa

            I live in a state where midwifery is legal, the biggest obstetrical malpractice case was actually involving CPMs. As the law is written, everything is pretty clear about how midwives can practice. There is even provisions for petitioning for hospital privileges but as yet, nobody has been granted that. I don’t know what that will lead to, time will tell. But I will say this, I have seen CPMs practice in perfectly legal and strict ways and be called out by clients who believed something they read on the internet, who saw fit to insult the midwife (who was beyond correct about something) and continue to make her life hell long after she transferred care. It comes with the territory of practicing within your scope and you will not be able to insult those people or even answer back in a respectful way.

          • SweetBabyJesus

            That’s unfortunate. If the CPM is found in the court of law to practice within scope and make good decisions, then they will be released from litigation. The same thing happens to OBs. This is not a perfect system and babies just… die sometimes. (<–how many times will THAT be taken out of context!?) That is why we need to hone the system and develop fail-safe ways of seamless transfer.

            You're just taking a journey into the hypothetical without knowing a single thing about how I will or will not communicate with my future clients. In short, please be quiet and move on to something more concrete.

          • Bombshellrisa

            These are actual situations that have happened. More than once the mother wouldn’t transfer during a labor that the midwife could see was going to need more care than she could give but she couldn’t make the woman transfer and she couldn’t abandon the woman. The midwife was on the hook for that despite the fact that she was doing the right thing. Also have seen women who won’t agree to hospital birth when it’s likely their baby will need immediate help. You might be doing everything right, but it’s not all about the care that you give, it’s about the care that your client agrees to.

          • PrimaryCareDoc

            See. Here’s the thing. If a doctor is sued and in a court of law is found not-liable…the issue doesn’t just go away. His malpractice rates will go up. He will have to report that lawsuit to everyone for the rest of his practicing years. Jobs, hospitals where he wants to get privileges, states where he wants to get licensed, insurances that he wants to get contracts with. That lawsuit, where he was found in the court of law to be not liable at not at fault, will haunt him to the end of his days.

            Still want to be held to the same standards as a doctor???

          • fiftyfifty1

            “develop fail-safe ways of seamless transfer”

            The fact that you think this is possible says a lot about what you don’t understand about birth. Certainly it’s possible to improve a transfer protocol. But creating a system that *cannot fail* and is “seamless” where seams exist? No.

            If women labor separated from lifesaving experts and technology, some will inevitably not make it in time.

          • Roadstergal

            The most fail-safe way to have seamless transfer is to have the woman present in the hospital with her blood typed and matched, heplock in place, etc.

            Again – I thought ‘an ounce of prevention is worth a pound of cure’ was a folksy saying perfectly in tune with Ancient Wisdom Granny Midwives?

          • MaineJen

            Here’s the thing, SBJ: CPMs HAVE NO standards of practice. They don’t want them.

            Previously healthy babies do NOT just die without anyone noticing in a hospital. That is what monitoring is for.

          • Sarah

            You could start by not calling an older woman you don’t like a witch, and doing enough research to understand that the WHO don’t have a recommended section rate. You know, just as preliminaries.

          • Daleth

            I will see heartbreak and death at some point–all birth workers inevitably do–but it will not happen as a result of my own ignorance or poor practice.

            That is a terrifyingly arrogant attitude, Abby Reichart. Even doctors sometimes “see heartbreak and death” as a result of their own mistakes. For instance, a doctor might be ignorant of some extremely rare problem, or on one occasion engage in a poor practice–surgeons’ mistakes sometimes kill people, for instance; it even happened to Virginia Apgar, who saved so many babies’ lives by inventing the Apgar score.*

            It can happen to DOCTORS. To people with vastly more knowledge of their field than you will ever have.

            So what on EARTH makes you so convinced it could somehow never happen to you?

            * You can read this article to find out how the Apgar score saved lives, and also what the mistake was that she made that killed someone–pay close attention to how she handled that, BTW, because she was scrupulously ethical about it, and hopefully you will be too: http://www.newyorker.com/magazine/2006/10/09/the-score

          • yugaya

            I loved reading that article, thank you for posting it.

          • Daleth

            Wasn’t it great? You’re welcome.

          • Roadstergal

            “but it will not happen as a result of my own ignorance or poor practice.”

            No, it will come about as a result of your arrogance, and your inability to learn a blessed thing.

    • Who?

      These are really nice photos of Dr T.

      Thanks for sharing.

      • SweetBabyJesus

        Eh, good one?

      • SweetBabyJesus

        Thank google. And for the fact that it’s a high res image. Gotta love the internet!

    • Sarah

      Ah yes, an older woman saying something you disagree with must be a witch. Your ageism is showing dear.

      • Roadstergal

        Sexist, too. Just like all of the midwives and doulas who are all “I am here to empower women!” and yet are the first to yell ‘witch’ and ‘cunt.’

  • SweetBabyJesus

    Ooo and this one! Because every balanced conversation where we discuss differing views and takes on the literature and come up with ideal practice models for all starts with… INSULTS!

    • Daleth

      She gives respect where respect is due. Not necessarily where you personally might WANT respect, but where you are actually DUE some respect because of your knowledge, skills, experience, wisdom, thoughtfulness, etc.

    • fiftyfifty1

      But it’s not FAAAAIIIRRR that nobody here respects me!! I came here to badmouth Jill Duggar for her totally fake midwifery education, but you didn’t praise me for that!! It’s not FAIR because MY fake midwifery education is gonna look so much more CONVINCING than Jill’s. I’m gonna be a WAY better snakeoil salesman than her. Don’t I get ANY respect for that!???

    • Roadstergal

      SBJ: It’s so _totally_ not fair that respect has to be earned!

  • SweetBabyJesus

    Just a few reminders: Jill Duggar is an idiot. And Dr. Amy is as zealous at the clay-mug toting patchouli spritzing woohoos out there–just in the opposite direction.

    • yugaya

      ” Jill Duggar is an idiot.”

      Pot. Kettle.

      How many times have we seen CPMs come in here and tell us all about how “there are some other CPMs who are indeed dangerous, ignorant, idiots, reckless and killers”… only to discover that the quack dissing her colleague frauds was just as bad if not worse?

      • SweetBabyJesus

        Do you find that out or is that your assumption. You know what assuming does @yugaya:disqus … I don’t even have to say it…

        • yugaya

          I know what answering self-talk rhetorical questions does – provides further proof just how substandard your CPM education was in all aspects.

    • PrimaryCareDoc

      Are you aware Dr. T is retired? She’s not pulling in a quarter million.

      • SweetBabyJesus

        I think you’ve missed the point here. But thank GOD she is retired! Phew! No more extreme-o training being passed on to the new OB gen. Hopefully they can get a more balanced view from someone who isn’t on a holy crusade against midwives.

        • Fallow

          Dr. Amy’s views are pretty close to mainstream conventional. They only seem extreme to you because you want to feel like a martyred birth revolutionary, when you’re really just a narcissist birth junkie.

        • Daleth

          If you think following ACOG guidelines is “extreme-o,” you are the one who is extreme.

      • Who?

        So what if she was? It’s no one’s business but hers; and whatever she is making it doesn’t involve killing anyone, so there’s that.

        • SweetBabyJesus

          Oh OBs have killed people. They don’t carry the hefty malpractice that forces most doctors into a different specialization because their practice is risk free, ya know? They also see a much higher risk level and a wider patient pool than a CPM so it makes sense.

          I wasn’t the one to bring up money first–Dr. Amy did that. And MWs out there are banking people. They make less than teachers or garbage men in many cases. Hence the humor in the meme–you’ll catch up.

          And don’t feel bad if you smirked. We can all laugh at ourselves a little, eh?

          • fiftyfifty1

            ” They make less than teachers or garbage men in many cases. ”

            That’s because there are actual standards for those professions.

            Teachers need, at a minimum, a bachelors in teaching, strictly supervised classroom experience and a teaching license. They can’t just grant themselves a made up credential CPT, Certified Professional Teacher, because they went to school themselves, have always loved kids, and read Summerhill (twice!).

            And for garbage men, garbage is more than just a hobby. There are criteria for what they can and can’t collect. And unlike CPMs, they can’t just dump it anywhere and run if they don’t like what they have on their hands. There are actual standards.

          • Amazed

            As I wrote far down the thread, my grandmother moved her whole family to the town she was attending a teaching program in. She didn’t wail, “But there are no teaching programs in our village! I just have to become a CPT and I’ll teach’em fine, you’ll see!”

            That was 50 years ago. Cars were almost nonexistent in my part of the road. Methinks that SBJ would have howled in anguish, had she found herself in my grandmother’s shoes. Grandma? Meh. She wanted to be a teacher and she didn’t want to leave her family behind, so she found what worked for her.

            I guess that’s why she was a teacher and SBJ will be just a Certified Pretend Midwife.

          • KarenJJ

            Plus you need a licence to drive that truck. You don’t just get to make up one from the back of a weetbix packet and award it to yourself.

          • Fallow

            What a slimy thing to say about garbage collectors. They keep our society running, while performing a Sisphyean, dangerous, disgusting job. All the while, people talk about them like they’re jokes or rhetorical crutches. Sanitation workers deserve to be paid well. They definitely deserve to be paid more than fraudulent medical practitioners.

          • The Bofa on the Sofa

            You know, if being a garbage collector is such a great job and makes so much money, why doesn’t she want to do that? And if she doesn’t want to do it, then she can’t really complain about how much they get paid.

          • Daleth

            Word.

          • Roadstergal

            Garbage collectors show up on time when they’re supposed to. Every week. CPMs seem to struggle with that part.

          • Bombshellrisa

            The ones in my area make $100,000 between pay and benefits. They do work very long hours and are punctual. All the ones here wave and honk the horn at my son when we take him out to see the truck. So they are polite and kind to strangers, they understand they are setting an example as an adult doing a job that helps others.

      • SweetBabyJesus

        Oh and you make money on the ads that you have on your blog. Dr. Amy still is getting that c-c-cash and you guys get the fortune of padding her pockets with targeting marketing from amazon and one of her extremist books! She’s really got a pretty good thing going if you ask me…

        Except for the extreme part. That really sucks for everyone, mothers who want transparency and choice after all.

        • KeeperOfTheBooks

          Like the transparent fact that they’re twice as likely to lose their babies in your care than in a hospital?

        • lilin

          She makes money off ads. You make money by putting babies in danger.

          Let me think about who I should trust. Oh, it’s a tough one!

    • MaineJen

      Claims retired doc is in it for the money.

      Accepts money in exchange for some random stranger naming her baby.

      • Roadstergal

        Excellent point.

    • fiftyfifty1

      It’s pretty clear what your motives are. You know who your competition is. You have to convince your clients to give YOU their money. To do that you have to demonize both OBs and other fake midwives like Jill Duggar.

    • Azuran

      Everyone is paid to do their work. Doesn’t mean they are in it for the money. Those who have higher paying job are not necessarily more in it for the money than others. Harder, more stressful jobs and jobs with higher stakes are usually paid better. It is entirely normal for an OB, who went through a long, expensive and hard training, who must keep her training up to date all the time, and who is now responsible for the well being of pregnant mothers and their babies (babies who are often more precious to the mothers than themselves) during one of the most dangerous time of their lives, is paid accordingly.

  • KeeperOfTheBooks

    Related: have any of you been following Navelgazing Midwife’s (Barbara Herrera’s) blog at all? It’s rather interesting. Back when I was neck-deep in woo, I’d read it religiously. Then I didn’t for several years, but got curious and googled her a few weeks ago.
    She’s a CPM/LM of some kind who has been practicing for decades. However, she’s gradually, over the last 3-5 years, been evolving in her thinking about homebirth safety, and that was quite interesting to watch.
    She’s calling for much better training of midwives in medicine in general, particularly in CPR/first aid, and is actually calling out the idiots who are against this or who don’t take it seriously. She used to be very pro-HBAC, now she thinks it’s a stupid idea. Used to support minimal monitoring, now thinks that’s a bad idea. Etc. Heck, she specifically called out Christy Collins et all.
    It’s interesting watching her thinking on this stuff change as she looks at the studies, and it’s extremely refreshing to see someone with her level of intellectual honesty confront things that have to be difficult for her to face. I still disagree with her on a number of issues, but she strikes me as the sort of person I’d enjoy sitting down and having a good intellectual argument with about them, rather than someone who’ll just scream “nasty oppressive person who doesn’t trust birth!” at you before running screaming for the nearest “Peaceful” essential oil blend, y’know?

    • fiftyfifty1

      I find her less idiotic than previously, but still pretty idiotic.
      It seems to me that when a person holds a cherished belief and then circumstances force them to really question it and reject it (e.g. when her daughter needed a CS), that this should make a person ask themselves “If I was so wrong about this belief, could I also be wrong about other similar cherished beliefs?”. But no. She is just a blinded by Dunning Kruger as ever before with her other beliefs.

      • KeeperOfTheBooks

        Like I said, I still disagree with her on plenty of stuff, and perhaps I’m over-reacting to the novelty of someone who can admit fault and point some fingers where they’re due. (Her post on the lunacy going on at Casa, for example, comes to mind.) I’ll probably check back in on her blog in a year or two, see what else has changed then.

  • Stacy48918

    Sweet baby jesus….. what an appropriate handle.
    That’s all I’ve got. 😛

    • yugaya

      Holy shit! is what I’m left with.

    • attitude devant

      I just wish she’d stick the flounce…..

      • Bombshellrisa

        Oh, but how else would we know that we are fear mongering meanies who don’t know how CPMs practice without her?

        • attitude devant

          I just keep hearing the Pirates of Penzance:
          “We go, we go!” (“But they’re still here!”)
          “We go, we go!” (“But they DON’T go!”)

          • KeeperOfTheBooks

            Mega bonus points for the G&S reference. 😀

          • Roadstergal

            “Dammit, they DON’T go!”

            *loves you*

          • attitude devant

            backatcha, babe!

    • SweetBabyJesus

      Lame, at best.

      • Stacy48918

        How about this one:
        Jesus H Roosevelt Christ!

        • SweetBabyJesus

          now THAT’S what I’m talking about!

  • moto_librarian

    Every single time that a CPM shows up here, it merely hardens my resolve to see their fantasy credential legislated out of existence. No other developed country would allow a CPM or DEM to practice midwifery. The fact that OBs do not want to collaborate with CPMs has nothing to do with ego, but everything to do with liability. Why should they agree to back-up women masquerading as health care professionals knowing that they are the ones who will be sued since their midwife colleagues don’t carry malpractice insurance. In fact, if anyone has an ego problem, surely it is CPMs with their delusions of grandeur and persecution complexes.

    • attitude devant

      I think the thing that makes my hair stand on end is her blithe assertion of statistics….that seem to come from nowhere, such as the claim that most maternal mortality is due to suicide, or that OBs only do 75 vaginal births in training.

    • Megan

      I get as angry as I do because these people con women and play with their safety and the safety of their babies. It is infuriating that they can do this with no consequences and still dismiss/rationalize that what they are doing is harmful. The fact that they can’t understand why we get angry about the issue and the safety of mothers and babies just disgusts me. They are terrifying.

    • SweetBabyJesus

      So many OBs ARE collaborating. Just not the ones who follow this hospital birth crusader. You don’t see what you don’t want to see. And if you want to do something about it…

      DO IT.

      • Daleth

        Really? Point us to some OBs who collaborate with CPMs. Better yet, point us to some CPMs who have hospital privileges.

      • moto_librarian

        Oh sweetheart, I am indeed doing my part to see that these faux credentials go the way of the dinosaurs.

      • lilin

        That’s kind of like saying that people negotiating a hostage crisis are collaborating with the people taking hostages.

        “Yes, Moon Dragon! A woman giving birth in a pool of water that she’s just shit it is a great idea. Do you think you could let me see if the baby’s heart is beating now? Thanks. Good collaboration, buddy!”

    • SweetBabyJesus

      Oh and OBs won’t collaborate with idiots, like the Duggar lady. So behind that decision.

      Oh and OBs also have their hands tied in so much hospital policy that their free will in that is often non-existent. Godlike as they may be!

  • SweetBabyJesus

    http://www.acog.org/Resources-And-Publications/Committee-Opinions

    /Committee-on-Obstetric-Practice/Planned-Home-Birth

    I would like to end on a high note with everyone and I must say that we’ve had some fun today. I will leave you with some stats on homebirth from ACOG, the governing body of OB/GYNs (as most of you know–except Bofa maybe). They say that although the safest place for birth is in a hospital or home birth, that the choice rests with the mother. The real risks associated in Homebirth vs hospital birth, according to ACOG, are as follows:

    Neonatal death—all newborns
    Homebirth: 2.0/1,000
    Hospital Birth: 0.9/1,000
    (increased risk with Homebirth is 0.1%)

    Neonatal death—nonanomalous
    Homebirth: 1.5/1,000
    Hospital Birth: 0.4/1,000
    (increased risk with Homebirth is 0.1%)

    Episiotomy
    Homebirth: 7.0%
    Hospital Birth: 10.4%

    Operative vaginal delivery
    Homebirth: 3.5%
    Hospital Birth: 10.2%

    Cesarean delivery
    Homebirth: 5.0%
    Hospital Birth: 9.3%

    Third- or fourth-degree laceration
    Homebirth: 1.2%
    Hospital Birth: 2.5%

    Maternal infection
    Homebirth: 0.7%
    Hospital Birth: 2.6%

    I will end with this: The perinatal risk of having a homebirth over a hospital is 0.1% greater. The cesarean rates, 3rd/4th degree laceration rates, and maternal infection rates are lower in a homebirth setting. ACOG admits “The relative risk versus benefit of a planned home birth remains the subject of current debate. High-quality evidence to inform this debate is limited. To date there have been no adequate randomized clinical trials of planned home birth”, meaning that more research on homebirth could shed more light on the safety of the practice. With what knowledge we do have here, we can see that the overall real risk associated with having a homebirth is only slight and can in turn help the mother to avoid many medical interventions, a few of which are demonstrated here. I am not anti-hospital (or anti-cesarean), I am not anti-medical. I am pro-collaboration and pro evidence-based care. For those that want to paint me into a wacky free-birther category, pop off the blinders and accept that people are not so black and white as you would comfortably like to believe.

    For anyone who is vehemently against out of hospital birth, I urge you to consider these numbers and also to consider the risks that mothers and babies may be exposed to in a hospital when they receive unnecessary intervention under non-emergent circumstances. This fault does not rest solely with the OB community but the OB community has more tools than any to unravel the stringent hospital protocol that uses fear to mitigate all risks and therefore costly litigation (impossible!). We all have our own path to walk and our own truths to find, and mine will always lie with the evidence. Birth is not zero risk, life is not zero risk. Personally attacking midwives who are choosing this profession for the right reasons and the right goals is a travesty to obstetrical care at large. Diminishing maternal choice in healthcare options is a function of an outdated system where women’s choice overall is the subject of a patriarchal debate about “what’s best for her”. Women are deciding what is best for them, and many are deciding that the abuse and coercion that happens in some hospital settings is not their ideal way. Saving a life is exceedingly important to the birth process and no one can rightfully disagree. Quality of life is another story and one that deserves more than a brief thought. Breastfeeding, bonding, perinatal mental health, maternal choices and low-cost access to healthcare are strong reasons to question the status quo every step of the way and to consider that there is more than one way to approach obstetrical care.

    We have all of the evidence we need in the practice of several leading European countries that can work and DOES work. I charge you birth care providers out there to exit your comfort zone and train the midwife that you want to see practice. To expand your own awareness without judgment so that you can get in the heads of your patients and out of the doctor’s mindset. I am asking for your help in allowing me to do the same and several of you today have shared things that I have learned from. Do not be afraid to be impacted in the face of going against everything that you were taught. This is the evolution of evidence-based practice and your responsibility to uphold as a birth care professional.

    Thanks for listening and thank you to the very, very few who did not personally attack me but provided their own research-based evidence and logic (Houston mama you were kind in your approach and that kindness makes learning from you or anyone far more palatable.). Dr. Amy–I’ll still be around and I will still be questioning, as long as I live. Worlds are turned by such folks and we are in this together, polarized as we might be.

    • Karen in SC

      I urge you to take off your blinders and become a CNM if you feel so strongly.

      The risk is real and translates to real babies that were healthy and alive before labor and dead at the end since their mothers were conned by women who don’t know what they don’t know.

      Do you think the mothers of the babies listed on this shirt would have cared if their nurse was mean? or they had to wear a hospital gown.

      • Karen in SC

        Or the mothers in this video? https://www.youtube.com/watch?v=CRhkZKUNyMY

        • Karen in SC

          Can’t even acknowledge these babies, can you, Sweet? I think deep down you are afraid this will happen to you someday when you miss a breech, fail to test for GBS, take on a home vbac and the uterus ruptures, lose the second twin. Even if you risk out as you claim, how can you predict a PPH, notice if your client is having a stroke during labor, handle a tough shoulder dystocia without the resources of a hospital team, do proper neonatal resuscitation?

    • KeeperOfTheBooks

      Neonatal death—all newborns
      Homebirth: 2.0/1,000
      Hospital Birth: 0.9/1,000
      (increased risk with Homebirth is 0.1%)
      Wait, what? Unless I’m missing something here, and that’s always possible, surely that’s a more-than-doubled risk, and an increase of 1.1%, not .1%?

      • SweetBabyJesus

        0.0011 is 0.1%, no?

        • Karen in SC

          Percent increase would be the difference in the two, divided by the base number, so 1.1/0.9 , times 100.

          • Amazed

            Gods! And she thinks herself educated. I fear for any pregnant woman and baby that might cross her path.

          • The Bofa on the Sofa

            This just goes back to the “it’s a tiny percentage” that we heard yesterday. Bah, deaths don’t matter, they are rare.

          • Megan

            I guess basic math isn’t in the CPM curriculum.

          • moto_librarian

            Remember, they weren’t even required to have a high school diploma or GED until recently.

          • SweetBabyJesus

            I have a Bachelor’s. But thanks for the reminder.

          • moto_librarian

            I have two masters degrees. What’s your point?

          • SweetBabyJesus

            Your comment “Remember, they weren’t even required to have a high school diploma or GED until recently.” is what I referring to….

          • The Bofa on the Sofa

            Yeah, we know. Based on your comments, however, it is not so evident…

            If you don’t want to be mistaken as a high school dropout, stop talking like one.

          • PrimaryCareDoc

            Did you study basic math for that Bachelor’s?

        • The Bofa on the Sofa

          Yep, in the same way that drunk driving increases the risk of death by 0.0002%.

      • KeeperOfTheBooks

        Nice to know that I’m only 50% incompetent when it comes to math; it would seem I was right on the “more than doubling” claim, but the increase would be 1.1% *of the total*–more correctly stated as an increase of over 100%. Ha! I learned something today! Thanks, commenters. 🙂

    • An Actual Attorney

      The fact that you think 1/1000 is rare is terrifying.

    • attitude devant

      Good Lord. You have no clue, do you? You don’t understand even fairly basic math and yet you think you understand these issues better than those of us who’ve devoted decades to studying and practicing. Please, find a teenager taking remedial math and have them explain these stats to you.

    • Roadstergal

      I have been spending some time trying to be kind and respectful, to ask questions, and give you the benefit of the doubt, and not use phrases such as ‘dumb as a sack of hammers.’ Now I am glad I did not inadvertently insult hammers. No amount of information will make you stop and consider that _maybe_ you don’t know as much as you think, and maybe it would behoove you to step back from your firmly held beliefs for a moment and listen to those with a lot more education and experience.

      I’m glad that most births go pretty sorta kinda okay without much help, so the overt damage you will wreak will likely be minimal, and luckily for you, substantially downstream from your involvement. Still, you could be a taxi driver in New York and do more good to pregnant and delivering women than you would as a CPM.

      • SweetBabyJesus

        Really? A taxi driver? REALLY?

        • Amazed

          Really. A taxi driver. REALLY. A taxi driver won’t write the editor of a lay midwifery journal to ask what to do aboyt a life and death situation. A taxi driver won’t take this question and post it on Facebook in real time asking other taxi drivers about their anecdotes about the same situation. Taxi drivers won’t flood the page with nonsensical “remedies” as the baby dies inside his mothers.

          CPMs did.

          • Bombshellrisa

            #gavinmichael #notburiedtwice
            A taxi driver wouldn’t write a poem to the mother of a baby who died because of their insisting on taking the long route. Yet that is what Christie Collins did, and she made it all about her feelings. I hadn’t read it until Gavin’s mom mentioned it and helped me find the link to it and reading it made me cry and then get angry.

          • SweetBabyJesus

            Whatever case you are referring to seems awful and tragic. It also seems like an isolate example of one idiotic midwife. That doesn’t speak for the whole. I am sorry for their loss.

          • moto_librarian

            It’s not an isolated case in the United States! And we don’t have any idea of the morbidity surrounding home birth. Once that’s factored in, the picture will get even uglier.

          • Bombshellrisa

            It would be sad, especially if she hadn’t been run out of another state for doing the same thing. She was on Facebook crowd sourcing this and to some very prominent midwifery advocates. The whole discussion got deleted, but there were screen caps. The Facebook page is In Light of Gavin Michael. The list of midwives who make a regular practice of killing and injuring babies and mothers can be found at sisters in chains dot com.

          • Who?

            They’re all ‘isolated’ examples, which is to say that without a system to keep track of them, the true stories don’t come out.

            Doctors or hospitals make a mistake, the system knows it, their insurance company knows it, before long the media knows it.

            Midwives-or as I like to call them, birth hobbyists-make a mistake, they block the family on facebook, call for support in their suffering, say the baby wasn’t meant to live, and get their victim face on.

            I know who I’d rather deal with.

          • Bombshellrisa

            Sentinel event. There is no brunch and feelings talk at those investigations

          • Who?

            So that’s like a meeting without coffee in corporate world? Where, it has to be said, usually no one has died.

            People talk about the arrogance of doctors, but to me they are exposed to their peers in a way most professionals aren’t, every day of the week.

          • Bombshellrisa

            Exactly, near miss situations are commonly swept under the rug by home birth midwives. Near misses are considered just as serious by doctors and nurses and aren’t easily excused.

          • fiftyfifty1

            No. A whole host of CMP midwives. Multiple CPMs including leaders like Christie Collins.

          • Megan

            Bofa’s law…

          • Amazed

            No, no, Bomb. You got it wrong. She wrote the mother a letter. That poem about babies not being library books, she posted it on Facebook mere days after this post-date baby died.

            I know it looks even more disgusting. But it’s the truth. Let’s share it in all its ugliness.

          • Bombshellrisa

            Omg, that is worse. I didn’t see it go down in real time, I had a newborn at the time. The only reason I knew about any of it was that Danielle shared it and then it was referred to in the group and I didn’t have a clue what she was talking about so she directed me to both. The part about her holding her baby and having him sleep in the bed with her after he died ripped me apart, because weeks before the nurses had tucked my son and I into the bed together (baby friendly hospital).

        • Roadstergal

          They can get women to prenatal appointments while pregnant, and to the hospital while in labor. That’s a valuable service in areas where many cannot own a car. And research has shown that when it’s an easy, uncomplicated delivery, untrained attendants, including taxi drivers, have pretty decent outcomes when oops-the-baby-comes-on-the-way. Because when it’s an easy, uncomplicated delivery, you don’t have to do much, which is the bedrock of the CPM business model.

      • SweetBabyJesus

        Nah, you’ve been pretty nasty all along. This is just par for the course.

        • Amazed

          Oh cry me a river! If a 1/1000 babies can die without it being a blip on your radar, you, as serving (and exploiting) the tiny 2% of women can take a blow on your poor heart without it being a blip on mine.

          • SweetBabyJesus

            That is a blip on my radar. That is also a trade-off for some of the things that can happen when only-hospital birth is enforced. And you are nastier than he is btw

          • moto_librarian

            I wouldn’t trust my care or that of my unborn child’s to someone who views preventable deaths as a “blip on my radar.” You are revolting.

          • SweetBabyJesus

            Those were @disqus_sW7nel5lNp:disqus ‘s words, not mine. I was repeating in sarcasm. Ya knowwww, sarcasm?

          • moto_librarian

            No, I don’t believe that you really are concerned about preventable deaths. You have written nothing that convinces me that you understand how sub-par the CPM credential truly is.

          • SweetBabyJesus

            Well obviously I don’t believe that so I am not going to write it. I am VERY concerned about perinatal death. It is a really deeply painful insult that you would suggest that I am not. But that’s the fear-based side of you speaking I am sure. There are so few stats on homebirth that are reliable. We will all find out more as this practice grows and is properly studied.

          • moto_librarian

            Perinatal mortality rate 2-3 times higher among home birth compared to all hospital birth is a remarkably robust finding. It holds up in the Netherlands and the UK. We don’t really need more studies to prove it. We need to figure out how to prevent it.

          • Bombshellrisa

            I guess it’s better than the baby being compared to poop, like what usually happens

          • Roadstergal

            The thing is, it would be fine (for a given definition of fine) if he/she explained that to her clients. “You are increasing the risk of death and injury to your baby by birthing with me. The statistics are fairly clear, across multiple studies and countries, that although the absolute risk is low, the majority of babies that die in a homebirth would have lived in a hospital, and also suggest that nonfatal negative outcomes, such as hypoxic injury, are also increased by delivering at home with me.” And let mom and dad and any other stakeholders decide based on that information. But I haven’t enough delusions in my various pockets to think he/she’s actually going to inform his/her clients of that.

          • The Bofa on the Sofa

            We saw your list of the risks of c-sections below. Most of them are readily treatable, none of them included perinatal death, and the risks of maternal death is much, much lower than .1%.

            For that you would sacrifice babies?

          • Amazed

            Again about your tiny hurt feelings. Are you ever going to get it into this thick head of yours that it isn’t about you, your whining that people are being nasty to you and your precious comfort which won’t let you to get the tiniest bir inconvenienced in order to be the safest practitioner possible? It’s about life and death. It isn’t about you and your fellow narcissistic CPMs and CPMs wannabes. IT ISN’T ABOUT YOU!

          • Who?

            Death as a trade off for discomfort? Nice.

          • Roadstergal

            The thing is, hospitals don’t have to be uncomfortable. Some of them are downright swanky! Why not push for more well-appointed birthing suites – especially in hospitals that serve low-income women, who get the shaft on so many things – instead of more HB? That would be a great use of money and effort.

            Or a van service so that CNMs can bring proper pre- and post-natal care to low-income women who struggle to find time to make hospital appointments.

          • Who?

            Oh I agree. But SWB and her appalling mates sell the line that they are-and somehow get far enough into people’s heads that they don’t find out the truth until it’s too late.

            But even if hospital was horrid, if death was the sole alternative, you’d go to hospital.

          • Roadstergal

            I have to admit, I love hospitals. I love how clean and professional the good ones are, how they’re full of people who are so knowledgeable and have so many good stories. I love that they are full of people getting needed care. I don’t pretend they always do great, and I love initiatives like Choose Wisely that are trying to make them work better. But whenever I’ve had something I needed dealt with, I’ve always liked the hospital. I wish that it was standard doula practice to walk women through the hospital and show them that it isn’t this scary boogy place of suffering.

            (Heck, maybe that sort of thing would help with policies around not delaying requested pain relief. Women screaming bloody murder doesn’t go over well as PR.)

          • Who?

            When you need hospital, it is awesome.

            My daughter broke her arm a few weeks ago, and the staff at emergency were amazing, so gentle and so forthcoming with the morphine.

            Call the Midwife was on yesterday and it was the episode where the gas and air was introduced. Even the old nun/midwife who didn’t approve of it at first was won over when she had it to help with the pain of her dislocated shoulder.

          • KeeperOfTheBooks

            It’s funny, in a kinda-not-funny way, but I actually feel happy and at home in hospitals. I grant that my experience isn’t exactly the norm, though. Grew up in a seriously crazy family. Started volunteering at my local hospital as soon as I turned 14, and transferred to the ER when I was 16. To teenage me, the hospital was a safe place I could go where adults not only gave a crap about me, but respected the work I did. (I make no pretensions that getting rooms cleaned and linens/supplies stocked saved lives, but I do like to think that that helped the people who did. The nurses and techs certainly seemed to appreciate it, and helping others helped me more than anything else.) To this day, I can feel myself physically relax when I walk into a hospital, like “oh, someone else really competent is in charge, I can sit back and let them take it from here.”

          • Bombshellrisa

            From what I have read, your early life and mine were a lot alike. The homeschooling, the way my parents treated me. It was actually something that factored into me wanting to be a doula and a midwife. I completely understand the feeling you are talking about. Having worth beyond my being the unpaid constant babysitter and doing the housework and having dinner ready at home meant so much to me.

          • fiftyfifty1

            Clean rooms and well stocked supplies do indeed save lives.

          • Monkey Professor for a Head

            When I did an antenatal class, the midwife took us on a tour of the labour ward. She took us into the assessment room first and was telling us basically how inferior it was due to being clinical and non homely. I remember looking around and thinking “No, this is familiar, I like this!” But I guess spending a good chunk of my life in hospital since graduation would skew my reaction.

          • Bombshellrisa

            Remember the list we compiled here awhile back, how people without any medical background could really help make a difference and improve birth for women? The overwhelming response was help with transportation or be willing to act as a postpartum doula without charging the $28/hour, 4 hour minimum fee. If someone is passionate and wants better outcomes for all women, something like that would be a better start than trying to “change the world” by becoming a CPM

          • KeeperOfTheBooks

            “Sure, Mary, you and/or your baby will die, but at least Sally, Ashley, Tricia, et all will have their babies at home, not in those nasty hospitals, so it’s all worth it! Why don’t you understand that?”

          • Who?

            You’ll hurt her feelings talking like that. And having your feelings hurt is just as bad as being dead, in SWB world.

          • Amazed

            Not so sure. Having SBJ’s feelings hurt seems to be worse than a BABY being dead.

          • Who?

            Fair call.

            The caffeine hasn’t hit the brain this morning, no idea who I thought SWB was?

          • An Actual Attorney

            What is a dead baby worth trading for? A lesser chance of an infection? How many infections?

          • Bombshellrisa

            Remember the one doula who said here that it’s worth it to have a dead baby if the mother has a healing vaginal birth? You can’t make this stuff up.

          • An Actual Attorney

            I try very hard to block that sh*t from my memory. The psychopathy is hard to process.

          • MaineJen

            Did you actually just say that 1/1000 infant mortality rate is a blip on your radar?

          • The Bofa on the Sofa

            Just a little hiccup, right?

          • Bombshellrisa

            You mean “hickup”. It probably has something to do with a “social moray”.

        • Roadstergal

          Alas, it’s always disappointing to know I could have just started with “Dear shitferbrains.” Well, it’s good practice.

          I would be laughing and baiting and having fun with this exchange, if it were not for the idea of you caring for pregnant women who are in a physically and mentally vulnerable state, and giving them incorrect data and misinformed consent. That is chilling. It’s just like if I hear that a friend of mine is out driving drunk. Yes, it’s more likely than not that nothing bad will happen, but it’s nonetheless chilling.

          Are you totally okay with moms driving drunk? It’s very low-risk, by your own stated standards.

    • SweetBabyJesus

      Edited for my poor math skills–HB risk is increased by 1.1%.

      • attitude devant

        Um, you still don’t have that correct. For instance, looking at your leading stat on risk of neonatal death, if homebirth rate is 2/1000, and hospital birth rate is 0.9/1000, the HB risk is more than 100% higher.

        • SweetBabyJesus

          So all babies die out of hospital, or the majority?

          • moto_librarian

            Quit being willfully obtuse.

          • SweetBabyJesus

            After you.

          • Houston Mom

            http://mathforum.org/library/drmath/view/58166.html

            “There are situations in which a percentage greater than 100% makes no sense. For instance, “The Math Doctors answered 146% of the questions received last month.” This makes no sense because if we received 5061 questions, we couldn’t possibly answer more than all of them. It’s just as nonsensical as saying “I ate 4/3 of the cake.”

            On the other hand, sometimes percentages are used like this: “The number of questions received was up 15.7%, from 5450 in February to 6305 in March.” In other words, the increase from February to March
            was 6305-5450 = 855, and 855 is 15.7% of 5450.

            Now, what if the number of questions received went up to 14000 in April? (It didn’t.) This would be an increase of 122% from March to April. There is nothing wrong with this – no law says that the number
            of questions can’t do more than double from one month to the next.”

          • LibrarianSarah
          • The Bofa on the Sofa

            Nice strawman.

            2 out of 3 babies that die in homebirth would survive in the hospital. That’s what the data show.

            And just like c-sections, we don’t know which are the ones that would die and not die, so don’t take the risks.

          • Roadstergal

            Babies die at home that would have lived at the hospital.

            You are quite callously dismissive about that in a way that makes us think you will not be letting women in your ‘care’ know this datum.

            In other words, your grasp of informed consent seems as tenuous as your grasp of math.

          • PrimaryCareDoc

            Are you really that stupid?

          • The Bofa on the Sofa

            Hey, hey, hey. She has a bachelor’s degree. Not sure how many math classes she took, but on the whole, it’s not clear. She might actually be really that stupid.

          • Bombshellrisa

            Oh geez. I think that even the Pablo Certified Midwife certificate would require some QSR or math classes….right?

          • The Bofa on the Sofa

            The math of a PCM is limited to 867-5309. However, advanced programs will have access to 1-2-3-4 by Gloria Estefan from the summer of 1989, but that’s rare.

          • Roadstergal

            You’ve blinded me with science.

          • The Bofa on the Sofa

            A very important lesson in the PCM curriculum: you tidy up, and you can’t find anything. It’s because of our extensive science training that we tend to be messier than most.

          • Bombshellrisa

            Is it bad that I loved that song in fourth grade? Maybe the PCM can have a credit course in musical appreciation that highlights songs with numbers and songs that spell words out. Extra credit if each song can be turned into a ditty to help remember steps to take if extra care is needed. Just promise me that any science class will ban the song “It’s Raining Men” as a explanation for anything (it’s playing here right now, my IPod picked it for me)

          • The Bofa on the Sofa

            Is it bad that I loved that song in fourth grade?

            Which one? Tommy Tutone? Or Gloria Estafan?

            Maybe the PCM can have a credit course in musical appreciation

            PCM doesn’t have a “credit course” in music appreciation. Music appreciation is embedded into the curriculum. Mostly, 80s, of course, but cheesy 70s music is also part of the program. Things like ABC by the Jackson 5 is a good combination of english and math.

          • Bombshellrisa

            Gloria Estefan. A group of friends and I worked out a little dance routine to it and showed it off on “Bring your boom box to school day”

          • The Bofa on the Sofa

            Just keep on counting, until you are mi-ine…

            That you know 1-2-3-4 by Gloria Estefan is to your PCM credit. I don’t even have it on my iPod, because it’s hard to find.

          • Roadstergal

            I have it stuck in my head now, you horrible people. *pulling up some Lyle Lovett to try to exorcise it*

          • The Bofa on the Sofa

            The song you are looking for is “Forever and Ever, Amen” by Randy Travis.

          • Who?

            No one is ever deliberately looking for a Randy Travis song, surely?

          • The Bofa on the Sofa

            To get Gloria Estefan out of your head, yes.

            Alternatively, you could go with Behind Closed Doors by Charlie Rich. Or anything by the Silver Fox, in fact.

            Hey, did you happen to see the most beautiful girl in the world? And if you did, was she crying, crying? Hey, if you happen to see the most beautiful girl who walked out on me…tell her I’m sorry. Tell her I need my baby. Oh, won’t you tell her that I love her.

          • Who?

            Fair point.

            I love that song! Though I hope she knows that she should stand firm.

          • Roadstergal

            Right, I’m switching over to John Hiatt’s Cry Love. I like a song that says, yes, you did the right thing in leaving that bastige, even if it sucks at first.

          • Charybdis

            Hello, Darlin’. It’s been a looong time…..

            or

            Happy Birthday Darlin’. I got no presents, no fancy cake. But I hope to make you happy, with everything I take…

          • The Bofa on the Sofa

            Conway Twitty is too Family Guy

          • Bombshellrisa

            My husband just suggested “Wake me Up Before You Go Go”, which would work for the midwives who nap during their time with laboring women.

          • Bombshellrisa

            To get Gloria Estefan out of your head you need the Spice Girls. Or Tim “Booty Man” Wilson and the “Booty Song”

          • Megan

            That was one of my favorites to dance to! That and Belinda Carlisle’s “Heaven Is a Place on Earth (I think my dance routine to that one involved baton twirling).”

          • Bombshellrisa

            Belinda Carlisle! We went out to lunch after the pumpkin patch on Friday and that was playing at the restaurant. My 21 month old son was dancing to it and all the other 80’s hits.
            No baton twirling here, so you have earned some PCM credits more than me there.

          • The Bofa on the Sofa

            Baton twirling to 80s music is certainly PCM credit! Flaming batons is a little too “Miss Congeniality” kitsch to count though. Unless you specifically do it to be “like that Miss Rhode Island in Miss Congeniality” in which case you have to get drunk on test tube shooters beforehand.

            Although if you are going with Belinda Carlisle, the Go-Gos version is better.

          • Who?

            Love the Go-Gos.

          • The Bofa on the Sofa

            Of course. Why wouldn’t you?

          • Who?

            Exactly.

          • Bombshellrisa

            What about a glitter baton?

          • The Bofa on the Sofa

            What about a glitter baton?

            Only if it has tassles, like we had on our bike handles.

          • Roadstergal

            I am going to suggest a new hashtag war to @midnight – #ChildbirthSongs

          • Bombshellrisa

            Now I am probably going to spend the evening with my iPod, figuring out what cheesy music can be turned into something about idiotic things CPMs and wannabes say. Maybe the Spice Girls song can be the start?

          • Roadstergal

            Thanks to the cheese below, I can only think of Total Eclipse of the Fetus sung to a breech. “Turn around…”

          • Who?

            No no no. That poor mother has enough going on without having to hear that as well.

            Though I grant it is relevant.

          • Roadstergal

            Roxette: “Listen to your fetal heart tones”

          • Who?

            You’re killing me.

            Actually that would be an apt lyric…for some of our visitors.

          • Roadstergal

            Berlin’s Take My Breath Away is Right Out.

          • Who?

            Hmm apt but a bit crass-though that is no barrier where our visitors are concerned, or so it seems.

          • The Bofa on the Sofa

            I heard yesterday that Total Eclipse of the Heart was originally going to be called “Interlude of the Vampire” or something like that. Something with vampire in the name.

          • Roadstergal

            The video does look like some high schoolers trying for Anne Rice cosplay.

          • The Bofa on the Sofa

            That’s just how Bonnie Tyler looked in the 80s

          • swbarnes2

            Yes. And then it got dragged into a hilarious bomb of a musical about a vampire ball. The wikipedia entry about behind-the scenes clashes in “Dance of the Vampires” is highly amusing.

          • Bombshellrisa

            What about Toby Keith’s “As good as I once was” when talking about placentas and women going post dates? Also applies to grand multiparas.

          • Charybdis

            C’mon. “Push It” by Salt and Pepa has got to be a shoo-in. Push it real good!!

          • Roadstergal

            Oooh, baby, baby!

          • Megan

            “Let’s wait awhile” by Janet Jackson? Or perhaps “Control” would be better?

          • Megan

            (DD and I are now totally rocking out to this album for bath time. )

          • Bombshellrisa

            My son is currently dancing to “Biscuits” by KC Musgraves. That one is more appropriate for lactivists.

          • An Actual Attorney

            When figuring out BFing, I used to sing “you and me baby ain’t nothing but mammals; let’s do like they do on the Discovery channel.”

          • Bombshellrisa

            Probably “Jesus Take the Wheel” as well, since “some babies aren’t meant to live”. And “Larger Than Life” by the Backstreet Boys for all those babies whose mothers had uncontrolled GD. “Let’s Get it Started” by the Black Eyed Peas for when they are drinking a castor oil concoction when they are post dates. “Material Girl” for the midwives who suggest bartering to be able to pay for their services or who expect a meal be provided for them at home birth.

          • KeeperOfTheBooks

            Late to the party, and all that, but might I suggest “Ultraviolet,” by the B-52s, as a nod to Ina May?
            “There’s a rest stop, let’s hit the g spot!”

          • Chi

            I LOVE that show!

          • An Actual Attorney

            It is bad, because I won’t even say what grade I was in when that song was popular.

          • attitude devant

            Personally, I’m gathering evidence on the hypothesis that she is indeed that stupid…..

          • yugaya

            Two days later and the verdict is in – she is indeed even more stupid than anyone anticipated.

          • Karen in SC

            Oh my. 100% higher means that it’s double the original, 100% of the amount is added to the base number. 2 is 100% higher than 1.

            50% higher means that half of the base is added, 1.5 is 50% higher than 1.

      • Monkey Professor for a Head

        Are you talking absolute risk or relative risk? Either way you’re incorrect. But thanks for trying to educate us!

      • fiftyfifty1

        Poor math skills indeed. Inexcusable.

    • Bombshellrisa

      “Do not be afraid to be impacted in the face of going against everything that you were taught. This is the evolution of evidence-based practice and your responsibility to uphold as a birth care professional.” This works both ways. I have read your answers. I was a doula and trained to be a home birth midwife. When I started questioning what I was learning, I found out very fast that tradition and the warm fuzzies are much more important to CPMs. My preceptor taught at a MEAC school. I had college classes before that experience. I didn’t end up following the path I had worked so hard to get to. Do read Judith Rooks CNM (who is very home birth friendly) analysis of the home birth injury and death rate in Oregon. I have talked to the Vice President of MANA. You will find that the answers run from a script when it comes to the philosophy that CPMs have.

      • SweetBabyJesus

        I work with practitioners where warm fuzzies don’t mean a thing and the health of the mother and baby do. I am sorry you had a bad experience with a CPM. The ones I work with are in direct contact with a physician and have excellent outcomes.

        • Bombshellrisa

          Then why would the idea that being comfortable and relaxed at home helps labor progress even be a thought if warm and fuzzy doesn’t matter? Why are prenatal appointments an hour long? Nobody who believes that outcome is more important than feelings would ever highlight the risks of c-sections while not doing the same for vaginal birth. It might be just that you will come to realize this as you attend clinicals and births, but when women are seeking home birth it’s because they believe home to be safer because they will be able to move around without an IV and fetal monitor, they can eat, ect. They are afraid of pitocin and C-sections and home birth midwives are feeding into that by highlighting the risks associated with these things. So what will you do when it’s clear that your client needs a higher level of care than you can provide and you tell her? She is going to be resistant to that because she doesn’t want anything other than an intervention free birth. You can’t just dump her because she won’t comply. If it’s during a birth, you are going to have to work very hard to convince her quickly that everything you have said all along doesn’t apply.

          • SweetBabyJesus

            That’s just not how any of the CPMs I work with practice. So sorry, try again.

            We transfer with our patients and assume the doula role, working alongside our BACKING PHYSICIAN. We transfer long before the trainwreck starts because that is was is ethical and safe and it is in our law. We don’t get paid shit–and if we transfer it’s even less. It seems like everyone hear would really benefit from having a sit-down with a qualified CPM who can explain their practice style and work to you. So much cluelessness and fear mongering. It really makes you look idiotic. Pathetic.

          • Amazed

            Stop lying. Stop pretending that this is the norm, even if it is for your practice which I highly doubt. Each of the murderer midwives dropping by here has spewed the same vomit.

            Did you check the story I and Bomb mentioned to you? I guess you didn’t. After all, it does make droves of your beloved CPMs look like a bunch of dumb murderers. Of course, that’s because that’s what they are.

          • SweetBabyJesus

            It is. I am here telling you it is. And you still won’t believe me. Because you believe what you want to. That’s fine, ignorance seems to be the standard here. I am going to seek out a thread where care providers treat each other like decent human beings and discuss things with a solution-oriented approach. This shit is juvenile.

            “Murderers”, an emotionally loaded statement and full of shit. I have not checked the story yet–I will do so. It is based on ONE shitty midwife, or a handful? Is that the sum up of all midwives in the united states? I have said that we could definitely make more stringent training and laws but noooooo, no one wants to hear that it will get better. Because that is threatening to you. Go ahead and hide out here and spew this nonsensical banter. I’m off to find those who are gonna do something. Change something. Make a difference and address the abysmal stats that y’all seem to like to ignore (“outside of the birth it’s not our problem!”)

          • Amazed

            Waiting breathlessly as you check. But I must tell you I’m touched how you automatatically think that everyone who cares about preventable deaths works in medicine and is threatened by mightily qualified birth junkies.

            I guess you haven’t checked the studies I linked you to either? I can tell you right now an OB who won’t be thrilled to work with any CPM: Amos Grunebaum. You know, the one who conducted one of the most damning pieces of CPM-related research. After MANA’s own “study”, of course.

          • Bombshellrisa

            Here is a list of them, although there are a fee CNMs mixed in: check the Sisters in Chains website, a CPM compiled the list.

          • DaisyGrrl

            What’s your practice’s transfer rate? Is it different for first time mothers versus mothers who have previously given birth?

          • Amazed

            Perhaps you’ll explain to us how people are supposed to tell unqualified CPMs from the qualified ones when they’re all CPMs? Plus, no one here is impressed by the CPMs talking points. They all say the nice thing you blabber – and at the end, unqualified midwives prevail hard enough to yield those terrifying mortality and morbidity rates that you still haven’t commented on. But I gather it’s fine and peachy for you since it’s just the unqualified midwives, so they don’t count. No matter that they’re the vast majority of CPMs, else their results would have been much better – and they aren’t.

            Your lack of humanity overshadows and supersedes your lack of basic maths that is taught when one is 12.

          • Bombshellrisa

            I would hope that is how it works, because in every state that is how the law is written. But it’s not how it’s practiced. If you look at any contract of care between a CPM and a patient, payment is required to be done before week 34. Which means any transfer in late pregnancy or labor Will not prevent you from getting paid. If you accept insurance, midwives use the emergency transfer fee which has no code, but is still billed to the patient at about $1000. Most midwives will stay with a patient during transfer but they bill a doula fee because they are spending even more time. I have talked to many CPMs from around the country, including some who write curriculum and consult with instructors at MEAC schools and MANA Vice President Serena Bennett. This is just how it is.

        • An Actual Attorney

          What are their morbidity and mortality rates?

          • Roadstergal

            “It was my understanding that there would be no math.”

          • Squillo

            That’s why I became a writer. I was misled.

        • fiftyfifty1

          “The ones I work with are in direct contact with a physician ”

          CPM: “Hi, I’m sending you a lady who has been pushing for 4 hours and I I swear the head was right there. But now it’s gone backwards. And maybe she seems a little warm?

          OB: (biting tongue). Thanks SO much for referring. Please never hesitate to send a patient our way. So nice to work with you. [gets off phone and barfs].

          • Bombshellrisa

            It’s probably more like CPM runs ahead of laboring woman being pushed into the ER in a wheel chair and tells someone she assumes is the doctor that there is a woman who needs to be admitted.

          • fiftyfifty1

            Oh Bombshell you silly goose! CMPs don’t show up at the hospital. They are long gone far before that. You are lucky if they are willing to even make a phone call.

          • Bombshellrisa

            Some will if you pay them extra $$. But those are in the minority!

    • The Bofa on the Sofa

      We have all of the evidence we need in the practice of several leading European countries that can work and DOES work

      To the extent it “works” in those European countries, it has nothing to do with CPMs in the US. At best, it is an argument for increased use of CNMs, which would the equivalent to the midwives there.

      No European country would allow the equivalent of a CPM any where near their system.

      You just made an argument against yourself.

      • moto_librarian

        It’s also worth mentioning that we are discovering that midwifery-led care in the UK, New Zealand, and the Netherlands is problematic. The perinatal mortality rate is higher for midwives, even when they deliver in the hospital. Something isn’t right there either, and I’m not convinced that we want to emulate them.

        • The Bofa on the Sofa

          That’s why I said “to the extent it ‘works.'” Indeed, the Netherlands is rapidly abandoning it’s homebirth model given the poor outcomes.

          • moto_librarian

            I know that you already know that, Bofa, but I’m guessing that SBJ does not.

          • SweetBabyJesus

            Source on that? You still haven’t produced one. Don’t worry, someone who actually works in this field might come to your rescue. Again.

          • Amazed

            Do your research, sweetie. It isn’t this hard. And you don’t need to work in that field to find the information. I hope you never do.

          • SweetBabyJesus

            Wasn’t talking to you, but as I predicted you rescued him! Man is this the place people without real human friends go to feel better about themselves? I’ll do my research SWEETIE, I’m doing it all the time.

          • Amazed

            No, sweetie, you didn’t predict anything. You predicted that someone working in the field would rescue him. By definition, not me. Although I’ll give you a finger to suck on: I might not work in anything related to healthcare, but I know how percentages work, although I don’t need it in my everyday job like you will. Which elevates me about 10 levels above you.

          • The Bofa on the Sofa

            ou predicted that someone working in the field would rescue him. By definition, not me.

            And you didn’t actually rescue me. Saying “look it up” doesn’t really address the point. Now HoustonMom did, and she linked the article that I had in mind. But she’s not “in the field” either. She’s a mom. In Houston.

            Or at least pretends to be. As far as I know, she could be a guy in San Antonio.

          • Amazed

            Hey! “I” want to be the guy in San Antonio!

            She’s hard to believe, isn’t she? At least, that’s what I would have said three or four years ago. After we’ve had Kim Mosney. Elizabeth of the Calling to Courtroom and whatnot, I can totally believe she’s real.

            And I totally rescued you. I gave her someone else to bite at with her superior knowledge. Now we’re friends, right? As your friend and savior, I want a PCM credential NOW, although I’ll undoubtedly fail the 80s music test again.

            EDIT: Not HoustonMom, of course. I meant SBJ.

          • The Bofa on the Sofa

            Has anyone ever seen Amazed and me in the same room at the same time?

            Hmmm? We aren’t friends, I’m just a sock puppet.

          • Amazed

            Why are you doing this to us! Exposing us for what we are!

            Or would it be “exposing me”? *scratches head*

          • The Bofa on the Sofa

            “And you don’t want us EXPOSING OURSELVES!” – Lewis Tully, Ghostbusters 2

          • Amazed

            But WHY are you doing it? It was so cozy around here! Now everyone will know that I/we am not/aren’t a doctor/doctors!

            Why, oh why!

          • The Bofa on the Sofa

            I have earned the right to be called Doctor. I prefer Professor, out of respect for The Great One (Russell Johnson), but Doctor is acceptable.

            Alanis Morrisette, however, is Not the Doctor. And it’s not at all Ironic.

          • Amazed

            OK, your part of us is a doctor. Mine isn’t. Where does that leave the awesome not-medicine being that we are? Are we a half-doctor now?

            Perhaps I should be your sockpuppet? Would that make me a doctor?

          • The Bofa on the Sofa

            Perhaps I should be your sockpuppet? Would that make me a doctor?

            No, that would make you Lambchop.

          • demodocus

            Everyone knows Who the Doctor is! Currently Peter Capaldi.

          • MaineJen

            Please, there are ladies present.

          • Bombshellrisa

            Also she who will not be named and isn’t a felon. We have also had a run in with the VP of MANA and any other number of passionate dolts who can’t do math.

          • Houston Mom

            http://www.dutchnews.nl/news/archives/2011/07/insurers_not_worried_about_cos/
            This is a news story that Dr. Amy linked to a few years ago. It is about declining rates of homebirth in the Netherlands.

          • The Bofa on the Sofa

            Calling my bluff? Really?

            Here’s your problem: you have put a lot of stock on your characterization of me as a clueless idiot, because I “don’t work in the field.” So you have an awful lot riding on me bluffing. Because God help you if you try to call me out as a clueless idiot when, in fact, I am right.

            Unfortunately for you, I don’t just make shit up. When I say things, it’s because I know what I’m talking about. HoustonMom posted the link below

            (actually you can find it linked in this blog post

            http://www.currystrumpet.com/2013/02/pregnancy-in-the-netherlands-home-or-hospital.html)

            http://www.dutchnews.nl/news/archives/2011/07/insurers_not_worried_about_cos

            Ten years ago, 37% of babies in the Netherlands were born in hospital but that had risen to 75% by last year. Professor Jan van Lith of Leiden University’s teaching hospital told the paper media reports about the high perinatal death rate in the Netherlands were driving women to chose hospital births.

            Whoops. Interesting, apparently the Dutch know the difference between perinatal and infant mortality.

            Now you can slink away knowing that you have been completely schooled by an idiot like me.

            Or you could hang around and learn. I know that I learn a lot here. There are a lot of really smart and experienced people here who have taught me a lot over the years. To the point where even I know more about it than you.

          • Nd:YAG

            Actually, although the percentage of homebirths in The Netherlands is declining, it is not at the astonishing rate the above numbers suggest – which appear to be based on an incorrect English translation of the original Dutch text published by the Dutch CBS (“Central Bureau of Statistics”).

            Please compare http://bit.ly/1PTtA5E (Dutch) and http://bit.ly/1M0igyM (English).

            https://uploads.disquscdn.com/images/f855b956661d1d0a162b168576c64e4e27e87fad99d9489ae76f422dcbc11a13.gif

          • Roadstergal

            Since you like anecdotes – I work with three women from the Netherlands, and at a little get-together a few weeks ago, one of them brought up the horrific Dutch perinatal mortality (we were talking about a soon-to-be-mom co-worker) and how the new research about the negative outcomes with midwives is causing quite a bit of noise and calls for reform. Dead and damaged babies make for bad politics, it turns out.

            Also, the way the midwives work to delay or deny epidural pain relief. That’s not going over well.

        • Bombshellrisa

          Thank you for mentioning NZ. When hundreds of people are seeking answers to the bad care they got, it’s really not working. One severely injured child or woman should make people take notice, the fact that so many are coming forward says so much.

          • moto_librarian

            I am quite familiar with AIM. It makes me physically ill to see what midwives are getting away with.

          • Chi

            Especially since the Royal NZ Council of Midwives (basically their governing body) is supposed to hold them accountable for bad outcomes.

            Guess I got lucky with my midwife.

    • SweetBabyJesus

      I truly am bowing out of this now. There are no words to say how
      aggressive this community is and how little room there is for any
      differing view on the research or ANYTHING, even in the face of various figures and facts (even in
      the face of me recanting any mistakes I’ve made along the way, humbly
      so). So sad for your community but I think I just gained a exacting and
      clear understanding of why many choose to run screaming in the opposite
      direction from OBs who think and act such as you. If the
      increased risk that is associated with homebirth isn’t enough to make the mother
      subject herself to your care, perhaps you should ask yourself what you are doing wrong?? As the
      homebirth rate rises, we shall see what the real numbers show. As
      consumers inform themselves they will vote with their dollar. And as we
      learn more of the risks of unnecessary obstetrical intervention over time maybe
      someone will start considering the opportunity costs that come with
      conventional OB practice, rather than screaming murder when someone
      decides they would rather assume the mild risks of one thing to avoid the moderate/life-long
      risks of another.

      • The Bofa on the Sofa

        how little room there is for any differing view on the research

        Differing view? You dismiss preventable deaths as the cost of doing business.

        You damn right I don’t accept that “differing view”

        • SweetBabyJesus

          No–a differing view that takes all of the risks surrounding infant, maternal and perinatal mortality into consideration. Where midwives/OBs/CNMs/Peds/PCPs etc. are able to collaborate more and hone the best practice and best skills to do right by their patients from start to end. But I already knew you’d come back with that Bofa. You really are an excellent groupie on this thread–a charming example.

          • Amazed

            Would you stop blabbering about infant mortality already? It just make you look even dumber. Not the right statistics. Not the right statistics. The fact that you love it so much doesn’t make it the right one.

          • SweetBabyJesus

            No it didn’t. You want to say it did so idiots like Bofa think I look dumber. That is a stat that DOES matter. It is a part of the bigger picture. Not the biggest part but to ignore it is folly. Of course maybe you just don’t give a shit what happens after the baby is out. Send them on, let it be someone else’s problem. It’s probably your feeble understanding of the midwife’s role in the community that makes you think it’s insignificant. We care much beyond the clinic or OR–and it’s the reason our client base is growing.

          • DaisyGrrl

            Infants are usually cared for by pediatricians. Or are you saying the midwife’s role extends beyond the first few weeks of life? Are you also a lay pediatrician?

          • Amazed

            She just wants to exclude stillbirths and basically everything that goes wrong with a midwife prenatal care, I think.

            Or perhaps she is really dumb enough not to know what infant mortality excludes.

          • Sarah

            Of course not, you turn them over to the homeopath and chiropractor then.

          • Chi

            Well, here in New Zealand, our Primary Care Provider (PCP) for our pregnancy, be they midwife, OBGYN or specialist usually looks after the woman and baby for 6 weeks post-partum. They’re the ones who do the well checks, weighing, asking about feeding habits etc.

            After 6 weeks the baby is then turned over to their secondary care provider, which is from one of 3 organizations (I chose Plunket) and their pediatrician of choice (it’s a joint effort, though the Plunket nurse is more growth and development and the ped is for health issues).

            So yes in SOME cases the midwife’s role extends beyond the first few days (sorry misread your post as days, not enough coffee today).

          • DaisyGrrl

            Yup, here in Canada midwifes provide well-baby care to 6 weeks post-partum too. After that babies are turned over to other primary care providers.

            No worries about the days/weeks part. My main point was that midwives don’t see the babies for very long beyond the neonatal period.

          • Chi

            Yeah it’s like ‘oops my part’s done now, see ya, here’s the bill.’

          • yugaya

            ” You want to say it did so idiots like Bofa think I look dumber. That is a stat that DOES matter.”

            You don’t have a clue about stats, and there is no need for anyone here to make any effort to portray you as being any dumber than you already are.

          • Roadstergal

            “Of course maybe you just don’t give a shit what happens after the baby is out. ”

            That’s quite ironic, given the established tendency of CPMs to bail once the baby is out – or even before.

            Science-based practitioners, including most CNMs and OBs, care more about a baby’s brain function than an empowering birth experience for mama. The CPM business model is based around the empowering birth experience for mama, and refusing interventions regardless of the risk of long-term deficits to the baby. This philosophy is the reason why, now that people are starting to collect good-quality data on homebirth, they are starting to see results like this:
            http://www.ajog.org/article/S0002-9378(13)01604-9/pdf

            “Women who delivered at home had 16.9 times the odds of neonatal HIE compared to women who delivered in a hospital (p¼<0.01). The odds remained significant after controlling for maternal age, ethnicity, education level, primary payer and prepregnancy weight (aOR 18.7, 95% CI 2.02-172.47). After controlling for mode of delivery the odds of HIE increased for home birth compared to hospital birth (aOR 32.9, 95% CI 3.52-307.45)."

            You're telling me homebirth midwives care SO MUCH about the baby after it's delivered? If that's so, why do they consistently warn women against practices designed to preserve long-term brain function, and why do they have such poor outcomes when it comes to brain damage to babies?

          • The Bofa on the Sofa

            Where midwives/OBs/CNMs/Peds/PCPs etc. are able to collaborate more and hone the best practice and best skills to do right by their patients from start to end.

            I’m all for better collaboration of OBs/CNMs/Peds/Internists.

            In fact, I would add that you could do things like having more “postpartum doulas” (for lack of a better name) to help improve postpartum care for all moms.

            But what does that have to do with CPMs doing homebirths and “unnecessary” c-sections?

      • Megan

        Gotta make sure to play the victim card before you leave, huh?

        What’s really sad here is that there will be women who entrust you with the safety of themselves and their babies and you have no interest in actually learning the science needed to help them. Dead babies are just a “cost of doing business” for CPM’s.

        Easier to talk about how MEEN we are than to deal with the cognitive dissonance that comes with knowing what you do isn’t the safest option. If you truly care about the safety of women and babies, ask yourself why you aren’t pursuing a real midwife degree (CNM) that would be respected by medical professionals.

        Going to medical school wasn’t easy or convenient but I didn’t go to homeopathy school instead just because I didn’t feel like doing the work of medical school. Women and babies deserve caregivers with the most knowledge and best credentials.

        Oh and by the way, stick the flounce this time, will ya?

        • Bombshellrisa

          Future sister in chains right there. At least we know she is going to fit in.

      • Who?

        Can you stick the flounce though?

        • attitude devant

          We live in hope…

          • Who?

            Her talent was stats, wasn’t it? I can hardly spell statistics, but I know that her interpretations (or the one she learnt from whoever taught her what it is she knows) are way off.

          • SweetBabyJesus

            Please don’t talk to me about correctness when you use words like “learnt”. I am no special hand at math but I’ve got the english language on lock.

          • DaisyGrrl

            Apparently not, since “learnt” is a commonly used word outside North America. It is especially common in the UK, which you may recognize as the place where English originated.

          • Sarah

            Probably not.

          • attitude devant

            (when all else fails, troll on tone, grammar, and spelling)

          • Fallow

            “Learnt” is fine. Dialect and regional differences are still perfectly “correct” English. No, you don’t have the language on lock. Not if you think there are inherently correct ways to speak it, no.

            I get that your career choice is meant to serve a very pampered, egocentric, privileged, largely white population. But you really prove those biases when you can’t deal with minor dialect differences.

          • The Bofa on the Sofa
          • Amazed

            In my language high school, we were given both “learned” and “learnt” as correct forms. Had to learn both too.

          • Roadstergal

            I learnt both. 🙂

          • Grace Adieu

            Dear God, when did British English become a “dialect”?

          • Linden

            Wait, “learnt” is wrong? Colour this Brit surprised!

          • Roadstergal
          • Barbara Delaney

            No, it’s correct. Learned and learnt are both past tenses of learn. Learnt is more common in British English. Here are some other examples, Spell – spelled, spelt,
            Leap – leaped, leapt, Burn – burned, burnt, Spill – spilled, spilt, Spoil – spoiled, spoilt,
            Dream – dreamed, dreamt, and Kneel – kneeled, knelt.

            So Sweet Baby Jesus doesn’t particularly excel at math or English. I’m stunned.

          • Barbara Delaney

            Actually, you don’t. “gained a exacting” That should be “an” exacting since it’s before a vowel. And in your last run-on sentence you failed to use commas where they were needed.

            “And as we learn more of the risks of unnecessary obstetrical intervention over time maybe someone will start considering the opportunity costs that come with
            conventional OB practice, rather than screaming murder when someone
            decides they would rather assume the mild risks of one thing to avoid the moderate/life-long risks of another.”

            Can you see where the commas are needed?

          • Daleth

            Seconding what Barbara D. wrote. Learnt is correct English (capital E for that, by the way). It’s how basically everyone but Americans spells it: the British, the Canadians, the Irish, the Australians…

          • Who?

            You might like to avail yourself of the services of an atlas, to check out the countries the posters below mention. Turns out there’s a whole world that isn’t the US!!!

            And your maths (we say ‘maths’, not ‘math’ here in some of the rest of the world) (see ‘atlas’ above) isn’t ‘not special’ it is atrocious. That you use it to try and lull women who don’t know better into your deadly trap is shameful.

          • Who?

            Oh, and to my question about sticking the flounce, this is a ‘no’?

            Knew it, no staying power.

          • Taysha

            No, you don’t. Your English (note – it’s capitalized) is about as accurate as your math.

            http://dictionary.reference.com/browse/learnt?s=t
            Learnt –
            verb
            1.
            a simple past tense and past participle of learn.

      • Bombshellrisa

        Consumers already overwhelmingly show that they prefer to get their care from OBs and CNMs in a hospital setting. Home birth appeals to a privileged few and the midwives who provide it know that.

      • Daleth

        And as we
        learn more of the risks of unnecessary obstetrical intervention over time maybe
        someone will start considering the opportunity costs that come with
        conventional OB practice, rather than screaming murder when someone
        decides they would rather assume the mild risks of one thing to avoid the moderate/life-long
        risks of another.

        Hospital birth risk, according to you: “unnecessary” interventions, such as epidurals, induction and c-sections.

        Home birth risk, according to you and everyone who pays attention to the facts: the baby is 3-4 times more likely to die. (Also, though we haven’t discussed that much on this thread, 17 times more likely to suffer permanent brain damage).

        Which one of those risks is a “life-long risk”? Which one is going to affect you badly for the rest of your life? Getting induced? Or having your beloved, much-wanted baby DIE?

    • PrimaryCareDoc

      “Neonatal death—all newborns
      Homebirth: 2.0/1,000
      Hospital Birth: 0.9/1,000
      (increased risk with Homebirth is 0.1%)”

      You don’t understand math. At all.

    • Who?

      So homebirth midwives in your world do cs? Or do you mean that once transferred to hospital, they get a cs?

      Because if that’s how you’re counting, I hope you’re putting deaths in hospital after homebirth transfer on the homebirth account not the hospital account.

      • Charybdis

        Now, now, she can’t do that. Those babies died IN THE HOSPITAL, so clearly that is where the stats should be places/counted. They died on the hospital’s watch, not at home with the CPM,, so they CAN’T be held responsible for that.

        This is dripping with sarcasm, by the way.

        • Who?

          These people make my brain hurt.

        • SweetBabyJesus

          I disagree with you @Charibdys:disqus. I would want to be held responsible for that the same way any OB would be–that’s called accountability and I am all for it.

          And the irony of sarcasm is you don’t have to actually tell someone it’s sarcasm. (Unless you suck at it)

          • PrimaryCareDoc

            So, you’re going to carry malpractice insurance with suitable limits? And tail coverage, because in Florida you can be sued until a kid is 12 for any sort of birth injury? It’ll cost you a minimum of $33,000 a year.

          • fiftyfifty1

            ” I would want to be held responsible for that the same way any OB would be–that’s called accountability and I am all for it.”

            So that means you will carry liability insurance to protect your patients. If you screw up and harm a child, you need to have a policy so that parents can get money to pay for their disabled child’s care for the rest of his or her life. Millions of dollars. Do you promise to carry such liability insurance? If you don’t, your claim that you want to be held responsible like an OB (or CNM) is just so much hot air…like everything else you’ve written so far. Ask your mentors whom you respect so much if they carry liability insurance. I think you will find that they all say they “don’t need it” or “can’t afford it”. They like to pretend they are responsible but in reality, they are all too glad to leave their patients high and dry if it will put more money in their own pockets.

          • Amazed

            “Do you promise to carry such liability insurance?”

            Ah, fifty! No one can give you what I can promise you.

            Even if she promises and intends to do good on her word, I suspect the first time she has to choose between paying the bills and paying for insurance, good intentions will fly right out the window. As we saw, she’s so sure that nothing will ever go bad on her watch. Why waste money on insurance then? And it’s the mother’s choice anyway! As Ina May put it, “the parents saw no reason to be punishing”.

            I throw up in my mouth each time I see a midwife embroiled in a preventable death or injury praising the lovely parents who took their full share of responsibility for their birth choices. If they demand to know what midwife’s share in this is, they are turned into greedy monsters.

            Beauty!

          • moto_librarian

            Do you plan to carry malpractice insurance? If you really want to be held responsible in the same way as an OB, this is a huge part of it.

          • Charybdis

            It needs to be clarified for some, the sarcasm. Some people believe the craziest things; things that sound like they SHOULD be sarcastic, but they are completely and totally believed as true. Stuff like “homebirth is as safe or safer than hospital birth”, for example.

          • Bombshellrisa

            The point is that as a CPM, you couldn’t be. Ask any of the women here who have had babies injured or that died due to a midwife missing something very simple like treating GBS. The most they could do is try to sue in civil court. Make no mistake, there is a whole process that home birth midwives are advised to take when they face “persecution” aka people attempting to hold them responsible for injury or death. It’s outlined in “From Calling to Courtroom” written by an RN non nurse midwife turned lawyer who practiced home birth. She isn’t sorry for the families, she feels sorry for herself. Serial killer midwives like Brenda Scarpino are featured in that ebook, documenting the “persecution” she has endured and how to lie to families so they don’t know the real risks of home birth.

          • areawomanpdx

            And they can’t even sue in civil court unless they’re willing to pay for the entire case out of pocket, unlike people who are cared for by providers with malpractice insurance. And then when they do spend the cash and win in court (Like Magnus’s parents), the midwives declare bankruptcy and start a new birth center under another name. Zero accountability.

      • SweetBabyJesus

        I think that is valid and the stats should be considered that way, where transfers and subsequent deaths count. I also think that the homebirth stats should be gathered in states where it is regulated and compare that to states where it is not regulated. I am willing to be there would be a difference in the results.

        • DaisyGrrl

          You clearly haven’t seen the stats for Oregon, where they’re collected based on intended place of birth and CPMs are (marginally) regulated. They’re horrifying.

          As far as regulation, most CPMs (and pretty much any organized group of CPMs) resist any real regulation because they view it as an infringement on their autonomy. I’m not saying you’re one of them, but it is a very pervasive view.

          I’d personally have far fewer problems with CPMs if they agreed to malpractice insurance and refused all twins, breech and VBACs. But since even this basic level of regulation appears to be unacceptable to the majority, the only reasonable way forward is to remove recognition of the CPM credential and join the rest of the developed world in terms of midwifery regulation.

    • Squillo

      If you are truly pro-evidence-based care and pro-collaboration, and want to give women the best choices for both in- and out-of-hospital birth, I would suggest getting the best education you can and actually contributing to those things. CNMs do collaborate with MDs and they do participate in research. CPMs as a profession appear to this observer to be incredibly complacent, with a distinct lack of interest in quality improvement or adding to the evidence base. You can do better.

      • fiftyfifty1

        “You can do better.”

        Don’t flatter her. It’s clear she can’t.

        • SweetBabyJesus

          I can and I will. Thanks for the vote of confidence.

          • fiftyfifty1

            You haven’t written a single thing that gives me confidence that you have either the intellect or ethics to do better.

          • Anj Fabian

            Reading this, I’m left with the assumption that she’s accepted everything her teachers and preceptors have told her. How home birth midwives don’t need all that stuff nurses and doctors learn. How that gets in the way of hands on midwifery. How CPMs specialize in home births so they need a different skill set. How doctors don’t understand that or appreciate it. How placentas are almost magical and how babies can tolerate long periods of oxygen deprivation without harm.

            How doctors think that everything is an emergency and overreact. Some babies take longer to breathe and pink up. Sometimes women take longer than we like to stop bleeding or deliver the placenta. As long as no one actually dies, it’s good. Happy endings all around!

            It’s mostly bullshit. It’s a mythology created to cover up the gaps in their care and their knowledge. If you don’t understand something, make up a story about it. It’s what humans do.

          • PrimaryCareDoc

            Let’s not forget that VBAC, breech, twins…all a variation of normal.

          • moto_librarian

            Oh, so you’re going to admit that the CPM is a substandard credential and go and become a CNM instead?

        • Squillo

          I don’t know if she can or she can’t, but it’s clear she prefers not to, which is the entire problem with CPM midwifery.

      • SweetBabyJesus

        I think that if OBs, CNMs and other care providers were to come together with CPMs to refine the education and training and make those standards higher for all. It’s so easy for everyone to pick me apart here because that is what you all seem to be here for. Ranting and tearing someone down doesn’t change a damn thing that you seem to feel to adamantly about. Put your money where your mouth is, make it better, work with us, make a change.

        • Amazed

          Indeed? It’s up to OBs to say that CPMs are dangerous – and they have started to do so. It’s up to CNMs to say that CPMs give them bad name and refuse to give them the title “midwives”. It’s up to CPMs to realize that they need to change and become real midwives – CNMs.

          The only ones who need the CPM “credential” are people like you – those who want to be perceived as midwives but their personal circumstances comes first, so they knowingly choose to endanger patients by striving towards a dangerous “credential”, instead of walking the hard road thousands of people walk every day in order to be the best practitioners possible.

          You are the problem, SBJ. Don’t expect of OBs and CNMs to fix it in a way that will be most comfortable for you, letting you retain this murderous credential of yours.

          • SweetBabyJesus

            “Started”?? No no no, it’s been said since the beginning. The establishment snuffed out the old granny midwives back in the early 1900s who had been birth attendants their entire lives. Should change happen? Yes. Should it be the function of elitism, apathy and gentrification? I don’t think so.

            I am not knowingly endangering anyone. I am not the problem. I am the solution–I am having these conversations and I am making the system better. I’ll do more than sit my fat ass behind a keyboard and ridicule the little person like you. I will work alongside the practitioners that have more than half a brain and half a heart to get women the care they need. I am walking a harder road than you will ever know and my training exceeds nursing school by at least a year. You will continue to drink your koolaid and ship women down the line under the guise of “choices in healthcare” but you don’t care about that. You want to offer no choice. It’s OB all the way and no other option. That’s where the scary stuff happens and comes the ONLY MATERIAL any of you can conjure against midwives–the rogue ones who practice with shitty training and no experience. Step up to the plate and shut your mouth until you’ve got something to say.

          • Anj Fabian

            “The establishment”

            Hospital care began to become more accessible and the outcomes improved to the point that women CHOSE to birth in hospitals.

            The typical home birth back in the day was usually the family bringing in a friend, neighbor or relative to help out. Only when the situation looked bad would they fetch a midwife. Midwives want paying after all and if you can do it yourself for free, so much the better.

          • SweetBabyJesus

            Go on and tell yourself that. It doesn’t feel better, doesn’t it? And I am saying that women still have CHOICE to go where they want. But who will be with them at home if that type of birth is demonized? CNMs and OBs won’t. Midwives will and then will STILL be ostracized. Go ahead and have your cake, but you can’t eat it this time. You’ve already thrown it to the dogs with the midwives you pretend to hate but refuse to help or teach.

          • Anj Fabian

            You retreat to “birth choice!” ?

            Why not refute my claims? Tell me that there were enough granny midwives back in the day to attend every woman who needed them. My friend from WV had a grandmother who was a “granny midwife” up in the mountains. She bragged that she never lost a mother. Babies? Well…they didn’t all make it. She did the best she could.

            That was the old days when child birth was understood to be perilous for all parties. Now we have people talking about “birth choice!” as if the dangers don’t exist.

          • Amazed

            A few years ago, I watched a video with a 80 yo former midwife who had worked in the mountainous region she had been born in. She had nothing but praises for the hospitals. She worked in communities that normally disdain OBs and anything to do with women pelvic care and she was like, “They’re all good people but they just don’t GET it.” The best she could convince them to do was to have the husband keep the car ready in case something went shady.

            She had nothing but contempt for midwives’ “knowledge”. She lost her own mother in birth. She was very proud that she had managed to be trained in a big hospital (those were the 50s and it was very hard for a poor girl from a very backward region to receive education). And yes, she was very clear that “During childbirth, a woman is looking into a grave” was not a thing of the past. She was so thrilled that we have hospitals – safety and less motherless children. Without talking about “low risk” and “high risk”. To her, childbirth was an inherently risky business.

            And yes, she thought that she, herself, had been a good and safe practitioner. She did see herself as savior. She just saw herself as the savior of those whose culture wouldn’t let them seek the most competent care, not the savior of women from big bad modern medicine. She thought she was a pretty good thing. Just vastly inferior to hospitals, that’s it.

          • PrimaryCareDoc

            I have patients who chose to smoke. Doesn’t mean I go out and buy them their cigarettes. Health care providers have no obligation to enable their patients’ poor choices.

          • fiftyfifty1

            “But who will be with them at home if that type of birth is demonized? ”

            The data from Oregon show that having a birth with a CPM is no safer than having a planned UC (freebirth). So if CPMs get drummed out of business, women are no worse off than before.

          • Monkey Professor for a Head

            Sure women should have a choice. But they deserve to make an informed decision. As a health care provider, it is your responsibility to give them accurate information to help them make that decision. Do you tell women that there is a higher chance that their babies will die at home compared with hospital?

          • Amazed

            Even if she does – and remember, she told moto she doesn’t believe it, so it’s rather doubtful that she does, – she will present it as “It’s just 1/1000, that’s so tiny that it’s practically nonexistent and it will not happen to you.” That’s what she believes – that 1/1000 is very tiny when we’re tallking birth. And we know that homebirthing mothers believe 300 babies delivered mean a huge amount of amassed knowledge, just like PolyAmethyst here is in awe of the “dozens if not hundreds of burths” she needs to get her CPM degree. SBJ will just reinforce this opinion.

          • Charybdis

            Maybe if they stop at 999 births, they will never encounter that 1 in 1000. Because they math so well.

          • Squillo

            Healthcare professionals are hardly refusing to teach or help midwives. In fact, there are national organizations dedicated to interprofessional education –the Interprofessional Education Collaborative, the National Center for Interprofessional Practice and Education–not to mention the schools of medicine and nursing that provide collaborative education, often alongside pharmacists, physical therapists, dentists and others.

            The difference is that all those groups already have established practice standards and have accepted regulation and accountability, which is why they are able to integrate into the system in the first place. When non-nurse midwifery does that, maybe they’ll have a place at the table. You seem to think the onus is on others to do the heavy lifting.

          • Amazed

            Yeah, yeah. And once upon a time, doctors didn’t wash their hands, dontcha know? So, dig off your appendix alone.

            I knew that at one moment, you’d start sniffling over the fate of the poor midwives from 120 years ago. I knew it.

          • PrimaryCareDoc

            You are not “knowingly” endangering anyone, because you are not educated enough to know what you don’t know. Your training does not exceed nursing school. Don’t continue to make shit up. Just because it’s going to take you longer to do less, doesn’t mean that you have more training.

          • Karen in SC

            The fact that CPM was only a temporary credential, to be given to those granny midwives, got lost along the way as women saw an easy way to get their birth junkie fix and get paid.

          • yugaya

            “I am not knowingly endangering anyone.”

            With your complete lack of basic numeracy skills that you so ignorantly displayed here you most certainly are. FFS, you’re supposed not only to provide adequate information on rates, percentages and odds to your clients but also to administer medications. You are going to kill someone because you can’t do numbers at all.

            What a parody of your own arguments you are. You are illiterate, ignorant, and arrogant enough to claim otherwise based on a fake credential that makes you a substandard care provider anywhere in industrialized world.

          • Amazed

            I am currently taking vitamins for hair and nails. The number of pills I can safely take is there, on the label. Vitamins for hair and nails, I must say again, so this fact isn’t lost on anybody. By definition, non-emergent and presumably not able to cause a great damage even if I take the wrong dose.

            At homebirth? With those oils and whatnots meant to help a mother “naturally”? The wrong dose can and will kill someone.

            Another anecdote: I am at the doctor’s. She takes my blood pressure, although I am there for a totally unrelated problem, so I don’t have any issues with blood pressure (yet). It’s great, she says, just where it should be, it’s perfect. Me: ah great. After 3 coffees in the last hour or so… She changes face and starts questioning me. Turned out that I’ve been lowering my blood pressure for months by eating yoghurt with cinnamon and honey in proportions that were recommended for people with high blood pressure.

            Totally natural. Incredibly tasty. And likely to give me some trouble if I had kept it for a year or two since I rarely change my breakfast.

            Natural can be freaking dangerous. And yes, maths is important in nature too!

          • fiftyfifty1

            “I am not the problem. ”

            You are the problem. People who think they can substitute their passionate feelings and Rebel Without a Clue personalities for real medical training. Women and babies pay the price.

          • Squillo

            And somehow, midwifery managed to survive and even become part of the system, starting in 1955, developing practice standards, QI initiatives, collaboration, and accountability. Elitism and gentrification? Maybe. Apathy, no. If anyone is apathetic, it is lay midwifery. CMs/CNMs may have a long way to go to be able to practice as they wish as equal partners with MDs, but they are at least 30 years ahead of CPMs.

            I can’t speak for others here, but I certainly don’t want OBs to be the only option, and my anecdotal discussions with OBs suggest they don’t either. There are certainly arguments over appropriate scope of practice and oversight, which increasing collaborative practice might resolve.

            Why are there midwives with “shitty training and no experience?” Because midwives permit it. There are certainly bad OBs and CNMs, but not because of lack of training or experience (although these could certainly be improved, and there are national groups focused on just that), but there are national baseline standards for education and training, and a regulatory framework for accountability, that non-nurse midwifery has rejected.

          • Roadstergal

            “It’s OB all the way and no other option”

            You truly are dense, in a way neutron stars would envy. Many women on this board, in this very conversation, have commented about their positive delivery experiences with CNMs. Many OBs have talked about their collaborative relationships with CNMs.

            For someone who claims to listen to women and mothers, you’re doing a terrible job of doing it just in this little discussion, where there’s no panic and no lives are at stake. How quickly will you fall apart when faced with an actual emergency?

          • Who?

            ‘I am not knowingly endangering anyone.’

            Exactly. Your ignorance and hubris, that you can’t, by definition recognise, is what makes you dangerous in environments where it is the norm.

            Life is not a suffering competition. Good on you if you’re trying to improve your circumstances-for your own sake, make sure you don’t back a loser, which is exactly what CPM ‘qualifications’ are.

          • Amazed

            She is knowingly endangering people, though. She admitted that she chose CPM to CNM not because she believed in CPM = Better but because it suited her better. If that isn’t a “I know what’s best but it’s haaaard, so I am not choosing it”, I don’t know what it is.

          • Squillo

            Thing is, it’s NOT up to OBs. It’s up to midwives to improve their own practice.

          • Amazed

            I am not saying that it’s up to OBs to imporve CPMs’ practice. I am saying that it’s their job to say, “Those are not midwives, I am not working with them, I am not cleaning their shit, they’re fucking incompetents (I use the word as a noun).” Which they do. It’s up to CPMs to improve their own practice, indeed, and since every “study” they do is aimed to show how peachy it all is, nothing needs to change and they’re simply the best, needing no stinking standards, they should go away.

          • Squillo

            Fair enough.

        • Karen in SC

          The higher standard is already there – the CNM.

        • fiftyfifty1

          CPM leadership has rejected each and every attempt to improve their training requirements or define their scope of practice. CPMs are snake oil salesmen.

          • The Bofa on the Sofa

            But why are OBs and CNMs responsible for increasing the standard of the CPM in the first place? The CPMs can do that all on their own, but choose not to.

            And the reason why is because they don’t want to! If CPMs were to try to raise to the standard of, say, a CNM, they would actually do things like be responsible professionals, and be held to professional standards.

            Remember when they tried to write homebirth guidelines for midwives, by looking at the fundamental common standards that were being used by foreign midwives (you know, the ones that keep getting held up as something to strive for?)? They couldn’t get them accepted, because it put too many restrictions on midwives! Midwives don’t want to be held to any standards, they want to play on their own.

          • Roadstergal

            “If CPMs were to try to raise to the standard of, say, a CNM,”
            …then they would just be CNMs to start with! The CPM credential exists because some folk wanted to be midwives, but didn’t want to do all of that bothersome and difficult schooling. The real credential exists, and they chose not to get it. As you say, fuck ’em.

        • The Bofa on the Sofa

          I think that if OBs, CNMs and other care providers were to come together with CPMs to refine the education and training and make those standards higher for all.

          I agree, kind of. CNMs have been WAY too accommodating toward CPMs, treating them like “sisters” instead of calling them out as the incompetent posers that they are. The ACNM needs to be clear that they expect all midwives to be held to the same high standards, and that the CNM is what everyone should strive for.

          The ACOG has also been too soft, and need to make it clear that the CPM credential is unacceptable.

          The CPMs have all the power in the world to refine THEIR education and make the standards higher. They choose not to. So fuck’em.

        • Squillo

          I don’t see the value in propping up a fourth category of maternity care provider to bring them close to where the other three are in terms of education, accountability and integration into the system. Especially since the leadership has fought against the first two. I’d rather see CM/CNM capacity expand (alongside obstetrics) to provide better access to care in underserved areas. I think we’ll get a far better bang for our healthcare buck.

        • Megan

          Couldn’t stick the flounce, huh?

        • Daleth

          All we need to do to make the standards higher is legislate CPMs out of existence. The standards we need already exist: they’re called “being a CNM.”

    • yugaya

      “Homebirth: 2.0/1,000
      Hospital Birth: 0.9/1,000
      (increased risk with Homebirth is 1.1%)”

      Wow, what a math fail we have here.

      • The Bofa on the Sofa

        And remember, this is her CORRECTED version.

        • yugaya

          “And remember, this is her CORRECTED version.”

          Well, in that case, Christ Pantocrator himself wouldn’t be able to fix all that is wrong with someone like SweetBabyJesus delivering babies.

      • Linden

        WHUT.
        There, in a nutshell, is the ignorance of NCB advocates.

      • SweetBabyJesus

        So what is the correct figure? Please do share.

        • yugaya

          “So what is the correct figure?”

          ^^^ You can’t make these CPM idiots up, that’s how stupid they are all over.

          • Who?

            I was beginning to think SBJ might be interested in learning something. It would take 2 mins to look up how to do this calculation, or she could read the excellent summary provided earlier.

            But no! Bat on in ignorance, and be proud of it.

            A budding sister in chains, for sure.

          • SweetBabyJesus

            Your turn to look it up. Up to the challenge? I’ve already done my home work.

            Your.Turn.

          • Who?

            I don’t need to look it up, I’m not claiming to be any good at statistics, nor am I quoting incorrectly calculated figures. Smart people who know way more than I do on this topic tell me, and I believe them, just like they believe me when we’re talking about my area of expertise.

            You think you have nothing to learn, which is why you are so very dangerous.

          • SweetBabyJesus

            I have so much to learn. This learning environment is about as welcoming as a cactus on fire. Y’all don’t want to teach, you want to witch burn. Admit it. You’d never treat a person like this to their face, whatever you believed of them. So hide behind your keyboard and tell me I can’t calculate things while you prove you have no skills of your own. Go on!

          • Who?

            This is a blog, not a learning environment.

            When I am unfortunate enough to come across an arrogant moron who would benefit from my correction, they get it, in real life way more often than on the internet, because in real life it makes a difference. I also don’t pull my punches-figuratively speaking-in real life as I do here, because that doesn’t help. Clear, concise, in the moment correction is a powerful tool.

            I’ve acknowledged I know nothing about stats. Smart people who know all about stats say you’re wrong.

            You don’t know you don’t know.

          • SweetBabyJesus

            So you still can’t answer me. That’s cool.

          • Who?

            Blah blah meeeeaaaan blah blah I’m so humble blah don’t tell me things I don’t want to hear blah blah sob, sigh, moan, blah, one in a thousand is not many dead babies blah moan sob bleat.

            Rinse and repeat.

          • yugaya

            Notice how she still has no fucking clue. So she’s left with resorting to ad hominem memes and repeated attempts at asking us to fill her in. Now who would have expected that? 🙂

          • Who?

            It’s not kind to mock the afflicted, but sometimes it’s just fun.

          • Monkey Professor for a Head

            I would be extremely wary of any healthcare provider who thinks that internet blogs are a suitable place to get an education. I would also be very wary of a healthcare provider who does not know basic statistics (such as the difference between absolute risk and relative risk).

          • Who?

            Quite so.

            I’d also be wary of any provider so obviously emotionally needy, and with such a very thin skin.

          • SweetBabyJesus

            Say it to my face!

            You wouldn’t DARE.

          • Daleth

            Are you 12 years old?

          • SweetBabyJesus

            It’s not the only place I’m getting an education, but then those in the older generation are still wary of new-fangled things like the internet. I mostly am here to make sure you people’s opinions aren’t the only ones getting out there. Because they are inflamed and erroneous.

          • yugaya

            “I have so much to learn.”

            Couldn’t agree more. Start here or somewhere similar, that’s your level: http://library.bcu.ac.uk/learner/Numeracy.pdf

          • SweetBabyJesus

            You haven’t shown for shit. And I’m the idiot. Don’t be skeered, show me what ya got stats wizard!

          • yugaya

            You obviously still have no clue what mistakes several people pointed out to you.

            Ironic how you keep providing more and more evidence of your own ignorance.

          • SweetBabyJesus

            I’ve made every attempt to honestly and humbly correct my mistakes. You obviously don’t care about whether or not I learn anything. You want me to crash and burn and you want to laugh while it happens. Shame, shame. I hope if you are in some way involved in academia that this is not your standard!

          • yugaya

            “I’ve made every attempt to honestly and humbly correct my mistakes.”

            Honestly? Humbly?

            I’ve missed all that in between you trying to school everyone who corrected you and you bragging at the top of your lungs how smart you are. Mah gawd, you even got to school a DOCTOR!!!

            (I wish you were just a parody but alas, you are not.)

        • PrimaryCareDoc

          If the mortality rate at home birth is 2.0/1000, and the rate in the hospital is 0.9/1000, that is an increased risk of over 100% not 1.1%.

          Keep in mind that home birth should be all low risk births, while the hospital group includes all high risk groups- obese patients, diabetes, VBACS, other chronic diseases, prematurity, IUGR, and congenital deformities. So the home birth group should have a much, much, much lower mortality risk, but instead it is 100% higher.

          • Who?

            Someone’s going to either completely ignore you or be really rude, very soon.

            Anyone want to start a book on which way that might go?

          • SweetBabyJesus

            Wait–this isn’t being rude? Sheesh! What’s coming? death threats on my son? Wouldn’t put it past this bunch.

          • Who?

            Oh honey, take it easy.

            If you can’t take it, don’t dish it.

          • SweetBabyJesus

            I’m still here and your dishing hasn’t touched some of the other assholes prowling this thread. Soooo step your game up?

            And don’t be redundant. I already realize that I’m a idiot-can’t-do-math-baby-mama-killing-machine-with-zero-education-and-no-respect kinda person. That much has been made clear.

          • Who?

            My work here is done then! Thanks for the positive feedback, it really keeps me going!

            Oh and keep at the maths, you’ll get it one day.

          • SweetBabyJesus

            Did you see yet, did you see it? Oooo so many more memes coming this way, just watch and wait!

          • PrimaryCareDoc

            Are you saying I’m being rude? I gave you the damn answer you were asking for.

          • SweetBabyJesus

            Nah that was for @who? not you @PrimaryCareDoc:disqus

          • Who?

            But it wasn’t the one she wanted-she wanted validation. And now you’ve hurt her feelings.

          • SweetBabyJesus

            See above. My math skills > @PrimaryCareDoc:disqus

            Can you dig it?

          • PrimaryCareDoc

            No. You don’t calculate relative risk by just dividing the two numbers the way you did. So, you know, nice try and all.

          • Who?

            I’m starting to think SBJ is a satirist.

          • The Bofa on the Sofa

            Ha. I was thinking it’s more that she’s 12.

          • Sue

            Nah – a smart twelve yr old can do math better than that.

          • SweetBabyJesus

            Dude that’s not how I did it and you know it. You just don’t wanna believe that I may have something here and that you’ve been drinking Dr. Amy’s shit-flavored koolaid. Watch this video:

            https://www.youtube.com/watch?v=FZzm3-RRlI4

          • Barbara Delaney

            You are so loathsome. No one has made any type of threatening remark towards you. You’re pathetic with your “dude” and “bucko” and your immature boasts.

            There are eyes on this discussion that you know nothing about it, suffice it to say that you’ve convinced a lot of bystanders that all CPM’s are unqualified hobbyists, and that Jill Duggar is far from an outlier in your group. As a matter of fact after the exhibition you’ve put on here, she may well be one of the leading lights in your group of rank amateurs.

          • Who?

            So true.

            The callousness about deaths, the absolute confidence, the careful hedging around who actually takes responsibility, the maudlin self-pity.

            A great testament to who you wouldn’t trust.

          • Bombshellrisa

            I know you aren’t a regular, but I do hope you stick around.

          • Who?

            Upvote that.

          • SweetBabyJesus

            Oh and you can ignore. All the people here who come looking for answers will still see my posts. Some of them will want to see more answers than y’all can offer.

          • Roadstergal

            The question remains – will these accurate numbers be part of the informed consent you provide to your clients?

            Will you carry malpractice insurance equal to that carried by OBs?

            I really don’t care if you want to help women take risks with their babies in excess of the risks of driving drunk with them. I feel bad for the kids, but that’s bodily autonomy. I do care if you’re lying, by omission or directly, to encourage them to do so, and if you are free to run off with the other Sisters in Chains after presiding over the preventable death of a baby.

          • SweetBabyJesus

            Yep, I am all for informed choice. And for not misleading mothers who want transparent choice (DR. AMY!!!!). I’ve even given an example of someone who should never be given the chance for a homebirth, to accentuate my point.

            Sounds like you are trying to apologize. I accept!

          • DaisyGrrl

            Also, the numbers are per thousand, not per hundred, so the 1.1% she’s thinking of would be better expressed as 0.11%. The mortality rates, expressed in percentages, are 0.2% and 0.09%. And yes, as you point out, that’s over a 100% increase.

            SweetBabyJesus: when discussing percentages you need to remember that percent means “per hundred” and thus if the rate of something is expressed in some other form, you need to convert to /100 to express it as a percentage (ex: 1/4 = 25%)

            When talking about an increase in something, the percentage increase is based on the value of the lower number and the proportion of the lower number to the higher number. Thus, if we’re looking at something that happens 1/x, then 1.5/x represents a 50% increase, 2/x represents a 100% increase (or happens twice as often), and 5/x represents a 400% increase.

            If I screwed up my explanation, hopefully someone will jump in. My math skills aren’t the sharpest, but I’m pretty sure that’s the gist of it.

          • SweetBabyJesus

            Percentages are always expressed the same way. I did my conversions and will be contacting a friend solid in stats to confirm. My calculations hold and you’re afraid to admit it. Sorry bucko, I’ve got you cornered.

          • yugaya

            “Percentages are always expressed the same way.”

            No, they are not.

            A helpful resource for someone with the lack of basic adult numeracy like yours: https://www.mathsisfun.com/percentage.html

          • DaisyGrrl

            It’s amazing when you think about it. I go shopping, and I see three stores have a sale. One offers 1/3 off, the other offers 33% off, still another offers buy 2, get 1 free. They all mean roughly the same thing (provided I buy 3 items at the last store) but they’re expressed differently. I wonder what SBJ would say they are.

            I’m having real difficulty understanding how anyone can go through life without basic numeracy. SBJ’s foundation is so shaky…I just don’t even know where to start in pointing out what’s wrong with her math.

    • Daleth

      I will end with this: The perinatal risk of having a homebirth over a hospital is 0.1% greater

      You do realize that that means if even 10% of US births happened at home, at least 400 healthy full-term babies would die every year because their mom went for a home birth?

      More than one baby every day.

      And if 50% of US births were home births, a good 2000 babies a year–healthy, full-term babies–would die, just because their mom tried a home birth.

      So that’s your goal, then?

      And BTW, studies that compare babies with similar risk profiles find that the numbers are much higher: low-risk, full term, head-down singletons weighing at least 2500g/5.1lbs are 3 to 4 times more likely to die in a home birth than in a hospital birth.

      http://www.ajog.org/article/S0002-9378%2813%2901155-1/fulltext

    • SweetBabyJesus

      Going to show off my stats learning skills (seriously was my worst subject in school–not a math person and fine admitting it)!!

      Relative Risk of homebirth vs. hospital birth: 2.22
      Relative Risk Interpretation: 122% increased risk or 1.2 times as likely to have adverse risk.

      NOW let’s apply this RELATIVE number to the situation at hand. If a healthy, normal mother presents with, let’s say for the sake of argument, with a 0.09% risk level (0.9/1000 risk level birthing in the hospital) and they chose to do a homebirth (2.0/1000) they will move to a 0.11% risk level. That’s an increase of 0.02% in absolute risk–not a 100% increase in risk which is easy to confuse because of the whole 122% business, until you apply it to a real situation ( @PrimaryCareDoc:disqus –it’s ok, I know math isn’t a prereq for med school so don’t feel bad dude, happens to the best of us.). This is a number that some may consider “inconclusive” or “unimpressive”.

      Let’s also remember that ACOG admits that homebirth data is scanty and inconsistent, and the recommendation is for more research on the matter to increase accuracy.

      And BOOM GOES THE DYNAMITE. Ok, I’m ready. Let me have it. How did I eff up? How are you going to take these simple numbers that overly prove my point, and twist them in a way that suits you. Come on takers, come on.

      • DaisyGrrl

        Relative risk interpretation: 122% increased risk or 1.2 times as likely to have adverse risk.

        Wrong. 122% increased risk. 2.2 times as likely to happen.

        I can’t even begin to untangle where you go from there. I just can’t.

        As for ACOG, the best evidence for now is that homebirth is 2-3 times more likely to result in death of baby (300%-400% increased risk). There are suspicions among many of us here that the number is higher (see Judith Rooks’ work on Oregon), but confirmation is slow in coming because the best way to gather stats is intended place of birth at onset of labour and birth certificates don’t collect that data (and we can’t currently trust midwives to properly self-report).

        • Who?

          It’s maths, DaisyGrrl, but not as we know it.

          • DaisyGrrl

            Certainly not as I have ever learnt it!

          • Who?

            I don’t know anything about maths, but how .9 per thousand is not just under half of 2 per thousand defeats me. I ran out of fingers and toes, even with the dog to help, but it keeps coming back as about half.

          • KeeperOfTheBooks

            Right. My math knowledge is faulty, I’ll be the first to admit, but it’s well beyond me how 2 is .011% bigger than .9.

          • Who?

            She’s got to be a satirist, surely?

            The alternative is appalling.

          • SweetBabyJesus

            Yes–the alternative being a bright, educated and willful student midwife who is not only intelligent but who follows evidence-based practice and just showed ALL of Dr. Amy’s Army up with the stats.

            That WOULD be the most appalling thing for you, I bet.

          • yugaya

            ” being a bright, educated and willful student midwife who is not only intelligent but who follows evidence-based practice and just showed ALL of Dr. Amy’s Army up with the stats.”

            Oh the irony.

          • Who?

            I lost it at that quote. This woman is a rock solid lunatic.

            It’s like she’s writing teenage fanfic. Only with people actually dying.

          • Roadstergal

            That’s it, you nailed it. “So Mary Sue swept in and rescued the woman from the evil OB, and they had the sweetest baby in the middle of the woods. And then Jacob found them there and said, ‘You are so pretty and smart! And your eyes are so interesting, they have a circle of a different color around the outside and golden sparkles in them.’ And when the OBs came to steal the beautiful baby away, Jacob roared at them and they ran off.”

          • Barbara Delaney

            You left out the part where Abby Hawkwind, defender of woodland faerie folk and righteous midwives, held high her flaming sword of innumeracy and intoned the sacred chant of the counterfeit midwives, “Lo, behold and know, two plus two equals five, correlation does imply causation, baselines can always be moved, and size doesn’t matter when it comes to samples!” There was much rejoicing of the faeries and midwives. There was triumphant music and sacred interpretive dances were performed. Sadly, in all the excitement the sweetest baby was forgotten and trampled in the sacred dance. But no one cried or showed sad visages because Abby Hawkwind declared ” It is the will of the Goddess that sweet baby is dead!” And so the festivities continued and laughter was heard throughout the night.

          • Megan

            I like you. I really do hope you stick around. 🙂

          • Sue

            A “bright, educated and willful student midwife who is not only intelligent but who follows evidence-based practice and just showed ALL of Dr. Amy’s Army up with the stats”.

            HAAHAHAHAHA ! That’s HILARIOUS. Both Dunning and Kruger.

            Dear “SBJ” – a quiz question for you:
            If something increases by 100%, does it double? Think carefully before you answer.

          • SweetBabyJesus

            No you look like the idiot. Furreal.

          • SweetBabyJesus

            Whoops, I said something mean but it’s you, and I said I was sorry for doing that.

            The thing is that it’s 2/1000 and .9/1000, and through the equations above you have to sift out the relative risk ratio interpretation to get to the meat of how much a person’s risk will increase or decrease, depending on their choice. If you look at the video link that I posted up there it is helpful. I sure have learned so much.

          • SweetBabyJesus

            Learnt??

          • DaisyGrrl

            Yes, learnt is the past participle of learn. I’m pretty sure we’ve been over this.

          • SweetBabyJesus

            So much drama on this page, I need some wine so I can get turnt.

          • Sue

            I don’t think that wine will make her stats skills any sharper, somehow.

          • DaisyGrrl

            How I feel right now:

        • SweetBabyJesus

          2.0/0.9 gives us 2.22, or the Relative Risk. Then to devise the Relative Risk Ratio Interpretation you must plug it into the formula:

          RRR(I) = |1-RR| x 100, or |1-2.22| x 100, which is 122% or 1.22.

          Then you multiply that figure times the original risk factor of the case at hand, in this case the mother who is at a risk of 0.9/1000 or 0.09% for hospital birth. The answer is 0.001098 or 0.0011%.

          Awwww, now whatcha gonna say. I just exceeded your skills and you made fun of me. Who’s the idiot now??

          Poor sweet things. You’re the ones learning. I tricked you! It’s because I’m a witch.

          • SweetBabyJesus

            And just to be clear that I support high risk mamas being in the hospital, let’s say Suzie Q has some complications in her hx (HTN, Pre-E, you name it).

            She is at a (made up for the purposes of this exercise) 0.25% risk level for vaginal birth. For homebirth she is now at a risk of 0.30% risk, which is just unsafe (it was unsafe to begin with, but the 0.05% jump is far, far worse than that little tiny jump for a normal health mom considering homebirth).

            Learning, we are LEARNING HERE!

          • Bombshellrisa

            Let’s say that the woman doesn’t have any history of anything but develops signs and symptoms while in your care. You want to transfer her care, she doesn’t wish to be transferred. What will you do? How will you take those numbers, put them into a scenario she can understand and convince her that you aren’t the correct person to care for her. What if she is frightened of giving birth in a hospital and says she will attempt UC before she will give birth there? This happens a lot.
            The other thing might happen is when an ultrasound suggests that a baby might need to be born where a team is available to assess right after birth. There is no indication that the mother will have any problems, the issue is the baby. How will you help this mother see the benefit of hospital birth? A mother who says “the hospital is down the street, I want to give birth at home/at this birth center/at my friends house and then we will bring the baby to the hospital after”.

          • SweetBabyJesus

            I will transfer because she is no longer safe for homebirth and needs to be in physician care. I am not responsible for what a person decides to do or not do once they are on their own–that is the same way an OB would handle a patient who they released. I will give them all attempts at solid advice as to why they are no longer low-risk and how they can endanger themselves or their baby. This happens in our clinic sometimes (happened this week, actually). We have a law laying out the exact proceedings and work with a backing physician. So yeah…

          • DaisyGrrl

            If she develops these signs and symptoms whilst in labour, you cannot just release her from your care (well, an OB can’t, I have no idea what you think is appropriate and/or legal). If you did that, you’d be abandoning your patient while they actively need medical care.

          • Grace Adieu

            Nope. If the increase in absolute risk is 0.05% from a baseline of 0.25% then the relative risk is 1.2 (120%), as opposed to 2.22 (222%).

          • PrimaryCareDoc

            Sadly, that’s not how you calculate relative risk. So your entire calculation is faulty.

          • SweetBabyJesus

            Then why don’t you demonstrate the right way, exactly as I have. I’m all ears.

          • DaisyGrrl

            I think you have made it very clear that you are coming to this debate unarmed.

            As for what I’m going to say, it’s this: with math skills like the ones on display, I hope you never have to calculate medication dosages (and yes, that includes children’s Tylenol).

          • SweetBabyJesus

            Yeah I’d probably OD my son. And everyone here would relish in it! You people are sick.

          • PrimaryCareDoc

            So by your math, the mother with a risk of .09% at hospital birth actually has a LOWER risk of infant death at home birth, even though the risk is 100% higher at home birth.

            Right.

            Excellent math work there.

          • SweetBabyJesus

            Nope. It’s 0.0011% higher. Are you problematic in math AND reading?!

          • Karen in SC

            You keep writing 0.0011% when you mean 0.0011 OR 0.11%.

            For example 5/10, is 0.5 as a decimal and 50% as a fraction.

          • PrimaryCareDoc

            0.09×1.22= .10

            Sorry, sweetie. You’re off by a factor of 100. So her risk has gone up by .1…or 10%. Someone check my math. But I’m pretty sure I’m right. So, you know, nice playing with you, SBJ.

          • DaisyGrrl

            Her absolute risk has gone up by .11%, but the risk increase is 122% if we assume baseline risk is .09%

            I’m not sure where your 10% is coming from, but it’s late here and I’m tired.

      • PrimaryCareDoc

        Honestly, I don’t even know what the fuck you’re talking about. This is not any form of statistics or risk assessment that is known to humankind.

        And actually advanced math (including calculus) was a prereq for med school, along with statistics and epidemiology in med school itself.

        • SweetBabyJesus

          hahaha no just not known to you.

          • PrimaryCareDoc

            Not known to anyone. Can anyone bat signal YoungCCProf to give a little stats review for our illustrious guest?

          • SweetBabyJesus

            See below. Read em and weep DOCTOR.

          • Amazed

            Listen, you fucking filth! Show some respect to those who, unlike you, didn’t go down the easiest road, didn’t snivel, “But there’s no medical school in my hometown!” and didn’t save money from real education.

            Don’t you DARE say “doctor” as if it is an insult. Because, moron, when one day you run into a complication, it’ll be you running to the doctors you so deride bleating, “Save her doc! Clean up my shit doc!” That’s, if you don’t just abandon her in labour, as you just wrote you’re ready to do. As many of your cherished preceptors do.

            Now scurry away, cockroach.

          • Who?

            Respect is not part of the lexicon, along with statistics, as it turns out.

            She’s being oh so careful to point out that whatever happens is mother’s choice, but of course, she’ll be by mother’s side. And having her there after a disaster would be almost as comforting and pleasing as having a live baby instead of a dead one, because that’s the kind of professional she will be.

          • Daleth

            Abby Reichert, or is it Abby Reichardt, if you can’t understand the numbers you’re talking about, that’s ignorance. It can be remedied: listen, read, and learn.

            But if you insist that you are right despite multiple people demonstrating mathematically that you’re wrong, that’s not ignorance. It’s stupidity. Oh, and arrogance.

            And that’s a bad, bad, BAD combination of traits in a supposed “health care provider.” That’s how you end up killing people.

      • KeeperOfTheBooks

        You yourself said that .9/1000 babies will die in a hospital setting, and 2/1000 babies will die in a homebirth setting. Ergo, the risk is just over twice as likely (100% more likely) that you’ll lose your baby in a homebirth setting…and that’s after being (supposedly) risked out, which hospital birth moms aren’t!

        • SweetBabyJesus

          Read below. I’ve spelled it out. Absolute risk is 0.0011% increase. You have to actually calculate your stats–everyone here taught me that and BOY am I glad. I just reaffirmed that I am in the right field and you ALL look stupid. Scoff, scoff.

          • Karen in SC

            You keep writing 0.0011% when you mean 0.0011 OR 0.11%

      • Monkey Professor for a Head

        I have no idea how you arrived at those figures. You seem to be mainly focused on absolute risk, so let’s focus on that. Using the figures you’re quoting, there are an excess of 1.1 deaths per thousand at homebirth compared to hospital birth, putting the absolute risk increase at 1.1/1000 or 0.11%. Not 0.02%. It seems small, but if 2% of births in the USA are homebirth X then that equates to approximately 86 extra deaths per year caused by homebirth.

        Unfortunately there’s a good chance that the risks of homebirth are even higher when you consider that 1) deaths that occur in hospital when a homebirth transfer happens too late are often included under hospital statistics, 2) hospital patient populations tend to have higher risk characteristics compared to homebirth patients. It also doesn’t factor in injuries such as hypoxia ischaemic encephalopathy.

        When you are practicing, what do you intend to tell women who ask you what the risks are of homebirth?

        • SweetBabyJesus

          That’s not how you calculate it. You have to apply relative risk to the baseline risk. Oh and “a good chance” don’t mean diddly until you find the numbers to prove it. I do advocate for more accurate reporting that includes transfer deaths. I think you’ll find that the number won’t shift too much, and moreover we should get some studies in regulated states so that our homebirth stats are smeared with the idiot practitioners out there like Duggar lady.

          Yes I will provide full informed consent to everything patient. It is their right as a consumer and my ethical obligation as a care provider. No fear, just the facts.

          • DaisyGrrl

            I don’t think you’re capable of providing informed consent if you can’t calculate risk properly. With no facts, there’s just fear.

          • SweetBabyJesus

            I calculated it below and you didn’t like the figure so you came up with one of your own. Try my formula–you can plug any number into it. And hey, here is a neato video laying it alllll out. Notice the part about “relativity”.

            https://www.youtube.com/watch?v=FZzm3-RRlI4

          • PrimaryCareDoc

            I finally watched your video. He’s talking about using risk ratio to calculate how an intervention changes someone’s risk. This situation does not apply to what we’re talking about AT ALL. For example, he uses someone with a certain baseline risk of heart disease, and calculates the risk reduction with adding a statin. There is no intervention being done with your numbers. They are already right there, staring you in the face. 2.2/1000 vs 0.9/1000.

            Sorry.

          • Who?

            You’re very good to check it out. It was bound to be entirely the wrong thing.

            I predict we’ll never see her again, at least not under that ‘nym.

          • Monkey Professor for a Head

            http://clinicalevidence.bmj.com/x/set/static/ebm/learn/665075.html

            AR (absolute risk) = the number of events (good or bad) in treated or control groups, divided by the number of people in that group
            ARC = the AR of events in the control group
            ART = the AR of events in the treatment group
            ARR (absolute risk reduction) = ARC – ART
            RR (relative risk) = ART / ARC
            RRR (relative risk reduction) = (ARC – ART) / ARC
            RRR = 1 – RR
            NNT (number needed to treat) = 1 / ARR

            So if we say that home births are the control group and hospital birth is the treatment group. The absolute risk of homebirth is 2/1000 or 0.2%. The absolute risk of hospital birth is 0.9/1000 or 0.09%. 0.2% – 0.09% is 0.11%.

          • Monkey Professor for a Head

            I’m pretty sure that my calculations are correct, but if any of the regulars here see a mistake, please let me know.

          • yugaya

            No, you are right and she is off completely: “Absolute risk is 0.0011% increase.” – she clearly has no grasp of anything decimal, let alone applying it to medical statistical analysis.

            That’s what happens when you learn how to be a fake, substandard quack midwife by watching youtube videos.

          • Amazed

            Meanwhile, here homebirthers (thank God, they’re a very small group. Big enough for a few preventable deaths though, sadly, and that’s far before they hit the 1000 mark.) march on. “There are midwives in the USA that aren’t nurses!” they sing. “Hear us roar!”

          • yugaya

            “Yes I will provide full informed consent to everything patient.”

            You are clearly incapable of doing that. Ever.

        • Amazed

          What the hell? You guys are now giving her maths lessons? You actually hope she has the intellectual capacity to grasp it?

          I appreciate that you want to make her as safe practitioner as her patently unsafe ilk can be but honestly, there is a limit to all things, even dreams.

          • SweetBabyJesus

            Oh no, I’m the one schooling everyone. Check out the equation I listed and PLEASE point out my mistake. The lives of all the babies I can’t wait to irresponsibly kill rest on it!

          • Amazed

            Sweetheart, I saw the limit of your maths skills yesterday. I don’t care about the teen you have grabbed to do the maths for you. I’d rather talk about the studies that you asked for and I supplied. As well as the case with poor, preventably dead Gavin Michael that you said you’d look up.

          • PrimaryCareDoc

            Your mistake is in decimals.

          • Barbara Delaney

            My God, are there any limits to your stupidity? Any woman who would have the incredible misfortune to encounter you in her labor and delivery would be better off with any taxi driver, kindly bystander, or child of average intelligence to assist her. You’ve shown that in addition to your lack of knowledge and your faulty reasoning skills, you’re lacking in any dignity. You’ve behaved like a petulant child.

            You’ve actually made Jill Duggar look good in comparison. I didn’t think that could be done.

          • Amazed

            Yeah, Jill grew up on me as well. I thought it was only me.

            Weird, isn’t it?

          • Daleth

            Grace Adieu and Monkey Professor did point out your mistake. Have you read what they wrote?

          • Sue

            “PLEASE point out my mistake”

            It’s been explained repeately, in every different way, upside down and back-to-front, and she still can’t see it! Sigh.

          • DaisyGrrl

            It’s not so much for her, but if others wander in and see her raging lunacy they’ll at least know we tried.

          • Who?

            Not sure the intellect is the problem, there is a definite emotional and potentially psychiatric issue though.

            And now she’s dreaming up threats to some (perhaps real, perhaps also imagined) child of hers.

            Really a great ad for CPMs.

          • Monkey Professor for a Head

            I must admit that there’s an element of this – https://xkcd.com/386/

          • Who?

            I know-I have some admin stuff to do but this is far more interesting.

            It’s great that she’s so open about all she knows-it can only do the cause of making clear how CPMs train and work even clearer for those who want to understand the differences between birth hobbyists and caring professionals.

      • Grace Adieu

        “122% increased risk or 1.2 times as likely to have adverse risk”

        Your error is here. “Increased risk” refers to the risk over and above the baseline. It is not “times as likely” – that’s “Relative Risk”, your starting number.

        A simple arithmetic example – 1 increased by 2 is 3 (1+2=3). 1 times 2 is 2 (1×2=2). See how they aren’t the same?

        “NOW let’s apply this RELATIVE number to the situation at hand.”

        The RELATIVE number is Relative Risk, that’s why it’s called “Relative”, geddit?

        0.09% x 2.22 = 0.1998%

        which is an increase of 0.1098% in absolute risk – more than double, ie more than 100% (which we already knew, because we already knew that the increase in relative risk is 122%).

        In other words:

        Relative Risk = “times as likely” = 2.22 x [baseline risk]

        Increase in Relative Risk (what you’re calling “Relative Risk Interpretation”) = additional risk over and above the baseline = [baseline risk] + 1.22 x [baseline risk] = 2.22 x [baseline risk].

        This is really elementary school stuff.

      • Squillo

        SBJ, the Susan Komen website has a pretty good primer on understanding risk for us laypeople: http://ww5.komen.org/BreastCancer/UnderstandingRisk.html.

        The tables and examples may help you understand where your error is.

      • Sue

        Let me apply my better “stats learning skills”

        Relative risk of x vs y: 2.22
        Relative risk interpretation: x is 2.2 times more likely than y

        1.2 times as likely means that the relative risk is 1.2

        There.

    • The Bofa on the Sofa

      Neonatal death—all newborns

      Neonatal death—nonanomalous

      Can someone help explain to me the difference here? What constitutes “nonanomalous”? My interpretation is that this refers to low-risk cases, but I’m not sure. Is that what it means?

      I’ll wait for an answer before I go any further.

      • Daleth

        I believe it means babies who are nonanomalous, i.e., no congenital defects, not premature, yada yada. But correct me if I’m wrong.

        • The Bofa on the Sofa

          Yeah, but my question is what is included in the yada yada?

  • attitude devant

    SweetBabyJesus where in the world did you get the idea that the number one cause of maternal mortality is suicide? That would be hilarious if it didn’t underline how sadly misinformed you are about the risks of childbearing.

    • SweetBabyJesus

      If you actually read the rest of the thread then you would see the correction. Way to come in on the last part of the convo.

      • attitude devant

        No, I saw where you were corrected. I just wanted to know where in the world you got that idea.

  • SweetBabyJesus

    Dr. Amy,

    First let’s clear this one up: Jill Duggar is an idiot. We good on that? Great!

    Outside of criticizing Mrs. Duggar’s motives (a favorite pastime, when I’m in the mood), this has to be one of the most factless, emotionally loaded and inconceivably pompous diatribes that I have ever read addressing the national out-of-hospital birth movement. Ever. Not only do you lump every single individual that practices in obstetrical care (legally) outside of CNMs/MDs into one individual category, you go on to say that to become a CPM ‘You can simply submit a “portfolio” of births that you have attended, pay the money and take the exam’. Nope, that’s incorrect. Actually, student midwives see a considerably larger number of vaginal births during their training than do OBs. By your own logic, our highly-skilled OBs don’t have the necessary training to manage normal vaginal childbirth! Most accredited midwifery schools are a minimum of two years of academic training (several programs being an upwards of 3-4 years) and by 2020 all CPM training will be conducted in a fully-accredited and regulated institution.

    With your impressing curricula vitae, Dr. Amy, it would appear from this post that the facts and examples you obtained came from sitting in the break-room with other colleagues from your exact background sharing anecdotal banter about “lay midwives” from a painfully narrow and biased perspective. Where are any real facts and figures in your post? What research have you conducted on midwifery training and accredited schools in the US, or for that matter the national infant and maternal mortality/morbidity rates in this country?

    Perhaps this is something you have not had a chance to review recently, but I’ll tell you that our stats aren’t great. The WHO shows that the US is ranked 54th place for infant mortality and 48th for maternal mortality, with countries such as Serbia, Greece & Taiwan exceeding us. That puts us very near last place for safe outcomes among industrialized or “first world” countries. Incidentally, we are the number ONE spender on healthcare per capita internationally. Over 90% of births are managed in a hospital setting with CNM or OB care. Although the WHO recommends cesarean section rates between 10-15% the United States’ cesarean rate vacillates between 32%-38% with some hospitals pushing the 70% mark. Yikes! With those stats it seems clear which body of practitioners are struggling to meet the criteria for safe birth outcomes. For as much as obstetricians, anesthesiologists and pharmaceutical companies get paid per birth, a consumer might rightfully question where their money is going. And many do.

    But I completely support most MDs, CNMs and L&D Nurses–the ones who follow evidence-based practice, specifically. Without them we would not have a place for those mothers who have crossed the boundary between low-risk and high-risk to get safe care. I have worked with several who support a vision of collaborative and seamless patient care that recognizes the safety of natural birth, the sanctity of maternal informed choice and the obvious necessity for both low-risk and high-risk care options, dependent on each individual patient’s needs. Indeed I don’t see a single passage in your writing that acknowledges the patient’s access to evidence-based decision making. What a shame for them.

    I do sincerely hope that the future of obstetrical training and practice is increasingly influenced by those collaborative and competent practitioners mentioned above so that the old-fashioned breed of medical management (and, I’m afraid to say, the foundation of your entire medical training, Dr. Amy) dies out. I am eager for us to move away from medical and obstetrical practice where patients are told what to do, given little to no information or informed choice and then admonished in cases where they decide that there are other options better suited to their own health and well-being. This is the age of information and once the so-called “millennials” reach child-bearing age we will be faced with this change whether we like it or not. Being bullied and threatened with fear-based tactics by condescending medical professionals just isn’t going to work anymore. Give me some hard evidence and a well-worded argument based on more than bias any day and I’ll be all ears.

    My final charge to you, Dr. Amy, is this: I challenge you to re-post your very same argument in response to my comments using REAL statistics and CURRENT information regarding obstetrical practice in the United States. I want to see facts that include the actual state of CPM education in our country and a comparison of those overseas. I’d also love a breakdown of why, in your professional opinion, that our outcomes are so bad in the US whilst we spend so much, while we are on the subject.

    Oh, and no need to ostracize Mrs. Duggar this time. As we’ve already established, she really is an idiot.
    ———————————————-
    Written by a student midwife seeking CPM/LM licensure in the State of Florida, previous Academic Director of a MEAC-accredited midwifery school and mother of one beautiful and safely home-born boy.
    ———————————————-
    REFERENCES and RESOURCES for those who want more:
    http://www.meacschools.org
    http://www.narm.org
    – WHO infant & maternal mortality stats via the CIA: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html , https://www.cia.gov/library/publications/the-world-factbook/rankorder/2223rank.html
    http://evidencebasedbirth.com/
    – “Why Not Home?” A new documentary following hospital-based birth providers who are choosing homebirth. http://www.whynothome.com/

    • Amazed

      I only needed to see the references (that we’re acquainted with) to know what we have in your face. If you know just how idiotic that last part dubs you, you would have hidden away in shame.

      I didn’t need to read through the rest of your diatribe, so I didn’t.

      • SweetBabyJesus

        I don’t need to feel shame for having this conversation. I am a birth care provider learning alongside all of the others in my field. There are sources that I can share that are approved in the view of the mainstream medical community. I like to consider all of the sources, not just the ones that prove my point. The proof is in the pudding with pregnancy & birth outcomes in our country, whether I sit here and argue my point or not!
        I do understand infant mortality, maternal mortality, and perinatal mortality. I will do better to include perinatal mortality in my comments as that is most relevant to birth itself, but remember that birth care providers care for mothers during pregnancy, birth and 6-8 weeks postpartum. My model advocates collaborative care–I do not think that homebirth is for everyone and I do not think hospital birth is for everyone. I know how I will be painted by those in disagreement with me. For those who want to be balanced in approach and have this conversation, thank you for stepping out of your ego and fear. Let’s talk.

        • The Bofa on the Sofa

          I do understand infant mortality, maternal mortality, and perinatal mortality.

          Then why have you been using infant mortality?

          • SweetBabyJesus

            See above when I discuss perinatal mood disorders. Also see above where I attacked you…

            (I didn’t. This is called Ad Hominem. Still waiting for your sources!!)

          • LibrarianSarah

            There are a couple problems in that post:

            1. The number one cause of maternal mortality is not suicide. It is cardiovascular disease. http://www.cdc.gov/reproductivehealth/maternalinfanthealth/pmss.html

            2. You didn’t cite any information that indicates that CPM’s are required to have any education (real education not reading stuff in books or on the internet) in psychology, counseling, psychiatry, etc. Cause if they don’t then they aren’t really better than a close friend in dealing with these issues. At least an OB/CNM could make an actual referral.

            3. A woman in a hospital is in a room full of mandated reporters with actual medical training including training in recognizing signs of abuse. These medical professional are also in frequent contact with social services as part of their career but yeah she would be totally better off at home with some chick who saw “dozens” of births with a mostly upper middle class clientele if she was being abused or neglected.

          • SweetBabyJesus

            1. I am sorry, I meant maternal deaths, not mortality rate. Someone else helped me clear that one up.

            2. Yes, CPMs receive this type of training. Here is a sample curriculum from a MEAC-accredited school: midwiferyschool.org/pdfs/fstm-catalog.pdf (page 13). The curriculum may vary school to school. Also, as a mother myself, I find that discussion of the type that one would have with a close friend is INVALUABLE to my survival as a mother. I applaud care providers who can hold that level of intimate sharing space in a professional manner. It counts and it changes lives.

            3. Yes I am aware of the training and team involved in Intimate Partner Violence (IPV) reporting in the hospital. I did not intend to say that women in obstetrical care don’t offer those services–I don’t think I did say that as a matter of fact. I just was saying that midwives tend to get much more facetime with their patients and are able to establish a rapport that can lead to more revealing details about a patient’s life. Also, I don’t see what how many births one has seen has anything to do with being able to detect IPV and refer to the appropriate channels, when one has the training to do so (many NGOs rely on trained volunteers from all backgrounds to do this, it’s not a skill solely picked up in an 8-year medical training)… Guessing that’s another redundant slight on how midwives don’t receive another training. Point taken sister, good GRIEF.

          • Bombshellrisa

            It’s inappropriate and unethical to be intimate friends with your healthcare provider. Professional distance is needed to be able to evaluate a patient accurately. Being friends with someone will not help you diagnose and treat anything. It can also make clients hold back from reporting issues to the proper authorities, especially in the case of injury or death.

          • SweetBabyJesus

            Yep, couldn’t agree more. See where I said “intimate sharing space in a professional manner”.

          • Bombshellrisa

            Intimate and professional don’t mesh that way. If you mean a patient should feel safe to share what really is going on, then yes. But that is more about understanding that a midwife has to know symptoms and situations that are concerning, not “the right answers” that would mean she would continue being able to seek care from the midwife and be considered low risk.

        • Siri

          “The proof is in the pudding” – do you mean the proof of the pudding is in the eating? What was that you had on lock?

      • SweetBabyJesus

        And also, please feel free to share your references! I haven’t seen any yet. No point in me hustling for my proof is y’all aren’t even up to the task yourself! So please… share away!

    • The Bofa on the Sofa

      The WHO shows that the US is ranked 54th place for infant mortality and 48th for maternal mortality,

      We already went through this.

      What is the relevance of infant mortality in this discussion? Do you even know what infant mortality means? HoustonMom has a great explanation below.

      And please explain how midwifery is going to address the causes of maternal mortality (hint: you have to know what causes it in the first place; I doubt you do)

      You are the typical clueless midwife.

      • SweetBabyJesus

        Your comment is scathing and hurtful. I am sure that was your aim. Now would you like to offer me any stats or is your game to make me do all the work?? 😛

        • The Bofa on the Sofa

          You’re the one making all the big claims, kiddo. I let you show us exactly how much you know. You and Mitt Romney have binders of women, but you admit you can’t point to a single unnecessary c-section. You claim our outcomes are bad, and then quote infant mortality. It’s exactly what I expected, and you walked right into it to show us your ignorance.

          • SweetBabyJesus

            What are you talking about Mitt Romney for? Now I’m lumped with that fool too?! You’re not worth arguing with. Ya got nothing, “KID”.

            Read my post above about maternal mortality. Infanticide is a result of perinatal mood disorder. But that’s the ped’s problem, right? You walked right into this discussion showing how readily you’ll shift blame and responsibility to someone else. It’s all connected and like I said, show me some stats. Now that you’ve allowed me to “show you exactly what I know”, it’s your turn. Don’t be shy!

        • The Bofa on the Sofa

          BTW, if you don’t want to get called a typical clueless midwife, don’t act like a typical clueless midwife.

      • SweetBabyJesus

        Maternal mortality: The number one maternal killer in the US is suicide. Midwives work with their patients one-on-one or in a small practice from the first prenatal visit to the last postpartum visit around 6 weeks postpartum. The relationship developed gives us ample opportunity to reach women who are experiencing breastfeeding problems, intimate partner violence, socioeconomic disparities (no food, etc), and perinatal mood disorders. We are able to offer screens for these and other issues, counseling in a well-cultivated care provider-client relationship, and references to local resources for help. Midwives are also often plugged into the local parenting communities that offer support for new parents and repeat parents alike. Some OBs do a good job of offering these same services, some do a awful job. OBs spend so little time with each patient and a given patient may see 5-6+ care providers throughout. When is a good time to say “I am being abused by my husband” when you don’t have the trust and rapport needed to divulge such information. It often doesn’t happen and that is a travesty.

        • Megan
          • Megan

            (Hint: It’s not suicide.)

          • SweetBabyJesus

            Check these out: http://www.who.int/mental_health/prevention/suicide/Perinatal_depression_mmh_final.pdf

            http://bjp.rcpsych.org/content/183/4/279

            Hint: You’re not looking at the big picture. Also hint: Stop doing the sarcastic “hint” thing because it makes you look rude.

          • Houston Mom

            I do think new mothers need better after-care in the US, but neither link actually shows that suicide is the #1 maternal killer in America. One is for the UK and the WHO link says that suicide is “a [not THE] leading cause of maternal death in the developed world.”

          • SweetBabyJesus

            Indeed. Shall it rise to #1 before we consider it a problem? A leading cause suggests top 3 or so, so yes I am officially incorrect and do apologize for naming it #1… still doesn’t speak to the bigger issue!

          • PrimaryCareDoc

            So, tell us in your infinite wisdom how midwife care will positively impact the number one cause of maternal mortality, which is cardiovascular disease?

            I’d also like to see some actual proof that midwifery care does anything to reduce the risk of maternal suicide.

          • SweetBabyJesus

            See above for the second part.

            I see what ya did there. Just to entertain the idea, I guess I could argue better nutrition counseling (?), but the reality is that we don’t see high risk clients so everything I am saying is within our realm of low-risk. People with major cardiovascular disease shouldn’t birth outside of the hospital. I would love to see YOUR research on Doctor’s efforts in preventative measures for treating cardiovascular disease, before it reaches the pharmaceutical/surgery stages. I’m sure it’s out there.

            I was referring to maternal deaths with suicide. Feel free to stop attacking me and stop skirting the issues. My goal is solution.

          • Megan

            Of course it’s a problem. But it’s not even in the CDC’s top 10, let alone top three. You’re just wrong.

          • Roadstergal

            “but neither link actually shows that suicide is the #1 maternal killer in America”

            Or that homebirth midwifery could do diddly squat to reduce it.

            What might help is if the lactivists stop encouraging women to forego medication to breastfeed, to sacrifice their sleep to breastfeed, and to starve their children (especially as the evidence base shows that initial formula supplementation supports long-term BF for women who are so inclined). PPD is real, sleep deprivation can exacerbate it, and pharmacological treatment can help.

          • The Bofa on the Sofa

            Or that homebirth midwifery could do diddly squat to reduce it.

            Is there any evidence that midwives have less PPD for example? When controlled properly, of course.

          • SweetBabyJesus

            I’m going on anecdotal evidence at best. There is not a whole lot of research on out of hospital birth as a whole that isn’t horribly slanted toward the hospital-birth bias. I would love to see more. Would you listen? When I posted evidencebasedbirthblog above everyone laughed, so apparently attempts to research it are made fun of. Preeeeetty discouraging.

          • The Bofa on the Sofa

            There is not a whole lot of research on out of hospital birth as a whole that isn’t horribly slanted toward the hospital-birth bias.

            Reality has a hospital-birth bias. I don’t care about your propaganda.

            Would you listen?

            Actual evidence? Sure. Blatant assertions? Of course not.

          • SweetBabyJesus

            Lactivists should know that SSRIs such as zoloft are shown to be safe for breastfeeding and all of the IBCLCs that I work with do know that and share it. Please stop lumping in zealots with those of us who are trying to practice safely.

          • Roadstergal

            I said lactivists, not IBCLCs. Sadly, there is a lot of overlap between those two Venn diagrams, and the BFHI is one of the negative outcomes of that fact.

          • Megan

            Maternal death and maternal mortality rate are two different statistics. One is a rate, the other is an absolute number.

            https://www.pop.org/content/definitions-maternal-mortality

            Second, your citations are very out of date when we are talking about the current leading cause of maternal mortality, which is cardiovascular disease (as I posted in the most recent CDC data above). Suicide is not even listed in the CDC’s top 10. Please feel free to let me know how data from the CDC in 2011 are wrong.

        • Karen in SC

          “In the United States

          Of the 1,751 deaths within a year
          of pregnancy termination that occurred in 2011 and were reported to CDC, 702
          were found to be pregnancy-related. The pregnancy-related mortality ratio was
          17.8 deaths per 100,000 live births in 2011.

          Considerable racial disparities in
          pregnancy-related mortality exist. In 2011, the pregnancy-related
          mortality ratios were

          12.5 deaths per 100,000 live
          births for white women.

          42.8 deaths per 100,000 live
          births for black women.

          17.3 deaths per 100,000 live
          births for women of other races.

          The graph below shows percentages
          of pregnancy-related deaths in the United States in 2011 caused by

          Cardiovascular diseases,
          15.1%.

          Non-cardiovascular diseases,
          14.1%.

          Infection or sepsis, 14.0%.

          Hemorrhage, 11.3%.

          Cardiomyopathy, 10.1%.

          Thrombotic pulmonary
          embolism, 9.8%.

          Hypertensive disorders of
          pregnancy, 8.4%.

          Amniotic fluid embolism,
          5.6%.

          Cerebrovascular accidents,
          5.4%.

          Anesthesia complications,
          0.3%.

          The cause of death is unknown for
          5.9% of all 2011 pregnancy-related deaths.

          http://www.cdc.gov/reproductivehealth/maternalinfanthealth/pmss.html

    • Trixie

      Pretty sure a first year OB resident sees enough vaginal births in their first month to become a CPM. How many births do you think doctors see?

      • SweetBabyJesus

        Normal vaginal birth, without forceps or vacuum delivery? Or all vaginal births? I would imagine below 75. Maybe that number is ridiculous… any OBs on the thread who can share their experience?? It makes sense–they do not need as much time to train in a normal process such as regular old vaginal birth. They needs lots of training in surgery of course. Nothing against the OB, they are surgeons and I would hope mine had a good deal of hands-on surgery before they were unleashed on the world.

        • Karen in SC

          You claim a number of 75, what is your source?

          • SweetBabyJesus

            I don’t have a source, that was a total guess. You asked what I thought. I haven’t found a number and that is why I threw that out there and asked if any OBs could comment.

          • Karen in SC

            Four years of residency, 12 – 15 hour shifts on the L&D floor. Most births ARE standard vaginal deliveries. 208 weeks. Probably 5-10 births a week minimum.

          • SweetBabyJesus

            Excellent. I was wrong! I have had other OBs share with me that they saw a much smaller number. I have had nurses-in-training who have seen very few at all during their rotation. I am glad to hear that it is more prevalent than I thought. I think that seeing normal is crucial to maintaining normal.

          • PrimaryCareDoc

            Such a typical trope. You’ve had OBs tell you that they saw less than 75 uncomplicated vaginal births in their 4 years of training? Bullshit. Complete and utter bullshit.

            I saw multiple normal, uncomplicated, unmedicated vaginal deliveries in my 3 weeks of L&D that I did as a med student. One of these was even a twin birth. Unmedicated, no forceps, no vacuum, nothing. Just the safety of an OB, and OR down the hall, and a pediatrician standing by.

          • SweetBabyJesus

            Excellent! I have heard other things so that is why I said that. Glad to know that there is more normal & uncomplicated birth in medical training than I thought. I would love to continue hearing more from OBs in the field!! Also, how they have collaborated with midwives (CPMs and CNMs alike). So curious.

          • areawomanpdx

            I am a CNM and we collaborated with residents constantly on our training together. We would do triage for them and vice versa. We had grand rounds and board rounds together and discussed all kinds of cases. At two hospitals I’ve worked in, CNMs supervise the OB residents for all normal deliveries.

          • SweetBabyJesus

            That is awesome! I know a CNM that also did well with the OBs on her floor, but she had to really prove herself beyond what I feel like any OB would have had to do, just because of a title. That’s what gets me!

          • Bombshellrisa

            Unfortunately it’s due to the philosophy that natural, hands off and watchful waiting is a good thing. CNMs are not immune to this type of thinking.

          • SweetBabyJesus

            Hands-off means not intervening when there is no clinical indicator (dip in FHTs, maternal fever, whathaveyou). You are referring to neglect and well-trained midwives don’t do that. The ones that do should have their licenses pulled.

          • The Bofa on the Sofa

            Hands-off means not intervening when there is no clinical indicator (dip in FHTs, maternal fever, whathaveyou).

            Who does that? You were the one complaining about unnecessary c-sections, but they aren’t happening without some indication. Unless the mother is asking for one, of course.

          • Roadstergal

            “Unless the mother is asking for one, of course.”

            Sadly, often not even then.

          • SweetBabyJesus

            Also, for all the CNMs out there, do you agree with bombshell? That you don’t get the same automatic respect because of the midwifery model of care? I am gonna bet that there just might be a link with elitism, OB ego and the fact that midwifery was traditionally female-dominated and medical doctor practice traditionally male-dominated. Not the only reason, but a contributing factor. We aren’t that far removed from the old way of thinking.

          • Bombshellrisa

            OB/GYN is a specialty that is practiced predominantly by females now. If CNMs aren’t getting respect, it’s because of the way they are practicing, not because they are women.

          • PrimaryCareDoc

            Why should an OB collaborate with a CPM? That’s like me collaborating with the local homeopath.

          • SweetBabyJesus

            I think that CPM-OB collaboration would look more like a seamless transfer. We have a lead OBs collaborating in our area with midwives and he has been in practice since the 80s and is very well-respected in the community. The reason is for safe, evidence-based options for women. When they move from low-risk to high-risk they shouldn’t be ostracized and/or refused from care. They should be taken care of with respect from all ends. When OBs collaborate, CPMs practice better and are held to higher standards.

          • Karen in SC

            I was thinking the same thing! Why?

          • Roadstergal

            All of my friends who had easy, uncomplicated vaginal deliveries had them in a hospital. (In addition to the safety net, they really appreciated that they didn’t have to do any cleanup.)

          • SweetBabyJesus

            No birthing woman should have to clean up, EVER. A good midwife would not leave a mess. Might even provide a meal if she has the means. Glad to hear that your friends had a good hospital experience. That is how my sister’s was and I could not have thought anything to be better for her.

          • The Bofa on the Sofa

            No birthing woman should have to clean up, EVER. A good midwife would not leave a mess.

            So what does the fact that many women have told us they have had to clean up on their own tell you?

          • Roadstergal

            And provide food and snacks for their HB MWs?

          • SweetBabyJesus

            That isn’t something all midwives require, but if they did they should make it clear from the start as an expectation of their practice. Willing to bet that many mothers would rather provide food than be restricted from eating at all during labor!

          • The Bofa on the Sofa

            That isn’t something all midwives require, but if they did they should make it clear from the start as an expectation of their practice.

            Um, WRONG ANSWER

            You have got to be kidding me?

          • SweetBabyJesus

            Um, it’s the real answer and no kidding. I don’t know what to tell you–I have never met a midwife that requires that but if they did they should state it at the start before the patient accepts care. What the hell else do you want me to say lol

            ALL of my answers are the wrong answers to you Bofa, so no surpise!

          • The Bofa on the Sofa

            What the hell else do you want me to say lol

            You really think it is acceptable to expect a patient to make you a meal as long as they “state it up front”? That is horribly unethical.

          • Roadstergal

            Are you high?

          • Bombshellrisa

            No, it’s because most clients view their midwives and the birth crew as friends. You feed friends who come over to share a special event with you. You don’t feed a professional coming to your home to provide a service.

          • moto_librarian

            Does giving birth at home have some magic effect that prevents nausea and vomiting during transition? I don’t feel hungry during active labor, and neither did any of my friends or acquaintances.

          • SweetBabyJesus

            That they had a shitty midwife.

          • The Bofa on the Sofa

            So what are you doing about the shitty midwives?

          • SweetBabyJesus

            Pulling their licenses in our state. There is a way to report them even if they have not been pulled into litigation, and then an investigation opens. Probably the same way someone reports a shitty doctor.

          • SweetBabyJesus

            I myself cannot go and do away with all the shitty midwives although I would dearly love to. I CAN be a good midwife myself and practice within my scope and have excellent OB backup to help guide my decisions when they start to leave the realm of normal and low risk. And I am PROUD to do so.

          • The Bofa on the Sofa

            Pulling their licenses in our state.

            OK, do you honestly think that a midwife in your state is going to lose their license because they did not clean up the mess after a homebirth?

          • yugaya

            “No birthing woman should have to clean up, EVER. A good midwife would not leave a mess.”

            So your midwife scrubbed your bathtub? Did the whole biohazard cleanup of your bathroom? Riiight.

          • Megan

            I even got to see a footling breech vaginal delivery (and boy was I glad it wasn’t a homebirth!) in addition to vaginal twin birth as a FP resident.

          • SweetBabyJesus

            Yeah footling breech is far, far beyond the midwife’s scope. I would love to see one in the hospital setting though, just to see how it is managed. We are learning about breech birth now and that is what my research is on this semester. Definitely a great case for a cesarean if detected early enough.

          • PrimaryCareDoc

            The proper management of a footling breech is section. That’s the only acceptable management.

          • SweetBabyJesus

            Well, right. Unless the baby is literally flying out. Which happens. That is what I meant by “detected early enough”. I’m sure it’s exceedingly rare that they go unnoticed.

          • Karen in SC

            I’m pretty sure that’s one of those cpm myths that footlings fly out. Palpations should reveal the position. I have a friend who had a footling for her 9th birth. She had plenty of time for a c-section.

          • Roadstergal

            I thought ‘flying out’ was CPM wink-wink for ‘let’s do this VB.’

          • Megan

            Yes, this was a private patient I was not managing and from what I know, it truly was a surprise. The OB was terrified and so was everyone else (myself included). It’s certainly not something the OB would’ve done on purpose.

          • moto_librarian

            Then you should know why the standard of care for breech is c-section. I don’t really give a shit if you would “love to see one in the hospital setting, just to see how it is managed.” OSU is getting sued for a vaginal breech that went wrong, despite the fact that they have very strict criteria. You can’t predict when a head is going to get stuck, and most women aren’t interested in taking that gamble. I think it’s rather sick that you want to observe this.

          • Bombshellrisa

            I have seen a footling breech too but that goes something like this: home birth midwife transfers a woman whose labor isn’t progressing. Woman doesn’t want an IV or fetal monitoring and will run everything suggested past her midwife (who stayed with her). Doctor comes in to do a cervical check and there is a little foot sticking out. Mom has to have an emergency c-section. Midwife writes down the name of everyone who was part of care including OB and wants all of us disciplined because we “rushed” care and wants the anesthesiologist sued for “doing the medicine wrong on purpose” and the mother having side effects.

          • SweetBabyJesus

            and when I say “normal” I mean outside of the births that NEED to be cesareans. I mean low risk births that end in low-risk delivery. There is nothing abnormal about a birth that ends in cesarean when that surgery is called for. Despite what everyone wants to think of me!

          • guesty

            In medical school my husband rotated in OB for one month. He saw around 50 vaginal births and two cesareans (one was a stillbirth due to a CPM who did not transfer an SD patient to the hospital in enough time to save the baby). This number was about equal to his peers. I would imagine an OB resident would see more.

          • SweetBabyJesus

            Thanks for your response. That is great!

          • The Bofa on the Sofa

            And maybe you can learn from it. Learn that you really don’t know what you are talking about, and that you should perhaps ask first before spewing nonsense.

          • SweetBabyJesus

            Troll alert! What is your background pray tell? I am dying of curiosity to see if you’ve got any real training or if you are just here to hate?

          • MaineJen

            LOL. If Bofa is a troll, he’s playing a reeeeeally long game.

          • The Bofa on the Sofa

            To be fair, I did troll her below, playing the JAQing off game. Of course, she walked right into it. Then again, I knew she would.

          • SweetBabyJesus

            Ah you two are old friends. Good! That’s the way to challenge your knowledge–stick to only those who present easily digestible and comfortable viewpoints that are exactly like yours. Teamwork, guys, teamwork.

          • MaineJen

            Wow. Okay, let me break it down for you. Those of us who follow this blog regularly will tell you that *every month or so,* someone like you parachutes in to educate us all. You share the same talking points. You bring up the same misinformation. It’s like you’re reading out of a playbook. The thing is: you’re wrong.

            You’ve got your facts wrong. You’re laboring under the assumption that uneducated CPMs like Jill Duggar are the outliers. In fact, they’re the norm.

            You know what else we see every month or so? Another life lost because a CPM didn’t know when to transfer. Thought she could handle things. Overlooked the warning signs. Crowdsourced the problem on Facebook rather than calling a professional.

            If we seem harsh, it’s because we’re tired of hearing the same talking points over and over. Nothing changes. Moms lose babies that didn’t have to die. Most or all of us know first hand that birth is dangerous, things can go wrong quickly, and you need someone at your side who knows what they’re doing. We also know that birth is something that is largely out of our control. No matter how devoutly you study normal birth, not every birth will be normal. No matter how carefully you plan and prepare, eat right and exercise, not everything will go right.

          • Bombshellrisa

            More like every week, for both parachutes and that awful Grim Reaper pic that breaks my heart every time I see it.

          • An Actual Attorney

            Where I trained, that’s called the Socratic method.

          • The Bofa on the Sofa

            Yeah, everything I know about law school I learned from Legally Blonde.

            Then again, I probably know more about law school than what SweetBabyJesus knows about med school.

          • An Actual Attorney

            Rent The Paper Chase, watch 2 episodes of How to get away with Murder, spend a day watching a court, and you can be a cpl

          • The Bofa on the Sofa

            spend a day watching a court

            Can I watch a couple of seasons of Night Court instead? It would get me to be a PCL.

          • An Actual Attorney

            Sure, it’s pretty much the same thing.

          • The Bofa on the Sofa

            I’m here to learn from experts. Which means, not morons like you.

            And I really have learned a lot over the years I have been posting here. For example, I learned how CPMs are a bunch of clueless clowns. I learned the difference between perinatal and infant mortality.

            OTOH, I try to contribute when I can. I know a lot about assessing risk and statistics, so I provide some insight there (although there are others who are better at than I am).

            But mostly, I follow the advice of Pablo’s First Law of Internet Discussion: Regardless of the topic, assume someone participating knows more about it than you do.

            It keeps me humble and keeps me learning.

          • SweetBabyJesus

            Read: I have zero training in birth care and am posing as if I know something. That must be why your only tactic is personally attacking me and name calling. Thanks for clearing that up!

            Trolling me @MaineJen:disqus. It’s easy to blindly follow the ones you agree with right? Learning clearly doesn’t extend out of his comfort zone.

          • The Bofa on the Sofa

            Read: I have zero training in birth care and am posing as if I know something.

            I didn’t pose as if I knew anything. In fact, I asked you a lot of questions.

          • SweetBabyJesus

            You are aggressive and immediately it was clear that anything I was to tell you was to be ridiculed and discredited without actual consideration. This would be the definition of a sheep. But hey, maybe you’re just a part of the population that Dr. Amy describes as “unable to attain higher education”. Shucks.

          • The Bofa on the Sofa

            You are aggressive and immediately it was clear that anything I was to tell you was to be ridiculed and discredited without actual consideration.

            On the contrary, I gave what you said complete consideration. It’s just that it was dumb.

            Get over yourself. You aren’t the first blithering idiot to come in here and think you know it all, but then to get pissy when others school you fourteen times over.

        • Megan

          As a family practice intern, (Not an OB intern), I did around 200 deliveries my intern year alone (working in an unopposed FP residency where we covered all OB on call and during our OB rotations). Those were almost all normal vaginal deliveries.

          That pales in comparison to what most OB residents do. According to the ACGME, they are required to do a MINIMUM of 200 normal vaginal deliveries to graduate. That is above and beyond the minimum number of required operative or cesarean deliveries. This is only a minimum and every OB I know did more. When’s minimum number of deliveries for a COM to graduate?

          • SweetBabyJesus

            That is great. More than I threw out there and glad to hear it. CPMs have varying rules–I live in FL and we have a strict law that is different from the regular CPM guidelines. In my training we have to attend 80 births, but of course there are other “numbers” as well (prenatals, postpartum, etc.). I am not sure if I think that number is low or not. I am not opposed to it being higher. Either way, it’s more than ANYONE has suggested on this thread, including Dr. Amy. More than a “few dozen” to be sure.

          • PrimaryCareDoc

            80 WHOLE births! Well, call the papers. 80 births clearly makes one an expert in home births. When the rate of shoulder dystocia is 1 in 200, how much experience do you get with that?

            You know NOTHING from doing 80 births. Dunning-Kruger personified.

          • SweetBabyJesus

            I bet myself a bajillion dollars that would be someone response. I’m RICH!

            Ok so what is a good number? What type of training should a midwife receive in order to manage out of hospital birth? Or specifically homebirth as you mentioned.

            Also good to know: there is a detailed risk screening for mothers that extensively excludes anyone from high risk category based on their age and medical/obstetrical hx (very strict, in my state anyhow). So remember that you are talking about an extremely low risk population that has been weeded out for the get-go. Shoulder dystocias still happen for sure, and they are resolved in most cases without incidence. The Gaskin maneuver was adopted by a… MIDWIFE! dun dun dunnnn (ducking all of the hate being thrown at me for bringing up one of the “birth junkie gurus”–cause I know it’s coming!)

          • PrimaryCareDoc

            I’m not a fan of home birth really in an scenario, but if it’s going to take place, it should be with a CNM- someone with extensive nursing experience and who has worked in a HOSPITAL as a CNM- that’s where you learn to see and manage complications. As I’ve said before, no one needs a midwife for a normal uncomplicated vaginal birth. You need someone in case the shit hits the fan.

          • Megan

            And why would you have a homebirth when it’s totally possible to have a lovely natural birth in the hospital but with lifesaving care at your fingertips if needed?

            My family doc is willing, in low risk deliveries, to do intermittent monitoring, heplock without continuous IVF, eat /drink if you feel like it and use any position the birthing woman desires during second stage as long as the woman is low risk. (And incidentally, she is willing to sit with the woman through the majority of her labor if at all possible. She spent an entire weekend in the hospital, away from her family, with me and even assisted with the peds care in the OR when I ended up needing a CS.) And I know her bedside manner isn’t uncommon; many of the OB’s here are that way too.

            I think this mythical OB who doesn’t care about women and just wants to cut them open to get to their tee time is at best the vast minority, and likely a caricature exaggerated by the NCB industry.

          • SweetBabyJesus

            Just like all midwives are uneducated birth junkies. Stereotypes really suck, huh? Your OB is a gem and an asset to birth practice. If they were all like that then maybe so many wouldn’t want a different option without their direct involvement, yeah?

          • Megan

            Most women don’t want homebirths.

          • SweetBabyJesus

            MOST, Megan, most. But some do. Actually, 2% of those giving birth do, which is about 6,451,660 women. And that number is going up. But yeah, who’s counting?

          • Megan

            And if those women want to have a homebirth they can do so, but it shouldn’t be based on false info, for instance, all the things you’ve been corrected about here today alone. They should know that there’s a higher risk of their babies dying or having HIE if they choose homebirth. If those facts were presented and true informed consent given, I’m betting homebirths wouldn’t be as popular (and shame on those who would knowingly out their birth experience over their baby’s safety). Unfortunately most wen who choose homebirth are basing on lies told by CPM’s who don’t even know what they don’t know.

            As an aside, I’m sure you wouldn’t care at all about women who want elective CS. But they’re out there too.

          • Monkey Professor for a Head

            Uh, 6,451,660 is about 2% of the entire US population. Including children. Including women past reproductive age. Including men! Either your knowledge of basic math and statistics is incredibly poor or you’re trying to deliberate mislead us.

            According to the csv website, there were 3932181 births in 2013. 2% of that would be about 78,643 women wanting homebirth per year. Quite a difference!

          • Roadstergal

            “Either your knowledge of basic math and statistics is incredibly poor”

            Well, we got the answer to that one.

          • PrimaryCareDoc

            Again with the math fails.

          • Bombshellrisa

            This is why I think midwives should have to go through nursing school first. The math part is brutal and errors get you a failing grade.

          • yugaya

            Epic fail, not just math: “2% of those giving birth do, which is about 6,451,660 women”.

            I doubt she gets why though.

          • Roadstergal

            This caricature makes zero sense to me. Every OB I ever had (and all but one were women – not that I sought women, they’re just the majority) were OBs because they really, really enjoyed helping women. If you just want to make good money on a good schedule, why in hell would you spend so much time in school, live through the sleep deprivation that is residency, be on call at all hours of the day and night? There are lots of easier and more certain ways to make money, and ways with much more regular schedules!

          • MaineJen

            1. Many many many midwives do not adhere to strict risking out criteria.
            2. Gaskin maneuver is not the most effective way to resolve a SD.

          • SweetBabyJesus

            What shitty care providers do is out of my hands and I wish that they would stop practicing because they really contribute to the stereotype that everyone here is adopting.

            Didn’t say the most effective maneuver, but it’s one of them and it works. And Ina May has the respect of the medical community because she is a good practitioner. Imagine if we produced more of those–with the help of OBs. Just imagine…

          • AirPlant

            Ina May has the respect of the medical community? That one is new. Isn’t she the lady who thinks that rubbing a laboring woman’s “button” without preamble is totes cool?

          • SweetBabyJesus

            Idk about that business, but yes she has the respect of some of the medical community, maybe not all.

          • The Bofa on the Sofa

            Do those who “respect” her know about how she sexually fondles patients?

          • Roadstergal

            Not the respect of any member of the medical community that knows what a sphincter is.

            Or thinks that playing with a woman’s tits during labor (her term) is inappropriate behavior.

          • SweetBabyJesus

            Seems like everyone here has taken a couple of tidbits that worked for Ina May and made them the entire reason that she is incredulous. Well-played and unsurprising.

          • The Bofa on the Sofa

            Sexual assault are “little tidbits”?

            Imagine if a (male) OB acknowledged to having stimulated a woman’s clitoris during labor. Would you dismiss that as “a tidbit that worked”?

          • Roadstergal

            Imagine if a male OB wrote _in a book_ that he found fiddling with the clitoris and handling a woman’s breasts during labor to be a good thing, and recommended it to other OBs in practice.

          • Bombshellrisa

            You don’t think that there are women here who have read Ina May Gaskin’s books and didn’t at one time respect her? There are many people here who have birthed at home and others who have been home birth midwives.

          • Siri

            Do you know what incredulous means, Ms english-on-lock? Hint: it doesn’t mean “not credible”.

          • Karen in SC

            From ACOG on shoulder dystocia. Takes a team. Note when the Gaskin maneuver is recommended. It’s not first.

            http://www.acog.org/-/media/Districts/District-II/PDFs/Optimizing-Protocols-In-OB-HTN-Series-3.pdf

          • Daleth

            You bet, and you were right! And the reason you were right is because hardly any labor complications (if any) have an incidence of 1/80 or greater. Which means that there is a near-zero chance that by assisting at 80 births, you would have even witnessed, much less been responsible for dealing with, any complications.

            My personal vote would be that you have to attend 1000 births before you can be the midwife in charge at a home or birthing-center birth. With 1000 births you have a pretty decent chance of encountering some serious complications.

          • Sarah

            Didn’t she steal it from some poor brown women and put her name on it?

          • Bombshellrisa

            Midwives from her time in Guatemala.

          • Sarah

            Another racist one, then. NCB seems to attract them.

          • Megan

            Even with all of the deliveries I have done, I still would not think I was experienced enough to do OB and handle its complications, let alone think that it was safe to do homebirths.

            How on Earth with an 80 birth minimum, (and I’m sure other states are lower) would you know how to recognize complications that occur once in hundred to thousands of births?

            Oh and by the way, the “dozens” quoted below came straight out of the mouth of a CPM student, not from us.

          • SweetBabyJesus

            Does every OB see every complication during training before they start managing birth? It’s not like #81 is guaranteed to be a cord prolapse. You train hard and you learn how to manage it and you practice in clinic and you continue education. Just like every single medical provider out there. Your standards are out of reach even for OBs and it makes for faulty logic.

            “a CPM student”?? Which one? Seems like an easy thing to quote someone on to make them look bad. And anyway there are idiots out there like the Duggar people–we cannot stop this.

          • PolyAmethyst

            It was me.

            80 is a quite a few dozen but even if it was double, it won’t ever be enough for some of these people.

          • SweetBabyJesus

            Don’t be surprised if ever single thing that you say here will be picked apart and you attacked. Nothing is good enough for this crew unless every birth is in a hospital. It’s sad that there is so little value to choice.

          • Roadstergal

            “Nothing is good enough for this crew unless every birth is in a hospital”

            Wrong. Nothing is good enough for us unless every woman is making an _informed choice_, whatever that turns out to be.

            Sure, we don’t like seeing dead babies. I think that’s a good thing. But if a woman makes an informed choice that increases her chance of having a dead baby, that’s her right.

          • SweetBabyJesus

            Begrudgingly and with judgment that is her right and she may or may not be refused from care or labeled a bad mother. Sounds really open and accepting to me.

          • Roadstergal

            “she may or may not be refused from care or labeled a bad mother”

            Again, you are just plain making stuff up. Many OBs, midwives, and L&D nurses who post here are full of stories of caring for HB transfers, working desperately to save women and babies who are in trouble. Care is not denied.

            What we do condemn are HB advocates who don’t advise these women about the real risks they face with their choice.

          • Amazed

            Yeah, it’s so much better for the OB to keep the mother in her (most OBs are women today, you know? Then perhaps, given the utter wrongness of everything you know, perhaps not) care and face the consequences and the lawsuit when the midwife screws up. I can feel your pain.

          • Amy Tuteur, MD

            Actually, we see all but the rarest complications (and even some of those) because we train in teaching hospitals. So not only did I myself perform hundreds of deliveries and care for thousands of women, but I went to Morbidity and Mortality rounds every week where all complicated cases were discussed. Since more than 6,000 babies were born at the hospital every year and since I was there for 4 years, I heard about complications from over 24,000 deliveries and how best to manage each and every one of those complications..

          • SweetBabyJesus

            We don’t see as many complications because we don’t manage complicated pregnancies. I would love for midwives to have a chance to participate in more hospital clinicals, but the establishment mostly does not allow for that. Another disparity in training that could be addressed with OB supporters.

          • Karen in SC

            Haha, when midwives investigate their own, it is a love fest where the midwife gets all the support. Nothing concrete is ever done.

          • Amazed

            Deleting posts already. SBJ? When are we to see you turn tail and run?

            “What are you talking about?” you wrote.

            You don’t even know? Sisters in Chains, anyone? Jan Tritten and her
            bunch of CPM murderers who collectively killed Gavin Michael and then
            turned on his mom and rushed to delete evidence? Rowan Bailey and the
            Sorensen women? You don’t know any of this? Faith Beltz and the
            ridiculous 500 bucks your cherished midwives seeking responsibility
            fined her for killing Liz’s baby?

            My not so sweet summer child,
            you know nothing. You’re a walking danger for any expecting mother you
            lure into your uneducated traps.

          • SweetBabyJesus

            I’m a fall child thank you, but really don’t give me a pet name because it’s weird. I don’t know what post I deleted here… I think I’ve been pretty up front and responsive actually. I have so much education and so much more on the way. You will never believe that because it’s not precious medical school. That’s ok, the establishment thanks you. I will practice, I will treat women with respect and do my damnest to keep women and their babies healthy. I bet you’d love to see a stumble so badly that you’d be willing to see a baby or two not make it, such is your sinister tone. Not on my watch sister. There will always be crackpot practitioners in any field–medical community is not immune from this fact. Those you have mentioned give a bad name to the group. Like catholic priests who molest little boys. Shall we overthrow the catholic church? Or reframe the paradigm?

          • Karen in SC

            If you are so sure of yourself, what is your real name and state of practice?

          • Megan

            The fact that you’ve been corrected on multiple accounts today and you are still so sure of your knowledge and abilities is downright terrifying.

          • Amazed

            My God, how can you walk around with this huge head of yours? You think you’re so important to an internet stranger that she’d wish someone’s death just so that your very great person can fall? The self-conceit of some…

            Not on your watch, huh? I hope so. And I don’t believe it. With this thick head of yours, you’ll stand between “your” patient and the life-saving c-section just because you think a forceps birth is better.

            No one starts practicing with the idea that someone would die on their watch. Even Christy Collins.

          • Bombshellrisa

            Probably even Lisa Barrett, but since she is all about “holding the space” I doubt she even let death cross her mind in the first place.

          • PrimaryCareDoc

            You have so much education? You mean your bachelor’s?

          • Karen in SC

            there’s even more! The midwives who are responsible for the loss of a second twin in Missouri got a restraining order against the father so he couldn’t attend the hearing. They ended up with no consequences. Even the CPMs that were responsible for the baby whose birthing center birth was classified as a homicide in a York County SC inquest have NO consequence. They are still delivering babies. And as they so clearly testified, measuring fundal height and using a doppler is pretty much the extent of their care model.

          • Megan

            Then become a CNM. They are welcomed in hospitals.

          • SweetBabyJesus

            And mostly cannot attend homebirth because of hospital protocol barring them in fear of litigation or who knows what else. So there goes our CNM option for homebirth and what a shame. The medical establishment largely does not want that option to be there or they would allow it. Period.

          • The Bofa on the Sofa

            And mostly cannot attend homebirth because of hospital protocol barring them in fear of litigation or who knows what else.

            Why should there be a fear of litigation? Oh right, because it’s risky. And when you do risky activities, and things go wrong, you get held responsible.

            Unless you are a CPM and have no professional standards, of course.

          • SweetBabyJesus

            We’ve already established you are just a bandwagoner with no real experience here. Please.Stop.Talking.

          • Amazed

            Sweetheart, you cannot establish a black dog if it bites you on the nose. And you cannot refute Bofa, so you resort to howling. Typical for a CPM wannabe.

            Want to know what YOUR experience will include? At least one dead baby, more likely. All because you wanna catch baybeees but you cannot be bothered to go down the safe route.

          • The Bofa on the Sofa

            Show me a single thing I have said that is incorrect.

            I wasn’t the one who tried to use infant mortality to show how bad the US is. I wasn’t the one who claimed that suicide was the most important cause of maternal mortality. My claims haven’t been corrected multiple times (in this thread).

          • moto_librarian

            So you think that since Bofa is a father that he has no right to be involved in this conversation? Wow, you are something else.

          • The Bofa on the Sofa

            No she thinks that because I keep exposing things that she gets wrong that she better find a way to ignore me

          • Bombshellrisa

            Just read the midwife written “From Calling to Courtroom” ebook. Then you can manipulate everyone into paying for your lawyer when you are threatened with lawsuit

          • Bombshellrisa

            Staffing and how well a hospital is equipped to handle an emergency is what will dictate that more than some nebulous “medical establishment” conspiracy. I have seen CNM run birth units within hospitals work well, and these midwives offered home births at one time too. They realized that they had to be able to offer seamless transfer to be real care givers and established a program that has strict guidelines and collaboration with specialists.
            Midwives who truly care about women work to improve outcomes, not to make home birth an option. The best CNMs are ones like the midwives who work with PRONTO International, who work with doctors and midwives in low resource settings to be able to manage obstetrical emergencies.

          • Megan

            “Does every OB see every complication during training before they start managing birth?”

            No, but the more deliveries you see/manage, the more likely you will see them. Would you rather see your first cord prolapse during training when you have help or at one of your homebirths? The more training the better. If you want enough training to manage everything, become an OB, or at the very least a CNM.

            Second, PolyAmethyst below was the one who said she will see “literally dozens of births” by the time she’s done. It’s pathetic what CPM programs think is adequate training.

          • Bombshellrisa

            Florida does have better stats with their out of hospital midwives but it’s not because of training, it’s because malpractice insurance is required.

          • SweetBabyJesus

            Whatever you say.

          • Bombshellrisa

            https://drive.google.com/file/d/0B8Uh2QgdpW19SDd6NkxFUDFmX3c/view?pli=1
            Here is the analysis done. Lower neonatal mortality rate (although still higher than CNM attended hospital birth)

        • areawomanpdx

          Um, all OB residents are required to have 250 vaginal deliveries, but where I went to school, the residents got more like 450-500 vaginal deliveries. You’re delusional if you think most of those are forceps and vacuum deliveries. The vast majority of hospital vaginal deliveries are not surgical. You clearly don’t have a clue what goes on in hospitals.

          • PrimaryCareDoc

            Yup. Actually, residents have a hard time getting enough experience to be credentialed to use forceps. So much for those impatient doctors lining up to yank the babies out.

          • SweetBabyJesus

            I think it’s sadly a dying art in fact, because I am in favor of it over opting for automatic cesarean. Betcha didn’t think that’d be my stance! Ha!

          • MaineJen

            Oh my god.

          • PrimaryCareDoc

            Actually, I’m not surprised at all that it’s your stance. Because you don’t know enough to know that the risk of a forceps delivery is greater than the risk of a C-section.

            And you value passage of a baby through a vagina more than anything else.

          • SweetBabyJesus

            No I don’t. But thanks for that assumption. I will educate myself more on the risks of c-section vs. forceps delivery. Maybe I am missing something but I was under the impression that it can be a very safe alternative to cesarean if the conditions are right. And anytime y’all want to give me some sources instead of sending me off to search, please do. It’s like, 50-1 here and y’all seem to have all the answers anyway so please do share!

          • Roadstergal

            “Maybe I am missing something ”

            Sweet Baby Jeeebus, you are missing so many things, but are under the impression that you know everything. You have very strong opinions that are not based on data. Your baseless confidence could influence people who aren’t well-informed into courses of action with higher risks of both immediate and long-term damage. You are not seeing hate, you are seeing horror.

          • Karen in SC

            Learn the risks of forceps first, there are many to review.

          • Houston Mom

            http://onlinelibrary.wiley.com/doi/10.1002/uog.14891/abstract
            This is from 2015. Authors’ conclusion was,”We found that mode of delivery was associated with POP [pelvic organ prolapse] and pelvic floor muscle trauma in women from a general population, 16–24 years after their first delivery. Forceps was associated with significantly more POP, levator avulsion and larger hiatal areas than were vacuum and normal vaginal deliveries. There were no statistically significant differences between vacuum and normal vaginal deliveries. Cesarean delivery was associated with significantly less POP and pelvic floor muscle trauma than were normal or operative vaginal delivery.”

          • Roadstergal

            “Cesarean delivery was associated with significantly less POP and pelvic floor muscle trauma than were normal or operative vaginal delivery.”

            But… but… unneccesareans!! Who needs to hold in their poop when they’re 40+, anyway?

          • Bombshellrisa

            Or in their 20’s and 30’s.
            ((OT, I just realized what the background is in your display pic!))

          • Roadstergal

            It was an atypically beautiful day! A friend of mine was doing a photo shoot of me and my bike as a farewell present, and I pulled out one of my toys and started goofing around – hence that pic.

          • Bombshellrisa

            I am really slow, I was sitting at dinner at Salty’s when it hit and I was like “OMG, THAT is why her pic looks familiar!”.

          • SweetBabyJesus

            Good to know. Thank you.

          • Roadstergal

            But when you did not know this earlier, you expressed an unhesitant, strong preference for forceps for women facing this choice.

            Will you change your stance based on data? Will you consider that perhaps there are many, many other things you feel strongly about – and evangelize to other women about – that are not based on data?

          • SweetBabyJesus

            I will ever consider that as a possibility and adjust my practice, for as long as I do this work. So yes, is the short answer. Will I change my viewpoint just because you shared this one article? Not necessarily. I will need to conduct more research. It’s all just for my own knowledge, again I will never be performing these types of deliveries.

          • SweetBabyJesus

            Also, this does not speak to the affect on the baby, just the mother. Just saying. I know there are risks with that too but I mean the long-term risks associated with cesarean as well as short-term/perinatal mortality.

          • An Actual Attorney

            Here’s the thing, SBJ. Imagine you came to my office seeking representation because you had been charged with a crime. You were offered a deal. I say: don’t take the deal. You’ll have serve 6 months in jail and that’s a long time. You say: but how much could I get if I go to trial? I say: No idea, never really looked it up

            If that happened, you better report me to the Bar. Until you know the risks of every option, you’ve got no business advising on any of them.

          • The Bofa on the Sofa

            Hey, that’s not fair. She wrote a paper on the risks of c-sections. That she knows nothing about the risks of vaginal delivery shouldn’t matter.

          • Bombshellrisa

            Forceps deliveries are more dangerous for the baby too. I don’t just mean the bruises and scars part either.

          • PrimaryCareDoc

            Hasn’t she seen the decapitated baby story? I thought NCB people love to trot that one out.

          • Karen in SC

            There are no proven long term risks of a c-section to the baby.

          • Taysha

            “Also, this does not speak to the affect on the baby, just the mother. Just saying.”

            Irony: ‘labor is about the mother, too, not just a healthy baby!’ from HB advocates followed by the above statement, which accounts to ‘screw the mother’.

            *golfclap*

          • Siri

            “Affect (sic) on the baby”? I thought you had english on lock?

          • PrimaryCareDoc
          • Roadstergal

            What are the risks of a forceps delivery vs a C/S? As you are in favor of one course of action over the other, you would be able to articulate the relative risks to a woman to support her informed choice?

          • MaineJen

            *picking self up off the floor* Why do you think it’s a dying art? It has fallen out of favor among OBs…perhaps there are some unfavorable outcomes as compared to C sections? You know…evidence-based care being put into practice?

          • moto_librarian

            Some of us like having our pelvic floor function preserved. Most of us also privilege the safety of delivery over the method.

          • SweetBabyJesus

            I do NOT think midwives should be able to perform forceps delivery. That is definitely out of our scope.

          • areawomanpdx

            Ya, I’ve seen 3 forceps deliveries in an educational setting. In one case, an attending was teaching another attending how to use them and in the other two, it was the 4th year residents doing the delivery. In all cases, there were about 40 people in the room to observe the delivery. Very rare, like a unicorn.

        • Selyxi

          I’ve logged about 50 spontaneous vaginal deliveries in 4 months of residency. Only about a total of 6 weeks of which have been spent on the labor floor. My co-interns that are nearing the end of their first 8-week block of L&D are over 100.

          The ACGME requires a minimum of 200 SVDs to finish residency. For comparison, the minimum for operative deliveries is 15.

        • PrimaryCareDoc

          There are 4 million births a year in the usa. Let’s say 2% are at home. That leaves 3,200,000 births in the hospital. 30% are sections (actually a bit less, but let’s say 30%). That leaves 2,240,000 vaginal deliveries. Only 3.3% of those are operative vaginal deliveries. That leaves 2,166,80 spontaneous vaginal deliveries a year in the hospital. Who, exactly, do you think is attending these deliveries? I’ll tell you who- the OBs that you claim only see 75 spontaneous vaginal deliveries in their careers. There are about 34,000 practicing OBs in the US. So they’re seeing roughly 63 spontaneous vaginal deliveries a YEAR.

          • The Bofa on the Sofa

            2% of 4 million leaves 3, 920, 000, not 3.2 mil

            You took off 20%

            70% is about 2.7 mil, and subtract 3% it’s down to 2.6 mil. Closer to 70 a year on average

          • PrimaryCareDoc

            Thanks! That’s what I get for doing it in my head. So the numbers for deliveries are even higher than I got.

    • SweetBabyJesus

      Posting Dr. Amy’s response, and then my response back to her. I am glad to promote transparency and bring my learning to the highest level in lieu of that goal. No one-sided babble.
      —————————-
      ou are confused, Abby. I do use real statistics and current information.

      There’s a reason why the only people who think homebirth is safe
      are the people who profit from it. They have created an alternative
      world of internal legitimacy with books, journals, conferences and fake
      credentials based on fabricated “evidence” or deliberate
      misinterpretations of the actual evidence, in other words, an echo
      chamber that advocates never leave. You live in that alternative world.

      Here’s a simple example:

      You appear to have no clue that infant mortality is a measure of
      PEDIATRIC care (it is death from birth to one year of age). According to
      the World Health Organization, the best measure of obstetric care is
      PERINATAL mortality (late stillbirths, intrapartum deaths, and deaths
      until 30 days of age) and according to the WHO, the US has one of the
      lowest perinatal mortality rates in the world.

      No doubt you consider yourself “educated” but until this moment you
      were completely unaware that you and your midwifery buddies have being
      using the wrong statistic. Why? Because you don’t have knowledge; you
      have “pseudo-knowledge” fabricated and propagated by the natural
      childbirth and midwifery industries. The infant mortality statistic
      circulates in the midwifery world and no one among you has any idea that
      you are using the wrong statistic. That’s Childbirth 101 and you have
      already flunked it.

      CPMs are lay birth junkies who
      couldn’t be bothered to get (or couldn’t hack) a real midwifery degree.
      They aren’t eligible for licensure in ANY first world country because
      they lack the basic education and training required for midwives in the
      UK, the Netherlands, Australia, Canada, etc Their national organizations
      have NO safety standards of any kind. Have you heard of any other
      professional organizations that have NO safety standards? I haven’t.

      Get out of the echo chamber and read the actual scientific
      evidence, complied by doctors and scientists and stop listening to the
      birth junkies who have created a fantasy world inhabited only by
      themselves.

      .

      Sincerely,

      Amy
      ——————————–
      My response back:

      Dr. Amy,

      Thank you for your
      response. Also, thank you for that correction. I actually do understand
      the perinatal mortality rates and their relevant application to birth
      outcomes. I’ll hand it to you though, you make a good point that those
      should certainly be considered in place of infant mortality rates. Of
      course, OBs do care for the woman postpartum for 6-8 weeks ideally,
      which exceeds that category. The number one cause of maternal mortality
      is suicide resultant from perinatal mental health disorders–something
      that at least partly falls into your realm as a birth care provider, not
      just managing the births themselves. I didn’t feel the need to bother
      mentioning that originally but it seems that the scope of care was being
      limited to birth itself, something that leaves out a big piece of the
      pie in the arc of childbirth care & management. The maternal
      mortality rate statistics still holds in this argument and the OB
      community is accountable for that dismal rate. And blaming that problem
      on a Pediatrician seems like a huge cop-out and another glaring example
      of the OB community’s reluctance to collaborate with other care
      providers in producing the best outcomes. Using perinatal mortality
      rates as the only metric and discounting infant and maternal
      mortality rates does exactly what you accuse me of:
      living in an echo chamber where your responsibilities are to produce a
      live infant only, no matter the mental and emotional state of the mother
      who
      is responsible for raising said child, or the sum of the risks to mother
      and baby involved in the large percentage of unnecessary medical
      interventions implemented in fear.

      It’s interesting how
      you, once again, place me in a single-lump category with other “birth
      junkies” without knowing absolutely anything about my educational
      background and training. It’s like the only way that I could possibly
      believe this stuff is because of my lack of education and my hunger to
      jump on the counter-culture bandwagon. That’s just not the case with me.
      I DO have a four-year degree and a decent understanding of research
      writing and evidence. I teach pelvic and breast exam and health to
      medical students part-time around the state. I live in no alternative
      world, I live in the real world with all of the other consumers at the
      mercy of our medical establishment. I am also a real mother of
      childbearing age and educated, responsible consumer in the birth market,
      so to speak. That likely means nothing to you, but it does to me.

      Did
      you know that there are only a handful of CNM programs even available
      in this country? One has closed recently in my hometown and leaves very
      few options left in our region of the country. Are CNMs also producing
      all of the bad outcomes that you speak of? Why are these programs
      disappearing? I have heard many accounts of CNMs being marginalized and
      bullied by OB/GYNs in the practice setting and it’s being played out on
      the macro scale. A real pity for the women who at least hope to get the
      benefits of midwifery care while also playing it safe with a hospital
      birth.

      My goal is not at all to make hospital birth
      outlawed and/or demonized. That’s just plain ridiculous and I’m sure is
      the corner that you would love to paint me and my other rag-tag “birth
      junkies” into. I am advocating for evidence-based birth choice that
      allows the mother the full spectrum of safe birth care with well-trained
      and qualified birth practitioners. That model includes both homebirth
      and hospital birth, as well as midwives, OBs, nurses, etc. all in one.
      It is a model that is happening in several countries in Europe with
      great success and better overall rates in infant, maternal and perinatal
      outcomes than our country. I have noticed that you have yet to address
      anything regarding informed consent and supporting patient choice. It
      seems by your example that patient choice is to an obstetrician as
      preventative nutrition is to medical school training. That is to say, a
      big joke. Thankfully, I refuse to lump all OBs, L&D Nurses and CNMs
      into a single category with you. I know there are those out there who
      are working and thinking differently than that, I work alongside a few
      of them.

      Birth practice is not a strict dichotomy, nor are
      the lives of human beings. There is so much variation and implementing
      “cookbook solutions” onto every case leaves no space for the safe,
      healthy and normal run of nature’s course. Risk cannot be mitigated 100%
      and pursuing that unrealistic goal leaves so much collateral damage all
      around. I know this because as much as any OB touts to receive a
      midwife’s “trainwreck transfers” (which no doubt they DO see in their
      practice), many midwives receive the OB’s emotional, physical and mental
      trainwrecks down the road as they decide to birth differently, often
      after being coerced and abused by a cold and unwavering medical
      establishment. They are livid to have been robbed of what might have
      otherwise been a natural, normal, safe and life-changing birthing
      experience for them and their family.

      I’ll be awaiting your
      undoubtedly scathing and derogatory response with the highest of
      anticipation. Although, honestly, if this conversation is just going to
      consist of your tearing down me down rather than actually having a real
      conversation about the leaves-something-to-be-desired state of birth
      care in the US and what we can do to change it together, I’ll get rather
      bored.

      Thank you, again, for your response. In spite
      of the sarcasm, I think that these are the exact hard conversations
      that we need to start having if we are going to get anywhere. I do
      appreciate you taking time to talk with me and I nod to your
      accomplishments as an OB/GYN.
      ————————–
      I have not heard back anything as of yet.

      • Amy Tuteur, MD

        I just sent you a response:

        “That’s just not the case with me. I DO have a four-year degree and a decent understanding of research writing and evidence. I teach pelvic and breast exam and health to medical students part-time around the state.”

        And you want to be respected for that, yet you don’t offer appropriate respect for the far greater level of education and training that I have. Let’s be honest: you wrote to correct me as if you somehow know more than I know (or any obstetrician knows) about childbirth. What gave you the idea that you are the one who has knowledge to impart to me? How could you imagine that your 4 year degree and reading of the natural childbirth literature trumps my college degree/medical school degree/4 years of internship and residency/attending thousands of births/managing hundreds of serious complications? You want respect, but you don’t give respect.

        “And blaming that problem on a Pediatrician seems like a huge cop-out and another glaring example of the OB community’s reluctance to collaborate with other care providers in producing the best outcomes.”

        You didn’t understanding my point. I’m not blaming the problem on pediatricians. I was giving you an example of what passes for “knowledge” in the homebirth community. You can bet that professional natural childbirth advocates like Henci Goer and Melissa Cheyney are well aware that the US has excellent perinatal mortality rates. But that won’t enhance their arguments so they DELIBERATELY use the wrong statistic because they figure people like you won’t know the difference and they’re right. But if they can’t be honest on such an incredibly basic point, how can you trust anything they say.

        “Did you know that there are only a handful of CNM programs even available in this country? One has closed recently in my hometown and leaves very few options left in our region of the country.”

        So what? Providing safe healthcare for women isn’t about what is convenient for you; it’s about the education and training needed to be a safe provider. Just because it isn’t as easy for you to obtain the necessary training is not a reason to dumb down the training to make it convenient for you.

        “I am advocating for evidence-based birth choice that allows the mother the full spectrum of safe birth care”

        You have literally no idea what the scientific evidence shows. That’s my main point. Most of what you think you “know” is a bunch of lies fabricated by the homebirth industry that supports itself on lies.

        The reason why it is difficult for obstetricians to take people like you seriously is because its like having a discussion on the meaning of life with 3 year olds. You lack the knowledge base and experience to know what you are talking about, and what’s worse is that you know so little that you have no idea that you are ignorant.

        Think about it. You wrote to me to “educate” me. What does that say about the lack of respect your showed me? I immediately corrected you on an item of very basic childbirth knowledge. What does that say about your understanding of the most basic facts? You failed to draw the most obvious conclusion — that perhaps your knowledge is deficient to mine. What does that say about your reasoning abilities?

        Homebirth is a business and virtually the only people who claim it is safe are those who make money from it. No one else does. Perhaps you should consider why that is the case instead of assuming that homebirth midwives have anything to teach obstetricians about the scientific evidence.

        • areawomanpdx

          Let’s not forget, most CPMs do not attend MEAC accredited schools, they get their certification through the PEP process, which requires zero didactic training and all of their births can be done under a single preceptor.

          • SweetBabyJesus

            That process will be phased out by 2020 if not sooner. Good riddance I say.

          • Bombshellrisa

            That does very little for the midwives who practice now and the ones who are being certified through the pep process. Even Bastyr/Seattle Midwifery School does a vast majority of their teaching through distance learning, plus the credits you earn will not transfer if you want to apply to a university.

          • SweetBabyJesus

            We are doing the very best that we can. Just to allow midwives to practice at all was largely hampered by the medical community, rather than embracing the collaborative form of care that several European countries enjoy (with better outcomes for all) from the get-go.

          • The Bofa on the Sofa

            Just to allow midwives to practice at all was largely hampered by the medical community,

            Well, when it comes to CPMs, it is with good reason. They have no business being anywhere near a patient.

          • Bombshellrisa

            Again, midwives who don’t attend schooling that qualifies them to be medical professionals are not going to be treated as such. Europe and the UK treat midwifery as a profession that requires a uniform type of schooling and have strict care practices. Lately, it’s been shown that midwives are used as a cost cutting measure in providing maternity care and that outcomes are not as good as most would believe. The pay out for injuries and wrongful death claims in the UK is MUCH more than the US and the midwives in the Netherlands who care ONLY for low risk women have worse outcomes than OBs who care for high risk women only.

          • LibrarianSarah

            You forgot to mention that CPM’s wouldn’t be able to practice in any of those European countries with the collaborative form of care you think so highly of.

          • Karen in SC

            Clearly YOU are not doing the best you can since you are not a certified nurse midwife, which is the only midwife credential equal to the midwives in other developed countries.

          • Amazed

            Care to site those European countries? Because they are, you know, a myth.

          • An Actual Attorney

            CNMs are embraced,

          • Karen in SC

            Tomorrow is not soon enough. CPMs that don’t know what they don’t know are responsible for these lost babies.

          • Squillo

            I can’t find anything from NARM on that. (Maybe I’m not looking in the right places?) Can you provide a source, please?

        • SweetBabyJesus

          Dr. Amy, you assume that I do not respect your well-spring of obstetrical knowledge, or that I know more than you? Good grief, I could never imagine claiming that and would be embarrassed for others to think that is how I feel. Let’s set the record straight here: You have more training than I, you have more experience than I and you have straight up seen more years on planet earth than I, therefore setting you in a much different category. I’ll admit it, I’m being fairly sarcastic and that is mostly just a result of the blazing anger that I burn up with when I hear and read the type of extreme nonsense that you have posted. You may know a whole lot about birth management, but I know more about midwifery education in the US and how that plays out. Where is my respect?
          I think you feel attacked because I am calling you out on some things that I am questioning–that others in the “lay” community and the some of the mainstream medical community alike are questioning. I am using the same sources that you are, admittedly padded with what you consider to be nonsense sources, and it is worrisome to you because I am not coming to the very same conclusions.
          Obstetrics is a business too and you make at least SIX TIMES as much as a midwife does. If money is anyone’s motivator, it is the medical community’s. I am not in the business of midwifery to get rich–hell I could wash cars and make more a year than I will as a midwife. I am in the business of offering women health choices–CHOICES–that is based on a foundation of evidence in safe birth within the low-risk category, lifelong learning and honed skill. To be compared to a Duggar because she stuck a CPM behind her name in some backwards way is an insult. You want to see the end of a profession that just will NOT end, and it will not end because there is economical demand for such services. There are economical demand for such services because some women are wanting more–another option that respects them and their choices. Outlawing midwifery will and does lead to unsafe, underground, half-assed birth management with detrimental costs to all involved. Training and regulating midwives who are only involved in normal, low-risk birth care can produce great outcomes, ESPECIALLY when obstetrical collaboration exists. No one on this entire thread wants to hear that–they want to hear that midwives are ONLY irresponsible people out to make money. They want to believe that midwives only consist of hippies and other religious zealots with no background in education and no understanding of the literature out there. YOU, Dr. Amy, are the one who started this conversation with your inflammatory blog post and YOU are the one who lacks respect for us. I am the one who will question you and say that I want more than a one-sided and biased commentary on homebirth practice in the US. I have more than an “idea” of what the evidence shows and I am eagerly awaiting for there to be more research as time goes. Diane Rehm and other big-timers in the journalism world are beginning to explore these topics as they see the same statistical disparities that I speak of. Feel free to continue to berate me and hair-split, it’s clear that you do not have all of the answers and it’s also clear that I have struck a nerve. Nerves aren’t struck unless your ego or your cause is threatened.
          I chose to pursue midwifery school over medical school long ago and I have never looked back. It has nothing to do with whether or not I was/am capable of attending either program. Also, it’s offensive that you assume that people do not attend medical school because they are dumb–there are many other barriers to education than that starting with SES and racial prejudice. Or are those who did not come from privilege therefore not qualified for higher education? Not all who are “birth junkies” are doing this for self-glory, a good deal of us have a different vision of birth care in mind as we navigate the future. If you find my questioning you as a disrespect, Dr. Amy, then you are losing sight of the basis of all academic knowledge, which is to question everything and accept nothing. And that’s, like, Academia 101.

        • The Bofa on the Sofa

          So what? Providing safe healthcare for women isn’t about what is convenient for you; it’s about the education and training needed to be a safe provider. Just because it isn’t as easy for you to obtain the necessary training is not a reason to dumb down the training to make it convenient for you.

          I liked this part.

          • Amazed

            It’s as if she wrote to prove my sarcasm right. Just today, I said that I’d want to take a CPM distance learning course because actually being present interferes with my personal circumstances.

            Who cares about the damage she will wreak! Her comfort is the Really Important Thing.

          • Bombshellrisa

            OMG did you read the Bastyr webpage when you were thinking that? Because that is basically what they say, people have real lives and can’t take all this time to devote themselves to real schooling so only having to show up certain times of the year is more convenient. If that isn’t a beginning of the definition of “birth hobbyist”, I don’t know what is.

          • Amazed

            No, I was thinking of the CPM in training we had last year. She wrote in the MANA stats posts, I think, to defend good midwives and explained that she’d love to be a CNM but for her family, CPM was just a better fit. Her husband’s job and so on.

            50 years my grandmother didn’t want to leave her 9yo or her husband alone. But she really wanted to be a teacher. So they all moved to where she was receiving her education for the number of years she needed to complete the program. She made it work in a way that was not perfect – but it worked. But our not so sweet summer child here and the Bastyr women are another piece of cake, for sure.

        • SweetBabyJesus

          CNM schools aren’t being shut down because CNM practice is not safe. That is my point. It has nothing to do with my convenience Dr. Amy. There is nothing convenient about spending hours arguing with a community that will simply not hear a different opinion, but yet I must offer a voice that calls into question some of the things that you are saying. The world is listening and it is your responsibility to give them the whole truth.

        • SweetBabyJesus

          Dr. Amy, CNM training programs aren’t being shut down because they are unsafe or because it’s the place those who couldn’t get into medical school go. It WOULD be convenient for OB/GYNs who don’t want to share their practice (AKA income) with CNMs to see those schools shut down. The reasons are bureaucratic and have nothing to do CNM competency as care providers. I thought you were pro CNM and now even that is being thrown out. I hope the CNMs on this page don’t read that comment!! They’re just one step above a “lay midwife” in your reckoning!

    • Sarah

      THE WHO DO NOT HAVE A RECOMMENDED SECTION RATE.

      In capitals because it’s such a common and important mistake. Haven’t for years. Evidence not there to justify it.

  • demodocus

    Some conversations make me rather glad I’m considered high-risk by all but the most ardent of home birthers. Very little was natural about my child(ren)’s conception* since I didn’t want to cheat on my spouse to have any and I see no reason to take any more risks than strictly necessary. I don’t want a birth experience. I want 2 or 3 healthy, cognitively unimpaired, young people to share with the world in my family. We’re crazy, but mostly okay. 😉
    *Seems unlucky to count my offspring before they’re born. I’m not even due for my first ultrasound yet.

    • Daleth

      Best of luck! Yay!

      • Amazed

        I second that.

    • Megan

      Congratulations! So happy for you!

  • Barbara Delaney

    Thank you for writing this. TLC is trying to bring the Duggar sisters back to television where they can continue to play obstetrical roulette. They will keep it up until there’s a neonatal death. TLC will be thrilled with the ratings boost. The Duggar fans will cry crocodile tears but will be titillated by watching an infant die for their entertainment.

  • Platos_Redhaired_Stepchild

    Another Duggar is a lying cheat? NO!!! Who’d a thunk it?

  • Karen Whiddon

    My great grandmother went to school in Wales to be a REAL nurse midwife! My Gran watched the kids while she went to school.A pox upon these phonies! (Gran was just a kid, but the eldest)

  • bob

    She’ll blame it on god’s will when someone dies or becomes disabled due to a complicated birth. Can you say lawsuit just waiting to happen?

    • The Bofa on the Sofa

      The problem is, there is nothing to sue. This is the MO for homebirth midwives – make sure that they don’t have enough assets for anyone to sue over. They certainly don’t carry insurance. Lawyers won’t waste their time in a civil case

      • Karen Whiddon

        My niece had a REAL midwife for her 3rd baby, a home birth. She loved it.

      • SweetBabyJesus

        Some midwives are required by law to have insurance, and also have a governing body of laws that provide guidelines within which they can practice. Do your research.

  • DistractedBySparklyThings

    Thank you for exposing fraud.

  • Lisa

    I’m sad to say it will take a death here in America of a baby delivered by Jilly to get anyone’s attention. Then it will be lied away.

    • Jocelyn Glanfield

      Or will be explained as “God;s will…” :-/

  • It is so scary that someone with absolutely no medical education, (no college either), who has been home ‘schooled’ by an equally medically illiterate mother, who believes the Earth is 6000 years old and that ‘evolution is a sin’ can have a ‘title’ that tricks people into thinking she is fit enough to have women trust her with their lives and with the lives of their children. It’s quite arrogant of Jill to believe she is fit enough for people to trust her with their well-being just because she spent a few sleepless nights and took a few on-line tests. For shame. Seriously, see a doctor, not some hack that judges your life (and sex) choices while you’re putting your life into her incompetent hands. ”But, she took an online course!” – oh give me a break. You want to deliver babies and be responsible for the lives of the mother and child ? Well be my guest – and become and MD. If her ‘degree’ (whatever the hell it is) wasn’t acquired in college, then I beg of you, do not put your life at risk by placing it into her hands. Please remember, just a few years ago, the only education she ever got was from Michelle Duggar around the kitchen table. A midwife with no college degree = danger.

    • Jocelyn Glanfield

      Jill would not even be educated enough to enter nursing school & START training…!! It’s disgraceful she is allowed to claim she is a midwife. Her “degree” is worthless but a danger to all those duped by the similar sounding title to the true professional (not by mistake I’m sure)!!

    • Karen Whiddon

      Let us just say no actual schooling, whatsoever!

    • PolyAmethyst

      CPMs from MEAC accredited schools do require medical knowledge. Sad that a celebrity is pushing the stigma that midwives are uneducated. In FL CPMs and LMs can get hospital privileges. They are taught medical terms, a&p 1 and 2 and Repro a&p and gyn and micro just like doctors in their first few years. The biggest difference is that OBs are taught surgery to get the best results in an emergency while CPMs are taught to trust the body and intervene only when needed.

      • Who?

        It isn’t stigma, it’s fact-though I can see that someone might be stigmatised for claiming or implying they have a level of skill or education that they in fact do not.

        Sounds like I could learn all those medical terms in a morning.

        And it depends whether or not you want an emergency to arise-many can be avoided by care and testing beforehand, and what outcome you want when it does. Dead or damaged baby or mum? Call the CPM, who will in the end run to the doctor, without any notes or useful information, then castigate the medical system if an injury or death occurs; or go to the doctor who will do his or her best, along with their team, and take responsibility for the outcome.

        • PolyAmethyst

          That is blatant fear mongering though. I love CNMs and OBs for being able to take a scary situation and have the best possible outcome in a hospital. Statistically though it isn’t needed and there are CPMs out there who are trained to recognize when a situation is even close to becoming bad then transfer. Realistically though transfer rates are low and bad outcomes are pretty low. Mothers have choices and there are good CPMs out there who are medically trained for 4 years and are great at out of hospital births. This doesn’t undermine the importance or necessity for high risk women that require Nurse Midwives and Obstetric Surgeons. Yes, CNM are some of the most educated midwives in the world but in Europe direct entry midwives get better results with less interventions. I don’t claim to be able to get a healthy outcome out of a morbidly obese mom with gestational diabetes who is expecting breech twins but for a completely healthy mom who is low risk and baby is showing no signs of distress then perhaps someone with 12 years of education isn’t needed to give that woman the birth she desires and is capable of having.

          • PrimaryCareDoc

            Tell me why a healthy mom with low risk and no sign of distress in the baby needs a midwife at all??? To hold the space?

            Here’s the thing. If a birth goes perfectly, no one is really needed at all. That baby’s coming out, and it’s coming out without a problem.

            You only need someone when things head downhill. And when that happens, it happens fast and mom and baby can die very quickly.

            That’s why you need someone with 12 years of education- to save lives and/or brain cells when the shit hits the fan.

            No one needs these self-proclaimed “experts in normal birth.”

          • PolyAmethyst

            Yes, they can. Nobody is denying the fact that bad things can happen but statistically it isn’t likely. Most of the time there are actually signs that things are going wrong and can be transferred. There are bad midwives our there just like there are bad doctors and nurses but there are also those that do keep charts and will be bale to present to the doctor upon transfer and also transfer before it becomes a life and death situation because she is showing aforementioned signs. People die from childbirth in the hospital as well and America has one of the developed world’s worst maternal and fetal fatality rates.

            You don’t need an expert in normal birth.
            Most hospital birthing mothers don’t know there are other options until after. Even then the top choices to why is because pain management and fear of not being able to do it on their own.
            There are those who can and do. For them an expert in a normal birth is what they want and have access to.

          • Kerlyssa

            Whoops, you lost your statistics there.

            What’s the difference in rates of death and injury for mothers and babies between group A, ‘Consistent, skilled medical monitoring and treatment throughout pregnancy and delivery’, and B, ‘No consistent, skilled medical monitoring and treatment throughout pregnancy and delivery’.

            Bonus question: which group is lowering the US’ outcomes?

          • PolyAmethyst

            http://www.ajog.org/article/S0002-9378(14)00275-0/abstract

            False.

            Though this shows that difference between hospital births neonatal deaths and out of hospital births is literally a difference of one integer. 1-2 out of a thousand. That is the difference in risk in out of hospital birth and in.

            My personal belief is that these numbers are also skewed by taking into account out of hospital births managed by one who has the training of this Jill Duggar. Those people are truly Lay Midwives and the fact that they operate does scare me. There are also CPMs who do have essentially 2 years of premed and then 2 years of specialized education in midwifery. They are good midwives.

          • Kerlyssa

            What. This is a link to an abstract of a paper showing higher death rates in home vs hospital births. Bit of a non sequitur. The disparity between the US and other countries lies in preterm births(which we do not classify in the same way) and post birth deaths(due to unsafe living conditions and poverty). It’s not because hospitals are dangerous places, or our medical professionals are unskilled in comparison.

          • PolyAmethyst

            Not always, we still rank highest when only birth deaths are taken into account. Without risk of infection or malnutrition. Our over 30% csection rate is thought to be the main contributor. This is all in a hospital with the surgeons and blood bags you would need to save a crashing mom.

          • Kerlyssa

            Are you still talking about infant deaths, or maternal deaths now?

          • PrimaryCareDoc

            Who, exactly, thinks that the 30% section rate is the main contributor of perinatal morality? You? Other CPMs? You pulled that out of your ass. Admit it.

          • PolyAmethyst

            http://www.ncbi.nlm.nih.gov/pubmed/23635679

            The numbers are there. In comparison with the maternal death rates they are nearly identical. In fact the csection mortality rate is higher then that of an average, unmedicated, out of hospital birth.

          • Amy Tuteur, MD

            Those are theoretical estimates, not observed numbers.

          • PrimaryCareDoc

            That doesn’t say that the US’s higher maternal morbidity is due to the 30% c-section rate. It doesn’t say that at all. So…got anything else.

            And of course a c-section mortality rate is higher than an unmedicated out of hospital mortality rate (which should, actually, be zero.)

          • Amazed

            How much of the 30% c-section rate is a primary, purely elective c-section rate?

          • Amazed

            Instead of liking my question, why don’t you answer, Ms Dunning-Kruger?

          • PolyAmethyst

            I didn’t know that answer but it would be interesting to see how many were. Verus induced for being “past due” or dystocia. I get patronized for agreeing with you?

          • Who?

            Why does it matter. If you’re, as you profess, an advocate for women, why do you care how they want to give birth? Surely you support their choice whatever it is; or do you support choice only if it agrees with your values?

          • PolyAmethyst

            Because I am interested in it?

            Absolutely not. Regardless of my personal belief the birth is about what the mother wants and at some point we both can respect that. We might not understand or agree with the other side. So not only does the patronizing continue but I get ridiculed on my desire for knowledge when a recurring complaint earlier was that CPMs are ignorant.

          • Who?

            I think what you want is to be agreed with-that standards in place will provide a better service for women who choose to birth at home. That in itself isn’t an unreasonable position.

            Birth at home is riskier than birth in hospital, because at home the life and brain cell saving treatments available quickly in hospital just aren’t there.

            Can homebirth midwives buy professional indemnity insurance? The answer is no. Insurance companies recognise and avoid bad risks.

            Nothing can make a birth at home as safe, in terms of physical outcomes for mother and baby, as birth in hospital. Your casual cruelty-perhaps unintended-around the ‘slight’ increases in risk ignores the fact that real people die or are badly injured giving birth, and with the best will in the world that can’t always be stopped. That happens more often at home.

            By all means advocate for home birth, but learn what the risks are. Be involved in some births that go horribly wrong in a moment, and ask yourself how you would manage that at home.

            Could you live with knowing that absent your support, someone would have been in hospital with a team to care for them, rather than at home with you alone?

          • Amazed

            You get patronized because you clearly cannot make the distinction between c-section and primary, purely elective c-section. You cannot take a c-section rate that includes Keeper of the Books transverse baby who would have died without a c-section (sorry, KtotB, you know it’s true) and then prove c-section is a bad, bad thing by pointing out at a study about elective c-sections. Unless you’re a midwife or a future midwife, of course. That’s one of their standars tropes.

          • Amy Tuteur, MD

            No, no one but natural childbirth advocates thing C-sections are the cause. The leading cause of maternal death is heart disease.

          • Daleth

            Wow. Um, no. We rank in the top 5 or 10 best in the world for perinatal and early neonatal mortality (the measures that tell you how safe labor and delivery is for babies). Here’s an interesting report–note that in perinatal mortality we here in North America are almost twice as safe as Europe (p18):

            http://apps.who.int/iris/bitstream/10665/43444/1/9241563206_eng.pdf

            Also, the fact you would believe that a higher cesarean rate causes a higher perinatal or neonatal death rate is just mind boggling. Every study out there shows that c-sections result in LOWER rates of dead babies, as well as lower rates of brain damaged babies, than vaginal births do.

          • Daleth

            PS: a recent study of over 2 million births in England showed that the LOWEST maternal death rate was when moms had c-sections before labor. The absolute numbers are extremely low either way, but a scheduled, pre-labor c-section is less likely to kill a mother than attempting a vaginal birth is.

            Here’s an article on that:

            http://www.telegraph.co.uk/news/uknews/1584671/Women-choosing-caesarean-have-low-death-rate.html

          • fiftyfifty1

            “2 years of premed”.

            I’m a doctor. Which means I had 4 years of premed before I even set foot in medical school. Those 4 years taught me *not one thing* that could help a patient. Those are 4 years of physics, chemistry, calculus, biology etc. Premed doesn’t teach you anything practical, it just gets your education up to the level that will allow you to understand the medical classes you take.

          • PolyAmethyst

            I have taken practically all of those classes as part of a separate degree already. So has my engineering counterparts, it doesn’t mean we could pass the MCATS.

          • fiftyfifty1

            And passing the MCATS won’t do a damn thing to help you safely deliver a baby if and when the shit hits the fan.

          • Daleth

            Though this shows that difference between hospital births neonatal deaths and out of hospital births is literally a difference of one integer. 1-2 out of a thousand. That is the difference in risk in out of hospital birth and in.

            Is it really okay with you that one baby out of a thousand who DID NOT NEED TO DIE, ends up dead?

            And have you thought about how many babies are born each year? Just FYI about 4 million babies are born every year in the US. Let’s say only 10% of those are low-risk births that you would be comfortable attending as a home birth midwife. So that’s 400,000.

            Now do the math: an extra one or two babies in a thousand is an extra 400-800, yes FOUR HUNDRED TO EIGHT HUNDRED, dead babies every single year. One or two dead babies every single day… and these are babies who were perfectly healthy until something went wrong in labor. In other words, they did not have to die.

            Is that a reasonable price to pay in order to give the other women (the ones whose babies aren’t dead) a feel-good candle-lit labor experience? Really?

          • KeeperOfTheBooks

            And in the case of a hemorrhaging mom, what is a CPM going to do, aside from call an ambulance? Ditto a baby in distress, or a placental abruption?
            Let’s say that with DD, she hadn’t been breech and I didn’t need a CS, and went with a homebirth as I initially wanted to. Let’s say, for the sake of argument, that the placenta abrupted with no warning–which is generally how that happens. Or that there was a shoulder dystocia, and they couldn’t get her out. Or that her cord prolapsed. In any of those cases, there would be little to no warning that something might happen.
            I live in the suburbs of a fairly major metropolitan area. The closest hospital is 15 minutes away with no traffic…and unless it’s 3 AM, there’s *always* traffic. But hey, let’s say it is 3 AM, the midwife notices a massive drop or total lack of baby’s heartbeat/my bleeding excessively/whatever, and we do make it to the hospital in 15 minutes.
            The hospital can’t operate immediately; they need to do an ultrasound to figure out what’s up with the baby, they need to type and cross-match my blood for a transfusion, they need to get an IV into someone going into shock, which can take quite some time because veins collapse in a person in shock. Let’s say, best-case scenario, that they get the requisite tests, ultrasound, cross-matching, IV et all done in ten minutes, then rush me to the OR, which takes another minute or two.
            You’re talking about a MINIMUM of a half-hour between initial “oh, shit” and actual emergency section, and that’s living, as I said, in a major metropolitan area.
            After four minutes of fetal oxygen deprivation, they’ll be brain-dead, or at least severely brain-damaged. Four minutes. Four.
            Whereas in a hospital, you have an IV already in place. You can be constantly monitored, and as soon as that abruption or hemorrhage or rupture occurs, someone will know, and you’ll be being wheeled into the OR. They’ll have already typed and crossed your blood, so there’ll be no question about that. In the best OB wards, if you have something really bad happen you can expect a decision-to-incision time of 90 seconds. That’s a hell of a lot better than half an hour.

          • Bombshellrisa

            Exactly. And this home birth to hospital transfer best case scenario doesn’t figure in the fact that the closest hospital might not be the most equipped to handle your particular emergency. Staff might have to be called in to make up a surgical team, there might only be two OB surgical suites and both are being used, and nobody is doing anything on the command of a home birth midwife especially one who doesn’t bring the patients chart with her on transfer. It’s not unreasonable to think that at least a partial H&P will be taken before a CS is done. Don’t even get me started on how hard it is to transfer a laboring woman. Getting to a car can easily take a half hour and an ambulance might not be much faster

          • PolyAmethyst

            The real issue here is why doesn’t the CPM have her charts?

          • Amazed

            Because doctors will go on a witch hunt, tearing the charts apart. They hate midwives, they are scared for their own profits. And they treat homebirth transfers terribly, to punish the mother for having chosen homebirth.

          • Who?

            She might not bother, what with nature being the caring being that she is, if you trust birth you don’t need to record it.

            Her charts might reveal that she has not monitored anything much for hours, and may be considered negligent, and therefore get lost on the way.

            Her charts might reveal that if she’d been thinking as well as jotting, the trouble now blindingly evident would have been evident an hour ago-again, lost on the way.

            And even if they do appear, what good are they to the hospital when they are not medical documents, but the random jottings of an amateur? This is not a transfer between equals, but from a hobbyist to people who actually take responsibility. I wouldn’t rely on them.

          • PolyAmethyst

            That is negligent on her part but I hope that most people keep better charts than that and are more observant.

            There are surgeons who have put initials inside people. There are doctors who are there from birth to death with patients. Not every person is made of the same caliber.

            Especially in alegal states where lay midwives may not be getting any truly pertinent information, there will be people that you can’t rely on. Surely though there are also midwives who properly chart, who will call ahead and see who is there and what is available before hand and then present the patient to you correctly. Would you rely on one of them?

          • Box of Salt

            PolyAmethyst “Surely though there are also midwives who properly chart”

            When they can all label themselves “CPM,” how can either their customers or the physicians who must deal with their transfers tell the difference between the good ones and the bad ones?

          • PolyAmethyst

            I would hope that there would be some form of relationship between the hospitals doctors as there is the case in my state. There is supposed to be someone that we send our mothers to if they test high risk and transfer to if their labors go outside the limits. A mutual professional relationship of respect would be the goal where if someone does desire a home birth there would be someone that you trusted there and if things were not looking well someone I would trust there.

          • Box of Salt

            PolyAmethyst “I would hope”
            “There is supposed to be”

            You seem to be very idealistic.

            I hope you learn from the conversations you are having here today. I also hope you consider very carefully if the homebirth system as it exists in the US at this time – not just in your own local area – and the “CPM credential” is something you would be proud to be assoicated with.

            If you find that it isn’t – please, aim higher.

          • PolyAmethyst

            Perhaps my issue is that I am an idealist.
            The state of homebirth in my local area is apparently very rare in comparison with the rest of the country.
            I have definitely learned quite a bit from here, I used to think that I would love for a CNM as a preceptor. Thank you.

          • PrimaryCareDoc

            Why should I, as a physician, respect some birth junkie with next to no formal training?

          • Who?

            At home? Never. Ever.

            I don’t think giving birth is a game-and I’ve had two natural deliveries, with midwives, in hospital.

            ‘Surely’ and ‘hope’ are not high enough standards.

          • Box of Salt

            PolyAmethyst “There are doctors who are there from birth to death with patients.”

            Only if the patient died young. Are you thinking your comments through before posting?

          • PolyAmethyst

            My point was that some doctors don’t care at all and some truly do and do great work. Same with midwives.

          • Box of Salt

            PolyAmethyst, yeah, I got that. But I also got an image of a nonagenearian with a stethoscope, patting the hand of someone he’d delivered who was in the process of predeceasing him.

            While my kids have been seen for sick visits by their dad’s pediatrician who was still practicing in the same organization as their own, my own pedi has already passed away.

            The image of the wise family doctor going on house calls is a thing of the past.

          • Squillo

            There are good midwives and bad midwives, just as there are good MDs and bad ones, and it is difficult for the layperson to tell them apart. For me, the problem is baseline standards:

            1. Less than 50% of CPMs have attended a MEAC-approved midwifery program. NARM admits this. The majority study under a single preceptor before setting out on their own. Surely you can see the problem with this.

            2. CPMs are trained only in home and birth center settings, with low-risk clients. This may seem to make sense because homebirth midwives are ostensibly only caring for low-risk clients. What it means, though, is that a CPM is very unlikely to observe, much less participate in, a birth that has any given serious unexpected complications before she encounters one in practice.

            3. When that unexpected serious complication occurs, she is likely the only trained medical professional available. If the client and her baby are extremely lucky, there is a second credentialed CPM there, but it is far more likely to be an apprentice. More help, both in terms of experience and expertise and sheer number of hands, is an ambulance or private car-ride plus triage away.

            4. Most CPMs practice in a vacuum. Because she is usually the only trained professional present at the births she attends, there is no opportunity for others to observe her or for her to observe others. If her skills, judgement or practices are poor, she receives no feedback until a tragedy occurs.

            5. The professional organizations for CPMs in the US have no practice standards. They have no interest in quality improvement. This is evidenced both by the grand total of three “professional standards essential documents” MANA provides, which contain no specific clinical practice or transfer guidelines; and by the fact that they have published exactly 0 clinical updates/guidelines or other quality-related documents that other health care professional organizations routinely provide their members to help ensure they are aware of changes to consensus about quality care.

            6. The vast majority of CPMs carry no malpractice insurance, ensuring that families who are injured by negligent care bear the entire financial burden alone.

            If there are systemic problems with OB-attended, hospital-based maternity care–and there are–how much worse are the problems in a system that requires so much less oversight and less accountability?

          • The Bofa on the Sofa

            6. The vast majority of CPMs carry no malpractice insurance, ensuring
            that families who are injured by negligent care bear the entire
            financial burden alone.

            This is the biggest difference between the two. If Doctors mess up, they pay for it. Literally. And they face major sanctions from their governing bodies, review boards and employers. Colleagues turn on them. Medical groups use them as examples of what NOT to do.

            When midwives mess up, they rarely face consequences. When midwives do face consequences, they get held up as martyrs. They bear no responsibility for their actions.

            One group is made up of professionals, the other is a bunch of spoiled, immature brats.

          • Bombshellrisa

            The quality of the information obtained and recorded during prenatal visits is the real issue. Letting clients do their own weights and urine dipsticks as well as letting them decline testing like glucose tolerance and basic labs and a Pap smear will make any chart useless. Nobody copies an entire patient chart and brings it to a home birth in anticipation of a transfer anyway. There may be a flow chart from the labor but it won’t say anything important. If there is no IV, I+O is going to be an estimate, no CEFM means that fetal heart tone is going to be intermittent and there is a huge possibility of missing decels.

          • KeeperOfTheBooks

            I met one midwife whose standard procedure if mom was in trouble was to dump her at the ER doors and run. Her clients actually thought that it was their duty to protect her from all those horrible doctors…you know, the ones saving their and their babies lives. *shudder* No information, no charts, nothing, just “oh, here’s a pregnant woman in labor who’s bleeding out.”
            And, as you say, women in labor don’t exactly move quickly.

          • PolyAmethyst

            In this case I would give her a shot of pit to stem the bleeding and inspect if I can see the cause. Immediately call in for a transfer but most hemorrhages are stopped before they hit the 500 mark which requires transfer. If they are one of the 1/1000 that spontaneously hemorrhages and are bleeding out then the pit usually serves to stabilize until transfer can get here within 4 minutes and to the local womens hospital in 10.

            Yes, in that 1/1000 birth it would have been better for her to be in the hospital but for the other 999 maybe a few of them think that it might be better to have a positive birth experience where they want vs playing on the off chance they could die. Where they could also die in the hospital still but it just MIGHT be preventable then.

          • Kerlyssa

            Ah. So you think that the handful of women/1000 that prefer a home birth experience is more important to national medical policy than the the one or two women/1000 that die. Unsurprising.

          • PrimaryCareDoc

            You think a shot of pit is going to help if a woman is bleeding out from an abruption?

          • fiftyfifty1

            Or from trauma, or from retained tissue or from abnormal thrombosis?

            Oh you’re bleeding out honey? Well “pit usually serves to stabilize” (whatever the heck that means). I’m sure the ambulance will be here in 4 minutes and you’ll be at the hospital within 10. Besides, what happened to you is only 1/1,000, which means it is so rare that it’s not really happening to you at all, hon.

          • Who?

            And don’t forget-‘as you’re dying, think about how happy everyone else is with their natural birth. What’s a few dead ‘uns if most people are having an awesome time?’

          • PolyAmethyst

            This is what you expect of all midwives?
            That is incredibly insulting.

          • Who?

            It’s what you’re saying-most people will be fine, therefore it’s fine. I find it grotesque, myself, but it’s where your attitude will carry you, unless you are mindful.

          • Daleth

            It’s what we expect because it’s what you’re SAYING.

          • Fallow

            I PPH’ed in a world-class hospital, with doctors and nurses fully cognizant of the situation, an IV line in my arm, Pitocin and Cytotec immediately administered, and still nearly bled to death.

            People like me don’t count to people like you. We’re acceptable collateral damage in terms of your ideology. You believe that it’s so important that 999 women have fun during labor, that it’s okay for 1 woman to have a preventable disastrous outcome. (If we accept your uncited ratio there, which I do not.)

            You will never convince rational people of your point of view, when we see you baldly state that our lives could have been acceptably lost in the name of your belief system. As long as 999 women feel good about themselves apropos nothing, it’s okay if one woman is urgently transferred to a hospital with half her blood supply on her bathroom floor, right? Can’t make an omelette without breaking a few uteruses.

            If that’s not what you truly believe in your soul, you need to get to work on your idiotic message. Because that’s exactly what it sounds like.

          • Who?

            And I think the ‘most’ is the iceberg you keep hitting.

            You’re putting it more elegantly than most, but your basic thesis is that the occasional death or serious injury is a small price to pay for a ‘natural’ experience.

            Clearly natural is best only when it suits though-you’re on the internet, for a start.

            The choice argument is of course valid, provided a real choice is offered. All natural birth carries a way higher risk of death or serious injury to mum and baby than 1/1000, and 1/1000 is not a small risk. Do the women for whom you claim to speak truly understand that? Have they spoken to loss mothers or widowers or children without mothers after a homebirth gone wrong, to understand how that really feels?

            No one likes fear, or pain. But they can keep us safe. Pretending there is nothing to fear, and the pain will be somehow an improving experience, is not being true to reality.

          • Amazed

            Good thing you weren’t my mom’s midwife when she hemorraged. She almost bled out in under 10 minutes in a hospital. They barely saved her.

            So happy that she wasn’t the 1/1000 you’d sacrifice happily so the other 999 can orgasm during birth (the vast majority of them won’t, BTW, no matter what you promise them.)

          • PolyAmethyst

            I don’t think imparting upon a woman an expectation to orgasm during labor either realistic or professional. Hopefully midwifery care and technology has advanced in the past few decades.

          • Amazed

            So you don’t promise birth orgasms, like some midwives do. Good to know.

            Bad part is, my mom would have still died after giving birth totally naturally. That’s the part that interests me. She would have died as you waited around for the ambulance. Or inside, if it indeed arrived in the 4 minutes you promise. I guess that would have been OK because bleedings so massive are quite rare indeed. As you say, most hemorrages are stopped before they become too bad. Pity for the ones that are not, but let’s focus on the happy outcomes that are so many more, right?

          • Who?

            No pity.

            Just the cost of doing business.

            Can’t make an omelette without breaking a few eggs, right?

          • Daleth

            I almost bled out too, in recovery. The only reason it was detected, since it was ENTIRELY INTERNAL–that’s in all caps for you, PolyAmethyst, to remind you that with the super-basic equipment you carry to a home birth you may not have any idea that a mom is bleeding out, much less how much blood she has lost–anyway the only reason it was detected is because I was at a hospital on continuous monitoring while I was in recovery.

            They noticed the drop in my blood pressure and a team of at least three doctors flew into my room, got fluids running on the IV port that I had in my hand “just in case,” and not only saved my life (I was going into hypovolemic shock, which is always fatal if not treated in time) but prevented me from needing a hysterectomy or even a blood transfusion.

            Could you do that for any of your patients, PolyAmethyst?

          • KeeperOfTheBooks

            Me? I’ll take “not dead” over a positive birthing experience every day. And most moms, if they’re honest with themselves and their midwives were honest with them, would agree. Even MANA’s own stats consistently demonstrate that your baby is much more likely to die in a homebirth than at a hospital.
            And, as I demonstrated, just because you get to a hospital in 15 minutes from time of call doesn’t mean that you’re going straight to an OR. You still have IVs to run (again, good luck getting one on a woman going into shock), blood to match, a surgeon to find, an open OR to staff, etc. And the whole time, mom’s bleeding out and baby’s losing brain cells.
            Placental abruption occurs in 1/200 pregnancies. 1/200 women trying for a VBAC will suffer a uterine rupture. Placenta previa also occurs in 1/200 women. Postpartum hemorrhage occurs in 6% of births. Is this a minority of cases? Sure, but it’s not in the least a statistically insignificant minority. I should add that a lot of CPMs don’t have their patients do ultrasounds at all (woo, ultrasounds “hurt” the baby and “cause autism”), so they don’t even know if a mom has placenta previa before she starts bleeding out during labor. Those aren’t 1/1000 numbers. Those are far, far lower.

          • MaineJen

            Do you hear yourself? Why on earth would I NOT want to be in a place that could save me “on the off chance I could die?” 1 in 1000 doesn’t sound that rare to me.

          • Amy Tuteur, MD

            Your ignorance is typical for a counterfeit “midwife.”

          • PolyAmethyst

            Well I am glad you think so but I am not one. I have never been anyone’s midwife or even done so much as a prenatal exam. There are levels of midwives, I will allow for that. My main objection is the stigma that is associated with CPM because of people like Jill Duggar who do this through a correspondence course. There are some midwives out there who do have a gold standard of training and must also pass a licensure exam much like doctors must do. The difference is that it isn’t by MANA or ACNM but the individual states Department of Health and that wouldn’t be an option if the government had decided it was detrimental to the public.

          • Amy Tuteur, MD

            You’re a doula and you’ve described yourself as a student midwife.

          • PolyAmethyst

            Very beginning of my training but not one. I have a long way to go until I have enough knowledge to even begin clinicals. But there will be YEARS. Literally years of education and dozens if not hundreds of births before I will be able to call myself a midwife.

          • PrimaryCareDoc

            You have a LONG way to go before you can even constructively participate in this comments section, quite honestly.

          • PolyAmethyst

            Quite possibly but who is to regulate when and where I can post my opinions. I appreciate the insight this has given me into the CNM world but if anything some of the people here are just as much, if not more, fanatical then some of the natural birthers. This isn’t a medical journal. It is an opinion forum from a former physician.

          • PrimaryCareDoc

            You’re welcome to participate. Come here to learn. Don’t come in here with the attitude that you’re going to teach us something. This is a forum filled with physicians and CNMs, scientists and statisticians.

          • PolyAmethyst

            Well further down there are some who say that not even CNMs are valid midwives. Even further down it becomes a conversation on the religious quackery that this girl was taught instead of applicable knowledge. They aren’t all made equal.

          • PrimaryCareDoc

            I’m not reading through the whole thread again, but if anyone is saying that CNMs are not valid midwives, then they are definitely the minority view.

          • Daleth

            The difference is, we’re fanatical about keeping mothers and babies alive and undamaged. The natural birth folks are fanatical about preventing “interventions” because, after all, those interventions only save a few lives.

          • fiftyfifty1

            “Literally years of education and dozens if not hundreds of births before I will be able to call myself a midwife.”

            Literally YEARS and DOZENS of births before you can call yourself a midwife!!!!! OMG!!!!

            Pathetic.

          • PolyAmethyst

            Do you disparage those over in the United Kingdom who call themselves midwives after ONLY 3 years?

          • fiftyfifty1

            3 years of FULL time rigorous study (not a couple of science classes mixed with bullshit about herbs and positive thoughts) which includes multiple mandatory hospital rotations, and guaranteed hundreds of births. And then this person is called a midwife and goes on to practice in a hospital under the supervision of more experienced clinicians before ever practicing at home (most never practice at home). But do I disparage them? It depends. What do YOU think of the ones at Morecambe Bay ?

          • Megan

            Dunning-Kruger anyone?

          • PolyAmethyst

            Narcissists abound.

          • Megan

            As your presence demonstrates. You know nothing about me and what I think of myself.

          • PolyAmethyst

            Yes, clearly I am the one that suffers from Dunning-Kruger. Clearly.

          • Megan

            If you think that you can recognize and manage obstetrical complications after “literally dozens of births” then yes, you do.

          • Amazed

            Megan, she just liked my doctor-bashing comment. With this attitude, I’ll say she sees herself as the great savior. Ms Dunning-Kruges, that’s who she is.

          • PolyAmethyst

            I didn’t consider it as doctor hating; I was liking it for the content of doctors are scared that CPMs will drop a train wreck on them without so much as a call ahead.

          • Amazed

            Liar. I deliberately framed it as something that could not be read in any other way but doctor-bashing. I wanted to see if you’d fall for it. Well, you did.

            Liar. Or idiot. Which one do you admit you are?

          • PolyAmethyst

            An idiot. According to you but I also liked your comment on faulty CPMs charts.

          • Who?

            Even a broken clock is right twice a day.

          • PolyAmethyst

            Nope, would not attempt to fix major obstetrical complications but minor ones and the complete absence of complications, yes.

          • Megan

            And if you think that being at home for a birth does not pose a major roadblock to recognizing and managing any obstetrical complication you definitely suffer from the Dunning-Kruger effect. If you think a shot of IM pitocin wil stabilize someone with an abruption that’s pretty telling.

          • PolyAmethyst

            It wasn’t for the abruption, it was for first situation as I read it. A minor hemorrhage.

            There are some midwives out there who can keep fully articulated and functioning charts who can bring in a slightly stalled mother before she ever gets to bleeding out or exhaustion or cesarean need and present to the OB. I am saying that those midwives are not all made of the same caliber as the religious send away course that this Duggar girl completed.

          • Megan

            It isn’t just about the CPM (though they are, as a whole grossly undereducated to manage much of anything). It’s about the fact that, when something goes wrong, which in obstetrics often happens quickly and without warning, there is simply not enough time or resources at home to safely manage it. If you care about individual lives, and not just if most fall on the right side of statistics, you don’t do homebirths. When I deliver my baby, I don’t need someone to hold my hand through a normal birth. What I need is someone who can recognize and quickly fix problems when the unthinkable happens.

            What will you do when a woman under your care has a placental abruption, severe PPH, or a shoulder dystopia you can’t resolve? Oh right, call the ambulance and pray. And then hope a doctor can save your ass and your patients’ lives.

          • Amazed

            And soothe any anguish she might be feeling with the happy notion of all birthing extasies she helped other women achieved. This was her one bad chance but think of the others who achieved orgasms! They’re the ones who matter! Besides, the woman herself made the choice to go with her.

          • Who?

            And this is the cruellest cut of all, that we see over and over. When it all goes wrong, it was mother’s choice.

          • Amazed

            Well, it was mother’s choice. It’s just that it was also the siren song of midwives, homebirth advocates and the other members of the homebirth cult. But that part is ignored, conveniently and immediately.

          • Who?

            Thing is though, she was often lied to, which contributed to the choice. Told it was safe, told she was loved and cared for, told it would all be wonderful.

            Then shunned, criticised or shamed when/if she finds it didn’t go as promised.

            I’m all for choice, but make it based on accurate information.

          • Amazed

            That’s right. Still, she was aware that she was making a choice that a measly 1-2% of women make. By definition, she knew she was going against what 98-99% of people thought was safe.

            I detest lying to vulnerable women for profit or ideology. But I cannot see future mothers like kids of 5 who say, “But Joe said it was safe!” and be let out of the hook entirely.

            With the internet, we’ll meet all kinds of misleading and blatantly untrue information. I guess we’ll have to develop some kind of filter to direct us at the information that is, well, informative. That’s just how it is. Now, we can choose who to believe and we don’t always choose wisely. Not that excuses the lying liars who lie for profit and endanger and ruin lives.

          • Who?

            Two questions:

            *how, after ‘literally dozens of births’ could you reliably tell what’s a minor and what’s a major complications? Because if you can’t do that you’re nowhere.

            *in the complete absence of complications, why are you needed at all? Surely if birth is mostly natural and beautiful, you’re selling smoke and mirrors, and having someone pay you so you can enjoy yourself?

          • Amazed

            And what happens to those who suffer the major obstetric complications that you won’t try to fix?

            Silly me. I forgot. They’re acceptable losses so the women with minor complications and non-emerging ones can have for the joy of glorifying each contraction. And of course, so you can line your pockets and scratch you birth high itch.

          • Box of Salt

            “and the complete absence of complications”

            How, PolyAmethyst, are you going to ensure that the births you will attend in the future have that?

            When I read your comments, I think “Pollyanna” would be a more apropos ‘nym for you.

          • Daleth

            Nice of you to admit it.

          • Dozens if not hundreds of births? Wow, that’s so many! (that is sarcasm, btw)

            You’ll not get a chance to see very many 1/100 complications then, will you. You won’t get a chance to see how to save lives because, yes, the chance of bad things happening isn’t that high. But what are you going to do when shit does hit the fan, then, because it eventually will? Will you be a “sister in chains” for practicing medicine without insurance, being investigated for a dead woman or dead baby who shouldn’t have died?

          • Monkey Professor for a Head

            I’m curious, in the future when you’re working as a midwife, will you tell patients that there is a higher risk of death at homebirth compared to hospital?

          • Sue

            “Dozens if not hundreds of births before I will be able to call myself a midwife” – while real clinicians will do dozens in a week. Sigh.

          • PrimaryCareDoc

            Are you telling me that a CPM passes an exam like doctors do??

            Are you really that ignorant?

          • PolyAmethyst

            Not for nearly the same amount but for licensure purposes in my states, yes. LMs can also gain CPM qualifications but the exam process is held by the governments Department of Health standards.

          • Daleth

            Um… just because there is an exam to pass, doesn’t mean that exam is “much like” the boards that aspiring doctors have to take.

          • The Bofa on the Sofa

            just because there is an exam to pass, doesn’t mean that exam is “much like” the boards that aspiring doctors have to take.

            And, more importantly, the exam is only the starting point. You pass your boards and you get to practice. But you still don’t know squat. Passing the boards means you have the bare minimum to practice, but doesn’t mean you know enough to do it well. That takes a lot more than just book smarts, because there is far too much too medicine to put it all into books.

          • Charybdis

            Yes, people do die from childbirth in the hospital and babies die as well. However, I would be willing to bet that a majority of that small percentage were homebirth transfers after things went sideways enough for the mother to be driven to the hospital or for EMS to be called to pick up the pieces. If you are already IN the hospital, if things go sideways, help is IMMEDIATE.

            In the US, the midwives with the medical education/background are the CNM’s and they don’t do home births. There might be one or two who do do homebirths, but they generally work in a medical setting. The CNM’s are on par with the ones in Europe. The CPM’s and LM’s are so NOT the same thing at all. They have no medical training, no recourse to medical backups and no real safety net if things go badly. They do things like lie by omission, bully mothers into NOT going to the hospital if the mother expresses a desire to do so, administering medication without consent (surreptitious Pitocin administration), perform procedures they are not competent to perform (vacuum extractions for example) deny pain relief when and/or if the laboring mom requests it, falsify charts and notes, if any are kept, gerrymander due dates, freely endorse and encourage the usage of essential oils, herbs and castor oil in lieu of medications that actually work and have been tested for safety and efficacy. And they have quite the track record for refusing to transfer a woman with legitimate risk factors: breech presentation, twins, signs of pre-e, GD, macrosomic baby, post-date pregnancy, PROM, low/no amniotic fluid, signs of placental abruption/uterine rupture, etc.

            If a woman wants to have a home birth for whatever reason and she is considered to be low risk by her doctor (OB/GYN, PCP) then she should be able to try. However, if at any time during the pregnancy she no longer meets the criteria for being low risk, she should no longer have the option. You should have to qualify to have a home birth, it should not be the default option. If women are truly educated about the differences between homebirth and hospital birth and they are willing to accept the risks of delivering at home, then fine. But as long as women are being lied to about the fact that birth is a dangerous endeavor and that things can go wrong quickly and when they do, the consequences can be devastating, then home birth needs to be strongly discouraged.

            Also, the fact that there seems to be a code of silence among CPM’s regarding what they actually do during a delivery and are not willing to share information if the woman has to go to the hospital, does NOTHING to increase the public’s acceptance of their legitimacy. They will lie, deny and shift blame to anyone but themselves when things go badly.

          • Daleth

            Exactly. Taxi drivers have safely delivered babies; so have children under 10. My dad, a 25yo carpenter at the time, “caught” me because the home-birth midwife he and my mom had hired WENT HOME when she decided, incorrectly, that I wasn’t going to be born until morning. Virtually anyone can do it when there are no complications.

            So why pay $3000+ to a Certified Pretend Midwife? If you don’t want the safety of a hospital in case things go wrong, have your husband or other co-parent attend your birth. If you do, go to the hospital. There–I just saved you folks $3000 each!

          • Monkey Professor for a Head

            The thing is, low risk is not the same as no risk. And when it comes to giving birth, things can go wrong in seconds, often with no warning signs. And if something goes wrong at home, there’s often little a homebirth midwife can do other than transfer, all the while precious minutes are ticking away.

            I was low risk. I would have given birth with a midwife in hospital, but when my sons heart rate started dropping dangerously due to a nuchal cord the obstetrician was called in. Even with a midwife and obstetrician giving immediate treatment after I gave birth, I still lost 1.6 litres of blood. There were no prior warning signs for a PPH. If I hadn’t been in hospital, I would have certainly lost more blood. I would have needed more than the one unit of blood I was given. And the more blood you lose, the harder it is to stop the bleeding (as you are losing clotting factors and platelets) so there’s a good chance I would have needed more aggressive treatment such as a hysterectomy. Worst case scenario, I could have died. Back in the good old days before modern medicine, I probably would have. In childbirth, low risk is never no risk.

          • Kerlyssa

            Statistically, we don’t need childhood cancer treatments, because most kids don’t get cancer. Statistics deals with populations- an individual cannot be 1.6% dead.

            Since in real life we place some value on individual lives, we offer treatments and monitoring that most laboring women will not need. By the time you have figured out who does need it, death, suffering, and injury have already happened.

          • PolyAmethyst

            That is a completely false parallel. More accurately would be to take something that most bodies do naturally and well and then add preventative treatment for a statistical anomaly across the general population.
            We don’t force everyone to take schizophrenic medication because a small number will die without. That small number are lucky to be alive in a time where we understand the complications and have the ability to fix through medicine. The rest of the populace though are happier without the intervention forced upon them for their greater good.

          • Kerlyssa

            Forcing schizophrenic medications on non schizophrenics? Are you under the impression that non pregnant women are getting these medical interventions? Otherwise, not understanding why you think this is a closer parallel.

            Yikes. Bodies certainly do it naturally, but well? Those big headed, aggressively parasitic human babies do a number on the woman carrying them. Incontinence, temporary and permanent changes to the immune system, scarring and prolapsing are all normal parts of carrying and delivering a child, and that’s before you get into issues that kill or majorly disable the mother or baby. Why do you think women and babies are happier and better off not being treated for these things? Where is the benefit?

          • PolyAmethyst

            No, I am implying healthy women are being treated to speed up a natural process that is unneeded.

            For the cases where it is too much or where death is likely then it is better treated. Benefit is for the rest being able to birth in a lower stress environment where they are comfortable and happy. There are those who do it well and for them pregnancy and birth is still thought of as a natural part of life that usually does not need to be interfered with.

          • Kerlyssa

            Ah. Golf game, eh. /sigh

            Longer labors are more stressful for both mother and baby, and lead to worse outcomes. The medical indicators and definitions of stress aren’t necessarily the same as what the mother or midwife would term stress, as well- the human body gets exhausted by labor, and if baby is losing oxygen with every contraction, then avoiding an intervention because mother dislikes them may be less emotionally stressful for her, but it sure isn’t stressing the baby or her body less.

            This is a basic values conflict, anyhow. You are privileging the personal values of a handful of people over the health outcomes recorded by the medical establishment, and wanting to base health policy on this. Women are already allowed to birth in your way if they wish to, the push to have _more_ women birth this way against medical research is only justified by devaluing death, pain and injury, which is what you keep doing in your comments.

          • PolyAmethyst

            I am a women’s advocate. My personal values are those that one’s birth should be whatever one wants to make of it.

            This gets back to the statistical part, most women would still have the happy and healthy babies without having the shorter, medicated labors and the push is so that more have the educated option.

            I am not arguing that it is a little more dangerous but as I posted through the article it is a basically negligible difference.

            Thank you for this discussion, I do see your points and respect you for having them regardless of whether or not I agree. I also thank you for being courteous to me throughout.

          • Amazed

            Negligible difference? That’s at least threefold difference! 1 or 2 in 1000 looks only so small if you don’t think just how many births there are. At my highschool, there were about 750 students. If I knew that at least 1 of them would die for sure if I agreed to do something, I would not do it. No matter how many blissful experiences I can promise to the other 749.

            I can say, But that’s just me. Only, it isn’t so. It’s also Megan, fiftyfifty1, Who, Monkey Professor, Dr Amy, Bofa, Keeper of the Books and the vast majority of us here. You’re the outlier. Your views are monstrous.

          • Bombshellrisa

            It’s not the woman’s birth, the birth is the baby’s.
            As a woman’s advocate and future midwife, did the MANA stats and Judith Rooks analysis of the Oregon home birth death rate shape your opinion at all? If so, how?
            Also, as a woman’s advocate and future midwife, how do you feel about the course of action to take suggested by experienced midwives in “From Calling to Courtroom” when it comes to a bad outcome?

          • The Bofa on the Sofa

            I agree, Kerlysaa’s analogy wasn’t a good one.

            A better one is drunk driving laws. Amazingly, NO ONE is allowed to legally drive drunk, although the US DOT’s own statistics clearly show that it’s only a small fraction of drunk drivers that have any problems. The chance of a drunk driver dying or causing someone to die is 50 times lower than the chance of a woman dying in childbirth. Moreover, a lot of those could be prevented if those drunk drivers would just wear their seatbelts, which they they unfortunately don’t do (they also do things like drive without their lights on at night).

            Heck, the chance of a drunk driver either getting in an accident or even getting a DUI is about the same as the baby dying in a low-risk birth in a hospital (which is 3 – 4 times lower than in a birth at home).

            So why should we outlaw drunk driving? Bad outcomes are statistically very rare – it’s a lot safer than childbirth. The real danger of drunk driving is not that it is so dangerous, but that it is so prevalent. Lots and lots and lots of drunk driving leads to an unacceptable number of deaths. But why should those people who only drink and drive once or twice a year have to be treated the same as those guys who do it a couple times a week?

            (note: all the stats and risk probabilities listed above are true, based on US DOT statistics)

          • MaineJen

            The preventative treatment we offer laboring women is fetal heart monitoring. Sure, most babies will tolerate labor well and the monitoring will have been unneeded, in retrospect. For those few babies that don’t tolerate labor well, that monitoring will save their lives. Or, you can stay home, where monitoring isn’t even an option.

          • fiftyfifty1

            Equating “direct entry” midwives from the US and Europe would be laughable if it wasn’t so obviously your intent to deceive.

            “Direct Entry” midwives in the US have no safety standards whatsoever. They enter into delivering babies directly, without a formal education being required. The CPM title is a false credential that US lay midwives made up to award to each other to trick the public.

            “Direct Entry” means something completely different in Europe. Midwives there have real medical educations from universities and receive extensive hospital training. In the case of European midwives, the description “direct entry” mean nothing more than that students enroll directly into their university’s midwifery program rather than entering university undeclared (i.e. without a field of focus). This is common practice for many majors in most countries in Europe. For example, students enter directly into medical school or engineering school after finishing their “highschool” degrees which are in reality at the same level as sophomore in college.

          • PolyAmethyst

            The high school degrees are generally undeclared, correct? So a 2 year equivalent plus 3 years of focused specialty study would be the equivalent of a European model midwife? What about Registered Nurses who are also CPMs or those with Masters who have the credential? They are equally uneducated?

          • Who?

            Anyone who thinks they can safely deliver a baby at home is, by definition, unqualified to do so.

          • PolyAmethyst

            The midwives over in England offer homebirth as an option as part of the NHS. They think it is safe enough to do with only gas and air and other basics.

          • Who?

            And deaths are on the rise.

            While costs are being cut, payouts for damage during birth are also on the rise.

            Fab outcome, wouldn’t you say?

          • Amazed

            And midwives in the Netherlands! They’re so incorporated that almost 30% of births take place at home. And homebirth midwife mortality rate is just the same as hospital midwife mortality rate!

            Before you like this comment as well, you might want to check just how midwife mortality in the Netherlands compares to obstetrician mortality.

          • Who?

            And let’s remember those midwives need to keep their jobs. I can’t see the midwife who delivered my first child, who spent years in Africa delivering babies, being happy to attend home births. She might be keen to keep paying her rent, though.

            She was the first one to call the doctor in when she recognised trouble. And there was no one I trusted more than her to recognise trouble, because she had seen plenty of it.

          • KeeperOfTheBooks

            Yes, and their death rates consistently demonstrate that it’s far safer to give birth in a hospital.

          • MaineJen

            Yeah, and look at all of the *great* outcomes over in England lately…oh wait.

          • Daleth

            They offer home birth with strict risking-out criteria (unlike CPMs here), oversight from OBs (unlike CPMs here), and malpractice insurance (unlike CPMs here).

            And because they actually are trained medical professionals, they are integrated into the healthcare system, which means if you do need to transfer, your midwife and all your records go with you, making it much easier for doctors to know immediately what’s wrong and what to do. Again, not the case here.

          • PolyAmethyst

            What I am realizing is that my state is the minority. We are trained with a strike out criteria, partnership with an OB and we also have to carry insurance. I haven’t even been in the same room as a mother yet but I have bought the insurance for when I hope to next year. What I have gotten from all this is to be the best midwife that I can and hope that maybe I can prove through my charts, my patient care, my ability to transfer before wrecks and relationships with the doctor that not all midwives are made equal.

          • Daleth

            That is a really good attitude. I’m curious, though–if you take midwifery that seriously (which is great), why become a CPM? Why not go to school to become a real midwife, with the greatest amount of skills and experience a freshly graduated midwife can have? I mean why not go to school to become a CNM. That would give you a lot more career options, too, and a lot more mobility in terms of moving between states.

          • PolyAmethyst

            It was a deeply personal decision that I battled with for a long time. In the end life made the decision for me through financial and location barriers. My ability to “hack it” isn’t in question for me, I am confident in myself but with where I am currently in my life this is the right path for me. There are plenty of others who have made the same decision for different reasons and majority of the time it isn’t because intelligence is lacking on their part (which therefor doesn’t make them “real midwives” to you). This assumption is not only ignorant to blanket upon all CPMs but highly insulting. In my state I have an amazing opportunity, that seems highly localized, to offer well woman care and offer mothers choices concerning their healthcare. If I can make even one doctor double take at the quality of services I will provide my community then hopefully I will considered myself validated as a midwife. Thank you for asking and not being overly hostile.

          • Daleth

            Intelligence has nothing to do with it. Whether someone is a real midwife depends not on someone’s intelligence, but on whether they have learned the skills that you learn in an accredited nurse-midwifery program. You don’t learn those skills in a CPM program, so unfortunately you won’t have them. Imagine how devastating it would be for you to be in an emergency situation that you just don’t have the skills to deal with. And how beyond, beyond, beyond devastating for the poor mother and baby.

            What I’m saying is that if you feel the calling to be a midwife, go for it–overcome the obstacles. Move to a place that has a school. People move for school all the time–it’s what you’ve got to do if your path in life requires an education that isn’t available where you live. And since being a CNM gives you so many more job opportunities than being a CPM, it will pay off and make the student loans worth it.

            Being able to “offer mothers choices concerning their healthcare” is not the same thing as being able to offer mothers good, safe choices concerning their healthcare.

          • fiftyfifty1

            All CPMs are uneducated. It’s obvious for anyone to see when it’s somebody like Jill Duggar. Unfortunately, a program such as Bastyr tricks many others, such as yourself. It’s filled with fluff like herbal study and ideology like “your cervix is a sphincter”.

          • Daleth

            Don’t be vague. What the heck does “3 years of focused specialty study” mean? What we’re talking about is, for European midwives, a bachelor’s degree in midwifery, earned in a country where you study nothing but the subject of your bachelor’s degree–there are no minors, no concentrations, no language requirements, etc.; you just study the subject of your degree (that’s how college works in most of the world outside the US).

            So on the order of 30-50 hours a week of nothing but midwifery, for three years, at a university, with extensive clinical experience in hospitals and real (medical, not hippyish) birthing centers, attending hundreds and hundreds of births under the supervision of highly educated professionals. That’s what European midwives have when they START their careers.

            And to say the least, that’s not what CPMs have. Which is why they wouldn’t be allowed to practice in any developed country other than the US (and they’re not allowed in all states here).

          • Who?

            This is breathtakingly heartless. Bad outcomes are ‘pretty low’ are they? Well that’s okay then!

          • The Bofa on the Sofa

            Yeah! Who’s going to sacrifice their baby up to the altar of All Natural?

            Not I, said the Duck.

            Of course, no one does it intentionally. However, someone is going to pay it. What do you tell them? We spun the wheel and it come up Green 0? Thanks for playing!

            At that point, the fact that you didn’t play on a wheel that didn’t have a 00 doesn’t seem to be much of a consolation, does it?

          • SweetBabyJesus

            Have you ever looked into bad outcomes associated with intensive unnecessary medical intervention and/or cesarean surgery? Or are we only considering bad outcomes that come from out-of-hospital birth?

          • The Bofa on the Sofa

            Which c-sections are unnecessary? Can you give a specific example of someone who had a c-section where it was unnecessary?

          • SweetBabyJesus

            Many cesareans are unnecessary. The WHO recommends a safe rate of no lower than 10% and no higher than 15%, and the US is at 32% nationally. If a first-time mother comes into the hospital and does not deliver the baby within a set time limit set out by administrative protocol they can receive medical interventions to “speed things up” even though the mother and baby are completely well and end up with a baby who is being pounded by excessive pitocin and therefore goes into fetal distress. This type of scenario plays out again and again sadly. That mother then runs other risks in future pregnancies because of having the surgery, and might likely end up with another cesarean.

          • The Bofa on the Sofa

            Many cesareans are unnecessary.

            That’s not what I asked. I asked

            “Can you give a specific example of someone who had a c-section where it was unnecessary?”

            I don’t want population statistics, I want examples. Give me an example of someone who had an unnecessary c-section, and, more importantly, explain how you determined THAT specific c-section was unnecessary.

            Someone had a c-section for failure to progress. How do you know that SHE would have had the baby successfully without a c-section?

          • SweetBabyJesus

            Yes, I can give you entire volumes of women in this country who have real stories of medically unnecessary cesareans for unfounded diagnoses that were perpetuated in an effort to mitigate the risk of a risk.

            And that’s silly–no one can “know” that they will end with a safe birth outcome. It’s impossible to mitigate risk 100% of the time and this is true in many other manifestations of life. When we start treating everyone as if they are “going to have a problem” then we incur all of the MANY risks associated with cesarean section just to avoid a potential risk that is hypothetical until clinically revealed to exist in that moment. This is what good midwives, nurses and doctors are trained to watch for. I did not say that any cesarean is bad–they actually save many lives–I just said the unnecessary ones are.

            I can refer you to a few places that contain these mama’s stories and how they influenced their decision for a different path the second-third-fourth… time around. Or I can tell you a specific story from a mother I have met personally, if that tickles your fancy. I do love a good birth story…

          • The Bofa on the Sofa

            no one can “know” that they will end with a safe birth outcome.

            So then you don’t know that the c-section was unnecessary.

            Thank you for conceding the point.

          • The Bofa on the Sofa

            So the lesson:

            Yes, most c-sections are unnecessary, in that the baby could be delivered successfully without having a c-section. However, the problem is that too many of them could not. Unfortunately, we don’t know enough to know ahead of time which ones will and which ones won’t. Given that, balanced against the safety of c-sections, we choose to act in certain circumstances.

            My favorite example is breech. Breech babies, with good technique, can probably be delivered successfully more about 95% of the time, maybe even better. However, modern practice is to do c-sections for all breech. Why? Because 5%, or 4% or even 1% failure is too high given modern c-section methods. So we do c-sections on all of them.

            The reason we have to do that is because we don’t know which breech births are going to fall in that 5%. Therefore, we would rather do 19 c-sections that are unnecessary to prevent the death of that 1 where it is necessary.

            If we knew which of the 20 was going to be the problem, we could reduce the number of unnecessary ones. But we don’t, so we can’t.

          • Fallow

            You were asked for specific examples. So yes. provide them. Skip the extraneous vague paragraphs about your binders full of women.

          • PrimaryCareDoc

            You said “mama.”

            Can you please refer to them as “women?” Not “mamas?”

          • Daleth

            If we treated “everyone” as if they were going to have a problem, the c-section rate would be a lot higher than 30%. (Most of that 30% rate, BTW, is women who’ve already had c-sections deciding that the risk of VBAC isn’t worth the supposed benefits–and given that even the best VBAC candidate still has about a 1/200 risk of uterine rupture during labor, can we at least agree that *repeat* c-sections are NOT generally driven by the imaginary bogeyman of cut-happy doctors trying to make it to their golf game on time?).

            As for the “many risks” of c-section, none of them are “the baby dies or is brain damaged because a c-section was performed.” In contrast, many thousands of people in this country have had their babies killed or permanently injured because a c-section was NOT performed in time or at all–in other words, “the baby dies or is brain damaged” IS a risk of trying to have a vaginal birth.

          • Barbara Delaney

            “mama’s stories” So you think some anecdotes are comparable to the actual facts determined through statistical analysis and scientific methodology? I’m not a regular here, I don’t know any of the people involved in this discussion. But I have marveled at their patience with you and you’ve been treated far more kindly than has been warranted by your own behavior. You’ve made egregious errors in mathematics and just shrugged it off. You’ve argued using “facts” that you’ve been unable to back up with actual evidence. But worst of all, you’re carrying an enormous chip on your shoulder because you feel you’re not getting the respect you deserve. But you’ve sneered at obstetricians, you’ve shown hostility toward actual medical professionals, and you’ve shown a stunning disregard for the infants who have died in home births.

            That’s the opinion of this outsider. However I understand this is my viewpoint and does not constitute evidence that you’ve made a fool of yourself.

          • Bombshellrisa

            She only likes birth stories that back up her ideas. There are plenty of birth stories here, even more on Hurt By Homebirth. She keeps insisting every bad CPM, every injured baby, every dead baby and every injured mother is an “isolated case”. If only,

          • Amazed

            I am turning awfully blue waiting for her to discuss Gavin Michael’s case with us. Or the stats that kinder posters than me and I myself had provided. But kiddo doesn’t want to play in this playground. I wonder why, I do.

          • Bombshellrisa

            I promised Danielle I would never let #gavinmichael be forgotten. I didn’t know of her until long after what happened, but her son and mine would be only weeks apart (maybe not even that far apart of we would have given birth closer to our due dates). Their family deserves better then what happened, all families hurt by CPMs and the NCB philosophy do. I know why I continue to counter every stupid meme that the parachuters come up with, it’s for the families who have been left broken hearted. It’s frustrating though, isn’t it?

          • Who?

            I think this hits the nail on the head. Because CPMs are a diverse bunch, every disaster is, by definition, an isolated case. It takes a network of people keeping their eyes and ears open for the stories to come to light.

            As much as each tragedy is individual, the broad outlines are the same: some kind of dependency develops between the ‘carer’ (hereafter ‘birth hobbyist) and the mother; mother is convinced she is well and healthy and all can happen naturally; any blots on the horizon are painted over or ignored; anyone who challenges the supremacy of the birth hobbyist is considered very negative and a risk to mother and baby; terrible injury or death ensues; birth hobbyist appears only to justify herself and collect her fee-my bad, she’s already collected it; birth hobbyist blames ambulance that didn’t come fast enough, doctors who were too slow to help, or, in extremis, ‘God’s will’.

            Which is not to say that all birth hobbyist deliveries go that way. But when they do, they are symptoms of blight, not random accidents.

          • Squillo

            Yes! Quality improvement is systematic. You cannot have a group of loosely regulated individual practitioners working in a vacuum with no quality guidelines and expect to improve outcomes. Complacency and destructive individualism will continue to rule the roost.

          • fiftyfifty1

            ” I’m not a regular here,”

            Come for the Duggars. Stay for the vaginas. So to speak.

          • Siri

            “these mama’s stories”? Sure you don’t mean mamas’? Sooo…you have english on…what was that boast of yours again?

          • SweetBabyJesus

            Oh, and you said “Which c-sections are unnecessary?”, not “Can you give a specific example of someone who had a c-section where it was unnecessary?”. It’s like, right there^^.

          • The Bofa on the Sofa

            Yeah, it’s right there:

            Which c-sections are unnecessary? Can you give a specific example of someone who had a c-section where it was unnecessary?

            Those are my exact words.

            Saying “many c-sections are unnecessary” does not answer either question (“which ones are?” or “provide an example”?)

          • Daleth

            FYI, back in 2009 the WHO admitted that there wasn’t and never had been any evidence supporting the claim that the c-section rate should be under 15%. They also admitted that there was no evidence supporting any particular rate as optimal.

            Quoting a number that the WHO itself has backed away from doesn’t help you here. We don’t even know if there is such a thing as an ideal/optimal “not to exceed” c-section rate.

          • The Bofa on the Sofa

            SweetBabyJesus is just another victim of Pablo’s First Law of Internet Discussion.

            Throwing out crap like infant mortality numbers and WHO recommendation is a sign of someone who is in over their head here.

          • Houston Mom

            Here is a BBC news story covering the WHO’s retraction of that 10-15% C-section rate.
            http://www.bbc.com/news/10448034

          • Sarah

            NO IT DOESN’T. THE WHO HAS NO RECOMMENDED SECTION RATE. LEARN THINGS.

          • Roadstergal

            “Have you ever looked into bad outcomes associated with intensive unnecessary medical intervention and/or cesarean surgery?”

            Have you ever looked into bad outcomes associated with vaginal birth? I noticed you’re ignoring my question above. You seem to think that vaginal birth is free of negative complications, and C-sections are always worse for mom and baby than vaginal births. Is that your view? What informs that view?

          • SweetBabyJesus

            Wasn’t ignoring. Was just away from computer. 🙂

          • SweetBabyJesus

            Definitely do not think vaginal birth is risk free. All birth bears risk. That is why I said “we cannot mitigate risk associated with birth 100%”.

          • The Bofa on the Sofa

            Wait a minute. How can you talk about whether c-sections are unnecessary, or even unadvised, if you don’t have a comparison to the risks of vaginal birth in those circumstances?

            There’s no basis for claiming that a c-section shouldn’t have been done if you don’t know the risks for the alternative!

          • Roadstergal

            “we cannot mitigate risk associated with birth 100%”.

            Why not? I think risk mitigation should indeed be practiced in 100% of births.

          • SweetBabyJesus

            They are very low, lower than the risk of complication associated with cesarean section for the average person. Taking that risk is worth it to save your child. Not worth taking the risks of surgery just because of the fear associated with normal childbirth. See the difference?

          • The Bofa on the Sofa

            The biggest complication of c-section is, what, infection of the wound? Treated with anti-biotics?

            Meanwhile, the bad outcome of homebirth is perinatal death, treatable by blaming the mother, it appears.

          • SweetBabyJesus

            Actually, I’d be glad to tell you as I just completed a research paper on this topic! The risk of cesarean is 24.1% but rises to 32% for mothers who are 9-10 cm at the time of surgery. The risks are intraoperative complications, blood loss, wound infection, cystitis, endometritis, hematoma, and reoperation. I can give you the direct link to this study if you would like.

          • The Bofa on the Sofa

            And what is perinatal mortality for c-section vs non-c-sections for those with indications?

          • SweetBabyJesus

            Just in case you wanted the source. And no it’s not whatever “woohoo” source you were making fun of me before. Somehow I imagine you’ll still find something wrong with it but will not offer any counter argument that is based in evidence. That’s kind of your thing here.
            http://www.ncbi.nlm.nih.gov/pubmed/14981385

          • Roadstergal

            What are the complications, short and long term, of a vaginal birth? If you were giving a woman informed consent on VB vs C/S, what would it consist of?

          • SweetBabyJesus

            I think that is a great question and vital to a true informed consent. I will get back to you on that because I think that it will take time to gather info. Normal vaginal births do not receive the attention in research that complicated births do, but it is out there. I think that there will likely be many answers dependent on the mother’s medical history and the current pregnancy status (baby’s position, multiple gestation vs singleton, etc). Each category presents with a different risk level.

          • The Bofa on the Sofa

            Each category presents with a different risk level.

            Yes. For example, stalled labor has a higher risk than normal progression. Things like that.

          • SweetBabyJesus

            Source? And what is stalled labor in your definition? Normal or abnormal V/S present? Maternal age/medical hx/pregnancy hx?

          • Roadstergal

            So you don’t have any statistics on the risks of vaginal birth to mother and baby – what they are, what the prevalence is – but you still feel justified in railing against C-sections?

          • SweetBabyJesus

            Pretty sure I said I’d get back to you…? Are we unclear? Also, not rallying against cesareans. They save many lives. I’m rallying against unnecessary medical interventions, include avoidable cesareans. Said that already too.

          • Roadstergal

            The comparative risks of two procedures are exactly how one decides which one should be ‘avoided’.

            You sound like you’d be a fan of the UK OB who stated in print that she did not give informed consent about vaginal birth to her patients, because then too many of them would make the ‘wrong choice’ and ask for a C-section. The risks of vaginal birth are well-characterized. That you’re such a strong advocate for minimizing the use of C-sections without even looking for it is telling.

          • SweetBabyJesus

            Did you gather that I’m “that type” from the part where I said “I think that is a great question and vital to a true informed consent.” in response to your original question? Or are you just trying to make me look bad? I’m the type that is going to protect both the mother and the child’s well-being no matter what, whether that means they need a necessary cesarean or that they are a good candidate for out of hospital birth. Seems like no one on this thread actually wants to hear that there is a way that links both practices. It’s all or nothing huh? Also, still no one commenting on maternal choice here. What does her choice matter anyway? Dr knows best! And if she doesn’t choose the Dr’s advice she’ll get thrown out of care. Awesome way to advocate for the safest outcomes!! (That was sarcasm.)

          • Roadstergal

            “Also, still no one commenting on maternal choice here.”

            I actually did. That’s almost all I’ve been discussing. Choice is only real choice if it’s informed, and informed consent is most of what I’ve been talking about.

          • SweetBabyJesus

            I kinda got the feeling that by “informed choice” you meant “your choice”. My bad. Because no matter how badly you want someone to make the “medically sound” choice to cover your behind, they just might not. Then what?

          • Roadstergal

            Why would you think that?

            Anyone, with any doctor, has the absolute right to make a choice that is AMA. L&D nurses here have mentioned being present at situations where a woman was encouraged to have a C-section because the monitoring was showing fetal distress, but she didn’t want one. And she was 100% free to refuse, up to the point where she pushed out a dead baby. Women are free to make that choice. To give them bad information, however, is ethically bankrupt, to my way of thinking.

          • Statistically it isn’t needed? Statistics is WHY we do all that! A low chance of a catastrophically bad outcome (and I consider a dead person (mom, baby, or both) and a brain-damaged baby both catastrophically bad outcomes) is something worth avoiding!

            How many dead babies do you accept as “pretty low” to justify avoiding medically indicated C-sections? How many brain-damaged babies? How many women have to die of treatable hemorrhages before you say that, hey, low chance isn’t that low when it happens to you? You do realize that absent modern medical care, the maternal death rate is 1%. The neonatal death rate is 10%. Those are NOT low chances.

          • SweetBabyJesus

            Most of our babies are born in-hospital and the stats are bad for the US. This means that we are having far worse outcomes than other countries utilizing midwifery care for the low-risk in a collaborative care setting. “lay midwives” aren’t to blame for these stats–they make up such a small percentage of births attended. No properly-trained CPM is trying to avoid a medically necessary cesarean. For many states it’s actually illegal.

          • The Bofa on the Sofa

            Most of our babies are born in-hospital and the stats are bad for the US.

            Tell us about that. In what way are they “bad”? Can you summarize the stats to which you are referring?

          • SweetBabyJesus

            Gladly! The US ranks 54th for infant mortality and 48th for maternal mortality according to the WHO, ranking close to last place for industrialized countries, while having a cesarean rate that doubles or even triples the recommended rate set out by the WHO. Over 90% of births are attended in hospitals by OBs (very few even get the chance at a CNM) and we spend more per capita on birth in the US than any other country in the world. How are all of these poor outcomes cropping up when “lay midwives” only attend less than 5% of birth. Weird!

          • The Bofa on the Sofa

            Can you please tell me the definition of infant mortality and explain how it relates to problems with childbirth?

            Similarly, what are the childbirth practices in the US that create high rates of maternal mortality? How is our approach to childbirth causing heart disease, which is the #1 cause of maternal death in the US?

          • Fallow

            Citing infant mortality is the most rank amateur mistake in these arguments. you’d think you people would have adopted a new red herring by now.

          • SweetBabyJesus


            WHO infant & maternal mortality stats via the CIA:
            https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html
            ,
            https://www.cia.gov/library/publications/the-world-factbook/rankorder/2223rank.html
            http://evidencebasedbirth.com/

            “Why Not Home?” A new documentary following hospital-based birth
            providers who are choosing homebirth. http://www.whynothome.com/

          • Houston Mom

            You might like to read this recent
            study http://economics.mit.edu/files/9922 that analyzes the actual causes behind our infant mortality rate. Here is a magazine article summarizing it also http://www.theatlantic.com/health/archive/2014/10/why-american-babies-die/381008/

            You should realize that this rate is a measure of pediatric care as it includes deaths in the entire first year of life. To measure obstetric care, you should look at perinatal mortality rate (late pregnancy and neonatal period). This study showed that 40% of the difference in infant mortality between the US and Finland can be explained by how we count premature births. Extremely premature babies are counted as live births in the US, while other countries may classify them as miscarriages or stillbirths. The researchers showed that the mortality rate in the first month of life was actually LOWER in the US than in Finland. And infant mortality rates for babies from
            high socio-economic status families was comparable between the US, Austria and Finland. Where we are lagging way behind is in our care of the poor. US infants born to poor families die at much higher rates than comparable infants in Europe . Poor European babies are surviving in higher numbers because they have a more extensive social safety net, not because midwives are attending their births. According to the CDC, the five leading causes of US infant mortality are, in descending order, congenital malformations,
            prematurity, SIDS, maternal complications of pregnancy (like gestational diabetes and preeclampsia), and accidental injury. None of these problems will be helped by home birth or less educated providers.

          • SweetBabyJesus

            Thank you! I am going to include more perinatal mortality risk rates in my comments. I should not have overlooked it and I appreciate your info. I also couldn’t agree more about our lag in the care of those who are low SES. I think that qualified midwives do really well in the social aspect of their care with their patients and it is one of my favorite parts of the midwifery model. I am not sure how OBs do, I don’t have any specific evidence to show one thing or another. I imagine it’s similar but I don’t know.

          • Our stats in the US are bad relative to other developed countries, but if you pull apart why, you find it has very little to nothing to do with being born in a hospital and everything to do with lack of access to prenatal care. Our health care system is messed up, I think we can all agree on that, and it is not shocking that babies born to women who can’t access preventive and prenatal care are not as healthy or likely to survive as babies born to women who do have access. The stats for healthy (as in, no congenital defects), full-term infants in the US are actually very good; most of our neonatal mortality comes from preemies and micro-preemies who don’t make it. If you parse the stats for countries that do have collaborative care, you find that midwives even in those countries have worse outcomes than OBs; they still have more deaths of otherwise healthy patients than OBs have in the hospital, though it is lower than CPMs in the US.

            Lay midwives attend a very small percentage of births, but they account for a disturbingly large percentage of otherwise healthy, full-term newborns who die. They’re supposed to only take low-risk patients, and yet their neonatal mortality rate is way higher than OBs in hospitals that deal with the highest-risk of high-risk patients. That should tell you just how bad lay midwives are.

            CPMs try to avoid medically necessary caesarians all the time; breech, twins, 10+ lb baby, all variations of normal right? Who needs Doppler, we can just listen intermittently (and frequently fail to realize she is listening to mom’s heartbeat, not baby’s), right? Furthermore, CPMs aren’t trained enough to know when caesarians are necessary, and they can’t provide them in a timely manner given that you have to get to the hospital first. It simply isn’t safe to have an ill-trained or untrained person as a birth attendant, nor is it safe to give birth at home.

      • fiftyfifty1

        Find me one who has hospital privileges.

      • Ash

        MEAC accredited schools? Like this class that a learning objective is to list ONE medication of the following list of medications?

        http://midwiferycollege.org/AcademicProgram/Downloads/ASM/Academics/Syllabi/Syllabus-MOD3-MW300-AP%20PHARMAC.pdf

        “Define and give an example of each of the following”

        Wow, such a breadth and depth of knowledge.

        • Angharad

          I’m beyond appalled. First that they included homeopathy, and second that this is considered adequate training. I have no medical training and I’m pretty sure I could master this course and meet all the learning objectives in a weekend.

          • The Bofa on the Sofa

            I always think that we should do something like that. We could all sit the midwifery exam, and quite a few of us would pass, I have no doubt (and not just the medical types).

            So the next time some big mouth midwife comes in claiming about all their training, we can say, hey, we passed the exam, too.

          • Daleth

            I would love to do that. Sign me up.

          • Amazed

            Can I do it through a distance course? That’s a better fit for me and my family (remember the CPM in training chick we had last year? That was her reasoning why she didn’t aim for a CNM). Plus, the tickets over the big pond will bankrupt me before I can have my first disastrous outcome upon which the family will try to do so. In fact, they’ll bankrupt me before I even attend my first dozen of births in learning.

          • The Bofa on the Sofa

            Do you need to even take a course just to take the exam?

          • Amazed

            Oh my, you’re right! I was operaring on that silly mindset of someone whose experience is that she could not fly out of nowhere and just sit for the exam *hangs head in shame*

          • Ash

            You mean the NARM exam? No, NARM doesn’t require any sort of education beyond a high school diploma.
            Behold, the rigorous portfolio evaluation process

            http://narm.org/pdffiles/CIB.pdf

            http://narm.org/pdffiles/AppForms/PEP-ELInstructions.pdf

      • Daleth

        Have you read the Honest Midwife’s blog? I think you’d be interested:

        http://www.honestmidwife.com/download-pdf-2/

        • Megan

          I second this.

  • walkingman

    Does anyone know exactly where Jill Duggar received her training? Apparently at least part of it was correspondence? Does anyone know the institution? I’m curious if any of it was done through IBLP or any related institution or program or alumni?

    • Lisa

      Institute of Basic Life Principles, Advanced Training Institute–their “little homeschool group” i.e. Bill Gothard’s cult

      • walkingman

        I know all about IBLP (was raised in the program). I’m curious if Jill’s midwifery training was done through IBLP. I’ve been out of the program for nearly 20 years, and I’m not sure if they even have any midwifery training at this time.

        • Alisson Leech

          You were home schooled and the same type of Christian?

          • walkingman

            I was home schooled nearly my entire life. I left the organization nearly twenty years ago and am about as far away from religious fundamentalism as one can get. I feel like most people don’t understand how closely tied to IBLP the Duggars are, and I’m just curious whether Jill’s midwifery training has ties to IBLP.

          • Lisa

            Yes it was. She went to one of their Centers for her so-called academic work. I don’t recall which center–Texas I think?

          • walkingman

            Funny, I was on staff at the DTC under current IBLP President Tim Levendusky back when it was first occupied by IBLP. It looks like they are running a midwifery program there (http://ati.iblp.org/ati/students/opportunities/plsc/). I’m sure like every other IBLP program it’s a total joke.

        • Former.Fundie

          Jill did not attend any IBLP midwifery programs.
          Instead she was apprentice to a woman who has had her license pulled in multiple states!

          • walkingman

            I’d be surprised if she didn’t participate in an IBLP midwifery program, given her family’s close ties to Gothard. Surely she did more than a simple apprenticeship?

  • Eva

    The “doctor” who shares her personal opinion on Jill Dillard isn’t even a doctor. “Dr. Amy Tuteur is no longer licensed as a physician. The Commonwealth of Massachusetts Board of Registration in Medicine reports that her license expired in 2003.”

    In addition to NOT having a license to practice medicine, she has lots of controversial opinions on a variety of medical issues. I’ll take Jill’s recent certification over this quack any day. You can read more about her by googling her name.

    On a more personal note, only one of my four children was delivered by an MD and she very nearly cost him his life. My other three were healthy, happy, goofy, giddy babies delivered safely by a nurse midwife in a local hospital. She is actually godmother to one of my sons.

    • Azuran

      An expired medical liscence is still much more than Jill Dillard will ever even come close to having.
      She is not even a nurse midwife.

      • DistractedBySparklyThings

        She has some expired milk in the refrigerator, therefor she is a nurse midwife.

        • Jocelyn Glanfield

          😀

    • Blue Chocobo

      Her opinions on medical issues are actually quite mainstream. Her unwillingness to pander and to cash in on popular trends is certainly uncommon, but since she allowed her license to expire (when she stopped working to raise her kids) she has zero financial incentive to be popular and every ethical reason to promote integrity, honesty, and evidence based recommendations in pregnancy and parenting advice.

      • Who?

        That must kill the homebirth pushers-stay at home mum, marathon breastfeeder-Dr T would be their poster girl if she would bend just a little.

    • Who?

      Let’s be clear-if Dr T was no longer licensed as a physician, but agreeing with you, you’d be plastering her remarks all over the internet:

      ‘Look, everyone!! A doctor agrees with us! OMG what we’re doing is safe!! And wholesome and other good things!’

      And the really sad thing is even though you claim to despise doctors, if you had a car accident, or a really serious illness, you’d expect a doctor to fix you, just like you expect doctors to fix obstetric emergencies that arise at homebirth.

      You are a piece of work.

      • David N. Andrews MEd, CPSE

        ‘Shit’ doesn’t start with ‘w’ and end with ‘ork’ ….

    • Nick Sanders

      Her license expired, her degree didn’t.

    • Dr Kitty

      It’s considered an ethical violation for me to accept a Facebook friend request from a patient…I’m not sure the fact that your CNM is a godmother to one of your children is the endorsement you think it is.

      • Fallow

        I KNEW IT. My friends who used homebirth midwives, are all Facebook friends with their midwives. It FELT unethical, but I had nothing solid to hang that belief on.

        • sapphiremind

          It’s a grey area. It depends on the relationship established via that friendship. I have a collection of former patients in my facebook – they are all blocked from seeing anything except what I specifically tag for them to see, and I recommend they block me from seeing anything except the occasional picture of their child as it grows. You have to be able to maintain professional boundaries, and it is difficult but not impossible with social media.

    • The Computer Ate My Nym

      I’m not sure you understand how licensing works. In the US, a license to practice medicine in a particular state is needed to set up practice in that state. A medical degree (MD or DO) is a requirement for obtaining this license. The license itself is not the degree and its expiration does not imply anything except that it must be renewed prior to the physician practicing in that particular state again. Dr Tuteur could renew her license or obtain a new license in any state, but she chooses not to because she does not want to practice medicine at this time and does not want to waste her money paying for a license she will not use.

      • Wren

        How many times has this been explained now? Honestly, anyone who actually wanted to know this would know it already.

    • areawomanpdx

      This just goes to show just how little these idiots know about anything. When you graduate from medical school, you get an MD and are a doctor, whether or not you’re licensed to practice. Once a doctor, always a doctor. And Jill Dillard is not a nurse midwife. Far from it. A correspondence course and watching another fake midwife deliver a few babies is nowhere near equivalent.

    • Daleth

      A person who has an MD degree is a doctor.
      A person who has a JD degree is a lawyer.

      Whether either of those people is a PRACTICING doctor or lawyer–in other words, whether they are currently licensed by a particular state to go to work every day and earn their money from being a doctor or lawyer–is a different question.

      That’s why we have the terms “practicing doctor” and “practicing lawyer,” or for that matter “retired doctor” or “retired lawyer”–because some doctors and lawyers are no longer practicing, whether because they have retired or for some other reason. They’re still doctors and lawyers… just not practicing ones.

    • Alisson Leech

      So what? She is still a medical DOCTOR.

    • Monica

      You do realize that you are sharing information that is right in her bio on her page here, right? She still has far more education than Jill will ever have on the subject even if she isn’t actually a licensed doctor. It expired, which means she simply didn’t pay to renew it in 2003, not that she was caught doing something wrong. It’s called retirement, perhaps you’ve heard of that concept? If a doctor isn’t going to practice medicine then why would she keep her license up to date?

    • Rachele Willoughby

      Can we have a post in how medical licensing works? You could link it in your bio and we could stop explaining this all the time.

      Repeat after me, ladies: A woman’s credentials are not worthless simply because you disagree with her.

    • Former.Fundie

      The so called midwife who Jill was apprentice to, has had her license pulled in multiple states! Mothers and babies have almost died / suffered irreparable damage under her “care”. This needs to be exposed!

    • John Rally

      And where did you get your medical degree Eva?

    • Jessica Matthews

      When she retired, POOF! She forgot everything!

    • Montserrat Blanco

      I am sorry that you had a bad birth experience. I hope you and your kids are fine.

      Once you get your MD you usually get it forever. It is very difficult to be stripped off that title. Even if you are not allowed to practice anymore you do not lose your MD.

      In order to practice medicine, however, you need a license. As someone else explained below one of the requirements for getting a license is to hold a particular title, in this case an MD.

      Take my case, for example. I live and work and practice medicine in Spain. I got my MD in Spain, got a license in Spain and started to practice medicine here. At some point in my career I moved to another EU country for some time and I registered there as a doctor. I got a license there and was allowed to practice medicine there. When I moved back to Spain I asked for my license in said EU country to be “stopped” as I did not want to practice in that country anymore. I appear as having relinquished my license in that country doctor’s registry. If I decide to move there again I might want to work as a doctor again and I am allowed to do it providing I pay the membership and I show I do not have any malpractice proven. It is pretty common to stop being registered and doing so out of the person’s will. It does not mean you have committed malpractice and does not mean you are not allowed to be registered again should you wish to do so.

      • seekingbalance

        same idea here in the states. I used to practice (and be licensed) in california. now I practice (and am licensed) in oregon. when I moved out of california, I wrote to their medical board and let them know–effectively “stopping” my license by not renewing something that I wasn’t using anymore. didn’t feel the need to pay thousands of dollars per two years for it. no malpractice or sanctions or anything unusual on my record. knock on wood. 🙂

  • Amy

    It’s really appalling. None of the Duggars has even the equivalent of a GED. The homeschool curriculum they used consisted of “Wisdom Booklets” based on Bible stories with nominal connections to history, English composition and MAYBE some really basic math. No science. They were too busy learning how to mix concrete and sew bridesmaids’ dresses on TV.

    • EmbraceYourInnerCrone

      How the hell is she going to for instance,estimate the amount of blood loss after a delivery and understand that what she is looking at is a PPH and if she doesn’t get some REAL professional help the mother may die. People playing at being medical professionals make me furious. My mother listens to all these acupuncturists and chiropractors and thinks they can help my Dad. Thankfully he has not tried any of them yet, but still she persists. Then she starts on the “Your father and I are on too many drugs!” Umm you are 85 and 87 respectively, you only GOT to be that old because you had meds to treat your Diabetes and high blood pressure, and prevent you from stroking out (or having your AAA aneurysm blow). Arrrggghhhh!

    • Eater of Worlds

      Actually, the Duggars do take the GED. How they pass it, I have no clue.

      • fiftyfifty1

        Because the GED is extremely basic.

        • Mary Teresa Crowley

          I don’t what state you in fiftyfifty1 but the GED isn’t basic at all.. They changed to make it harder actually… I’m studying for my GED so I know if it’s easy or not and I wish it was easy or basic.

          • fiftyfifty1

            What I mean by basic is that it sticks to the basics. It doesn’t ask questions about things that the Duggars wouldn’t have encountered such as evolution, the Scientific Method, philosophy or honors math. All you need to pass is a reasonably strong grounding in the basics such as algebra, reading and writing. Sure, that could be plenty difficult for somebody who didn’t finish school and maybe hasn’t used these skills in years. But that’s not the situation for the Duggars.

            ETA: Best of luck to you!

          • Mary Teresa Crowley

            Thanks 🙂 I understand what you mean 🙂

        • Alisson Leech

          Umm, no it isn’t. I have heard stories about it being hard. Not defending the fame sucking Duggars either.

        • Lisa

          Its actually easier to show up for high school and get a General diploma than to pass the GED these days.

      • Lisa

        Not defending them but they do more than the Wisdom Booklets. They used to use Switched on Schoolhouse which is on par with the curriculum in many alternative high schools. I have personally seen it. Again, not defending them, but it is incorrect to say they just use the wisdom booklets.

  • ersmom

    CPM = Certified Play Midwife.

    • Daleth

      Certified Pretend Midwife.

    • Jocelyn Glanfield

      Certified Phony Midwife!! 🙂

  • Jenny_from_da_Bloc

    Jill Duggar didn’t even realize the danger and distress her own baby was in during her attempted stunt birth. Her baby was breech and over 9lbs, a recipe for disaster and she still wanted to give birth at home. My prediction is she will be pregnant within 6 months, attempt to have another home birth with a large baby and a uterine rupture is bound to occur. Between their fundie beliefs and lack of education she is going to hurt or kill someone, possibly even her own unborn baby. They will call this God’s will instead of what it really is, medical quakery

    • AirPlant

      I have a little more hope for her I think. Their family places a high premium on the life of their unborn children and both her andher mother was more than happy to accept medical intervention for their pregnancies when things went sideways. I can’t imagine that the spacing will be ideal for a VBAC attempt but I don’t see the OB raising too much of a fuss. You can expect her to have 10 pregnancies at the very least and that tips the risk/benefit ratio quite a bit.
      If anything I would bet that her obtaining her CPM license is just so that she can keep her ability to leave the house and bring in some money now that the reality TV gravy train is drying up.

      • Jenny_from_da_Bloc

        I surprised she continued her “education ” after she got married. I don’t believe that they put such a high value on life considering that she put her own baby’s life in so much danger knowing what she knew about him being breech, her membranes being ruptured over 24+ hours and laboring over 72 hours. Then they were more concerned with her being sewed up tight so she could attempt more homebirths instead of recognizing that she and her baby eluded danger very narrowly. Look at what the mother did and continued to do until one baby was premature and one died in utero and they still continued to try and conceive. They value sex and reproduction, but not necessarily life

        • AirPlant

          It might have been a publicity stunt but they made a pretty big deal over their miscarriage. If I remember right they had a name and a full funeral with some glamour shots of the fetus. I am the last person to defend these people, but they did appear to want and love that baby and they did everything in their power to save it. After the disaster that was her first birth Jill and her husband have to know that her death is a real possibility and for all their religious bullshit they genuinely seem to love one another. I can see them attempting a homebirth again after a sucessful VBAC, or trying to labor at home as long as possible, but with their family still just starting I don’t think they will screw around, particularly when her fertility could be at risk.
          I tend to be a sunshine and roses kind of person though so it is possible that I am just grasping and the happiest outcome, but I hope that I am right. Just because her mom shot out kids like a t-shirt cannon is no promise that her daughters will do the same, and it would break my heart for one of those poor girls to die before they really get to live at all.

          • Roadstergal

            I give that creepy den of child molestation the benefits of no doubts at all, given how little they cared about the well-being of their daughters once out of the womb. They care about optics, not about people.

          • Jenny_from_da_Bloc

            It breaks my heart to see the Duggar women suffer at the hands of Jim Bob. Michelle should have never had to bury her baby and it would not have happened if they had accepted the blessings given to them and realized that her body could not cope with a 21st pregnancy, especially after their last daughter was born so premature due to Michelle’s advanced maternal age, pre-eclampsia and her uterus being just plain worn out from so many pregnancies and births. I hate to see any women suffer the loss of a baby but at some point they need to have some personal accountability for their bodies and the health of their babies. Instead, they believe and trust in some archaic interpretation of the Bible that says they should fill their quiver with arrows for God. These women are being led like lambs to the slaughter house in the name of Jesus by their maniacal father and husband. It is sickening to watch these beautiful, smart and talented women be turned into nothing but breeding machines instead of reaching their true potential or given the opportunity to get a real education and experience the real world on their own terms. If you watch the show, Jim Bob always says that of each of his kids have X amount of kids he could have X amount of grandkids and to me it is sick. I believe they love their children, but put no real value on the quality of life they would have without a proper education or the opportunity to explore the world for themselves. These children are stuck in such a narrow tunnel that they will never be given the chance to grow or foster any idea outside of what their father dictates for them

      • swbarnes2

        I think I’ve read elsewhere that CPM is a common career for these women, their culture doesn’t allow them to have very many kinds of jobs outside the home, but this one is considered okay.

      • acumenata

        I think dabbling in midwifery without proper education makes her a danger to herself and others. Neither enthusiasm nor personal beliefs that place a high premium on life diminish ignorance.

    • Elizabeth A

      Jill Duggar is on record as saying that her long labor helped her and her husband bond. This is a hideously dangerous attitude for someone who will be monitoring other women’s labors. Labor is an exhausting exercise, and it’s possible for women to labor to death. Someone who believes that prolonged suffering is a positive emotional experience may not be sufficiently alert to the harms that can come from it.

      (And IIRC, her baby was undiagnosed transverse? So any labor at all was futile. She could have had a pre-labor c-section and bonded with her husband over night feedings or showing the baby his first televised ball game, or WHATEVER.)

      • Roadstergal

        I feel like it’s related to the creepy pain fetishization that was on display with the “C-sections are bad, look at my GF in pain!” photo spread. Pain fetishization belongs in safe, sane, consensual bedroom times, not with your baby involved.

        • Lisa

          I was surprised–her mother went straight to the hospital when it was dangerous–even before TLC.

          • Blue Chocobo

            Her mother wasn’t raised on camera.

      • The Bofa on the Sofa

        Of course she needs to find a way to put a good spin on it, because otherwise people are going to question her sanity for choosing to do it.

      • Jenny_from_da_Bloc

        So protracted and unbearable pain that endangered their son’s life brought then closer together? Well that’s a first for me. (sighs when head hits desk)

      • Jocelyn Glanfield

        I was waiting for her to have a shoulder dystocia – it was evident she was having a good sized babe & with being past her EDD I wondered… I absolutely agree with you about the “hideously dangerous attitude” too!! I sort of choked when she said they “were encouraged” by the fact things didn’t go to plan… that “God” was “directing their steps”. If it weren’t so utterly dangerous & appalling it would be funny.

  • attitude devant

    Reading this, I’m reminded of Vyckie Garrison’s harrowing descriptions of her births within the Quiverfull world. For the cult, the idea of a believing, minimally trained midwife is entirely consistent with the rest of the doctrine: women are submissives whose role in the family is to bear and raise children. If a woman or a child dies in that process, it is a matter for faith and prayer, not for science or medicine.

    • Renee Martin

      Her stories are hair raising, I simply cannot believe that woman is still alive! She was unfortunate to be caught up in Quiverfull, which is horrible zealotry as well as NCB beliefs.

      However, her stories aren’t even uncommon, and that is whats so scary. She continued with HB because of her religious beliefs, at the time, but she could have easily been just a secular NCB kool aid drinker.

      • yugaya

        There’s a website documenting birth and infant deaths and medical neglect abuse in some fringe Christian cult in Idaho, linking to coroner and autopsy reports. All births are reported as unassisted in order to cover up for illegal faith homebirth butcher attendants.

  • Bombshellrisa

    The midwife that was preceptor to Jill Duggar recently lost her license. It’s scary to think what Jill was taught to be “variations of normal”.

    • Gene

      How bad does a fake midwife have to be for the fake credentialing group to take her license away?

      • The Bofa on the Sofa

        Dennis Miller: “What the F%$^ do you need to do to get kicked out of GunsNRoses? ‘Izzy, get that heroin needle out of your dick and get over here!'”

      • Bombshellrisa

        She delivered a baby who almost died due to untreated GBS in the mom. Her explanations are all about her, as seen by her Facebook posts. She is still catching babies, she has learned nothing.

        • Ash

          Yes, the MW moved so she could practice in another state after she was reprimanded.

          • Bombshellrisa

            Wonder if that makes her an official sister in chains?

        • Who?

          The really annoying bit about this is the self-absorption. No thoughts expressed for the baby, the family or any of the other participants in this little tragedy: it’s all about her. No hint that she might reflect on how she practises, or even wonder what she might do differently next time.

          I love ‘…so long as I am able.’ since able she is not. Willing, yes; ready (at least in her own mind at least0, certainly. But able (as in prepared and competent), not at all.

        • The Computer Ate My Nym

          Is it just me or did she basically claim that it was the baby’s fault for giving her “mixed signals”? WTF is the “looked me in the eye” bit about anyway?

        • Angharad

          She fought for her “right to make the call”? What does that even mean? As far as I know, medical professionals don’t have a right to misdiagnose life-threatening conditions. When it happens, it isn’t because they had a right to do it, it’s a terrible tragedy and possibly malpractice, not standing up for their unalienable right to be wrong.

  • JJ

    The Cal Assoc of Midwives are trying to pass SB408 to make “midwife assistants” legal to even further lower the standard of our care providers! You can become one through a distance learning program for $1,250. (Two of my sisters are cosmotologists and had more rigorous standards to get trained and licensed!)

    • YesYesNoNo

      Dog groomers have more rigorous standards and training.

    • Liz Leyden

      Nursing assistants get more hands-on training.

      • Bombshellrisa

        They also can’t just move to another state and take up where they left off if they have had their license revoked.

  • Lana Muniz

    Great article. Thank you for writing this!

  • Anonymous

    What I really wonder here is how much people would believe this in other fields:

    CPP: Certified professional pilot. No need to go to flight school, just fly on a couple of planes and read a book. Great job openings, people just go to your website. You don’t even need to have insurance!

    CAP: Certified architect professional. Why spend years learning about drainage, pressure, etc when you can just take a correspondence course and walk around a few buildings?

    CPW: Certified professional welder. Who needs 1000+ hours of actual training and a firm understanding of metallurgy to bond metals for highly dangerous and stressful tasks like aircraft wings, submarines, cars, and boats? Just take this online class, look at a few welded pieces of metal and viola!

    • Squillo

      But people die in planes flown by CAA-certified pilots all the time. Clearly, the absolute numbers of aircraft fatalities show that CAA certification and licensing isn’t any better than CPP.

  • Anonymous

    I’ve sen exactly one CNM attend a homebirth and that was by accident. She decided to participate in our hospital’s “ridealong” program and found herself in the middle of a woman giving birth in a motorhome on the highway on the way to the hospital. I guess that’s “technically” attending a homebirth.

    • Roadstergal

      A motorhomebirth! Don’t give them any ideas…

      • fiftyfifty1

        Isn’t that where Ina May delivered her first? Or was it a bus?

        • moto_librarian

          Bus.

      • Anonymous

        Believe me the CNM was petrified. She had on a BT headset and was conferencing one of the senior OBs the entire time.

        • Kelly

          She did not trust birth. Good for her.

      • Inmara

        My mother-in-law could give them even better ideas, like, attending birth in horse-drawn sleigh in deep snow because ER van which was supposed to drive birthing woman to hospital slid into ditch. Fun times for ER nurse, and it was only one of her stories from time when she worked on ER in rural area.

      • SporkParade

        Ugh, I Facebook-know someone who is planning a homebirth and her biggest fear is going into labor too far away from home to drive back in time to deliver. Because her first birth was 13 hours from start to finish and her mom and sister had second births that were both under two hours. I am shocked that her midwife has not counseled her that she should be in the hospital given her history. But I have reason to believe that her midwife isn’t a real midwife given that her first homebirth was illegal.

  • KBCme

    I know a few wonderful, very skilled CNM’s. None of them would *ever* consider attending a home birth. Why? They have the education and experience to know all of the awful things that can happen even to the low risk patients. They know that a hospital is the safest place to have a baby. CPM is as phony a title as my BSD (Bullshit Detector) title.

    • The Bofa on the Sofa

      Should I change my title to PCM*** again in honor of this post?

      ***Pablo Certified Midwife

      • Amazed

        Do not. They’ll probably mooch off yout reputation as well. You’re better trained than any of them since you know the basic rule for a safe homebirth: Get your ass up if you can manage in between contractions, get into my car and let me take you to the freaking hospital!

        • The Bofa on the Sofa

          …and turn on the 80s station on the radio on the way.

          • Amazed

            I guess that means I failed my PCM exam again? Third time in a row… They’ll use THIS to show how high standards CPMs, aka PCMs hold. If you won’t take an Amazing Ms Amazed like me, what are the chances for someone not so amazing? That shows how strict they are!

          • For a low fee, you can take the Certified Hamster Midwife exam. The CHM credential is like the PCM credential, only we are experts in normal birth and eating your newborn(s) afterward.

          • Amazed

            What about the baby’s spiritual twin? Do moms get to keep it until it grows stale and mouldy? Can they make a spiritual twin cooklies still?

          • SporkParade

            Can I use attending a gerbil delivery towards my CHM credential, or does it have to be hamsters?

          • Mad Hatter

            I’m going for Certified Bovine Midwife. After all the cow and goat deliveries I’ve observed on the farm along with a few diy vet books, surely I’m qualified. Not to mention the numerous times I’ve had to pull calves after being up to my armpit in the cow to re-position a calf.

          • Who?

            as if being in labour isn’t bad enough.

            that’s just mean.

          • Megan

            Actually, I’m a big fan of the 80’s station, but maybe I’m showing my age…

          • Who?

            In the supermarket this morning they were playing Eric Carmen ‘Make me lose control’. I swear half the shoppers were singing (crooning, really) along.

            I was a young adult in the 80’s, but tend to prefer 70s music, or jump way through to the early nineties.

          • Megan

            I’m a bigger fan of 80’s alternative: Tears for Fears, Depeche Mode, REM, The Clash, etc. I actually wasn’t a teenager until the 90’s but my mom got me into music from a very early age. I remember singing along to the radio at age 5 or 6.

          • Who?

            You’d love my husband’s cd collection. All that plus Colourbox, Propoganda, Style Council…

          • Megan

            Nice.

          • Roadstergal

            And the Eurythmics… and Cyndi Lauper…

          • Who?

            Alison Moyet.

            And just btw how amazing do Annie Lennox and Cyndi Lauper continue to be?

          • The Bofa on the Sofa

            Love Eric Carmen. “Go All the Way” by the Raspberries is one of the best songs of all time, and his 80s stuff is also good.

            “Jennifer sings Stand By Me and she knows every single word by heart ”

          • Who?

            Well you would have been loving the supermarket this morning.

            Not familiar with the work of The Raspberries, just you tubed the song, and thought it was going to be like ACDC, but it wasn’t. Sad face.

          • The Bofa on the Sofa

            ACDC? It’s Eric Carmen!

      • attitude devant

        Since you asked….
        While I love you as Bofa (HOW MANY TIMES did I read that book to the girls????) I really really really miss Pablo PCM. Just saying…

        • The Bofa on the Sofa

          Sorry, sometimes you have to grow and change. Like Peter Brady’s voice did in the “Dough Ri Me” episode of Brady Bunch.

          Then again, some things never change.

    • Tumbling

      I live in NZ, and am appalled by the number of midwives here who volunteer for homebirths. Yes, they’re fully trained and certified, but they seem to believe that homebirth is just as safe as hospital birth. I don’t understand this at all.

  • manabanana

    “Why are the minimum standards so low?”

    And why is the ACNM cavorting with MANA/NARM/MEAC etc in US MERA and endorsing standards for midwifery lower than their own excellent standards?

    Would love to hear Judith Rooks’ opinion on this one.

  • Monica

    Isn’t she going to take her counterfeit experience to women who are already seriously lacking in medical care to boot? It’s just the gift that keeps on giving, err taking I suppose ;).

  • Roadstergal

    “if the birth is uncomplicated a taxi driver can do it and legions of taxi drivers have done it successfully and for free”

    It’s been mentioned here many times that a taxi driver is probably a better attendant than a CPM. A taxi driver won’t try to keep you from going to the hospital or talk you out of it, and he/she will likely get you there rather quickly.

    • Sarah

      Basically, John Travolta in Look Who’s Talking is more qualified than CPMs.

      https://www.youtube.com/watch?v=ahk8bfWRi2A

      • Roadstergal

        Well, of course – he’s an Operating Thetan… *ducks and runs*

        • namaste863

          You rock!

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  • Mel

    And now, Jill Dillard is off to practice pretend-midwifery on the good people of El Salvador where she’s away from the media spotlight when a baby or mother under her dies.

    I looked over the CPM guidelines for the test; I’m pretty certain I could pass the exam and I’ve never been at a human birth.

    I noticed that the guidelines are bad by standards for white, middle-class women who probably have access to doctors most of their life.

    I also noticed the absence of the following words: chronic malnutrition, malaria, HIV/AIDS, Hepatitis B or C, or Chargas disease. Nothing about arraigning transport in a poor country or counseling women on saving to cover an emergency medical surgery because ER care of all comers regardless of pay is not universal.

    Plus, she doesn’t speak Spanish with any level of fluency.

    She’s on her way to a death trap – and I doubt she’s educated enough to realize that. I just hope she gets out and gets counseling before too many babies and moms dies.

    • Mel

      Oh, also:

      The website is covered in potential repercussions on signing off on student “midwives” credentials when you’ve never seen the practice.

      Holy.FUCKING.SHIT.

      You can’t even get your proctors to obey the rules.

      What part of professionalism DO you understand?

    • Michele

      I hope she, and her “patients,” are lucky and that this Certified Pretend Midwife doesn’t kill or severely injure anyone. Because that’s all it will be, luck.

    • fiftyfifty1

      “And now, Jill Dillard is off to practice pretend-midwifery on the good people of El Salvador where she’s away from the media spotlight when a baby or mother under her dies.”

      Her hero complex is vile, isn’t it?

      News flash for Gringos: When they named their country El Salvador they weren’t, in fact, referring to you.

      • Mel

        Honestly, I think she’s more ragingly naive than anything else.

        She has no education at all – she’s been home-schooled her entire life and the one “science” lesson I saw on the single episode of “19 kids” was barely acceptable for a 5 year-old and completely horrifying to have teenagers involved in. She can’t have the scientific literacy or critical thinking skills to figure out that she’s a shill in the CPM game.

        She lives in a homogeneous community and has been sheltered from any people substantially different from her. She’s been on a few mission trips but never for an extended time or in particularly remote/dangerous situations.

        She might have a hero complex – but I think it’s more likely that she has NO freaking clue of what is actually going on or what is actually needed on the ground.

        It reminds me of the speech that Maggie Smith’s character gives Whoopi Goldberg’s character in “Sister Act” describing the naive sisters moving out into a dangerous neighborhood:

        “It’s one thing to rabble rouse, to sweep into town and declare a holiday. You’ve raised the sisters’ expectations. You’ve excited and confused them. They imagine this neighborhood to be some sort of delightful ongoing bake sale. Now, you and I know that things are not that simple. There’ll be disappointments and rude shocks. And you will have vanished. How fortunate.”

        • Renee Martin

          Then lets hope she LEARNS SOMETHING while she is out there instead of just causing more harm.

      • Sue

        “News flash for Gringos: When they named their country El Salvador they weren’t, in fact, referring to you.”

        Touche’ !

      • The Computer Ate My Nym

        Hero complex or just the only acceptable excuse to get the heck out of the awful situation she’s in? She’s probably never been out of her home state before and El Salvador likely sounds exotic and interesting. And she can go there without unduly upsetting her owners.

    • RMY

      It’s going to be horrible. I really hope she has the self awareness not to be one of those “it must’ve been God’s will” people.

      • Lil’ Kitten Girl

        You know that she will be one of those people.

    • Squillo

      Maybe she will learn something useful from the traditional midwives there, since she plans to practice developing-world midwifery back in her own country.

    • Jenny_from_da_Bloc

      She also won’t recommend or counsel on birth control or spacing out pregnancies either. Her birth bag probably includes a hacksaw, fishing line and some tape to repair 3rd and 4th degree tears. Jill is way too indoctrinated and brain washed to ever get the helpnthat she needs and what is sad is she is going to a 3rd world country to spread the Duggar’s special blend of insanity and reproductive madness on those poor women who don’t know any better. This poor woman truly believes that what her brother did to her wasn’t molestation or sexually assault because she was sleeping. He molested her and 3 of her sisters and one of them was under 5. Jill and Jessa came forward the other two are obviously Jana and Jinger because there were no other sisters born yet besides Joyhanna who was an infant/toddler. So that sicko Josh was sexually assaulting babies and they think it was just an adolescent/pubescent mistake. Jim Slob and Michelle knew what he did and just gave him free reign to abuse their daughters because they didn’t want to do the right thing and get their pedo son some help. They didnt get there kids professional help because it would mean their daughters would speak to people who would have educated them on their rights and other “worldly” beliefs. Ugh don’t get me started on the Duggar’s, they are a cult and use their cheery and delusional version of Christianity to brainwash their children and now their children’s spouses. TLC sponsored and supported child abuse and emotional abuse for the viewing pleasure of America.

      • RMY

        TLC, like most channels, is only about selling advertising time. Well being of the people involved be damned as much as they’re legally able to get away with it.

      • Renee Martin

        Women in developing nations aren’t fools. They lack resources, and will go along with whatever is needed to get them, but they are not fools. Lots of women resist fundy zealots trying to convert or help them!

        • Jenny_from_da_Bloc

          Thank god right lol

      • Lurker

        No, Joyanna was a victim. She was the only one still under 18 when it came out, and someone was able to get the records destroyed when it came out, on the grounds that she was a minor. So yes, Josh was molesting a toddler.

        Also, from the police report, he may have molested Jill while she was sleeping, but the two younger girls were wide awake (he trapped one in the laundry room and was reading to another who was sitting on his lap).

        • Jenny_from_da_Bloc

          Wow…. even worse

    • Monkey Professor for a Head

      I just had a quick glance at those guidelines. They recommend use of “non allopathic medicine” in the treatment of shock. They do suggest fluids and transfer as well, but still wtf. If someone’s in shock (and I mean the medical definition of shock, not emotional) then that is a life threatening situation. Don’t feck around with homeopathy and herbal medicine when someone’s life is in danger.

      They also suggest castor oil for post dates induction and an alcoholic drink for pre term labour.

      • Mel

        It is honestly a surreal reading experience. The section where they list actual drugs that can control PPH – and follow up with homeopathic remedies.

        The part that scares me is the distance / time to real medical help. Relatively few mothers have died in the US, EU or Australia at least in part thanks to EMTs who arrive within 10 minutes and can start fluids before mom bleeds out even if the baby is dead. I’m betting that the Dillards will be working in a rural area where an emergency could easily lead to maternal death as well as infant death. Plus, I doubt Jill has learned how to do most of the genuine medical practices allowed for CPMs. Where would she get the drugs she needs to stop PPH? Can she test for STDs or HIV? Does she know how to take BP?

        • Ash

          Arkansas doesn’t allow prescribing privileges of any medications for lay midwives , so…hemorrhage =herbs and chatting, basically.
          http://www.healthy.arkansas.gov/aboutadh/rulesregs/laymidwifery.pdf

          • Don’t forget cinnamon candy!

            What’s more likely in Arkansas is that they do carry useful drugs, telling the patients that they’re “herbs” or “minerals” when injecting them.

        • Phascogale

          You can always chew on a bit of your placenta to stop a PPH

      • Nick Sanders

        Wait since “allopathic” is the homeopaths’ term for counteracting a symptom instead of trying to double induce it, wouldn’t that mean that they are saying people who have lost blood shouldn’t get transfusions?

        • Sue

          Exactly, Nick! This term drives me crazy when applied to modern medicine.

          “Allopathy” was a term coined by Hahnemann – the German dude who made up homeopathy. The idea was that Homeopathy treats like-with-like, while “allopathy” treats disease with the opposite of that condition. Unfortunately, Hahnemann, working in the pre-technological era, knew very little about pathophysiology.

          Conventional medicine isn’t “allopathic” – it’s multi-modal – from counselling to vaccination, surgery, antibiotics, insulin. The term “allopathy” is meaningless, and generally only used by people who don’t understand how medicine works.

          • Mariana Baca

            It just occurred to me that Homeopaths should endorse vaccination. It treats “like with like” — i.e. uses a protein expressed by a virus to prevent said virus, and uses extremely low concentrations of said antigen to prevent a full-blown infection.

          • Sue

            Ironically, Mariana, I suspect Hahnemann developed his ideas because, at his time, so much of illness was infectious, and the concept of acquired immunity was developing. In his own context and time, what he said had more plausibility than much of medicine at the time (eg blood-letting).

            Even more ironic that, now we understand the immune system at sub-cellular level, proponents of homeopathy reject real immunisation and prefer to deliver magic water with a mere “memory” of a “remedy” in it – and generally not an infectious agent anyway. Sigh.

          • Roadstergal

            Homeopathy caught on because ‘heroic’ medicine, in favor at the time, wasn’t science-based, and was quite bad for patients. Doing nothing (homeopathy) was actually better…

          • Roadstergal

            They go in the other direction – they try to justify homeopathy because vaccines. But that misses the point that a: there are measureable (though small) quantities of antigen in vaccines, which b: have a measurable effect vs placebo.

      • Azuran

        Give them homeopathic blood transfusion 😉 http://gomerblog.com/2014/12/blood-bank-2/

  • Hannah

    You’d think she would have learned better after her own emergency transfer and C-section. Sadly, her desire to have a job at all is likely preventing her from seeing it.

    • Angharad

      Unfortunately that probably just cemented her belief that there will always be plenty of time to transfer in the event of an emergency.

      • Mel

        I am very curious – and will never know – how the medical professionals take on her labor and delivery vary from the story sold the media. What I heard from People was “20 hrs of labor at home – Jill sees meconium, goes to hospital – labors for 50 more hours – has baby!”

        What I read between lines: Primigrav. with minimal prenatal care appears with very post-date pregnancy, broken waters and meconium staining. Medical professionals spend 50 hours trying to keep the baby alive while mom lives in denial. Mom eventually gives in due to ….something?. Docs pray during CS that the baby is alive and not having meconium inhalation or a massive infection…..

        • Lisa

          BUt if she’d died they’d have blamed the hospital for interfering and she’d have been a martyr.

  • Sarah

    This is the point that I don’t understand this debate anymore. If your goal is to have a birth as “unhindered” by “unnecessary interventions” as possible, why not find a CNM who practices in a hospital or as part of a larger OB/GYN practice? Why is the focus on leaving the hospital (and potentially life saving interventions) and putting our lives and babies in the hands of self certified individuals and not having a safe and secure place where no decisions are made without your input or knowledge of all risks and benefits? I thought this was about empowering women, not pushing them towards a less informed choice.

    • Amy M

      It’s the ostrich thing: they don’t want to know. If they know they are taking a huge risk, they can’t justify taking it, so they insist the risk is small. If they know there’s a complication, they have to address it, so better not to know, and then no action is necessary. In these cases, less information is “empowering” the woman to stubbornly insist on the homebirth. She knows she’ll likely get push-back from friends/family so if she knows nothing, she can tell them (and herself) that she is making the right choice, because no news is good news.

      As soon as she admits there is a problem or risk, she’s handing over power to a medical provider. Of course that’s not really true, because a women in her right mind can refuse any treatment. But if that old “dead baby card” is played, and the baby is actually killed or injured, well, she must blame herself because she ignored potentially life saving advice. Instead, CPMs won’t mention any risk of death, and if it happens, its a lot easier to blame god, the universe, bad luck, etc and anything or anyone else but yourself. Deep down, I’m sure many, maybe most, women who lose babies at homebirth DO blame themselves, but that’s very hard to live with, so it must be quashed down.

    • YesYesNoNo

      Just go on babycenter, they abhor hospitals as well. They claim once you enter a hospital that you are on their time table; and that hospital must have you deliver within a certain time frame or else the evil interventons will occur.
      Only homebirths or births at a free standing birth center will suffice.

      • Roadstergal

        That’s a helluva advertising slogan, delivered in a gentle, calm female voice. “Come to our free-standing birth center. We’ll wait for your baby to die.”

    • The Bofa on the Sofa

      If your goal is to have a birth as “unhindered” by “unnecessary interventions” as possible, why not find a CNM who practices in a hospital or as part of a larger OB/GYN practice?

      Because the vast majority of CNMs work in collaboration with doctors, because they recognize the importance of quality medical care, which includes interventions.

      There’s a reason CNMs for the most part don’t do home births, and those that do tend to be at the whacko end.

  • JJ

    We have fake doctors as well: Chiros and naturopaths.

    • Who?

      Indeed.

      I sat in a marketing meeting this morning and listened to 3 different people, from 3 different organisations, touting their all-natural and chemical free cleaning and beauty products, described as being of great interest to the ‘ladies’ in the room.

      This woman almost had a stroke listening. There is so much of this nonsense out there and I swear it is getting worse.

    • Mishimoo

      There’s a local chiro who advertises via homemade leaflets. One of them ended up inside on the couch where our youngest likes to sit. He refused to touch it and threw a small tantrum until I took it away and put it in the compost. Children’s intuition *snickers*

  • Elizabeth A

    While a CPM is not a real midwifery credential (or a real credential of any kind) it is one of the few credentials (again, of any kind) that a woman who espouses Jill Duggar Dillard’s religious beliefs and pursues her lifestyle of female submission and constant childbearing can realistically obtain. Pursuit of a real nursing degree would take substantial time outside the home, and commitment to a career would take more. Extreme religious fundamentalist groups are comparatively enthusiastic about CPMs because it’s a way that they can pretend that it’s safe to avoid avoid engagement with medical institutions and authorities.

    I cannot say enough how much this is a bad idea.

    • mostlyclueless

      Frankly I’m shocked Jill Dillard is allowed to have a job.

      • Burgundy

        I truly believe she was allowed to have a “career” after their show was canceled. She is an attention hoarder and this new job has the potential to keep her and her family in spot lights and keep the money rolling in.

        • eli

          So she enrolled in classes and training for years before the show’s cancellation for a job she shouldn’t be “allowed” to have?

          • Bombshellrisa

            The point is that there aren’t any classes to enroll in if you want to qualify as a Certified Professional Midwife. Jill simply apprenticed a midwife and it’s not as involved as it sounds.

    • Barb Simkins

      I read somewhere that she wanted to be a “real” nurse but her father said “NO”. It’s probably true, because the Cult does not accept “real” education.