Kelly Brogan, will you take responsibility if a baby dies because of your misinformation?

responsibility

Kelly Brogan, “holistic psychiatrist,” and a charter member of the Quack Pack (along with Bob Sears, Aviva Romm, and other physicians who promote pseudoscience) recently shared a thoroughly misleading Facebook post about nuchal cords.

Kelly Brogan 9-5-15

Natural childbirth and homebirth advocates get very excited about nuchal (neck) cords, the medical term for an umbilical cord that gets wrapped around the baby’s neck. They get excited because they believe that obstetricians dramatize the risk of nuchal cords (“the baby could die”) when they aren’t dangerous at all. That claim is a deadly lie. It’s bad enough when a layperson makes a deadly claim, but it’s truly inexcusable when a physician offers misleading, potentially deadly information.

10-15% of stillbirths are associated with problems like nuchal cords and true knots.

How does an umbilical cord get wrapped around the baby’s neck in the first place? For most of pregnancy, the baby has a lot of room to move and the cord is relatively long. Moving around, up and down, and somersaulting, the baby can easily get the cord wrapped around itself. Most of these loops will slip off at some point, generally without causing a problem.

Contrary to popular belief, the danger of a nuchal cord has nothing to do with the fact that it is wrapped around the baby’s neck. Since the fetus does not breathe, compressing its neck has no impact on whether there is adequate oxygen in the blood. In other words, the effect of neck compression is fundamentally different than if the neck of a child or adult is compressed.

In order to understand the danger of a nuchal cord it helps to think of the cord as similar to the air line of a deep sea diver. It’s easy to understand that if a diver moved around such that he wrapped his air line around an object, it could pose a serious problem. If the air hose isn’t pulled tight, there is no problem. The oxygen can pass easily through the loop. However if the air hose gets pulled very tight, the diameter of the hose could narrow and, supply of oxygen can get cut off, and the diver could die as a result.

Similarly, a loose true knot in the umbilical cord is not a problem for the fetus because the oxygen continues flowing through the loop. However, if the knot gets pulled tight, either by the cord being pulled as the baby descends into the pelvis or the cord getting pulled by being snagged on an arm or leg, the baby will be deprived of oxygen and die.

That’s not what the piece by Karen Strange that Brogan linked to says.

It also is frequently misunderstood to be dangerous, which is a problematic myth – if occurs so commonly, how did humans ever survive as a species?

Gee, it’s probably the same way we survived as a species despite the fact that the natural miscarriage rate is 20% and most women will have a miscarriage during their reproductive years. Population increases as long as couples have more than 2 surviving children. They could have 3 or they could have 10, 7 or whom have died. The population increases by the same amount either way.

The truth is the cord around the baby’s neck is NOT harmful, as it does NOT strangle a baby who is NOT using lungs to breathe until AFTER birth.

As it typical of most natural childbirth/homebirth “information,” it is a half truth. Not all nuchal cords are dangerous. Only tight nuchal cords are dangerous, but according to what passes for “reasoning” in the natural childbirth community, if 100% of nuchal cords don’t end in death, then 0% of nuchal cords are dangerous. It’s the equivalent of claiming that since not buckling your seat belt doesn’t have a 100% death rate (or anywhere close), not buckling your seat belt is therefore safe and that anyone who suggests you should buckle your seatbelt is a fearmongerer.

Of course a tight nuchal cord doesn’t strangle a baby. It kills by depriving the baby of oxygen.

What proportion of babies die from nuchal cords? You won’t find that information anywhere because neither Brogan nor Strange appears to know. They don’t tell you that 10-15% of stillbirths are associated with cord problems like nuchal cords and true knots. Without that information, anything they say on the topic is worse than worthless.

Does Brogan care that she is transmitting and amplifying misinformation? Apparently not.

If a mother refuses a recommended emergency C-section because Brogan convinced her that a nuchal cord is not a problem and that baby dies, will she be offering compensation for the mother’s anguish? How about if her baby survives but sustains a serious brain injury due to a tight nuchal cord? Does Brogan plan to donate the millions of dollars it will take to provide appropriate care for that child? Or will she simply ignore those who suffer and die from her misinformation and keep right on peddling it?

Does she plan to take ANY responsibility if a baby dies from the misinformation that she endorsed?

No. You can bet your baby’s life on it.

  • HollywoodDUMP

    Great article!!!!!!

  • Reneé Coetzer

    You are certainly catering for the conventional medicine mindset where people live careless and depend on the dysfunctional conventional medicine approach to keep them healthy instead of taking responsibility for their own health LONG before they get sick.

    • Heidi

      An OT (off-topic) before you post would be appreciated!

    • Roadstergal

      How do you ‘live careless’?

      I eat lots of diverse fruits and vegetables, I exercise, I’m ridiculously healthy with a low BMI, low resting heart rate, low blood pressure, great HDL/LDL ratio, you name it.

      I’m not stupid enough to think this makes me magically immune from disease. I’m also not stupid enough to think that genetics didn’t help everything that follows ‘ridiculously healthy.’ I take responsibility for my own health by following the advice of medical professionals.

      I like the nasty implication you have that people who get sick didn’t take ‘responsibility for their own health.’ I’m sure you have some bullshit explanation as to why my mom dying of brain cancer was her own fault because she ate a “GMO” at some point.

  • Jenny_from_da_Bloc

    Almost one year ago I gave birth by repeat c-section to my second son. What we did not know is that he had a nuchal cord, wrapped 3 times around his neck and was very close to death. My doctor told my husband and I that if I had went into labor and tried for the VBAC he most definitely would have died or suffered irreversible brain damage, cerebral palsy, but most likely would have died.I never intended to have a VBAC, but was pressured by my sister and her CPM friend to have a HBAC. They both would tell me how the HBAC would be the most empowering day of my life and constantly were sending me info from the woo-sites. Not to mention that a CPM attended home birth was much cheaper than a c-section.
    If I didn’t know better ( I’m a RT) I could definitely see how they could have convinced someone to have a homebirth. She was a very nice women, but completely infected with woo and she backed up every thing she said with statistics and articles. A person with no real medical knowledge could have easily seen this information as good advice and had a HBAC. I shudder when I think of the outcome if I had decided to have a HBAC
    Watching and hearing my baby being resuscitated was the most horrifying experience in my life thus far. I was literally trying to get up during the c-section and needed to be sedated because I was so scared and panicking. I do not understand how any medical professional can state such dangerous information and stand by it in light of all the evidence that proves other wise. My son spent 4 days in the NICU and had no permanent damage. He is healthy, happy and alive

    • Maya Markova

      How good for you and your son that you didn’t succumb to woo!
      I have a friend who (sarcasm) apparently didn’t trust enough her reproductive organs, because her only pregnancy ended in a miscarriage. However, while in hospital because of the miscarriage, she helped a stranger’s baby be born alive. There was another patient, in late pregnancy, who was hospitalized for “observation” because she had had 2 stilborn babies with nuchal cords. My friend urged that woman to insist to the doctors not just to “observe” her but to perform a C-section. They finally did it, and the baby was taken out alive – with a nuchal cord again! Maybe just a coincidence (I don’t know whether nuchal cords have a family pattern of occurrence), but still good that my friend was there.

      • Jenny_from_da_Bloc

        Thank you. Even before I got pregnant the 2ND time I was a SOB reader and I briefly considered a VBAC in a hospital. After reading the stats and discussing my situation with my doctor it was decided that a RCS was the best route for me. I know this sounds like woo, but something told me I had to have that baby today and I did, thank God he was ok in the end. I fear for a women whose baby is in the same condition as kine, but they are stunt birthing at home and the results would have been horrendous

  • Roadstergal

    I just realized that Douglas Adams even wrote a prayer for lay midwives.

    “Protect me from knowing what I don’t need to know. Protect me from even knowing that there are things to know that I don’t know. Protect me from knowing that I decided not to know about the things that I decided not to know about. Amen.”

    (And of course, the followup – “Protect me from the consequences of the above prayer.”)

  • Who?

    Off topic, and I hope I’m not boring with this, but this is one inspiring man. I don’t think any of his patients would give the Quack Pack the time of day.

    http://www.abc.net.au/news/2015-09-15/dr-dim-dim-australian-doctor-on-quest-to-save-lives-in-png/6773992

    • Mishimoo

      That’s beautiful and heartwarming. What a lovely fellow, I really admire him!

      • Who?

        He was just on Foreign Correspondent, it showed how beautiful but wild and isolated PNG is, and the difference his work, including training local people, makes.

    • Sue

      Inspiring story. Not only can he improve maternal and infant welfare, but also re-build after cyclones!

    • KeeperOfTheBooks

      Wow. What a story! Shared on Facebook; he sounds like a big damn hero to me.

      • Amy

        Fellow Browncoat? 😉

        • KeeperOfTheBooks

          You can’t take the sky from me!

          • DelphiniumFalcon

            Curse your sudden but inevitable betrayal!

          • KeeperOfTheBooks

            To tie into a discussion going on in the Onision thread…
            Preacher, don’t the Bible have some pretty specific things to say about killin’?
            Quite specific. It is, however, somewhat fuzzier on the subject of kneecaps.

    • DelphiniumFalcon

      Now this man is one spectacular human being. What a wonderful, loving heart he has. And that he didn’t crow from the mountain tops how awesome he was so give him money, just did it himself despite the cost and loved giving service to others without the expectation of something in return.

      These are the types of people who need to be celebrated in the news all over the world. Shows a little kindness can make all the difference in turning around a struggling community.

  • Sue

    Anyone who fails to grasp the function of the umbilical cord has NO PLACE commenting on any obstetric issues. None.

    • Who?

      Trouble is they don’t know they don’t understand how it works. And looking it up would be entirely out of the question.

  • Sue

    I don’t know whether there are any psychiatrists here, but in my working world, psychs are not known for a great interest in physiology or internal medicine.

    I happily accept their advice within their specialty, but I won’t be inviting one to the next neonatal resusc. Or ANY resusc, for that matter.

  • Cartman36

    I have a question for Dr. Amy and all the other physicians here. Do you, as a physician, have concerns giving medical advice outside your practice? I ask this because I assume that Dr. Brogan has some sort of liability waiver on her website but that won’t prevent a costly lawsuit or damages if the lawsuit is upheld.

    • Sue

      I work in a generalist specialty (Emergency Med), so I have to have a working knowledge of most areas, so I could runa neonatal resuscitation, but I wouldn’t be giving advice about obstetrics to obstetricians or midwives. Having a psychiatrist commenting on neonatal issues is much like having an orthopaedic surgeon do so – or worse. As I said before, psychiatrists are not known for embracing internal medicine, or pediatrics, let alone neonatology.

  • Lombardi

    One thing ncb advocates fail to grasp is we did not evolve to perfect
    Evolution does not remove all flaws. We evolve to good enough. The spices can absorb very high numbers of failure and still be good enough at birth to survive.

    • Kq

      Well, it is true that “the spice must flow…”

      (Sorry sorry sorry, I do so many typos, but that one tickled me)

      • Lombardi

        LOL

      • demodocus

        Plus a Dune reference! My morning is complete 😉

    • Sue

      I’ve lost track of how many times I’ve heard this “how did humanity survive” trope.

      The answer is simple – by having lots of children, just like the rest of the animal kingdom.

      • Cobalt

        Humanity survives, but how many billions of humans didn’t?

        There are millions of children dying every year around the world of very natural causes (leading causes being preterm birth complications, pneumonia, birth asphyxia, diarrhoea and malaria).

  • D/

    “The truth is the cord around the baby’s neck is NOT harmful, as it does NOT strangle a baby who is NOT using lungs to breathe until AFTER birth.”

    Soooo, a veteran NRP instructor of 24 years posts a physiologically ridiculous fb statement about neonatal resuscitation which is widely distributed, especially in professional home birth circles (now 3,000+ shares) … where she asserts that uncommon birth tragedies are actually impossible occurrences, uses repetitive CAPITALIZATION OF NOT(s) and makes reference to the survival of the human species up to this point to assure NO likelihood of harm, and implies that interventions beyond the scope of home birth midwifery are ‘unnecessary’ and to be suspect … AND she has taught her unique NRP course to ~8500 (primarily homebirth-professional) participants.

    Wow, I wonder how many NCB attitudes will ultimately be ‘effected’ by this particular expert opinion?

  • Insider

    Dr. Amy, would you please cite a source for this statistic? “10-15% of stillbirths are associated with cord problems like nuchal cords and true knots.”

    NCB advocates cite this study, which seems to form a very different conclusion:

    http://www.ncbi.nlm.nih.gov/pubmed/16374604 [Arch Gynecol Obstet. 2006 May;274(2):81-3]

    “Of 166,318 deliveries during the study period, 14.7% had a nuchal cord…. [T]he perinatal mortality rate was significantly lower in pregnancies with nuchal cord as compared with the comparison group…. Nuchal cord is not associated with adverse perinatal outcome.”

    I wonder what accounts for the differing conclusions.

    • Cobalt

      The details on that data need to be attached, there’s a lot missing from the abstract.

      The results include a correlation between nuchal cords and MORE non-reassuring fetal heart tones and FEWER cesareans.

      No data on what percent of stillbirth was attributable to nuchal cords, but there was less mortality in the nuchal cord group than the untangled group.

      Their conclusion is that induction because of a nuchal cord is unnecessary, which makes some sense because it’s not so much labor timing as delivery route and logistics that will pull the cord tight (although something can be said for calling it as soon as you hit term just to stop accumulating risk).

      The data also goes back to 1988, which muddies things a bit as interventions and monitoring have become safer and more effective over the 15 years studied.

      • Roadstergal

        The paper itself is linked in PubMed, and it’s pretty thin. I have a sort of dumb question – as they used nuchal cords diagnosed at birth as their retrospective analysis. In the case of stillbirths/miscarriages, are nuchal cords reliably diagnosed and entered into the database? If the cord is wrapped around something other than a neck, does it go into the ‘control’ group? That doesn’t seem right, as the cords would be equivalently compromised?

        Also, they mention that labor induction leads to increased cesarean rate, which isn’t the case…

        It was interesting that the Apgar scores less than 7 were the same at 1 minute, but lower at 5min in the nuchal cord group. I wonder if babies with a nuchal cord get more attention, as it were?

        • Cobalt

          If they exclude a lot of the mortality through inconsistent data collection, that will certainly skew the numbers. The higher numbers for distress but lower numbers for cesarean make me think the data collection on nuchal cords in cesarean deliveries is poor- higher distress numbers don’t typically lead to less intervention.

    • Roadstergal

      This article, and the references therein, are interesting (to me at least):
      http://www.sciencedirect.com/science/article/pii/S0143400409003014

      • Cobalt

        This makes a lot more sense, showing a clearly visible relationship between anatomy, physiology, intervention, and outcome.

    • Amy Tuteur, MD

      The study you cited refers to babies who were alive at the start of labor. The statistic I am talking about refers to stillbirths, nearly all of which occurred before labor began. Those are two different groups with barely any overlap.

  • Bugsy

    Thank you, thank you, thank you for this post.

    I’m 32.5 weeks along with #2, and every ultrasound since he was 18 weeks has demonstrated a nuchal cord. It doesn’t appear to be tight – the tech at our 3D ultrasound over the weekend described it as looking like a scarf wrapped loosely around the neck – but it still concerns me. We fought so hard through infertility to get to this point, and I don’t want to take _any_ chances.

    Do moms ever ask for elective C-sections due to this reason alone? Anyone know if this is ever done in Canada (specifically in British Columbia)? My OB wasn’t overly concerned about the nuchal cord when I asked her a few weeks ago, but I’m still not at ease w/ it.

    • Lauren

      In Ontario you can schedule a C-section just because you want to. You don’t need a medical reason. You may have to change your OB, if she or he is unwilling, but you can’t be denied one if you persist. The easiest way to find out if that is the case in BC is to ask. And keep asking, and insist on full andwers (instead of ‘let’s leave thst discussion till later’).
      I scheduled mine and it was the best decision I made for my baby.

      • Bugsy

        Thanks – that’s really good to know. I have my next appointment on Wednesday, and I’m going to discuss it further with my OB. My sole goal is to have a healthy child, however he may arrive in this world.

        • KeeperOfTheBooks

          Best of luck to you and the kiddo! FWIW, that sounds like a pretty good goal to me.

        • Anna

          Good luck to you! These are the words of a Mother, not a selfish arrogant teenager like the natural-birthers-at-whatever-cost, who wouldn’t tolerate the slightest discomfort! And I believe the reason for c-section in your case is pretty real. Why take ANY risks at all?

    • Allie

      I should think this would be a great reason to have a c-section, and I wouldn’t even say it was “elective,” per se, since there is a medical reason for it, just not necessarily an acute one. I am in BC, and many women in my circle had elective c-sections for various reasons. If your OB isn’t on board, perhaps see if you can get referred to someone else. Very best wishes to you. I went through infertility too, so I have an idea how you’re feeling. But I have a strong feeling you’re going to do just fine. You must be smart, since you clearly don’t trust birth : )

      • Bugsy

        Thanks, Allie. 🙂 Nope, I don’t trust birth (or frankly pregnancy) much at all. #1’s birth went about as smoothly as one could hope, but I’ve known way too many women who have had complications to presume his smooth birth was because of me!

    • Bugsy

      An update – I spoke to my OB yesterday, and she said that for now, the cord isn’t demonstrative of further monitoring during the third trimester. If I make it to 39 weeks, she’ll do an u/s to check on the little guy, and is planning on not letting me go past my due date (I’m high risk due to age, IVF, previous gestational diabetes and previous pre-term labor). She’s aware of my sneaking suspicion that #2 will be noticeably bigger than #1 was.

      We’ll see…she thinks that I am likely to have a pretty quick, smooth labor given that L&D with #1 went well; put the likelihood of the cord causing issues at less than 5%. For now I’ll just see how the rest of the third trimester progresses.

  • Anna

    In these 50/50 cases idiots like Brogan will say that you have to avoid a c-section at all costs because it is – what do you think?…surgery! And then I just want to scream: SO WHAT!?? Its OK these days (well, at least nobody makes posts on Facebook to condemn it) to have perfectly unnecessary surgery to improve the looks of your tits or nose, but it’s not OK to have surgery to ensure safety of your baby and everyone will rant about “unnecesserean”. Oh, crazy time!

  • Sarah

    I’ve been thinking about misinformation and the NCB groups lately. Two of my friends went the homebirth/birth center route, and I was a little surprised at what I learned from their experiences. It definitely seems like NCB is the goal. Things like ultrasounds and GTT are dissuaded (that could help determine the actual risk level of a pregnancy) so that no one feels “unnecessary” pressure to give birth in a hospital. So, we have lying by omission in that case and just outright misrepresenting facts in the case listed in this article. You cannot make an informed decision regarding the health of your pregnancy and baby if you aren’t given any real information to begin with.

    • JJ

      Yep. This is my experience as well. It’s like if the CPMs don’t look for GD ect. then it is not there and therefore the patient is low risk.

      • It’s magical thinking: if you don’t detect the problem, there must not be one.

        • Amy M

          Well, you know those intuitive mamas always know if something is wrong and have plenty of time to get to the hospital in those vanishingly rare cases.

      • DelphiniumFalcon

        This is the same logic my mom’s cat used to get on the counter tops.

        She’d jump up and traverse the counter tops with her eyes closed. If I can’t see you can’t see me! My logic is flawless!

        And then she was unceremoniously dumped off the counter tops again wondering how my Grandmother saw her.

        These lay midwives appear to be no more intelligent than a common house cat if they use the “If I don’t test for GD they can’t have it!” philosophy.

        That’s not very comforting.

        Edit: Also less intelligent on interpreting outcomes.

        Cat: Why do I keep getting thrown off the counter? I can’t seem them! How is this happening?!

        Lay Midwife: These babies keep dying and being brain damaged but I can’t see any problems because I can’t see in the womb! How is this happening?!

        • Roadstergal

          I believe you just called lay midwives Ravenous Bugblatter Beasts of Traal – which isn’t a bad comparison, really.

          • DelphiniumFalcon

            Sounds like I gave them too much credit!

          • Charybdis

            I think they are more like the Vogons, though. Those vile creatures that smash the scintillating jeweled crabs of their homeworld and sit on the backs of the dewy-eyed small creatures that live there too. They break their backs, but they sit on them anyway. Gotta love Hitchhikers Guide.

          • Roadstergal

            The ones who wouldn’t even lift a finger to save their own grandmothers…

          • KarenJJ

            And recite awful poetry. Sounds a bit like lay midwives to me.

    • MaineJen

      You know…I was listening to a podcast this weekend (WTF with Marc Maron…still trying to decide whether I like it), and one of his guests was talking about her home birth. This woman is a total lay person, not medically affiliated (a comedian/actor)…all she talked about was how the birth made her feel, what she went through as far as pain, how empowered and awesome she felt afterward, how quaintly old-fashioned everything was, how she didn’t have to put up with lying in bed in a hospital gown, how it connected her to the larger community of women around the world…and how messy and disgusting the cleanup was.

      Not one word about safety. It’s like it didn’t even enter her head, that something could go wrong. I’m convinced this is how 90% of the population think about pregnancy and birth. Modern medicine has lulled us into thinking that a healthy baby is a foregone conclusion, and it doesn’t really matter where we are. Nothing bad could possibly happen. Not to us.

      That’s why this misinformation is so dangerous. People literally do not know any better than to believe it. Even if you are highly educated in another field, it is so easy to be taken in by the woo.

      • Megan

        Modern obstetrics, like vaccines, is a victim of its own success.

        • mostlyclueless

          Wow. You hit the nail on the head.

        • DelphiniumFalcon

          So true.

          These people should look back on their own genealogies and see how many names are on there they have heard nothing about. Because their birth date and death dates are in the same year if the not the same day.

          Or just a walk through a cemetery of appropriate age. Here in a cemetery over one hundred years old has six or seven tiny little plaques next to the main graves. All babies with the same death date as their birth dates.

          It must have been beyond heart breaking.

          • EmbraceYourInnerCrone

            I have examples in my own family, my grandma’s mother died at about 20, in childbirth, probably from PPH. Her second child, a baby girl died 6 weeks later. I had always been under the impression she died the day she was born but when I was tracing family trees I discovered she lived for a little while. I don’t know what she died of although being the newborn child of a widower who already had a 2 year old to take care of probably did not help. Nor did living in rural Maine.

          • DelphiniumFalcon

            Definitely not good conditions at all.

            We know why one of my great-grandfather’s siblings died soon after birth. Almost as soon as she was born and was afflicted with the “Black Pox” or hemorrhagic variation of Small Pox. She was his oldest sibling but no other siblings would ever know her as she died twenty one days after her birth and was ill the entire time.

            In my great-grandfather’s biography he wrote for all of us shortly before his death in I want to say 1994, he was talking about how amazed he was that Small Pox had been eradicated in his lifetime when talking about what he was thankful to see in his lifetime.

            He said:
            “One thing to be thankful for is the progress made in medicine. Years ago small pox killed thousands. Today it is wiped out completely. Polio, the crippler, has been wiped out, also many other diseases. One day soon I am sure cancer and MS will be conquered.”

            At the time shortly before his death polio was set to be eradicated within a few years. I can’t imagine how disappointed he’d be that people who never saw these diseases say “they’re not that bad” and have delayed the eradication over twenty years past his death.

            This is also my relative that lost his first wife to PPH and she bled out in the car on the way to the hospital while he held her. It all but destroyed him and without thinking he gave his newborn son to his sister in law that couldn’t have children. He regretted it the rest of his life.

            The things people take for granted these days… Stories like these make it so clear.

          • KeeperOfTheBooks

            Wow. He sounds like an amazing person! I don’t suppose his autobiography has been published/is widely available?
            And yep, I have a few older relatives (think mid/late 80s) who, if you get them started on anti-vaxxers, generally foam at the mouth. They lived through polio, measles, etc. They’ve seen what they did to their friends, cousins, siblings. They have slightly less than no interest in seeing them make a comeback, and make no bones about their *low* opinion of the fools who don’t think they’re a big deal. These are generally very pleasant, gentle people, but say “anti-vaccination movement” and you’d better be prepared to duck.

          • DelphiniumFalcon

            Email me at delphinium.falcon@gmail.com

            I have several biographies you’d probably enjoy. Especially this great-grandfather’s mother who used to bait molesters and rapists out in the mining town they lived in and beat the ever loving crap out of them if they tried anything on her. Or if in the movie theater and got frisky they got a hat pin in the leg. One time she didn’t get it back. But men certainly didn’t want to mess with the women in that dirty little town. It might have been the crazy lady with the hat pin.

            Yeah violence doesn’t solve violence but it was the 1910s. Women didn’t have a lot of recourse back then so she took matters in to her own hands.

          • Daleth

            Y’know, actually, sometimes violence–when very selectively and judiciously applied–DOES solve violence.

          • DelphiniumFalcon

            True! And hey it was an early 20th century mining town. Gotta speak the right language in those places.

          • Daleth

            Right. Pacifism was probably not exactly the coin of the realm.

          • Who?

            My cousin has six kids. Each of those six were born quickly, the old fashioned way, in hospital.

            Two of his daughters have had babies in the last month-both required sections after failure to progress for more than 48 hours.

            My cousin and I are the children of two sisters, part of a family of 14, all born quickly the old fashioned way, in rural hospitals in the 1930s-1950s (go Nan!!).

            Even the best breeders can have children whose works don’t go quite according to the textbook.

          • DelphiniumFalcon

            Exactly! My mom is one of six and there could have been more if Grandma hadn’t put her foot down. The kids were begging for another sibling lol. She and my grandpa were DONE though. But Mom and her youngest sister were only able to have two kids after years and years of infertility treatments.

            Dad is one of five born to a woman told getting pregnant would kill her. His oldest sister only had one biological child and after years of treatments finally decided adoption was a very wonderful thing and completed their family that way.

            Just because previous generations were able to pop out kids doesn’t mean the next one will be all quick vaginal birth and roses.

            …personally I’m hoping that the easy baby making just skipped a generation though. Not afraid to admit it!

          • fiftyfifty1

            “Just because previous generations were able to pop out kids doesn’t mean the next one will be all quick vaginal birth and roses.”

            Especially with delayed childbearing. Teens just have it easier. They have, on average, smaller babies, more flexible pelvic joints, and stronger uterus muscles. The lowest rate of needing a CS in the US is at age 16. When you wait into your 30s your rate is substantially increased.

          • Rosalind Dalefield

            My mother and her mother had very easy childbirth. Two of my sisters had to have C-sections and my first two babies both required forceps assistance. My other two were persistent occipito-transverse and needed the OBGYN to diagnose that and hook them around with his finger (what he calls the ‘dial a baby manouver’ which just shows he remembers dial phones!).

        • Bugsy

          Related to the mention of vaccines – anyone heard of the book “Vaccines 2.0: The Careful Parent’s Guide to Making Safe Vaccination Choices for Your Family” ? My library was advertising it in the Parenting section today, and I couldn’t help but thumb through it.

          The authors say that they don’t deny vaccines altogether, but instead help give the readers a fair and accurate assessment of which vaccines are safe – never mind that neither of the authors has a medical background, one has a daughter w/ autism who has admitted to having a conflict of interest w/ respect to the study of vaccines, and who refers to anything positive about vaccines as “propaganda.”

          Argh – left me so mad, especially with a title implying that you’re only making good parenting choices if you follow their research.

        • Rosalind Dalefield

          Too true, but it is amazing how quickly society forgets the ‘bad old days’.

      • Erin

        I definitely think too much emphasis is put on the “experience” as if it’s the same as going to a theme park for the day. One of the few things I do remember from my son’s arrival was the midwife who brought my husband to theater told me he was a keeper and when I asked why, she said that she had been giving him the speech about what he could/couldn’t do and how to make his experience as good as possible during the section and that he had stopped, looked at her and said that all he cared about was me and our baby and apparently that was “refreshing”.

        I have a friend who is about to start trying to conceive again, having had a c-section which she classes as traumatic because she didn’t get to deliver her baby herself and she felt forced into it because her little girl was distressed (although she prides herself on the fact that she argued for over an hour with the Consultant).. and she’s already planning the best possible “birth experience”, no nasty Doctors, no life saving equipment and she just can’t understand why I’m not being supportive, especially since I’ve had a section myself. Her answer to everything is “variation of normal” but I’m just clinging to the hope that once she’s actually pregnant, common sense will kick in. Although she called me a sheep for saying I’d have a repeat because the phrase “uterine rupture” makes me think of the Alien movies and I’d rather not experience it so I suspect our friendship may be limited unless we can agree to stay off the topic of childbirth but we’ll see.

        • DelphiniumFalcon

          Death is actually pretty normal. I mean everyone will experience it at one time or another. Doesn’t mean I’m rushing to meet this particular variation.

          And better a sheep than whatever she is. At least a sheep will let a rancher help get that lamb out when things go sour. Even sheep have c-sections when it gets really bad.

      • demodocus

        “Even if you are highly educated in another field, it is so easy to be taken in by the woo”
        Oh my goodness yes. My psychology professor uncle thinks I should drag out my son’s vaccines. He’s been listening to people talking about too many-too soon. We ignore this well-meaning but inaccurate advice. Now if I have a question of how to deal with an autistic child (which the toddler clearly isn’t) I might ask him about it, but that’s a horse of a different colour.

        • nomofear

          Oh gosh, my dad (a RN, albeit inclined towards woo and conspiracy theories) recently asked if I knew if the kids’ vaccines had mercury – or maybe he phrased it as preservatives – at any rate, I told thin l him I hoped so, since shelf stable is a good thing. And that it’s a different type of mercury – ask your friendly neighborhood chemist!

          • SporkParade

            A distant relative, a dentist who grew up in the USSR, asked me if Israeli kids get as many vaccines as American kids, his opinion being that American kids get too many. I said that Israeli kids actually get more because they also receive the OPV. His response? “That’s okay; the gave the oral polio vaccine in the Soviet Union.” That was his safety standard; if it was given 30 years ago in the Soviet Union, it must be safe.

    • Roadstergal

      That’s a good way to put it – lying by omission. That’s the thing about NCB – if you go to a hospital and someone tells you, “There’s a moderate chance your child will die if you don’t do X,” you’re still 100% free to decline X! But the NCB-ers want to be in a position where everyone is lying to them by omission, where they can’t be held responsible for refusing life-saving treatment because nobody told them they needed it. It’s just, to me, morally reprehensible. They don’t have the strength of their convictions to deny an intervention when the risk is presented, but they do have the strength of their convictions to deny any knowledge that an intervention might be called for.

      • Rosalind Dalefield

        Some of them, at least, justify it by saying that it is wrong to scare a pregnant woman with what *might* happen. Their argument is that if a woman is scared going into labour, she will have a more difficult labour. I think it is bullshit. Throughout history and prehistory, women knew that childbirth might kill them, and that the risk of mortality to their baby was even greater. They saw it all around them. I would argue that going into labour being afraid of a bad outcome is the normal condition for Mulier sapiens.

        • Who?

          It hurts my brain to imagine how anyone can decide that they won’t warn a woman about the possible risks to her health and the health of her unborn child, ‘for her own good’, while at the same time castigating someone else as patronising or paternalistic for advising care that a woman mightn’t be entirely happy with.

          When they advocate ignorant neglect it is kind, when others advocate careful management, that’s paternalistic. Ridiculous.

          • Rosalind Dalefield

            I totally agree, it is patronising in the extreme. Nevertheless, that’s what at least some of them say; that it is wrong and nasty to scare women. They quote evidence from animal studies that if a cow or sheep is agitated she may have a slower more difficult labour. However, they ignore the reality of what I have written above, that for most of history and prehistory, women knew that childbirth was very likely to result in a dead baby and also quite likely to result in their own death.

          • Cobalt

            Cows and sheep give birth at the mercy of predators- “pausing” labor to flee may be an evolutionary advantage, especially because the rest of the herd will be just fine with the laboring individual being the slowest.

            Humans are social predators that cooperate to protect the vulnerable instead if letting them be a handy way to slow down the wolves.

          • Rosalind Dalefield

            That’s true too. When I’ve asked for evidence that fear of a bad outcome interferes with progress of labour in human beings, they never seem to be able to give me any human-based evidence. They just refer back to the animal studies, ignoring the many centuries during which our species and its predecessors knew from experience that childbirth is a dangerous time.

          • JJ

            I had a homebirth with my first and the MW (a CNM) decided not to tell me the baby was posterior because she did not want me to be afraid. So much for being informed.

        • Indeed. One thing historians do is actually count how many children a woman had by how many times she updated her will; it was common for a (educated, or at least upper-class) woman to update her will every time she got pregnant since she knew death was not unlikely.

          • Rosalind Dalefield

            Quite so, and it really wasn’t that long ago.

  • MaineJen

    This is an MD who doesn’t understand why a compromised umbilical cord is dangerous? …?

    • The Bofa on the Sofa

      She’s a “holistic psychiatrist,” whatever that is (sounds pretty quack to me). Her OB rotation is long forgotten.

      • Sarah

        I can’t wrap my mind around what “holistic psychiatry” is as a field. Why wouldn’t you just be a counselor that also offers sugar pills or something?

        • Amy M

          Wouldn’t that be a psychologist? Or therapist?

          It makes sense that a if a person sees a psychiatrist for a mental health issue, that any other doctors this person sees should be aware of the issue and whatever medication the person is taking. As far as I can tell, this is how it is, because even the dentist wants a list of meds and they get a medical history at some point. Maybe she feels that a holistic psychiatrist would “treat the whole person” as opposed just the mental issue, but I agree with Dr. Kitty above—that would be overstepping boundaries huge.

          • The Bofa on the Sofa

            Dr. Frasier Crane: Carla, this psychic business is just a crutch to avoid reality. I mean, it’s very easy for people to get hooked on this hocus pocus, and well, before you know it, this woman is going to be holding your hand once a week, charging you $100 a hour and filling your mind with all sorts of confusing jargon.
            Carla LeBec: And how is that different from you?
            Dr. Frasier Crane: Well, ah… I can prescribe drugs.

          • Sarah

            Yeah, I’ve been to psychologists and counselors who are able to offer excellent therapy while not being able to prescribe drugs. They asked me what kind of medication I was on (if any) in order to refer me if necessary. The last place I went had someone in house that could prescribe if that was necessary, even though my actual therapist could not.

            My point was more that if medicine is seen as an evil (in the case of a lot of holistic people, it is), then why would you bother with getting a medical degree at all?

      • JellyCat

        Holistic Psychiatrists means that you’re not a big Pharma shill and stay away from pharmacological management of any kind. Instead, try gluten free diet, acupuncture, chiropractor, yoga, meditation, vitamins and herbal supplements (if not homeopathy).

        • The Computer Ate My Nym

          Gluten free diets can be extremely helpful…if you have celiac disease. If you don’t, it’s probably unnecessary (there may be some non-celiac sensitivities, but the actual antigen is poorly defined, if it is even a specific sensitivity). A good many pharmaceuticals are derived from plants, but there is no advantage to taking them as “herbal supplements” instead of as a purified drug and a number of disadvantages, i.e. less standardization and higher risk of toxicity or ineffective dose. Yoga can be fun and a good way to stretch if you are into that sort of thing. But aerobic exercise is more likely to be helpful for psychiatric issues (some depression can be lessened by regular exercise.) Chiropractor, acupuncture, and homeopathy are a waste of time and money.

          • KeeperOfTheBooks

            “But aerobic exercise is more likely to be helpful for psychiatric issues (some depression can be lessened by regular exercise.)”
            OT, but I’ve gotta say, this is DEFINITELY true–for some people, of course. I’ve had depression and anxiety for most of my life. It usually gets worse in the summer, oddly enough, because I’m in a hot, humid climate and tolerate neither well, which means I tend to go outside as little as possible.
            This last summer, I decided that come hell or high water, I was getting out for a long walk 5-6 mornings/week even if it made me feel disgusting and uncomfortable. And it did. But you know what? After a few months of doing it, and recently adding in some jogging intervals plus abs/arm work, I feel more level than I have in a very, very long time. When something minor-but-stressful happens, I can nearly always take a deep breath and say “Okay, not the end of the world, I’m going to do X and it’ll be okay” rather than going straight to “THE BABY WON’T NAP MY LIFE IS HELL.” I’ve also been eating better overall (nothing crazy, just more protein, more fruits and veggies, less sugar), and I think that may be playing a part, too.
            I’ll never be crazy about exercising per se. It’s boring and annoying and requires time I’d rather spend doing something else. Can’t argue with the results, though.
            *insert standard Results-May-Vary-Talk-To-Your-Doctor spiel here*

          • Montserrat Blanco

            Exercise has been tested in various clinical trials and it has demostrated to work in order to improve a variety of health conditions. I am really glad it worked for you. It improved my asthma as well.

          • Amazed

            Never say never sista… That was what I said, most sincerely, a few years ago. Never be crazy about exercising, I mean. Then I discovered zumba and ah! I am going to a zumba weekend (more like four days) in a few days along with most of our class. I have found out that in addition to the regular workouts, I can spend 6 to 7 hours a day working out in those weekends and be as happy as a pea. And yes, it does work for seeing the world through slightly less dark glasses. Reduced or overall nonexisting period pain is an added bonus to me!

            I discovered zumba by chance. Never say never because you cannot argue with chance! Perhaps your exercise will find you by chance.

          • KeeperOfTheBooks

            You never know! Actually, something I’d *love* to get back into (and it would be good exercise, come to think of it) is Irish folk dancing. I did it as a kid and teen, and loved it, but haven’t done so since.
            Come to think of it, I may even know where my old shoes are…hmm…

          • Kq

            Oh god, the Irish toe shoes…

          • KeeperOfTheBooks

            Ugh! I’d love to get my hands on the fool who got the idea in the ’90s that that stuff was a good idea. It’s not traditional, it’s a stunt dancers used to do briefly in a look-what-I-can-do sort of thing, and then some choreographer said “ooooh, that looks showy, let’s do it” and presto! Lots of dancers with really screwed-up feet, because Irish dance schools, unlike ballet, usually don’t train their dancers for years just for toe work. At least back when I was dancing, the schools were just starting to introduce toe work Because Cool, and the qualification for someone to do toe stands in a routine was “can you balance? Okay, go for it!”. I sincerely hope it’s changed since, at the least to provide a solid background and ensure that shoes fit properly before the dancers try it. (Come to think of it, unless they’ve changed the makeup of the “hard” shoes, those shoes have no support at all for toe work, unlike pointe shoes.)
            Better still would be to go back to a more traditional style of dance, but methinks that ship has probably sailed. Grrrrr.
            /rant over 😉
            Me, I’ll be doing soft shoe (“ghillie”) dances, thankyouverymuch.

          • Kq

            Eh, the dance school I went to at 5 (in the early 80s!) started at toe shoes. Soft toe shoes, not on pointe or anything. Dunno how traditional it was, but I can still do the basic reel and jig at near-40

          • KeeperOfTheBooks

            I think your soft toe shoes and my “ghillie” shoes are one and the same. ;)Black leather, long laces crossing over the feet several times through loops of leather before wrapping a couple of times around the ankle?
            My rant was about the pointe (ie, balancing on the ends of the toes, not the balls of the feet) stuff, not the more traditional dances you would have learned; Irish dance didn’t start becoming quite so…showy?…until the late ’90s/early 2000s. Back in my day *waves her cane around* it was unusual in the extreme to see a girl wearing more than a little makeup while competing, and I still remember the first wig I saw. Now heavy stage makeup and wigs are required, and to my pseudo-amusement, tanning practically is, too. I do rather hope the lot of it’s a passing fad.

          • Amazed

            The two of you have me interested. I’ll have to see this Irish thing. And shoes!

          • Dr Kitty

            Funny, I think of soft shoes with laces as being for Scottish dancing, I always wore black leather ballet pumps held on with a crisscross black elastic band.
            I could probably still do a single, light double, treble and slip jig, “The Bridge of Athlone” and “Jockey to the Fair”.

            All the stuff with wigs and fake tan, competitions and three figure outfits that has come in since I was a child has totally put me off involving kiddo#1 in any Irish dancing. She does ballet, which, here anyway, is the low pressure dance class where you send your slightly un-coordinated child if you want to opt out of the high-pressure world of competitive Irish Dancing. Kiddo’s ballet class is full of galumphing clumsy children with laid-back, easy going parents.

          • KeeperOfTheBooks

            Sadly, that’s true for me, too. I think I’ll probably teach DD the dances I remember, and if I ever find a low-key ceili group, maybe we could get involved as a family. That would be fun. If she’s interested in it, I’d love to pass on a bit of my heritage that I really loved, y’know? But I don’t want to get neck-deep in the crazy that that world has become.
            When I was a kid, there were some gorgeous, pricey dresses, but it was quite standard for them to get passed around in the school for free or for a minimal cost, and then whichever parent had custody of a given dress at the time was responsible for keeping it in good shape with mending, cleaning etc. It was possible for not-especially-wealthy kids to compete in nice dresses without their parents going totally broke. Now? Definitely a rich kids’ thing, and that’s rather sad, given the humble roots of the art itself.
            Lastly, at the risk of being tacky, I’ll say it : the makeup/fake tan/giant poofy wig ensemble just looks silly and fake, like a bad 80s throwback.

          • Dr Kitty

            Oh yeah, my sister and I borrowed dresses in the class colours for competitions, and my first pair of hard shoes were bought second hand from an older girl in my class. The only real expenses were soft shoes and the classes. My mother didn’t go in for any of the curled hair and makeup stuff.

            One of my patients spends £3000 a year, for each of her three daughters on dresses. Yes, they are champions, but seriously… That is nuts!

          • DelphiniumFalcon

            I couldn’t believe how expensive it was for my cousin to do competitions for Irish dance.

            I do wig work for my cosplay and when my aunt told me how much one wig piece cost I just about hit the roof! I could do one for a quarter of the cost with a $20-30 wig, wooden dowels, and hot water! If I was just using loose wefts it’d be even cheaper! I was in the middle of researching if those kinds of wigs would be acceptable when she had to quit dancing.

            And those costumes… Holy freaking crap. My mom is a good enough seamstress to he commissioned for prom dresses when I was a baby. She looked at what went in to those getups and went “No. Just no.” I’d probably break one if I looked at it wrong.

            She was really good but she can’t do it anymore. The “wtf is this diagnosis?” struck my mom’s side of the family again and she ended up with her lungs nearly destroyed from Primary Hyper-eosinophilia. Checked for parasites, tumors, everything that could have caused it to be Secondary but nope. Her immune system just hates her that much.

            She has more affordable hobbies now like learning Mandarin and Korean. Had a looooot of down time while she was in a drug trial trying to recover from the years of steroids that were trying to keep her eosinophils under control and the damage the cells actually did. She’s a lot more motivated than I am.

          • Who?

            I loathe exercise. Loathe it. Hate getting hot and sweaty as I stomp the neighbourhood, hate the clothes, hate feeling hot and sweaty after, hate the whole wearisome business.

            But I feel better for it, so I do it. Many years of noting the correlation between exercise and well-being hasn’t improved my attitude to exercise but has confirmed my need to do it.

          • demodocus

            I have never in my life felt better after exercise. Also, I don’t get the warm fuzzies from nursing (not the dmers thing). Sigh.
            Glad it works for nearly everybody else, though.

          • MJ

            Me too. Another exercise-loathing, dmer mother here.

          • Who?

            I feel good when I stop. And it improves my sleep, appetite and general sense of wellness, but I get none of the exercise buzz my two children get from their various pursuits, including distance running.

          • KeeperOfTheBooks

            Ha! If we lived in the same area, we could be walking accountability buddies, and discuss our loathing of getting hot and gross while walking and jogging. Bleh. But it does mean a massive improvement in mood for me, so it’s worth it.

          • Who?

            You’re a book-lover too, right? Sorry if that is stalky. We could talk about books if it all got too negative.

          • KeeperOfTheBooks

            If it’s in the screenname, it’s not stalky. 😉 And yes, definitely! I collect books. Got the bug when I was a kid, and it’s only gotten worse since, mostly because I don’t consider it a problem in the first place!

        • Roadstergal

          “My Natural, Holistic doctor doesn’t encourage me to take pills to manage everything. She just has me take 15 vitamin supplements daily!”

          • JJ

            So true!!!

        • DelphiniumFalcon

          Or I can go to a psychologist for CBT and add medication to it if needed. Seems a lot easier than all that listed above.

          Also, how the hell do they manage to involve MORE needles in alternative therapy than conventional medical therapy? You can keep your pin cushion. I could have gotten the same treatment walking around my half-blind grandma’s sewing room for free.

          Edit: I’d also probably have less gastrointestinal symptoms on conventional meds despite that being the most common side effect.

          Iron constipation isn’t a fun thing. And some of those vitamins and herbs turn my intestines into World War I.

          • JellyCat

            She is not in favour of conventional BigPharma and even agains taking antiretroviral medication to prevent HIV transmission to fetus. She dosnt believe in that.

          • DelphiniumFalcon

            She does realize that big Pharma manufacturers like Wyath and Bayer also produce vitamins, right? She’s still lining Big Pharma’s pockets and duping others into following suit.

            And what you just said basically makes her a murderer in my book. We’ve been able to prevent infant HIV infection, something that was and still is a complete death sentence for those that can’t afford AART therapy, and she wants to spit all over those that still suffer and would give their left leg if it meant their child wasn’t HIV positive? Horrible.

    • Dr Kitty

      She’s a psychiatrist…the branch of medicine where you don’t touch patients…never mind examine them. You can also forget a lot of medical knowledge, because you’re not using it on a daily basis.

      Most of my friends who are in psychiatry have kittens at the idea of being in some sort of Good Samaritan situation, never mind giving advice about obstetrics!

      Will I ask my psychiatrist colleagues to advise me on managing meds or behaviour issues… Yes.
      Will they ask me basic questions about rashes, their kids’ minor ailments etc…Yes.

      I think that when it comes to medicine, you should stay in your lane and know your competence.

      • Gene

        I was once on a plane where they asked overhead “Is there a doctor on the plane?” I responded as well as a dermatologist. The derm started laughing when I said what I did and said, “You totally trump me. Call me if she has a rash!”

        The ED: jack of all trades, master of none!

        • Dr Kitty

          I have an OB/Gyn friend who said she always hopes that if they ask for a Dr on a plane it’s someone giving birth and not a heart attack…

          After hearing the stories of my cousin who is a pilot, I just assume if they ask for a Dr it’ll either be because of some sort of sex mishap in the lavatory or to verify a death.

          • Bugsy

            The “sex mishap in the lavatory” reference intrigues me. 🙂

          • Roadstergal

            It’s a reasonably common place to resort to for the Mile High Club – and given the number of people in the world who are interested in joining, I’d be shocked if some rather interesting accidents haven’t happened in the course of same… with or without the help of turbulence.

        • AirPlant

          I want to google what an ED is, but I am so very scared.

          • guest

            Emergency department. Nothing too scary!

        • Rosalind Dalefield

          ‘Can you land this plane within four hours?’

      • Amy M

        Yeah, but I’m not remotely a doctor, not even a psychiatrist and I can understand that if a fetus’s entire supply of oxygen is via the cord (blood) and that cord is compressed or pulled tight so blood can’t flow through it, then that is a dangerous situation. Total no brainer.

        I think these jerks recognize that many lay-people conflate cord compression with strangulation, so they can honestly tell people that their babies won’t actually strangle, since their airways aren’t functional yet. However, its disingenuous of them to stop there and not mention that a cord pulled tight around a neck, limb or knot can cut off the blood supply and therefore the oxygen supply. Different mechanism, but ultimately, no or low oxygen to the brain. Wanting people to know the difference is one thing. Capitalizing on their ignorance for profit and/or to control their actions, however, is very sleazy.

        • SarahSD

          Right? It would be one thing if they said “nuchal cords don’t strangle the baby, since the baby does not get their oxygen from breathing yet, but from the umbilical cord. The real risk comes from cord compression, which can cut off the oxygen supply to the baby, and can happen with tight nuchal cords, with knots, or with other placements of the cord. Careful electronic fetal monitoring during contractions and pushing can help your care provider tell whether the baby is receiving enough oxygen.” But of course that’s not what they say, because they’d rather roll the dice and hope for a good outcome than be burdened with ambiguous or downright scary information that would indicate intervention.

    • Fallow

      I think it’s quite possible she does know it’s dangerous, but has built her career around denying the tenets of medical science.

    • Roadstergal

      Well, she also doesn’t know the difference between ‘affect’ and ‘effect.’

    • D/

      More than that, the creator of the original fb post is a veteran AAP/NRP instructor who has provided resuscitation training for ~8,500 (primarily home birth professional) course participants to date?