Evidence based support: it doesn’t mean what this doula thinks it means

Evidence based practice

Australian doula Lizzie Carroll is miffed.

Last Wednesday I wrote about another dead baby born to a member of Meg Heket’s unassisted birth group, and the subsequent praise for the mother “achieving” her goal of a vaginal birth over a baby’s dead body. Meg Heket and the other women who encouraged this mother have blood on their hands; Ms. Carroll and other women who support dangerous homebirths have blood on their hands, too. They bear responsibility for the steadily rising death toll and, not surprisingly, they don’t like responsibility.

Carroll wrote:

There’s a big difference between supporting a person’s right to make a choice and supporting the actual choice.

I got up this morning to find myself tagged in a comment in a group that I am in. I occasionally get tagged in this group by someone mocking my work and so that I can be reminded that I am a horrible human being. Or something like that.

The comment this morning that had my name against it went a step further though. No longer content to simply mock me, I am now being accused of killing babies, by way of supporting a woman’s right to bodily autonomy.

She ridicules those holding her responsible as illogical:

As a supporter of a woman’s right to choose homebirth, if she deems it to be the best option for her, I am responsible for any deaths that occur during homebirth. Regardless of whether I’ve ever even heard of the family in question. BUT what if I were to say (and rightly so!) that all women should be allowed to choose a caesarean if they deem it the best choice for them? Am I responsible for all the women who then die as a result of a caesarean? …

But it is Ms. Carroll who is having problems with logic on a number of different levels. Let us count the ways:

1. There is a big difference between supporting a person’s right to make a choice and supporting the actual choice.

We see this often in the area of free speech. For example, American free speech advocates DO support the right of the Ku Klux Klan to hold public rallies. They DON’T support the Ku Klux Klan and they don’t support what Klan members say.

My position on homebirth is analagous to this. I DO support a woman’s right (bodily autonomy) to give birth where and with whom she wants, up to and including unassisted homebirth. I DON’T support homebirth and I certainly don’t support unassisted homebirth; I often refer to is as “stunt birth.”

Ms. Carroll is being disingenuous when she claims that she is merely supporting a woman’s right to bodily autonomy. She actively and affirmatively supports homebirth itself both theoretically and practically; she profits from it. It’s the difference between supporting the KKK’s right to free speech and offering members a special Klan discount on the purchase of white sheets. This is not a subtle difference, but in her effort to absolve herself of responsibility, Ms. Carroll refuses to acknowledge that difference.

2. There’s a difference between supporting someone’s right to do something dangerous and claiming that dangerous choice isn’t dangerous at all.

Ms. Carroll writes:

What about those of us who support a person’s right to enjoy dangerous sports like rock climbing, horse riding, racing car driving? Are we responsible for any deaths that occur as a result?

If you encourage someone to participate in race car driving by telling them it’s NOT dangerous and the person dies as a result, then you DO bear responsibility for that death. That goes double if you are the one renting out the race cars. The reason that Ms. Carroll and other members of homebirth and unassisted birth groups have blood on their hands is because they refuse to tell women that it is dangerous, not because they support the right to have a homebirth or unassisted birth.

If you see a suicidal person standing on a ledge and you yell “Don’t Jump!”, you aren’t responsible for the person’s subsequent death when he jumps despite your plea. But if you see a suicidal person standing on a ledge and you yell “Jump! Your body is meant to survive jumps from tall buildings!”, you bear responsibility for his dive to death on the pavement below.

3. Evidence based support MUST be based on scientific evidence.

Evidence based support doesn’t mean what Ms. Carroll and her compatriots think it means. It should be obvious to them (apparently it’s not) that evidence based support requires scientific evidence. There is NO evidence that unassisted homebirth is safe. None, zip, zero, nada. So it’s ludicrous to suggest that support of unassisted homebirth is evidence based; it is in direct opposition to what the scientific evidence shows.

These are just the most egregious of the many logical errors in Ms. Carroll’s attempt to shed responsibility for encouraging and profiting from dangerous homebirths.

Ms. Carroll claims that her philosophy can be described as:

‘Throughout my pregnancy I deserve to feel well and whole, physically, emotionally and spiritually.’

I understand how dangerous homebirths and unassisted births contribute to Ms. Carrol’s financial well being, but I’m confused on how they help mothers.

Ms. Carroll, please explain how giving birth to a dead baby contributes to a mother’s physical, emotional or spiritual health. Inquiring minds want to know.

  • Hannah

    I find it ironic that they say they support bodily autonomy while routinely denying their patients/clients informed consent. Ironic and enraging.

    The public system midwives guilty of the same in Australia and the UK are equally enraging.

  • Michelle

    I’m still confused with how you can say you support a woman’s right to give birth unattended, when in a previous post you referred to unattended birth as child abuse. If you view it as abuse, how can you support the right to choose it?

    • Amy Tuteur, MD

      Because women have a right to control their own bodies even if it harms their babies.

  • Megan

    OT: In the hospital being monitored for my blood pressure and ruled out for preeclampsia. Went in for BPP/NST and couldn’t go home, same as with my older daughter. Baby is looking great but blood pressure, not so much. Will probably be getting CS tomorrow or Wednesday, hopefully Wednesday. Ironically, Wednesday is hubby’s birthday!

    • Who?

      Hope it goes well!

    • BeatriceC

      Good luck! Hopefully everything stays relatively boring.

    • Empliau

      Good luck! Best wishes for a lovely, uneventful birth.

    • An Actual Attorney

      Good luck! Post updates soon.

    • Mishimoo

      Good luck! Hope everything goes smoothly.

    • Bombshellrisa

      Hugs!

    • Inmara

      Good luck for you and baby!

    • Amazed

      Good luck, Megan! Fingers crossed all goes nice and boooooring.

    • Sue

      Best wishes – hope all goes well for you and family.

    • demodocus

      Good luck!

    • momofone

      How exciting! Best wishes for a smooth, uneventful delivery.

    • Dr Kitty

      Best wishes for smooth sailing and a safe arrival!

    • seekingbalance

      good luck! will be sending good wishes your way!

    • DelphiniumFalcon

      Good luck and hope both of you are healthy and happy!

    • The Computer Ate My Nym

      Good luck! Hope all goes well for you and baby!

  • yugaya

    “The comment this morning that had my name against it went a step further
    though. No longer content to simply mock me, I am now being accused of
    killing babies, by way of supporting”.

    That was me. And yes, that is exactly what goes on in the groups that she and Heket admin – women get *supported* into going against medical advice and when babies end up dead as the result of such *support*, Heket, Rodley and Lizzie just nonchalantly move on onto their next victim.

    • Who?

      It’s the ultimate ‘all care, no responsibility’ line.

  • Sue

    This woman’s blogs drip with hubris. Despite admitting that she has no clinical training whatsoever, she spends a lot of time arguing that Dr Michael Gannon, the West Australian AMA President, who happens to be a specialist Obstetrician, should “get educated”.

    • yugaya

      She was the laughing stock in that evidence-based group (which hurt her feefeelz so much that she had to write a separate blog about it) over how it’s virtually impossible to find any blog post of hers that does not use her own birth anecdata to reinforce her opinions.

      Lizzie is just another sad proof how NCB perfectly serves the purpose that stems from its profoundly patriarchal nature and origin – that of dumbing women down into birthers unable to think past their own vaginas.

      • Krista

        “anecdata”

        Did you come up with that? Its brilliant!

        • demodocus

          I’ve seen it on Science Based Medicine, for one.

        • yugaya

          LOL no, but it is a perfect word that completely conveys what goes for *evidence* in NCB universe.

  • Who?

    Clicking around in that site gave me a headache. Lizzie is very muddled in her thinking.

    Was up in her part of the world over the weekend, the neighbour is a ‘midwife’ who had gone off to support a client. At last count she had been there for 18 hours, and I remarked to my host that I wasn’t sure she’d be good for much actual decision making/medical help after all that time on the job, particularly considering she’d been called in the early hours of the morning.

    Got the hairy eyeball in return.

  • Hilary

    “But if you see a suicidal person standing on a ledge and you yell “Jump!
    Your body is meant to survive jumps from tall buildings!””

    This made me literally laugh out loud.

    • Deborah

      So did the “special Klan discount on the purchase of white sheets”

      • BeatriceC

        That one had me shooting coffee out of my nose.

    • Kq

      Considering David Lee Roth claims the inspiration for “Jump” came from a traffic jam caused by a suicidal jumper…

  • AirPlant

    I really would take it as a personal favor if all the Meg’s mentioned on this blog would stop being crazy-pants. I like my name and the woo association is getting a bit old.

    • demodocus

      Well, fellow regular Megan is pretty close and fairly sane, so far as i can tell. 😉

      • AirPlant

        But is she a Meg? There is a very important distinction 🙂

        • Megan

          Nope. Just Megan.

  • Ellen Mary

    Someone recently claimed to me that there was no evidence that unassisted birth was less safe than hospital birth because ‘it hasn’t been studied’. No I know that the absence of evidence is not the evidence of absence & that we can say that CPM birth is less safe than CNM HB, which is less safe than CNM hospital birth so we can surmise from that that no care at all is less safe than CPM HB, but are there an studies that specifically look at unassisted birth that I can pass along?

    • yugaya

      CDC Wonder database, check out outcomes for healthy term babies over 2 500 gr born to white women that were born out of hospital with “other” listed as birth attendant. Those are the births where there was no adequate medical help available. And ignore their cries how unintended, accidental births are in there too – if unassisted birth away from medical care was as safe as they claim ,that magical safety would statistically extend to all of them.

      • Young CC Prof

        And keep in mind, a lot of those unintended out of hospital births were unusually fast, and therefore may be LOWER in risk than average.

      • The Computer Ate My Nym

        Using some generous assumptions (white, at least HS educated women, 37+ weeks, 1500+ grams), I got a neonatal mortality of 0.66 per 1000 for births in hospital with MD attendant, 1.24 for out of hospital, other midwife, and 2.11 for out of hospital, other.

        Interesting side note, CNM in hospital was 0.35, CNM out of hospital was 0.74 per 1000, that is, an out of hospital birth with a CNM was over twice as dangerous as an in hospital birth, despite, presumably, having the same low risk profile for both sets of patients.

        Also note that this does not include term stillbirths, which are much more likely with out of hospital births, especially with inadequate attendants.

        • yugaya

          Term stillbirths out of hospital are where the insane, horrendous intrapartum death rates of OOH birth are hidden – this is what a homebirth midwife told me just the other day: “when a baby dies in labour it’s actually a stillbirth”.

          Many, many cases that were covered on this blog spring to mind.

          • The Computer Ate My Nym

            Intrapartum death is extremely rare in hospital because if the fetus is in distress a stat c-section will be done and the baby will get at least as far as being born, though some do still die after birth.

        • The Computer Ate My Nym

          Just for fun, I did the “as low risk as I can make it” analysis as well: non-Hispanic white women age 20-44, who are married and have at least a high school degree, in their 2nd to 5th pregnancy, who had singleton pregnancies with prenatal care and delivered vaginally in weeks 39-41, with babies 2500-5000 grams at birth in the years 2007-13.

          Results: MD 0.29 per 1000. CNM in hospital 0.20 per 1000. Other midwife out of hospital 0.89 per 1000. Other attendant out of hospital 1.00 per 1000. So much for the claim that it’s okay to give birth OOH in the second or later pregnancy.

          • guest

            Correct me if I’m wrong (really, because I’m not great with statistics), but are these analyses saying that an in-hospital birth with a CNM had a lower mortality rate than an in-hospital birth with an MD? Is the difference statistically significant?

          • demodocus

            At my hospital, the ob was on standby just in case while the CNM actually delivered my baby. If everything had gone haywire, the ob would have taken over Wouldn’t a potential mortality then be under the OB’s stats rather than the CNM’s?

          • The Computer Ate My Nym

            I don’t know whether it’s statistically significant, having not done any kind of testing for significance, but given the numbers, it likely is. The most obvious explanation is that women who go to MDs are more likely to be older, have more comorbid problems, fetuses with possible issues, and be generally at greater risk than women who go to CNMs. Responsible CNMs risk anyone who has problems past the very routine out to OBs.

          • DelphiniumFalcon

            I’d say from my limited experience that sounds about right. The first lady doc I had in this area was a CNM and one of her big selling points, if you want to call it that, was that she was backed up by not one but two OBs she worked with directly so if something was outside her scope of practice she could refer a patient to them immediately. The two OBs were also usually the ones on call for emergency c-sections and other surgeries if she needed to call one in and could vouch for their competence and bedside manner. She also mentioned that she had good relationships with the other OBs in the area but didn’t have as close a working relationship. The two she works with are literally just down the hall a hundred feet or so.

            I liked her a lot but the OB I’m seeing now has a fantastic success rate for infertility cases so I switched over to hedge my bets. Several of my friends had gone five or more years with miscarriages or just not getting pregnant at all and they’ve all been able to get pregnant and carry to term after seeing him.

            I still speak very highly of her to others looking for a female care doctor, especially if they’re extremely religious and sex negative. Since we’re in a really religious area with multiple faiths that can have a very sex negative upbringing, intentionally or unintentionally, for women she has a whole unofficial premarriage it’s okay to have and enjoy sex and as long as it’s consensual it’s not a sin class with book recommendations on why it’s okay not to feel ashamed of being a sexual being in marriage. Also likes to have the partner in to emphasize focusing on his future wife’s needs as much as his own. And not to freak out if she wants it more than him because libidos don’t always match up. She also tries to make the first experience as painless and enjoyable as possible. She’s the reason I didn’t bleed like a stuck pig all over the place my first time since she recommended stretching my very thick hymen. Also recommended alternatives to the very expensive dialators usually used for the procedure because she thought it was stupid to charge so much for series of medical dildoes.

            Yeah, I really, really like her lol.

          • Roadstergal

            That’s fantastic. Oh, if only they were all like that, the word ‘midwife’ wouldn’t make me cringe.

          • demodocus

            She sounds awesome.

          • Monkey Professor for a Head

            Plus if someone is low risk but develops complications during delivery, presumably the hospital CNMs will call in the obstetrician. So that will artificially make the MDs figures look worse.

          • EmbraceYourInnerCrone

            OBs have to deliver the complicated cases as well as the low risk cases, the preemies, the complicated multiples, the mothers with pre-existing health conditions like diabetes, heart conditions, uterine fibroids, placenta previa. A CNM should NOT be delivering those but that means that OBs are going to have more complicated cases with a higher chance of adverse outcomes.

        • The Computer Ate My Nym

          Because I’m addicted, I also did yet another analysis, excluding congenital anomalies from consideration (i.e. included all causes of death except CA). MD in hospital, 0.14 per 1000. That’s about the same as maternal mortality, IIRC. In fact, I think it might be lower than maternal mortality in the US at the moment. Other midwife OOH 0.63 per 1000. Other OOH 0.46 per 1000 (based on very small numbers, though.)

    • Jocelyn

      The Grunebaum study singled out unassisted births. It found they had death rate 18 times higher than hospital birth: http://www.ajog.org/article/S0002-9378%2813%2901155-1/fulltext

    • Cartman36

      I know I’m not giving you the information you are asking for but I think this is one of those situations where a reasonable person doesn’t need a study to prove to them that unassisted birth is more dangerous than hospital birth. Common sense tells you that.

      • Who?

        Not in love with ‘common sense’ but I’d suggest the same conclusion could be reached by looking in any graveyard older than the early 20th century.

        • Mishimoo

          Or reading old novels/books. I’m currently re-reading ‘Chronicles of Avonlea’ and it’s mentioned frequently that someone died in or after childbirth. I was also going through a family history book recently and found that one of my relatives is listed as “died at 35 of a post-abortion haemorrhage, leaving behind 9 children” in the late 1800’s.

          • Erin

            Whereas all contemporary fiction seems to have natural epidural and complication free bond at first sight fantasies. Bet there is a thesis in there somewhere.

            Just a shame my birth experience was closer to Dickens and the Marquis de Sade than Marian Keyes.

          • demodocus

            *thats* alarmingly descriptive. Not that I’ve read Keyes or de Sade, but I’ve heard of the latter and I’ve read Dickens….

          • MaineJen

            If you read “Anna Karenina” there’s an alarmingly accurate description of childbirth, at least from the husband’s perspective. It turns out all right in the end, but he honestly thinks that she’s dying from the way she’s screaming.

          • Mishimoo

            Now I want to write it! Dammit Erin :p

    • Hannah

      Look at death rates in women prior to modern obstetrics. Or, you know, developing nations the world over today.

  • MaineJen

    http://matterhatter.com.au/i-could-have-died/

    Here is another post. She rants on and on about how very few women die having an unassisted homebirth, a much much lower number than people who die in auto accidents. We’re silly to worry.

    She does not mention THE BABY’S safety. Ever. Anywhere.

    • BeatriceC

      That writing is so bad she could actually learn something from Stephanie Myers and E.L. James.

      • Kq

        BURRRRRRN

      • MaineJen

        Oh my god EL James. There are so, so many more examples of excellently-written fan fiction in the world. Why oh why did it have to be hers?? I tried to read an excerpt of that rotten book on Amazon, and I couldn’t even finish the excerpt…it was so poorly written, it was difficult to figure out what she was trying to say in certain passages.

    • Young CC Prof

      If a ten-mile car trip was as dangerous as unassisted birth (to the mother, even), cars would not exist.

    • The Bofa on the Sofa

      Jesus fucking christ.

      The death rate in the lowest risk childbirth (call it 2/10 000 to be generous) is in fact 100 times HIGHER than the risk of dying in an 8 mile drunk drive, so something like 1000 times higher than an 8 mile sober car drive.

      Does she seriously think unassisted childbirth is 1000 times safer than assisted?

      Of course not, she’s just a dumbass.

      • guest

        Do you think she’ll next argue that unassisted homebirth while drunk is just as safe as a hospital birth, too?

        • The Bofa on the Sofa

          Not drunk. High on weed

          • guest

            Whatever makes it into an epic spiritual journey, the way our bodies were meant to birth. Maybe peyote?

      • BeatriceC

        Granted, there are some roads that are more dangerous than others. I grew up near two of the most deadly roads in the country. There’s a sign right at the beginning of the southbound US1 “stretch” (or 18 miles stretch) leading off the mainland into the Florida Keys that says something like “Drive safely. ____ fatalities this year.” I’ve seen that number hit the 30’s. Also, Krome Ave, which from US1 a couple hundred feet from “the stretch” to US Route 27 in North Miami Dade county sees at least a dozen or so fatalities every year, particularly near “Dade Corners” (the intersection of Krome and Tamiami Trail). Unfortunately, I couldn’t avoid Krome because of where my parents lived, though they lived far south of the worst parts of the road.

        That said, those roads are *still* safer than unassisted birth. Yes a lot of people die on them every year, but tens of thousands of people drive on them, so the risk is actually quite small. To put it this way: Until a couple years ago, about three miles of Krome made up part of my favorite jogging route.

        • Who?

          Someone driving-drunk or sober, bad road or good-would expect the ambulance would come if there was an accident, and would accept whatever help the ambos offered.

          Homebirth/unassisted birth-all help, apart from what the supporter offers on an all care, no responsibilty basis-is by definition bad.

        • Kq

          We live near a passage of highway nicknamed “Killer Alley”

          • DelphiniumFalcon

            Is that Highway 26 or 101 by chance? If it is my home town calls it the Death Strip.

        • Inmara

          I’ve seen signs with numbers of fatalities and injuries in Lithuania too – they were on newly reconstructed road sections where people tend to push pedal to the metal. They also have warning signs with “black dots” – places where number of accidents is unusually high due to some circumstances like poor visibility.

    • Twice as many Israelis have been killed in road accidents than by terrorists in both intifadas. That doesn’t mean that no Israelis have been killed by terrorists. It also doesn’t mean that road fatalities are less or more dead than fatalities from terrorist attacks, or that the families suffer differently when losing a loved one by either method.

  • Madtowngirl

    I find so much of the “evidence-based” or “science-based” woo incredibly ironic. It’s usually cherry-picked in a way that’s similar to religious fundamentalism. For example, “science says breast is best!” “What? Your pediatrician says bed sharing isn’t safe? He doesn’t know what he’s talking about, he’s ignorant! Doctors don’t have to keep up with new research.”

  • Gatita

    OT but relevant to breastfeeding research: An influential psychological theory, borne out in hundreds of experiments, may have just been debunked. How can so many scientists have been so wrong?

    An entire field of study—and significant portions of certain scientists’ careers—could be resting on a false premise. If something this well-established could fall apart, then what’s next? That’s not just worrying. It’s terrifying.

    • swbarnes2

      I read that same article…It wasn’t really clear to me if they’s found statistical weaknesses in every single paper published on the phenomenon. It seems to me that if you can craft a bunch of similar scenarios and you get the outcomes you expect, there’s something there. You don’t jump to throwing away 10 papers because one paper of the same quality contradicts them.

      The source is Slate. Contrarianism is their thing, you can’t jump to believing them about things like this. Their paper on pre-natal testing was dreadful.

  • Trixie

    Anyone looking for evidence based, birth after cesarean support (whether that’s for VBAC or RCS) is welcome to join the group that Lizzie Carroll is upset about, here: https://www.facebook.com/groups/birthaftercsectionfacts/

    • Jocelyn

      It’s the best group on facebook! Even if you’ve never had a c-section or aren’t going to have a baby any time soon, there is so much opportunity for debunking woo there. And woo-debunking is supported by the admins.

      • Trixie

        Thanks Jocelyn!

    • BeatriceC

      I clicked to join, but I can’t see anything yet as it’s still pending.

  • indigosky

    Ms. Carroll, tell me exactly how “dangerous” horseback riding is please. Because I am an avid rider in both English and Western disciplines for nearly 25 years and have never heard anyone call it a dangerous or risky sport.

    That just tells me how out of touch this woman is.

    • The Bofa on the Sofa

      Don’t horseback riders wear helmets? At least the fancy-schmancy ones here do.

      Horsebacking riding is not without risks at all, although all risk is relative.

      • Azuran

        You don’t need a helmet, you just have to trust yourself and the horse to both know exactly what needs to be done. Horses were made to be ridden. Beside, a helmet will prevent bonding between you and the horse.

        • Daleth

          Helmets are a form of hatting. And we know how bad hatting is.

        • The Bofa on the Sofa

          Cowboys rode horses without helmets and they survived.

        • SarahSD

          Helmets are annoying and impede the rider’s freedom of movement. Here is a statistic I made up that shows that riders who wear helmets have 25% more falls than helmetless riders. That’s because the helmeted riders don’t trust their horse.

          • The Bofa on the Sofa

            You joke, but I just read a website (looking up horse accidents by cowboys) that DID pull those types of crap arguments. “Helmets make riders ride more carelessly” and “helmets might save your head but cause more damage to the spine” and “I know a case where the horse rolled the helmet into the person’s head” (as if it would have been better to just have the horse roll on the head?)

            It’s the same old anti-seatbelt argument. He even pulls out the “seatbelts on school buses aren’t safe so it proves seatbelts aren’t always safe and so that means that we don’t need helmets” and the random “expert” that doesn’t refute his claim (“it’s not so clear”) and therefore assumes it is supportive.

          • SarahSD

            SOOO INANE. I rode horses for years and years as a kid and teenager, and was fortunate to never hear these ridiculous arguments from the people I rode with.
            Not so in the natural childbirth world, which is a lot more pervasive I guess than the helmet-free horsepeople. I bought into NCB pretty fully until about a year after having my daughter. Fortunately I chose to have her in the hospital where she had all kinds of “annoying” monitoring that made her birth much safer. I shudder to think what might have happened if I had refused that stuff or had tried to have her at home.

          • MaineJen

            That’s the same reason the governor of my state gives for not wanting to allow EMTs and family members to carry Narcan. “If addicts know they can be saved from an overdose so easily, they are more likely to use.” DERP.

            Yeah…he’s special.

          • Young CC Prof

            Serious people have explored the helmet –> carelessness hypothesis, mostly for motorcycles, and found that helmet laws do not appear to increase overall accidents, and they definitely do decrease head injuries.

          • Roadstergal

            Yes, there’s a loud group of motorcyclists who are anti-helmet, and they often yammer about how much safer it is to ride helmetless.

            The Hurt Report in 1976 showed that helmeted riders were underrepresented in accidents and that no aspect of vision or hearing attenuation appeared to be involved in accidents (in fact, lack of eye protection was a contributing factor to many), and every decent study since then has had the same conclusion, but the Anti-Helmet Brigade (including the AMA, which is why they won’t see a dime of my money) don’t care.

          • The Bofa on the Sofa

            Actually, I think Orac recently had a post about this. Some state (Michigan?) recently relaxed their helmet laws. The result has been (surprise surprise) a major upsurge in the number of head injuries in motorcycle accidents. As a control, they compared to states that did not change their laws, and (again, surprise surprise) there was no change.

          • Sean Jungian

            yep, my home state, Michigan. Sigh.

          • Gatita

            My husband is a motorcycle fanatic and he’s rabid about helmets. I can’t tell you how many lectures I’ve listened to about impact absorption and torque and oy. But I’m glad he understands how important it is. He’s so into it that he wants to make a YouTube video about it. ETA: Don’t get him started on “fake” helmets, aka not SNELL or DOT approved. He foams at the mouth whenever he sees one.

            When my son went ice skating this winter my hubby insisted on a helmet. The only other kid on the ice wearing one was the daughter of a former pro hockey player. We had a good time talking about helmets while the kids skated. Yes, our family is weird.

          • Roadstergal

            It didn’t take a lot of wearing one for me to feel naked without it.

            And it’s so much more comfortable – screw the wind in my hair, I like having my face protected from bugs, rocks, debris – even the wind is uncomfortable at 30mph when I’ve had to open the visor for one reason or another, I’d hate to think of what it feels like when you’re kissing triple digits.

          • Young CC Prof

            Hmm. As a child, I didn’t wear a helmet for skiing or for ice skating, because no one did. Now I wear a helmet for skiing, because it’s become standard gear, but I still don’t wear one for ice skating.

            Given that I’ve never hit my head while skiing, but I have in fact hit my head while ice skating quite a few times, perhaps I should rethink this.

          • Roadstergal

            Ice is _hard_.

          • Young CC Prof

            Ice is especially hard when you lock your blades into one another and fall backwards with your body arched so far that you hit headfirst. Which is a thing that happens to figure skaters attempting certain maneuvers.

          • Roadstergal

            I twinged just reading that. 🙁

          • BeatriceC

            When my son started with layback spins, his coach taught him how to fall in a way that gives him the least chance of hitting his head.

            Of course, my son is the king of the “butt spin”. This is when he falls on his butt when an flying entry to a spin fails, or his skate comes out from under him in a sit spin, and the skater winds up doing several rotations on his butt instead of his skate.

          • The Bofa on the Sofa

            And slippery. Ask my wife.

            She got the boot off last week

          • Who?

            Ouch.

            I have an entirely irrational fear of having my fingers sliced off by the blades, which I am sure is impossible and certainly can’t happen unless you are on the ice sprawled out, which is unfortunately where I often am when on the ice.

          • BeatriceC

            It’s not irrational. I’ve seen some pretty nasty hand injuries over the years, and the set up is exactly what you describe: Somebody falls and somebody is coming up too fast to stop or swerve and the blade hits the other person’s hand. A pair of freshly sharpened blades are extremely sharp and those toe picks on high level figure skates are vicious.

          • Who?

            Thanks for the nightmares, I’d always thought/hoped that somehow that wasn’t possible.

            It always looks lovely, and people do seem to be enjoying themselves. We saw skaters at an outdoor rink at Christmas, and I was surprised how the obviously very good ones were mixed in with the giggly amateurs. Made me feel bad for the good ones who were probably the least likely to cause or have an injury.

          • BeatriceC

            Sorry. 🙁 By the time you’ve spent as many hours in an ice arena as I have (which is nothing compared to the actual skaters and coaches), you’ve seen a lot. It’s amazing how creative people can be in injuring themselves. Actually, I’m more afraid of my toes getting sliced off by some skater losing their balance walking to where their bag is while I’m in the process of changing in or out of my own skates.

            As for public arenas/sessions, that’s just part of the deal. A serious skater pays for freestyle time (ice time with a limited number of skaters at a certain skill level or above) so they don’t have to dodge newbies. Freestyle time can be expensive. My son goes to two different arenas. One is ten bucks an hour, the other is 15. He goes to public sessions on weekday mornings because they’re generally pretty empty, and sometimes goes to busier ones just to goof off.

          • BeatriceC

            Tell me about it. I went down on my hip a number of years ago and the resulting bruise was so big and so nasty the ER doctor insisted that I must be being abused. One of the girls at my son’s current arena uses thick yoga mats cut into various sizes and shapes and shoved under her tights to protect herself from falls. I think that’s brilliant, and have been trying to figure out a way to keep something similar in place under boys’ clothing. They sell fall protection pads, but they’re thin and expensive.

          • Mishimoo

            My mother shattered her tailbone after slipping on the ice while iceskating. She complained a lot, and I took a certain amount of joy in telling her to “walk it off” and “it’s not that bad, you’re just weak” because I am a terrible person. To be fair, I simply repeated her own words back at her in the same tone as she used when I broke mine. Spiteful, but I had to suffer without pain meds while looking after two kids, attending school, and cleaning her house when I was 12 with a broken coccyx; she got to rest and complain when she did hers.

            (Mine was confirmed by x-ray two years after I broke it, along with a previously broken toe. It was a bit awkward.)

          • BeatriceC

            Your mother sounds almost as lovely as mine.

          • Who?

            Now you’ve both become kind and loving mothers, which is amazing and wonderful.

          • BeatriceC

            Awwww. Thanks. I do the best I can and have made all sorts of mistakes along the way. I just have to hope the good stuff outweighs the mistakes.

          • Who?

            That’s the hope…

          • Mishimoo

            Thank you! You’re pretty wonderful yourself!

          • Who?

            🙂

          • Gatita

            The former pro hockey player was adamant about not stepping on the ice without one. I thought that said a lot.

          • BeatriceC

            These days only figure skaters don’t wear helmets. Most ice arenas even provide helmets for free or rent for public sessions.

          • BeatriceC

            Oh, one other thing regarding figure skaters:

            They don’t learn those jumps entirely unprotected. There’s a rig that’s attached to a cable that runs along the ceiling to which the skater is harnessed into. They use it for anything more than a single jump. The skater doesn’t attempt those jumps until they can land it while in the rig. There’s another harness that’s attached to a fishing pole like device that the coach holds to keep the skater from falling too hard when the skater is working on a more difficult jump sequence or set up.

            So, while they don’t wear helmets, safety isn’t ignored entirely.

          • Sue

            Your husband is right to be obsessed with head protection. I’ve lost count of the number of injured riders I’ve seen in ED with a huge dent in their helmets – clearly saved from having a huge dent in their heads.

            Motorcycle riders are so vulnerable – to other people’s driving skills as well as their own.

          • Roadstergal

            I’m not a big fan of Icon gear, but their Statistics helmet delights me – it’s a nice numeric representation of why I wear a fullface everywhere.
            http://www.motorcyclegear.com/street/closeouts/helmets/icon/airframe_statistic_helmet.html

          • Sue

            Love it!

          • DelphiniumFalcon

            It’s funny how your perspective changes once you’ve even just worked the clerical side of the ED but still see all the patients.

            Things I’ve learned from the ED:

            Skiing + Route out of your skill = You’re gonna have a bad time.

            ATVs – Helmets = You’re gonna have a bad time. Also probably a TBI.

            Driving drunk – seatbelt = You’re gonna have a bad time and probably a police escort with your back boarded self.

            Mandolin veggie cutter + fall + hand = Bigger bloody mess than most car accidents.

          • demodocus

            mandolins of the nonmusical variety scare the crap out of me.

          • DelphiniumFalcon

            They didn’t used to scare me but they do now!

            This person came in with a dish towel and bath towel wrapped around their hand and it was just dripping blood while they ran over to check in. All I could think was “Holy shit, are they missing a finger under there?!”

            Saw them after they got stitched up. Just slightly under an inch long cut on a finger. No tendon or nerve injuries thank goodness. Couldn’t believe that much blood came from that tiny cut. Their mandolin had fallen out of the cupboard and sliced their hand on the way down is what they told me when I had to collect accident information.

            I went home after work and immediately moved anything that could be considered sharp, including cheese graters, to the floor level cabinets.

          • BeatriceC

            Other than figure skating, my son is adamant about helmets. That wasn’t always the case. He’d wear them, but sometimes “forgot”. Not quite a year ago he decided to test the theory of human flight using a skateboard and a very steep hill. It ended badly. The helmet he was wearing at the time (thankfully, it wasn’t one of those times he “forgot”) is now in several pieces, but his head is intact. He and his brothers have been adamant about it ever since.

          • demodocus

            Bicyclists have these arguments too, apparent, judging by my (fairly sane) ravelry bike group.

          • Siri Dennis

            Tell that to Lawrence of Arabia.

          • Who?

            Bear in mind the people running those arguments may already have a head injury, or two…

      • Roadstergal

        My favorite supplier of body armor for motorcycling (T-Pro Forcefield) also makes horse riding armor.

        I believe the comment about horseback riding might have been a reference to the infamous micro-mort equivalency of horseback riding and the drug Ecstasy.

      • indigosky

        Of course it has risk, but it truly is not a risky sport unless you make it so. I can count the number of times on one hand, minus my thumb, that anyone has had to go to the hospital for regular riding. I have been to the ER multiple times, but I train horses and do stunt riding as well. Very much not your average day on a horse!

        I only wear a helmet for English, not Western.

        • Dr Kitty

          Is your decision not to wear a helmet for Western based on habit, aesthetics, or something else?

          I rode horses a lot as a child and teen, and my father (who comes from a long line of horsey people) was adamant that we had boots, gloves, helmets and back protectors. We’re Irish, so no Western riding.
          Lots of hacks over fields and jumping dry stone walls though.

          • demodocus

            Western just doesn’t, typically. They’re more likely to wear cowboy hats if anything. Maybe like figure skating?

          • indigosky

            Aesthetics, and the fact that one sits deeper in a Western saddle. English is just a tiny piece of leather, and your legs are up much higher. Western has a high front and back, and your legs are left much longer in the stirrup. I ride Western about 60% of the time, but 75% of my “regular” riding falls are from English saddles. There’s really nothing to stop you when momentum hits. Western you have a better change at staying aboard. And you’re not jumping things in a Western saddle either 😉

    • Erin

      My Mother now claims horse riding is a dangerous sport… along with any other physical activity I might sign my son up for. Yep, all the things she happily paid for me to do as a child are now far too dangerous for her Grandson.

      I do know of two people who ended up with life changing injuries following riding accidents, one whilst hunting and one whilst hacking on a country road. The latter got hit by a car so perhaps it’s a bit unfair to blame horse riding for that, more a criticism of our interesting twisty country roads which would give the Romans nightmares. That said my son is joining the Pony Club as soon as he hits the minimum age for it because a life without some risk isn’t a life at all.

      Also I got knocked out doing “Strip the Willow” so if you put your mind to it (or there is alcohol involved) most things can put you in hospital.

      • Roadstergal

        I think Christopher Reeve put a pretty dramatic face on what can happen riding horses. Not necessarily what’s likely (I haven’t a clue about the stats), but a dramatic anecdote, as we all know, can have a lot of power.

      • Charybdis

        I love “Striip the Willow”! It’s such fun, and a workout to boot

      • Who?

        To be slightly fair to your mother, everything does seem scarier as you get older. And I think a lot of older people feel that others aren’t as competent as they were ‘back in my day’ so perhaps she thinks the instructors etc won’t be up to scratch.

        Which is silly, when you think how much less was understood, even 20 years ago, about safety and how to make thinks less unnecessarily dangerous.

    • Hilary

      I used to ride and work with horses, until I sustained two concussions (the second being more serious) and injured my back. I miss riding very much – I regularly have dreams about it despite not having ridden in ten years. But after experiencing severe chronic back pain and extensive physical therapy (which helped), I’m not ready to get back in the saddle. There are certainly risks with horseback riding. It’s still not as dangerous as childbirth.

    • Kq

      This also goes for racing cars and rock climbing. I’m married to a man who was an avid rock climber for years and is currently driving in autocross (in fact, drove in his first one yesterday!). 

      Both hobbies are quite safe when done correctly and with the appropriate safety gear. Climbers use helmets and harnesses and myriad other safety gear. They research their climbs. They use designated areas and runs, work in teams, and can climb peaks that would be impossible for the average person.

      Of course, there are the fringe types, who climb alone, or without ropes, or over terrain and to peaks that just aren’t safe. That doesn’t make it an unsafe hobby – it means that some people will take stupid risks. The hobby is safe if done correctly.

      Racing cars – same thing. Not all cars can race, and cars that race meet stringent criteria. They use safety gear – helmets, five point harnesses, roll cages installed on cars… They are checked by mechanics  before each race and lovingly (even worshipfully) maintained and upgraded with gear that will give them the best, safest results. The courses are carefully planned, even purpose built, with areas for emergency maintenance and padding and space for vehicles that lose control.

      Of course, there are the fringe types, who drag race on residential streets, or take part in races on bad courses or that are deliberately risky. Or drivers who don’t bother to follow the rules, or learn how to handle their cars. Or drive under the influence. That doesn’t make it an unsafe hobby – it means that some people will take stupid risks. The hobby is safe if it’s done correctly.

      There’s also the fact that these are *hobbies* and not *lifesaving medical care* – but really, doesn’t it all come out to the same thing? Because birth is pretty damn safe – when you follow the rules of safety and use the correct equipment and procedures to ensure it?

      • BeatriceC

        Count me among the stupid (and very lucky). You know how when you’re 17 and bullet proof? Combine that with a mountain climbing hobby and Bad Things happen. I fell about 25-30 feet and am lucky to be alive.

        • Kq

          Damn. You did get lucky!

    • The Computer Ate My Nym

      Rock climbing too. With proper training and safety equipment, the most dangerous part of climbing is the drive to the climb.

      I must admit, horseback riding intimidates me. I keep thinking, “What happens if this large herbivore gets tired of having a smaller predator on top of it and decides I need to come off?” Fortunately, I’ve only ridden extremely calm and well trained horses so mostly they just snort at me in disgust.

  • PrimaryCareDoc

    Thank you for this. Perfect.

    • MaineJen

      “I never claimed to be a medical professional…if any women followed my advice, that is ON THEM”

      • yugaya

        AKA the standard victim-blaming. Lizzie just propagates the party line while attempting to wash her own conscience clean.

  • mostlyclueless

    OT question. Any non-woo resources for alleviating anxiety about birth? My first was pretty traumatic (even though everyone got out ok thanks to modern medicine) and I am having a hard time feeling anything other than terror and dread at the idea of having to go through it again. And I don’t think reading anything by Ina May Gaskin is going to help me…

    • Gatita

      A short term course of cognitive behavioral therapy could do a lot to help. Do you have access to therapists through your insurance?

    • nomofear

      Ha!

      Personally, this website fully divorced me from NCB lies – I was googling Ina may when this blog popped up, I clicked, and I could. not. stop. reading. For weeks. When I came up for air and told my husband I suddenly trusted medicine, and wanted an epidural and a 39th week induction, he cried tears of relief.

      However, you may be coming from a different place, so reading this blog and its comments for the next month may not help like it helped me!

      • SarahSD

        Me too! It came a year after having my daughter, but in the unlikely event that we have another, I am going to be a way less annoying patient than I was during my first labor.

    • Ada Barnes

      Birth-related questions aren’t OT here! How is your relationship with your OB? I think one of the things that will help the most is feeling comfortable and secure in your relationship with him/her, and in his/her skills and experience. If he/she delivered your last baby, ask details about how things proceeded and what could have been done differently, or what couldn’t have. If not, discuss in detail what happened before and what your resulting fears are. Form a plan between the two of you. You have a golden opportunity to be so well-informed and prepared.

      My first birth was very traumatic (vaginal, but I wish it hadn’t been) and in your position, I was still listening to the woo-heads who promised me that it would be better the second time around and that I’d have a “healing birth.” I wish I’d spent that time exploring my options with my health care provider instead because the second one was worse. It wasn’t fair or reasonable of me to expect a birth experience to be the thing that healed my false expectations, unfortunately.

      Much support to you in your journey! Wishing you the best in prenatal care and delivery.

      • mostlyclueless

        Thanks. I’m actually seeing hospital midwives (CNMs) for this pregnancy — they have the best VBAC rate in the area and are still down the hall from the OR. I kind of obsessed over everything that happened in my first birth, including getting my medical records from the hospital and reading them multiple times, and I believe 100% that the OB made the right calls and had excellent judgment.

        I’m just afraid of being in that much pain again and being that out of control of my body. Labor hurt, the c-section hurt, recovering from the c-section hurt, getting re-catheterized when I couldn’t pee afterward hurt, etc. Just like days and days of pain.

        And I know everyone is like, “if you poop during labor you totally won’t even care!” but I totally cared about vomiting uncontrollably and pooping in front of people and all the gross body stuff that goes with birth. I just wish I could teleport this baby out of me.

        • BeatriceC

          I analyze things until nobody wants to be around me anymore. I agree that discussing what happened the first time around with your providers and figuring out exactly what happened and what can be done to minimize the bad stuff should it happen again will go a long way towards making you feel better this time around.

        • Ada Barnes

          On a psychological level, are you and your CNM both sure that a scheduled C-section might not be the way to go this round? If I had it to do over, I know I would have.

          • mostlyclueless

            I really, really, really don’t want to have another c-section. It was the worst experience of my life.

          • AirPlant

            I really hope you get the birth that you want and that your delivery is quick, and drama free.
            But just in case things don’t go as planned, I don’t know if this will help with your anxiety but my mother assures me that her repeat sections were not nearly as brutal as her first section, even after getting all the way to transition with section #3.
            I am sorry that your recovery and experience wasn’t what you wanted, but I am sending you all the good thoughts that this time will be better for you and you get exactly what you want with no hiccups.

          • Gatita

            A scheduled CS is very different from a crash CS. Not that I blame you for not wanting one! But if you talk things over with your care providers you may find yourself less frightened by that prospect.

          • Roadstergal

            “A scheduled CS is very different from a crash CS.”

            In all aspects – mental and physical…

          • BeatriceC

            I’m going to agree with Gatita and Roadstergal. While neither of my c-sections were planned, my first section (second live baby) was far more relaxed. The doctors took their time, everybody was joking around, I was alert, etc. It was a much better experience than my youngest, which was done in a huge rush (under 10 minutes). On the flip side, the recovery from the second section was actually easier in spite of the fact that I was sicker.

            In other words, it’s worth talking to your provider about.

        • cookiebaker

          I’ve had 6 vaginal births and I worry every time. I detest the thought of pooping and peeing while pushing the baby. Honestly, I try not to think about it and I try to take comfort from the fact that a good OB/CNM/nursing staff has seen it happen thousands of times and are completely unfazed by it. I never ask if it happened and I don’t want to know.

          My first birth was rough. I had an OB as my provider. I bowed to her wisdom and agreed to any interventions she wanted to do. I didn’t know it at the time, but she had a reputation for being rough. I don’t want to criticize her by providing details, but if she had reasons for doing what she did, she didn’t share them with me. I had a 6lb, 4oz baby, but I tore badly in 3 places: the vaginal wall, the perineum (don’t know the degree), and up toward the clitoris. I’ve never experienced any incontinence problems, so I will admit, she patched me up well.

          While the baby and I survived the birth, I decided not to see her again. I went with a CNM the next time. As far as the NCB crowd would judge, that 2nd birth was “perfect” and I guess could be described as “healing.” My thoughts were that unmedicated birth hurt and was overrated. The labor was shorter and I didn’t tear, so I did recover faster, but you’ll never hear me call it “healing.”

          How do you feel about your doctor? For the rest of my kids, I found an OB I love. She comes to my birth even if she’s not the one on call. How amazing is that? I trust her completely to take care of me and the baby.

          When I was expecting my 5th, I decided I was done with natural birth. I’m over 35 and often need augmentation, so I decided to get an epidural during labor. Having a positive pain management plan in place helped ease my trepidation tremendously. During his labor, it made a huge difference.

          I hope things go smoothly for you.

    • Liz Leyden

      Sometimes a “debriefing” is helpful, finding out exactly what happened, and why, now that the danger has passed, and discussing your feelings about it. Can your OB or PCP refer you to someone? If you live near a medical school, they sometimes offer cut-rate therapy.

  • FortyMegabytes

    Minor nit: “Jump! You’re body is…” Should be “Your”

    • Amy Tuteur, MD

      Thanks! Fixed it.

    • Who?

      And how about ‘comrades’ instead of ‘compatriots’-not all Australians think like the irritating Lizzie…

  • Mel

    “Ms. Carroll claims that her philosophy can be described as:

    ‘Throughout my pregnancy I deserve to feel well and whole, physically, emotionally and spiritually”

    I have no problem with that philosophy; but like any mission statement having an urge for things to turn out well doesn’t magically cause things to end well.

    • Daleth

      Interesting how she doesn’t even mention, um, CHILDBIRTH. Just pregnancy.

      Also interesting how she pays no attention to the fact that we don’t necessarily get what we deserve. For instance, many women feel physically terrible during some or even all of their pregnancy. Do they DESERVE to feel great? Sure, but that’s irrelevant to whether they actually do.

      • yugaya

        And how only the perception of well-being matters. Brainwash them hard enough, and a vaginal natural birth that resulted in preventable death of a child will be celebrated as a victory.

      • Young CC Prof

        If she thinks health has anything to do with justice or what people deserve, she needs a thwacking with the reality stick.

    • Sean Jungian

      I was thinking how close this is to “The Secret” and other magical thinking (cancer woo, etc.) that if you just WANT something badly enough (and do all the correct rituals and procedures flawlessly) you will receive it.

      • Roadstergal

        Which always, always carries with it the nasty corollary that if something goes wrong, it’s because you didn’t want it enough/didn’t commit to the rituals enough – it is, in some way, your fault.

        • Sean Jungian

          Always, never the people who convinced you it was safe.

      • Kelly

        Is that what that book was about. I refused to waste my time in reading it to figure out what the hype was. I am now glad I did not read it.

        • Sean Jungian

          TBH I didn’t read it either but it’s a common belief and it got WAAY too much traction thanks to Oprah. I’ve read more critiques and take-downs of it.

    • Sue

      You can “deserve” to have a childhood free of respiratory infections, a teenage without acne, an old age without dementia…..but what does “deserving” have to do with anything?

    • Who?

      It’s the same mentality that says ‘if I birth at home I won’t have interventions’; doesn’t mean they won’t be needed, though.

  • Karen in SC

    Apparently the fact that enough mothers and babies survived in the era of Clan of the Cave Bear that is evidence that unassisted birth is “safe.” No, it just means that enough will survive to continue the species.

    • SarahSD

      Or that they read a blog about a lady somewhere who had a week-long homebirth at 43 weeks with twins after 2 c-sections, and the babies lived, therefore that lady made a safe choice.

    • Young CC Prof

      Anthropologists believe that human women have been assisting one another at least a little bit since the evolution of the modern pelvic shape.

  • fiftyfifty1

    “‘Throughout my pregnancy I deserve to feel well and whole, physically, emotionally and spiritually.’”

    Oh, special special Lizzie and what she deserves. And what about all the mothers and babies who have died or been maimed through childbirth over all of human history? And who continue to die when Lizzie cheerleads them into avoiding obstetric intervention? Not special enough!

    • Roadstergal

      “Many that live deserve death. And some that die deserve life. Can you give it to them?”

      • Kq

        The wisdom of Gandalf – like a broken clock, right twice a day.

        • demodocus

          hush your mouth about Gandalf!

    • SarahSD

      And if I don’t, it’s obviously some doctor’s fault for not believing in me and sabotaging – nay, penetrating – my force field of positive affirmation that is supposed to guarantee an empowered and safe birth.

    • Dr Kitty

      Clearly Lizzie has never spent 16 weeks of her pregnancy vomiting multiple times a day despite Zofran and Cyclizine.

      Early pregnancy were the times in my life when I have felt most unwell and least like myself, and I’ve spent time in high dependency units recovering from major surgery…

      • fiftyfifty1

        Exactly. I was a wreck from N/V for nearly all of my pregnancy. What “I deserve” and “well and whole” were not even part of my reality. I was using all my energy to get through, one day at a time. She’s so entitled.

        • Who?

          It’s part of the whole glowing, healthy nacheral world view. If you were doing everything right, you would have been well.

          You probably should have taken some colloidal silver, or wheatgrass, or upped the affirmations you were doing, or some other nonsense.

          Sick=failed in this space.

    • Kq

      Not to mention mothers who didn’t feel “well and whole, physically and spiritually” for reasons beyond their control – oh, say, like hyperemesis gravidarum for eight months…