Why women hire dangerous homebirth midwives and why preventable deaths are inevitable

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Yesterday I wrote about the tragic death of homebirth advocate Caroline Lovell, who bled to death while a midwife blithely ignored her pleas to call an ambulance. That midwife, Gaye Demanuele did not relent until Lovell suffered a cardiorespiratory arrest and by then it was too late.

A number of homebirth advocates have insisted that Lovell did not die because of homebirth; they blame the midwife’s horrific negligence in ignoring basic safety measures. But Lovell hired Demanuele specifically because both believed that ignoring basic safety measures was critical to achieving the desired homebirth experience.

Preventable deaths are inevitable at homebirth because identity creation is the focus, not safety.

Lovell was a high risk patient. Three different physicians told her that she was not a candidate for homebirth because of her history of retained placenta and postpartum hemorrhage. Lovell ignored the basic safety criteria that risked her out of homebirth and Demanuele attended her because she, too, believed that ignoring basic safety standards was completely acceptable.

Why would a pregnant woman and her midwife conspire to ignore safety standards?

If you want to understand homebirth, you need to understand this: homebirth is not about birth or about a baby; homebirth is about the creation of meaning and identity.

As Rutherford and Gallo-Cruz write in Great Expectations: Emotion as Central to the Experiential Consumption of Birth:

…[W]hen selecting alternative providers of birthing services, women are not simply purchasing health care, they are choosing and purchasing guides for and co-creating an event that is idealized and emotionally charged.

No less an authority than anthropologist and homebirth midwife Melissa Cheyney concurs. Cheyney explains in Reinscribing the Birthing Body: Homebirth as Ritual Performance:

As a socially performed act of differentiation, homebirths are constructed in opposition to dominant ways of giving birth …

In other words, homebirth has little to do with birth and virtually nothing to do with the baby or with safety. It is a piece of performance art whereby women signal an identity in opposition to medical authority.

A homebirth advocate hires a midwife not to catch the baby or even to support her through labor, though that is included. According to Rutherford and Gallo-Cruz:

Midwifery is not simply a service to be purchased, but is also an embodiment of cultural meaning; through its consumption women make the ordinary experience of childbirth a symbolically charged and extraordinary experience of “meaning transfer.” … [Campbell] argues that “the essential activity of consumption is…not the actual selection, purchase or use of the products, but the imaginative pleasure seeking to which the product image lends itself …

The choice of midwife is extremely important:

… [T]he midwife’s role is critical … because she is fluent in the alternative symbolic orientations to and understandings of natural birth … [She] also provides her association and emotional support either by sharing beliefs about the experience or by affirming the woman’s right to assign her own unique beliefs to birthing. This seemingly simple service of association and presence is a critical social need in the context of extraordinary experiences and rites of passage that depend a shared cultural consensus for their significance.

Had Lovell merely wanted a safe birth, she could have gone to the hospital where she undoubtedly would have survived. But Lovell wanted a homebirth because a safe birth was not the goal; the goal was the pleasure she found in anticipating her defiance of medical authority and the anticipation of pleasure she would experience boasting of her success in the face of being counseled that homebirth was too dangerous for her.

She hired Demanuele because Demanuele shared her belief in the symbolism of homebirth and affirmed her desire to ignore basic safety standards. Lovell wanted to create a piece of performance art and Demanuele understood that and was fully committed to helping her achieve the desired performance.

I cannot begin to imagine Caroline Lovell’s horror when she realized that Demanuele was willing to go further than she was to achieve the idealized birth they had agreed upon. Lovell was dying and she knew it. She was going to leave her children motherless and she knew it. She literally begged for her life and Demanuele ignored her pleas. She bled to death slowly, surrounded by people who could have helped her, but chose not to do so.

Of course by hiring a midwife instead of having an unassisted birth, Lovell was implicitly relying on Demanuele’s greater knowledge to recognize and treat an unforeseen serious complication. I doubt Lovell could have imagined that Demanuele would be willing to let her have a cardiac arrest before she would give up on an idealized birth experience they had planned. Who could imagine that?

But the difference between Demanuele and many other homebirth midwives is merely one of degree. Midwives who attend high risk homebirths, and there are many, do so because they share with their clients the belief that birth is an opportunity for meaning making and identity construction.

Or as Cheyney might say:

… It co-opts and restructures what Babcock has called “symbolic inversion,” where the gradual psychological opening to new messages characteristic of the liminal or transitional period of ritual is intensified by metaphorically turning elements of the normal belief system upside-down or inside-out.

It is inevitable that preventable deaths will occur at homebirth when symbolism is the focus instead of safety. Homebirth midwives and homebirth advocates “trust” that complications will not occur and, if they do, there will be plenty of time to deal with them. In waiting for complications to occur instead of acting preemptively to prevent them, homebirth midwives and their clients routinely risk death. It is much harder to treat a complication than to prevent one; it is much more dangerous, too. Inevitably, midwives will judge wrong and by the time they understand what is happening, the life of a baby or mother or both is forfeit.

The problem with homebirth isn’t merely structural (being far away from emergency personnel when an emergency occurs), it is philosophical. Nothing more clearly illustrates how viewing birth as an opportunity for identity creation leads inevitably to preventable death than the hideous experience of Caroline Lovell … who knew she was dying, begged for her life, and was ignored by the person she hired to help her make meaning from birth.

  • I wanted an in hospital natural childbirth. Yes I said in hospital. It is possible and so much safer. I talked with my NP and had a plan fully in place, but my body had other plans. First I had morning sickness so severe, I had to be hospitalised sevral times throughout my pregnancy and then I developed PE. My son was way overdue and though I did finally go into lador the night before my induction, it was to erratic and I was not progressing at all, that I had to have a pitocin drip, it was Murphys law with my pregnancy and labor. After 36 hours, they had to break my water (goota love those knitting needles lol) and finally my last hope for a drug free birth was gone after 48 hours of labor, no sleep and endless pain, when my blood pressure would not go down. Here comes the epidural, the oxygen and the whispering of my husband,mother and medical staff. I told my husband and mother I had signed paperwork leaving any and all decisions up to them if I could no longer do it. After a little over 72 hours and getting prepped for a c section, I finally was fully effaced and fully dialated and could start pushing. Then baby could not move down, what Doctors failed to discover was I had a too small of a pelvis and should have not ever tried to deliver naturaly, but had a c section. The episiotomy was a complete one. It took a while but finally my son was delivered. I am thankful that I chose a hospital setting, because all that went qrong and could not be prepared for in a home setting could have in the end cost both my and my son our lives. My son is a loving, intelligent and very healthy man now. I thank all the nurses, Doctors and everyone else that I came in contact with over that 3 plus day of labor and delivery.

  • sdsures

    Can I just say, I love the graphic you chose for this post!

  • Adele

    I’m a little disturbed reading some of the posts. Surely it doesn’t have to be hospital/all interventions/ breastfeeding is overrated vs home birth/all natural/hospital is evil? I’m a doctor. I was very keen to have natural births and did hypnobirthing which was wonderful, had vaginal births and breastfed until babies were 2 and 3. I also think home births can be acceptable with low risk women and qualified midwives and not too far from hospital. I had my babies in a hospital with an obstetrician on call: I didn’t want to take any risks. But there’s still no doubt my labours slowed right down with the stress of arriving at hospital and I can easily see how that could have lead to a cascade of interventions which I really wanted to avoid. And yes childbirth is both very ordinary and very special.

    • demodocus

      Many of the women here did indeed bf, and the regulars don’t give a damn if you choose not to have any pain meds, only if you’re denied ones you wanted. My mom had 4 “natural” deliveries and a cs with the twins, all in hospitals, because when you live with a paramedic, you generally get unusually aware times when even being next door isn’t soon enough. Plus, her 1st was an 8th month stillborn; she barely had time to arrive in the ambulance before she delivered.

      • Adele

        Sorry, as I have replied to the others my comments were not fully informed! It seems that the regulars feel like there has been a bit of a backlash against conservative medical care in child birth. My babies are late teens now so I might be a bit out of touch and my patients are generally quite conservative. It’s the “alternative” ones who feel hardly done by in our hospital system. I absolutely agree that women should be respected in their choices for pain meds or not, as long as they are fully informed (in either case as eg. sometimes an epidural can speed up a posterior labour incredibly and other times it can set off a cascade ending in episiotomy/forceps.. Pethidine often just makes a women drowsy and inhibits breast feeding without helping the pain.)

        • Roadstergal

          “sometimes an epidural can speed up a posterior labour incredibly and other times it can set off a cascade ending in episiotomy/forceps”

          Citation for the epidural being causative and not just correlated?

          • Adele

            No citation sorry. Just years of observation.

    • The Bofa on the Sofa

      I also think home births can be acceptable with low risk women and qualified midwives and not too far from hospital.

      …and if this is just what was happening, this blog wouldn’t exist. But that’s the problem – homebirths are being done by some combination of incompetent providers (particularly in the US) and ideologues who are willing to sacrifice babies at the altar of homebirth and NCB. Meanwhile, those aren’t of this ilk, supposedly the good ones, are either ignoring the problem, or, worse, circling the wagons to protect those who cause it. Consequently, SOMEONE has to speak out to protect the victims of their ideology and/or incompetence.

      Read up on how midwives have treated James Titcombe, after he complained when they killed his son through their incompetence. It’s appalling.

      That’s why this blog exists. It’s a response to the actions of those people who are causing people to die. If you think that homebirths CAN be acceptable but only with 1) low risk women, 2) competent providers and 3) sufficiently close to a hospital, and you think that it is unacceptable if these three criteria are being met, then, in fact, you aren’t all that much in disagreement with anyone here.

      I’ll say it again: if that’s all that was happening (low risk, competent midwives, close to hospitals), this blog wouldn’t exist. Clearly, that is not all that is going on. Just read the stories here of the babies (and mothers) that have died. It’s typically incompetent providers, over their heads in out of hospital situations, and very often with women who shouldn’t be doing out of hospital birth in the first place. From what you say, you would also not support them. See? You agree with Dr Amy.

      • Adele

        You are right, I didn’t know enough about the blog before I made the comments. I certainly support dr Amy from what I see

        • The Bofa on the Sofa

          Cool. Stick around as you can. We always like input from doctors.

          FWIW, if you do stick around, you will see that most of what Dr Amy talks about is the mainstream position of most medical associations. We do push back against overselling breastfeeding, but you won’t hear anyone push back against BF itself – in fact, you will hear a lot about doing (real) things to support it.

    • Charybdis

      You hit the nail on the head there, with the “acceptable with low risk women”. The problem is that the women are getting to decide for themselves if they are “low risk” or not. HBAC? HBA2C? Home birth for twins? UBAC? UBA2C? 42 +5 weeks? 43 weeks? GBS positive? Macrosomic baby? Any and all of these have been home birth scenarios, with CPM attendants at “best” and no attendants at the worst.

      You should have to qualify FOR a homebirth, it should NEVER be the default option. If you meet the requirements for the homebirth option, then it should absolutely be a choice for the mother, along with the caveat that if x,y or z (stalled labor, no progression for “x” amount of time, ruptured membranes for “x” amount of time, etc) happens, then the mother will be transferred to the hospital, no ifs, ands or buts.

      If you choose to try and forgo any and all medical pain relief (narcotics, epidural, either alone or in combination), that is your choice. No one is saying you shouldn’t have the choice. But if, for whatever reason, you decide that you DO want pain relief, it should be respected and the pain relief administered. The mother should not be put off, encouraged to “have a snack, change position, walk around a bit, maybe let go and scream, er, VOCALIZE” or any of the other not terribly effective methodology pushed by the NCB crowd. Again, if you want to try the “natural, non-medicated” option, no one is saying you can’t/shouldn’t have that opportunity.

      It is called “labor” for a reason, the mother has to work for HOURS to have her baby, often times without much sleep, food or drink. Then to INSIST that she immediately have skin-to-skin with her newborn and immediately if not sooner attempt to initiate breastfeeding and then REQUIRE her to continue to care for her newborn without getting any quality rest, sleep and recovery time while trying to cope with her exhaustion, sleep deprivation and general worn-outness and dealing with pushy LC’s is cruel and unusual punishment.

      Informed consent is the lynchpin here, that and women should have to qualify to have a home birth, it should NEVER be the default option. But women are not getting real information from the NCB crowd; they are getting “birth warrior, you really open up to the cosmos as you feel the completeness of the miracle of giving birth, your psyche touches and is in communion with the universe and all the ancient mama wisdom of the ages” crap, along with the “trust your body, you were MADE to give birth, your body cannot grow a baby it cannot deliver vaginally, trust birth” party line that is so prevalent. That, plus the so-called “cascade of interventions” that you made reference to, that is SURE to happen if you come within mile of a hospital while you are in labor, where the Evil Doctor and Nurse Ratched will strap you down to a gurney, shave you bald whilst delivering a HHH enema, give you medication that makes you loopy, add more straps to the restraint system you are already in, reach in with forceps to unceremoniously rip your baby from your womb, give you shots to dry up your milk, and take your baby away from you to perform medical experiments on him/her, give them a bath and then place them behind glass so you can never, ever see or touch them until you leave the hospital. This is the sort of picture they paint and preying on people’s fears of the unknown during a particularly vulnerable time is unconscionable.

      • Adele

        I agree. Home birth should never be default. Women should be supported in their (informed) choices regarding labour etc. and you write very eloquently the extremes of each view! I spend half my life as a doctor trying to find moderation between 2 extreme views I think! (Though my weak point is the anti-vaccers. I have read extensively both sides and it seems to me that there is no case at all for anti-vaccers)

  • AA

    Too bad this is not in English

    http://www.heise.de/tp/artikel/36/36001/1.html

  • sdsures

    Will Ms Lovell’s story be put on Hurt By Homebirth? If it’s not there, it certainly deserves to be.

    • Amazed

      I also think it deserves to be there but I doubt it’ll ever happen. Hurt by Homebirth hosts stories told from the mother or father themselves. Only Ms Lovell’s mother or husband can ask for the story to be placed there – at least that’s my understanding. And Caroline Lovell’s mother has never mentioned Dr Amy, AFAIK. Perhaps she hasn’t heard about her, or perhaps she did and she’s aware that Dr Amy doesn’t share her view of her daughter solely as a victim. She certainly glosses over the fact that Caroline was into homebirth enough to campaign for it and threaten an unassisted homebirth if she didn’t get what she wanted, aka a legal midwife-assisted homebirth. Granted, I think she did it before she got pregnant with her second and at that moment, she wasn’t putting any child that was actually on its way into the danger of unassisted homebirth. Tragedy is, she might have been alive if she had. But her mother seems to be ignoring the homebirth advocacy part and focusing solely on her daughter as your average homebirthing mother who is supposedly not against hospitals at all.

      • sdsures

        OK.

      • sdsures

        OK, just wondered. I just hope the father has some support.

        • Amazed

          I read somewhere that he’s no loner working and he’s full time carer to the children. I also hope he has some support.

          • demodocus

            both mental and physical. Who expects to loose their wife to childbirth in the West these days?

          • Amazed

            Especially when everything seemed fine. The hardest part was supposed to be over already. The baby had been born and they were supposed to be both fine.

  • Susan

    piloerection……one of your best ever posts I think Dr. Amy

  • Charybdis

    As odd as it sounds, check eBay. I remember seeing cases of specialty formula from folks who had just gotten an order shipped to them when they got the OK to switch to milk based formula or some sort of milk itself.

    I just checked eBay to see if they still did baby formula and found a seller selling 12 eight ounce cans of ready to feed Alimentum formula for $18.00 and $13.45 shipping.

  • Sean Jungian

    “She hired Demanuele because Demanuele shared her belief in the symbolism of homebirth and affirmed her desire to ignore basic safety standards.”

    Thank you for writing this, Dr. Amy. Yesterday’s post raised a lot of these questions and to me it seemed very clear that Lovell had hired Demanuele almost specifically because she shared her radical commitment to homebirth, but I was having a hard time understanding and articulating why.

    You’ve put it very well and also given me some very good sources to pursue as I continue to try to understand why women choose such a dangerous path for what, to me, seems to be a very transitory and relatively unimportant (ordinary) event.

    • Erin

      Purely anecdotal but from the Birth Trauma group of which my Health visitor suggested I join in the aftermath of my son’s arrival, I’d suggest the following reasons:

      1. They bought into the fairytale of the birth we deserve and feel robbed. I think society (we never read “I had an amazing c section” in the mainstream media) and midwives are at least partially responsible for that. Here in the UK,the focus is on normal to the point of pretending nothing ever goes wrong and any attempts to dig below the surface is shut down. So first time mums fall roughly into two categories, those like me who spent hours reading about fourth degree tears, fistulas and induction (although I still managed to lose the plot) and those who think hypnobirthing, lukewarm water and visualization cards will fix everything.
      2. The relationship between midwives /doctors. I had the ward supervisor commiserate me on my “unnecessary” episiotomy and tell me what a butcher the Doctor who operated on me was. Now she knew I was already mid mental breakdown so what on earth possessed her. Bearing in mind that I had just relived being raped so couldn’t bear the thought of anyone looking between my legs so it was 4 months later when I forced myself to get a smear test (a friend had abnormal cells and threatened to drag me) that I discovered there was no episiotomy at all. Midwives telling women they didn’t need x or y seems to be a common theme, whether it’s malicious or telling them what they think they want to hear,I don’t know but it damages trust and sets them off on the path to 3.
      3. In the search for answers, they fall into “bad” company. They get told they were “birth raped”, they get told it was because the patriarchy made them labour on their backs, that birth is women’s work and that your labour stalled because you didn’t feel safe but no amount of women have babies in unsafe settings like concentration camps, war zones and other decidedly more dangerous locations than the average hospital cuts any ice because it’s become an obsession. Something bad was done to them and they need to “rewrite the ending”.
      4. Psychologists. Most of my trauma group have been seeing them and a fair number seem to have taken the “rewrite the ending” advice literally in that instead of applying it to what’s already happened, they’ll have another baby and do it right this time. Pointing out if it was that easy, they wouldn’t be here in the first place doesn’t go down well because that’s “victim blaming”.
      5. High risk limiting their choices. I discussed this with the midwifery manager at our maternity hospital asking why they won’t let women with one prior section into the MLU attached to the hospital and she said transfers show up on the stats and so they don’t want to risk it. So maybe looking into options within hospitals which don’t seem so clinical would get women through the doors.
      6. Continuity of care. If you go for homebirth, you’re likely to get a midwife you’ve met before. In hospital, no chance. I’ve seen lots of women complaining because one doctor has agreed to y or z but they turn at hospital in labour to be told no chance by whoever is on duty. That lack of a relationship so no prior trust seems to contribute to a lot of the problems.

      Needless to say I don’t go that often now. Partly because I can see that being yelled at is unpleasant but I find using birth rape to describe it offensive but also because part of my post partum illness had me convinced that my son died inside me and I know how devastating that feeling of loss was, even though in my case it wasn’t real. So I struggle to cope with the risks they are taking because believing I’d lost my child almost broke me, the reality must be soul destroying.

      • sdsures

        “I had the ward supervisor commiserate me on my “unnecessary” episiotomy and tell me what a butcher the Doctor who operated on me was. Now she knew I was already mid mental breakdown so what on earth possessed her. Bearing in mind that I had just relived being raped so couldn’t bear the thought of anyone looking between my legs so it was 4 months later when I forced myself to get a smear test (a friend had abnormal cells and threatened to drag me) that I discovered there was no episiotomy at all.”

        This is unbelievably horrible. Unprofessional, to say the least. My coffee hasn’t kicked in, so my list of PG-rated adjectives is short. I live in the UK, and although we haven’t had children yet, my husband and I know we will require a c-section and are perfectly happy with it because we know without even pausing to think that a vaginal birth would probably kill me. I also have a history of sexual assault and PTSD that complicates things.

        I’m very grateful to all you posters here on the SOB who have given me reassurance and survival tips for being on an NHS maternity ward. I’m saving all the stuff you guys tell me in an Evernote notebook so I can re-read it when the time comes (can’t TTC yet because of medical issues, even though we very much want to atm). <3

        • Erin

          In her defence (started on the Easter eggs early so feeling charitable) I think she assumed that because they’d tried forceps first but (TMI) I’m stretchy.

          I’d suggest something to do if you cant sleep for whatever reason/you have to wait for your section. One of my friend’s swore by the adult colouring book and pens she took. You can get birth related ones but I think that’s several steps too far.

          • BeatriceC

            There’s no defense for that. None. Giving false medical information is simply not acceptable.

            Also, I’m really glad you’re here and sharing your story. There are far more lurkers than posters, and I think that the more that real women speak out about their real experiences, the better things will get (I hope).

          • sdsures

            I have scads of adult colouring books, and I love them!

      • Sean Jungian

        Erin, I want to thank you very much for sharing your perspective so clearly. I am usually more of a lurker than a commenter, but lately some of these posts have really thrown my cognitive dissonance into stark relief (my own experience vs. the experiences NCB advocates promote and also the ‘conventional’ experiences they warn against) which has made me speak up more.

        Whenever I read your comments I always wish I had magic words of compassion to tell you that, while I do not and can not truly understand your experience, I do grieve with and for you in empathy and in sympathy.

        I am in the states which doesn’t have (yet) the abundance of NCB option in-hospital that you have in the UK, although it is certainly possible to have alternative birth attendants, it isn’t standard. I understand the UK embraces it for cost-effectiveness reasons.

        The demonizing of “conventional” medicine and treatment goes farther than just the NCB movement, but that is the iteration in which we see the most death and destruction, and it has done the best job of co-opting and engineering mainstream advocacy. We see the same demonizing in anti-vaccination groups as well as natural cancer treatment groups (or any major illness) and clean-eating or non-gmo adherents, but they have not been nearly as successful in translating their ideological fanaticism as the NCB movement has been.

        I’m 51 years old now and I’m as much of an ardent feminist as anyone else my age, and I do lay some of the blame for the mainstreaming of NCB at the feet of feminism coupled with the new age movement, specifically the strains we saw with my age group through the 80s and 90s. There was a huge increase of seeking for increased meaning in ritual that I remember during that time (going back into the 70s) as feminism worked to dismantle many structures of the patriarchy. I’m not going to say it was unnecessary, but I do think it gave rise to a particularly resistant flavor of protest specifically practiced by women with their bodies that put them in opposition to ‘conventional’ medicine straight down the line rather than fixing the parts that needed fixing and keeping the extremely useful innovations.

        I think it has also gained mainstream appeal for reasons that Dr. Amy has articulated in the past. NCB is a distinctly anti-feminist ideology very cleverly disguised as feminist on the surface. So it automatically doubles its supporters to include both feminists and anti- or non-feminist fundamentalist groups.

        I don’t have any answers, but I find the entire phenomenon fascinating.

        • Erin

          Oh so I do. That’s why I’m still here, came looking for an opposing perspective to the one I was hearing everywhere else and also to see if Dr Amy was as evil as certain sections of the internet paint her. Decided its better than therapy and stayed.

          • Sean Jungian

            I like that there is a broad variety of experience represented by the commenters here, both with childbirth and with breastfeeding – although I think we have more women who had trouble BF? Maybe they are just the ones that have more to say on the topic, though.

            The thing is, people like me – for whom childbirth (at a hospital) was uneventful and even *easy*, and for whom breastfeeding was easy – we don’t talk as much about our experiences as perhaps someone with a more traumatic or disappointing experience might. Possibly it’s because people like me feel it’s the default, the “norm” (uneventful hospital birth in particular) and thus not worth mentioning, or at least that’s how I usually feel about it.

            There’s also a disconnect for me between the expectations that NCB creates in parents and what I’d consider to be more “realistic” expectations for childbirth. For me as a skeptic and an atheist it’s just plain difficult for me to get swept up in spirituality/faith kinds of things. It’s something I’ve always desired, but have never been able to achieve. However, I have a number of very beloved friends who do have faith (in both the traditional religious sense and in the more new-agey “empowering”, sign-seeking sense) and I don’t think they are stupid or anything of the sort. It’s just a bit more difficult to understand the way they see things sometimes.

  • Maria Miller

    One part of this article reminds me of some modern horror films where a group of 2 or more usually younger people are doing something untoward and then one of them realizes that the other(s) are going farther into evil in the plan than they were willing. Does anyone know what I’m talking about? I hate that moment! How terrible when it involves feeling like your life is draining away. I suffer from lower blood pressure sometimes to the point of my vision blacking out some and I can’t think i’ve ever gotten close to how she felt!!! 🙁

  • Montserrat Blanco

    My son was on a pretty expensive formula as well for some months. My piece of advice: shop around. We found an online provider that charged around 30% less than the cheapest pharmacy near us.

  • Amy Tuteur, MD

    OT: Check out the sidebar for a video of me discussing Push Back!

    • CSN0116

      OMG you are soooo much softer spoken than I am lol. It’s lovely seeing you speak and iterate as yourself 🙂

    • sdsures

      That was incredible! You’re so much gentler than your writing sometimes suggests. God knows I’m also blunt a lot of the time, so I get it.

    • Kq

      Marvelous! I can’t wait for the book

  • Bombshellrisa

    Your local Buy Nothing page on Facebook. So many people offer up formula that has been either been used to make one bottle or not opened at all

  • Cartman36

    As your pediatrician to call the company for samples if they don’t already have a rep that comes by. I would also email the company directly and ask for samples and coupons. I got a CASE of formula from enfamil just for calling.

    • BeatriceC

      Oh! This is a good idea. Also calling the company yourself might yield you a few free samples and a bunch of coupons. Additionally, the company may have its own program for getting you formula at a reduced rate, similar to how some of the pharmaceutical companies have programs to help under or uninsured people purchase needed medications at a lower than retail cost.

      • Rachele Willoughby

        When my middle boy needed the special preemie formula from Enfamil, the hospital social worker gave me a number to call and they sent us a free *case* of the powder (six cans!). I’m not sure what sort of program that was though as those first few moths are kinda blurry.

    • Megan

      Ooh, good idea! I will call Similac!

      • Megan

        Just FYI for anyone else in this position, I called Similac and they had no samples of the RTF but are sending coupons! Hooray! I also found the best price through Abbott themselves using their subscription, so if it works out well for her (no constipation), I will do that if insurance doesn’t cover (and I suspect they won’t for oral use, only for enteral).

  • Commander30

    My daughter was on Alimentum for a few months and we were thankfully able to get freebies from our pediatrician. I saw below that your clinic doesn’t do that, which sucks big time! Thankfully my daughter outgrew her intolerance. At about four months old we starting mixing her bottles half Alimentum and half the “regular” stuff, and it took probably about a month or so before we were able to give her just straight regular stuff, but she’s fine on it now at eight months and has been for awhile. Hope that your little lady is able to make the switch in a few months too! I don’t miss those days of dropping so much money on a tiny can of formula.

    • Megan

      Yes! I can’t wait to try to switch again in a few months! I have so much regular formula that I was planning to use and i don’t want it to go to waste. I outgrew my dairy allergy as a baby, so hopefully she will too!

      • Cartman36

        I had the same milk allergy thing that I outgrew. My mother still complains about the cost of soy formula she had to buy and I am in my 30s

  • NoLongerCrunching

    Did Cheyney actually say “…It co-opts and restructures what Babcock has called “symbolic inversion,” where the gradual psychological opening to new messages characteristic of the liminal or transitional period of ritual is intensified by metaphorically turning elements of the normal belief system upside-down or inside-out.”

    WTF does that even mean?

    • Valerie

      In context, she’s talking about a mother pushing from an upright squatting positon, instead of pushing with an epidural on her back and the doctor looming over. She is saying the transformative element of childbirth is based on restructuring/subverting the existing medicalized model. In other words, midwife-supported, woman-led childbirth is great because of the contrast and the symbolic reversal of woman/caregiver positions. Or something like that. The piece is so gag-worthy I could only read the bits around that quote out of curiosity.

      • MaineJen

        Does she talk about how you’re more likely to tear if you push while squatting? No? What a shocker.

        • Valerie

          I don’t think she cares. She appears to be all about the ritual, culture, symbols, feelings, etc, and does not have the background to evaluate medical risks.

          • sdsures

            Well, she’s an anthropologist, not an MD. I’ll hazard she might have done research on how women in the Stone Age likely gave birth, but that in no way gives her the authority or the educational chops to deliver a baby.

        • Mad Hatter

          That’s something no one tells you! Its all about how horrible and evil laboring on your back is and how squatting is like the ideal position. I pushed from a semi-sitting/squat position (whatever they call it in the hospital) and had 2nd degree tearing. I’m scared to think it could have been worse if I was fully squatting! And my mom kept suggesting I change positions… because gravity!- I learned afterwards about the increased tearing risk, probably on this site.

          • sdsures

            Maybe she’s never had a bad bout of constipation. Sounds more like she’s prone to episodic bouts of verbal diarrhea. *grin*

        • sdsures

          Basic physics, right?

      • sdsures

        But why not just SAY SO?

        • Bombshellrisa

          Then how would she feel superior? Have you ever listened to Melissa Cheyney speak? I have, and she makes me dizzy in a bad way.

          • sdsures

            *gulp* No.

    • Roadstergal

      That is the very definition of ‘baffle them with bullshit.’

      • namaste863

        It’s rather like trying to read Finnegan’s Wake, isn’t it?

        • Amy

          Naw, Joyce was less judgmental and had a better sense of humor.

          • namaste863

            Touché

    • sdsures

      “Rubbish, rubbish rubbish…”

      I’d hate to have been her PhD thesis advisor.

  • lawyer jane

    Our pediatrician gave us multiple cans of Nutramigen for free, bless her. She must have been given a lot as samples. It was like $300 worth! You could try asking your ped.

    • Megan

      Wish our health system allowed samples, but they don’t, especially not (gasp!) formula samples. Grr…

  • lilin

    I got into an argument with a homebirth advocate on another site (that happened to post about homebirth) where *he* linked to a study that showed homebirth had a higher rate of death for the baby when he wanted to show me that homebirth had a lower rate of interventions.

    When I pointed out that his study showed birth with interventions had a lower death rate than birth without interventions he replied that, well, yes, sure, there’s a better chance of dying, but why was I focusing on that when I should have been focusing on the lower rate of interventions? Birth, he believed, wasn’t about having a living child. It was about an intervention-free birth.

    This post is right. They really are all that far gone. The higher death rate is an ideological feature, not an ideological bug.

    • Roadstergal

      I’ve said this before, but – if you’re willing to trade off a higher rate of death for a lower rate of interventions, you can do that at the hospital – just refuse the interventions. But what you get at home is the inability to know when an intervention is called for. Home birth is lying by omission as performance art.

      • Gave birth outside hospital

        In theory yes, but as with evaluating midwives, you have the problem of that some OBs, hospital administrators, and/or hospital lawyers don’t respect your ability to decline any medical procedure you are offered. There are women who have been operated on with their active discontent in labor, for example. (Google Rinat Dray.) How do you screen your particular OB and hospital for craziness? Are the midwives in your area more or less likely to be up on the latest evidence-based care and respect your wishes than your local OB/hospital options? It’s not like you can look up stats on what fraction of midwives provide poor care vs OBs, especially not for the options you happen to have.

        I was told on the hospital tour as well as by my OB that I could not decline a hep lock, and even a hep lock was tremendously generous bending the rules for me. I was told I could not eat and drink in labor and that I could not decline continuous EFM. Notice the language of no choice for me to say no. Legally I should have the right; depending on the individuals I encounter, my rights could be violated. I wanted to read up on risks ahead of time so I could give some thought to risk/reward decisions before being in labor and based on OB textbooks and the literature, I wanted to avoid all of the above policies unless entering labor with particular risk factors (post-dates for example).

        Going in to birth at a hospital with that mindset was clearly going to be a huge fight from beginning to end. How could I know whether I’d get a crew that respected my right to decline offered interventions? I couldn’t. We found a team of midwives at a birth center who we judged the better option, but perhaps we are lucky to have such good midwives in our area.

  • moto_librarian

    Definitely check into your insurance. My younger son was on Alimentum (I felt like it smelled slightly less rancid than Nutramigen), and constipation was not a problem. He was initially on soy, and that definitely made him constipated.

    Good luck!

  • MaeveClifford

    If you can swing the one time purchase, see if you can buy in bulk. Amazon Moms with Subscribe and Save is another avenue to try (watch out though, they change prices unexpectedly). I used S+S even when I was breastfeeding, because cheap diapers+free delivery= happy mom.

    That sucks though. Hydrolized formula is soo pricey. I’m assuming other options are out? My girl was milk reactive (hives) and has done great on soy, but she was allergy tested and ok’d for it. I’d try not to offer RTF if possible, just because god lord, the cost.

    • Megan

      I do this for diapers and wipes too! I will try this if insurance isn’t an option. Thanks!

    • Sean Jungian

      Just seconding Amazon S&S – I live out in the boondocks so free delivery of my cat food and some other staples is awesome.

  • BeatriceC

    I broke down yesterday and tried to watch “The Business of Being Born”. I was rolling my eyes within 30 seconds (misleading stats), horrified within the first two minutes (watching the midwife pack her bag in a less than clean environment and taking supplies out of packaging), and had to give up because I was about to rage stroke at the 17 minute mark. I think I begin to understand why women are being swayed to believe dangerous things, if this is the type of information they’re being exposed to.

    • Rachele Willoughby

      It’s worth it to watch the end where the director (producer? it’s been a long time) who was pregnant and planning a homebirth at the beginning talks about her hospital birth and her baby’s NICU stay and how things don’t always go as planned.

      Ms. Lake keeps trying to lead her by the nose into denouncing the hospital and digging into her “trauma” but she just shrugs and talks about how these things happen sometimes and at least the baby is okay.

      • BeatriceC

        I don’t know if I can make it. I was cursing at the screen. It’s a good thing I’m injured right now (fell ice skating Wednesday night), or I might have actually had a rage tantrum.

        • Rachele Willoughby

          I’d just skip to the end. 😉

          I can’t help imagining how frustrating it was for Ms. Lake to have the director (producer?) not take the bait. How could she betray her like that? Pretending that a healthy baby is more important than the birth experience! Smdh.

    • guest

      I tried to watch it when I was pregnant, and I, too, had to turn it off before I sprained an eyeball. I think I got fifteen minutes in and they still hadn’t gotten past just rhapsodizing about how “amazing” their births were, and I was like, I don’t have time for this, bitches. Give me some evidence or go home.

      (Not that I didn’t fall for other woo, mind you, just that movie was too much to take.)

  • BeatriceC

    See if your insurance company will pay for it. Some will if it’s medically necessary. Ask your pediatrician for samples. That won’t work long term, but if he/she can give you a few bottles here and there it will help.

    • Megan

      Good idea. At first glance it appears Cigna doesn’t cover but I will try calling them too.

      • BeatriceC

        Your doctor may have a way of coding it, similar to how they code the formula required for people who need to be tube fed.

  • Madtowngirl

    It is so hard for me to understand the mindset of someone who wants a home birth, so I try to compare birth to a wedding. They aren’t the same, I know, but much like your wedding day is only one day – hopefully a tiny fraction of your marriage. Sure, plan a great party and fun time, but most women accept that something could go wrong- but they still leave the catering, dressmaking, photography, etc. to professionals (or at least someone who knows what they are doing). In the same way, a child’s birth is only one day -an important day, but a tiny fraction of his or her life. It’s fine to make birth plans, and have an idea of how you want things to go. It’s fine to have whoever you want there, whatever music playing, whatever. But leave the birth to the professionals in a hospital. Something can go wrong so quickly, and minutes matter in medical emergencies. They have gone to school for this and done it hundreds, sometimes even thousands, of times. I know it’s fun to think you might know more than a doctor, but perhaps you should stick to knowing more about chess, religion, zookeeping, etc., than medicine.

    I know this analogy is problematic, primarily because weddings are not inherently dangerous (well I suppose there are exceptions), but this is the best comparison I can come up with before coffee.

    • demodocus

      A friend of mine got married during a record breaking flood, but aside from that, lol. Actually, the only professional at our wedding was our minister, but as you say, weddings are not inherently dangerous.

    • AirPlant

      I feel like a wedding can actually be a pretty good analogy, minus the life threatening aspect. When I started thinking about my wedding with my husband, my ultimate goal was to be married at the end, but I also wanted something emotionally resonant and beautiful. I got most of the things that were in my power, but there were other things that I was not able to have because my circumstances were not amenable. The big example is that my inlaws don’t like me very much, and even though I wanted them to come together and celebrate with me, they decided to be dicks.
      .
      Because my goal was to be married, I didn’t let their idiocy stop the wedding or damage my relationship, but I still look back regret their role in that day. I am angry that I let my SIL sneer at my dress and I am angry that my MIL couldn’t even smile for my photos, and I am angry that during my beautiful ceremony they were all on their phones. I am angry that they left early and I am angry that my FIL told my mom that I was lucky that anybody would even want to marry a girl like me.
      .
      I got married that day so my wedding is a success, but because of something completely out of my control I did not get to have the “wedding experience” that I wanted. I try not to fixate on it, but it is still a piece of grief in the back of my heart. I can’t begrudge anybody a bit of disappointment that they did not get to meet their baby in the way that they wanted.
      .
      Of course, I knew that my inlaws were not very likely to play nice so I managed my expectations and planned accordingly. Risking your baby for an experience is utter madness.

      • CSN0116

        I wen to Vegas and got married in a chapel on the Strip by Elvis.

        That about sums up my birth experience expectations as well 😛

        • BeatriceC

          I had a Big White Wedding to my first husband. I had no desire to do that again. Honestly, I would have been perfectly happy to get married at the courthouse over lunch and invite a random stranger to be the witness, then tell everybody about it after it was done.

        • AirPlant

          It isn’t cool to say it, but I really wanted a wedding. I wanted the poufy dress, and the cake and the matching toasting flutes and just the everything. I was a little girl who dreamed of formal dinners and ball gowns and lace and tulle and I never really grew out of it. I wasn’t a bridezilla, I had no budget, my hair first looked like shit and then fell out in ungraceful clumps and my flowers were the wrong color and eight of the 14 guests were deeply committed to being actively unpleasant, and I thought that I remained remarkably chill throughout the whole thing and I even have a generally fond remembrance of the day.
          .
          I worry that I will go a bit nuts when baby time comes, I already read this blog hoping to god I can micromanage the baby ejection process in a way that will not fuck up y pelvic floor, but I really am the last person to judge someone for falling down a feelings hole. I only get salty when someone actively risks the life and wellbeing of their child.

        • Sean Jungian

          Yeah, I called off our Big Wedding – twice – and we got married downtown by a Justice of the Peace. I bought my wedding dress and our rings at J.C. Penney because that’s where I had a charge card. And we had a big open house afterward with all our friends and family. My best friend’s busia made our wedding cake.

          I am going to get shit for this, but, while I can understand someone being upset if people behave badly at their wedding, I ultimately think it’s a…fantastically privileged thing to get upset about, and to remain upset about for years.

    • Erin

      Depends on your family…it’s not a wedding if someone doesn’t wind up in either hospital or jail in my family.

      • BeatriceC

        It’s not a real party until grandma is searching for her dentures when everybody knows they’re actually at the bottom of the beer mug she has in her hands.

    • Sean Jungian

      A wedding was the closest analogy I could come up with, too. People put an INORDINATE amount of importance on what is, in reality, a transitory, single-day event.

      I used to work in an art supply store where we also sold very fancy and expensive papers. Every spring we would have wild-eyed brides-to-be come in to order special paper for their wedding invitations, and they would have extremely complicated and involved instructions for cutting said paper, laying it out, etc.

      I always wanted to tell them NOBODY CARES. No one attending your wedding will look twice at the invitation, and guests only hang onto them because they have the date & location of the wedding on them. All anyone who loves you cares about is that you are happy and that they have fun at your reception.

      All anyone cares about when you’re having a baby is that you’re happy & healthy and the baby is healthy.

    • The Great Queen Spider

      “weddings are not inherently dangerous”
      You have not seen Game of Thrones then.

      • demodocus

        weddings not held on Klingon or in Westeros are not inherently dangerous.

    • Poogles

      Dr. Amy also had the same idea – birthzillas:

      http://www.skepticalob.com/2012/01/birthzilla.html

  • Amy M

    The homebirthers and the CPMs should have a safeword that they agree on, before labor even starts. That way, when the woman includes “don’t take me to the hospital even if I beg” in her birth plan, she’ll still get taken there if she says “rutabaga” or whatever word. Of course, there’s no way to guarantee the midwife would comply with that, but some probably would. And then there it would be in writing, with hopefully another witness like a partner—so if the woman calls the safeword and the midwife ignores it, the partner could respond.

    • Megan

      You one, the fact that a safe word is needed should tell you a lot about the midwife-homebirther relationship…

      When I was preparing for my first delivery, my doula had me fill out some form (I think authored by Simkin) that actually had an option for “don’t give me pain less even if I beg,” and even then, semi-entrenched in woo, that gave me pause. Looking back, I really wish I had not believed a natural delivery would be better. If I hadn’t, I probably would’ve had my CS sooner (rather than after four days of induction) and possibly avoided my PPH. It’s amazing how awesome an experience my scheduled repeat CS was this time around. Way better than attempting VBAC!

      • Megan

        Ok sorry for the typos. That’s what I get for posting with my phone while feeding my baby! Hopefully it’s still understandable.

      • guest

        I had a doula who wasn’t very experienced (therefore not very expensive) but we still discussed at what point she should stop encouraging me to forego the epidural and ring for the nurse to set it up. I thought about it and we chose a number of times of me asking for it – three. So if I asked once, she was to encourage me to keep going or suggest a change of position, and if I asked twice, the same thing, but the third time, just stop and do what I asked. It worked for us (I did get the epidural).

    • Mel

      The only problem I see with the safeword is what you alluded to: In sexual situations where you need a safe word, you can be pretty sure your partner cares enough to stop if you use the safe word – and there is the potential of criminal charges if they don’t.

      In home birth midwives, the ones that you need a safe word with a) don’t care enough to stop their satisfaction is based on enforcing your vagininal birth and b) there are no criminal punishments for killing a woman through neglect in childbirth.

      • BeatriceC

        I can count on one hand the number of times I’ve had to safeword out of a scene, and one of those times wasn’t even a real scene, just run of the mill sex that had gotten a little too intense for me. Every time I’ve had to safeword out, the scene stopped cold. Nothing else mattered to my partner. I’d just said the safe word so game over (sort of…then there’s “aftercare”). What you say about trust is at the heart of the matter. Even if a pregnant woman finds a midwife who will agree to a safeword arrangement, can she really trust the midwife to respect that instead of just thinking that she can “reassure” the laboring woman that she’ll be okay and doesn’t really want that intervention? I don’t get into BDSM scenes with a partner until I really, really trust them, and then I work my way up to more and more trusting situations. We don’t start by pulling out the ropes and floggers. Those don’t come out until the trust is fully established. Unfortunately, you only get one chance at labor in each pregnancy.

      • Sean Jungian

        “Enforcing your vaginal birth” I like the way you put that.

        NCB advocates are Vaginal Birth Enforcers.

  • MaeveClifford

    Beautifully put. As I said in the last thread, negligence is a feature, not a bug, of homebirth. The more safety measures you try to introduce, the more you take away from what homebirth advocates find appealing about it. The whole point is that intervention isn’t necessary if you just trust birth. Demanuele didn’t need to check on her hemorrhaging patient; she “trusted birth.”

  • lawyer jane

    O/T: Labor epidurals come to Bhutan. “Epidural analgesia was launched at the Thimphu referral hospital as a gift from Her Majesty The Gyaltsuen to all the mothers of Bhutan.” http://www.kuenselonline.com/20-women-opt-for-epidural-analgesia/

    Progress!

    • MaeveClifford

      Hooray for epidurals!

    • Chant de la Mer

      I think that the queen of Bhutan just had a baby, so I think its pretty neat that she is gifting something like that, she has an experience and then has the opportunity to make that same experience better for other mothers.

    • Sean Jungian

      I would kiss whoever invented the epidural. What a remarkable treatment, I would not give birth without one.

      • BeatriceC

        I proposed marriage to the (female) anesthesiologist who showed up to place my epidural when I was in labor with my oldest. My husband wasn’t amused.

        • Sean Jungian

          I no longer remember the OB or the nurses who attended me but you’d better believe that after 14 years I still remember the very competent, no-nonsense female anesthesiologist who gave me my epidural. May she have every happiness in life!

          • BeatriceC

            I don’t recall many details from that part of my labor, but I remember the doctor’s response being something along the lines of “this is why I love l&d calls, since you guys are always so happy to see me!”. That’s probably not exact, but that was the general sentiment.

          • Sean Jungian

            Well I was overjoyed to see her, and I did not have an unmedicated labor even before the epidural.

          • lawyer jane

            I was a little concerned about the anesthesiologist because he appeared to be about 12 years old, but I will never forget the nurse who held my arms while he inserted the needle. I had a contraction and she said “wow, that was a big one” (in a compassionate way). She was literally the ONLY person in my entire l&d experience to recognize, name, and be compassionate about my pain.

          • Sean Jungian

            I’m sorry you had that experience. I don’t know where you are, but I have never had a nurse that wasn’t compassionate, and in fact almost to a one every nurse I’ve interacted with has done more for my comfort and peace of mind than anyone. I actually cry thinking of the nurse that talked to me when I terminated a pregnancy.

            Not that I’ve been in the hospital a lot myself, but my mother had extended hospital stays through her cancer. I have never had a bad experience with a nurse (I have had a few unfortunate experiences with doctors) and to me they really are superheroes.

          • BeatriceC

            I’ve seen them all; good, bad, ugly, indifferent. The overwhelming majority of nurses are wonderful. It seems to me that most of the time when they’re not, they’re extremely bad, with very few that are simply “competent”. But like they say, there are bad seeds in every profession.

          • guest

            I don’t remember *anyone* from my birth, not really. The nurses seemed to be different every time I saw them, the anesthesiologist came in the middle of the night (bless her) and spent most of her time behind me, and the surgeons didn’t even introduce themselves or even put themselves in my field of vision (totally understandable, given the circumstances), and surgical anesthesiologists stood behind my head and discussed golf during my surgery.

            They told me to try and sleep during early labor, so I did, and I was thereafter just really out of it (I’m sure the magnesium had something to do with it too).

          • BeatriceC

            I don’t recall the anesthesiologist from my middle child’s birth at all. I clearly remember the one from my youngest, because he decided that the best place for him to be after dinner that night, so long as he wasn’t paged elsewhere, was hanging out in my room chatting with me and watching TV. I was only 24 weeks pregnant so they were trying really hard to keep me pregnant, but my health was precarious enough that they decided that a doctor or nurse had to be in my room at all times, around the clock. The anesthesiologist would hang out with me, call a nurse to replace him when he got paged, then come back between cases. It’s a good thing he did that too, as he could set orders in motion faster than nurses could, and the shit hit the fan that night forcing a “smash and grab” c-section. I’m also thankful that he talked me into placing an epidural earlier in the day, “just in case”, and he was able to start the meds while the crash team arrived in my room to transport me so it didn’t happen under general.

    • The Bofa on the Sofa

      Someone needs to tell the women of Bhutan that epidurals are evil, and lead to nasty interventions.

      And then, all the women if Bhutan, altogether, can tell that person to fuck off.

  • lawyer jane

    “I cannot begin to imagine Caroline Lovell’s horror when she realized that Demanuele was willing to go further than she was to achieve the idealized birth they had agreed upon.”

    This was exactly the experience I had with my woo-infested hospital-based CNM midwife. I had no idea how drastic a mismatch there was between our goals and intentions until things started to get complicated. Thankfully nobody got hurt. But this well-regarded CNM continues to have a cult following in my highly education city.

    • AirPlant

      That is exactly why I am still pretty supportive of the concept of a birth plan in spite of all the eyerolling ways that they are used. Childbirth can be managed a whole spectrum of ways, and I like the idea of having that decision be informed by the woman’s preferences. As long as a basic standard of medical care is met, a more woo-like midwife will get great results for women who value her style of treatment, but she is a bad match for someone less process oriented. A short and sweet birth plan can communicate how the patient wishes to be handled without the medical staff having to either guess or make crazy assumptions.

      • lawyer jane

        Well, the problem is that I just didn’t know what to put in a birth plan! In restrospect, what I wanted was a medical professional who would use the standard of care and prioritize a healthy baby and healthy mother over “natural” labor. I also didn’t realize that I would want an epidural until the pain hit. Until I actually went through the event, I just did not really comprehend that I was chosing a care provider who was that far outside the medical norm. Now that I actually have the child, I would NEVER pick an “alternative” provider. I just simply didn’t realize that I was chosing an “alternative” birth practice, as dumb as that might sound. I believed due to propaganda and the respect this midwife practice has in an extremely educated community (and is located in a hospital too) that I would get care that prioritizes the health of the baby. I was wrong, and lucky that it only resulted in aggravation,a bad birth experience, and some extra pain, and not anything worse.

        • An Actual Attorney

          I’m pretty sure I know the practice you are talking about. I don’t understand why the OBs at the hospital put up with it. But I don’t know any OBs well enough to ask.

          • Megan

            Probably the bean counters and administrators at the hospital saw it as a good marketing tool and didn’t much care what the OB’s thought. That’s pretty typical of today’s large health care systems.

          • attitude devant

            If you share the hospital with me I might know someone you could ask…..

          • An Actual Attorney

            I don’t know for sure about Lawyer Jane, but I was referring to George Washington University Hospital. The midwife program is a stand alone practice.

            ETA, here’s where they recommend img and the bbb.http://www.gwdocs.com/midwifery-services/considering midwifery