Response to critics of my homebirth piece in The New York Times

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I was thrilled to write a piece on homebirth for The New York Times. As of this morning it was one of the most read opinion pieces of the last few days, and one of the most emailed articles of the entire paper. The comment section quickly grew to 337 comments before it was closed.

Positive comments might have had a slight edge over negative comments, but there were certainly many negative comments and they were entirely predictable. Today I’d like to address the main negative comments.

The NYTimes did not “let me” write about homebirth. They approached me to write a piece and this was the topic they chose.

Women have the right to refuse to go to the hospital for birth, but have no more right to an attended homebirth than to a home appendectomy.

Many homebirth advocates complained that the piece had not been fact checked. I’ve written for many publications and I can tell you that not a single one has fact checkers as diligent as those of the Times. I had to provide a citation for nearly every sentence including the one about taxi drivers and children assisting at uncomplicated birth. Every scientific claim is supported by scientific citations and I often had to point out the specific language in the paper that supported my assertion.

Beyond those basics, criticism fell into two large camps. The first claimed that women choose homebirth because the maternity care system is in crisis. The truth is that hardly anyone chooses homebirth. Homebirth is a fringe practice representing only around 1% of births. Indeed, the vast majority of women are very happy with their maternity care. Every few years, the Childbirth Connection, a lobbying group for the natural childbirth industry, conducts a “Listening to Mothers” survey and every time they are forced to acknowledge that over 80% of women rate their maternity care as good or excellent, with no decrease from the prior survey. Only 2% rate the quality of care as poor.

Many critics cited infant and maternal mortality statistics as reasons for to reject hospital care. But infant mortality is a measure of pediatric care (deaths from birth to one year of age). The best statistic for assessing obstetric care is perinatal mortality and the US has one of the lowest rates in the world. If you look at maternal mortality you find that the women who died did so for LACK of high tech care, not medicalization of childbirth. Most women who die in childbirth have serious pre-existing medical conditions or major complications of pregnancy. Indeed the leading cause of maternal death in the US is heart complications. Homebirth is not the answer to improving maternal death rates.

The second camp of critics apparently believes that demanding measures to insure safe homebirth violates women’s autonomy. This reflects a profound misunderstanding of medical autonomy. Medical autonomy is a negative right, not a positive right. It means that you have the right to refuse care, but you do not have the right to demand that medical personnel give you medically unsafe care.

The classic example is that you have a right to refuse amputation of a gangrenous leg if your provider recommends it, but you do not have the right to demand amputation of a healthy leg.

Similarly women have the right to refuse to go to the hospital for birth. But women have no more right to demand a medical provider attend a homebirth than to demand a medical provider perform a home appendectomy. Mandating safety standards for healthcare providers is not a violation of anyone’s medical autonomy.

Moreover, even the right to refuse comes with caveats. An autonomous decision is not merely a wish, but a decision made with appropriate information and rational consideration of the outcomes. That’s why simply telling your doctor that you want him to amputate your healthy leg is not a sufficient reason for him to honor your request.

An example of a rational but deadly decision is the refusal of a Jehovah’s Witness to accept a desperately needed blood transfusion. The decision may be hard to fathom because it can lead to death, but it is rational because the individual values spiritual well being above health and even life itself.

Respecting the medical autonomy of a Jehovah’s Witness REQUIRES a determination that the individual understands the risk of death. Similarly, respecting a woman’s autonomy to refuse to give birth in a medical setting REQUIRES a determination that she understands the increased risk of death of her baby.

In other words, a doctor’s choice to refuse to attend a homebirth is not a violation of a woman’s autonomy. In contrast the failure of CPMs to disclose that they don’t meet international midwifery standards, that the safety of homebirth in other countries has no relevance to the safety of American homebirth, and that their death rates are dismal IS a violation of women’s autonomy.

The bottom line is that you may not like me or what I have to say, but:

  • My piece was zealously fact checked.
  • Homebirth is a fringe practice.
  • Our maternity system is not in crisis.
  • And safety standards for homebirth do not violate anyone’s autonomy.

I can’t wait to see how professional homebirth advocates address these issues.

  • Amy Tuteur, MD
    • attitude devant

      Good on Barb Herrera. She has integrity. Of course the more she speaks out the more they try to silence her.

  • Soph

    Hi there- I’m a nursing student and I have been researching this issue extensively in the past month. I have yet to form my own opinions and position on the topic, since I still consider myself relatively uninformed. I would appreciate any input on my thoughts
    I’m still not understanding the strong dislike of natural birthing, particularly home birth. From reading her NYT article, and 6 posts on this blog, I’m interpreting her assertion to be that all pregnant women should not consider a home-birth? What do you think about perfectly healthy, low-risk, well-informed mothers with a good support system and frequent assessments of the pregnancy’s progress? Why wouldn’t that be an acceptable decision for that mother to make? Should we actively discourage mothers in that situation from choosing alternate methods, or would it be more ethical to provide them with all of their options in an unbiased fashion?
    So far, I’m beginning to think that women should not be pressured or shamed for not choosing a home birth, birthing center, or drug-free birth, but I’m getting the impression that she wishes to shame women that DO choose alternate forms of birth. Why is that? Additionally, I don’t understand how a baby is comparable to a septic appendix…If you are low-risk and have carried fully to term, that doesn’t sound like a medical disaster waiting to happen. I suppose I’m confused as to why so many people are adamantly against alternate practice…Anyone care to enlighten me? Thank you!

    • The Computer Ate My Nym

      Shamed, no. Given all the information so she can make an informed choice, yes. Information such as that there are rare but possible complications that can’t be treated or treated as well at home, including cord prolapse, shoulder dystocia, postpartum bleeding, PE, amniotic fluid embolus, uterine rupture, sepsis, and others. Information such as that there is a higher risk of perinatal mortality and morbidity such as hypoxic encephalopathy at home birth. Information such as that labor is extremely painful for most women and that the options for dealing with that pain at home are limited. Information such as that there are only limited things a paramedic can do for a labor gone bad and that it’s going to take time for the ambulance to get there, for her to get in the ambulance, and for the ambulance to get to the hospital, even if it’s “only 5 minutes away” in principle. If the pregnant person understands those risks then fine, it’s her decision.

      Conversely, the provider needs to understand the risks they are taking with their license and patients’ lives. They should be required to carry malpractice insurance so that they can be sued in the event of a bad outcome. They should be licensed and monitored to ensure quality. They should be willing to accept that they are there alone and have only limited backup in the case of emergency: there may be a doctor and hospital willing to accept their patient in an emergency, but there will not be an ICU in the patient’s bedroom. If they’re willing to accept those risks and can find a hospital willing to accept the risks of backing them, then, again, their decision.

      It’s not the decision. People make bad decisions all the time. That’s their right. It’s the lack of information that’s the problem.

    • Daleth

      If you are low-risk and have carried fully to term, that doesn’t sound like a medical disaster waiting to happen.

      Except that it sometimes is. Try researching–in reputable medical journals, not feel-good blogs–shoulder dystocia, postpartum hemorrhage and placental abruption, just for starters.

    • MaineJen

      Because a low risk birth can turn high risk very quickly. And the type of midwife who does homebirths in the US–a CPM–gets nowhere near the amount of training that a CNM gets. CPMs require a high school diploma and an apprenticeship, that’s it. Their track record for delivering live babies is horrible (see MANA’s own data for details). They do not have enough knowledge to recognize potential problems, they regularly attend homebirths for high risk pregnancies (breech or twins, for example), and many actively discourage women from having any prenatal testing.

      Home birth with a CNM (preferably two!) would be safer, and should be an option for low risk women. But as it’s practiced now, home birth in the US is nowhere near safe.

    • Karen in SC

      Have you had your clinical in L&D yet? That experience should clarify things very quickly.

      I’m all for CNM attended homebirth for women who are low risk and have a proven pelvis. Where there’s OB back up, and a known transfer plan, if needed.

    • moto_librarian

      Until the CPM and DEM “credentials” are abolished, I think it IS irresponsible to encourage women to give birth at home with these types of midwives. There are some CNMs who do home births, but they are in the minority. Why? Because most of them are too familiar with the types of complications that can occur and are unwilling to deal with them in a resource-scarce environment.

      I also don’t think that Dr. Tuteur has ever dissuaded someone from choosing a drug free birth. Two of her own children were delivered in this way. What she is campaigning against is the idea that an unmedicated delivery is somehow better or more acceptable than any other type of delivery. She is against misinformation being used to convince women that they should not get an epidural.

      I will conclude this by telling you that I was incredibly low-risk during my first pregnancy and delivery – gained the correct amount of weight, no GD, no pre-E, etc. I had SROM at 38 + 3 and arrived at the hospital dilated to 9 cm. I had a bit of intermittent monitoring, but no other interventions, not even a heplock. My CNM described my labor as “textbook.” Then I delivered the placenta, and I started hemorrhaging badly. I endured a manual exam of my uterus with no pain medication, and was diagnosed with a cervical laceration. I was not going to stop bleeding until it was repaired, and even with prompt surgery, I narrowly avoided a blood transfusion. In the meantime, our son was having some breathing difficulties due to TTN, and was admitted to the NICU. You can only say that birth was low risk after the fact. I don’t know if you’ve had children yet, but any naivete that I had about childbirth was stripped away during that first delivery. I know that I would have died if I had been at home. Birth is not to be trusted, but respected.

    • Who?

      There’s a world of difference between ‘natural birth’ and homebirth.

      ‘Perfect health’ is no guarantee of an uneventful labour and delivery with everyone alive and well at the end of it. No labour is guaranteed safe until it is over. Realistically, probably not until at least 24 hours after.

      Women should choose whatever suits them. They are best placed to do that when armed with the facts. In the US, choosing to give birth at home carries 4 times (roughly) the risk of death to the baby that choosing to give birth in hospital does.

      ‘Alternative’ is such an abused word. It implies that there are options of equal value to select between. Homebirth, particularly with an unqualified birth hobbyist who is ignorant of what risk and danger look like, is in no way equivalent to hospital birth. The woman runs a dramatically increased risk of death or injury to herself or the baby.

      If people find Dr T’s opinions make them feel shame about their choices, it could be worth reflecting on why: have they made, or are they about to make, a choice that isn’t the best choice?

    • Amazed

      “What do you think about perfectly healthy, low-risk, well-informed
      mothers with a good support system and frequent assessments of the
      pregnancy’s progress?”

      I think that for them, homebirth is a bad choice. For Pete’s sake, no one is demanding that they marry their obstetricians or move home to the hospital. All that the safer choice demands is that they go to a hospital for a few days to ensure that they and their babies have the best chance of surviving birth unscathed should inexpected complications arise. I still have a mother because she wasn’t playing at being low-risk and whatnot. She went to the hospital and was there when she had that postpartum bleeding that would have killed her for under ten minutes at home, with the ambulance just having arrived… perhaps.

      “Why wouldn’t that be an acceptable decision for that mother to make?”

      It’s perfectly acceptable. Her body, her choice. I just consider it a very bad one. No one can live their lives according to the values of strangers, after all. And they shouldn’t.

      “Should we actively discourage mothers in that situation from choosing alternate methods, or would it be more ethical to provide them with all of their options in an unbiased fashion?”

      Yes and yes. You see, in this case unbiased fashion included telling them that the risk of death is at least 3 times higher at home (if that’s what you mean when you say ‘alternative methods’), so of course we should actively discourage mothers in that situation from making a choice that carries such a higher risk of death,

    • LibrarianSarah

      I’m still not understanding the strong dislike of driving,
      particularly without a seat belt. From reading her NYT article, and 6 posts on
      this blog, I’m interpreting her assertion to be that all drivers and riders
      should not consider not wearing a seat belt? What do you think about sober, experienced, drivers that are not on the phone or texting and aren’t driving very far? Why wouldn’t that be
      an acceptable decision for that driver to make?

  • Rebecca Kammer

    I agreed and disagreed with your NY Times piece. Some of the studies you cited were not the best studies and the statistics were skewed to show your bias. That’s the thing about statistics, we can make them prove our viewpoints, even if it’s not totally accurate of the bug picture. The Oregon study, that only looked at a small sample size, it isn’t quite right to apply that to the entire country. Especially in an area so overrun with hippies that often make questionable choices; you cannot really apply that one subset of counter culture to the entire population of the US. And I honestly believe you know that you cannot use that one flimsy study as solid proof that home birth is dangerous. But, because you can cite it, you use it to continue the fear mongering.

    But, as a home birthing, highly educated woman, I do agree with the majority of your opinion piece. We look at all the countries who have great maternity care in and out of hospitals, they follow pretty solid guidelines. Home birth IS as safe as hospital birth BUT only when mom is low risk AND she is attended by a qualified midwife. And I agree with you, CPM is not a qualification I would trust. Any midwife willing to take on any pregnant woman is doing a major disservice to home birthers everywhere.

    I am fortunate enough to live in a part of the US where I have access to CNMs who attend home birth. But they don’t take on all women. Only low-risk women. Anything that comes along in a pregnancy that qualifies you as high risk, they transfer you to their collaborative OB and you use the hospital instead. And this model allows them to transfer patients in labor if things don’t seem like they are going straight forward in order to avoid emergencies, because they have nothing to fear.

    There is absolutely nothing wrong with asking that our midwives are internationally credentialed, and their home birth clients remain low risk. This is good, evidence-based practices that I can get behind. I was just beyond shocked to see you back that stance.

    • Who?

      A lot of people who dismiss Dr T haven’t taken the time to read her writings.

      You will have upset many homebirth hobbyists by your remarks.

      The saddest and most difficult stories are ones where a woman is lied to by someone masquerading as a qualified professional, and a damaged or dead baby, with or without injuries to mother, is the result. And then the victims are shunned by those who claimed to be their biggest supporters.

      • Karen in SC

        Like the mothers of these babies

    • An Actual Attorney

      Serious question, why where you shocked? Dr. Amy has had that stance for years.

    • swbarnes2

      If CNMs outside of hospitals are so great, why are their death rates so much higher than CNMs in hospitals? Go look it up on the CDC WONDER database (limit to 37+ weeks, 2500 grams, and deaths in the first month)

    • The Computer Ate My Nym

      Would you consider this person to be a candidate for home birth? 34 year old with no comorbid conditions, no pregnancy complications, head down fetus with an estimated weight of about 3500 grams. Went into labor at 40+4. Swam the day before going into labor. Do you need to know anything else before making your decision?

      • Daleth

        I would want to know her history.

        Does she have any uterine scars (e.g. from fibroid surgery or a cesarean)? If so, she’s at high risk of rupture and should be in a hospital.

        Is this her first birth? If so, that makes her higher risk and hospital should be considered.

        If it’s not her first birth, how has labor gone for her in the past? For instance, did she ever experience shoulder dystocia? If so she’s at high risk of recurrence, so she should be in a hospital. Ditto postpartum hemorrhage. And what were her babies like: do they tend to be bigger or smaller than the ultrasound suggests, or close to the estimated weight?

        Assuming she has no uterine scars, this is her 2nd through 4th birth (5th and higher puts even low-risk moms at higher risk of severe hemorrhage), her previous labors were uncomplicated and her kids have been below or not too much more than their estimated weights, I would say she’s a very good candidate. Personally I still wouldn’t do it in her shoes, but assuming all this, she’s clearly low risk.

        • The Computer Ate My Nym

          No surgical history at all except for dental surgery. First birth. No family history of birth problems except for pre-eclampsia in mother’s first pregnancy, but pt herself has no signs or symptoms (normal BP/no protein in urine within a week of onset of labor.)

          • Daleth

            I don’t have the stats at hand but I seem to recall US studies showing that first-time moms had a very disproportionate number of the homebirth neonatal deaths and severe injuries (brain damage etc.). If that’s correct, I wouldn’t call a first-time mom low risk, both because of statistics and because of common sense (unproven pelvis/you don’t know how her body handles labor). Medium risk rather than high, based on the history you’re describing, but not low.

      • seekingbalance

        well, that described me exactly. except that I swam my usual laps in the morning before going into labor later that morning, and we were at 40+1. my son weighed 3590 g at the time of his birth @ 40+2. thank goodness, though, that his birth was in the hospital (I’m a physician and never considered home birth) because, in retrospect, we know that he certainly would have died or had severe brain damage if it weren’t for the emergency cesarean that we got after ~20h of spontaneous “normal” labor, when his heart rate suddenly plummeted to the 60s, and for the pediatric team that identified and treated his collapsed lungs almost as soon as he was born…. he’s now a smart and healthy 7yo. so what you describe sounds like a good candidate for home birth–low risk by any official assessment, assuming the questions that daleth posed below check out too–but so did I. I’m so grateful that we didn’t choose that route. our experience was more than enough for me to want the same access and emergency services nearby*, even if they’re never used, for the women and families that I care about….

        * nearby = in the next room. we live “5 minutes” from a wonderful hospital with an outstanding NICU, where I worked at the time my son was born. that’s much too far when you truly need help.

        • The Computer Ate My Nym

          Actually, if it’s not obvious, it was me. Except for being a primip, I was basically an obnoxiously low risk patient. My CNM midwife described my pregnancy as “boring”. (Note: in medicine, this is a compliment.) I was in good shape. The baby was a good size and head down.

          It didn’t matter. The baby’s head was ever so slightly malpositioned–nothing that could have been palpated or seen on ultrasound–and we both would have died of obstructed labor at home. Or, with a responsible midwife, been transferred and had an emergency c-section rather than the controlled “urgent” c-section I actually had. Which was done under epidural, not general because I had the epidural already in place. Since one of my biggest non-disaster fears (i.e. those that didn’t include someone dying or being permanently injured) was “missing” the birth, that is, being unconscious, I was extremely grateful for the epidural.

          That’s the moral of the story, in the end: both your story and mine. You don’t know when an emergency is going to come up. Most of the time it’ll go okay, but “most of the time” is not acceptable when we can make it safe almost all the time with a few simple measures, like being near necessary emergency equipment.

          • seekingbalance

            exactly. so grateful to have this happy ending in common with you! 🙂

          • Monkey Professor for a Head

            Your pregnancy sounds similar to mine – easy pregnancy, no medical issues, 3.3kg head down baby (albeit OP). I didn’t need a c section, but despite immediate medical attention during and after birth I lost 1.6 litres of blood and needed a blood transfusion. I shudder to think what could have happened if I wasn’t in hospital.

            Whilst disasters may not happen often for low risk women, they do happen- there is no such thing as a “no risk pregnancy”. And if a disaster does happen, seconds count.

      • Chant de la Mer

        That sounds exactly like me except the estimated fetal size was higher. Baby was estimated to be >4000 grams, but I’d successfully delivered two babies that size previously with no problems so no one was worried. And then everything went haywire with a precipitous birth in a now GBS positive mom and then a horrible shoulder dystocia because apparently I grew a baby too big at 4,500 grams.

    • moto_librarian

      Too bad not all CNMs restrict their practice to low risk women. My friend lost her son because a CNM assured her that she was a great candidate for a HBAC. Despite transferring at the first signs of a problem, her child was stillborn.

      And before you accuse me of hating midwives, know that both of my sons were delivered by CNMs in the hospital. I am alive today because I delivered in a hospital rather than at home.

    • Amazed

      Let’s see the countries you’re referencing. Netherlands, right? It’s true, homebirth IS as safe as hospital birth when mom is low risk AND attended by a qualified midwife. If we compare midwives to midwives, that’s true. The rub is, midwives are LESS safer than doctors, although midwives ONLY care for low-risk moms and obstetricians only care for high-risk moms. So much for the myth of the safe Dutch homebirth.

      UK, right? It’s true, homebirth IS as safe as hospital birth when mom is low risk AND attended by a qualified midwife.But ONLY when you take such a tiny subset that it basically ignores the existing homebirth regulations and relies on artificially improved low-risk qualification that is NOT used in real UK homebirth. AND even in those artificially imporved conditions and strictly followed safety guidelines, first time mothers had much WORSE outcomes at home. That’s without even taking into account that in the UK hospitals, there are midwifery-led units where doctors have no say and actually, no information who the fuck is dying right there because midwives will not ruin perfect birth by referring to a doctor simply because a newborn is clearly dying and the parents are begging for them to refer to a doctor. Point in case (one of many): Joshia Titcombe. RIP, poor little one.

      The thing is, studies show that such a thing as homebirth paradise doesn’t exist. Not in the Netherlands. Not in the UK. They can hide it behind biased studies but the moment you look out the doors of paradise, you can feel the stinking of the corpses. Literally.

      • Roadstergal

        “It’s true, homebirth IS as safe as hospital birth when mom is low risk AND attended by a qualified midwife.”

        I do want to clarify – that’s only for women with a proven pelvis. For low-risk primps, 3x the death rate at home vs hospital – even with the killer midwives in the hospital.

        • Amazed

          That’s right. I wrote it in my reply but I did not articulate it this clearly. Thank you!

        • swbarnes2

          And of course, the homebirthing mothers were older, whiter natives with more money, so if they are getting the same outcomes as immigrant teens get in the hospital..that’s weird.

  • Kandice Jenkins

    Loved my birth with my midwife. For those with healthy pregnancies without complications, a hospital isn’t necessary. I had WONDERFUL prenatal care by a midwife. Your generalizations regarding those who choose midwifery & homebirth are unfounded.

    • DelphiniumFalcon

      Sure it’s all good…until it’s not. And when it’s not things get very dire very quickly.

      A “normal” birth can become an emergency in seconds. I won’t risk my child’s life or cognitive development on the possibility that everything could be fine.

      Similarly I’ve never even had a fender bender but I still wear my seatbelt. I’m a very safe driver with a spotless history but shit happens. I’m not risking life and limb because so far I haven’t had an accident.

    • Valerie

      That’s like saying, “for those who are good drivers, putting an infant in a car seat isn’t necessary. “

    • Mary Hawthorn

      Just because you had “WONDERFUL prenatal care”and had a trained

      professional midwife doesn’t mean the rest of us have that option.

      Having taylored prenatal care from a professional midwife is of course safer than an institutionalized hospital birth,but this isn’t the netherlands or some other northern european country that emphasizes safety and health before cost.This is the US where hospitals are for profit buisnesses that are responsible to the shareholders before the health and safety of the patient.Having a homebirth is obviously the safer option for healthy mothers(statistics don’t lie!) but it’s too expensive for the other 99% of us.

      • Kandice Jenkins

        North Carolina isn’t a foreign country (although sometimes it feels like it). Statistics don’t lie, but in this particular article, the statistics were skewed and limited. Proper midwifery care IS available. Many times, the home births in some states are “illegal” and the mothers that choose that route are putting themselves at risk to birth at home alone or without properly trained birthing assistants.

        • Amy Tuteur, MD

          Okay. Show us statistics that show homebirth with a CPM is safe. Don’t bother citing the MANA statistics paper since it is a self-reported survey of only 25% of midwives, not a study.

          • Amazed

            AND it doesn’t show what Kandice thinks it does.

        • swbarnes2

          Proper midwifery care is appropriate in a hospital, under OB supervision. No one here denies that. But sorry, if a complication does arise at home, it is very likely that a hospital’s care will mean the difference between a scary story and a healthy child, and a tragic story and a damaged child.

          CPMs are not properly trained in any state. Prior to 2012, high school diplomas were optional. One of the Duggar daughters is a CPM. Her sole trainer was a midwife who was barred form midwifery in her home state. That’s a “legal” homebirthing midwife.

        • Charybdis

          Proper midwifery care is available…..by CNM’s in a hospital/medical setting, although it appears there are *some* who will attend a home birth. The problem we have is with the CPM’s who do attend home births. Home birth is NEVER as safe as a hospital birth, ever. It is all fine and good to look back with hindsight and say “everything went just fine…I could have done this at home.” The problem is that these CPM’s don’t monitor the baby often enough or for a long enough period of time to pick up fetal distress. They encourage the mothers to go post dates, 41 42, even up to 44 weeks gestation. They will delay a transferring the mother to the hospital if she states that she wants to go to the hospital because she can’t take it anymore. They tell women is is just fine to labor for 24-72 hours with ruptured membranes which significantly raises the chance of infection. They don’t do / don’t recommend the test for gestational diabetes, nor do they do the Strep B test. “Your body cannot grow a baby you can’t deliver vaginally” and “Just shove garlic up your vagina and/or douche with Hibiclens and that will work just fine” are their answers to those issues. They will cheerfully tell a woman to use a huge dose of castor oil to “naturally” induce labor but are completely against induction in a medical setting. They lie, deceive and play to a woman’s ego by praising her choice to have a home birth and to use a CPM instead of an OB. Their response to a PPH is to shove a chunk of placenta in the mother’s mouth, tell her “firmly” to stop bleeding and administer a handful of herbs.

          The thing is, that if something goes wrong during a birth, there are only minutes, sometimes only seconds to deal with it. There is not time to summon an ambulance, get the mother loaded, get her to the ER, have her evaluated in the ER and then finally get her and the baby proper help. How long can you hold your breath? Because if the placenta has abrupted or the cord is compressed, the baby is not receiving oxygen.

          You should have to qualify FOR homebirth, it should not be a default option. Things that make you high risk (previous CS, history of obstructed labor, large babies, GD, previous PPH, placenta previa, accretia or percretia, multiple pregnancy, breech position, health conditions in the mother, etc) should be risked out to an OB. Women with any of those conditions should not be encouraged to have a home birth, but if they are educated about the risks involved (it is NOT “fearmongering” to address risks truthfully and make sure the mother understands what they are) they can make their informed choice. You can choose what you want, just be ready to deal with the fallout and consequences. You can’t do something like that AMA and then cry “Foul” after the fact if something goes wrong.

        • Amazed

          Would you explain how statistics were skewed and limited? Let me guess: Henci Goer wrote so. MANA wrote so. And you, of course, believed what you wanted to hear.

      • Amazed

        True, statistics don’t lie. It’s just you who do.

      • Nick Sanders

        You know what hospital shareholders hate? Avoidable deaths. Between the lawsuits, insurance premium hikes, possible government investigations, and decreased market share, they are absolutely horrible for business.

    • sdsures

      You were lucky. That is all.

    • Life Tip

      Drove home drunk last night and got home fine. All the generalizations about drunk driving are totally unfounded. I didn’t get into a wreck, so calling an Uber was unnecessary.

      • Roadstergal

        For those with a car in good nick and a clean driving history, sobriety isn’t necessary. I had a WONDERFUL drive home the other night after a few drinks.

    • momofone

      Loved my birth with an OB. I had WONDERFUL prenatal care by said OB. Fortunately, my OB knew exactly what to do when my to-that-point healthy, uncomplicated pregnancy became complicated. I shudder to think what would have happened if I’d been under the “care” of a CPM, and at home.

    • guest

      She doesn’t generalize about people who choose midwifery. I’m a regular here. My prenatal care was done by CNMs, and they presided over my hospital birth. And I am still quite welcome here, because I am open to factual information about best practices in childbirth and labor, where the focus is having a healthy baby and a healthy parent at the end.

    • The Bofa on the Sofa

      I had WONDERFUL prenatal care by a midwife.

      OK, I know I’ve been hanging around annoying educators and dealing with accrediting agencies, but I have to ask:

      How do you know? By what measure did you determine that your care was “WONDERFUL”?

      Note, I’m not asking you how much you liked it, or felt good about it. I want to know how you can know how good the “care” was?

      • moto_librarian

        Oh, are you going through re-accreditation too? I’m up to my eyeballs in metrics for ours right now.

    • moto_librarian

      A CNM in North Carolina with a good reputation transferred a friend at the first signs of trouble during a HBAC. It was already too late, and her son was stillborn.

      You also cannot predict certain rare but lethal complications that can occur with no warning. I suffered a cervical laceration during my completely textbook unmedicated first delivery. I was fortunate to be delivering in a hospital with a CNM who was able to get me back to the OR within minutes of the onset of the pph. If I had been at home, I would not have survived transfer.

      • swbarnes2

        But Rebecca upthread PROMISED us that CNMs don’t do risky homebirths like HBACs.

        • moto_librarian

          Yup. Too bad that isn’t universally true.

    • Amazed

      Let me guess. She came to your house, instead of making you going all the way to an office and then wait if another patient had an unforseen problem. She weighed you, she gave you one of those lovely ultrasounds that serve no purpose but are fun to have. She discussed your diet in detail and assured you how great you ate. How great you generally were. She sat there, stuffing her face with your food, and talked about how you felt ablout your pregnancy, how naturally you lived and how wonderful that was for the baby. She palpated your belly. From time to time, she might have even tested your urine. She made you feel good about yourself. Of course you’d feel it was wonderful.

      The question is, was it competent care? Because, if your lovely midwife has filled your head with this nonsense that a healthy pregnancy didn’t need a hospital, you were duped by an incompetent, at best, and a liar aiming to relieve you of your money, at worst. How can you say that for the women with healthy pregnancies and unexpected, unforseeable complications who posted here hospital wasn’t necessary? They happen to think that their lives/quality of life and their babies’ lives/quality of life are extremely important.

      What you say simply cannot be true… unless you mean that birth following a healthy pregnancy doesn’t need a hospital. It’s true, usually it doesn’t. Mothers and babies, on the other hand, often fund themselves needing one. Too often without enough time to make it there unscathed if they weren’t already there in the first place.

  • attitude devant

    OT but here’s a thing: a wonderful young woman who has married a distant relative has approached me for advice. Her lay midwife mother dragged her along with her to births when she was a small child and birthed her younger sibs at home, and now she is absolutely terrified of pregnancy, so much so that she’s pursuing adoption rather than trying to get pregnant. Has anybody encountered this in offspring of NCB fans?

    • Daleth

      Omg. I haven’t, personally, but it makes sense.

    • Bombshellrisa

      My husband watched his siblings being born at home. The births were straight forward births that resulted in healthy babies. He was completely traumatized and told me more than once that he was all for maternal request c-sections. His sister (the oldest child) decided she never wanted to be pregnant because of what she saw. She is 40 and it’s doubtful she will change her mind.

  • DirtyOldTown

    OT: Interesting article full of the usual drama about forced interventions, but one that ends in a comfortable (dare I say, more rational than usual?) place.

    The Real Reasons Why I’ll Never Regret Getting An Epidural https://www.romper.com/p/the-real-reasons-why-ill-never-regret-getting-epidural-9700

  • Marie

    How scary. Thinking of you.

    • Marie

      This was supposed to me in reply to BeatriceC’s comment below.

  • Marie

    OT: I met a mom of infant triplets at Costco today. She is my hero. I made a Facebook post along the lines of “met a mom of 10-month-old triplets at Costco today.” One of my lactivists FB friends commented “can you imagine breastfeeding three babies?!! Omg!”

    I’m working up the courage to mention that Costco mom had formula in her shopping cart.

    • Who?

      I’d leave it, honestly. Maybe send a winky face.

      • Marie

        Probably a good idea. The same person went nuts suggesting anti-vax books when I innocently asked for suggestions for what to read on my vacation.

        I have no clue how I ended up with so many lactivist/anti-vax/NCB people on my FB.

        • Who?

          They’re around, and tend to find each other. In my world they are the most active on fb as well. I have an account because I like messenger, but I don’t post on it. So I see the posts but don’t engage with them.

    • LaMont

      I also recommend against mentioning the formula, but if you’re going to do it, go for broke and also post the near-100% chance they were born by c-section as well! (In all honesty, I’m in awe of triplet-having parents, they must have an amazing amount of chill. Pretty sure that my brain would explode if I got that verdict. Because f*ck breastfeeding, mom and the tree musketeers have to make it through pregnancy first!)

      • Medwife

        Remember the Friends episode where Phoebe has triplets vaginally? No epidural either. Rachel didn’t get an epidural when she had a baby, either.

        • swbarnes2

          Recently saw that one, Rachel had a vaginal frank breech.

      • EmbraceYourInnerCrone

        I’ve only know one family that had triplets personally, one of the warrant officers at my last duty station, and his wife. The were quite premature and spent weeks in the NICU but they all came out relatively unscathed. I let him know about the groups and resources for parents of multiples and that writing to companies(diaper, formula, baby food, etc) would sometimes get free cases/samples or coupons for stuff they needed. He was really happy about that! The local parents of multiples group had regular swap meets for people who wanted to donate the stuff their twins or triplets had outgrown (strollers, cribs, etc)

        I don’t know how parents of multiples or toddlers and newborns do it, I was exhausted sometimes with just one!

        • Michelle Singleton

          One of the first things I did when we found out we were having twins was to sign up for the Emfamil coupons. We went through18-20 cans a month before they started solids. Those coupons – and prices at the commissary – were the only way we were able to afford formula.
          I attempted to BF, but stress of being a new mom, being a new mom of twins, trying to sell our house, getting ready for a PCS to Drum with 3mo babies, and knowing that Superman would be deploying when they were 5mo dried me up within 6 weeks.

        • guest

          I’m a single parent to twins and a member of a couple multiples support groups. We get as much help as we can in the early days, is how we do it, including hiring paid professionals if necessary. I know many two-parent families with twins who hire a baby nurse for nights so they can sleep. And the multiples groups I’m in are much more accepting of different practices. We don’t all sleep train, but those who do aren’t chastised. We don’t all breastfeed, but those who don’t are fully supported by all. Etc. And we get our babies on a synchronized schedule very early on. When one baby wakes to eat, you wake the other(s) and feed everyone at once.

          And then the secret that they tell you when you have multiples is that it’s hard in the beginning, but around age four, they become easier than singletons because they can play together for long periods of time, where a singleton is more likely to crave parental company.

  • BeatriceC

    OT, but I’m completely freaking out. Remember a few weeks ago when I was worried about middle kid? Well things aren’t any better and he’s continuing to lose weight rapidly (20 pounds in the last 4 weeks). All the easy stuff has been ruled out. Kidneys look fine today, negative for diabetes. Doctor is concerned enough today to suspect pancreatic cancer. That’s a death sentence. I’m losing it here. He just had a bunch of blood drawn in addition to ultrasounds. I’m sick thinking about having to wait for the results.

    • Spamamander

      I wish I had something of comfort to say. Pancreatic cancer is… evil. There is no other word for it. Sending the best of thoughts they keep looking and find something that they can actually help. And please take of yourself through all of this.

      • BeatriceC

        I’m trying not to freak out too much. We don’t have a positive diagnosis yet, but the doctor warned me that he has all of the symptoms and all the risk factors except he’s not african descent. Though that’s not entirely true because my great-grandfather (his great-great-grandfather) was black. It could still be some sort of pancreas related metabolic disorder, though diabetes has been ruled out. I’ve never hoped so much for a metabolic disorder in my life.

        • Kq

          Oh no! Please keep us posted

          • BeatriceC

            Thank you everybody. Blood work came back and doc emailed me. He said there are some signs of infection and/or cancer, but other signs that lead away from cancer and, oddly, to malnutrition, which makes absolutely no sense considering is excellent diet. The overall results are contradictory. He wants me to try to overload him on protein and redo everything next week. If one of the doctors here is willing to look at the blood work (via email, I’m not posting here) and help me understand it, I’d be most appreciative.

          • Karen in SC

            Sounds optimistic, even if contradictory. Hope he likes steak 🙂

          • Kq

            That’s better than a straight no hope. Thinking good thoughts for you and yours.

          • Madtowngirl

            Oh man, I wish I could help you out, but I have zero experience with this. That’s frustrating that it’s contradictory, but in a sense it’s positive, since it doesn’t straight out indicate cancer. Thinking of you.

          • Mrs.Katt the Cat

            Whew, glad the results weren’t awful. Good luck to you in getting it figured out.

          • KeeperOfTheBooks

            Not even a medical professional, so all I can offer is sympathy and hope. Please do keep us updated! I hope that someone here is able to help you out on the bloodwork. I’m sorry you and he are having to go through this. 🙁

          • DelphiniumFalcon

            Thinking of you and hoping it’s not cancer! Never have I hoped for an infection so much in my life…an infection susceptible to many antibiotics specifically.

          • The Computer Ate My Nym

            How about every altie’s favorite, celiac disease? True celiac disease is highly treatable with diet and can cause quite extreme weight loss if not treated. There are specific blood tests that you’ll need to request.

          • BeatriceC

            Here’s where it gets weird. He fessed up to additional symptoms as soon as he realized how deadly serious this could be. Ive emailed his doctor with the new information, but that was well after office hours, so I have to wait for a response. The new symptoms are runny, floating stool after he eats, possibly bloody. His neck is also frequently swollen, and he’d taken Advil before today’s appointment to treat the discomfort. He didn’t admit to that today. Also occasionally bloody urine. His urine is dark but no sign of of dehydration. His WBC and total neutrophils are high, but not “OMG” high; about double the upper bound of normal. His C-reactive protein, however, is six times the upper bound. On the other end of the spectrum, his alkaline phosphate just over half of the acceptable lower bound. Even with his drastically reduced appitite (and corresponding decrease in activity…he’s not skating even every day and when he does he lasts at most 45 minutes, and isn’t doing any off-ice training because of pain), he’s eating enough that he shouldn’t have any nutritional deficiencies. He’s also drinking more than adequate amounts of water. He’s not jaundiced, but his bilirubin level war exactly the upper bound of normal. None of it makes sense.

          • The Computer Ate My Nym

            Is the urine dark from bile or blood? Floaty, runny, possibly bloody stool is consistent with malabsorption. Especially if it smells bad. Undigested fat smells horrible! It would also explain signs of malnutrition in a child who is eating well. I’d suggest going down that route. Unfortunately, that does not completely preclude pancreatic cancer, which can cause malabsorption. Usually, though, pancreatic cancers that are big enough to cause malabsorption also cause massive increases in bilirubin. (FWIW, there were 18 cases of pancreatic cancer in children in the SEER database areas, so it’s extremely rare in children.)
            I can’t fit the neck pain in with anything obvious. I’m a little worried about lymph node swelling, which can also be a bunch of things, including some cancers that are much, MUCH less ominous than pancreatic.

          • The Computer Ate My Nym

            BTW, I’m trying very hard here to not give a false reassurance, but hope I’m not going too far in the other direction and making things sound scarier than they are.

          • BeatriceC

            Thanks. I’ve done some reading, trying to understand all this, and MrC, while not an MD, is a PhD biophysicist working in pharmaceutical research with a heavy emphasis on biochem, so he’s been trying to help me understand some of the things that I don’t that he actually does understand (between his area of expertise and the fact that he lost his first wife to cancer, he knows a lot, but not to the level an MD does).

            You are providing exactly the balance I need. There is something wrong, but I’m becoming more and more convinced that it’s something treatable and manageable. But still in the back of my mind I have his history and family history. He was a preemie and had kidney reflux and reduced kidney function that was resolved with a combination of surgery and simply time to grow out of preemie problems, and he also had reduced pancreatic function from newborn to age 10. Also, one of my aunt’s died from pancreatic cancer. She was perfectly healthy and then dead 6 weeks after the first symptom appeared. So you can imagine I just freaked the fuck right out. But you’ve been helpful. I like a balance of information. I like to know real risks and not the Pollyanna version. So thank you.

          • Irène Delse

            Just wanted to add a thing here: even the case of pancreatic cancer, a non negligible proportion are amenable to a surgical cure if taken early. Or so I learned from reading Respectful Insolence on Steve Jobs’ cancer.
            But I fervently hope for him and for you that it’s something less ominous. Fingers crossed.

          • Dr Kitty

            Hoping your Drs get to the bottom of it soon.
            Whipples disease is one of those really weird, rare things that might fit the picture.

          • The Computer Ate My Nym

            That would make the neck pain and swelling fit in. Weird disease, though, particularly in a kid.

          • Taysha

            Has he been assessed for celiac?

          • DelphiniumFalcon

            I was wondering this too just because it sounds so similar to what happened to my mom, sister, and a good friend. My mom.and sister gained weight from the inflammation but the friend dropped weight like crazy and was practically on death’s door from malnutrition before she was diagnosed. My mom and sister also had swollen neck lymph nodes quite often but I don’t know if that’s related. It did go away once they went gluten free but it may have just been from the constant irritation/inflammation going on so there’s that.

            My mom also suggests that if it’s a possibility, get the small intestine scope and don’t just rely on the blood test. A portion of Celiacs patients do not respond on the blood test and only a biopsy and the typical scalloped look of the small intestines were diagnostic for them.

            But if it is cancer don’t give up right away! Intermountain in Utah and Stanford have precision genomics programs that are getting more and more successful. I’ve met several cancer patients who have declared the local genomics doctor to be a miracle worker. Including a woman who had advanced ovarian cancer. I didn’t see her for her regular ultrasounds for a few months and feared the worst. Then she showed up and said she’s been able to space the ultrasounds out farther since her cancer is all but undectable. Her tumors had one of the gene mutations that was easier to target than others. Her hair had even started to grow back.

            Here’s a conference video of Dr. Lincoln Nadauld who now heads the southern portion of intermountain’s precision genomics. Mr.C may also like it. The technology is still in its infancy and not everyone has tagetable mutations but the patients that have been able to take advantage of the program that I’ve met are extremely happy with the treatments. I don’t understand all the science behind it so Mr.C and others here could probably poke holes in it but from the average Joe standpoint it sounds impressive.

            https://youtu.be/IMocc_p5jzs

          • BeatriceC

            As of the doctor’s email this morning, he’s looking at things that are more fat malabsorption. I’m having the kid keep a food diary though, so we can figure out if he reacts to specific foods.

          • Joanne Peterson

            Cystic fibrosis? Milder cases can present with malabsorption and weight loss. It can also cause elevations in alkaline phosphates and CRP.

          • BeatriceC

            He’s 14, so I’d assume CF would have presented long before now. Also, they did suspect CF when he was an infant and he was tested then. It’s was negative.

          • Roadstergal

            You’re not kidding about it getting weird. I hope they can sort all of this out – sorry you and he are having to go through this!

          • Daleth

            I was going to suggest celiac disease too.

        • momofone

          I know you must be terrified. Hoping with you.

        • DirtyOldTown

          Fingers crossed for you!

        • Who?

          Hoping for a positive outcome for all of you.

        • Taysha

          A few things to ask your doctor to check:

          MODY – genetic metabolic disorders that present like funny shaped diabetes

          pancreatic neuroendocrine tumor – not the traditional version of pancreatic cancer, treatable.

          Hang in there and good luck. i hope you get good news.

    • demodocus

      *hug* hope its something weird and with a good prognosis. Mom had pancreatic, but at least she was middle-aged.

    • yentavegan

      Thinking of you …

    • Allie

      A friend’s daughter experienced rapid weight loss a few years ago and it turned out she had a tapeworm. She used to do competitive rowing and had fallen in and swallowed some nasty lake water. Not sure how they figured out what it was, although I recall that (as a teen girl) she was accused of having an eating disorder. I hope everything turns out okay.

    • The Computer Ate My Nym

      Wow. That is terrifying! FWIW, pancreatic cancer is extremely rare in children. Also, it’s horrible and nasty, but there is a small but rising 5-year survival* rate. If it’s suspected at all, ruling it out quickly is the best thing to do.

      *Probably most of those are cures, but I can’t say that with available data.

    • Not much to say, but my thoughts are with you. Waiting for a diagnosis is extremely hard. Hope you get results soon, and the news is good.

    • Amazed

      I’ll be thinking of you.

    • Mishimoo

      Oh goodness! Sending massive virtual hugs, what an awful suspicion! Hope his health stuff gets figured out asap and that it’s not cancer. 🙁

    • The Computer Ate My Nym

      Kind of off topic, but the pancreas is a disaster as an organ. Not only do the islet cells fail to function adequately in a large percentage of the population, it goes cancerous relatively frequently and is particularly hard to treat when it does. I propose doing away with it. As in, let’s fund a “moon shot” program to develop an artificial pancreas that is better at sugar regulation and can’t go cancerous and just install it into everyone at age 40 or 50. Heck with this “natural” stuff. I want cyborgization!

    • PeggySue

      AIEEEEE! How terrifying. Thinking of you all.

    • MI Dawn

      Oh, no! I hope not, but will keep you in my thoughts. Keep us posted. Sending hugs and whatever goodies are needed to keep you going.

    • attitude devant

      You poor thing! I’d be frantic! Please keep us up to date.

    • sdsures

      🙁

    • anotheramy

      🙁 Aww, I’m sorry. I’ll be thinking of you.

  • Anne Catherine

    Bravo, again, Dr Amy. Thanks for this great article.

    • crazy grad mama

      Agreed! I was amazed at how many of the comments on the NYT piece boiled down to “waaah, she’s mean and I don’t like her so she must be wrong.”

  • Amazed

    OT: Today, my mom and I helped Amazing Niece meet a peer and start her social life. One of my oldest friend’s little girl is just 8 mo, five months older than Auntie’s Little Treasure. They “talked” to each other, older girl touched Amazing Niece’s hand a few times and they got the equivalent of a shower in the gym after practice. My friend was fascinated with Amazing Niece and I spent my time focused mostly on her baby. They were both giggling, sleeping, and listening and watching the singing bunny. Everyone was happy (except for us when we had to realize that while taking care of the little ones, our coffes had gone cold), everyone was excited. My friend’s parents were thrilled to meet Amazing Niece. While this was taking place, my SIL slept at home. Then, she came to meet my friend and her baby and take us back. Why would anyone want to trade this for attachment parenting is beyond me.

    Not so OT: That’s the same kid who, if born home to her healthy, very slim and fit mom, wouldn’t have lived. Placental abruption. Long live HM C-section!

    • BeatriceC

      “except for us when we had to realize that while taking care of the little ones, our coffes had gone cold”

      Welcome to motherhood. Or Auntie-hood, in your case.

      • Amazed

        Yeah. I think I much prefer nappy duty to this so cold cup of black liquid. It smelled of hopelessness.

    • Dr Kitty

      So much of being glad to get back to work was about being able to have a hot cup of coffee and a biscuit in peace!
      Oh sure, I have 13 patients to see, 10 phone calls and 30 prescriptions to do before I GET that cup of coffee, but it will be hot and I won’t have to breast feed anyone while I try to drink it!

      • Amazed

        There is a certain nice ring to saying, ‘hot coffee”, would you agree?

        I’m afraid I ruined attachment parenting for both old friend and SIL by sucking at the plastic end of both babies’ pacis. Turned out Amazing Niece wouldn’t believe me when I told her that paci was a great thing indeed and fist (in its entirety) was NOT nearly as tasty. Auntie’s smart little girl didn’t want my talks, she wanted deeds, so… And the other little darling tried to kiss me with her paci still in her mouth and it was hilarious so I ended up sucking this paci as well. She thought Amazing Niece was giving me a kiss… I ruined it for both of them. Now, they’ll grow terribly unattached. Then again, the very fact that they are given pacis pretty much unattaches them, right?

        • Dr Kitty

          I’ve had two that won’t take pacifiers.
          Still happy for my coffee!

  • Linda Rosa

    A pro-CPM group in Colorado — “Elephant Circle” — has been using this “survey” to promote lay midwifery and condemn hospital care.

    https://www.surveymonkey.com/r/PMBYHCF

    • Azuran

      yay, unsupervised and uncontroled surveymonkey survey. Time to mess with it.

    • sanveann

      OMG, it asks if your pubic hair was shaved or if you got an enema.

      • AirPlant

        Does it count if you paid your esthetician for the honor beforehand?

        • An Actual Attorney

          I’ve been waiting for the right thread to mention my recent realization. I’ve had 2 kids. Both times, I got a Brazilian wax in anticipation of a planned c section. Both times, I was in labor within 12 hours of the waxing. Therefore, with n=2, I conclude that Brazilians are a method of induction. Notably, I believe that being able to offer this particular “natural” induction requires more education and oversight than most CPMs have.

          • Bombshellrisa

            You got that right! Plus most salons and spas that hire those trained to do waxing require them to have insurance and and have regular “education days” to keep their skill up and to train them in the latest techniques and products. You also must be licensed with a minimum of so many hours and have done a certain number of waxings, facials, ect. It’s more than 50 facials or waxings before you can be licensed.

  • Linda Rosa

    In her op-ed piece, Dr. Tuteur wrote that it is up to the states to “abolish” CPM practice. In recent months, this is what activists like myself have tried to convince Colorado legislators to do, alas, without success.

    HB-1360, the “Direct-Entry Midwife” practice bill, is not on the desk of Gov. Hickenlooper, and we would ask you to email him, urging him not to sign the bill.

    Here is the governor’s email address:

    Governor.hickenlooper@state.co.us

    Colorado’s 64 lay midwives have a high perinatal mortality rate (18 deaths/1000 in 2015). This bill will allow them to start suturing and continue doing VBACs in the home.

    Colorado probably has violated constitutional law in exempting only the lay midwives from carrying liability insurance and any formal education. This makes it nearly impossible for Colorado’s 304 Certified Nurse Midwives — who must have a master’s degree and insurance — from competing with them in the home birth market. This situation limits the public’s ability to access safe home birth attendants.

  • AA
    • Dr Kitty

      Play “spot the scepticalob commenter’s Kinja name” in the comments 🙂

      • AirPlant

        It is so weird when my worlds overlap. 😐

        • Kq

          Been waiting all day to get home and post this.

          https://youtu.be/lsV500W4BHU

          • Mishimoo

            I love that song! (and that band)

          • Michelle Singleton

            Haven’t heard that song in awhile…

      • BeatriceC

        I’ve seen a few names in other places I thought I recognized, but I don’t say anything because it’s just weird.

        • The Bofa on the Sofa

          I’ve actually been contacted by someone from here once in a different location, but I don’t think I ever responded.

          • BeatriceC

            Every once in a while I get a message from somebody when they see a story I’d originally submitted to the “not always” sites, but has been picked up by a number of click bait sites, asking if it’s me, because how many people have two of three boys with a rare, genetic bone disease? I’m amused by how far that story has travelled, btw.

  • attitude devant

    My favorite part of refusing adequate care is trying to make sure that people who transfer into our hospital understand the risks of refusing. Because in homebirth circles, actual discussion of risks is ‘fearmongering,’ and they do not hear you. I have no problem with someone making a choice that wouldn’t be MY choice, but I have an ethical, moral, and legal duty to make sure they understand the consequences.

  • NGonzales

    This is what is going on in NM right now. North, South, East, and West of Santa Fe and Albuquerque, access to birth services is a major issue. In these situations it matters not what your credentials are-our women, families, communities need sustainable birth services, reproductive services, basic human rights here are not being met. As a Certified Nurse-Midwife I support home birth and I fully support Indigenous midwifery practices that have been practices for centuries. Today this would be viewed as “out-lawed,” but we as Indigenous people value the preservation of cultural knowledge systems that articles like this don’t value at all. We love and support our indigenous midwives.

    http://m.santafenewmexican.com/news/local_news/rural-health-care-gaps-complicate-pregnancies-for-new-mexico-women/article_dab558a4-3d7f-5dab-834b-d4a782ad410f.html?mode=jqm

    • Nick Sanders

      To hell with the midwives, try loving and supporting healthy babies and moms.

    • Gene

      So the answer to a lack of access to good medical care is to provide INFERIOR pseudo medical care by poorly trained faux midwives? Yeah, that’s brilliant.

      • Kerlyssa

        Hey, worked for chinese traditional medicine…

    • T.

      Tell me again why indigenous women deserve inferior standard of care, because I am not sure I understand it.

      • Azuran

        They don’t need medical care because they have not tried to raise themselves above their role as baby makers and therefore they don’t actually feel pain nor develop any complication during pregnancy. Or some crap like that.

      • DirtyOldTown

        Look, it’s all in the Good Earth. Women of non-European descent just squat in a field, wipe the baby off, and go back to picking rice or whatever. I just don’t think if you’ve never read Pearl Buck you’re qualified to comment. It won a Pulitzer!

        • T.

          I have actually read it and quite enjoyed it (with all the caveat of course)! Still, even while I was reading the book I noticed that the woman-character has to kill a child because famine and another one of hers ends up permanently disabled due to lack of nutrition…
          So idk, but I don’t think it truly count…

          • DirtyOldTown

            Good point. I suppose being closer to a romantic state of nature (as indigenous women logically must be) isn’t all sunshine and roses all the time.

    • LaMont

      Telling people that they are empowered as women or as members of their culture *by denying science and refusing lifesaving care* is racist and sexist as hell. How does it *not matter* what credentials are when picking medical providers?! Also, if you want to talk sustainable, having one midwife (or more!) working with one person rather than having a real medical team in a centralized location is way more expensive and time-intensive for the workers. Not sustainable.

    • AA

      There are frequent news stories about lack of healthcare–medical, dentistry, vision, podiatry, in rural and underserved areas.

      It is strange how no one brings up the idea of Certified Professional Dentists because of these concerns, isn’t it?

      • Nick Sanders

        That’s because there isn’t much money in doorknobs and string. :p

        • Charybdis

          Or pliers.

          • The Bofa on the Sofa

            When our older guy was about to lose his first, he was annoyingly wiggling it all the time. We tied a string around it and let it hang. He complained about the string, so my wife gave it a yank…

      • Phoenix Fourleaf

        Actually there is a huge controversy about dental therapists. The ADA wants them banned, but the tribes are desperate for dental providers. The dental therapist has 2 years of education to a dentists 8 years.

        • Azuran

          Well, at the very least they appear to have real training. I’m not very familiar with them but they are apparently doing all kind of real medical treatment. (usually under supervision of a dentist).
          I’m not saying they should replace dentist altogether. Efforts should still me made to allow them to have proper care and have a dentist available. But in the mean time, if it’s a dental therapist or nothing I’d go with the dental therapist.

          Same thing, I guess if I was stuck all the way in the north or something and was in labour, I guess I’d rather have a CPM along than being alone. Doesn’t mean we should consider CPMs as proper health providers for indigenous people and just leave it at that.

    • moto_librarian

      Clearly, there are huge problems with rural healthcare, and I’m sure that the problem is exacerbated for Native peoples, but I don’t see how the solution is more CPMs and DEMs. Isn’t it better to encourage Indigenous women to become CNMs or doctors and return to practice in their communities?

      • AirPlant

        Where I am from there are actually huge scholarship programs set up specifically to encourage children of our local immigrant communities to go into medicine. Apparently the program has worked out really well!

    • The Computer Ate My Nym

      I fully support Indigenous midwifery practices that have been practices for centuries.

      Why? At least two cultural genocides separate me from my (minority) native ancestors, so I can’t claim to speak from any viewpoint but mainstream western, but I don’t see why people assume that non-western cultures are static and that, say, Navajo culture today is identical to Navajo culture 100 years ago. Or that the people who live in that culture want it to be. I don’t want to be treated with traditional western medicine as it has been practiced for centuries or live in traditional European culture as it was practiced for centuries. My ancestors ran from that shit as soon as they could, thank you very much. Why would I expect people in other cultures to want to never be allowed to grow and change as a culture but to always maintain their “traditional ways”?

    • Daleth

      it matters not what your credentials are-our women, families,
      communities need sustainable birth services, reproductive services,
      basic human rights here are not being met.

      Isn’t it a basic human right to get medical care from people who know what they’re doing? Getting inadequate care from people who don’t know what they’re doing is a human rights VIOLATION, not a human right.

      So credentials do matter, since “credentials” means EDUCATION AND TRAINING.

    • Medwife

      Don’t you think native women want their babies born alive and well just as much as white women?

  • Dr Kitty

    Completely OT:http://www.scarymommy.com/10-little-monkeys-parody/
    This made me laugh, on a day I needed it.

    #2 is feverish, cranky and insisting on being held and nursed all day, after a very poor night. #1 has thankfully gone to stay with relatives (they have a pony to ride, a dog to walk and calves to bottle feed- getting her back might be a struggle).

    • Megan

      Funny! I found this blog post very good comic relief last week after I rediscovered it (initially found it with my older daughter during the 6-8 weeks fussies). We are in the midst of the 6-8 week fussies again now.

      http://www.pregnantchicken.com/pregnant-chicken-blog/2011/10/1/my-baby-wont-stop-crying.html

      It’s nice to have a laugh when you are feeling a bit frayed! Also, can’t believe your little guy is already 8 months old! Holy cow!!

    • Gene

      That is the most awesome thing I’ve read in years!

    • Kq

      Generally I adore scarymommy. Every now and then it gets woo-y, bit for the most part…

  • Jackie

    OT: I’ve been reading this blog for months and I love how sharp and no-nonsense Dr. Amy is. As a feminist, I am disturbed the archaic, anti-woman beliefs held by many in the natural parenting movement. But today, I had my heart broken. It turns out that Dr. Amy has espoused some extremely misogynist, archaic, and homophobic beliefs about single-motherhood, gay parenting, and divorce. Take a look at this: http://theskepticalmother.blogspot.com/2012/01/will-real-dr-amy-please-stand-up-part.html. Yes, The Skeptical Mother is a biased source, but she provides screenshots of Dr. Amy saying ridiculously offensive bullsh*t about divorce.

    And though there are no screenshots, if what people in the comments section here (https://www.sciencebasedmedicine.org/the-skeptical-o-b-joins-the-science-based-medicine-crew/) are saying is true, Dr. Amy is a homophobe. “All children have a mother and father, but in the case of gay couples the biological parent substitutes someone he or she likes better. That may be nice for the biological parent, but it is not fair to the child.” For someone who so loves scientific objectivity and rational deliberation, that’s a very strange argument for Dr. Amy to make. Study after study after study has shown that children of gay parents fare as well as children of straight parents, all else being equal.

    All in all, I am disappointed. I will always appreciate Dr. Amy’s attempts to “push back” against pseudo-science and the tyranny of breast-is-best, “natural” childbirth and parenting, but this is beyond the pale. Advocate for women my ass.

    • OttawaAlison

      From what I understand, her views have evolved since then. A lot of people’s views have.

      • Jackie

        I haven’t been able to find any record of her repudiating these statements, but if she has, great. That would make me very happy. In any case, she can be wrong about divorce, single-motherhood, and gay parenting, and still be right about infant care, childbirth, and formula/breastfeeding (her areas of expertise as an OBGYN). Unfortunately, though, it would make her a far less effective spokesperson for the cause. (As an aside, she of all people should know not to conflate “natural” with good, normative, or ideal). I look forward to seeing her response.

    • moto_librarian

      I hope Dr. Amy will respond directly, but I believe that she has stated that her views have evolved with time. In fact, I think she credits her children with the evolution of her views on gay marriage.

      • Valerie

        I’d have to search through the comments, as this has cropped up every now and again. I do remember reading that she regretted ever posting that.

        I do agree, though, Dr. Amy, please address this. It stands in stark contrast to your current views about raising children, insisting that parents can never be loving, “good enough” providers unless one of them provided the sperm.

    • Azuran

      I believe she did come out a long while ago to say that her views back then were bad and uninformed and that her thoughts on the matter have evolved since then.

      People’s mind change over time depending on their experiences. You are not born perfect and with all the knowledge. The important thing is to not close your mind to the idea that you might be wrong. As you gain knew knowledge, you are able to change your view. And that is what Dr. Amy has done.

      I used to be against abortion. I used to think gay people were sick. I used to think also that a child needed both a mother and father. Since then, I’ve seen the world and opened my eyes and don’t think like that anymore.

      • DelphiniumFalcon

        Just agreeing with this whole heartedly.

        I think a lot of people’s views have changed in the last five years especially as advocates for LBGT+ have been able to stand up and spread their message about the discrimination they face. With considerable risk to themselves even now when attitudes have started to be more accepting.

        I know my views regarding gay and trans people have evolved significantly in the past two years. I’m ashamed to say in the past I would have been one of those people who didn’t understand the violence that so many trans people face just using the bathroom and wouldn’t have spoken up. I still can’t ever understand what it’s like to have such a discrepancy from your mental self to your assigned physical self as I am a cis gendered person attracted to the opposite sex. I can’t understand the struggles my favorite boss ever has had as a gay man, especially a gay man who isn’t white.

        I’m still learning when it comes to feminism myself. I’m far from perfect. But I’d hate to have my nose rubbed in my views on gender roles from five years ago. Especially with parenting. These days I’m just happy to see a child with loving parents, regardless of how they identify. Especially a child that was taken in from foster care that needs a safe, stable place where they know they’re loved. I still mess up now when I end up struggling to get across what I’m trying to say and realize I’ve basically said the exact opposite if what I meant and have to try to rephrase. And then I have other times where I have to stop and think about if I ever considered that angle before. It’s a long process.

        • Jackie

          I totally acknowledge that people’s views can change and evolve. We’re all works-in-progress.

      • Charybdis

        I remember reading that too. And cannot a person’s ideas and views change over time? No one is static in their thoughts and feelings and just because you *once* held a certain belief does not mean you will *always* hold that same belief. Things change, you gain perspective and experience and your thoughts and feelings can change. Admitting that you have evolved/grown as a person isn’t a bad thing; hating/disliking/discounting a person BECAUSE they have evolved/changed /grown as a person seems a bit black and white.

        Just because someone said something years ago and now says something different does not mean they are lying, untrustworthy, flip-flopping, or other negative thing. Like those who have been up to their ears in the NCB woo garbage. They held and espoused one viewpoint, sometimes vehemently, until *something* happened to cause them to question those beliefs. After some reflection, soul-searching, education and life experiences, a few of them come to believe that NCB/Homebirth/EBF/AP is not the only way to rear a happy, confident child. They have changed their mind about the topic. Does that suddenly make them unfit for discussion or render their thoughts and feelings on related topics null and void?

      • guest

        Yes, I seem to remember this too. As a person who falls into one of those categories, I haven’t felt unwelcome here, and I haven’t seen Dr. Amy say anything negative about those groups recently.

        I was a racist homophobe in my youth. It happens sometimes.

      • Kq

        I also remember her discussing her changed opinions on this issue.

    • Dr Kitty

      If it matters, there are parents who post here who are in same sex relationships, who have chosen single parenthood through gamete donation or surrogacy and parents who are divorced.

      Dr Amy doesn’t say mean things to them in the comments, doesn’t ban them, doesn’t say that they are bad parents because of their circumstances.

  • AA

    I wish there was some sort of data on how many women choose planned OOH (out of hospital) prenatal care and delivery due to financial considerations. I really don’t think it’s a significant amount of the homebirther population. For example, a significant % of births nationwide are paid for by Medicaid, yet Medicaid in most states does not pay for OOH birth. And frankly, it seems that a significant % homebirthesr are of a more privileged class and more likely to have health insurance.

    I bring this up because some commenters that state that lack of health insurance coverage can lead some women to choose planned OOH birth.

    • Amy

      I think you’re right. And on the contrary, health insurance itself often does not cover home birth. In know in my state it doesn’t. So while home birth may be “less expensive” in terms of COSTS than hospital birth, I’m already paying for health insurance that will turn around and cover all but $20 of prenatal care and hospital birth with a CNM or obstetrician.

      And honestly, the “lower” cost isn’t even across the board. Nancy Wainer of “Silent Knife” fame was charging $5K a decade ago to attend a home birth (you were still on the hook for your own testing costs and supplies), while the CNM practice that cared for me disclosed that they charged a total of around $4000 for all prenatal care, testing, supplies, and attendance at the hospital birth. So my choice is pay less for safer or pay more for less safe? No brainer.

      • The Bofa on the Sofa

        In our first C-section, we paid a total of $300 for EVERYTHING – appts, delivery, meals at the hospital for her and me, and even an extra day for the baby and a room for us because he was under the bili light.

        In the second, we didn’t pay anything because we had a different insurance plan.

      • Jessica

        I would never ever choose home birth, but I have insurance through my employer (they pay the $437/mo premium) and I hit my out of pocket maximum of $6,850 after giving birth in March. My insurance has a separate deductible for the baby’s nursery charges, so we insured him through my husband’s group plan and we owe $1536.96 to the hospital and his pediatrician, and only then because that plan has an HRA funded by the employer that covers one-half of the annual deductible. I was in the hospital for less than 48 hours for my induction, and the baby was discharged at 24 hours old. I still can’t quite believe we have to pay $8000 for a relatively uncomplicated vaginal delivery….

    • Valerie

      I think if you are uninsured but ineligible for medicaid, then OOH may be cheaper, provided everything goes as planned. It’s probably going to be cheaper, though, all things considered, to get some insurance.

      • AA

        Agreed, just saying as far as I know, the majority of women who are pregnant in the USA do have maternity coverage due to the expanded eligibility of MEdicaid for pregnancy (and the option of a Medicaid spend down) and now more plans are required to provide maternity coverage due to PPACA. Does it cover all women? No. The % of women of childbearing age who don’t have insurance is about 14% March of Dimes, but this does necessarily capture how many women have insurance at the time of pregnancy (given that a woman can qualify for Medicaid during pregnancy and then no longer qualify afterwards). I’m guessing that a lot of women w/o health insurance coverage during pregnancy are undocumented immigrants. It doesn’t seem that’s a substantial population of the planned OOH birthers in the USA.

        • Valerie

          Yes, I think you are right. I’m envisioning a relative-of-a-friend who is the self-reliant, self-employed conservative type, who would rather complain about Obamacare than, you know, have health care. Insurance can still be quite expensive if you are purchasing it as an individual.

      • Daleth

        Not only would it be cheaper to just get insurance, but even if OOH technically has a lower price tag, it’s one you actually have to pay, and usually up front. With hospitals, you can just show up in labor and have your baby safely, and then ignore the bills they send or make arrangements with the hospital to pay them off in small chunks over X number of years.

        Seems like a lot of people somehow don’t know that.

        • AA

          “Just get insurance” is not so easy. The open enrollment period to the ACA is closed right now. A young woman could be in this situation, and not eligible for Medicaid

          http://khn.org/news/under-26-pregnancy-coverage-michelle-andrews-080712/

          • Daleth

            True, although the ACA open enrollment period is three months long (Nov-Jan inclusive), so as long as you don’t get pregnant in February or March right after the window closes, you could still have your childbirth covered by enrolling the following November. The later in the year you get pregnant the better, obviously; if you got pregnant in, say, August or September you would only need to self-fund the first three-four months of prenatal care.

            So really, the women affected by this problem are only those for whom ALL of the following are true:

            – They chose not to sign up for Obamacare during the open enrollment period

            – They either didn’t sign up for their employer’s insurance, or don’t have a job that provides insurance

            – They’re over 26 so they can’t be on their parents’ insurance, or under 26 and their parents didn’t sign them up

            – They’re not covered by a spouse or partner’s insurance

            – They’re in states and at income levels where they wouldn’t qualify for Medicaid if they got pregnant, and

            – They got pregnant early in the year, but too late to sign up for Obamacare (i.e., after January 31)

            I’m guessing that’s not a huge group.

            I can see arguments on both sides as to whether getting pregnant should be a qualifying event that lets you sign up for Obamacare outside the open enrollment period. On the one hand, it would be better for the health of the women and babies who fall into the above group, small though that group may be, if they were allowed to sign up upon discovering the pregnancy.

            On the other hand, it would make insurance more expensive for everyone if we let a medical event qualify you to sign up outside the open enrollment period; insurance is only affordable if a lot of people sign up for it when they’re not going to need it or won’t need much of it. We have to have a system that motivates people to sign up “just in case,” instead of waiting until they know they’re going to need it. That way insurance remains affordable for all, which, big picture, is healthier for MORE babies and moms.

            I think the second argument is stronger than the first.

          • Nick Sanders

            So many states refused Medicaid expansion, and in those states, the low cost plans are also very low coverage. Without the Medicaid expansion, the only kind of subsidy or payment assistance you can get is federal income tax rebates, which only help if you are making enough to pay taxes. Low income people like me got shafted.

            Some days it’s enough to make me consider communist revolution, and I’m not even a communist…

          • AA

            You can be under 26, on a parents’ insurance plan, and not have the parental plan cover maternity. Most people would not know to really dig into it, especially with the public trumpeting that ACA helps cover maternity services. It’s also not just ignorance of ACA open enrollment, the premiums can be just too much to afford. Self-funding even a few months of prenatal care is hard. Where I work, a BMP is $167, a urinalysis w/o micro is $18, venipuncture $17, the hepatitis titres would be $100 each. Office visit, over $200, not to mention ultrasound…

    • KeeperOfTheBooks

      I suspect it will vary widely even among the insured, just as health insurance plans do.
      For example, thanks to DH’s employer being insanely generous with insurance, we pay slightly under 5K/year in premiums for our family. After that, it’s a $25-$30 copay for doctors’ visits. For prenatal care, childbirth, etc, it’s a one-time $30 copay…that’s it. That $30 covers prenatal visits, labs, ultrasounds, hospitalization for baby and me, et all. However, it will not cover homebirths. Thank goodness, or I might have tried for one with disastrous results.
      For us, leaving aside the question of safety (not that it should be left out, but…), it’s a financial no-brainer: hospital birth/OB or CNM care it is!
      On the other hand, I have a close friend who pays nearly twice that for her family, and still has a 3K or so deductible to meet. 3K is what a lot of CPMs charge in her area for prenatal care plus birth plus postpartum care. Fortunately, she isn’t at all into the woo, so she sees an OB, but if she were, I can quite understand why she’d see it as a financial wash either way to go with the CPM, with the longer visits/more personalized attention as a bonus.

    • Rebecca Kammer

      My insurance, United Healthcare, private not through Obama care, pays for home birth at the exact rate it pays for hospital birth, BUT only if your birth is attended by an in network CNM.

  • NoLongerCrunching

    Link?

  • AirPlant

    I m just gonna put down my prediction that there is going to be gnashing of teeth and wailing of nonsense, but that could just be a reflection of the caliber of trolls we get around here.

  • Gene

    To borrow a classic lawyer saying: “If you have the law, hammer the law. If you have the facts, hammer the facts. If you have neither the law nor the facts, hammer the table”.

    Or as we said during our graduate school dissertations: “If you can’t dazzle them with data, baffle them with bullshit!”

    • demodocus

      The latter explains a couple politics books I’ve read; the one by the politician was clearer.

    • The Bofa on the Sofa

      I thought the Razzle Dazzle was a lawyer thing?

      https://www.youtube.com/watch?v=hNxGvBQi–0

  • Madtowngirl

    The fact that doctors in the U.S. refuse to attend a home birth should be a clear indication of how dangerous it can be. Doctors aren’t willing to risk a lawsuit, or revocation of their licenses to create a “better experience.”

    I still have no idea why anyone would want to clean up that mess at home. But then, I also can’t stand a dirty toilet.

    • Angela

      Good point, another reason not to do a home birth. Birth is messy, I don’t want that at my house.

      • Azuran

        Pfff, If you don’t want to wash out amniotic fluid and blood on all four, 15 minutes after you gave birth, you shouldn’t even be a mom, you clearly don’t care enough about what’s best for your baby. 😉

      • Inmara

        Also, I wouldn’t want to traumatize our cats.

        • AirPlant

          I would not want to emotionally cope with my cat’s feelings about placenta. There is not way that goes well.

        • Bombshellrisa

          We have two dogs, I couldn’t do that to them. I once had a waxing done at home and my yelps and squeals upset them even though they were locked in the garage.

        • guest

          And I don’t want all my neighbors listening in on my birth. Co-op walls are like paper screens.

      • CognitiveDissonaceHurts

        To be honest, I didn’t have to clean up anything and I didn’t even really see it. The midwives whisked it all away quickly. They use those large disposable pad things. Lots of them. As many as needed. Now, the placenta in the freezer inside an old ice cream tub, that was a little freaky mainly because I kept forgetting what was inside it. “Ice cream! Oh wait…NOT ICE CREAM!!” Spring couldn’t come fast enough so we could bury that thing.

    • Bombshellrisa

      There is an OB who attends home births in the US, but he charges between $10,000–$12.000 for care. So that rules out the possibility that people are choosing him because he is more affordable

      • AA

        There’s a few MDs that attend OOH births to a select population–mostly Amish and Mennonite pts.