Routine induction at 39 weeks? Natural childbirth advocates are spluttering!

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Natural childbirth advocates are in danger of losing their minds.

Obstetricians have been discussing the data that shows that routine induction at 39 weeks may be safer than waiting for labor to begin on its own. The possibility of consensus on this issue was discussed at the recent annual meeting of the American College of Obstetricians and Gynecologists. As the Washington Post explained:

Nature is a terrible midwife.

Norwitz argued against simply letting nature take its course.

“Nature is a terrible obstetrician,” he said, referring to the “continuum” of pregnancy and birth: the large number of zygotes that never implant, the 75 percent lost before 20 weeks, and stillbirth.

And, he said, the risk of stillbirth and neurological injuries rises after 39 weeks. “Stillbirth is a hugely underappreciated problem,” he said. “There are anywhere between 25,000 to 30,000 stillbirths a year in the United States.”

Indeed, the argument can be summarized in a simple graph:

image

This is a graph of stillbirths vs. gestational age. As you can see, the stillbirth rate begins to rise precipitously at 36 weeks. But babies born at 36 weeks have a small but significant risk of immature lungs leading to breathing problems requiring intensive care. The graph below summarized the data of 3 studies on the risk of lung immaturity.

image

The lines on the two graphs cross at approximately 39 weeks when the risk of lung immaturity is 0% and the stillbirth rate continues to rise.

In other words, the optimal time for birth is at 39 weeks gestation.

Not surprisingly, natural childbirth advocates are horrified.

Cristen Pascucci, an advocate for giving women more control over childbirth decisions, thinks the doctors’ remarks suggest that all babies need to be “rescued by birth,” creating an anti-woman mentality. “It’s as if women and their babies are fundamentally in opposition to each other and the female body is dangerous by design,” said Pascucci, a vice president of the advocacy group Improving Birth.

It calls into question the fundamental conceit of the natural childbirth movement that childbirth is inherently perfect. But nature is a terrible midwife; the day of birth is the single most dangerous day in the 18 years of childhood. The risk of a baby dying on the day of birth is not exceeded until that baby is 92 years old.

Childbirth, like any aspect of body function, is subject to the multiple competing demands of natural selection.

Natural childbirth advocates don’t seem to understand that natural selection leads to the survival of the FITTEST, not survival of everyone. Those that aren’t fit often simply die.

For example, the distinguishing feature of human beings is their large brains. Overall, large brains confer a tremendous evolutionary advantage at birth and throughout life. The larger the brain at birth, the more neurologically mature the newborn and the better the chances of its survival.

But large brains are an evolutionary disadvantage. That’s because the size of the maternal pelvis has an upper limit. As the maternal pelvis gets bigger, the mother’s ability to walk and run decreases.

Every single birth involves an evolutionary compromise between the neurological advantages of a larger neonatal brain and the potentially deadly consequences of a larger neonatal brain leading to obstructed labor. Prior to the advent of modern obstetrics, babies whose heads were too big to fit simply died and their mothers died with them.

The brain continues to grow throughout pregnancy. Babies born at later gestational ages have bigger heads and are more neurologically mature but also more likely to die in labor. Babies born at earlier gestational ages have small heads which gives them a tremendous advantage in childbirth.

The same thing applies to the size of babies relative to the function of the placenta. Some placentas last longer than others. The longer a baby remains inside the mother, the more neurologically mature and fitter it will be. However the longer a baby remains inside the mother, the greater the chance that its growth will outstrip the placenta’s ability to supply oxygen. If the baby stays inside longer than the placenta can function, the baby is stillborn. The timing of birth represents a compromise between these competing imperatives.

Natural childbirth advocates are fond of pointing out that the a due date is just an estimate; a baby can be born any time between 38 weeks and 42 weeks or beyond. But they draw the wrong conclusion from this. They ascribe the variation in length of pregnancy to necessity (“a baby knows when to be born”) when it is merely due to evolutionary chance.

The idea that a baby knows when to be born and therefore is always born at the perfect time makes as much sense as the idea that a nose “knows” how big to grow and therefore everyone’s nose is the perfect size for her face. It makes as much sense as claiming that everyone’s blood pressure “knows” the ideal level to prevent heart attack or stroke, or that everyone grows to a perfect height. In other words, it makes no sense at all.

If babies truly knew when to be born, the first graph above would be a straight line; there would be the same number of stillbirths at every gestational age. That clearly is not the case. Babies DON’T know what to be born.

No wonder natural childbirth advocates are spluttering.

But their spluttering also illustrates another fundamental problem with natural childbirth. It’s not a matter of science, but of belief.

The Washington Post article reports that the ACOG debate changed the minds of many obstetricians in the audience. When presented with new scientific information, they reached new conclusions. In contrast, natural childbirth advocates would not give up cherished beliefs (“natural is better”), regardless of the evidence they were shown.

It reminds me of the debate on evolution between Bill Nye and creationist Ken Hamm. When Nye was asked was asked what would convince him that creationism was true, he responded, “Evidence.” When Hamm was asked what would convince him that evolution was true, he answered in effect, “Nothing.”

Natural childbirth advocates are like Ken Hamm. They start with the conclusion and work backward trying to cherry pick evidence to support it. They’re spluttering because no amount of evidence will ever change their minds.

  • Sara Barnson

    I’ll be 39 weeks in three days and plan to request an induction if possible. I’ve been researching this, and have only been able to find a couple of sources on Google Scholar. Any help would be appreciated!

    Looking for studies on:
    – gestational age vs. stillbirth risk
    – risks associated with low birthweight babies and induction (baby is small)
    – postpartum recovery after induction vs. spontaneous labor.

    • demodocus

      Did you peruse the various comments sections? A lot of things get posted here that way.
      Recovery is pretty variable. I had my daughter via induction and bounced back and my son without and took forever to heal, but others have the opposite and others found no difference.

  • SarahG

    Hi! I have been reading here for a while but haven’t joined the discussion yet.. 16 weeks pregnant currently. I’d love some opinions about whether I should be seriously thinking about asking to be induced at 39 weeks – or even 40, if it is looking like it will go past that. Due just before Christmas so I can’t say it doesn’t appeal for practical reasons too.

    To be honest I can’t see it going down well. Here we have midwives as lead maternity carers throughout pregnancy. Trained and qualified mind you, and working as part of the medical system.

    • Allie

      How old are you? I was 42 when I had my daughter, and had no faith in my placenta due to my age. The hospital where I gave birth would not induce before 40 weeks unless there were complications (I’m guessing they will change that policy soon), so I insisted they adjust my due date earlier. They had based it on my last period, although I had IVF and knew exactly when we conceived, pretty much down to the hour. So, I was booked for induction on the day I was exactly 40 weeks, although I ended up going into labour on my own and having her the day before. She was born Dec 22 and we brought her home on Christmas Eve. Best Christmas present ever : )
      I would suggest if you are 35 or over, definitely ask about 39-week induction. If you are younger, I wouldn’t worry so much unless your due date is questionable.

      • SarahG

        I will be 28 so probably fewer concerns, but have PCOS and I could swear the midwife said something about that causing possible placenta issues? I might be imagining that.

        I am certainly hoping this one is born before Christmas! Or even after.. I’m a Christmas freak and a little afraid of missing it by being in labour!

        • Dr Kitty

          PCOS increases your risk of pre-eclampsia and GDM, as well as placental insufficiency.

          • momofone

            This is so helpful to know. I’d had PCOS for 20 years when my son was born, and though I didn’t develop GDM or pre-eclampsia, placental insufficiency was an issue. I never connected the two.

          • sdsures

            I have PCOS, too. While we are not at the moment TTC, PCOS is still a bugger to have. It’s like the elephant in the room.

          • SarahG

            Thanks! I will definitely ask then. She has already suggested I do the 3hr GD test earlier than usual to check for that.

      • Nola1967

        I wouldn’t – I was induced at 41 weeks although my body was showing no signs of being ready and I ended up with a c-section. I’m sorry but c-sections suck. Recovery is difficult and lengthy and makes breastfeeding and child care very hard. I’m 11 months post partum and my abdomen still hurts. I’m sure vaginal birth is no picnic but I wouldn’t induce unless it was medically necessary unless your cervix was already showing signs of preparing for labor. Honestly sometimes I think Dr. Tutuer is as bad as natural birth advocates in what seems to be a complete disregard for the mother (routine early induction? You’ve GOT TO BE KIDDING ME).

        • Megan

          Unlike Dr. Amy, I have had a CS. Two, in fact. And they were as different as can be. You cannot generalize about which mode of delivery is easier. Either can be easy or difficult. A decision to induce or have as CS is between a patient and her doctor and based on discussion of risks vs. benefits. I get really tired of people saying all CS recovery is the worst thing ever. Sometimes it is. Sometimes it isn’t. Vaginal birth sometimes has an easy recovery. Sometimes it doesn’t.

          • Nola1967

            You had two? Please expound upon your experience. How was your first one? Delightful? Do you think you might be overgeneralizing based on the fact that you had two and yours were different, therefore “c-sections” must all be different? How many vaginal births have you had?

            And frankly, I don’t care what you’re “tired” of hearing – maybe the reason you hear it so much is because it’s true. Your attitude that women should just “shut up and suck it up” isn’t helping anyone and is, frankly, rude and condescending to women.

          • FormerPhysicist

            I had three c/s, and they weren’t bad at all. My recovery was pretty reasonable for the post-labor c/s, and a snap for the pre-labor c/s. It’s really not fair to compare a c/s for failure to progress (or other emergency) with a planned pre-labor c/s. They are quite different.

            Pretty ironic that you’re accusing someone of over-generalizing.

          • Nola1967

            Oh are the c/s for failure to progress somehow different? Please explain. As far as I know, the procedure is the same.

          • momofone

            How is your generalizing your experience different from someone else’s generalizing theirs? Yours was bad; others weren’t. How does that minimize yours?

          • Nola1967

            I’m reacting to the poster’s rude reaction to my post –
            She’s “tired of hearing” about c-sections being bad experiences.
            You know what? Who gives a rats ass – some of us are still going to talk about that as a factor.’

          • Megan

            No, what I said is: ” I get really tired of people saying all CS recovery is the worst thing ever. “

          • Nola1967

            Do you have any idea how insensitive that statement is to people for whom it was “the worst thing ever?” So sorry to have burdened you with my experience on this public forum and so sorry I didn’t wrap it in 1000 caveats so that you’re not irritated. I guess I’ll shut up now.

          • Daleth

            The CS for failure to progress are different than planned, prelabor CS. It’s more tiring for your body because you spend many hours in labor trying to have your baby, and then on top of that effort you also have a CS to recover from. And it can be more difficult emotionally because presumably if you were being induced, you wanted to have a vaginal birth, and then it turns out you can’t.

            So on average, statistically, yes, the type of CS you had is more difficult than a planned, prelabor CS. But some women have a much better recovery than average and some much worse. I’m sorry that you ended up being in the “much worse” category.

          • Megan

            I’m sorry if it came across that way. I truly only meant that NCB advocates often discuss that CS recovery will be the “worst thing ever” to try to coerce people into delivering a certain way. No woman’s story is a burden and I never told anyone, you included, not to tell their story. I am only saying that we cannot know how the recovery from a specific birth will be and we shouldn’t generalize. We can only make a guess based on the circumstances surrounding that delivery.

          • Amazed

            When did “the people for whom it was “the worst thing ever” become all people who had c-sections? Just how many millions of caveats should have Megan wrapped it in to spare you the sad realization that you can’t talk for all women who had c-sections?

            Don’t try to lie that you despise Dr Amy and natural childbirth advocates all the same. You’re a natcherel birther wannabe all the way through. Your laments that you wasn’t strong enough to keep risking your baby’s life and brain functions until your body was ready to eject it, living or dead, healthy or not, say it all.

            And you won’t shut up. Your ilk never does. Especially when they have nice people like Megan on the other side. Whining that she’s rude coming from someone like you? Quite the nerve you have! Making up for the lack of brains that won’t let you understand the difference between a pre-labour c-section and an emergency one, perhaps?

          • guest

            And some of us are going to be tired of hearing c-sections maligned, and it’s pretty rude of you to refuse to allow other opinions of c-sections to be expressed, particularly when you are visiting a blog known for taking the position that medicalized birth is safer and better than all-natural home births. You basically walked into our house and spit on the floor – we didn’t come to you.

          • Elizabeth A

            A c/s for failure to progress happens after hours of painful contractions. The muscles are already sore and a touch banged around.

            When you recover from that c/s, you are ALSO recovering from the pain and strain of the labor you underwent before surgery. It’s harder than recovering from the surgery alone.

          • Roadstergal

            My friend’s VBAC absolutely shredded her abdominal muscles, to a point that was immediately visibly obvious to a layperson (me). I’m sure it’s not the same for everyone, but that can be some intense strain.

          • sdsures

            *cringe* Hope she’s doing better these days.

          • Charybdis

            Nope. Bad experiences happen to people all the time. You had to have a CS. You are still pissed off about it and want everybody to know that for you, a CS was the equivalent of hell on earth. That’s fine and no one is saying that you don’t have a right to feel how you do. But the “big picture” climate of “Vaginal Birth is ALWAYS better and easier to recover from and CS’s are from the Devil, are horrid and should never be considered *easy*” is so damn prevalent that those of us who HAVE had pleasant CS’s will speak up when CS’s are bashed (in general).

            Again, anybody can have an unpleasant experience with either CS or vaginal delivery and have every right to vent, bitch, moan, keen, wail and flail about their personal experience.

          • FormerPhysicist

            I didn’t censor you, nor call for it. But you called out Megan for generalizing her experience, and discounted it because it doesn’t match *your* experience. I still call that ironic.

            And, yes, ANY c/s after hours of labor is different from a planned c/s where the mother shows up early in the morning, rested, and doesn’t stress her body right before surgery – at least not more than pregnancy already stresses it. Recovery from c/s is generally easier than recovery from unproductive labor + c/s.

            You obviously didn’t like your c/s, and didn’t feel great after it. I’m sorry it went that way. But not all women suffer all of those side effects.

          • sdsures

            Going into ANY type of surgery being stressed out can’t be a good thing.

          • Azuran

            They way you are describing your surgery does show a good amount of negative feeling and bias against it.
            It’s ok that you didn’t like it. But using terms like ‘shake you around’ is not really adequate and is putting the procedure in a voluntary negative light.

          • guest

            I don’t recall any shaking involved in mine.

            But if your water had been broken for 24 hours, then your baby WAS in danger at that point.

          • Sarah

            Well I’ve only had an EMCS, but I reckon the ELCS wouldn’t have involved going into labour first, everything going quite badly wrong, people legging it down the corridor shouting brady and me being told we’ve only got one chance to get the spinal in or we’ll have to go to a general. I imagine the cutting procedure is the same, although when people are forced to do things at great speed they tend to do them worse than if they get to take their good old time. But there’s a bit more to the section experience than the cutting and sewing bits.

          • Megan

            “Your attitude that women should just “shut up and suck it up”
            That isn’t my attitude at all. What I’m tired of is people generalizing about what the recovery from each mode of delivery will be like. As I have said, recovery is different for each woman and each birth, even for the same woman. I never told anyone to suck it up nor did I tell you not to talk about it. I said that we should not tell women that across the board their CS recovery will be horrible and vaginal delivery recovery will be wonderful, because that is not universally true. The circumstances surrounding the individual delivery have a lot to do with how the recovery will be. I also said that the decision about mode of delivery should be based on shared decision making between patient and provider. You are putting a lot of words in my mouth that I didn’t say.

          • Nola1967

            so you think there’s no merit to the common wisdom that ceseresn sections are more difficult than recovery from vaginal birth? I don’t agree with that – I think the reason you’re tired of hearing it (i.e. It’s said often) is because there is truth to it. It’s something that should be acknowledged and studied and addressed before anyone goes for arguing for any type of routine induction.

          • Megan

            What does a recommendation for routine induction have to do with the likely course of recovery from a CS?

          • Nola1967

            my understanding is that induction while a woman is at zero station (which many women are at 39 weeks) will increase the likelihood that she would need a c-section because the cervix may not ripen and interventions may not work. It’s safer to do it if the cervix is ripening on its own – otherwise it’s best to induce only if medically necessary (i.e. Later in the pregnancy because the water levels may begin to drop and the placenta will become unviable.)

          • Megan

            But that “conventional wisdom” is not true. From the WP article cited here:

            After Lockwood found that recent studies suggest that elective inductions at 39 weeks decrease Caesarean delivery rates and might reduce the rate of infant and maternal complications, what was supposed to be a debate proceeded as a discussion in support of induction.”

          • Azuran

            It would make sense. 39 weeks babies are probably slightly smaller and have a healthier placenta. So they could generally be easier to push out and handle the stress of labour better.

          • Roadstergal

            The way I think about it in oversimplified non-OB layperson terms is – once the baby is capable of surviving outside of the mom’s body, waiting longer only makes a: the baby bigger and b: the placenta weaker, which makes an uncomplicated vaginal birth less likely…

          • Daleth

            Totally agree, except you might want to rephrase because even 24-weekers may be “capable of surviving outside of the mom’s body,” albeit with a lot of medical help and possible longterm consequences.

            So the cutoff point shouldn’t be “can survive” (since that could be 24 weeks) but “is full term/isn’t a preemie/will be fine on the outside” (i.e. 37 weeks and up).

          • Roadstergal

            Ya, I guess I was thinking more ‘would generally be fine on the outside without intense medical intervention.’

          • guest

            I thought it was clear enough as is, but it doesn’t hurt to clarify.

          • The Bofa on the Sofa

            It’s a revision of the old saying, “Nothing good happens after 40 weeks”

            What they are suggesting instead is that nothing good happens after 39 weeks. All you get by waiting is higher risk of adverse events.

          • Irène Delse

            Waiting for the amniotic liquid to be depleted and the placenta to give signs of failure? Seems like taking unnecessary risks, here, given that the baby is already at term and unlikely to get benefits from an extra week or two in the womb. And that’s without counting the strain for the mother of the weight and metabolic demands at that stage of pregnancy.

          • Azuran

            Basically everyone I know who reached 39 weeks were practically praying everyday for their labour to start and were doing all kind of things to get it started. They all thought their induction was late for no good reason. Those who reached over 40 weeks where all miserable, exhausted and couldn’t wait to get the baby out.

          • moto_librarian

            No, a large study demonstrated that induction at 39 weeks resulted in fewer c-sections than expectant management, regardless of parity or Bishop score. Dr. Amy blogged about it.

          • The Bofa on the Sofa

            so you think there’s no merit to the common wisdom that ceseresn sections are more difficult than recovery from vaginal birth?

            All things being equal, c-section recovery is slightly more difficult than vaginal birth recovery.

            But all things are never equal, so that says little about any individual situation.

          • moto_librarian

            My recovery from vaginal delivery was hell. On opioids for several days due to pain from a surgically repaired cervical laceration, so weak from blood loss that I had to be wheeled to the NICU to visit my son in a wheelchair. You can only say that a recovery was or was not easy in retrospect. It is a crapshoot.

          • Azuran

            Here’s the thing: And absolute easy VB without any complication is probably easier to recover from the easiest C-section.
            But most people don’t have either the easiest VB or section recovery. They end up anywhere on a spectrum from a walk in the park through crawling through hell. So no, you cannot do a generalization that c-section are by definition more difficult.
            You can never know how easy or hard any type of birth is going to be for any woman, nor what kind of long term complication anyone is going to have.
            How much everyone is affected by each of those complications is also very personal.

            Due to my own personal circumstances, I absolutely don’t give a damn about having a scar, surgery doesn’t scare me, post-op pain don’t bother me that much since I’m very pro analgesia and don’t mind taking medication. I can live with weakness in my abdominal muscle. But the possibility of urinary incontinence or having painful sexual intercourse or a diminution of the quality of my sex life in general are very horrible prospect to me.

            Other people will feel differently, and that’s totally ok. But branding one option as inherently worst than the other one is giving false information. For you, it might have been, and that ok, but it doesn’t mean it’s the same for everyone.

          • Amazed

            Interesting, given the fact that routine inductions don’t raise the rate of c-sections.

          • guest

            At various points in time, it has also been common wisdom that sparing the rod spoils the child, that getting caught in the rain causes pneumonia, and that a bottle of sugar water is a good way to calm a fussy baby down. But through a combination of scientific research and getting the word out in everyday conversations, these are no longer “common wisdoms.” In other words, just because we’ve inherited a narrative that c-sections are the worst recoveries doesn’t mean it’s true – especially keeping in mind that all c-sections used to be “classic” (that is, vertical) and some are “inverted T” – and both of these are different experiences than the now preferred low-transverse.

          • Daleth

            If someone had told me what a c-section recovery could be like, I would have resisted longer and waited until it was definitely necessary. But I had no idea, and suffered as a result of that. I’m glad to be past it, but you telling me that I’m not allowed to talk about it is outrageous.

            You’re absolutely allowed to talk about that, of course. The thing is, though, that nobody could have told you what your recovery from that c-section would be like, because recovery from any form of childbirth spans the entire spectrum from easy-peezy to hellish. It all depends how your labor and/or c-section goes and how your body responds, none of which can be predicted in advance.

            All anyone could have told you is the statistics. The general stuff–as in, an uncomplicated VB is easier to recover from than an uncomplicated CS (but no one knows in advance whether a particular patient will have an uncomplicated one or not)–and some semi-specific stuff about women in your situation (your age, having emergency CS after failed labor, etc.). But that just tells you the chances, not whether it’s going to be easy or hard or average in your particular case.

            And I think that’s all most people here are saying: that they’ve had multiple VBs or multiple CS and each was different, or that they have friends or relatives who had the same type of delivery (VB or CS) and completely different recoveries, etc. I had an emergency slightly preterm CS due to pre-eclampsia, and although I had some wound healing problems because in late pregnancy I started retaining massive amounts of fluid, in terms of what I could do when my recovery was pretty easy. I was fine 6 weeks out, vs. the 12 weeks it took you. And emotionally it was probably easier for me because I’d been planning to have a CS anyway–it just came earlier and more suddenly than expected.

            And my reason for saying that isn’t to shut you up, it’s to say that unfortunately there was no way anyone could predict with certainty how good or bad your recovery would be. Statistically, though, recovering from labor plus a CS is harder than recovering from a CS alone–but again, some women breeze through recovery from both while some women have a terrible time after just a CS. There is unfortunately no way to know in advance.

          • Azuran

            I like how you think: ‘It’s different for everyone’ is a generalization. And no, stating that everyone has different experience does not mean ‘suck it up’

            You are the one generalizing with your: 100% of c-section are worst than vaginal birth attitude. We are not saying that you don’t have the right of talking about it. We are saying that you cannot generalize your own personal experience to every single c-section out there. You are the one saying that Megan’s positive experience should not be shared.

          • Charybdis

            Your attitude that “all CS are horrid and the recovery is a bitch and people who say otherwise are rude and condescending” isn’t helping either.

            There are risks and benefits to both CS and vaginal deliveries. The risks of CS are generally well communicated, because it is surgery. People tend to know that there are risks to surgery and that recovery can take awhile. The risks of vaginal birth are *not* generally as well communicated. Things like third and fourth degree tears, cervical lacerations, shoulder dystocia, cord prolapse, PPH, pelvic floor damage, broken coccyx, ligament damage, prolapse, urinary and fecal incontinence, rectoceles, tearing “forwards” through your clitoris, episitomy, amniotic fluid embolism, retained placenta, potential for manual removal of the placenta, etc don’t seem to be addressed as real risks of vaginal birth. One regular here had her levator ani completely ripped off the bone. You can’t fix that. Another has to have reconstructive surgery for her pelvic floor damage from a vaginal delivery. Others find it necessary to “splint” so they can have a bowel movement. Leaking urine when you sneeze, cough, laugh, walk, etc is common.

            The thing is, no one can tell YOU exactly what YOUR recovery will be. They can provide risks, give you an idea of what to expect, etc, but YOUR recovery will be YOURS. It sounds as if you didn’t have a quick, non-complicated recovery from your CS. That is unfortunate and can be difficult to deal with. But there is no guarantee that if you had had a vaginal delivery that it would have been completely free of complications and a breeze to recover from. You may think longingly about how a vaginal delivery would have been better for you, but you don’t know that would have been the case. Even if you have had previous vaginal deliveries, it is no guarantee that the “current” one would have been as easy or damage free.

            Anecdata: My father had both his knees replaced. The first one went very well. Smooth surgery, no complications, uncomplicated rehab; it couldn’t have gone better. A year or so later when he had the second knee done, it did not go as smoothly. The surgery was a little more complicated due to some osteoporosis, he had some post-op issues with fluid around the new knee, had to have a wound vac for a bit and the rehab took longer and was more painful for him than the first. Same surgeon, same hospital, same patient, same rehab, I think he even had the same PT person, but the recovery was longer and more difficult than the first one. If he had had the second knee done first, he might not have had the other one done.

            Experiences color our perceptions and you have a perfect right to be pissed off that you had to have a CS and/or were denied a vaginal delivery. But there is no guarantee that a vaginal delivery wouldn’t have had it’s own set of potential issues, just because you preferred it. I LOVED my CS. Best way to have a baby in my opinion and if I were ever to have another, it would be a CS all the way and I don’t understand why anyone would choose otherwise. But that is *my* view and I certainly don’t have a problem with someone who was upset by their CS, because it was *their* experience.

          • sdsures

            Barring an ECS, can it be said that a CS is more predictable because of the protocols involved in how it’s done (cut here, cut there, snip there, extract baby, sew up the incisions)? Whereas, nobody can predict during a VB whether someone will tear, have prolapse, etc, and to what extent these might be. We know all these are possibilities, but can’t say for certain how much of a probability there will be in one patient to the next (correct?).

          • moto_librarian

            I guess I’m wondering how much longer you would have wanted to wait, given what we know about the risks of stillbirth, placental deterioration, etc.? I truly am sorry that your c-section was so unpleasant, but 41 weeks is postdates. There’s no way of knowing whether or not waiting longer would have resulted in a vaginal birth either.

            I had two vaginal births, the first an unmedicated delivery at 38 + 3. I suffered a serious pph and a cervical laceration. My second birth was easier and painless (thanks to an epidural), but I do have serious pelvic floor damage. I am looking at surgical repair of a rectocele that will require 8 weeks off of work, as well as an interstim device to end the bowel problems that I have due to nerve damage from my first delivery. Had I been told that this outcome was a possibility, I likely would have asked for an elective CS.

          • Squillo

            Me, too, Moto. I knew a fair amount about the risks of c/s, but the only thing I ever heard anyone say about vaginal birth was that some women have stress incontinence afterward. And there was often the implication that Kegels would prevent/fix it.

            No one told me my tailbone could be so bruised or broken after birth that I wouldn’t be able to sit comfortably for a year. No one told me about rectocele or vaginal vault prolapse, or about the fact that I could ever after have trouble controlling farts and that I’d often “queef” when bending over. All of this is still happening (except the tailbone, which healed) 10 years after my last vaginal birth, despite Kegels.

            It seems to me that women are beginning to talk more openly about these problems, which is a good thing. Women need information about the risks and benefits of both modes of delivery.

          • moto_librarian

            Yup. The only good thing about my visit with a uro-gyn is that the physiotherapy has left my bladder and urinary function in terrific shape. The doctor told me that I had done half of her work for her, but that no amount of PT was going to fix the bowel issues (I also have issues of uncontrollable gas, and I am terrified that it’s going to happen while I’m teaching a group of undergraduates).

          • Amazed

            Last night, my mom needed to find a bathroom VERY urgently… twice. Not with urinary issues, I might add. Two times in half an hour. Can’t say it was great for our walking tour around the city.

          • moto_librarian

            I’m sure it wasn’t. I’m getting very tired of having my routine disturbed by bouts of urgency too. I’ve pretty much decided that I’m going to see if the interstim device will work for me. If it does, I’ll have that done, and hold off awhile on the larger repair.

          • The Bofa on the Sofa

            Have them pull your finger. They’ll love it.

          • moto_librarian

            That actually made me laugh out loud!

          • rosewater1

            No one has told you this. You are clearly angry. You’re allowed to be. But why are you so angry with other people whose experience isn’t like yours?

            No one is trying to silence you. But your comments seem designed to put words in the mouths of those who aren’t walking in lockstep with you.

            Why? For what purpose?

          • guest

            Are you tired, Nola? Maybe you should get some rest. You’re going off the rails here. Who said “shut up and suck it up”? Who told you you’re not allowed to talk? Why do you get to generalize based on one birth, but we don’t get to add other birth experiences into the discussion to get a fuller picture?

          • Sarah

            Your responses to women who have talked about their more positive section experiences are rude and condescending, and could lead other women to kake choices out of ignorance of the real potential consequences. If it’s ok for you to speak about what happened to you, which it is, it has to be equally ok for others to speak about what happened to them. You telling people that they are not allowed to talk about their positive section experiences, which is effectively what you are doing when you accuse people who disagree with your universalisation of silencing, is outrageous.

          • sdsures

            I get really tired of seeing/hearing vaginal birth as “natural” or “normal”. A CS is “OOOOH,SCARY! Unnatural, therefore bad!”

            “Unnatural”, to me, would be Scotty beaming the baby out.

          • Sarah

            To me, that sounds like the most natural thing in the world! Much more so than when I had to shove one of mine out of my vag and have my stomach cut open with a scalpel to remove the other.

          • sdsures

            Death is also natural, and without a c-section, that’s what will happen to my babies.

          • Megan

            I think it would be downright lovely if babies could be beamed out. 🙂

          • sdsures

            By Simon Pegg? 😉 In a red shirt?

        • momofone

          I’m sorry you had a bad experience. Mine was completely different. I say that just to say that it’s not universally miserable; some people are very happy with their c-sections.

          • Nola1967

            I’m glad for you – my issue is that it’s never even raised as an issue that’s up for discussion. For every good experience, there are many terrible ones and it should be part of the conversation, especially when they’re talking about routine early induction. Frankly, the mother is treated as an afterthought by lots of obs – that might be a reason the natural childbirth movement has gained traction to the danger of babies.

          • Gene

            The entire goal of obstetrics is healthy mom, healthy baby! How in the world do you think that the mother is an afterthought?

          • Nola1967

            This discussion for one, “oh you had a bad experience? Shut up drama queen.” “C-section recovery plus motherhood is hard? Pfft, suck it up.” Let’s just induce everyone at 39 weeks because it’s theoretically safer (no discussion of what that might do to the rate of unnecessary c-sections if the mother is at zero station).

          • Azuran

            No one is saying to suck it up. We are saying that everyone has different experience. You can sadly never know in advance whether your c-section or vaginal birth is going to go smoothly.
            Many people had good experience with either vaginal birth or c-section, many other people had bad experience with either of them.

            Which is why we are advocating choice. Mother’s and OBs should have discussion about both options and their pros and cons in relation to each woman’s personal obstetric situation. Then each woman can chose which risks she prefers to face.

            Same thing with 39 weeks induction. We are absolutely not saying that it should be mandatory. However, if it is proven to be safer than waiting up to 41-42 weeks, then pregnant women should be informed of it and offered the possibility of choosing 39 weeks induction. If she’d rather wait, that is absolutely fine.

            It’s all about informed consent and choice.

          • Gene

            So you are saying that your OB told you to suck it up and that you are a drama queen?

          • Amazed

            No, she’s putting words in the mouths of people here who had been nothing but polite when sharing their own expert or personal opinion. She’s busy playing the victim to the people who daresay that her experience is not valid for everyone.

          • Amazed

            It’s an interesting discussion. You are a drama queen. Not because you’ve had a bad experience but because you’re determined to pretend that people here are telling you to shut up about it. And you can quote me on this – please try to make it a real quote and not a theatrical lie.

          • guest

            I haven’t seen anyone here call you a drama queen. Did you think you could give us your one personal experience of a failed induction and we would roll over and ignore the evidence?

          • Sarah

            Nobody has told you to shut up drama queen. They have told you not to universalise your experience, because yours doesn’t trump anyone else’s. The same would be true if someone who had a brilliant section experience decided that matters more than people who have a crash EMCS and get a wound infection afterwards.

          • momofone

            “my issue is that it’s never even raised as an issue that’s up for discussion.”

            “Never” is a tricky proposition. It was absolutely raised in my case, but if I had questions or specific topics I wasn’t sure about, I asked. It doesn’t have to fall to the OB. (Mine might have preferred that I give him a chance to bring things up; he had treated me for so long he knew I was coming in with a list each visit. 🙂 )

          • Erin

            I do think there needs to be more discussion but I know just as many women who wished the risks of vaginal birth were properly explained as I do those who wish c-sections were. In an ideal world, I wish everything was discussed frankly and we were left to make our own choices based on the information available.

            I’m in the UK and as I was “low risk” until everything got a bit pear shaped, no one would discuss anything bad with me. Not the risks of vaginal birth, not the pros and cons of forceps and definitely not the pros and cons of c-sections. Apparently if they were 100 percent honest, we might make the “wrong” choice or at least that’s what the Midwifery manager said to me when they were apologizing for my treatment.

            I ended up with a emcs after a 75 hour labour, a baby in NICU for a few days and a massive mental breakdown. Had I been offered a section at any point before the last 6 or so hours, I’m pretty sure the last two could have been avoided.

            I’m sorry your recovery was so bad. One of my friends had a repeated infections for around the first 3 months and it really took a toll on her.

        • Gene

          Each method of delivery has its pluses and minuses. I’ve only ever had vaginals (each after induction, each time without any signs of cervical maturity). I was up and walking around 45 min after pushing out a monster of a baby, but have some pelvic floor issues. My sister had a section for twins and had some issues related to pre-e and HELLP, but her only section complaint was her tiny scar (she wears a tiny bikini at the beach and you can’t see it). Another friend had a repeat section (<2y in between). The first was simple as pie without issues, the second she dealt with wound dehiscence for 18 months. Another friend just had her second section. First was awful (she labored for 36hrs first). The only complaint she had with the second was dealing with the 2hrs of labor before they took her to the OR. She loved the second.

          Every birth is different.

        • Irène Delse

          I’m sorry you had a bad experience, but induction at 41 weeks is what my mother had when she gave birth to me and it worked as advertised. I was born vaginally and was healthy but in retrospect, it’s obvious that it was not too soon. I was a big baby, had shoulder dystocia, mom needed an episiotomy (recovery was miserable for her) and the skin on my fingers was all wrinkly. In the doctor’s defence, it was 1969. Nowadays, they’d probably suggest an induction sooner.

          • Azuran

            Apparently in the 90s they still didn’t do it sooner.
            With my mom, they waited until she was 41 week for her first baby. She had a vaginal birth, but it took 12 hours of pushing, forceps, vacuum and 2 broken clavicle for the baby (over 9 pounds).
            Somehow, after everything they went through, they didn’t think it would be better to induce me sooner. So I was also born after a long labour, over 9 pounds, with forceps and a broken clavicle.
            On her 3rd pregnancy she had GD on top of it. They still waited until 41 weeks. still a super hard labour, with a huge baby born unresponsive (luckily she survived, but it still took 5 minutes to get he breathing)
            At her fourth, she was so scared and traumatized about her labour that she actually smoked through the entire pregnancy to try and make the baby smaller… But she was still induced at 41 weeks, it went better than other other 3 labours, but was still long and hard.
            A lot of this could probably have been prevented with earlier induction.

          • guest

            If family history is correct, my mother’s OB chose not to induce her and I was born at 43 weeks, or close to it. Crazy. And it was a difficult birth. Mind you, I can’t say whether her dates were accurate.

        • Dr Kitty

          I’m sorry your experience was miserable, but it is isn’t a typical CS recovery any more than someone with a 3rd degree tear will describe a typical VB recovery.

          You took 12 weeks to recover from your CS, and your recovery was complicated by PPD.

          I was pushing a buggy around IKEA four days after my second, driving after 2weeks and back to Pilates and yoga in 6weeks.

          I have enough prior experience with spinal and gynaecological surgery to know what to expect from surgery, and to know that I recover more quickly than most people, but certainly not extraordinarily so.

          Some people, no matter how long they wait, just aren’t going to labour.
          Like my mother, when she was pregnant with me. Waters broke at 42weeks. No contractions after 48hrs. 8hrs of pitocin with hard contractions and she never dilated and she ended up with a crash section when my heart rate crashed (because 42 week foetuses without amniotic fluid for more than 48hrs do not tolerate labour well). Waiting for labour to start naturally would probably have killed both of us. I’m the oldest of four, all CSections. My mother had the same easy recoveries as me, FWIW.

        • Sarah

          With respect, your experience of a miserable section is, while entirely valid, not universal.

          About the only thing we can say for certain on the matter is that the easiest VB recoveries are easier than the easiest section recoveries. I do sympathise on the induction point, though. It has its place, but I’ve always felt that if I were in a position where the baby needed to be delivered soon enough to make induction desirable, I’d rather have an ELCS instead.

        • Bee

          You know what’s sucks, what is really miserable, shoulder dystocia. What sucks and is even more miserable, what makes your whole body hurt for far more than eleven months, stillbirth. If somebody weighs up the options and risks and concludes that induction is what they are most comfortable with, then all the best to them. Descriptions of incredible pain and doom is not necessary. PPD is not limited to those who’ve had a c-section, what a ridiculous thing to insinuate.
          Completely anecdotal here (as was the above), I’ve had one perfectly uncomplicated induction, four births and it was the best of the lot in every aspect. Labour was short, the placenta came away the quickest and I lost the least amount of blood.

    • lilin

      It can’t hurt to ask. If you don’t get an answer that satisfies you, politely (and enthusiastically) say that you really want a lot of different takes on the issue, and ask if you can talk to a variety of people in the medical system. Most medical professionals have thick skins and understand that some patients want a lot of opinions.

      • SarahG

        True!

  • BeatriceC

    Since it’s somewhat of an off-topic day: Stripping wallpaper, sanding ceilings and cleaning said walls and ceiling in preparation to pain using only your non-dominant arm is a slow and painful process. (The fractured arm is in an air cast so I don’t have to worry about not being able to get a good shower). I cut out a huge damaged spot of wall last week and patched it, but I wanted to make it look nice, but there was this hideous orange/floral wallpaper in the bathroom that was peeling, in addition to the ceiling paint that’s peeling, so I just sort gave in to the inevitable and started a complete bathroom rehab project. I really need to be doing the other bathroom, which doesn’t have a functioning shower, but I’m doing this one instead.

    • sdsures

      Do you have anyone around to give you a hand? Doing all that with a bum arm sounds tricky.

      • BeatriceC

        MrC was out of town and the boys weren’t home for the most part, so I was basically on my own. I did get help pulling the large mirror down and putting it back up, but other than that, I did it on my own. The only thing I really needed my right arm for was cutting out the bad part of the wall, and that was done before the bird incident. I do have one advantage. I’m technically left side dominant but my Catholic nun kindergarten teacher forced me to switch. I do most fine stuff right handed but do most gross motor skill stuff left handed and am far better with my left hand than most people are with their non-dominant side. I can’t write on paper, but I can write on a white board just fine with my left hand. And from the pictures I posted yesterday, we can see that I can apparently do a passable job painting left handed.

  • Nick Sanders

    OT: My family and I are on vacation, and while stopped at a park entrance in Utah today we walked very close to someone my mom swears is the husband from Sister Wives. It was pretty hard not to confront him over his treatment of his family, and how he nearly killed his most recent baby with a homebirth despite shoulder dystocia.

  • momofone

    I enjoyed the Today Show piece, even though you were promoting crazy ideas like letting mothers decide for themselves. Next thing we know, you’ll be saying things like breastfeeding isn’t magic, or babies can thrive on formula!

    • Azuran

      I know, right. As if women were capable of making their own decision or even having different preferences.

      It funny how they get mad when OBs make broad recommendation like c-section for breech and twins and call the medical establishement paternalistic when it won’t let you birth in water, walk around the entire hospital without any monitoring and give birth upside down because your yoga instructor told you to. But they have no problems imposing rooming in.

      • The Bofa on the Sofa

        I would think that mandatory rooming in would be just as offensive as forced non-rooming in.

        Our hospital allowed rooming in, but allowed you to send the baby to the nursery at night between feedings if you wanted.

        How awful, right?

        I think the thing that pisses these people off is that, in that situation, most parents opted to use the nursery, and very few chose to room-in. And that is clearly unacceptable, right?

        • Azuran

          Indeed it should be. I don’t understand how people could be so opposed to giving people choices.

          What annoys me is how they are so disconnected from reality. Sure, when the mother goes home with the baby, she has to take care of it herself. But they seem to forget that most will have a partner to share the duty, many will also have new aunts/uncle and grandparents who will be very happy to come over and take care of the baby while the mother takes a shower or a nap if she asks them to.
          I doubt the BF hospitals offer beds large enough for the husband to also spend the night, and adjacent rooms for the other children of the couple, and provide adequate food for the entire family.
          I doubt that when people had babies in the past, the midwife and the entire family just left ran out of the house as soon as the baby was born to let the new mother take care of it herself.

          • swbarnes2

            Also, mom in the hospital might = mom who has just been through a day long medical ordeal, or mom who has just been through surgery, or mom who has just had a major hemorrhage, or mom who is still on mag sulfate for pre-e, or mom who is on strong pain meds…none of which is going to be true for a mom at home a few days after being released from the hospital.
            Mom in a hospital is a PATIENT, mom at home is not a patient, so is up to doing more child care than a hospital patient.

          • The Bofa on the Sofa

            Also, mom in the hospital might = mom who has just been through a day long medical ordeal,

            When I was doing Dad’s Boot Camp, one of my most important messages is, remember, mom has (usually) been in labor and awake for a long time. Therefore, you need to help her recover.

            I say, when you hear the stories of women in labor for 30 hours, that means that she has been awake (usually) for that whole time. And now you’ve got a baby to take care of. She needs help.

            I wish hospitals would get that.

          • sdsures

            Or new big siblings to help with simple things like feeding their new smaller human.

          • sdsures

            “I don’t understand how people could be so opposed to giving people choices.”

            Funny, they (NHS, RCOM) go on about wanting to give women choices re home birth, birthing centre or hospital, but when it comes to something like rooming-in, YOU HAVE NO CHOICE! Behave yourselves, or ELSE!

            :-/

    • CSN0116

      I’ve decided on a new campaign to speak out against BFHI 😉

      #imamothernotamartyr

      • momofone

        I love it!

      • SL27

        #babyfriendlyisnotmotherfriendly

  • Gene

    OT: saw you on the Today Show this morning! Way to go!

  • antigone23

    My children are 5.5 and almost 3 and even then I knew that 39w was the safest time to have them. My eldest was born at 39+1 after my water broke, the day before my scheduled induction, and my youngest at 39+2 for an elective c-section. I wanted to have the baby on 38+6, a Friday, but elective inductions/c-sections before 39w are now strictly not allowed.

    My mother delivered me at 44 weeks (doctors just shrugged and insisted she had her dates wrong until they did an ultrasound and found almost no fluid). She delivered my brother and sister at 41-42 weeks. So I’ve always known that this “babies know when to be born” crap was just that. I’m incredibly lucky to be alive.

  • graysmama

    I will be 34 weeks pregnant tomorrow. I have gestational hypertension but as long as my blood pressure remains stable and it doesn’t turn into preeclampsia my repeat c section is set for 39w1d. My first child was an emergency c section at 36w0d due to preeclampsia. Women are constantly attacking and judging other women in some online due date clubs I belong to for even suggesting induction or scheduled c section. You can see the influence of the natural childbirth movement strong in the shaming that goes on. Even women who have a medical reason that would qualify for an exception to the 39 week rule are jumped on and told to wait and called selfish. Yet I see way more women posting with 41 and 42 week stillbirths in parenting communities now than I did 6 years ago when my first baby was born. Where is the disconnect between the increased late term stillbirths and the natural is better movement? The connection seems obvious but a lot of women ignore it.

    • demodocus

      one of my due date groups has a couple people who’re over 41 weeks and it’s making me nervous for them. (We were all due in June) They feel I’m being alarmist because I think being that late is dangerous.

      • graysmama

        I see a few women saying their doctor won’t do an early elective induction until 41 or 42 weeks as well which is alarming. How is the 39 week rule getting pushed to 41 or 42 by some medical providers? I had a first trimester miscarriage last year which is fairly common but I was in a group after it happened with other women trying to get pregnant after a loss and there were way more women with late term losses than I would have expected. It makes me anxious waiting on this baby to come

        • Gene

          My prior hospital refused any induction excepting medical reasons prior to 40w. Size doesn’t count. #2 was induced at 39.5 and I never went into labor. We decided to try again at 40w exactly (in retrospect, had we broke my water, it likely would have worked. Anyway, my OB got yelled at for inducing early my the high risk OBs. He had a bit of vindication after #2 was born and was so huge.

          And I was thrilled #3 could go at 39w. Given my age, nothing good happens after 39w.

        • demodocus

          2 1/2 years ago, my providers’ policy was to induce at 41 weeks. Moot point this time, so i’m not sure OB would have induced before that if asked.
          i’ve always been aware that my mom’s first pregnancy ended in a 8 month stillbirth, and that she went wicked late with my younger sister.

    • Fleur

      The hypnobirthing classes at the hospital where I had my baby strongly pushed the idea that there’s nothing wrong with going over 42 weeks. I’ve since heard a number of stories of stillborn babies who died under the care of that hospital after the pregnancy went past 42 weeks. “Baby knows when to be born” rhetoric plus understaffing and insufficient monitoring seems me to be a recipe for tragedy.

    • Montserrat Blanco

      I hope you have a healthy end of pregnancy and an easy recovery from your CS.

    • Guestll

      It’s not as simple as “a lot of women ignore it.” I wasn’t informed of the risk of stillbirth in a postdates pregnancy. My provider never discussed it with me, just encouraged me to “keep on keeping on” like everything was normal. And in my country (Canada) the official recommendation is offer induction at 41 to 42 weeks, and fetal surveillance at 41 weeks if the mother decides not to induce.

      And then there is often the problem of actually getting a bed. I was induced via AROM at 41+5, but ONLY because the senior RM at my clinic screamed bloody murder at the hospital that was putting off my induction for another three days because they were full. And I was 40 years old.

      Really, it’s just not as simple as “a lot of women ignore it.”

      • BeatriceC

        Not exactly on topic but can I just say I can’t imagine having a baby at 40? I’m 40 and would probably go stark raving mad if I had to start over with the child care thing at this age. My hat’s off to you. I don’t have the energy to even think about taking care of a newborn at this age.

        • Linden

          I had my first a month before turning 39, and it is *hard*.
          I was the fittest I’d ever been in my life, and two years on, the sleep deprivation and running about has not been kind to me.

        • Old Lady

          It’s pretty much like anything else, you do what you have to. I’m not quite 40 myself and it’s hard but for me I never was an energetic 20 something because of health problems so it doesn’t seem like an unimaginable hardship for me. I’d take sleep deprived with a newborn in my late 30’s over the exhaustion I felt throughout my 20’s anytime.

        • Guestll

          I had more energy when I was younger, but more patience now. It’s kind of a trade-off. I knew I wanted children in my 20s and 30s, but I don’t think I would have been much of a parent at those stages of life, for a variety of reasons. We are pretty much “settled” now and financially comfortable, and there’s not a lot of stress and worry in our house, which is nice. But tired? Yes, more tired now at 45 than I was even at 37. Perimenopause sucks.

          Most of the parents of my daughter’s Kindergarten class are in their 40s, it’s not unusual around here.

        • Guestll

          To add, this weekend we’ll be attending the 50th birthday party of a neighbour. Her youngest daughter (5) is my daughter’s friend. She had her first at 41, her 2nd at 43, and her last at 45. She tried for a 4th but it didn’t happen. If you’re wondering how she does it, she has a lot of help (full-time nanny) 🙂

  • Marki
    • Box of Salt

      This is data from (per the abstract) From January 1, 1990, through July 31, 1997

      What point are you trying to make with it?

    • swbarnes2

      So the induction rate increased, and the C-section rate stayed steady at 20%. Somehow, I don’t think this is the conclusion you wish to draw from this data.
      Also, google “elective surgery”. I bet it doesn’t mean what you think it means.

  • Marki
  • Marki
    • Sue

      WHere’s the bit where they stratify cesarean rate by risk level? You WOULD want to know this to properly interpret the data, wouldn;t you?

      • Marki
        • Amazed

          Thanks for the laugh. I sure appreciate being told that all the teaching hospitals with all levels of NICUs should be able to lower their c-section rate under 24%. Sure they can. The percent of dead or injured babies will soar up but hey, who cares? Not your MD from the article and certainly not you who couldn’t understand what’s wrong with a Midwife (capitalizing yours) who put a woman through hell to make her deliver vaginally a baby the dumb didn’t know had died before labour even started. You aren’t to bright, are you?

          A little hint for you if you want to be taken seriously here. Not by me, I wrote you off after you revealed your true colours and ignorance by whining for the poor ignorant midwife. But the rest of the regulars here who have shown amazing grace to people like you. So, that’s the secret: each time you cite MDC, you lose another bit of your not too great to start with credubility.

        • Sue

          It says “The data do not include information on some factors that may increase C-section risk, such as pregnancy-related high blood pressure, diabetes, obesity, or other chronic diseases. ”

          Thought not.

          Did you not realise those factors were important?

          • Marki

            Well that is not low risk pregnancys right. …increase C section risk for low risk pregnancys at term is what it talks about.

          • Azuran

            But here’s the thing: If half the c-sections are not necessary, find someone who is able to tell you BEFORE the baby is born, which one do and which one doesn’t. You can’t, if you lower the c-section rate, you will cause some babies to die.

            Yes, most people will be able to have a vaginal birth eventually, most will end up fine. But some of them won’t and we don’t yet have the adequate tool to properly identify them.

            Most breech babies won’t get stuck, but some will, and if they do they risk severe complication or even death. As such, you have to inform women of the available options and risks of both and let her make her decision.
            And don’t forget, vaginal birth has a lot of risks and complications too. So you can’t complain about risks of c-section without acknowledging those as well. In the end, it’s up to individual women to decide which option they want and we shouldn’t limit their options because of some arbitrary number.

          • Daleth

            Well that is not low risk pregnancys right. …increase C section risk for low risk pregnancys at term is what it talks about.

            But the data don’t include the information that would let us know which pregnancies were low risk and which weren’t. In other words the data includes both low and high risk pregnancies, and there’s no way to know which ones were which… so the data is completely useless for the purpose of evaluating the c-section rate in low-risk pregnancies.

      • Deborah

        It would also be useful to know perinatal mortality rates and admissions to special care nursery for the hospitals with such low rates of c/s. If these rates are higher than those of hospitals with higher c/s rates then the whole argument for lower c/s rates is null and void.

    • swbarnes2

      Dr. Amy covered this in an previous post; Consumer Reports had NO information AT ALL about the medical conditions of any of the patients. Obviously if one hospital has the level three NICU and doctors experienced in complications, all the women for miles around with that complication will be advised to deliver there. That doesn’t make it a bad hospital. It makes it a good one that gives experienced care to women who need it.

    • Montserrat Blanco

      Well, I could have delivered vaginally in order to get the stats for my hospital even better than they are, and more in line with the 15% that somebody made up decades ago. In fact, that would have been far better for me. A 850 grams 28 weeker is surely pretty easy to deliver. The fact that he did not tolerate well even the weakest contractions ever that I wasn’t even feeling during a NST made me and my doctors think: well, maybe a CS is a great idea. But yes, I could have delivered vaginally. I could have refused the CS and not sign the consent and make my baby get on with labour and it might have turned out well. For some reason I consented to the CS and got it. The recovery was great by the way. You have been lucky enough to have healthy babies with vaginal deliveries and I am happy for you. In fact it was what I hoped for when I became pregnant. Things turned out other way and I still got a healthy baby. Because yes, having a healthy baby and not risking his brain function was far more important for me than my health, my recovery and even my own life at that point. There are a lot of women like me out there. We prefer to be cut open than to put our babies to the smallest risk ever. Call me too posh to push if you dare.

    • Azuran

      Yea, so?
      You only think this is bad because you take for granted that c-sections and other interventions are necessarily a bad thing.
      Both vaginal birth and c-section have risks.
      In any situation where a c-section is safer than vaginal birth (breech, twins, signs of foetal distress etc) then c-section will be recommended. (woman can decline, but it still HAS to be recommended and the majority of women will take the safest option)
      Any woman who wants to have a c-section also 100% has the right to get one.
      So, how are you going to lower this rate? Do point out to which c-section you think should not have been recommended. Show any kind of proof where a lower c-section rate results in lower foetal and maternal death.

    • Gene

      When I, as a medical professional, see a hospital with a high section rate, I see a hospital that likely has a level 3 NICU (the sickest and most peemie) caring for mothers with the worst complications. And where do I want to be? THERE!!!
      Because if the shit hits the fan, I want to be where my complication is all but routine and everyone from the docs to the janitors know what to do. Do you want to be in a place that sees a cord prolapse or uterine rupture daily or annually? I never needed them…but I may not need that reserve parachute either

      My father is a pilot and I can’t remember a time not hearing about this crash: United 232 in Des Moines. Now people will call Capt Sullenberger a hero, but the crew of 232, my god they ran it like a training session.

  • Dr Kitty

    OT.
    Boys.
    Seriously, what is up with baby boys? Not smart.
    #2 is teething and has a cold and has decided to refuse solid food and formula and lie on me and nurse instead, and he must have drunk all the milk after an hour or twobut just kept latched on, like a little limpet, all last night and all day today.
    Managed to get three petit filous yogurts and 15oz of formula into him, but he was not happy about it.
    He’s 10 months old and over 10kgs.
    I could have done without that.

    • BeatriceC

      Boys are, um, interesting. It just gets more fun as they get older. 🙂

      • Charybdis

        You find the oddest things coming out of your mouth when you have a boy. Things like:

        The footboard of your bed is NOT a balance beam, stop treating it like one!

        Get back in the shower and scrub yourself! The soap is DRY, that’s how I know you didn’t use any!

        Come here and let me smell your pits……EWWWW!! Go put on deodorant!

        Letting the dog lick your plate does not exempt it from the dishwasher!

        Stop jumping down the entire flight of stairs.

        If your crotch is THAT itchy, maybe you need some anti-fungal cream. Or looser underwear. Or a doctor appointment.

        Stop licking the dog’s head.

        Yeah, boys are fun.

        • BeatriceC

          I’ve said all of those at some point. I’ve also said:

          -A wheelchair is NOT an off-road vehicle!

          -No, you may not run over your brother.

          -Stop shooting small legos out of the lego gun you made. It hurts when they hit your ankles.

          -Get off the roof! Again!

          -You are banned from power tools.

          • Dr Kitty

            I have all of this ahead of me!
            My daughter is one of those quiet, happy, independent and motivated little people who is perfectly happy entertaining herself safely and rarely misbehaves enough to warrant more than a talking-to.

            I have a feeling that parenting #2 is going to be a very different experience.
            He is a very easy, happy baby but an important self preservation circuit appears to be missing, and he’s already perfected ignoring me while giving me a cheeky grin.

          • BeatriceC

            Boys are a whole lot of fun once you learn to appreciate the crazy. I’ll give you the single best piece of advise I ever got, from an elderly Trinidadian lady who raised 7 kids, 4 of whom were boys. She said to me, “Mama, you don’t tell the boy not to swing from the rope, you teach him to tie a knot in the rope to give himself a way to hold on to it.”

          • Monkey Professor for a Head

            I like that! I’ve told myself a few times to stand back and let my son fall (within reason obviously) so that he learns what not to do.

          • Who?

            I think that’s right-‘natural and inevitable’ but not super bad consequences are a great teacher!

            He’ll probably look surprised then do it again. And again.

          • BeatriceC

            My boys’ motto seems to be “I’ll try anything once. Well, twice really, just to make sure that if the first time was a failure, it wasn’t just a fluke.”

          • Charybdis

            Mine seems to be of the opinion that if he did it once, he should be able to do it again, whatever *it* is. Because it can’t have been sheer luck or a fluke that he was able to do it that first time.

          • BeatriceC

            I agree with her greater message: Kids in general, but boys in particular, are going to test limits, do physically demanding things, “experiment”, etc. It’s much wiser to teach them how to do so safely than to tell them not to do it at all. They’re going to ignore you if you just say no, but will often times meet in the middle if you give them safety tips.

          • Who?

            So true. I taught mine very young to go down stairs backwards-not that they ever should have been in a situation to be going down stairs by themselves. But their mother not being quite perfect, and them being quick and curious, being prepared seemed sensible.

          • Mishimoo

            See, I did that for my brother and then he proceeded to attempt to knock the house down with his head. One doctor’s trip later and he was the proud new owner of a couple of stitches (we also discovered that he has a high pain tolerance and is resistant to local anesthetics)

          • Mishimoo

            – “You’re not a cat! Don’t drink from the fishtank.”
            – “Don’t fork the dog.”
            – “No hammer for you.”
            – “The dog is not a horse!”
            – “Mummy is also not a horse.”

          • BeatriceC

            I forgot about all those. Also,

            No! You may not use the machete to cut all the banana trees down. Oh, you already did that? Oh, shit.

            And from the teen years:

            -The eave over the garage isn’t an escape route out of your bedroom window.

            – The pool doesn’t protect the neighborhood from accidental fire in poorly controlled explosions.

            – I know MrC helps sometimes. He’s an adult and a scientist. He’s allowed to blow things up. You’re not.

            -No we’re not getting a penguin.

            -Or a cow

            I’m sure there’s more I’m just not thinking of.

          • Who?

            ‘Do not chase snakes armed with a kitchen knife. Come to think of it, don’t chase snakes at all.’

            Actual words, out of my mouth.

          • BeatriceC

            Hahahaha! That reminds me of my little brother (who’s 6 months younger than my youngest kid). He and my kid were collecting worms in one of the corners of my parents’ property and lil bro comes in all excited “Bea! Bea! Look at the really BIG worm I caught!” I had to tell him to get the snake out of the house before our mother, who’s snake phobic, lost her mind. Then we had to have a discussion about snakes and worms and the kind of nasty snakes that live in south Florida.

          • demodocus

            my grandmother dispatched a snake in her bathroom with a couple kitchen knives a few years ago.

          • Who?

            We’ll just keep that one to ourselves, shall we?????

          • demodocus

            Not everyone is a ninja granny 😉

          • Mishimoo

            “No, you may not put a bell on your brother. He is not a cat.”
            “But Muuuuum, then we’ll know where he is when he’s getting into stuff!”

          • Charybdis

            No, you cannot get into the dryer.

            Why is there cheese on the kitchen ceiling?

            Why are your socks in the freezer?

            Don’t put empty milk cartons back in the refrigerator!

            Why did you stuff your grilled cheese crusts under the coffee table?

            NONONONONONO!!!! Don’t put liquid dish soap into the dishwasher!

            WHAT…..THE…..HELL….IS…..THIS, THIS……STUFF….IN THE ICE CUBE TRAYS?!??

        • Who?

          My son’s first words were ‘get down’, which I swear is what we said to him the most before he was a year old. We lived for a long time with dining room chairs on the table, as he would be on the table in no time if left in the room unattended for a second. He could climb vertical surfaces long before he could walk.

    • Who?

      That’s a big boy! Take it easy. He must be feeling rotten, and you probably are too by now. I hope you don’t catch the cold, just to add insult to injury.

      I’m never sure I understand either of my kids-they are continually surprising-so no sage words I’m afraid.

    • demodocus

      Mine just tumbled off his ride-on car, for the 2nd time in 5 minutes. *eyeroll* You aren’t supposed to stand on them, especially on a slope

      • Monkey Professor for a Head

        Mine has gotten wedged in the footwell of his car three times today, with much yelling for rescue each time. You’d think he’d learn, but no. He’s rolled it a few times too. At what age do kids develop common sense?

        • demodocus

          Depends on whether he takes after me or his father. A certain spouse thought my “cast-iron stomach” was an implant rather than a metaphor. As a senior in college.

        • Who?

          Well now, I wouldn’t hold my breath. There are plenty of adults around who make the same bad decisions over and over again…

        • BeatriceC

          Boys? By 40 or 50. Maybe.

        • Nick Sanders

          I’m 29, my dad is 62. As soon as either of us gets some, I’ll let you know.

      • Dr Kitty

        Mine keeps trying to use phone chargers, speaker wires and electrical leads as chew toys.

        Put him on a rug with age appropriate toys and he ignores them all to chew shoes, lick and poke the internet router and finds the single most dangerous thing in the room and make a bee-line for it.

        Also- he hates dry cereal and cookies, but thinks the cat’s dry food is some sort of baby buffet and keeps trying to eat it.

        I have been told that this is normal with boys.
        Apparently they all have a built-in deathwish.

        Another night of limpet baby, but his fever has settled and he seems in better form this morning.

        • Montserrat Blanco

          Welcome to my club! Mine needs under 10 seconds to make a disaster. Playing with knifes, fire, etc is of course much better than toys.

          • BeatriceC

            All of my best “I can’t believe he did that!” stories start with “Well I had to go to the bathroom…” 10 seconds would have been a really long time for my boys to find trouble.

        • demodocus

          you may be right; my TWO YEAR old keeps chewing on wires.

          • Lisa Cybergirl

            Get some Bitter Apple at a pet supply store and spray it on all accessible wires! It’s harmless, and has worked like magic on my wire-chewing pets.

        • Box of Salt

          It’s not just boys – my girl did the same thing. The phrase “Wires are not for babies” was coined for her, not for her brother.

          • Old Lady

            Yeah my older daughter is more trouble than my son, she doesn’t think rules apply when we’re not looking. Sometimes I know she’s getting into trouble because I can hear her twin brother saying she’s not supposed to do x.

        • Nick Sanders

          At least it can be put to good use:

          http://www.smbc-comics.com/comic/2015-01-17

    • Monkey Professor for a Head

      You have my sympathies – my minimonkey does the same thing when he’s teething. New teeth and continuous nursing is not a fun combination.

    • Kelly

      Mine hates the bottle but will eat baby food. I think the sucking hurts her teeth and ears. She also tends to not sleep well. Teething sucks.

    • Sue

      Maybe a precocious case of Man Flu?

    • Juana

      Mine is about the same age and also has a cold.
      But with her, it’s me who could do without solids during the cold. Why?
      She’s a puker (do you say so in English?), since ever. She’s grown up out of it a little, but when she has a cold, she always remembers. A lot.
      Conclusion: Semi-digested milk smells a lot better than semi-digested Spaghetti Bolognese puree.

  • SporkParade

    Maybe this is why there’s increasing evidence that 39 weeks is actually the global average for length of gestation, and 40 weeks is only average among people of European descent.

    • Deborah

      That’s very interesting. I was entering data awhile ago on outcomes for the Aboriginal clinic I work in and I noticed that the vast majority spontaneously delivered at 39+ (a day or 2).
      Very few of our women go post-term and we also have high preterm rates for various reasons. (infection, mat smoking, substance use)

      • SporkParade

        Yeah. There were a couple of studies in the UK that showed an average gestation of 39 weeks for women of Asian and African descent.

    • Bombshellrisa

      Can you point me toward this info?

  • Amy Tuteur, MD

    Rebecca Dekkers instructed her followers to flood the comment feed on the Post article:

    • Gene

      Let’s see: #1 induced for no labor after SROM at 38w = baby. #2 induced at 40w for size = baby. #3 induced by maternal request at 39w = baby. No complications, very smooth. Three inductions, the babies, all vaginal fwiw. I honestly could care less about the last bit. Also all breastfed, cloth diapered, homemade baby food, etc. I’m like a crunchy poster child.

      Hey, given my anecdata, induction obviously causes successful vaginal births, breastfeeding, and general bonding! Inductions FTW!

      • Tori

        I had an induction at 38+3 – suspected big baby. His birth weight wasn’t huge although decent, but head circumference is off the charts. He’s still a big baby now, probably the size I was at 9 months when he’s 4 months! Our dates were certain due to IVF, and the decision for induction was right for me. I expected a section but wouldn’t try a VBAC in future so wanted to experience labour once. Part of me wonders if I should have waited until 39 weeks, but was surprised by a vaginal delivery, which I attribute to the induction. I often don’t say he was induced because of the judgement from the NCB community though, can’t be bothered arguing about it. I haven’t been able to breastfeed but that’s lack of glandular tissue amongst other factors rather than induction. There is the nagging thought that if I’d waited a few more days I’d have had an easier time breastfeeding. Logically I know it would have made no difference though.

      • Azuran

        Yea, my mom had induction at 40 weeks for all four of us. All were vaginal birth. I’m the only one who wasn’t breastfed and that was due to severe allergic reactions to breastmilk. So yea, go inductions!

    • CSN0116

      Never heard of this woman. But trying to demean or totally disregard an evidence-based recommendation regarding birth, instead of discussing it openly, …while “supporting” evidence-based birth… seems pretty backwards, shady, and hypocritical.

  • BeatriceC

    Totally off topic: Parrots are perpetual toddlers, with far more destructive potential. I went to the bird store to get my spoiled parrot new toys. I went into their adoption room to play with the adoptable birds. I was paying attention to this cockatoo on one perch and the military macaw on the next perch took objection to that. He wanted attention. He grabbed my arm with his beak and pulled me towards him. He barely broke the skin, as he wasn’t out to hurt me, but just wanted to play. Anyway, as the day went on the spot was getting uglier and weirder, so the nurse line at my insurance advised going to the ER. Turns out the darned bird actually fractured my arm! In addition, there’s small scale “crush injuries”.

    • Stephanie Rotherham

      -winces- Ouch! That must hurt. Hope you got some good stuff for it, anyway. I’ve been scratched silly by a bunny, but never broken a bone.

      Many pets can be like toddlers. I’m pretty sure my rabbit sees me as her slave. Actually, she sees most humans as her slaves; I’m just her favourite. She will throw a mini tantrum if you don’t have her preferred food or if you go off schedule (bunnies can be somewhat OCD about things). Her favourite game is basically ‘push stuff off the couch and watch the humans pick it up, then push it off again’, and we have our own version of Pooh sticks, where if you give her a stick she’ll throw it on the ground. It’s a lot funnier than it sounds.

      • BeatriceC

        Yeah, all pets are like toddlers in some ways, but birds are just something special, especially the big ones. I kinda feel bad for the bird that did this. He really was a sweetie and he just wanted to play, but he doesn’t know his own strength. Macaw beaks are really strong. I’ve seen them reduce 2×4’s to toothpicks in a matter of minutes. They don’t make a “macaw safe” wood. The hardest wood on the planet is no match for a macaw beak. I’m just glad he did this to me and not somebody who’s not familiar with parrots. If I had jerked back the front of his beak would have likely punctured my arm in addition to startling the bird, which would have made him chomp down harder. Instead I froze and used my other hand to pry his beak off my arm, which limited the damage.

        Your bunny sounds adorable. I love animals of all kinds, but MrC is allergic to anything with fur, so we have birds.

        • Stephanie Rotherham

          Wow, that’s really fascinating, I didn’t know that about macaws. I’m quite the animal lover but I’ve had most experience with mammals. Hopefully he’ll be able to learn better- parrots are quite smart, right?- not to do it next time, or at least go to an owner with a similar degree of knowledge as you do that can handle him. I hope he goes to a good home. What kind of birds do you have? I have a rabbit named Amy and a hamster called Boba Fett.

          Thank you, she is (well, mostly). That sucks; Amy once nearly killed someone because they were allergic to cat fur and had asthma. She’s currently digging around in her blankets.

          • BeatriceC

            Macaws in general are the gentle giants of the bird world, but there’s a reason bird exhibits generally only use blue/gold or Scarlett macaws for public interaction. They all can have attitudes, but military macaws are a lot more unpredictable. This one is an early adolescent, and like adolescents of all species is both rebellious and wants to play all the time, but is unaware of his own strength. If he winds up with a good human who can teach him about bite pressure he will be just fine.

            As for my birds, we have a 31 year old yellow nape Amazon, a 9 year old Senegal and a 25 year old cockatiel.

          • 25! That’s a venerable cockatiel. Ours are 13 and 14 or thereabouts – they were both rescues so we don’t know for sure.

          • BeatriceC

            MrC’s animals are practically immortal. He had a fish live almost 20 years. But yeah, Cookie is extremely old. We’re kind of taking bets on how long he’ll last. He’s so far beyond normal life span that it could be any day, though he’s not showing any signs of demise (except for being a crotchety old man).

          • Puffin

            My cockatiel is much the same. He’s 19, I’ve had him his whole life. He’s had a couple of accidents that really should have finished him off. His feet are arthritic and he’s clearly losing some of his visual acuity, but he can still fly better than the rest of our birds. He puts the young conures to shame. Our cockatoo has no idea what to make of him.

            Sorry about the arm! Macaws are such fascinating birds and my son (who *loves* the birds and works closely with the parrots) desperately wants one, but the risk of inadvertent serious injury with the big macs is just a little too high for me to be comfortable with considering we’ll soon have another baby in the house.

          • BeatriceC

            I’m still planning on adding a Mac to our flock at some point, but I wouldn’t consider it if I had small kids for exactly that reason. Most injuries by a Mac are accidental or failure of the human to successfully read the bird’s signals and the risk of either of those things is just too high with mini humans. Macaws can obviously break bones, among other things like removing fingers and creating significant puncture and crush injuries. Just not a good match for little kids who don’t always observe their surroundings or pay attention to anybody but themselves.

            Cookie still flies, but neither Goofy nor Leo do. MrC keeps Goofy clipped after one to many close calls with being lost and I think Leo’s original human clipped him before he fledged. I’ve let his songs grow back out but he just drops like a rock when he tries to fly.

          • Puffin

            One of our conures, Fawkes, is like that. While his sister (a clutchmate) learned to fly a bit even with clipped wings, Fawkes just beats the air desperately while essentially just softening his inevitable landing. He just completely lacks grace. We have to move him around so he can keep up with the other conures.

            Our cockatoo wasn’t clipped when we got him, but he’d been caged most of the time (badly neglected bird) and so we didn’t know if he’d be able to fly, let alone do so safely. While he does prefer to climb, he’ll fly to find us if we’re not in the room with him.

            I’ve done some work with macaws and I’d love to have one some day, but my flock is more than enough for now and since most of my birds are rescues instead of planned additions, who knows what I’ll end up with when we’re reading to expand the flock!

          • BeatriceC

            I’ve been considering a cockatoo instead of a macaw. They’re a little less expensive and come up for adoption a little more frequently. I have absolutely no interest in a baby or preadolescent bird, so I’m looking at the rescue groups in the area, though the one that houses their birds at the store where I get my bird supplies is the most convenient. There have been a couple cockatoos that have caught my interest, but I haven’t spent as much time with them as I would if I was seriously considering them because their noise level make me a little nervous. I do like my neighbors, you see. I should pick your brain about all the pros and cons of cockatoo servitude. I always hear stuff, but it’s nice to hear from people who actually have them.

            Leo might not be able to fly, but he’s smart as a whip. He broke off a piece of a wooden toy and used that to move the latch on his cage in order to break out when he didn’t want to go to bed when I put him to bed (I leave the cage open during the day so he can climb all around it as he sees fit). I now use wires twisted like twist ties to keep the cage shut at night. Silly bird.

          • Puffin

            We’ve had our ‘too less than a year and he’s come a long way but as a neglected bird there’s a lot further to go. His story follows the usual cockatoo pattern: cute and cuddly baby hit sexual maturity, started experiencing aggressive periods owners couldn’t handle, rehomed repeatedly, was stuck in a cage. Started plucking to cope. He had no toys, one short perch, and a filth-encrusted cage with food bowls on the floor when we got him. He’s almost 6 now.

            He doesn’t trust women, and he does bite somewhat often (including just to get a reaction out of me, the stinker) but he’s getting a lot better about it. Plucking has reduced by probably half but we don’t know if he’ll ever stop completely. He’s actually been very quiet, which surprised us. He’s probably only had maybe 5-10 periods of normal cockatoo playful screaming since we got him mid last year. He’s only just learning that it’s okay to be loud at our house. Works well with my son (9) but is very wary of my daughter and stays away from her. He’s very attached to my husband. Classic ‘velcro bird’ – follows him around, snuggles up to him, wants head rubs, wants to do whatever he’s doing. He actually does enjoy watching TV and will get quiet if a movie he likes is on.

            It took him a long time to learn to play with toys, which was heartbreaking. He would hesitantly nip at his toys and then look over at us to make sure it was okay for weeks before he’d actually start destroying them the way he should, and he’s still confused by a lot of toy types. He’s really a generally lovely bird, we’re just continuing to work on the problem behaviours (plucking, biting) which will be a work in progress for a long time.

          • BeatriceC

            Awwww. Poor sweet bird. I’m glad he found a good home with you guys! It breaks my heart that people get these large birds with absolutely no clue how to handle them and then mistreat them instead of giving them up to somebody who can care for them. One of the adoption groups in my area makes potential bird-slaves take several bird care and psychology classes and observes potential adopters with the birds multiple times before they place a bird. It’s time consuming and means the birds take longer to go to permanent homes, but it’s worth it if it’s actually a permanent home and not yet another human who’s going to get in over their heads. Birds are a lot of work; even the small ones, but the big guys are pretty intense. I wouldn’t even consider it if I wasn’t a full time housewife/mother.

          • Azuran

            I know the feeling. I’ve been planning to get an african grey, once the actual flock thins a little bit more. But at this rate I won’t get it until I’m 50.
            (But anyway, I’m gonna put that plan aside until I have kids and they get somewhat older. I don’t think newborns and big parrots go well together.)

    • demodocus

      0.O oh my,

  • demodocus

    i certainly didn’t object to the recommendation of induction after 9 pm at 38 weeks. Granted, it was for blood pressure, but i was so done with pregnancy.

    Daughter has an umbilical granuloma, but otherwise is doing well,. Doc painted it with silver nitrate, and we’ll be back for her month old check next week anyway. already 18 oz over birth weight

    • Kelly

      My third had that too. It took two months for us to get it cartirized. She sounds like she is doing well. Congrats again. It is nice to be holding your baby when your due date rolls around too.

      • Dr Kitty

        I kind of love applying silver nitrate to umbilical granulomas.
        The parents hear “cautery” and expect screaming and smoke and the smell of burning flesh and are usually terrified.
        I smear some Vaseline, tickle the baby, apply the silver nitrate while making small talk and get asked when I’m going to start, and can then tell them it’s all done and I’ll see them in two weeks in case it needs a second go.

  • CanDoc

    Gah, the WP comments are excruciating. So grateful for this site and commenting group! 🙂
    The evidence is clear and unequivocal, and honestly, the writing’s been on the wall that it’s been coming for about seven years now, ever since the Scots first reviewed their massive national perinatal database and noted lower stillbirth rates with non-medically-indicated inductions anywhere from 37 to 40 weeks. This issue was debated at one of the Canadian Ob/Gyn society meetings in 2014, and nationally in 2015, with similar results (although there have been a few more studies out since then.)
    There will be an associated increased cost that I’m sure has been calculated, and can be distilled to some simple data points: how much extra money will we spend in monitoring and nursing care during an induction at 39+ weeks (vs waiting) per baby spared asphyxia, brain damage, or stillbirth? By how much is the cesarean section rate lowered? And then women can decide what they’re most comfortable with doing.

    • Dr Kitty

      The numbers need to be properly crunched.
      Including the settlements and lifetime care for the “bad baby” cases.

      I know that in any future pregnancy, when I would be over 35 with 2 CSections and 2 babies on the 9th centile (so, only just over IUGR) there is NO way I would want ERCS any later than 39w0d.

      But at the moment kiddo #2 is enough of a challenge that #3 is merely hypothetical.

    • SporkParade

      Heck, how much extra will we spend in monitoring and nursing during an induction versus how much we (at least in Israel) already spend on extra monitoring every couple of days as soon as the woman goes past 39 weeks?

  • Brooke

    Every article written about this on medical websites has comments from OB/GYNs that they would be reluctant to do this because of the risks associated with induction itself and stress that more data is needed. But yeah, let’s make it up that natural birth advocates are flipping out by cherry picking quotes, as if they actually have any controlor authority in the medical setting which is where 99% of births take place.

    • Irène Delse

      You surveyed them all and didn’t link to at least one of them? How curious.

    • Who?

      Brooke can I say well done. This is a perfectly appropriate comment, no swearing, no glaring grammatical errors, no spelling mistakes. I’m putting ‘controlor’ down to a slip of the finger on the keyboard.

      Just a couple of pointers: I haven’t looked at any medical websites, but I suspect ‘every’ is a stretch-sometimes it’s better to understate slightly to make a strong point-so ‘many’ would have been the more thoughtful choice there. I would have said ‘cherry-picking’ but smart people who write well don’t all agree on that, so just a note for future reference.

      And your content represents a perspective that is arguable, and acknowledges objective fact.

      I think we’re having a positive effect on you.

    • Sue

      Can the obstetricians here point us to the websites where OBs might be commenting?

      Based on the lack of reliability of previous comments, I would like to check out Brooke’s assertion.

  • slandy

    I have to be induced at 37 weeks, but if I ever have an actual normal pregnancy, I will be all over a 39-week induction.

    • demodocus

      I hear you; I definitely hoped for a reason to have my kid before 40 weeks! Granted, I hoped it would be natural labor rather than being induced for high blood pressure but I wasn’t going to argue with the recommendation.

  • Mac Sherbert

    I’m sure the natural childbirth people would have the vapors, but in my area induction at 39 or 40 weeks seems to already pretty much be routine. Almost, all the women I know are given the option so long as everything looks good. Also, to the natural childbirth people’s dismay I have to say my friends don’t turn the OB’s down on the offer. My last pregnancy I went 40 weeks and couple of days. The last week was horrible! The baby ended up being 9 lbs.+ and the C-section was the right choice for us. If by some miracle I ended up pregnant again the baby will be out at 39 weeks!!

  • Sue

    OT: there’s a new Dahlen article on The Conversation:
    https://theconversation.com/explainer-what-are-womens-options-for-giving-birth-55133#comment_1015246

    The author purports to be describing the various options for childbirth, but uses language like:

    “Midwives regard the emotional, psychological and social needs of women as a high priority, so midwifery is described as a social model of care.”

    vs

    “Obstetricians are medical doctors with specialist training in caring for women during pregnancy, the birth and immediately after. Their particular skill is in dealing with complications that may arise.”

    In Australian hospitals, where midwives provide all the routine care for uncomplicated deliveries, they are using the same model of care as doctors – antenatal testing, in-labor monitoring, drugs and suturing.

    • Mel

      According to that first quote, a midwife is more of a social worker than a childbirth worker.

      So, shouldn’t midwives be working in conjunction with an OB to maximize care for at-risk women? I mean, a woman who needs emotional and social support during pregnancy needs to be hooked up with a midwife along with an OB according to Dahlen’s description herself.

      This reminded me of the one woman I know who home-births. Her educational background is in the humanities from the same tiny college I went to. She decided during her first pregnancy that her OB and her midwife were providing identical levels of care and dropped the OB. So far, she and her babies have been fine, but I always worry about her.

      • I certainly worked WITH , not “for” doctors during most of my career. In the UK especially, it was clearly spelled out when I had complete autonomy and when I had to bring the OB in. There was an attitude of both mutual responsibility and cooperation. Never did I have this paranoia that I’ve seen expressed by some US midwives that the doctor was seeking to interfere unnecessarily or inappropriately. But then, I was always working where midwifery was a branch of the nursing profession, and not with pseudo-midwves like CPMs.

        • Dr Kitty

          I have had occasional issues where I have been frustrated by NHS midwives.
          Like the pregnant woman with classical thrush symptoms who, after seeing her midwife on a Monday was advised by her to contact me the next day to arrange to be seen as an emergency for swabs.

          A) Midwife just as able to swab as a nurse or GP.

          B) Midwife could have asked one of the GPs to prescribe empirical treatment on the Monday.

          C) Even if midwife unable to swab or ask a GP- my practice nurse could have seen the lady the next morning and stuck her head around the door for a script.

          D) Instead, not only did the patient have to wait until the next afternoon to see me, an appointment that should have been available for genuine emergencies was used for a minor ailment, and swabs weren’t necessary, because even a cursory glance made the diagnosis obvious!

          I was told the midwife had felt “under time pressure” which is why she didn’t examine the patient herself. She has 15 minutes for each appointment slot. When I do antenatal appointments, I have 10 and make a decision to run late if there are clinically appropriate examinations or investigations that need done.

          To say I was unsympathetic and unimpressed is an understatement.

  • FEDUP MD

    I was induced by my own request with my first at 40 weeks and 6 days (41 weeks fell on a holiday.) I just felt like he wasn’t moving as much and like something was wrong. Indeed it did turn out in retrospect that the placenta was failing (by path report) and I even developed a bit of chorio but not enough to cause a fever. He didn’t tolerate even early labor (no pit, just cervical ripening leading to labor) well AT ALL and needed an emergency section with some low Apgars and bad meconium once my (nonaugmented) labor started. I shudder to think what might have happened if I had waited even later, if the placenta had completely gone off the rails a few days later. Of course, I guess the NCB people wouldn’t have believed that I knew my body and that something just wasn’t right.

    Based on available evidence and minimization of risk to the baby, I had my RCS scheduled at 39 weeks 1 day (39 weeks was a weekend). Fortunately worked out for me because over that weekend (I saw the OB on Friday) I went from borderline maybe about to turn into preeclampsia into “oh my god look at that blood pressure she could stroke out right now” levels as they wheeled me in (the OB said, if I wasn’t getting a section now already, I would be getting a section now). If I had known ahead of time what I know now, I would have either asked to induce # 1 at 39 weeks, or asked for a MRCS then.

  • StephanieA

    Stillbirth is so devastating, and it’s not rare at all. We see it regularly at my BFHI, and I have a difficult time dealing with it every time it happens. I was so relieved my first son came at 38+4. He had zero issues and is perfectly healthy. With my second son my doctor wasn’t big on induction until 40 weeks. I had him at 39+6, and it made me wish I could’ve been induced earlier. His giant head caused quite a bit of damage and recovery was awful.

  • BeatriceC

    I probably shouldn’t have, but I read the comments and came upon this gem:

    “This discussion once again assumes that the only important part of pregnancy and birth is that the baby is alive and healthy in the end. What it fails to remember is the importance of the bond between mother and child and the mothers ability to parent happily.”

    What she fails to grasp is that if they baby is born dead, there’s no parenting, so yes, a baby born alive is the OB’s first priority. A living baby is a non-negotiable pre-requisite* to happy parenting.

    *I am not minimizing the “parent” status of loss mothers, and would like to remind folks that I am a loss mom times three. But the simple fact remains that I only actively parent three children, not six.

    • CSN0116

      The word “bond” makes me want to vomit every time I read it.

      • StephanieA

        Same with the skin to skin promotes bonding nonsense, and that rooming in after birth is essential for bonding. Such bull- tell that to my adopted sister and parents who adore her.

        • Fleur

          I find it faintly depressing that I keep coming across the message online that women in the process of adoption need to start trying to induce lactation now, so that they can provide breastmilk to their adopted babies and toddlers (with the implied threat that they won’t be a “real” mum unless they do). Back when I was considering adoption as a route to parenthood instead of pregnancy, I considered one of the advantages to be that I wouldn’t be under any pressure to breastfeed. Apparently I was wrong.

          PS Your family sounds lovely. My conclusion based on observation of pretty much every family ever is that blood relationships count for roughly sod-all.

        • CSN0116

          I don’t do child psychology or anything but this isn’t me first rodeo, I know a thing or two about infant bonding:

          #1 It doesn’t require rules or rituals to make it happen
          #2 It doesn’t require the mother whatsoever
          #3 It can’t happen immediately after birth
          #4 Simply respond to the infant’s needs consistently

          By ~age 3 months my infants are all bonded to myself, my husband, their siblings, and their nanny (they will bond to my mother, mother-in-law, and my sister shortly after that). They will cry for any of these people, and stop when any of these people respond to them. I could run away, die, disappear and they would be none the wiser …they would move on to their next bonded caregiver.

          This whole bonding thing is a maternal mindfuck and it’s made up. It’s all designed to make sure the MOTHER feels X, Y, or Z, and the baby is the device used to invoke the desired feelz. Just like with NCB and stunted VBACs — it’s all about how the mom feels and what SHE wants accomplished. The baby does not care who is holding or feeding it; it just wants to survive and needs *anyone* to respond to it. And the fact that women who cannot follow the bonding rituals feel ashamed, or slighted, or doomed, is bullshit.

          • Jules B

            Exactly! This seems to be a no-no for mothers to say in certain circles, but for me at least, it took time before my daughter and I truly bonded. It took my demonstrating to her day after day and night after night that I was there, and would respond consistently to her needs, for her to bond. And similarly, I needed time to get to know her before I felt that “mother’s love” every Mom is supposed to feel instantly. I was (and still am) her primary caregiver, and that is why, at this stage of her life, she is connected/bonded to me the most. But that is just a result of the fact that I have spent four years caring for her, no other reason.

          • CSN0116

            I don’t believe a single fucking person who claims to have initiated the mother-child bond at first contact. They’re liars.

            Enamored? Devotion? Enthralled? Overjoyed? — Sure.

            But bonded? — NO. I don’t buy it.

          • guest

            I don’t know about this idea that women can’t be bonded immediately after birth. I do think that bonding is a process and doesn’t happen instantly, but a lot of women feel bonded to their fetus, so it’s not a sudden switch that goes off at birth where they felt nothing before, but when the baby is on their skin suddenly they have bonded. But the first time you hold your baby (whenever that is) can be intensely emotionally and at least sometimes mark a transition.

            Bonding is a process, and a parent can feel fully bonded at any time. There’s no need for a magic “hour” when it happens – but I do think parents can feel bonded at birth.

            Now as for the infant, does it feel bonded at birth? My guess is no, that the process of bonding takes longer for the baby because it’s experience of birth seems far more likely to be traumatic to me. But that’s just a guess – no one knows what babies think, really.

          • The Bofa on the Sofa

            The hard part of this whole discussion comes down to, “What the hell does ‘bonded’ even mean?”

            When you say, “a lot of women feel bonded to their fetus” is that necessarily truly bonded? Isn’t bonding a two-way interaction? Baby is bonded to adult, adult is bonded to baby? If you feel bonded, but the baby can’t stand you (hyperbole, but ok) is that still a bond?

            We have seen lactivists insist that breastfeeding is a sign of being bonded, and that the absence of breastfeeding indicates lack of bonding. But is it? Or is it all self-serving nonsense?

          • guest

            I’m not sure bonding does have to go two ways. It’s going to be pretty unsatisfying if you’re bonded to someone who has no regard for you at all, but that doesn’t mean it isn’t bonding. I think this happens in abuse cases sometimes, where a child has to be removed but is bonded to a parent even though the parent has little regard for the child.

            But I agree that whatever “bonding” is, it has not been defined. Maybe the psychiatrists have a specific definition somewhere.

          • The Bofa on the Sofa

            I think this happens in abuse cases sometimes, where a child has to be removed but is bonded to a parent even though the parent has little regard for the child.

            That’s kind of the point. If the parent has little regard for the child, are they really bonded?

            I think the NCB crowd considers bonding only in one direction – the parent attachment to the child. They just then assert that the child must be attached in return. Granted, I think given the child’s need for attachment (as your abuse example illustrates), they will get there eventually, but that doesn’t mean a baby is attached to the parent just because the parent “feels bonded” to the baby.

          • guest

            But the child IS bonded, meaning bonding can go in one direction, at least my understanding of it. So then it *could* go the other way, where the parent bonds before the child does. I just don’t think we can discount the fact that parents can also bond with a fetus before it is born – I have heard accounts from people who felt they were, and fears from people who did not feel it and thought something might be wrong (nothing is wrong with not bonding before birth, or even a long time after). I wasn’t a fetus-bonder myself, but that doesn’t mean no one is.

            I agree that the NCB crowd makes a great big stink about basically nothing – bonding happens between parents and children in multiple ways and over a period of time, not in one magical all-or-nothing instant.

          • Tori

            We used IVF to get pregnant, and I started chatting away to our now Bub as soon as the embryo was implanted- just at home or in the car by myself, but still. As soon as I saw a heartbeat I chatted even more at home or in the car. I felt attached to him long before he showed any sort of bond to me, and before the first breastfeed. Breastfeeding hasn’t worked out for us – I have low supply so it’s just not possible and I feel sad about that because I enjoy it. He still breastfeeds recreationally, but all the calories are in a bottle. In my neurotic postpartum state I cried that we wouldn’t be ‘bonded’ because I couldn’t breastfeed – at that point I didn’t care about the pop hype about IQ, obesity, allergy, whatever. I was more concerned that he wouldn’t be attached to me and end up growing into some terribly maladjusted individual. My kind OB pointed out that he was male, so ‘what did he really know’ but he hadn’t breastfed his kids and he was bonded to them, and mothers in the NICU aren’t breastfeeding but are still incredibly attached to their infants. I stopped and realised the logic of what he was saying, and when the postpartum haze had shifted felt OK about it all. So yeah, fetus bonder here, and you can’t breastfeed a fetus.

            In terms of child being bonded to parent, I think of it does the child respond in a way that they expect their needs will be met? Which with low supply, maybe breastfeeding isn’t as good for bonding… My baby was always hungry after feeding (and then starving and a bit dehydrated, thank goodness for formula), so I’m sure that’s not a great contribution to the idea that ‘someone is here for you and your needs matter.’

          • sdsures

            In an abuse case, I don’t think they’re bonded. But on the other hand, Stockholm Syndrome exists.

          • Beth

            most children are bonded to their parent even if the parent is abusive. In my years working with foster care I saw lots of kids who were desperate to get back to parents who had treated them terribly. That’s the crazy thing about this idea some parents have that your baby won’t bond to you unless you do everything right. Your baby will bond to you because babies are wired to bond to their caregivers. If the caregiver severely neglects them there may not be a bond, but if they provide the necessities of care, yet are abusive, the bond will be there.

          • Angela

            Agree. It took time for me to get to “know” my babies. I have three children, and each time, they were born as strangers. We bonded as we got to know each other. It wasn’t instant. My husband had the same experience.

          • Kelly

            I just posted above but that is probably the best way to describe it. I will be using that description from now on when I discuss that time. They were strangers and the way they acted in the womb does not come out until they are one. So far the amount of activity they have had in the womb has corresponded with their personality at about one and two.

          • sdsures

            That makes sense to me, even though I’ve never had kids yet. When a baby is born, it’s essentially a non-verbal needy creature. It can be difficult to bond with a language barrier. Their personalities haven’t developed yet.

          • Madtowngirl

            In my post-partum mental state, I very distinctly remember staring at my newborn thinking, “oh God, we’ve made a huge mistake!” A year later, I find myself looking at her and catching myself think about how much I love her. I’d even dare say we’re pretty well bonded!

          • Charybdis

            That’s what superglue is for. Or epoxy.

          • BeatriceC

            I felt a whole lot of things when my babies were newborn’s but “bonded” wasn’t one of them. That took time. Hopelessly in love but guarded is a better description. I’d experienced loss prior to my oldest surviving child (and in between him and MK), and they were all born sick. In a lot of ways I was afraid of getting too attached in case they also died. Now that they are teens, none of that matters. We have good relationships. They early days didn’t make two shits of a difference.

          • Jules B

            Yes, exactly! I felt incredible relief, mostly, that she was here alive and healthy. I was fascinated by her and it felt surreal (in a good, “is this real life?” kind of way). And I thought she was perfect, of course. But yeah, the real bonding came later…how could it be otherwise, since bonding requires time spent together?

          • Irène Delse

            The thing is, taking a few months for establishing a meaningful relationship with one’s baby is totally normal and in line with infant biology and psychology. In my year studying biology at university, we did a comparison between what is call imprinting in ethology and what goes on in human infants. Turns out, babies generally imprint (make strong emotional connection) with a care-giver between 6 months and one year of age, not at birth. I certainly noticed that in my niece: she didn’t start crying when her mother specifically left the room until a few months after the birth. Before that, she cried for anybody (or not at all).

          • Jules B

            So interesting that you say babies develop the strong bond at that stage (6 mos-1 year) – it is between that exact time-frame when I first felt I was getting something “back” from my daughter. Until that point, you kind of feel like you are just taking care of a pooping, screaming being that doesn’t really care who you are, as long as their immediate needs get met. (Which is another reason why that first year is so hard). And I felt that way not because of some defect in me or my daughter, but just because that is biology etc at work.

            I think this reality needs to be discussed more openly for sure. It might empower new mothers to take care of their own needs more, as they recover from labour/delivery, plus navigate the transition to new motherhood. If they knew that their babies truly would be OK without their constant presence (unlike what AP folks like to claim). There is no need to be a mommy martyr, because the kid doesn’t know you from a hole in the wall anyway 😉 (Or rather, they do know you as the Bringer of Food etc, but someone else really can fill that role occasionally and all will be well).

          • Kelly

            I have noticed a trend amongst my three kids. Their personalities start to emerge at six months when they cry to get attention. Then, by a year, their true personalities come out. I look at pictures of my kids as newborns and it seems surreal to me. Their personalities just were not there when they were born and so I don’t feel this huge connection to them until about six months.

          • Jules B

            I would say my daughter had a few basic tendencies in her temperment as a newborn that have carried over or become parts of her overall personality now (at 4 years old). But yes, most of the stuff I thought of as her “personality” back in the early days was just fairly common newborn behaviour. And again, I could have been switched out with another primary caregiver before 5-6 months and as long as they cared for her well, she would have been none the wiser nor worse for wear.

          • Old Lady

            I noticed a difference in personality right away with all my children (although I think of it as temperament at that age). Of course I had twins with very different personalities to start so I could see the difference side by side as they have been growing up. Babies are not all the same ! As a parent I have to adjust to each of my children. Some babies need to be held others are more independent. Some babies are very regular, some aren’t. These are not random, they are a result of a babies genetic temperament which develops into their full personality.

          • Kelly

            All three were very chill until they hit six months. Their personalities started to really emerge during that time. Now, the way they acted while I was pregnant with them was very different for each child. Maybe when I have a fourth, it will be different.

          • guest

            I agree with this. It was very comforting to me that newborn’s aren’t picky about caregivers and also have horrible memories. This knowledge made it easier to walk away when I needed a break and to let other’s care for them, and in general not worry that I was traumatizing them for life. I usually worried more about the babysitter than the child when I left them because both my kid’s had a tendency to cry nonstop and that can be difficult to deal with if you’re not used to it. No one every volunteered to babysit twice!

          • Sarah

            Mine were similar, they preferred me generally but a warm lap was a warm lap, and often when we had visitors they actively wanted to be passed over. They got more picky about who they wanted later on!

          • StephanieA

            I bonded with my oldest son pretty quickly. I felt that fierce, willing to die for him kind of love. I had minimal skin to skin with him and did not breastfeed. He’s 2 now and I can’t imagine my life without him. My 5 month old had extended skin to skin and was breastfed longer than his brother. Despite that it’s taken me longer to bond with him. It’s made me feel a little guilty, but we are getting there.

          • sdsures

            The institutionalized rooming-in is so scary here.

        • graysmama

          Yes the whole skin to skin and rooming in thing is ridiculous. My 6 year old is completely bonded to me. I had an emergency c section, didn’t hold him until he was 12 hours old and he spent a week in the NICU so no rooming in. I still fell completely in love with him once I was able to hold him and take him home. He still developed a firm bond with me and is still my snuggly sweet big kid. He also has strong attachments to my husband, my mother in law, my parents and his child care provider who has cared for him while my husband and I are at work since he was a baby.

    • The Computer Ate My Nym

      I like to use the airplane analogy: The only part that really matters about an airplane is that it takes off, flies, and lands safely. If you’ve got those basics down, then you can start worrying about on time arrivals rate or leg room or in flight food quality. But landing on time means nothing if you “land” by crashing into the runway and the quality of the in flight meal won’t be much of a difference if the flight crashed on takeoff. The first priority has to be to avoid compromising safety. After that, if there is time and energy left over to worry about making things nice, go for it! But don’t ever lose sight of the need for safety.

      • sdsures

        There was a news story here a while back about a couple who was suing their airline on their honeymoon. Why? Because on the RETURN trip – note, nothing DURING their honeymoon – the pilot had to do a go-around for safety reasons.

        The couple whinged to the Daily Mail that their honeymoon had been “ruined”.

        I wonder what they would have said if there had not been a go-around and the pilot crashed the plane instead?

    • Amy

      Exactly. There’s a difference between parent the noun (which all loss parents are) and parent the verb (which requires a living child).

    • sdsures

      Stuff like this also tends to forget that fathers are parents, too.

  • Sue

    “They start with the conclusion and work backward trying to cherry pick evidence to support it.”

    Indeed.

    it’s not about safety – it’s about ideology.

  • Alexicographer

    “It’s as if women and their babies are fundamentally in opposition to each other”

    Um — they are. In important ways. Right? Don’t we know this? And as for, … ” and the female body is dangerous by design,” Well, sure — to babies (and indeed, to mothers), it can be, just as babies’ bodies can be dangerous to their moms. Welcome to reality …

  • sighs

    Great, so all the “Baby Friendly” hospitals are going to start doing this, right? Right?

    • CSN0116

      Well, of course. They’re all about evidence based practice and shit.

  • Anna

    “Natural childbirth advocates don’t seem to understand that natural selection leads to the survival of the FITTEST, not survival of everyone. Those that aren’t fit often simply die.”
    Or those that aren’t fit enough simply don’t deserve to live and have living babies. What if THAT is the real profound message of the NCB cult?

    • namaste863

      Actually I’ve seen anti-vaxxers make just that argument.

      • Fleur

        Yup, that argument has always made me want to punch someone: children who suffer rare complications after vaccination are always said to be “perfect” beforehand, whereas the victims of vaccine-preventable diseases “must have had something wrong with them anyway”. First, that’s bollocks. My younger brother was the healthiest baby imaginable until he caught measles, and after that his general health went to pieces for a decade. Second, what kind of sociopath regards “imperfect” babies as disposable? They’re still loved.

        • demodocus

          and they themselves might have perfectly healthy babies.

    • Who?

      The joke is on them then. It seems as though they think their ‘fitness’ is up to them-not a matter of dumb luck, which unfortunately in nature it so often is.

      Which is very unfortunate to anyone who hitches their star to the NCB.

      • The Computer Ate My Nym

        Ironically, it kind of is up to them, much of the time. Evolutionarily, “the fittest” is the one who survives and reproduces. Evolution doesn’t care how that person managed to survive and reproduce, just that they did.

        So a person with a congenital and genetically heritable malformation of the uterus that made vaginal birth impossible but who chose to have scheduled c-sections for her children is fit whereas a person with perfectly normal anatomy who happened to get a breech baby who died due to the parents insistence on a “natural” birth is not.

        In short, people can’t choose to be perfectly evolutionarily fit–there are things we still can’t control–but they can choose to be evolutionarily unfit simply by refusing to use the available medical technology.

        All evolution cares about is the healthy baby. Using technology to get there is not cheating.

        • Monkey Professor for a Head

          The human brain came about through evolution, and is probably the one thing that has made our species so successful. So using intelligence, using knowledge, using technology, is all perfectly in keeping with how we have evolved.

      • Amy

        Sure it is! You just have to eat enough kale, see a chiropractor regularly, lie on your amethyst crystal biomat, and diffuse essential oils all over your house. And trust birth, of course.

    • Azuran

      And those people forget, survival of the fittest doesn’t mean that everyone fit survive and only the unfits die.
      The fittest has a usually slightly better chance of surviving, but both the fit and the unfit die in mass.

  • CSN0116

    25,000 – 30,000 deaths per year that could be mitigated given 39-week induction?

    Remind me again, would that be more or less lives saved per year than breast feeding? 😉

    • attitude devant

      Snort! Good one.

    • Sue

      Touche’ !

    • Young CC Prof

      Well, most of those stillbirths happen long before 39 weeks. There are only 2,000 or so stillbirths at 39 weeks or more in the USA every year, which is still a heck of a lot for something that we now have a fairly straightforward way to stop.

      • CSN0116

        I can’t use bumper pads, a Bumbo chair without straps, a walker (in Canada), a drop side crib, a Nap Nanny, or sleep my kid on its stomach for far less than that…

        • Jules B

          Man, I eyed that Nap Nanny thing with envious eyes a lot when my girl was a baby…never got it though because “what if.” Sigh.

  • The Bofa on the Sofa

    The claim that “babies know when to be born” is a serious insult to all those babies that were still born. Are they claiming that my nephew, still born at about 41 wks, was stupid? Or what?

    Apparently, he DIDN’T know that he should have been born a day earlier.

    It’s so friggin insulting, I can hardly type.

    • BeatriceC

      Also an insult to all the babies like mine who came early. Three of mine came too early to survive and one of the surviving three barely made it. The longest I ever stayed pregnant was 36 weeks.

      • The Bofa on the Sofa

        My wife’s college roommate had two kids born at <30 weeks, because of umbilical prolapse. With the first she was sitting in the waiting room at the doctor and the cord just kind of fell out.

        See? Her baby knew to do it at the doctor's office!

        She spent a month in the NICU, so you'd wonder why she was so anxious to be born.

        • LaMont

          My social circle has ~0% parents in it yet, but I still know two people on Facebook who have lost children due to prematurity (one instance was twins, but hey, not like that’s high-risk or anything). This situation isn’t rare, like VPD issues, it’s everywhere. How the hell do the NCB people get away with this?

          • Megan

            I think a lot of people really believe in the just world hypothesis whether they realize it or not.

          • The Bofa on the Sofa

            I think you are right.

            Maybe that’s why I have actively albeit unwittingly rejected the “just world” hypothesis. I have said it for years, the motto of my life, and what I hold to be true and guiding, is that sometimes, shit happens for no reason at all.

            As I said, I have said this for years. And years and years, in fact. Long before I ever heard of the just world hypothesis, or even the concept.

          • Mel

            Remember, it’s an entire package. NCB has magical (in a completely non-ironic sense) ceremonies, talismans, and mantras needed to produce that healthy term infant in the first place.

            People who have babies prematurely didn’t eat enough kale, or brought the evil eye on themselves by reading about birth complications, or didn’t believe enough in the power of their body and birth.

            In many ways, NCB promotes an extremely selfish form of psychological protection for pregnant women and mothers. Unlike actual medicine where the goal is to protect all mothers and all newborns, the goal of NCB is to isolate the practitioners from the natural fears of pregnancy loss by creating long lists of “healthy” behaviors that will protect believers from the heart-breaking situations of non-believers.

          • BeatriceC

            Yet another argument for NCB as a cult/religion.

    • guest

      Babies don’t know shit. That’s why they’re so much work to take care of.

      • J.B.

        Although shit is one of the few things babies can do! (Facetiously, totally in agreement with your comment! )

        • guest

          You don’t even know, the kind of week I’ve had, diaper-wise. My current problem is that they don’t know when they are shitting, and so it doesn’t end up where it’s supposed to be. I may not survive potty training.

          • baileylamb

            Wait, until they figure out when they are sh*ting and that they can do it in on command (or at least mydaughter can).

          • guest

            Noooooooooooo.

        • Mariana

          My son couldn’t figure out how shit… Really! He was the most constipated baby ever. He was breast fed during the day and formula fed at night (for the sake of my sanity) and thriving (so I know for fact he was getting enough milk). But he couldn’t figure out how to push poop out. I spent a lot of hours massaging his belly and doing bicycle legs. Then one day he kind of got the hang of it, and we haven’t had any problems since.

    • Mel

      I find the whole argument stupid in the extreme.

      Under that premise, my twin sister and I figured out how to induce labor at 28 weeks to save our life from TTTS – but couldn’t figure out how to land far enough away from each other in the uterus to avoid that in the first place. Or figure out how to punch or kick at the offending vessels long enough to clot them off.

      • CSN0116

        TTTS gives me zero faith in the human placenta. Those things are not some beautiful trees of life waiting to be buried, made into smoothies, ready to fight PPD, etc.

        Contrary, they are human organs with the ability to kill not one, but TWO separate people, simultaneously.

        Placentas are bitches — time bombs with the ever-present ability to fuck up royally.

        • Megan

          I feel the same way about my placenta every pregnancy, like it’s a ticking time bomb waiting to kill me and/or baby. Once I get to 30 weeks or so, the drama really begins and I count the days until even early term and pray that damned placenta cooperates….

        • guest

          Seriously. My daughter had a small placenta, and no one knows why. She didn’t “know” to grow one the right size? She seems smart enough now that she’s on the outside.

      • The Bofa on the Sofa

        It’s not an argument, it’s a platitude.

        And as a platitude, it is stupid in the extreme.

    • Mac Sherbert

      I would like to know how a baby in the womb is able to start labor. Does it kick the uterus and be like “yo, let me out?”

      • Mel

        If you’ve ever seen “Ocean’s 13”, there are two scenes where playing a slot machine at a certain tempo – feed a coin, wait 5 seconds, feed a coin, wait 3 seconds, feed two coins etc – triggers an automatic jackpot.

        Fetal kicking works the exact same way in NCB-land, I guess.

  • Roadstergal

    “Nature is a terrible obstetrician”

    I love this quote so much.

  • Squillo

    Much of the argument against it seems to boil down to: It’s not natural because it’s not good, and it’s not good because it’s not natural.

  • Amy

    My daughter was born by c-section at 42 weeks 1 day. We actually went in for an induction the week before (41 weeks exactly, which was the standard of care then), but it failed, the baby seemed to be okay according to an ultrasound, and Christmas was coming. We made plans to do kick counts and come back in on the 26th to retry the induction. I was deep into the woo and hoping for a natural birth.

    Two more days of failed inductions and it was clear that my baby did NOT “know” when to be born. She was also malpositioned (something I wish they would have figured out before any of the inductions and just headed straight to surgery, but whatever). All her vernix was gone, she was skinny, and her skin was cracked and peeling. Clearly past the time for her to come out!

    We totally dodged a bullet letting it go that long.

  • Azuran

    I like how Cristen Pascucci is opposed to recommending induction at 39 weeks because women need to have more control over their birth. Because clearly, letting nature do whatever it wants is having more control.

    Really this all goes down to informed consent (which the NCB advocate are SO obsessed about) If induction at 39 weeks is safest, then you need to properly tell this to women, and then let them make their own decision.

    • AA

      NCB’s definition of control is doing their version of the hokey pokey. Want to lie down during labor and delivery? Oh, no, mama, you can’t do that! Also don’t forget the NCB commenter on the SkOb page once…said that women would be able to birth better if they did Ina May approved moaning. That’s right, NCB even demands that women vocalize in certain ways.

      • Megan

        My doula said that to me, that my moaning was “too high pitched.” Not low enough or enough like an animal I guess.

        • MaineJen

          Did you slap her? Because that would be an appropriate response.

          • Megan

            I have no idea where I got the self control to resist at the time.

        • AA

          Thank Ina May’s book for that, she claims that low, open mouth moans open the cervix.

          • demodocus

            that doesn’t sound sexual at all.

          • Roadstergal

            Something creepily sexual from Ina Mae? Knock me over with a feather.

          • guest

            Funny, my OB-GYN didn’t ask me to do that for my IUD insertion…

          • Sue

            Oh. My. Goodness.

            What meridian connects the facial os with the cervical os?

        • Daleth

          My doula said that to me, that my moaning was “too high pitched.” Not low enough or enough like an animal I guess.

          I would have throttled her, if physically possible to do so during labor. What an obnoxious thing to say.

        • Young CC Prof

          Does she bring a tuning fork, to teach women to moan in the right key? Perhaps they can harmonize with her

          • Daleth

            Does she bring a tuning fork, to teach women to moan in the right key? Perhaps they can harmonize with her

            Or stab her with it. Hmm, maybe that’s why she doesn’t carry one…

        • Charybdis

          I would have said something like “the screaming will be even higher pitched.”

    • Karen in SC

      I don’t think NCB advocates are obsessed about informed consent. Surely they don’t do it properly or ignore anything they want.

      • MaineJen

        No no…you only need informed consent about the things a *doctor* can do. Like anesthesia, induction, or c-section. Anything a midwife can do (and often does, without even telling you!) cannot possibly be bad or unnatural, right? Why would you need informed consent for that? Silly “mama.” /sarcasm

      • Azuran

        well, they do, kind of…
        As in everything natural is 100% safe and everything a doctor does is super dangerous. They often think that any woman who agrees to any kind of medical procedure has not been properly informed of those risks and therefore have not given informed consent. Because no women would agree to those if they had been properly educated.
        They just are totally wrong and clueless about the actual risks and benefits of everything.

    • J.

      But not so much control that she can request an elective c-section. Any woman who wants that needs to be “educated” out of it.

    • TheArtistFormerlyKnownAsYoya

      And also, women actually *wanting* to induce at 39 weeks is simply impossible. Women should have more control, as long as it’s in line with what Pascucci believes.

      • Spamamander

        At 39 weeks I was at the point of “GET IT OUT RIGHT NOW.”

        • TheArtistFormerlyKnownAsYoya

          I’m 21 weeks now and have a ton of anxiety about stillbirth. I know it’s going to ramp up after 39 weeks, because I’ve seen the graphs. I feel it’s dangerous to just leave them in there! I want to be induced or MRCS if it doesn’t look like it’s coming ot on its own. Not taking any chances!

          • Kelly

            Talk to your OB about your concerns. They can let you know what they normally do.

    • Who?

      That struck me too-‘control’ in this context means ‘sit back and see what happens’.

      No thanks.

    • Mac Sherbert

      Honestly, all women I know who aren’t into woo are happy to be induced at 39 or 40 weeks!

  • OttawaAlison

    As I’m going to be moving across the continent to the PNW next year (and to the US) I hope I can find an excuse MFM who is sympathetic to the fact I lost my daughter at 37w1d and that they’re not stimied by 39 week policies. I’m hoping since I’m high-risk they’ll have some flexibility. I also hope they’re at a hospital in my insurance network.

    • sapphiremind

      Most docs that I’ve encountered will take into account if you have a previous stillbirth that they will offer section or induction prior to the gestational age when your previous child died. I’m incredibly sorry for your loss 🙁

    • Bombshellrisa

      If you end up near Seattle, I can suggest a couple MFM groups.

      • OttawaAlison

        That would be lovely! Yes, it would be Seattle!

        • Bombshellrisa

          Ok! I am going to just say that any doctor you pick that is part of Swedish medical group is going to be amazing. Obstetrix is the name of the MFM group I saw through them. Both of my friends who have given birth after a precious stillbirth have gone with Swedish and the compassion they were shown was incredible.

          • AA

            PBI: Did you see my response to one of my previous posts with my email address?

          • OttawaAlison

            Awesome, funnily enough when I researched it a few weeks ago the Swedish hospital mfm team came up on top and I am fairly certain Premera has them in their network (this is one thing that is definitely a culture shift from a single-payer system)!

          • Bombshellrisa

            Not sure if they are in network for you, but Tanya Sorenson and Darcy Barry are part of the Obstetrix MFM group. We saw Dr Barry for the genetic counseling. The hospitalist OBs are very good too.
            Swedish has such a good NICU too.

  • moto_librarian

    25 to 30,000 stillbirths in the United States annually. That is not a small number. Women need to know this, especially given that so many of us are having babies when we’re older, heavier, and more prone to pre-existing health conditions that also increase our risks (I fit all three of these categories, btw). Personally, I was glad that both of my sons decided that they were ready to come out during week 38 (38 + 3 and 38 + 5, respectively). Our eldest had TTN, but that was preferable to death or serious disability. After 10 days of prodromal labor, stripping my membranes finally got me into labor with our second. When the CNM broke my waters, there was mec, and he had serious distress during crowning. Again, I was glad that he was out, since there was clearly some stress going on in the womb. The vast majority of us want to take home a living baby. This is at odds with the NCB cult which cares for more about process and magical thinking than whether or not mother and child come out unscathed.

    • Heidi

      I had gestational diabetes, which required a couple of extra growth scans. My GD almost seemed non-existent as it was very easy to control and didn’t require any major diet modification. During the growth scans, the baby looked a bit small – about 9th percentile which got me an induction. I kind of figured he was just a bit bigger than the U/S was showing, but I was so relieved to get the induction at 37 weeks and 6 dats. It was almost a guarantee he wouldn’t be a stillbirth and that was a huge worry of mine. He ended up being about 20th percentile at birth, which isn’t considered IUGR at all, but he came out healthy and alive! Besides labor pain, the induction was far from dramatic. From the start of pitocin to his birth, it took about 6 hours and his heartrate was always great.

      • Heidi

        *days, not dats

    • BeatriceC

      But if we talk about the actual, real risks of childbirth we are fear mongering.

    • Heidi_storage

      Ugh. More stillbirths than SIDS deaths, and no one says anything about it.

    • Jessica

      My mother had a stillbirth at 43 weeks, as did her sister. I am overweight and have chronic hypertension – ended up with an induction at 39w3d with baby #1 when my blood pressure was no longer stable. No complications and a healthy baby. With baby #2 my blood pressure was stable at my 39 week appointment, but there was a family crisis and I could not bear being induced at that time. Went back for a checkup at 39w5d, and my blood pressure had soared – 190s over 100s, as I recall. Another induction and meconium when the OB broke my water although there was no sign of distress during the labor. Baby was healthy and all went well, but I wonder sometimes whether we would have avoided the potential risk of meconium aspiration by inducing a week earlier.

  • Heidi

    What irritates the crap out of me about these natural birth “feminists” is that women should derive their self-esteem from their bodies. What the crap? Just NO! How’s that any different than thinking your worth is only how big and perky your breasts are or how tight and round your butt is? I don’t think I’m unworthy because of cellulite or my stretch marks but I also don’t think I’m a failure because I don’t make enough breast milk or because I was induced and needed an epidural.

    • BeatriceC

      I made a post the other day in one of my Facebook groups on this topic. Deriving one’s self worth and/or sense of empowerment from how your body parts function is bs. That’s not real empowerment. Wanna know what makes me feel empowered? Finally getting the tool I needed to fix my angle grinder then finally getting around to fixing a water damaged wall in my bathroom. I didn’t need no stinking man. Gimme the right power tool and I will fix what breaks in my house (except electrical…I will gladly let MrC deal with that). I had a problem. I solved it. That’s real empowerment.

      • Can I invite you to come to my house? I could do all the necessary home repairs until about a decade ago, but no longer. My family used to keep me as far away from Home Center as possible, but now that I’m knocking on the door of 70, all I want is to win the lottery and go on endless cruises…

        • BeatriceC

          If I had he money I wouldn’t hesitate to hire somebody, but since I don’t, I do the work. I do enjoy it to an extent, but I’m totally with you on the endless cruises. That said, I feel empowered because I know I don’t have to rely on anybody when things go wrong.

        • BeatriceC

          I just thought of you just a few minutes ago when MrC was inspecting my last receipt from Harbor Freight. Apparently I can’t be trusted in that store. Harrumph.

          • MI Dawn

            Yeah, I get that. I’ve been warned that I shouldn’t be allowed to go to Lowe’s alone anymore, either. Just because I like tools.

            Wanna see my collection of hex wrenches? I probably have 40 or 50 because I save the ones that come with various purchases, have bought some (metric vs inch) and inherited others. Get rid of some? Why?

          • BeatriceC

            I went in because I needed to replace the pin wrench necessary to change the wheel on my angle grinder, which I needed to cut out a chunk of wall. I’m also missing the stabilizer handle. I took it apart to move into MrC’s house and shortly after that a bag of tools got stolen out of my car. I think both things were in that bag. Anyway, they apparently don’t sell a replacement part for the handle. Im debating getting a heavier duty angle grinder, plus I want a reciprocating saw and a jig saw. A belt sander would be nice too. I left most of my tools behind when I moved to California, so I don’t have those things anymore. He was checking the receipt to make sure I didn’t acquire any more power tools. I was good. I only bought the pin wrench, an new grinding wheel (masonry wheel, since I only had metal wheels), razors for a utility knife and a couple pairs of work gloves they had on sale for a buck each. This is Harbor Freight. They have good stuff on sale for really low prices. I spent 12 bucks.

    • Amy

      It’s not real feminism. I know other commenters as well as my dad have said this, but it bears repeating. On a lot of issues, there’s not a left and right so much as a circle. At some point the hippies start to look like religious fundamentalists with how they revile technology and progress, and how they reduce women to biological functions.

      • ModerateMom

        Ha, I always say it’s a circle that meets up in Crazytown.

      • Heidi

        Ha, I was just telling my husband the other day, instead of a spectrum, it’s a circle where extreme left and extreme right meet, and they become nearly indistinguishable.

  • Jules B

    Totally OT, but I need some input from some smart folks. My daughter just turned four and had her check up at the doctor’s. She is 41.5 inches tall and 39 pounds, currently, which apparently puts her in the 70-ish something percentile. I thought that was fine, but the doctor made an off-hand comment, after we discussed her appetite (she has a very healthy appetite), that I shouldn’t “let her eat too much” because she is “close to the overweight category.” Am I wrong to be a bit miffed about this?? I mean, I know making sure kids are a healthy weight is important to their life-long health, but she *is* a healthy weight right now so why say that to me?

    • guest

      I don’t know what to tell you, but my three year old is 38 inches and 34 pounds and no one has ever said anything about her being overweight.

    • moto_librarian

      So she’s in the 70th percentile for both height and weight? She’s proportionate, not in danger of being overweight. I’d probably tell that doc to fuck right off.

      • BeatriceC

        If that’s for both height and weight I’d tell the doctor to stuff it. If she’s in a much lower percentile for height, then he may have a point. On the other hand, I noticed all my kids get pudgy right before a growth spurt, so the timing could just be “bad” for lack of a better word.

        • BeatriceC

          And I meant to reply directly to Jules. Sorry. Posting from my phone at the courthouse. I didn’t sleep well last night so between brain fog and tiny keyboard I hit the wrong thing.

      • Jules B

        I think the 70th percentile was for the combined height and weight. Which is healthy in my books! Still kinda scratching my head at his comment for sure.

        • Kelly

          At this age 1 or 2 lbs can jump you up pretty significantly so maybe he was referencing that. It was pretty stupid to say that to you though when there are no other warning signs.

    • Daleth

      Our pediatrician started saying something like that when he saw what percentile one of our twins was for weight (he’s like 2lbs heavier than his brother). Then he switched to the screen showing what percentile he is for height, and said, “Oh, well, he’s proportional. So forget that.” In other words, big kid is big, and that’s fine.

      • Jules B

        Exactly – people come in differeht shapes and sizes, and as long as they are healthy, it is fine!

    • fiftyfifty1

      Yes, that is dumb advice. If her BMI is in the 70th percentile that is very normal and healthy. It’s not “in danger” of anything. Some people have a natural thin build, others are bigger. A natural bigger build person who tries to be skinny and goes hungry to get there will be unhealthy. You can’t buy a Golden Retriever and then wish you had bought a Grey Hound and just put your Golden on a diet and transform it into a Grey Hound.

      • Jules B

        My thoughts exactly

    • Amy

      ALL of the recommendations I’m seeing from nutritionists and child psychologists are saying the same thing– don’t talk about weight in front of your children.

      One of my kids is on the chunky side, but she’s a competitive Irish step dancer who practices anywhere from 1-2 hours a day, does pilates and core work, and runs around and rides her bike and climbs on things half the day. She’s built like her dad. Her sister is tiny, like I am. And we all eat roughly the same diet.

      And FWIW, I’m not a pediatrician, but those numbers sound perfectly normal to me. That’s a BMI of 15-16.

      Also, I just checked the CDC’s height-weight charts and yes, she is indeed in the 70th percentile for weight. AND she’s in like the 80th for height! Really failing to see how that puts her anywhere near overweight by any metric.

      • guest

        I refuse to even talk to my pediatrician about my kids’ weight because they’re too young to leave the room. (I don’t have major concerns, or I’d find a way.) But I do sometimes tell my kids they’re “too heavy” for me to pick up anymore. I hope this isn’t damaging – it’s not about being an unhealthy weight, it’s what happens when you grow up! Of course they are disappointed when I don’t pick them up as much, but I try to frame it as part of a positive narrative about growing big and tall so you can do more of the things you want to, like ride roller coasters.

        • MI Dawn

          I never found “too heavy” to be damaging. After all, you use it at other times – “I can’t pick this up alone, it’s too heavy for me, I’ll need XX to help me”. As long as it’s shown to be based on your own knowledge of limitations (i.e. it’s possible that another person *could* pick up your child, just not you), not an accusation of excessive weight, I wouldn’t worry about it.

          • guest

            Oh yeah, it’s totally me who can’t pick them up all the time. Other people – especially male people – can. And I don’t say “fat,” ever. They are 3 – some day we’ll discuss fat and why you don’t fat shame people, but I mean I don’t use it to refer to their weight or my weight.

          • BeatriceC

            You could switch to “too tall” if you’re really concerned. Something like “you’re growing up so fast! You’re just too tall for me to lift anymore!”

          • guest

            I could, but it doesn’t really make sense because I’m a very tall person and it’s not their height that I can’t manage. They also usually asked to be picked up because they are not tall enough for something, so it wouldn’t make sense to them. I use “big” sometimes, though, which encompasses the whole package of height, weight, and age.

          • BeatriceC

            Ah, yeah, that might not work then. I was trying to come up with reasonable synonyms for “big” that don’t have negative connotations. My parents always called me a “big girl” and I grew up translating that as “fat”. I look at pictures and I wasn’t fat at all, I just inherited the linebacker body type from my father where my sisters inherited the tiny, petite frames from my mother.

          • guest

            Yes, I’ve heard “big girl” used that way and I don’t use the phrase. Mainly, I just try not to talk about their weight, and I don’t weigh them on my scale, although they can use it if they want to. I’ve mentioned this before, but the only reason I stress about it is because a neonatologist told me my daughter’s low birth rate and small placenta put her at risk for obesity later in life. No guidelines about what to do with that information or anything. I kind of feel like, if it’s in her genes, maybe fighting to keep her weight down is just a losing battle and I shouldn’t bother, other than teaching her to choose healthy foods over junk and to exercise for health. It’s way outside my personal experience.

            Sometimes I say *I’m* “too old” to pick them up anymore.

          • Charybdis

            I wasn’t (still not, dammit) tall, but I was muscular (gymnast legs, like Mary Lou Retton back in the day) and have broad shoulders. I wasn’t fat, just compact and muscular, you know, SOLID.

            I also remember someone telling my Mom that I was “a chunky little thing” when I was around 4. I know that was when it was, because we were new in Alabama and I remember that slow, feminine southern drawl saying it.

            This started the whole body image thing; because I wasn’t some little wispy, frail Southern Belle type.

          • Who?

            It’s hard to know how kids interpret our words. One of my friends was devastated when she realised that in talking to her toddler about the ‘new’ baby, the girl thought she meant her parents would somehow be ‘getting rid’ of her when the new one arrived.

            Speak kindly, is all you can do. The busy little brains will make of it what they will, along with the gazillions of other inputs they are trying to make sense of.

          • Kelly

            I wouldn’t worry. My daughters are proud of their big bellies and butts and show them off all the time to me. They are 2 and 4 and I try to be careful about weight talk but I do talk about trying to get healthy.

      • Jules B

        I know…which is why I was a bit perplexed by it.

    • mayfly

      I went through the same thing when my daughter was 4 (40lbs and 40 inches). She’s thin but surprisingly muscular and tall, as is her little brother. The pediatrician was giving me advice about cutting out sweets and switching her out of art into a sport, until she began the abdominal exam on my daughter. Then she said “oh, maybe it’s not a problem”. Yeah, you think?
      We switched pediatricians after that.

      • Jules B

        Yeah, my daughter has no abdominal fat on her either!

      • FEDUP MD

        Yeah, that’s why you loo, at both height and weight. My son is about 80th percentile for weight for his age at 4.5. Which I guess would be a concern except for his height is 97th percentile. He is thin and muscular and looks like a miniature version of someone like Kevin Garnett. You can literally count his ribs when his shirt is off, and he has actual slight defined abs, no fat whatsoever. If you did no critical thinking you could think, ooh, 80ile, that is getting concerning, unless, you know, you actually see him.

    • MaineJen

      I thought that as long as the height/weight percentiles lined up, they were good to go. My own daughter is 4 too, we just went for her checkup and although she has always been tiny, her growth has dropped way off. Right now she is 38 3/4 inches and only 32 lbs, and she does look very small next to other 4 year olds. So she is being monitored for growth.

      But that was only mentioned because looking at her growth curve, she is “falling off the chart” so to speak. As long as growth is consistent…why worry? Some kids are bigger than others, for goodness sake.

      Unless it’s an extreme case, isn’t 4 too young to be talking about this anyway?

      • Charybdis

        DS was a tiny baby. 18 inches and 5 lbs, 15 oz at birth. He was on the bottom end of the growth and weight curves for a long time. When the pediatrician mentioned something along the lines of “if he is still in the same place or falls lower at the next visit, we might have to think about doing something”.

        Next visit, he had grown and was up in the 10% range for both. This seems to be his pattern; he will inch up the growth curves at a slow, but consistent rate, plateau for a bit, then get a growth spurt that catches him up to a nice, comfortable middle of the road percentage for both height and weight. This pattern continues today. Last couple of weeks he has been eating non-stop (honey-nut cheerios, yogurt, milk (gallon and a half in 4 days), chicken, pizza, chips, frozen fruit, 2 lunches a day, cheese, crackers, cookies, ice cream,etc) and has gotten clumsier than usual. He’s getting ready to grow again. And he is only 12. Gotta love that teenage/puberty stuff.

        As DH and I are not tall (I’m 5-3 and DH is 5-9) this wasn’t too much of a surprise, although we do have height on both sides, we just didn’t get any of it. I was 4 years old before I was tall enough to turn a light switch off. My brother was doing that at 18 months. I also wear size 5 1/2 shoes.

        As long as she is proportional, so to speak, I wouldn’t worry too much. Especially if she is active and eating well. I know that childhood obesity is a problem and that they have to have *some* sort of benchmarks with which to compare children, but jeez. As long as it doesn’t look like the kid is carved out of lard or is rail thin, then they are probably okay.

        • MaineJen

          LOL yeah, I am pretty short myself at 5’1″, so the poor kid may just take after me. 🙂 Maybe I will put her in gymnastics…

        • BeatriceC

          On the flip side one of the alarming things about MK’s issues is that his weight, in the 80th percentile, is too low. He’s been in the 99th percentile for height and weight most of his life, (he was off the charts for a little while because he was a 5lb 4oz 32 weeker), and was around the 93rd for weight before he got sick. His height (5’11”, just turned 15 six days ago) hasn’t changed, but his weight curve has gone on a steep downward trend. Not good. (He’s finally putting on a little weight…five pounds according to the home scale with an official weight check next week).

          • Charybdis

            That’s good news. Or good-ish news. Have you gotten approval for a second opinion yet?

          • BeatriceC

            Not yet. All the paperwork is in but my insurance company is dragging its butt.

      • Jules B

        I feel it is too young, for sure

    • Mel

      My little cousin is 5. He looks like a solidly built eight-year old. He’s been like that since birth. It’s never bothered his pediatricians because he’s huge, but proportional across the board. (We actually celebrated his height/weight dropping down to the 99th percentile on the checkup around his first birthday because he was on the chart again.)

    • Sue

      If she’s active and healthy and eating a mostly nutritious diet, a healthy appetite is great.

      How much time do we agonise over kids who WON’T eat and try to get them to eat more? Celebrate her good appetitie!

      • Jules B

        I do thank my lucky stars for it every day!

    • Irène Delse

      It seems to me that this doctor could have phrased it better, but they may have a point. Allow me to elaborate.

      When I was four, I was already overweight, something which is obvious in the family photos. But as I was also growing in height, my parents didn’t think something was odd. They didn’t try to monitor the quantity of food I was eating – in fact, being of the old school of “clean off your plate before leaving the table”, they indirectly encouraged overeating instead of paying attention to one’s body’s cues. I became obese before I was a teen.

      In the case of your daughter, it’s hard to say if she’s on the way to being overweight without seeing how she’s built (at 4, I was solidly built, looking more like a 6 or 7 year old, but there was also a substantial amount of fat around the muscles and bones). And something important to consider is family predispositions (in my case, my mother was also overweight, and her mother before her).

      So, while it’s great that the child has a good appetite and that her growth is within normal parameters, it’s not a bad idea to think about teaching children to recognise when they are satiated, when they are hungry, and when they just want another serving.

      However I realise I’m saying all that without knowing whether your family already does this, but I’ve seen enough people trying to approach nutrition through objective external measures, like calories and ounces, while the subtler cues our body gives get more or less ignored. But it’s really important, especially for people who tend to put on weight easily.

      • Jules B

        All great points! It is hard for me to be objective, of course, but she looks pretty…average-sized to me. She hasn’t got a lot of extra padding, though, if that makes sense. I have always tried to get her to listen to her body’s cues, but she just seems to keep eating! Maybe that was what the doctor was keying in on – my honest bafflement that she seems to have “hollow legs,” as my British-born parents would say. I mean, I don’t want to tell her “stop eating,” but at a certain point it gets a tad silly. (She is very active and physical, so most of that food energy gets expended – but I have honestly seen her pack away more food than my S.O. typically eats).

    • Jen

      There is a lot of research showing that restricting intake in kids actually has the opposite effect and can lead to obesity. That’s not to say that focusing on providing a good variety of healthy foods and plenty of activity is ever a bad thing. But that’s good for all kids regardless of size. Restricting intake is what leads to problems later on. I recommend checking out this blog http://thefeedingdoctor.com/love-me-feed-me/ and possibly considering a new pediatrician.

  • The Computer Ate My Nym


    “It’s as if women and their babies are fundamentally in opposition to
    each other and the female body is dangerous by design,” said Pascucci, a
    vice president of the advocacy group Improving Birth.

    Ding, ding, ding! Congratulations, you got it! You are correct! Fetal life is dangerous. Giving birth is dangerous, to both mother and baby. Nature only optimized to the point where more women and babies survive than die, not to the point that the process is “safe” by any sane definition of “safe”.

    • J.

      People used to know that. There was a phrase, “a tooth for every child.” Now everything natural is all happiness and sunshine. I’ve actually heard people (pro-lifers) argue that pregnancy is physically beneficial for women!

    • Mel

      If all of the DNA in a baby came from the mother, babies and mothers would likely be more aligned in terms of safety. Tests in mice and some genetic disorders in humans involving epigenetics demonstrate that female-derived DNA often produces smaller offspring that deplete maternal reserves less and leaves resources available for her future offspring

      Male-derived DNA has different priorities for fetal growth. That pushes much larger fetuses that essentially transfer maternal resources for use in passing on paternal DNA.

      Pardon my gross-oversimplification, but if a baby takes after Dad, a woman will end up growing a baby that may be too big for her body.

      • swbarnes2

        I think you see this in ligers. In lions, there is a genetic arms race between males to have big cubs, and females to have smaller ones. Tigers don’t really have that (I guess because mother tigers parent solo, or maybe because infanticide is less of a concern). So when a male lion and a female tiger have offspring, they are huge.

      • BeatriceC

        My mother’s family are all short and skinny (the women are short, anyway, the men are tall and skinny). My father’s family look like NFL linebackers, including the women. My mother weighed 89 pounds pre-pregnancy. I took after my father’s family and weighed 10lbs 12oz at birth. I wasn’t coming out the usual route. It was either a sunroof exit or maternal and fetal demise. I’m so glad my mother wasn’t opposed to medical intervention.

      • Sue

        That makes so much sense, it’s amazing that the NCBers don’t get it.

        How can a baby be ideally adapted to its mother if half its genetics come from some totally unrelated male?

  • mostlyclueless

    Maybe just because I haven’t had my coffee yet but the first figure seems wonky to me. Surely fetal demise is lower in the 37-41 week range than 26-32?

    • guest

      I’m hoping someone can explain that, too. I have some guesses, but they are only guesses.

    • moto_librarian

      It’s based on number fetal deaths per 1000 live births at gestational age. If this says what I think it does, it means that stillbirth kills more babies than prematurity. Can someone correct me if I’m wrong?

      • mostlyclueless

        CDC says otherwise…

        “Preterm birth is the greatest contributor to infant death, with most preterm-related deaths occurring among babies who were born very preterm (before 32 weeks).”
        http://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm

        There are more statistics here (http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_16.pdf), I’m going to extrapolate from Table 7:

        They report 4,849 deaths per 100,000 births due to “Disorders related to short gestation and low birth weight, not elsewhere classified.”

        They also report 4,090,007 live births over the same period.

        So that gives me 198,324 total deaths due to prematurity ((4,090,007 / 100,000) * 4,849).

        Compare to the figures given in the article above that there are approx. 25-30,000 stillbirths annually — deaths due to prematurity appear to be far more prevalent.

        But, still no coffee here, so please check my math and logic.

        • Amy Tuteur, MD

          Those numbers don’t sound correct and the link doesn’t work. Can you screen protector the table?

          • mostlyclueless

            Clicking on the link adds a ) to the end; if you delete that you should be able to get the whole pdf.

            Just in case, though, here is the table:

            http://imgur.com/rPfeaWc

          • Amy Tuteur, MD

            Here’s a side by side comparison of stillbirth and neonatal death:

        • sapphiremind

          That seems to make sense to me. Your baby is 4 times as likely to die from complications of extreme prematurity as it is to die from stillbirth at full term

          • Daleth

            But that’s EXTREME prematurity, which isn’t relevant here–we’re talking about delivering babies at early term in order to prevent stillbirth. Extreme prematurity is before 28 weeks. Early term is at or after 37 weeks. There’s like 2.5 months between those gestational ages–which is huge.

          • sapphiremind

            Right, I wasn’t disagreeing at all. Someone was saying that they thought it was odd that there were more preterm deaths than stillbirths. Preterms are not more likely to be born still, they typically are born alive and then die from complications, not stillborn (though it does happen sometimes)

        • moto_librarian

          I think you are confusing the actual number of deaths with the rate. The total number of deaths out of all live births was 27,995. This is a rate of 684.5 per 100,000 live births. Does that make sense?

          • mostlyclueless

            I converted from the rate of deaths per 100,000 live births to an estimated actual number of deaths.

            27,995 was the rate of deaths per 100,000 live births according to table 7.

          • swbarnes2

            I don’t think you are reading it right. Right next to the “27,995” figure is a column called “Rate” which says 684.5. The table says “Rates per 100,000” so that you know the Rate column isn’t per 1,000, it doesn’t mean that every single number in the table is a rate.

    • Amy Tuteur, MD

      Stillbirths before 27 weeks are more likely to be caused by congenital anomalies.

      • mostlyclueless

        I’m still having some trouble understanding the figure, can you link to the original text it came from?

      • Margo

        Recently my daughter at routine 36 week scan was found to have chorion amnion separation, on scan it looked like a sheet draped across the baby. After some dx it was decided to adopt the wait and see approach, daily ctg and monitoring of fetal movements, and we stayed within five mins of the hospital and were in contact with the obstets, which was a huge relief. My daughter got to 37 weeks and the waiting was becoming intolerable as expert opinion as what was best action to take was divided. In the end,following in depth dx with team she decided and felt confident that if she went ahead with induction it would be successful. Thankfully it was. My point is that a lot of women only ever get the message that obs rush in and intervene at the drop of a hat so to speak, which of course is not true, as illustrated by this example and many others that I have witnessed over many years of working in maternity.

        • Daleth

          My point is that a lot of women only ever get the message that obs rush
          in and intervene at the drop of a hat so to speak, which of course is
          not true, as illustrated by this example and many others that I have
          witnessed over many years of working in maternity.

          That was my experience too. I was carrying mono-di twins (very high risk: 1 in every 8 pairs develops TTTS, which is invariably fatal unless properly treated and sometimes fatal even when treated), and they were large on every scan, so I was pushing to have them born as soon after 36w0 as possible. I had looked at a bunch of studies and the consensus seemed to be that very early in week 36 was the sweet spot where you prevented the most stillbirths without increasing the risk of preemie-related breathing problems.

          My MFMs were like, nope. Hospital policy is we deliver mono-di twins at 37w0, but since that’s a weekend we’re going to schedule your delivery at 37w2. I spent the last week of my pregnancy quite stressed and basically praying.

          As it turned out I developed pre-e that got severe VERY quickly so I delivered at 36w6. But even two days earlier, when my blood pressure was quite high but there was still no protein in the urine and thus no pre-e, they wouldn’t deliver. They waited until I clearly had pre-e.

          They also tried VERY VERY hard to talk me out of a c-section, but that’s another story. Still, the point is: they didn’t jump in and push to deliver early–in fact, they wouldn’t deliver early even though I was pushing for it; and they didn’t want to do an intervention (CS) that I very vocally said I wanted. So much for the whole “OBs push interventions and get babies out too early” thing.

  • Irène Delse

    “It’s as if women and their babies are fundamentally in opposition to each other”

    Which they are, actually. Evolution simply managed to strike a compromise between the needs of foetuses and the women who beat them.

    • guest

      I think all of us, NCB types and skeptics, can agree that beating fetuses is not good practice. 😉

      • Irène Delse

        True. Natural selection is a messy, wasteful process.

  • AA

    Isn’t it amazing how NCB advocates conjure ideas from thin air about the benefits of NCB? One NCB commenter in a news article said that induction at 39 weeks had a higher incidence of babies with dry mouth and therefore, difficulties with breastfeeding.

    Wat.

    • E.C.

      Once that’s disproved, they’ll trot out “bonding” as the rationale. Bonding is always the last resort of the NCB crowd. Do what they say or your baby won’t love you!

      • AA

        NCB does not believe in disproving. You can conjure whatever you want out of thin air…with the exception of stuff you can only do in a hospital or a clinic.

    • Megan

      Yes, the same commenter I think, who said that the last week of fetal development fetuses grow special cells in the cheek to help them find the breast after birth.

  • guest

    OT: I just heard a story about a woman inducing lactation just to decrease her risk of breast cancer. I know there’s a protective effect from breastfeeding, but is it strong enough to warrant inducing lactation in the absence of a baby to feed?

    • AA

      Expressing milk for at least a year in absence of a baby to feed is a pretty big lifestyle change…on the cynical side, at least she could make some money off of it by selling it online. Gross but true.

      • guest

        It’s second-hand knowledge, but I don’t get the sense she plans to do anything with the milk. I’m not sure if she even understands that she’d need to lactate for a year or more (I mentioned this to the person who knows the woman in question, though).

    • mostlyclueless

      “Individual data from 47 epidemiological studies in 30 countries that included information on breastfeeding patterns and other aspects of childbearing were collected, checked, and analysed centrally, for 50 302 women with invasive breast cancer and 96 973 controls. Estimates of the relative risk for breast cancer associated with breastfeeding in parous women were obtained after stratification by fine divisions of age, parity, and women’s ages when their first child was born, as well as by study and menopausal status…

      “The relative risk of breast cancer decreased by 4·3% (95% CI 2·9–5·8; p<0·0001) for every 12 months of breastfeeding in addition to a decrease of 7·0% (5·0–9·0; p<0·0001) for each birth. "

      http://www.sciencedirect.com/science/article/pii/S0140673602094540

      • guest

        Thanks. It depends on what it’s a 4.3% reduction *from.* And I also wonder how she’s inducing lactation. If manually, I don’t see any potential harm, but if she’s using unregulated herbs or using domperidone without doctor’s supervision, it doesn’t sound wise.

        • mostlyclueless

          The same study reports an incidence of breast cancer of 6.3 per 100 women by age 70 (in developed countries). I wonder if the woman in question has some reason to believe she is at an elevated risk; I know mine is higher because of family history. An acquaintance is having a double mastectomy and hysterectomy (maybe oophorectomy? not sure of details) because a geneticist estimated her lifetime risk at 95%. Scary stuff.

          • guest

            Yes, I don’t know the woman in question, so I don’t know why she is especially afraid. Prophylactic mastectomy seems to be more recommended and common than prophylactic lactating for high risk women, though.

            I think I read somewhere that when women hit 80 years of age, the changes of breast cancer for all of us go way up to like 80% anyway. Perhaps I am remembering wrong.

            If there were a better pool, though, I’d put money on the woman in question quitting her lactating efforts before a year if she is able to successfully induce it. That’s a shit-ton of work and a lot of mess and discomfort to deal with just to maybe prevent cancer.

          • mostlyclueless

            Not that I would bother myself with it, but lactation does seem quite a bit less troublesome when you don’t have to worry about feeding a baby with the milk. You can take whatever meds you want, you don’t become the “default parent” (my biggest problem with breastfeeding), you don’t have to worry about your supply, etc.

          • guest

            I’m not sure you don’t have to worry about your supply, though – it depends on whether making any trickle of milk has the same effect as something approaching enough to feed a baby. I think there simply isn’t enough information, although I guess someone could start at study on women who induce lactation and track their rates of cancer over time. And you’d still have to be pumping all the time to maintain your supply at whatever level.

          • Roadstergal

            And you’d need a lot of women to do that and follow them for a long time vs a well-matched control group.

    • Heidi

      “An inverse association between increasing cumulative duration of breast-feeding and breast cancer risk among parous women has been reported in some, but not all, studies; the failure to detect an association in some Western populations may be due to the low prevalence of prolonged breast-feeding. It appears that the protective effect, if any, of long-term breast-feeding is stronger among, or confined to, premenopausal women.” http://jnci.oxfordjournals.org/content/92/4/302.full

      Does she have a family history of premenopausal breast cancer? My family has a history of breast cancer, but not until their 70s, so it looks like in my case, lactating isn’t going to be of much benefit. I also don’t imagine, with the absence of drugs (which probably carry a higher risk than the underwhelming benefit of lactating), that she’d be lactating a whole lot. I’m not sure on this, but I thought the small benefit was thought to be caused by not ovulating during this period so the hormones aren’t there to “feed” the cancer. I have my doubts she’d lactate enough to quit ovulating, if that’s the case.

      • guest

        Yes, excellent points. If this was a friend of mine, instead of a friend of a friend, I’d be having conversations with her about it. But alas, I do not know her myself.

    • The Bofa on the Sofa

      I thought the main benefit of lactation in terms of preventing breast cancer was that it prevented ovulation, and that was the benefit?

      If that is the case, it would be better to just go on the pill full time, or norplant or something.

      • guest

        I haven’t seen anything definitive on why it happens. One proposal was that breastfeeding women usually eat healthier and drink less, and that might account for it!

        • TheArtistFormerlyKnownAsYoya

          So yet another confounding socioeconomic factor being touted as a “benefit”.

      • mostlyclueless

        The pill isn’t protective against breast cancer:

        http://www.nejm.org/doi/full/10.1056/NEJMoa013202#t=article

      • FEDUP MD

        I started my periods back every time after the babies slept through the night (> 8 hours). Is she really committed to possibly slightly reduce her risk of breast cancer by sleep depriving herself for a year? Which does have known risks (metabolic syndrome, etc?)

        • guest

          Mine came back before they were even sleeping through the night.

    • AnnaPDE

      Given how this whole breastfeeding/cancer thing is about growing and maturation of the breast tissue in a controlled and desirable way as opposed to going off the rails, I’m a bit doubtful that there would be benefits without going through the whole hormonal process of pregnancy and lactation. And even prolonged breastfeeding of 2 kids doesn’t protect a lot when your genetics says otherwise, e.g. with my grandma who had cancer in both breasts. (Her sister died with the first, as did her aunt.)