Several weeks ago someone forwarded a picture posted in an unassisted birth group.
The mother noted that the baby’s umbilical cord was unusual; it looked like a candy cane or barber pole.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The mother could have killed her baby, but her chief concern is her image.[/pullquote]
As the mother recognized, this is abnormal; it’s often associated with a serious infection of the placenta, the baby or both.
I publicly urged the mother to take the baby to the hospital. A newborn can have a serious infection without showing any signs of illness. The baby could collapse and die before the mother ever realizes that the baby is ill.
Not surprisingly, the mother ignored me. If you don’t give enough of a damn to have a medical professional present at birth, you don’t give enough of a damn to investigate even serious problems. Unassisted birth is medical neglect; bringing in a baby with a complication after unassisted birth will raise all sorts of red flags with medical professionals and child protection authorities.
Not surprisingly, the baby did have an infection. Ultimately a pathology report showed acute chorionitis and acute funisitis as well as meconium staining. In other words the membranes were infected and the baby was mounting an inflammatory response.
Fortunately, it was mild enough that the baby was able to fight it off, though there was no way the mother could know that at the time.
Does she feel bad that she risked her daughter’s life? Of course not. She feels bad that I might think that I “won.”
… I fell like there’s a high chance of my words getting back to “Dr Amy” and I’m not sure if I’m ready to be in that negative spotlight again. Her callous remarks and the hatred from her followers really took a toll on my family that first week … But I finally decided to post an update here because … she doesn’t get to win. She will not make me live in fear. She will not stop the spread of experience, knowledge and information that is so critical to the birth community. She will not silence me.
I, I, my, my, me, me. It just reinforces my contention that unassisted birth groups are cesspits of stupidity, ignorance, and, above all, narcissism.
There is nothing natural about unassisted birth. It is an affectation of privileged, primarily white women who confuse defiance of authority with intelligence.
The mother could have killed her baby, but her chief concern is image. Therefore, let me explain something:
When your baby has a homebirth complication, I don’t win … but your baby loses. My self image is not on the line when YOU do something irresponsible and narcissistic. Don’t flatter yourself by imagining that I care what you think about me.
Unassisted birth advocate Ruth Rodley “dead babies are hickups [sic]” had this to say:
Thank you for sharing, hopefully Amy (Skeptical OB) will blog about this… She ran over me too. Blamed me for things I had no control over in a VBAC group I help in. She is a nasty piece of work.
`And the inimitable Modern Alternative Mama Kate Tietje weighed in:
I can’t stand that woman and her brigade of losers.
Says the woman desperately trying to monetize her ignorance.
I comment about homebirth complications and deaths because I want to PREVENT them. I get no joy from the thought than an innocent baby faces injury, brain damage or death because her clown of a mother wants to impress her equally ignorant friends.
I don’t need validation of my education, training and experience. If I needed that I would look to my professional colleagues whose own education, training and experience I hold in esteem, not to women who are breathtakingly arrogant in their ignorance.
When you risk your baby’s brain function and life in choosing homebirth, unassisted or otherwise, please don’t imagine that I “win” when your baby is harmed. But make no mistake … YOU lose.
Have to say I feel a little pride to be part of this “brigade of losers” : )
Hands up who’s devastated that someone who let her kids suffer through whooping cough doesn’t like us? I’m just barely containing ALL OF THE TEARS.
You said a lot more people should have a scheduled c section. Are you aware of the rate of serious complications from c sections? The US does way way more than any other country in the world. I don’t think way more people should do it. So yes your nuts, and rude, and condescending, and I’m sure you’ll pick out something I’ve said with poor grammar to feel how smart you are
Where did anyone say that?
And how do you manage to talk out of your @ss with your head wedged in there?
It was said in this conversation. How am I taking out my @ss?
Again…
“The most control a woman can have is a scheduled prelabor C-section”
=/=
“everybody should have a section”
Though i have to admit that I *really* wanted a csection about halfway through pushing, lol
I really wanted one when my daughter went into fetal distress and then I got 2 long tears and one episiotomy to make room for the vacuum extraction…Cuz recovering from a C-section would have been SO much harder than that (not) (now with extra occasional urinary incontinence Yay)
“The US does way way more than any other country in the world.”
Wrongo. According to the WHO–who doesn’t much care for high sections rates–the US as of 2008 was behind Brazil, Iran, Mexico, Italy, the Dominican Republic, Argentina, South Korea, Cuba, Paraguay, Uruguay, Malta, Chile, and Australia. See http://www.who.int/healthsystems/topics/financing/healthreport/30C-sectioncosts.pdf.
I’d be prepared to bet that most of the regular commenters on here know the rate of serious complications, and they’re pretty good at not getting really basic facts wrong.
Your right I was to absolute in saying any other country, but the point is it’s still way to high. Double what WHO recommends, and since most people on here are so knowledgeable about serious complication rates they would know that for example it’s more dangerous statistically to do a C-section then a Natural breech birth. Am I wrong there? Just trying to have a conversation here be nice if you could be respectful
You do know the WHO pulled that number out of it’s ass right? They have no scientific justification for that number. As things stand now, lowering the rate of c-sections with out current scientific knowledge and current medical equipment would mean more dead or damaged babies.
We all agree that many of those babies would have been fine without a c-section. But some would have died, and we do not have the tools to know which ones are which.
Seems to be a lot of ass pulling going on. I think they came up with it based on more than inadvisable insertions. I do believe they gave some justification for their reasoning. Basically this whole conversation affirms my original point that women don’t feel respected and able to have the birth that they want or planned without a good chance they will be mocked, threatened, and pushed into decisions that they disagree with. I’m not saying unassisted birth is a good answer for most people. I’m saying US OB’s are arrogant and often money driven. One of the reasons President Garfield died from his wounds is US doctors have had a haughty superiority complex over the rest of the world’s doctors which led to then being one of the last to accept sterile techniques. We now will be one of the last to realize we should back way off on interventions which tend to lead to further interventions and increase the assistance of the natural process. I’m not taking about obvious things such as placenta previa before you get all upset. There is a time and a place for interventions but I believe as many doctors also believe, we are getting involved too much, jumping the gun so to speak in many cases.
“One of the reasons President Garfield died from his wounds is” antibiotics were not available. X-rays were not available. One of the doctors treating him was a homeopath. Take your pick.
What does that have to do with obstetrics in 2016?
Awww, women don’t feel respected! Because you showed the hell of respect when you asked an OB/gyn if she’s aware of them possible complications from evil c-sections. What was that if not blatant disrespect to women who choose c-sections? Because, if an OB/gyn doesn’t know those terrible complications, women who aren’t OB/gyns and can’t possibly know as much as one go into this blindfolded. Stupid women, choosing the most dangerous mode of birth! Just ask Dan!
And President Garfield? Wow, I was spot on when I labeled you dishonest and giving out incorrect information. Now, I upgrade you to being an outright liar.
If it’s just those evil American OBs why is the section rate similar across a lot of countries with national health care?
I would have loved the birth I planned, it was going to be painless, easy and over fast. Instead I got a big headed baby attempting to leave via my spine for 75 hours of agonizing contractions ending in a emcs because despite everyone involved desperately trying to get that baby out of me normally, he wasn’t coming.
Sometimes you just don’t get to choose and giving women the idea that they do is quite frankly dangerous to their mental health if they don’t get “lucky”.
“I do believe they gave some justification for their reasoning.”
You “believe” it, or you can back it up?
“Basically this whole conversation affirms my original point that women don’t feel respected and able to have the birth that they want or planned without a good chance they will be mocked, threatened, and pushed into decisions that they disagree with.”
You do understand that most of the commenters here are women, many of whom have had quite different experiences with birth than those you describe, right? I had a wonderful c-section and would not hesitate to have another. I would absolutely feel disrespected and pushed into a decision I disagree with if someone tried to coerce me into a vaginal birth. The great thing is that I have the ability to express my own feelings and preferences, rather than needing some well-intentioned person on the internet to 1) assume what they are or should be, and 2) campaign based on his incorrect assumption. I’ll stick with my OB when it comes to making decisions about my care.
And as I’ve explain: We don’t have the tool to properly know before hand which babies are going to have complications and which ones aren’t.
As things are now, lowering intervention rates basically means: ‘wait and see’ and if your baby ends up damages, then you Shrug and say ‘oh well, at least we avoided some intervention’
That’s what you are advocating for.
And I’m sorry that women don’t have all the control they want with their births. But that’s just l life and birth. I Had only very limited control on successfully becoming pregnant, I’m actually lucky it took only 4 months. My coworker became pregnant at the same time as me and lost it at 8 weeks. She had no control over that. I had no control over mine staying alive. I have no control over if it’s a boy of a girl. I have no control over if it’s going to be premature or term. I have no control on which day I’m going to get into labour, I have no control of the baby’s and the cord position when labour will start. I have no control on how long it will take, I have no control on the size of the baby, or whether or not it’s going to fit. I have no control over how how much injuries like tearing or PPH I might have.
Control during birth is an illusion peddled by lay midwives and sellers of natural birth. Nature is uncontrollable and it just pulls you around for the ride. Avoiding intervention is not control, it’s closing your eyes for the duration of the ride and hope that everyone turns out well. And if it does goes well, it’s not because you were ‘in control’ or because nature accepted your sacrifice or pain or something, it’s just because you were lucky.
And actually being able to have an induction or C-section if that is what you want, gives some control over some of those things(provided you don’t go into labor before your induction like my SIL)
Let me know when you give birth, Dan. I’ll even be there to hold your hand.
Sorry, but this is an ignorant and sexist post. If you want to exclude men from a conversation about a public health matter, you will inevitably lose half the amount of valuable conversation.
I disagree with Dan but I also disagree with you.
He doesn’t get a say in what other people – male OR female – get to do with their bodies.
Neither you, Dan, or anyone else gets to decide what another person does with their body. Is that fair to say?
Dan can’t give birth because he hasn’t got a uterus. You dispute this?
No, but none of Dan’s (specious) arguments depend on whether he’s able to give birth. They depend upon a whole lotta “facts” (that are false): That women are systematically disrespected by OBs, that OBs are arrogant and greedy, and that interventions lead to bad outcomes. The (nil) truth value of these statements is independent of Dan’s ability to give birth.
As a woman who has given birth twice and found the natural, intervention-free method to be wholly unsatisfactory, I could do without having childbirth mansplained to me, dan. The majority of women who feel “robbed” of their birth experiences, be it because they had an epidural or a c-section, are in that position because of the ridiculous expectations that modern culture places upon middle and upper-class birthing women. Most women and babies survive childbirth, so we have the luxury of defining it as a penultimate experience in a woman’s life. This ignores the fact that as a population of birthing women, we are generally heavier, older, and more likely to have preexisting health conditions that used to preclude pregnancy. No one wants to talk about these elephants in the room. If you’re in your late 30s or 40s, you are more likely to need a c-section. That’s hardly surprising. Our bodies fail as we get older, and as we push child bearing to the outer fringes of possibility, we are going to have more complicated pregnancies and births. It’s ridiculously self-absorbed to complain about interventions without acknowledging that something like a woman’s age is a huge indicator of the likelihood of complications.
Haha! I’m not trying to “mansplain anything to you but I like the term. I respect your experiences though I question your ability to speak about all women’s experiences, expectations, etc. Just like you think I was doing. I simply am advocating for women’s rights and respect from the medical community in their choices. I sense you do not respect the women who do believe natural childbirth can be and is a powerful important act as you appear to be mocking but maybe I’m wrong on that. I’m not trying to criticize you for your choices, just asking you do the same for the other side.
I’m here to tell you that natural, unmedicated vaginal delivery has very real risks to both mother and child. Since you are hung up on the risks to the mother, let me tell you what it did to me. I suffered a cervical laceration that initially manifested as a severe pph immediately after delivery of the placenta. Since I did not even have a hep lock (you know, wouldn’t want to start that “cascade of interventions”), I got to experience having a manual exam of my uterus with no pain medications (the CNM was in up to her elbows). I began weaving in and out of consciousness, which meant that my husband had to give consent for emergency surgery to repair my cervix, up to and including a hysterectomy should they be unable to control the bleeding. At 38, I now suffer from a rectocele and serious nerve damage from the delivery and the surgical repair. This means bowel incontinence and urgency, and will require both an inter-stim device and a surgical repair with an 8 week recovery. All that I ever heard about prior to that delivery was how bad c-sections were. Everyone glossed over or outright ignored the potential complications of a vaginal birth. In retrospect, an elective c-section would have spared me from the problems that I have now, and given that we only wanted a small family, would not have been a concern at all. That birth left me in a very bad place psychologically, in large part because so many people couldn’t fathom how my natural birth could be so disempowering. Equating empowerment with a biological process that we have little control over is misogynistic. It is biological essentialism under the guise of feminism. And that is very wrong.
Women have the right to bodily autonomy, and if a woman really wants to have a vaginal breech delivery, she can do it. What she should not expect is for any decent midwife or doctor to condone or encourage a risky, ill-informed decision. Women can refuse to have c-sections, but they had best be prepared for the potential consequences of that decision, which may be a dead or profoundly disabled child.
Is it disrespectful to point out that you’re wrong? You are, by the way, wrong in thinking that it is safer to do a vaginal breech birth than a section. See ACOG’s Committee Opinion on breech birth. (I can’t do the link on my iPad, currently, but a Google search for “breech birth” and ACOG will give it to you.)
LOL are you here fulfilling some 7th grade weekend homework assignment? Just tell us what the project requirements are and we’ll get you the content you need 😉
Yeah no, this risk is just the other way round.
And you’re welcome to give birth naturally whenever you feel like it, Dan. Keep your ignorance out of the decisions of people who prefer to keep pretty useful parts of their anatomy intact and their babies safe & healthy.
The WHO doesn’t have a recommended section rate and hasn’t in years.
Yes, you are wrong here. The WHO fabricated their CS rate out of thin air. Technically, they based it on Marsden Wagner’s PERSONAL belief, without any evidence of any kind, that the “optimal” C-section rate was somewhere between 5-15%. He convened a conference of like mind health professionals in 1985 and they simply declared the optimal rate by fiat.
In 2009, the World Health Organization surreptitiously withdrew the target rate. Buried deep in its handbook Monitoring Emergency Obstetric Care, you can find this:
Although the WHO has recommended since 1985 that the rate not exceed 10-15 per cent, there is no empirical evidence for an optimum percentage … the optimum rate is unknown …
For 24 years the World Health Organization touted a C-section target that was an utter fabrication, created to suit the prejudices of its creators, without any evidence to support it. http://www.skepticalob.com/2014/06/the-childbirth-lie-that-will-not-die.html
Now, let’s tackle your idea that a natural (I’m guessing you mean vaginal) breech birth is safer than a CS. Um, no.
Being nice is irrelevant in the face of medical fact.
since most people on here are so knowledgeable about serious complication rates they would know that for example it’s more dangerous statistically to do a C-section then a Natural breech birth. Am I wrong
there?
Yes, you are misinformed. It is much more dangerous statistically to do a vaginal breech birth than a c-section.
Term Breech Trial (a study of breech birth in 26 different countries): “Perinatal mortality, neonatal mortality, or serious neonatal morbidity was significantly lower for the planned caesarean section group than for the planned vaginal birth group (17 of 1039 [1·6%] vs 52 of 1039 [5·0%]… There were no differences between groups in terms of maternal mortality or serious maternal morbidity.”
https://www.ncbi.nlm.nih.gov/pubmed/11052579
The difference between 1.6% and 5% is 3.125. In other words a breech baby is 3.125 times more likely to die or be seriously injured at birth if the mother delivers vaginally than if she has a c-section. And mothers who delivered via CS had the same risk of death or injury as mothers who delivered vaginally.
There are a number of studies about the risks and results for caesarean
section vs vaginal birth for breech babies. The medical evidence is
conflicted on this issue. A good summary of the different studies is the
article by Deans and Penn in the Obsetrician and Gynaecologist (2008,
10: 139-144). There have been several studies, the most well known being
the PREMODA study (Goffinet et al, American Journal of Obstet Gynecol
(2006, 194: 1002-1011) showing that in carefully controlled
environments, there is no significant difference in outcome between
planned vaginal birth and planned caesarean section. Other studies
suggest caesarean is safer for the baby. NONE take into account the long
term morbidity of caesarean section on the mother including the affects
on her future pregnancies and the psychological aspects sufficiently
well.
Dan, the evidence is not conflicting. C-sections are almost always safer for babies; vaginal births are often safer for mothers.
The key issue is that childbirth is INHERENTLY dangerous. We cannot (yet) reduce the risk to zero; the major decision we face is how to apportion that risk between mothers and babies. Most women would prefer to take the risk on themselves.
Anyone who tells you that childbirth is not risky or that the risks can be reduced to zero or that vaginal birth results in the lowest overall risk is lying.
OK that kind of statement that the evidence is not conflicting makes me a little annoyed because I’ve researched enough to know that it is. I never said anything about reducing risk to zero either. It’s fine we can agree to disagree.
“Researching” by reading natural childbirth websites is like researching by reading Breitbart. Both are fake news.
well I spent hours at a university reading medical journals from around the world and I have to say that on the whole the natural childbirth websites are just as fair if not more so than the anti natural sites, though both can be one sided
Hours? That’s it? Hours is nothing.
Any doctors out there want to tell us how many year equivalencies you’ve spent reading and researching?
I’m an attorney and I was only in professional school three years. During that time I spent 80-100 hours per week, about 35-40 weeks a year, reading and researching. I also had to know and understand the material well enough to pass exams written by experts.
I’ve spent many, many hours reading obstetric articles and information as I have recently had children. I am not an expert and I am in no way qualified to opine about the data itself. I’m simply too ignorant of the science. Unless you have a medical degree, I suspect you are, too.
I read opinions and data collected by doctors, those for and against, and neutral studies, evaluated how the numbers were tabulated, and arrived at an opinion. I also have some experience elsewhere in the medical field that makes me very familiar with and suspicious towards the way decisions are made in american medicine. Since it is an area of interest to me I have spoken to thousands of woman to get there anecdotes. All of this has contributed to my opinion that when all is said and done I think a c section is scarier than a vaginal breech when the whole picture is taken in. That is my opinion which is shared by many others, and if I am ignorant of the science then so are the hundreds of doctors I’ve read or talked to on this particular subject since it has been quite a while since I’ve heard any expert talk about something I didn’t already know about.
“…[…]…a c section is scarier than a vaginal breech when the whole picture is taken in. That is my opinion which is shared by many others, and if I am ignorant of the science then so are the hundreds of doctors I’ve read or talked to on this particular subject”
I call BS. I’m a physician. I trained in a hospital where breech births are done, and I assisted on some of them. None of the many papers we read, none of the experts brought in for talks, and none of the doctors I trained under ever held the opinion that a CS is scarier than a vaginal breech. Quite the opposite. They were of the opinion that in a small, *very* select set of patients, that breech vaginal could be a reasonable choice, although still always more dangerous than a planned CS. And even though they did offer breech vaginal birth, none of them ever chose it for themselves or their loved ones. And ALL of them found it “scary”. They did it only in a surgical suite, with a full team scrubbed in and ready to go, and a neonatal team waiting in the room.
right that is the general feeling but not all agree with that. Since when has a general consensus been unassailable? Lots of the common practices today had to be fought for and were at one time against what was the generally accepted practice of the past. Maybe I’m wrong but I think someday breech natural birthing will be more and practiced.
“Since when has a general consensus been unassailable?”
Never. But to do so you have to provide facts, and you’ve failed to do so.
“I think someday breech natural birthing will be more and practiced.”
I anticipate this happening only if the world becomes very resource-poor. We already know what happens in countries where women are routinely expected to birth breech babies vaginally–5% of babies die (and that’s *in* the hospital, with CS available, but reserved only for “emergencies”).
The terribly important thing which you entirely fail to take into account here is all dan’s fee-fees.
“Scarier” – now there’s a scientific measure to quantify the advantages and disadvantages of a medical procedure!
You clearly have no first-hand idea, Dan, and are embarrassing yourself.
Yes all the possible present and future effects of a c-section are “scarier” to me. Do you find it useful to act childish instead of useful conversation. I have mentioned in some generalities and specifics advantages and disadvantages of the medical procedure. Can’t we just disagree.
What do you mean, “Can’t we just disagree.” We’re disagreeing already. With me knowing what a c-section is like first-hand, and glad I had one, and you speaking about generalities and completely misunderstanding how numbers work.
But yeah, go with “scarier”, if a calm 30-minute surgery with most likely a healthy baby at the end sounds scarier to you than hours and hours of pain, good chances of pelvic floor damage, and a possibly dead baby.
I’m very glad yours went well. I’m not speaking of generalities though, I know women for whom it did not go so well. I am also familiar with the numbers both here and elsewhere and capable of understanding them. A dead baby can happen either way and yes I know you believe the facts point to natural being more dangerous. When a person looks at all the options and comes to believe there are real benefits to natural methods, then chooses to have it naturally they face insults and obstacles for their choices. To such a degree that sometimes they feel they need to go away from the hospital completely. So if OB’s could have a little more respect for those that believe in the benefits of natural childbirth despite that particular doctor’s feelings they might alienate less patients. I have faced rude condescending comments for a long time on this thread instead of mutual respect and understanding. It is called practicing medicine for a reason, nothing is set in stone. Years from now we may find that doctors have backed way off on how fast they are to intervene in the natural process and have instead practiced more aiding the process unless absolutely necessary. Right now that certainly is not the general attitude among most hospital births.
Even though you know women for whom it went badly, yes, you are still doing generalization.
3 of my coworkers had 4 c-section in the past 3 years.
2 of them are 100% satisfied with 0 psychological effect.
The fourth one…..well she does have some things to say about it: She’s mad she’s the one who had to insist to get a c-section because her baby was in obvious distress. Because everyone around her was so obsessed with the natural process. She has 0 problems with the c-section herself.
But using those example as to why c-sections are awesome would be a generalization. You can’t use a handful of people’s feeling to decide what is best.
See, people have the right to make their own decision. However, just because they made that decision, it doesn’t automatically makes this option the best or the safest.
So yea, you can decide to have a vaginal breech birth. But don’t expect the medical professional to tell you it’s the ‘best’ decision or that it’s ‘safest’
Dan, you tell us which papers showed that vaginal birth was safer and quote the relevant findings (NOT the conclusions).
Are there really any?
Respect is earned. When you come in here claiming that vaginal breech is safer while offering zero proof, you don’t deserve respect. I don’t believe that you’ve talked to thousands of women; you probably haven’t even talked to hundreds. Nature doesn’t care one whit about survival on the individual level. A species can survive and grow while accommodating huge amounts of individual deaths and disabilities.
Well your wrong I have talked to that many, and as for facts I’m not going to get into a citing war, not trying to prove anything more here than that there are doctors and studies showing it can be just as safe for the baby and safer for the mom if attended by a professional who is skilled at breech birthing naturally, which is a key factor. The studies are out there, so maybe belittling those that disagree we could all respect each other.
Then where are they?
Basically, you are saying: A breech birth can be as safe as a c-section, IF you have a professional with lots of experience in breech birth, in a properly staffed hospital prepared to respond to any emergency, with a perfect patient with 0 risks factors for any kind of complication and very extensive monitoring of the baby.
Yea sure, that’s probably true. But that’s not real life.
In real life, Most women will have some kind of risk factor that makes vaginal birth more risky. Many hospitals don’t necessarily have the base staff or material for the increased monitoring necessary. Many others won’t have the emergency staff on hand to respond quickly enough to all possible complications. Only very huge hospitals in large cities probably have the means to offer that kind of service.
Which means that, overall, in real life, C-sections are safer. It doesn’t matter that ‘theoretically’ some vaginal birth are just as safe. MOST breech vaginal birth will be riskier, and those who aren’t require a lot more care, staff and equipment.
And then you also have to factor in ‘who’ mostly wants those vaginal births.
Most women are actually perfectly fine with getting a c-section for breech. Those who really want the vaginal birth are often also adept of the ‘natural birth’ community and are also the least likely to adhere to the standards required to have a safe vaginal birth. They don’t care when the doctor tells them they are not good candidates. They don’t want to go to the super staffed hospital 4 hours away. They don’t want to have continuous foetal monitoring. They don’t want to have lots of doctors and staff around them ‘disturbing’ their natural process. They don’t want to have an IV or an epidural ‘just in case’. They refuse to do what it takes to make their vaginal birth safe, and then they complain that doctors won’t do it.
Yeah no. You’re spewing unsubstantiated nonsense and unqualified opinions, parroting platitudes about how doctors don’t respect their patients and should practise differently according to your vague feelings of how they do too much in childbirth. All the while dismissing the statistical facts (aka the documented reality) as beliefs.
Guess what, no one’s buying it.
You’ve spoken to THOUSANDS of women? really? and HUNDREDS of doctors? Seems pretty unlikely for something that’s just an ‘area of interest’.
Hours? I’ve spent 35 years reading the obstetric literature. Which of us do you think has a better idea of what it shows?
that is a straw man argument. I know doctors who have spent just as much time as you and have a different opinion than you. My point was not that I have spent more time reading than any one else in the world, just that I didn’t just get my info from pro natural childbirth websites as was accused. I do think someone with a talent for research at a university library can spend 8 hours at a university, read many of the best studies and ideas from around the world on any given subject, and form the beginning of a fairly well informed opinion. I did not stop my research there of course. If you’ve spent 35 years and haven’t read any literature from the opposing view that could point to natural breech as being as safe as a c-section then you are not looking at both sides. If you have then you know there are two sides and you just agree with the c-section side.
How is it a straw man argument? YOU were the one who boasted about the “hours” you spent in the library reading the literature, as if we were supposed to be impressed. When someone trumps that, then all of a sudden, nah, how long you spend isn’t important?
Natural breech is not as safe as c-section. Back before we had spinal anesthesia and other techniques to make c-sections relatively safe, you might have had an argument, but that’s not the reality now.
And yet you failed to note the details of PREMODA and the term breech trial! Anyone can read a study, but few of us laypeople have the ability to truly understand it.
Nothing to say about the morbidity and psychological effects on the mother of undergoing a breech vaginal birth, then?
Right. It’s incredibly patronizing to assume that having a planned CS has any psychological effects on the mother, much less any lasting ones.
And it’s also absurd to wring one’s hands about microscopic increases in the risk of an incredibly rare complication in future pregnancies, when we’re living in a world (Europe/North America/Japan) where most women only have between 1 and 3 children.
Not to mention, a world–and here I’m referring to the entire world–where ALL women carrying wanted babies care way more about the safety of the actual current baby they’re about to give birth to, than the safety of some potential future baby that they may never even conceive.
Well it’s the woman who have had the c sections that speak of adverse psychological effects so I’m no patronizing any one.
If it is so rare and microscopic an increase in risk then why do doctors wring their hands about some of them, requiring premature hysterectomies, no future pregnancies, scar tissue complications, just to name a few.
As for the safety of the baby being greater in a c section that is precisely the argument here. I don’t believe it is, that is what this whole thread is about.
How about the psychological effect of having a dead baby vaginally who could have been saved by C-section?
I’ve seen many people who had adverse psychological effect after their vaginal birth. It can happen to both.
absolutely
So why are you so hung up on the psychological effects of c-sections?
If anything, a planned c-section is probably the option with the least chances of causing psychological distress. It’s planned well in advance, you have time to get emotionally ready, you have the time to make sure everything is ready, family/friends who want to help you can plan their vacation/days off to be there for the birth and stay a little afterwards to help you. Doctors have all the time to explain everything and answer all your questions. there is all the time in the world to have proper analgesia before surgery. No rush during the surgery, and you are more likely to be handed your baby right away since it’s way less likely to be in distress.
Well it’s the woman who have had the c sections that speak of adverse psychological effects so I’m no patronizing any one.
I had a c-section, and that’s what I’d choose if I have another child. No adverse psychological effects here. So beware of generalizing–that IS completely patronizing.
In my experience the women who have adverse psychological reactions to c-sections have them for one or more of the following three reasons:
(1) they’re made to feel it “doesn’t count” as giving birth, that they somehow failed, that having a vaginal birth would have been a success and made them a “real woman,” etc.;
(2) things got really scary during labor due to the complications that caused the need for the c-section, they felt a complete loss of control, they got rushed into emergency surgery with no time to mentally prepare, and they really wish it hadn’t happened that way; and/or
(3) they believe the NCB lie that doctors try to force women into unnecessary c-sections and they think that’s what happened to them.
Reason #2 is a completely understandable reaction to trauma. That’s just how emergency surgery is. It’s scary. But of course, this mental trauma doesn’t happen to women who choose a pre-labor c-section due to breech or whatever, or to women who go into labor knowing that things could go wrong and mentally prepared to opt for a c-section at the first sign of trouble rather than insisting on continuing with the VB attempt until things get really bad.
Reason #1 is the result of being shamed and lied to, usually by other women, sometimes by weirdly controlling husbands. In other words it’s caused by false beliefs and social shaming. Also, often women get PPD and latch onto these particular false beliefs as part of the PPD.
Reason #3 is also caused by false beliefs; there is no way to know in advance whether THIS PARTICULAR fetus in distress/stalled labor/other complication is going to lead to tragedy if a c-section isn’t performed–in other words there’s no way to know in advance whether a particular CS actually is unnecessary. So doctors recommend them when the complications raise the RISK of tragedy.
As for the safety of the baby being greater in a c section that is
precisely the argument here. I don’t believe it is, that is what this
whole thread is about.
You’re entitled to your own beliefs, but not to your own facts. A fact is something that can be scientifically or rationally proven. Now, to illustrate why CS is safer for babies, I’m going to list all the possible complications to the baby of vaginal birth. I invite you to reply with a list of all the possible complications to the baby of cesarean birth. Then we can compare which list is longer and more severe…
VB complications:
Cord compression leading to hypoxia (can cause brain damage or death)
Placental abruption (can cause brain damage or death)
Shoulder dystocia (i.e., getting stuck) (can cause brain damage or death; less serious complications include a broken clavicle and/or permanent nerve damage)
Brachial plexus palsy (nerve damage resulting in permanent partial paralysis, e.g., one paralyzed limb)
Forceps injuries (can cause brain damage, death, or neurological damage–for instance, my mom was permanently handicapped due to being yanked out with forceps)
Vacuum extraction injuries (can cause brain bleeds leading to brain damage or death).
Your turn!
why should I have to waste my time writing a list of the possible complications to you if you are so knowledgeable, as you obviously are, then you already know, or do you deny they exist? I know there are risks both ways. I also know there are skills learned that can make a vaginal breech just as safe as c-section in an otherwise low risk birth. In places where it is routinely done they have similar outcomes for babies and generally less complications for mom down the road.
In other words, you have no idea. Hardly surprising.
To back up your argument.
It’s really not much of a waste of time, since there are only two complications that can be caused by CS: (1) baby gets nicked by the scalpel, and (2) baby experiences transient tachypnea, which as the name implies is a brief and temporary bout of breathing problems.
Do either of those complications sound to you like they are remotely on par with the brain damage, nerve damage and death that can result from complications caused by vaginal birth?
There. I think that took me less than forty seconds to write.
“Adverse psychological effects” – stop making up stuff. From your handle, assume you haven’t had either a vaginal birth nor a CS and never will. So listen to those who actually have experience with this: A planned CS is a painless, relaxed and quick thing, with a clean, quickly healing cut just above the pubic bone. I had one, it was great. In my opinion, infinitely preferable to labour pain and possible damage to the pelvic floor and perineum. Or the psychological effects of the baby being distressedafter hours of labour and then having to get it in an unplanned operation.
“Well it’s the woman who have had the c sections that speak of adverse psychological effects so I’m no patronizing any one.”
I’m one of those “woman (sic) who have had the c sections,” and I had a great experience. Your beliefs about where and for whom the risk is greater mean nothing.
My wife’s mother had two vaginal breech deliveries. Not only were the psychological effects devistating, so were the physical effects. They tore her to shreds.
And she let my wife know about it, long before my wife was pregnant. My wife had heard so many horror stories about vaginal delivery from her mom that she was relieved that our first was breech and it gave her an excuse to do a c-section.
And she had so little psychological effects of the c-section that she gladly did a repeat with our second, who was not breech.
The “adverse psychological effects” that result from vaginal births are dirty little secrets that aren’t talked about. I mean, we have even invented the “God has made us forget what childbirth was like, because if we didn’t, we’d never do it again” meme!
Another explanation is that it causes PTSD and we block it out of our memory.
https://birthtraumas.wordpress.com/2016/12/05/tearing-in-childbirth-not-just-a-physical-problem/
Was reading this earlier, hopefully studies like the one discussed will help change the “dirty little secret” narrative.
The problem is that you’ve not bothered considering the adverse psychological effects on women who have breech vaginal births.
I hang out in a lot of Birth Trauma circles and whilst I 100 percent believe that c-sections can have a negative psychological effect (I still wake up screaming having nightmares about mine), I think society and it’s demonisation of sections pays a huge part in that.
At least once a week, sometimes more someone joins the c-section support group I’m in and posts asking for reassurance that they’re a “real Mother”, that they “gave birth”, that they didn’t fail at the first hurdle of Motherhood. Those ideas don’t exist in a vacuum, there are women out there, our sisters, mothers, aunts telling us we failed because for whatever reason our children didn’t transit our vaginas.
Taking my own experience, on the face of it, yes my emcs gave me PTSD but that’s not the whole picture. I live in a country with socialised health care, where if they can get your baby out “naturally” they will. By the time they’d exhausted all options for unsticking what turned out to be a 90 % percentile head from my “flat” pelvis, my waters had been broken for 81 hours, I was dehydrated, seeing snakes and running a fever. I thought my baby was dead and then managed to relive a previous traumatic event before passing out.
My baby ended up in NICU because other people wanted me to deliver him vaginally. My opinion wasn’t asked for because as a first time Mother what could I possibly know… I had midwives lie to me and Doctors congratulate my husband on the fact that when he came out with agpars of 9 that our son was “clearly a fighter like his Mum” but that they hadn’t expected that. They thought that the baby who had been perfectly healthy when I was admitted hours previously was going to come out struggling, sick and half dead.
Our healthcare system does a lot of what you seem to think is preferable to yours and yet, we still have women being traumatised by their thousands not to mention the babies who aren’t as lucky as mine, who don’t make it or who end up with life long injuries.
You don’t “believe” it is. The facts tell a different story. MANA’s data shows that the mortality rate for breech birth is unacceptable. So do other studies quoted here. You can have all the feelings you want, but the actual studies (reviewed elsewhere on this very blog) show that breech birth is very, very risky for babies.
Yeah, surgery is scary. No one is disputing that. But vaginal birth is scary too. (Ask me how I know). And scariest of all would be losing a baby, which all the stats show has about a 5% chance of happening if you attempt a vaginal breech birth.
There is truthiness, and then there is the truth.
The PREMODA study wasn’t randomized, the Term Breech Trial was, and the doctors in the PREMODA study managed women’s labor very strictly, to a degree that virtually all NCB vaginal breech fans in the U.S. would refuse to consent to. Women wanting to attempt VB (remember, in PREMODA they chose which group to be in rather than being randomly assigned) had to:
– Undergo pelvimetry to give the doctors confidence that their pelvis would be up to the task of delivering their baby’s head (82.4% of all the PREMODA women had pelvimetry, vs. 9.8% of the TBT women)… and notice how, in PREMODA, far more women underwent pelvimetry than attempted VB? Apparently undergoing pelvimetry persuaded many of them to go for a CS instead;
– Consent to Continuous Electronic Fetal Monitoring during labor (that alone would be rejected by almost all NCB vaginal breech fans in the U.S.); and
– Consent to CS if the active phase of your second stage of labor lasted more than 60 minutes (only 0.2% of the PREMODA women went longer than 60 minutes, vs. 5% of TBT women–adverse outcomes for the baby were associated with going longer than 60 minutes in the TBT, which is why PREMODA managed labor this way and that is also why PREMODA had fewer adverse events).
So long story short, if you apply strict risking-out criteria and intervention requirements that VIRTUALLY ALL American women interested in vaginal breech birth would absolutely reject, and the birth takes place in a hospital with emergency CS available immediately, THEN you can have approximately similar safety rates between planned VB and planned CS of breech babies.
But that’s not the real world. That’s the ideal world, and it’s unachievable in the US because the women interested in vaginal breech birth are NOT interested in any of the safety measures necessary to make it comparable in safety to planned CS.
And in addition keep in mind that even in the TBT the risk-out criteria were pretty strict.
It’s so interesting that Dan has no response to this post. Isn’t that interesting?
Bwahahahahahahahahahaha
Ha
Ha
Ha
Haaaaaaaaaaa
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Are YOU aware of the rate of serious complications from c-sections? Are you aware of serious complications from vaginal births? Are you aware that some complications affect the mother, and others the baby? Are you aware that some women might have a preference over whose health should be put at greater risk?
It isn’t this hard to be smarter than you and no, not because of your grammar. It’s because the things you write are one-sided, dishonest and factually incorrect. Starting with the c-section rate in the US, going on with your presumption that you know more than an OB/gyn and stretching over to your disgusting attempt to present c-sections as laden with danger while vaginal births, by the virtue of being omitted from your post, come out all in white.
This isn’t about “smart.” It’s about knowledge.
I know a lot of really smart people. Some of them even certifiably smart. As in, MacArthur “Genius” award winners and Nobel laureates. These are really smart people.
Yet, when we talk about things, there are a lot of things that I tell them about that they don’t know, and they can learn from me. And they do. And I learn from them, about things that they know that I don’t. It’s not about who is smart – it’s about what we know.
There is an internet meme known as “Pablo’s First Law of Internet Discussion” that says, “Regardless of the topic, assume someone participating knows more about it than you do.” It’s a really good rule of thumb. Instead of bursting into a new place and spouting off, Pablo’s First Law reminds us to be humble, and start by learning.
When you’ve been around for a while and know who knows what and who doesn’t know what, then you can start recognizing your own authority. Until then, though, listen to others. It makes the discussion go a lot easier.
I already said I was incorrect in saying the US is the highest, but my point was we do to many. The WHO may have retracted the specific number of “twice what they recommend”, but the point is still that we do to many. They haven’t retracted that sentiment! Yes bad things happen during vaginal birth sometimes, but from the research I’ve done I would be even more worried about a c-section and it’s complication rate in most situations. I am not going off just my own knowledge but the opinions of many doctors and published peer reviewed articles in medical journals. It’s funny that my original point was that many women don’t feel able to plan the birth that they want in the hospital without getting pressured, mocked, and threatened by hospital staff and their doctor. I have gone on to say that American Doctors in particular have a reputation of being arrogant and dismissive of anything they don’t agree with as in my example of late acceptance of sterile practices. That attitude of arrogance continues to be far to pervasive. I have suffered all sorts of insults here which is exactly what a woman who wants a natural birth to happen without someone itching to do something to “help” things along can expect.
Threatened how? Let’s have some examples and how about citing some of those published, peer-reviewed articles while you’re at it…
WHO=world health=countries other than the US. What number is too many? The percentage of c-sections can reflect access and availability of obstetrical care, which is a good thing. Nigeria, for example, c-sections reflect 1.8% of deliveries. Only 35% of births are attended by skilled birth attendants (a doctor or trained midwife). The maternal mortality rate is 1:13, everyday 2330 children under five die and a quarter of those are newborns with birth asphyxia being a leading cause of death.
Have you seen who is practicing obstetrics lately? It’s overwhelmingly a female dominated specialty.
“I already said I was incorrect in saying the US is the highest, but my point was we do to many.”
Based on what?
Hi Dan (and well written reply BotS),
Reading through the comments here, I would have to say those here have been pretty ‘kid gloved’. I’m glad you are asking questions and learning about some common misconceptions about “the right c-section rate” but are you open to hearing anything than what you already believe?
You cite the “opinions of doctors and published peer reviewed articles in medical journals” but don’t actually cite those opinions or articles. You also dismiss “American Doctors”. So what’s it going to be? Do you value the opinion of doctors? Or only the ones that agree with you (the non-American ones?) Let’s see some data.
If you are going to call your light reading “the research I’ve done”, I think you are overstating. Research involves a study design and a statistical analysis. It also, yes, requires peer review and publication before you can go about touting “your research” over others.
Glad you support women. You care about an issue that impact women’s health deeply. I hope you can land on an evidence-based side of the issue.
OK you got me. I’m on my phone and didn’t notice the your, but everybody should have a c section? Now I know your nuts.
Are you functionally illiterate or just a troll?
“The most control a woman can have is a scheduled prelabor C-section”
=/=
“everybody should have a section”
Everybody should be forced to have a section, even if they’re not pregnant.
Your demeaning insulting attitude and verbage is unlikely to win over women who feel they want to have a respected voice and input into the birth process. OB’s in the US are not the most naturally minded when compared to others around the world. Many women worry with good cause that no matter what their birth plan says, pushy dismissive doctors will take over in crunch time and push interventions, using scare tactics or flat out doing things previously agreed against such as breaking the water. I think the hospital wouldn’t be as scary a place if women were allowed to feel more respected and in control during the process. Maybe your not that type of OB, but I’m guessing you are.
“who feel they want to have a respected voice and input into the birth process”
That’s the problem. The birth process is not something that pays too much attention to what women want. If your baby isn’t facing the right way, isn’t descending, gets the cord wrapped around its neck, if the placenta starts to detach, etc etc – you can talk to your baby, the placenta, the cord, the cervix, all you want – it won’t help.
“OB’s in the US are not the most naturally minded when compared to others around the world”
Thank goodness. I don’t like natural. I don’t like debilitatingly painful periods, lack of control over my own fertility, or, when it comes to birth, the horrific death toll of women and babies that nature has typically delivered. I don’t go to an OB for natural. I go for better than natural.
“Many women worry with good cause that no matter what their birth plan says, pushy dismissive doctors will take over in crunch time and push interventions,”
Yes, because when it’s crunch time, the baby and/or mom can get hurt or dead without interventions.
“I think the hospital wouldn’t be as scary a place if women were allowed to feel more respected and in control during the process. ”
The most control a woman can have is a scheduled prelabor C-section. I agree, that option should be a lot more respected! But if the woman wants ‘nature’ to be in control, then she is just along for the ride. As is her baby, who is often sidelined in these narratives. An OB has two patients.
“Maybe your not that type of OB”
You’re. You are. That’s an easy one to get right.
“I don’t go to an OB for natural. I go for better than natural”
Exactly!
Who appointed you spokesperson for women and their feelings?
In terms of naturally minded, no thanks. I’ll take actual professional medical care over Nature any day.
If there is a complication during birth, there is a VERY limited time to deal with it before there are increasingly bad consequences for both mom and baby. Shoulder dystocia. Nuchal cord. Cord prolapse. Nuchal arms or head entrapment if the baby is breech. True knots in the cord, short cords keeping the baby from descending, placental abruption, meconium aspiration, uterine rupture, mother has an aneurysm from pushing, amniotic embolism, things like this require immediate attention from the medical team. There is often not time to hold the mom’s hand, talk gently and softly to her and allow her the luxury of “thinking it over and discussing it with others for 15 minutes” before giving consent or not. If the baby is stuck with a stubborn shoulder dystocia, or the cord has prolapsed, that is an EMERGENCY. The medical staff is not your cruise director nor concierge and your baby’s birth is not a spa vacation. Preventive measures taken when the woman presents in L&D can save time and lives if things go wrong later. Placing a heplock so the staff isn’t trying to find a vein for an IV if you have a PPH, fetal heart monitoring to keep an eye on how the baby is tolerating labor, IV antibiotics if you are GBS positive, monitoring your temperature and blood pressure, etc. They do these thing to help them obtain the best outcome for mom and baby, not to make the mom miserable and ruin her experience. But some women seem to think that they can dictate their own medical treatment and expect the doctors and nurses to follow their requests/demands. The medical staff do this every.single.day and are experienced in handling and managing potential crises and actual crises. They are hyperfocused and doing things quickly and efficiently to obtain the best outcome and don’t have time to explore the mom’s feelings, thoughts and motivations right then.
Now, that is not to say that a debriefing meeting with the mother afterwards would not be a good thing. The staff could explain what happened, and how they dealt with it and answer any questions the mother and/or father have. “You were having a PPH and I needed to do a manual exam of your uterus to ascertain if there was any placenta tissue retained. I understand that it was painful and I am sorry that I had to do that, but it was necessary so that you wouldn’t bleed out. Do you have any questions for me?” Or “You had had ruptured membranes for over 15 hours and were spiking a fever. This is indicative of an infection and the best way to give you and your baby a good outcome was to do a CS. I understand that you were hoping to avoid a CS, but at the time, it was the best option for the two of you.” Things like that, where emotions aren’t running so high and there is time to discuss events.
Because the vast majority of OB’s, CNM’s and L&D nurses are NOT jackasses who are out to make you miserable. They are willing to let you have leeway (being able to move around during labor, push in any position you want, labor in a tub or shower, provide birth balls to bounce on, wireless monitoring if available or intermittent monitoring (15 consecutive minutes every hour or some such), stuff like that. Bring your music, movies, dim the lighting, fine. But sometimes, some things will not be negotiable, nor will there be the luxury of time to “sleep on it” or come to terms with it if it is diametrically opposed to the woman’s “birth plan” or “fantasy birth experience.”
For all the “evil doctors don’t listen to women”, there is a hell of a lot of “women don’t/won’t listen to doctors because they don’t like what they are saying”. It works both ways.
I’m a woman of child-bearing years and Dr. Amy has absolutely “won me over.” Why? Because she tells the truth and is honest about the risks . Informed consent, friend.
I find your insinuation that women need to be talked gently to/have their hands held, etc to be incredibly demeaning and misogynistic.
You find it demeaning to women that I think that there wishes should be respected? That’s a strange comment. You agree with all of the interventions and not being very naturally minded when it comes to the birth process so you and the doctor or typical OB in America will get along great. But what happens if you change your mind because of research that you do in the future and you do want to be more naturally minded you don’t want to have a C-section except for under circumstances that are extreme and as a result you’re insulted and threatened as is common in hospitals today, I’ve seen it many times and heard many many many stories of women who’ve gone through it. So I’m speaking on behalf of you theoretically if you ever disagree with something that they want to do to you in the hospital I don’t know how that is demeaning and insulting towards you. You wouldn’t believe the number of absolutely illogical and irresponsible things that I’ve seen done to people in the hospital setting and if they try to argue against it the hospital treats them very badly not just in the birth setting but also in the birth setting that needs to be a change of attitude towards patients rights. It’s funny how doctors just almost believed their gods and could not be wrong when medical science is really a practicing art, they change their mind all the time, find out they’ve been doing things wrong for years all the time. And please don’t hit me with the oh really give me examples of that line, if I need to go back just in the last 50 years and give you a hundred different examples of when Medical Science has done one eighties that would be time taking an unnecessary because if you don’t know about any of those examples then you really are sheep. So go ahead let doctors have free reign on you do whatever they want? Otherwise you’ll be insulted as this original article was
Who on this site has advocated for doctors to “have free reign”? Has anyone suggested mandatory sections or epidurals or any other of those eeeevil interventions?
Who on this site thinks patients should be treated with anything other than respect for their autonomy (a core value of medicine)?
I have no doubt that hospitals, doctors, and nurses do crappy things to patients. This is wrong. It should be called out–and is, in news, blogs, and in extreme cases in malpractice suits. The Morecambe Bay disaster was perpetrated by arrogant medical professionals, and Dr. Tuteur was firmly on the side of the families who suffered loss because of the medical professionals’ actions (or lack thereof).
NONE of this is relevant to the fact that improvements in obstetrics (and medicine in general) have saved thousands of lives for those who are able to access them.
Edit: “Thousands” should be “millions,” if we’re talking about medicine as a whole–antibiotics, vaccines, blood transfusions, etc.
Thank you for your reply in a respectful tone. It’s a breath of fresh air in this discussion. My point was that the original case that this article mentioned in the unassisted birth where the baby had an infection and a candy cane umbilical cord, likely will be repeated more often because it is so difficult for women who disagree with some of the modern OB practices to feel that their wishes will be respected and that they can have a peaceful birth experience of their choice. So they are resorting sometimes to an unassisted birth and I’m not saying that that is the right thing to do but women are threatened with child protective services or flat out told they don’t have a choice all the time in the hospital setting. I actually think it is showing signs of getting better recently with some hospitals not being as willing to do c sections except for certain circumstances and seeming to be more willing to follow birth plans. Anyway in this article she is just very insulting and I don’t think that that furthers the cause of healthy birth processes
Why is it okay for hospitals to not be willing to do c-sections except for certain circumstances? If a woman wants a C-section then why should her birth plan not be followed?
I think the ones perpetuating what is largely a myth, that is you go to the hospital and everything is done to you without your consent, is the natural childbirth movement. As one who has heard the NCB side and experienced an actual hospital birth, I wasn’t forced into anything. OB gave her recommendations and I was free to yay or nay it.
Good point that hospital should be willing to do C-sections if that is the patient’s desire. They do however tell the OB’s and patients from the start their parameters, they do not tell you they will do a C-section and then pressure you into not having one once you’re in the process. I have witnessed and I know personally people that have been pressured into things they were not comfortable with and there’s millions of anecdotal evidence of it out there so it does happen frequently. And there’s no shortage of places where you can do a scheduled C-section without a worry. Now finding an OB and hospital that you’re confident that the staff will be respectful of your natural birth plan is getting better. I severely doubt that with the attitude of the author of this article that she is one of those respectful OB’s, and therefore contributes to that which she is ridiculing
I’m going to have to disagree with that last line. I think a few of her other readers would, too.
“they do not tell you they will do a C-section and then pressure you into not having one once you’re in the process”
Yes, that is very true. Women are often pressured by midwives and ‘naturally’-minded OBs into not having wanted C-sections. There is even a quote from a UK OB floating around from an article where she said she doesn’t give an accurate risk/benefit comparison for C/S vs VB, because then too many of her pregnant patients would make the ‘wrong’ choice (as she thinks of it) and opt for a C/S. I don’t know why you think this strengthens your position, though.
“I have witnessed and I know personally people that have been pressured into things they were not comfortable with”
Yup. Many women here can recount their experiences of being pressured into breastfeeding when they weren’t comfortable with it, for example. Some women here have stories of hospital personnel grabbing their breasts without permission. This is all in service of the ‘natural’ mindset you revere, however.
“Now finding an OB and hospital that you’re confident that the staff will be respectful of your natural birth plan is getting better”
It’s nice that mom has a natural birth plan. If everything is going smoothly, OBs will happily let it go on. I’ve had friends who had completely natural births with no interference at your run-of-the-mill hospital – because they were lucky enough to have textbook pregnancies and births. Nobody intervenes when it’s sunshine and roses.
The bit that you – and all of the ‘natural’ mamas – miss is that it isn’t the OB who is messing with the ‘natural birth plan.’ It’s nature. It’s nature that just doesn’t care if a woman randomly doesn’t go into labor at term, if her placenta gives up, if a kid is doing somersaults and gets the cord tangled around its neck, if it goes breech and won’t go back, etc. Bacteria are ‘natural,’ and why should nature care more about your baby than the bacteria? She’s not human-centric, she’s not moral, she has no agency. OBs are there to save your baby when nature is happy to let it be starved of oxygen, get infected, get stuck, or any of nature’s other curve-balls.
“they do not tell you they will do a C-section and then pressure you into not having one once you’re in the process. ”
Not once they’ve started surgery sure but despite being told that I absolutely could have a repeat section prior to getting pregnant, I’m now getting pressure to agree to a trial of labour should I labour prior to week 39. Scans so far show a slightly smaller head than my big headed son (age for age) and I have a posterior placenta this time (had anterior last time).
They know how traumatic and horrific my emcs was. They know that my worst possible scenario (assuming healthy baby) is a repeat emcs. They know this is my last child so I don’t care about placenta problems in subsequent pregnancies because there won’t be any subsequent pregnancies (and yes, I’m aware I said my last baby was my last baby but this one definitely is). Yet every single appointment since becoming pregnant it’s been raised.
And not only has it been raised, the numbers are getting lower and lower. At first it was show up at 7/8 cms (I live between 35 minutes and an hour away from the hospital) and you’ll probably not get a section without a medical reason. Now it’s down to 4-5 cms and I’ve still got months to go.
For various probably screwed up psychological reasons I don’t want a vbac. I don’t want to be pressured into one with the threat of “someone else’s dead babies” and yes, someone (midwife) said that to me… that I would being selfish if I persisted in demanding a section if I was labouring normally yet I have that hanging over me.
How……..how are you being selfish? A pre-labour C-section practically has the lowest possible risk for the baby, especially for a VBAC. You are the one taking the risk.
It’s only if I labour prior to the section date but I imagine the selfish component comes from demanding a section I may not need if I’m labouring “normally” and dilating quickly.
For some reason that they have yet to explain to me, everyone seems to think this baby is coming before 39 +. My theory is that it’s because they’re intent on stressing me.
But wait! I thought stress made the cervix not dilate! Or is that only the stress of modern medical interventions? :p
Sigh. I’m so sorry they’re giving you such a shit time. They’re being very selfish by not letting you make an informed choice for your own mental health that is, statistically, safest for the baby.
My husband thinks they’re being honest and that I’m too sensitive. That they don’t want me to think that if I labour pre-section date that I can just waltz into hospital and demand a section regardless of the circumstances.
If that’s the case I’m fine with that. I understand that there has to be a triage sort of system and that just because I have a scarred uterus doesn’t mean that I can automatically leap to the head of the queue if everything looks good with me and baby. Too many of my friends had sections for fetal distress for me to have an issue with that plus the labour ward at our local hospital does vbacs for a huge area plus inductions and any other “difficult” births so it’s always really busy.
What I’m not fine with is the emotive language and the refusal to take the olive branch of “we can discuss it when and if I’m actually in labour pre section date”. Given my feelings on the matter, I think that should be enough.
Also stressed about my cousin’s wife. She was due eight days ago with her first, still no baby, still no plan. Really into natural birth, wants a huge family and seems oblivious to anything which could go wrong. Worst from my perspective is that she is so into natural because of what happened to me with my section. I’ve tried to explain that it was the circumstances/what happened in my head not the surgery itself, but she won’t or can’t listen.
In the case of CPS, it’s not about the birth itself, it’s because the baby had an infected cord, and the mother didn’t take it to the hospital. That is medical neglect. Once the baby is born, it become it’s own being with it’s own sets of right that are entirely independent of the mother. The mother had the obligation to have the baby checked out after she was informed it was potentially dangerous.
That is true it would be medical neglect if she did not take it into a doctor when she noticed something out of the ordinary and was told the danger of what it was. I cannot say the time frame around this particular case but when I was referring to the threat of CPS it is sometime use to get people to give their kids medical procedures or vaccines that are the things that a parent might not agree with. I’m not trying to focus on that one thing I was just giving it as an example of some of the threats that are used against parents simply because a particular doctor or even the majority of doctors disagree with their decisions. As previously stated many times the majority of doctors are wrong and if there are doctors out there that can make Lucid arguments that the parent agrees with that doctor instead of the one in the hospital and their particular child’s case then calling CPS is clearly not the right thing anyway you get parents just not trusting the medical system and being more hesitant to bring their child in because of the threats of CPS then if there was no threat of that sort of thing. We have to get away from such absolute statements this is absolutely right or that is absolutely wrong medicine is practiced our doctors are practicing because they have not perfected it and we have to give parents latitude to make what they feel is the best choice for their child. Obviously there comes a point when it does become medical neglect but we need to be very careful about pulling that card. Algorithms do not fit every patient and many times the parental instinct is dead on even went to algorithm would say you should do something else as a treatment for that child
“sometime use to get people to give their kids medical procedures or vaccines that are the things that a parent might not agree with.”
Do you think child-seat laws should be done away with?
Well, there is a lot of questioning lately about the right of a parent to refuse medical treatment for their child based on their own values or religions. And I agree with this questioning, since kids can die or have long lasting health problem secondary to their parent’s choice.
You obviously do not know much about medicine if you think we work with algorithms. The individual variable of each patient are taken into consideration when taking decision.
And when it turns out that the ‘parental instinct’ was right, it’s not because they were right, it’s just because they were lucky.
I’ve seen it many times in my works. Let’s say for example that I see a dog that ate an object. The owners refuse the surgery (against medical advice) because they ‘feel’ it’s going to pass. Sometime it does pass, but it’s not because the owners had a good feeling. They were just lucky. And for each one of those lucky owners, I have another one who’s intuition was wrong and the dog died. They made a gamble and where lucky, that’s all there is to it.
If you decided to have a VBAC and it went well, it doesn’t make you better than the OB. You just took a gamble and won. Same thing with a Breech birth, or with refusing a C-section when your baby is in distress.
“not being very naturally minded when it comes to the birth process”
You say that like it’s an insult. The natural course of the birth process is one that has a fairly high mortality rate of babies and women.
“you don’t want to have a C-section except for under circumstances that are extreme ”
What are extreme circumstances? What is the odds of death to the baby that have to count as ‘extreme’ to you, Dan? And can you, as a bonus, relate that % risk of death to the baby to the risk of getting in an accident while driving drunk on the average American commute. It’s a handy baseline.
Does only death count? How about hypoxia causing brain damage? What is the % risk of that outcome that is ‘extreme’ according to Dan? Numbers, please.
“I’ve seen it many times” “You wouldn’t believe the number of absolutely illogical and irresponsible things that I’ve seen done to people in the hospital setting”
You can’t toss those lines off without more explanation. Why are you at ‘many’ hospital births? Are you a stalker? A doula? A janitor? What is your medical training that allows you to judge ‘illogical’ and ‘irresponsible’ better than trained OBs (many of whom are women with babies themselves, come to that – including Dr T, who has had a few ‘natural’ births herself)?
I find it interesting that you consider the ongoing process of evaluating approaches to interventions and non-interventions in a scientific fashion, then altering recommendations based on acquiring new knowledge, to be a bad thing. Do you think that the ‘natural midwife’ approach of never changing their approach, no matter what the data show, is superior?
How do you get that I think that it is ‘demeaning for a woman’s wishes to be respected’ from what I said? My response was only 5 lines long, read it again.
Can we have some “loser brigade” tee shirts printed up? It warms the bottom of my coal black heart to know that I’ve gotten under Kate Tietje’s skin.
Wow…..just wow.
I have chronic depression AND had PPD with one of my kids (though not the other). Someone being “mean” to you, especially online, doesn’t trigger it any more than eating a Hershey bar gives you diabetes. It’s a physical disorder (neurotransmitter imbalance) that affects your mental health.
And Kate “measles is better than autism” Tietje has some nerve. Her very livelihood depends on more people buying into the woo. She presents herself as an expert when she has NO education or training in nutrition, health care, child development, or pedagogy. And she tries to get people to pay her for her supposed “expertise”!
I just don’t get people who see this as a situation with winners and losers. Your child’s life/health isn’t a competition. The doctor doesn’t “lose” when you buy into the woo, your kid does.
Right? That was my first thought! It’s not PPD if you got upset that someone said something “mean” to you and you take 6 weeks to get over it! PPD is about the physical things that happen to your body after giving birth and you don’t just crawl back out of it, that’s the baby blues. So frustrating and utterly dismissive of the reality and experience that real women have with PPD. Its just another waving flag for attention, oh I’m a woman and I will get sympathy for PPD and so I need to say this mean woman made me get it.
I don’t think there’s any rational reason why a woman in this day and age, in the US, would plan a home birth. It’s safer to be right in the midst of competent care. I’ve had three babies. I felt safe in the hospital. I would have been very scared at home.
I knew it was time to adjourn to the hospital when I realized we were running out of hot water. They put me straight into an in-room hot shower when I arrived, while they got the room ready with all the equipment and supplies that might be needed. Conveniently enough, my water broke in the tub. It was dirty, so out came the fetal monitor (totally portable and unobtrusive) and the pediatrician was put on alert that he would need to be in attendance in case of meconium aspiration. I felt very safe, especially given the unlimited hot water supply, which was a great comfort : )
Dr. Amy, I’m an RN and agree with a lot of what you say, especially about unassisted home birth. I disagree, however, that parents who are working with a competent midwife, who’s working closely with an OB (I don’t mean an OB who meets patients for the first time in the ED, I mean actually working with an OB who knows the patient and all the variables.) and determines that homebirth is safe for the mom and the baby, are irresponsible. A skilled practitioner can safely use a doppler in the home or birth canter environment and recognize warning signs in time to get to a hospital. Prolapse and dysplasia can happen in the hospital just as easily as home or birth center, and again, a skilled, responsible midwife can call 911 and manage the situation en route to the hospital. There are thousands of people who get prenatal care, arrange with a pediatrician to see their baby within 24 hours after birth, only use midwives qualified to assess their newborn, and opt to go to the hospital immediately if the midwife says it’s necessary. We’re not all uninformed and negligent narcissists. Unfortunately there are some loud mouthed lunatics out there who have led such privileged lives that they can’t conceive there being someone in the planet who knows more than they do.
That’s great! You’re just disagreeing with something Dr. Amy has not said: she’s never written anything against competent, well-trained midwives working closely with an OB. In fact, she advocates for more of this type of midwife.
Read the last paragraph in the essay.
Right…
But would you agree that home birth as currently practised in the USA is unsafe?
And therefore that it is reasonable to advocate against home birth as currently practised, until it can be assured by legislation, professional registration or other means that a midwife attending a homebirth in the USA *is* competent and working within her competency and with appropriate medical backup?
Advocating against home birth, meaning advising women of the risks of the current system and ensuring that they are aware of the facts, BTW. Dr Amy has never suggested that women don’t have the right to deliver at home, just that it is patently less safe to do so, especially in the current “anything goes” CPM culture.
She isn’t against fully informed home birth. She’s written as much. The problem is that women, like me, are lied to, about the whole nine.
“Prolapse and dysplasia can happen in the hospital just as easily as home or birth center, and again, a skilled, responsible midwife can call 911 and manage the situation en route to the hospital. ”
Really? A cord prolapse or a shoulder dystocia (I assume you mean dystocia and not dysplasia) that occurs at home under the care of a midwife has the same outcome as one that occurs in the hospital with an entire team and immediate access to the OR?
The fact that certain emergencies where minutes count “can happen in the hospital just as easily as home” does not mean that the outcome is the same. Quite the opposite.
Actually, if the home birth midwife knows what she’s doing, prolapse can be safely managed en route to the hospital. And when home birth midwives are using portable US and other appropriate fetal monitoring techniques, shoulder dystocia can be recognized quickly and the mother can be in the OR very rapidly. There’s a huge difference between a safely managed home birth and an unsafe one. And by the way, I never said the outcomes would be the same if the mom stayed at home.
How do you define “safely managed”? And “very rapidly”?
Just out of curiosity.
Safely managed means prenatal visits/diagnostics and clearly defined qualifications for approval to home or birth center birth. Very rapidly, I’d say within a few miles of a hospital.
“A few miles” is a time period? Like light years?
parsecs
It is less than 12 parsecs!
Safely managed to me means: with the lowest occurrence of death or injury across a population of individuals whom I care for. I would like this to be as close to zero as possible.
Very rapidly in my mind is: 5-7 minutes. 10 minutes is damn fast, but not what I would call very rapidly
No decision that I could make as a responsible midwife to assure safety of my patient in an emergency situation by transferring to a hospital for care could ever occur ‘very rapidly’ if we were ‘within a few miles’ of the hospital. Never. Ever.
Maybe that means I’m a shitty midwife and not very skilled at what I do. Maybe that means I’m too far away from critical medical services that can minimize death and injury during childbirth.
I used to think homebirth was safe. Or safe-ish.
I can’t ignore the logistics of the distance to the hospital, though. That, in itself, increases risk.
Many people will have “safe outcomes” at homebirths. In fact, MOST will. But a few will be harmed by a complication that occurred too far from medical help. That, to me, does not fit my definition of safety. (See above)
How the HELL would you diagnose a shoulder dystocia with a Doppler?
I mean, it’s a blinding obvious clinical diagnosis.
No auscultation or imaging required and it is not preventable by foetal monitoring, nor entirely predictable either.
You may be an RN, but I don’t think you have much hands on obstetric experience.
I believe I already said multiple times that I meant cord prolapse. I was multi-tasking when I wrote what will definitely be my last post here on any topic.
A wise decision. Thank you.
Nope, the outcomes would be “good enough”, because some babies were just mean to die or sustain a birth injury, right?
Why would that be an acceptable level of care for any patient? “Good enough” isn’t good enough. The infrastructure in the US and in many other countries as well, is not good enough to manage home birth transfers safely. It’s reasonable to find home birth inappropriate, across the board, when it means “not the same” outcome as a hospital birth.
Did I say babies dieing was good enough? Good grief, I thought for all these months that I’ve been reading Dr. Amys posts that it was the unassisted home birth people who were the loons, now I see that you’re all whackadoodles
IF. That word right there is the crux of the matter. And with so many under-trained and under-educated “midwives” presiding over home births, you are taking a very big chance. There are too many home birth midwives who eschew any form of diagnostic testing that might help to diagnose problems ahead of time (like GD testing, ultrasound, etc.), and they routinely refer to high risk scenarios as “variations of normal.” Very few home birth midwives have the types of relationships with OBs and hospitals that would facilitate crash sections. They often do not pre-register their patients at hospitals, withhold medical records, and even tell their patients to lie to the doctors.
As someone who had an extremely serious complication after a “textbook” unmedicated delivery (this was how my CNM described it), you are extremely cavalier about the stress and mental anguish that emergency scenarios cause. I had a cervical laceration, and I still vividly remember the manual exam of my uterus that was undertaken without pain medication. It was absolutely necessary, but it was horrible. I was fortunate that I was in a hospital where I could be wheeled down to the OR for a surgical repair, but I still narrowly avoided a blood transfusion, and the experience stayed with me. You act like a transfer during a prolapse or dystocia isn’t really a big deal. That is ludicrous.
Did I act like that? I’m sorry you had a traumatic experience, really I am.
I don’t think that you necessarily intended to minimize these experiences, but the bottom line is that a cord prolapse or a dystocia are emergencies. To keep a baby alive during a prolapse requires someone to hold the cord to prevent compression, which means having their hand in your vagina for however long transfer takes. That would be terrifying. In an unresolved dystocia, the baby is not getting adequate oxygen either, and time equals brain. That is also a terrifying emergency to manage at home. My point is that when things go wrong, they go very wrong, and stating that a competent midwife can handle this and that all will be well is far from certain. There is a lot of anxiety, pain, and chest-crushing fear when you know that you and/or your baby are at risk of death.
I second the request for you to define how rapidly a person at home can get into the OR. Because multiple people here who would know say that it’s agonizingly slow, even just to physically get there, to say nothing of what happens between when you roll in the doors, and when the first cut of the C-section happens.
“prolapse can be safely managed en route to the hospital”
Sometimes a baby survives, often it won’t even if you do everything you can. You can stick your arm in and try to hold the baby off the cord, but depending on the position of the baby and the cord and the strength of the contractions, it frequently doesn’t work, and that is IF you notice the prolapse in a timely fashion (not a given unless a woman is hooked up to continuous monitoring…something not available at home)..
“when home birth midwives are using portable US and other appropriate fetal monitoring techniques, shoulder dystocia can be recognized quickly ”
LOL! Midwives need an ultrasound to notice that the baby is stuck with its head out of the vagina to the level of the neck?! If they need special equipment to notice that it’s no wonder they have such abysmal death rates.
Okay, as an OB with almost 2 decades of experience, I can’t even entertain this. Your credibility is officially in question now, for the following:
1) Cord prolapse can NEVER be safely managed. You can do lots of fancy manoevers to minimize cord compression, but you still can’t alleviate it completely: try to hold the head up vaginally, try to retrofill the bladder. But the ONLY “safe management” is a crash cesarean section.
2) There is no fetal monitoring or portable ultrasound that “recognizes shoulder dystocia”. You recognize shoulder dystocia because the head comes out and the shoulders don’t. Although there are risk factors, most shoulder dystocias are unpredicted. And then you have about 7 minutes until you have a baby at risk of severe brain damage, assuming the baby’s oxygenation was good when the head delivered.
So many qualifications here that are often unmet in OOH birth in the US, though.
Also, as a nurse, would you rather deal with a cord prolapse at home, or down the hall from an OR? I’ve been in the OR with a patient who had a cord prolapse – and I tell you what, none of us felt we were working fast enough to get that kiddo born – AND WE STARTED OUT IN AN OPERATING ROOM. With a prepped patient.
When seconds count, it all takes too long. In theory, and in our minds, we all act heroically in an emergency. I cannot fathom willingly dealing with an immediate, life threatening emergency such as a cord prolapse in a home setting. Even if it occurred in a location “5 minutes from a hospital” – the most reasonable, sane estimate of ‘decision to incision’ has got to be at least 45 minutes. If not longer.
There is no teleportation to an operating room. Don’t minimize the risk of distance alone. In an emergency, you could be giving birth at home with an awesome obstetrician – that distance to the OR and timely surgery is the problem. Not necessarily the skill of the provider.
A responsible home birth midwife wouldn’t agree to work with a mom in a rural setting. And when I say skilled, I mean a midwife who has the knowledge and clinical skills necessary to evaluate the variables and determine if a mom is a candidate for home birth.
How are you to know ahead of time that working with a mom in an urban setting is a good idea either? You can’t predict what traffic is going to do on any given day. I live in a city with at least half a dozen hospitals, I live within 5 or 10 minutes of one, but roads are currently being torn apart, wrecks happen, rush hour happens, and a big one here – game day happens. A 10 minute trip becomes an hour.
How “city” am I that my first reaction was “well, of course you walk or take the subway, roads are a total gamble!” (There are several hospitals within 30m walking distance of me, one ~10m walk. None are even Catholic. I’m very spoiled.)
I found subways (and especially city buses) to be a gamble, too! I lived in Alphabet City in NY and there wasn’t a hospital that close by and the subway was at least a 15 minute walk.
Subway?!? No way. I can’t tell you the number of times I’ve been in a subway train that is unmoving supposedly “because of train traffic in front of us.” You’re underground with no way out of the train. If that train gets held up you have no options.
My experience (admittedly mostly limited to the main Manhattan 1/2/3/4/5/6 slate) has been that attempting travel on the roads is far more likely to go totally sideways, but yeah I’ve had some subway experiences (the C is some Kafka sh*t).
How California am I that my first reaction was “Well, get on a motorcycle, you can lane-share.” Now that would be a fun way to get a laboring woman to the hospital…
Saw a documentary – Babies(?) – while preg with my first, so 2010, that followed the first year of life for a few different babies across the world, and the Mongolian woman rode on the back of a motorcycle home with her baby. Assuming she got there that way, too. I hadn’t been in labor yet. In retrospect, yikes! I was in transition (though didn’t know it till we got there) while riding in the car during the labor of that first, and Jesus, every bump in the road… I remember my husband asking about the a/c and music and I was just SHUT UP and DRIVE please. Motorcycle… Lord help anyone who has to…. At least they can’t be asked about their comfort during the ride?!?
A branch of the midwifery practice that delivered my children has opened a birth center in our city. They brag about how close it is to the hospital, but it’s still driving distance. At rush hour, that’s a real gamble.
Thankfully, we just got a CNM-ran birthing center that’s actually in a hospital. You can go all natural and it has the home-like setting, but if you find you hate labor pain, they have epidurals! Seems like a decent compromise to me, but I’m sure the hardcore ones don’t find it acceptable.
The hospital I gave birth even has that kind of facility right in the labour ward. As in nice rooms, bouncing balls, tubs, whatnot, midwives all over the place, and still also doctors and an OR next door. Also, WiFi and pay TV (clearly you don’t want to miss Game of Thrones while in labour.) Ok, it’s a private hospital but insurance to cover it is pretty standard.
Some German mum friends tell me their hospitals had this kind of labour ward too (minus the pay TV), and that was even all public.
I like how this just removes the whole line “but hospitals are so cold and intimidating” problem.
I have a pretty dim view of this decision. I could see that some of the younger midwives were more into the woo than I was comfortable with during my last pregnancy (for instance, I asked for physiotherapy for SPD, and instead I got a referral for chiropractic). I had absolutely no problem having an unmedicated delivery in the university hospital. No one asked me if I wanted pain medication, I was able to drink fluids during labor, pushed in every position imaginable, etc. There was even an inflatable tub for labor (but not delivery). I see this as a way to cater to upper middle and upper class white women who want to give birth in a homey environment. There is no other reason as to why they would do this.
Yeah, but women who might otherwise choose a freestanding birth center or home birth can deliver in more safety. My local hospital got one of these wings, too, and I’m really hoping that women will choose this center with the CNMs and the operating room down the hall rather than going with the CPMs and hoping that no emergency occurs.
I might not have been clear – the CNMs were already delivering in a hospital that offered these things, but they opted to open a free-standing birth center not attached to the hospital. That’s the part that I’m having problems with. They already had a great thing going.
Absolutely. I don’t understand the dim view, tbh. It’s not for me, any future babies would be repeat section in any case, but they’re pretty popular and have decent stats too.
In Australia, “birthing centres” are generally the less clinical end of the labor ward, decorated in a more homely fashion and with baths, music etc if you want, where the lower risk labors can proceed. Then, when emergencies happen, the rest of the hospital is just down the corridor.
Best of both worlds, in my view.
Like hospital based MLUs in the UK. They’re pretty popular.
Where I live, we have winter storms, blizzards and ice.
Where I live we have predictable annual riots, co-inciding with a two day public holiday with reduced hospital staffing.
The maternity hospital is on an interface (“flashpoint”).
My due date with my daughter was 4days after the worst usually happens.
The year after my daughter was born one of my friends had a petrol bomb thrown at her car as she drove into the hospital at 2am… she was the paediatric surgeon on call.
There are some things that really test my opposition to the death penalty.
Or god forbid 2 games and a presidential campaign speech. Ah, to live in a swing state and a town with 3 professional teams.
And you can’t run out to your car when you’re having contractions and some fool has her hand wedged up your vag
The thing is though, you can be an excellent candidate for home birth right up until you’re not.
I was told approximately 65 hours before my son was delivered by emcs that I was an excellent candidate and that was by an NHS midwife with years of training behind her.
If you get the gamble wrong, the stakes are incredibly high.
Indeed, as I too would have been until a few hours before my EMCS (under 35, previous VB, well positioned singleton etc). That said, NHS homebirth midwives are usually pretty good about transferring at the first sniff of trouble. Usually.
Therein lies the problem. Here in the US we have CNM’s (Certified Nurse Midwives) who are the equivalent of midwives in Europe, Australia, etc. They have a nursing degree plus years of extra education/training AND an exam and a board to oversee credentials. They also carry malpractice insurance. Very few of them do home births; they work in conjunction with OB’s in birth centers/hospitals.
The CPM’s (Certified Professional Midwives) are the ones who do the home births. They recently tightened up their standards to require a HIGH SCHOOL DIPLOMA. No college/university degree required, never mind a couple of years more of specialized training/education. Just a high school diploma. They have an approximation of the apprentice system; a CPM “in training” has to assist a “real” CPM in as few as 20 births and then be the lead midwife in as few as 20 births. There is then an online exam to take and if you pass it, then you can hang your shingle and start “practicing”. They are the “space holders”, the ego-strokers, the cheerleaders, the “trust your body and birth” promoters, the non-charters, non-note taking, transfer-delaying, GBS denying, GD minimizing, prenatal care eschewing, outright DANGEROUS PEOPLE. One of their number wrote a book on how to avoid prosecution when things go badly. How to hide money, how to pack up your kit bag and move on to another state and continue practicing. They have no malpractice insurance and are big proponents of “babies die in hospitals, too.” They value the “pregnancy journey and birth experience” over maternal and fetal/neonatal health and well-being. They will slip the mother medications on the sly (pitocin and cytotec) and not tell the mother they did so. THESE charlatans are the ones who need to go away and stay there.
That being said, OOH birth with a properly educated midwife is STILL more dangerous than a hospital birth. You should be allowed to choose either midwife-led care or OB-led care when you are pregnant, once you have been informed of the pros and cons of each option. There should be strict risking-out criteria and first time mothers should deliver in a hospital. Subsequent deliveries, once she has a proven pelvis, could occur at home if she so chooses. VBAC’s should be addressed on an individual basis and be delivered in a medical setting. You cannot guarantee a woman a successful vaginal birth with minimal to no damage to either the mother or the baby. Things can go awry quickly and there is precious little time to deal with the issues that crop up: Shoulder dystocia, cervical lacerations, retained placenta, PPH, placental abruption, 3rd and 4th degree tears, cord prolapse, tight nuchal cords, short cords, breech positioning, head entrapment from breech presentation, meconium aspiration, etc. Minutes, hell, seconds count when there is an issue and medical help needs to be immediately available, not “5-10 minutes away.”
It’s interesting but the criteria you describe are very similar to the criteria for being accepted as a patient with the birth center I opted for.
Link? I’m curious about this supposed utopia.
You completely failed to respond to the main points: that even a “responsible home birth midwife” would still be increasing the length of time it takes to respond to an emergency because transfers don’t happen instantaneously. Also you’re completely ignoring that we’re talking about emergencies like cord prolapse or shoulder dystocia, which cannot be predicted by evaluating the mother beforehand.
Also, you don’t seem to understand the US system (perhaps you are not from the US?). You seem to be imagining a scenario where the homebirth midwife works under an OB or has admitting privileges to a hospital so there can be a smooth transfer of the patient and all information. That’s not how it works here.
Very perceptive, I actually have dual citizenship. And yes, I know it’s rare but it does exist because that’s exactly how I had my baby.
No, you said you gave birth in a freestanding birth center run by an MD and NOT AFFILIATED with a hospital.
Right. But in the US, that’s what you have.
The majority of home births in the US are done by CPMs, who don’t know the first thing about clinical skills. There are CNMs who do homebirths, but are mostly the whackaloons who are driven by ideology.
I’ve said it many times, if homebirth in the US was done the way you’ve suggested, this blog wouldn’t exist. But it’s not, and so we are here.
https://elmcitydad.wordpress.com/the-birth-of-silas-orion/
Attended by two cnms.
Wow, that blog is so raw and honest. I’m so glad they had another baby even though I know it doesn’t change what happened.
The fact is that there are thousands of CNMs, ND’s, and OBGYNS who are competent, responsible practitioners, who can be relied upon. If the parents don’t educate themselves enough to know how to choose a midwife, then they shouldn’t be considering home birth. When I was shopping around with my last pregnancy, I interviewed several midwives, birth centers, and doctors before fining a birth center where I felt comfortable. Meaning comfortable that my baby and I would be safe, not comfortable with the lighting. My birth center is run by an MD, and it’s not affiliated with any hospital or network. I spoke to midwives who would have taken me on up to 36 weeks with no prior blood work, and that’s totally crazy. But that’s not all of them. There are good, educated, experienced professionals out there who can do this well.
Sorry, I aspire to a better standard than “buyer beware” when it comes to maternity care!!
NDs? Naturopathic doctors?
No, they are not competent and responsible. They peddle horsesh*t.
Here’s just one example:
https://www.naturopathicdiaries.com/one-question-nplex-exam/
Can you explain exactly how someone, say, learns that their midwife was banned from practice in in another state under another name?
If your birth center wasn’t affiliated with a hospital, you might not have been able to get to a hospital in time in case of an emergency. It doesn’t matter that you felt safe, you and your baby were not.
The top story on the “HurtByHomebirth” link has just such a story. The birth center was just across the street from the hospital. It still took a LONG time to get in there. Other people here who actually work these kinds of cases has repeatedly said the same thing.
How is a layperson who “trusts birth” supposed to judge what is or is not crazy?
If there are so many good out of hospital midwives, why does the CDC WONDER database show that out-of-hospital midwives have death rates many times higher than in-hospital ones? We know those stats grossly underestimate the true death count of OOH birth, because it’s counting transfers as having happened in hospital.
AN experienced midwife would understand that having a low-risk, healthy pregnancy does not preclude having unpredictable mechanical complications during labor – obstruction, cord accidents, bleeding.
Oy my, I died when a local journalist (who’s usually great) ATE the spoon-fed tripe from local activists that ‘direct entry midwives are just what rural Alabamian women need, because then they don’t have to drive an hour plus to the hospital while in labor!’
Yeah, they’re not only saying this in Alabama.
It’s freaking insanity to claim that CPMs solve the issue of access to maternity care. Especially when there are no maternity units in rural hospitals for these midwives to transfer to.
CPMs are delusional themselves. (I’ll fess up to having been a delusional apprentice CPM myself at one time – so I speak from authority on this issue). They really do believe they’re offering some sort of improvement in care. But it’s just nuts.
Even if a midwife has an insanely low cesarean rate with her patients – say 5%. It’s not ZERO. And those people need access to real medical care, and a real hospital and to real physicians who can provide surgical care.
What the hell is their birthing cabin in the woods 67 miles from anywhere going to do to improve birth outcomes?
Oh, they’re just nuts. BAH!
I wrote a letter to the editor on it, but balked on sending it when I found out that your name and email has to be published. Those folks are unhinged, and I didn’t want to expose myself to possible retribution. I probably should have anyway, since I found myself duking it out with the local ICAN group on Facebook a few months later…
Sure and if a cord prolapse happens at home in the USA with a competent midwife a woman can experience what it feels like to have said ME’s had inserted into her vagina to hold the presenting part off the cord, not just until the ambulance arrives, not just until she arrives at hospital, but until the baby is delivered by CS, probably a minimum of an hour after the cord prolapse is diagnosed.
Which is exactly the situation my mother was dealing with in Zimbabwe in the 1970s- women arriving in the back of pick-ups with the granny midwife of the village elbow deep in the woman’s vagina holding the head off the cord. Sometimes the baby even survived.
In a shoulder dystocia you have minutes until the baby dies. Of course the majority can be resolved with McRoberts and suprapubic pressure, but what about the 20% that can’t? Well, in that case the MW will be cutting an episiotomy, breaking your baby’s clavicles and attempting to deliver your baby as fast as she can while your husband and her assistant hold your legs back, and you better hope the baby is out before the ambulance arrives.
If you’re going to tell women that their midwife can manage cord prolapse and SD until they can get to an OR, why not actually tell them what “managing the situation” involves, and manage their expectations of how fast a transfer and delivery can actually happen if it all goes pear shaped.
Too often women are told that the midwife can “manage the situation”, that “the hospital is just minutes away” and that “we’ll be able to detect a problem with plenty of time to transfer”. None of that is necessarily true in the case of real obstetric emergencies and you know it.
I used to work with CPM in an out of hospital birth center. I remember one transport – an emergency transport – where it took us 22 minutes from the decision to leave the birth center – which was 4 blocks from the hospital – to get inside the door of the emergency room.
That was just getting the mom *in the building*.
When parents hear that a birth center is only “4 blocks from the hospital” they aren’t imagining that it will take over 20 minutes just to get into the door of the hospital.
It was another half hour before she was in the OR.
This is not an issue of the skill of the midwife – this is an issue of distance to the hospital and the logistics of getting a patient admitted and prepped for surgery. There is no STAT c-section in a OOH situation. You can call it STAT – but it’s gonna be an hour, most likely.
Which is what I want women to be told.
I’ve been at crash CS in hospital where the baby was OUT within 5 minutes.
With a bad SD, where 10 minutes has already been wasted with fruitless manoeuvres, those 5 minutes might just be quick enough.
With a SD, remember, the baby can’t breathe and the cord and great vessels in the neck are compressed. Time is of the essence and is just what you don’t have OOH.
This exactly. I lived across the street from an ER for several years. I had a bad reaction to a medication once, gave me a mini stroke. Took me almost a half hour to be admitted. Literally a 5 minute walk and it took 30 minutes to get me there (husband called ambulance as he was afraid to move me), in a room and with a doctor. And it was a very quiet night, a lot less patients than usual but still their full staff there.
So anyone who thinks a hospital is 5 minutes away is right…but to get help a hospital can take much longer than that.
IMHO, the skill of the midwife means very little once you’ve reached a complication that cannot be resolved without hospital technology.
Skill of the midwife or the best damn surgeon in the world – doesn’t really matter if you’re nowhere near an operating room.
I suppose the best damn surgeon could do a perimortem cesarean in the field. Not something I really want to think about. And not something that comes to mind when one thinks of safety. Or any sort of a positive birth experience.
Anyway I don’t want to discount the skills and ingenuity of trained surgeons. In a low resource setting (aka home birth), a trained surgeon would have some additional skills in a really shitty situation. I do think they highly prefer operating in an OR, though.
But there really is no equivalent to having readily accessible an operating room, trained staff, medications, anesthesia, NICU and a blood bank. Interventional radiology is rather nice, too.
We agree. It has nothing to do with the skill of the provider. The location (distance from the hospital) is the problem.
I was due in mid-January with #2 and my OB lived about 3 blocks from me. I joked with her that she was on speed-dial in case of labor during a blizzard and she said “I’ll just call 911, same as everyone else”. (I said I was having the ambulance pick her up right after me, so I knew I had a skilled provider along with whatever resources we could get to.)
Exactly. And in a lot of the US, the average person lives really far away from an OR, or even just a hospital. My dad lives in such an area–about ten minutes from the nearest town with a clinic (open M-S 9-4, or some such), but more like an hour from the hospital. Oh, and the EMTs are all volunteer. You call 911, as he’s had to do when he had a heart attack or a bad diabetic episode, and…wait. A lot. The dispatcher pages the volunteer EMTs. Volunteer EMTs drop what they’re doing (harvesting? Planting? Housecleaning? Grocery shopping?) and make a run for the station, where they pick up the ambulance and head to you. Takes about 15-20 minutes, if you’re very lucky, and then these are EMTs–they can’t do a whole lot more than pressure, CPR, and a few medications, not being paramedics. Then you have a solid hour-long ride to the hospital, maybe closer 45 minutes *if* you never hit traffic AND the roads are passable (not icy/snowy/wet) AND you don’t hit traffic in that town AND it isn’t night, when you have to slow down to avoid hitting deer.
god that’s horrific
“The hospital is just minutes away.”
Yep, and so is the death of a child who could have been saved by immediate professional intervention. Even in a hospital birth, it’s gotta be a white knuckle elevator ride to the OR, hoping you’re not too late by the time the door opens. Very well put, Dr. Kitty.
I’ll give you the benefit of the doubt and assume that you have not read the many times that Dr. Tuteur has made a distinction between CNMs and lay midwives.
How proficient do you really think a midwife like Jill Duggar is at neonatal resuscitation? You really think she is skilled and practiced enough to intubate a newborn? You really think that’s a procedure that can wait until 911 has been called and the ambulance shows up?
and even then, how skilled and equipped are EMS at neonatal intubation and resuscitation?
Right, like they keep neonate equipment on the truck?
This is definitely a problem, and I’ve never seen a homebirth advocate acknowledge this.
In my area, for example, EMS is generally equipped but not necessarily skilled enough. I’ve seen multiple babies over the years arrive with their stomachs being obviously ventilated and another who had been correctly intubated, and yet extubated/reintubated *multiple times* in response to CO2 detector readings. (Any experienced provider would anticipate delayed detector response with a severely compromised infant and not immediately extubate them.)
What does Jill Duggar have to do with it? I don’t know the first thing about her or her qualifications. As for intubation, yes there are many home birth midwives who come prepared with both the knowledge and the supplies necessary for emergencies. If you want to discuss laws surrounding licensing requirements for CPMs, that’s definitely something this country needs to improve on. However, the fact that there are bad ones doesn’t mean that there aren’t any good ones. Unfortunately the negligent make better news, so you hear a lot more about them.
Homebirth midwives intubate? I’m calling bullshit on this one. BVM maybe, but intubation? I can intubate a god-damned insect, but I’ve NEVER heard of a homebirth baby Intubated in the field by anyone other than a paramedic.
My favorite conversation along this line was a Reddit AMA a while back with a CPM home birth mid-wife. She was under the impression she was prepared enough, as a *Basic* NRP provider with O2 tanks and an infant resuscitation bag, to provide complete resuscitation … except for a *tracheotomy*! That, of course, she can’t do. LoL
“Unfortunately there are some loud mouthed lunatics out there who have led such privileged lives that they can’t conceive there being someone in the planet who knows more than they do.”
You mean like the sort of person who would try to school a bunch of doctors about how homebirth midwives are safe because they can diagnose a shoulder dystocia with an ultrasound machine?
I’m sorry, I was under the impression that I was posting a discussion topic, in a forum that’s open to the general public, I didn’t realize that I was “schooling a bunch of doctors”. And I never said dystocia can be diagnosed with u/s, I said many complications can be avoided when the midwife uses one.
“When home birth midwives are using portable US and other appropriate fetal monitoring techniques, shoulder dystocia can be recognized quickly and the mother can be in the OR very rapidly”.
That is what you said.
Copied and pasted.
You DID say “portable ultrasound” could be used to recognise a shoulder dystocia quickly.
Which is ridiculous, and which you were called on.
And even if you meant to say that ultrasound imaging could be used to predict and prevent shoulder dystocia before it happens… not so much either. Shoulder dystocia remains hard to predict and difficult to prevent. It can happen with normal sized babies and not with macrosomic ones.
So you’re wrong all the way around.
I’m generally with you. I think that women who choose to birth at home need to understand that there are risks and benefits to homebirth with a skilled attendant.
Benefits: Far lower chance of interventions (forceps, vacuum, epidural, cesarean section, episiotomy)
Risks: Possible need for emergency transfer to hospital. During emergency transfer to hospital, there is a delay that isn’t present in the delivery room and as a result, in the very rare case of a true catastrophe (unresolving shoulder dystocia, cord prolapse) the risk to the baby of brain damage or death is higher with home delivery.
In this balance, there isn’t a clear winner for everyone. For many modern women, who are highly risk averse, delivery in hospital is a better choice. For some women, who have a strong desire to avoid interventions, the small risks are worth it to deliver at home. There is not a one-size-fits all solution, although it is easy to the case made in that direction.
The problem with your viewpoint is that you are assuming that women have 1) good information and 2) access to “skilled attendants.” I’d posit that in the US, most women have neither. They’re convinced by propaganda (or outright deception) that “interventions” are worse than they actually are; and they don’t have access to truly skilled attendants. It’s not a blank slate with expert mothers making truly informed decisions. Look at it this way — there is a VERY small percentage of women who, if the actually suffered one of the “true catastrophes” at home and lost a baby because of it — would not chose to reverse there decision. The ONLY women who should birth at home are those who can truthfully say “I’d rather than my baby die than be born in a hospital.” That’s a very small number.
Me! I’m one that was sold on the BoBB Ricki Lake/Ina Mae BULLSHIT-presented-as-fact. Fortunately, my first child and I were fine after a birth center birth. Also fortunately, I found this site whilst trying to conjure a way to convince my husband to enable me to birth at The Farm for the second baby. (We don’t live that far from them.) Thanks to ALL THE GODS that this site came up when I searched for The Farm. Once I understood that the bullshit was absolutely BULLSHIT, I gladly requested an induction and epidural, and would have been fine with a c-sec the MOMENT it was indicated, if that had happened – because now I get it, a c-section is NOT the thing to avoid, DUH…DEATH IS. Sad that it took a good, “mean,” straight-talking Yankee to lay that out for me, even after a shitshow of a first birth (though, with good outcomes, somewhat understandable that I refused to see it). God, conspiracy theories…. Just. So. Enticing.
The biggest problem is, those lunatics DO NOT call 911 when necessary, and even argue that it isn’t necessary long past when it is because they don’t want to face their own ineptitude. The majority of homebirth midwives are uneducated, ignorant CPMs who have no business pretending to be professionals when they have no idea what they’re doing.
As for dysplasia and prolapse happening in hospitals, true, but with a hospital you have an OR down the hall (or a couple of floors), blood banks on tap as well as resuscitation equipment.
At home you don’t have ANY of that and so the time it takes for a midwife to recognize a problem, get an ambulance there and get to the hospital can be the difference between a severely brain damaged baby, or even a dead one.
“Prolapse and dysplasia can happen in the hospital just as easily as home or birth center, and again, a skilled, responsible midwife can call 911 and manage the situation en route to the hospital. ”
Do you really believe that a mother in that situation gets to an operating theatre just as quickly as a woman who is already in hospital.
That’s just not plausible.
You can argue the right to choose, but you can’t argue that the choices are equivalent.
PPD….or guilt? Possibly “mamma” feels guilty because she knows she’s a selfish a$$ hat who could have killed her kid just so she could show off.
Dr. Amy,
Out of curiosity:
Suppose, for sake of argument, that the mother received the appropriate prenatal care from an OB-GYN, would the most glaring symptom (“candy cane striped” umbilical cord) or any other symptoms have been apparent during the fetus’s prenatal development or would this have been first observed during the birth?
Thanks.
She admits to suffering infection of some sort for weeks prenatally but you know, she was self-diagnosing and self-medicating…
There is no way that would have been part of standard prenatal care.
This is true. For clarity, I meant “suppose she was infected and then sought the appropriate prenatal care post-infection.”
She would have gotten prenatal care for the infection that caused the candy cane cord. If the baby was born with the candy cane cord or other placental abnormalities were evident at birth, the baby would have been carefully monitored for sepsis, possibly given antibiotics. Infections in babies of that age can progress extremely rapidly to life threatening.
In short, this kind of life-threatening complication is *exactly* why you go to an OB-GYN instead of Dr Facebook.
I had strep with my first and got antibiotics before anything else when I was in labor with him. My daughter seemed fine until she started to turn blue at a couple minutes of life. They put her on antibiotics just to make sure. THe baby next to her in the NICU had the same problem, but that baby, it turned out, did have an infection. (She was doing well by the time my girl was discharged, and hopefully is perfectly fine and the delight of her older brothers)
Thank you.
OT: Guess who spent the day applying to her local college so she could start her nursing school pre-reqs next year?
*takes deep breaths, possibly from paper bag*
I’ve wanted to do this since I was about 14. I’m 29. It’s about damn time I at least gave it a shot. Who knows if I’ll make it…but I’ll have tried, at least. And while you don’t get all the credit ;), the commenters here were a big part of that decision, as was our gracious hostess.
Now to go study harder than I ever have before.
Good for you! That’s a huge step!
Oooh good luck, that’s an awesome step to take!
I’m a bit scared, but so excited!
Good for you!
I hope nursing is everything you want it to be, but know that the humour and resilience you have shown here stand you in good stead when it isn’t!
Thank you for your kind words!
Well done! Keep at it.
Well done!
Thanks. 🙂
woo-hoo!
I’m excited out of my mind, to say the least!
Congrats on finding out what you want to do – and such a good vocation it is!
🙂
This is amazing! I know what you have gone through to get to this point, you are smart and patient and you can do this!
Awwww, thank you!
Yay! I don’t doubt for one second that you’ve got this!
Thank you! 🙂
Yaaaaay!
Good luck.
A comment from Kate Tietje telling me I’d made rational decisions all along would make me doubt every decision I’d ever made.
Wait What? She developed post partum depression because Dr Amy was mean? Couldn’t her baby’s health scare have played a role?
Huh. Well, she does seem to be starting to question things a little bit. Maybe having this complication will help her realize the whole point of obstetric medicine. Or maybe she’ll resolve her cognitive dissonance by deciding that it was rare and unpreventable and would have been the same in the hospital …
It’s sad to think that this is probably only the first of many medical crises the poor tyke is going to experience.
Where did she actually share the diagnosis?
https://www.facebook.com/search/top/?q=banned%20from%20birth%20pages
These babies need to be taken from these worthless parents. If they can’t care enough for their safety in their first moments, god only knows what’s around the bend. It’s sickening that I as an foster-adoptive parent, have to go through a battery of home visits, deep into my personal history which brings up crap I really would have preferred to leave buried, medical tests, and a ton of classes and continuing training to take in a child who has been waiting to be adopted for five years, yet these morons can just pop them out willy-nilly for their own arrogant performance art.
Just a bit bitter that moving our future son to our home has been pushed back due to two caseworkers in disagreement, when he wants to live with us. And him being 12, he’s old enough to make that decision per the courts, ugh.
I hear ya. DH and I have been talking about possibly adopting at some point. A friend’s husband is a social worker who works for an adoption agency, so I sounded her out on the basics of what to expect if we went that route. Among other things, it’s SOP to ask about the details of our sex life as part of the home visits. *cringes* I don’t really think I’m a prude, but, um, how is it any business of a stranger exactly what sort of foreplay DH and I prefer? And how the hell is it relevant? (Provided, obviously, that it involves just the two of us and not, of course, kids?!) I mean…EW.
OK, that’s not something we were asked about. We were asked how satisfied we were with our relationship as a whole, not sex details.
“Among other things, it’s SOP to ask about the details of our sex life as part of the home visits.”
Is this a state that has rules against gay folk adopting? Just wondering if that’s why it’s in there…
I’m not familiar with the exact regulations on gay adoption here, but I do know slightly a quite openly gay man who adopted a couple of kids with his partner a couple of years ago in this state, so I assume not…? I could be mistaken, of course.
So she has PPD and she’s blaming that on Dr. Amy’s advice to take her baby to a doctor for what turned out to be a real infection.
I’m wondering how “knowledgeable” any of these clowns could possibly be, when they ALL missed something that Dr. Amy was able to diagnose in one photo. It’s almost like…studying for years, having an actual medical degree and attending hundreds of births count for more than browsing Google U and “attending” 20-odd births for your rinky-dink CPM license, if you even have that. Who would have thought?
I spent some time in one of my graduate level stats classes messing around with how many nth birth midwives would have missed one or more category of “normal” birth. (I assumed that anything within 3 standard deviations of the mean was “normal” since that covers probabilities up to 1%)
Long story short: If you have 30 midwives at their 20th birth, the number of midwives never having seen a complication with ____ rate of occurrence is:
Complication with 34% chance of occurring: 2 (6%)
Complication with 13.5% chance of occurring: 7 (23%)
Complication with 2.5% chance of occurring: 26 (86%)
If you have 30 midwives: 40th birth:
Complication with 34% chance of occurring: 0 (0%) (Yay?)
Complication with 13.5% chance of occurring: 6 (20%)
Complication with 2.5% chance of occurring: 25 (83%)
If you have 30 midwives: 100th birth:
Complication with 34% chance of occurring: 0 (0%)
Complication with 13.5% chance of occurring: 0 (0%)
Complication with 2.5% chance of occurring: 24 (80%)
If you have 30 midwives with 300 births:
Complication with 2.5% chance of occurring: 9 (30%)
So, yeah. At 20 births, most midwives have missed at least one “normal” complication. At 300 births, 30 percent have missed at least one “normal” complication.
And I biased this in favor of the midwives. I counted a single incidence of a complication in the range as “has seen it”. I didn’t add a “saw it but didn’t recognize it” bias.
And even at 300 births, most midwives will not have seen the “kind of rare” complications that occur at 0.5% range or 1 out of every 200 women.
None of them have seen the super-rare complications that occur at 5 deviations away from normal – but those are the ones that scare me as a pregnant woman.
Wow, this is an incredibly clever analysis. Sadly I think most people are so innumerate that I don’t think it’s likely to impress them. They think 2.5% is so rare that it will never happen to them. But — maybe it would stand a chance of convincing regulators/lawmakers/licensing authoritis!
Yeah, they’ll think they have that one midwife that resides at the perfect Venn overlap of seeing them all.
just because you’ve played cow midwife more often than some of the cpm have seen human babies?
If I think about MAM’s post, especially in light of her recent rant about telling an OB that the patient refuses tests or follow ups. On that post one of her followers bragged about how she refused the glucose tolerance test and her OB warned that the baby could die. She of course, laughed it off and bragged about having a 9+# “completely healthy” newborn, soundly demonstrating the depth of their ignorance. I recall when I was having my babies and the GTT wasn’t standard of care. Two babies in my circle of friends were still born due to undiagnosed gestational DM.
In my case, one baby from undiagnosed GDM, another from GBS sepsis. Otherwise, full term and perfect.
So sorry.
Oh Karen, I’m sorry too.
*hugs*
So grateful the baby is ok. Wow that is scary, came out of the blue. It seems the mom had no symptoms before hand, and if she did, perhaps thought it was part of the pregnancy.
I mean, she may have been showing symptoms during/shortly before labour, but as she had no monitoring or intrapartum care…who would know?
“It seems the mom had no symptoms before hand”
Except for the chronic infection she was trying to treat by putting garlic and oils in her orifices.
“If you don’t take a temperature, you can’t diagnose a fever.”
To paraphrase The House of God
That seriously seems to be the motto of the extreme-NCB crowd, as opposed to a piece of satire in a work of fiction.
“Spread of experience, knowledge and information so critical to the birth community”….. “Wow what valuable information, thanks for sharing” … and the conclusion is to learn something about placenta pathology prior to your UC??? From where? With what context! If you could shortcut your way to this kind of knowledge by reading a couple chapters in a textbook why would anyone go to medical school?
There is a serious lack of insight demonstrated here. These people are confronted with their own ignorance and instead of thinking…. wow, I really didn’t know and what I didn’t know that I didn’t know could have killed my baby…. they think, “Cool! I guess I’ll just read a couple more things on the facebook UC group for next time.”
Here is a shocking idea, maybe it would be a good idea to seek the aid of the educated professionals who hold a collectively immense repository of systematic knowledge about maternal child health. Oh no, that would be too mainstream.
“and the conclusion is to learn something about placenta pathology prior to your UC???”
Hey, you know who knows a lot about placentas? OBs! Maybe have one of them there, next time?
Hooray, I’m in a brigade!
do we get hats? or special T-shirts of some kind?
I still haven’t gotten any Shill Bucks.
I don’t get shill bucks from here OR the FB pro-vax groups I’m in. This is getting to be a ripoff!
I still haven’t received my Shit Mom shirt.
Brigade of losers, hooooooooooo
I call the band name!
I love the irony of being called a loser by the idiot who did not have her third/fourth degree tear repaired and who walks around with permanent damage to herself caused by her idiotic ways.
There’s a story out there of a wild dolphin that went up to some divers when it had a hook or a net or something on one of its fins. The divers removed it and it swam away quite happily. A frickin’ dolphin made more sensible medical decisions than these clowns.
the less inspiring sequel to Band of Brothers.
Better than “basket of deplorables,” I guess
Hey, could you help me out? Why do people choose an unassisted birth? Why? I mean, homebirth with a midwife, I can somehow understand. But why unassisted? Alone? I always thought, that through history and through the world it was more “normal” for women to help each other through birth, than to do it alone? At least that is what I think I remember from that little house series: If a woman got a baby, they tried to get the doctor. If he was not available, they asked assistance from a neighbourhood woman with birth experience. And that is how my granny from Italy told me it was in her village when she was young: Get the doctor. If he isn’t there, get the only nurse/midwife of the village. If she isn’t there, get a neighbourhood woman with birth experience. So, why unassisted? Would women not always choose to get the best available help/assistance?
You might be asking the wrong crowd, I fear.
No clue, myself.
These women are idiots. Nowhere in history has a woman ever birthed alone. There would be her mother, sisters and sister in laws and possibly some form of midwife or healer. And usually those female relatives would help nurse the baby while the mom/baby nursing relationship worked out its kinks and mom’s milk came in and take care of both baby and mother anywhere from a few weeks to a month or so. None of this dump the baby on mom and make her care for it 100% alone.
Social Anthropology was my other major, so I’m pretty informed on this topic.
Supposedly the Piraha in Brazil give birth alone on the riverbanks (including under water!) but I doubt the accuracy of the anthropologist who wrote it. He seems to have a very rosy view of their culture. It could be that some women are forced to give birth alone, but I doubt the women like it that way. It may be a deliberate form of birth control or infanticide/murder in fact.
IIRC, that was the tribe whose philosophy could pretty much be summed up as “if you can’t make it on your own, you ought to die.”
Me, I prefer to live in a society that doesn’t have that as its overarching motto.
Me too, but I can see why they might come up with that in an environment where having to care for someone who’s sick might impact on the survival of others.
rosy? didn’t he describe a woman screaming for help as she died, and was ignored by her family and neighbors?
Yes. I can’t find the original quote on the internet, if you google “jared diamond piraha childbirth” you can see the google books preview of his book with that bit. So that’s Jared Diamond quoting Daniel Everett, quoting Steve Sheldon. The other common place to find that anecdote is David Brooks, citing Jared Diamond. So make of that what you will.
Mabye rosy isn’t the right word, but he fits it into what he calls a “cultural” value that prizes self-sufficiency over all, and the gist of his story is that this self-sufficiency is often a better way than our weak sauce Western ways, with our OBs and our fancy science. What I think he fails to see is that it’s the men’s culture he’s reporting — the woman dying of a breech birth on the river bank might not think it was her “culture.” More darkly, I also suspect that in some cases the women was deliberately left without care if the tribe wanted her or the baby dead. In any event, as N says, these are cultures where it is not funny to be a woman, so hard to hold them up as any sort of example.
I tend to be highly skeptical of male anthropologists who worked without female colleagues views / understandings of childbirth from the women’s POV. It’s not that I think the male anthropologists are biased so much as many cultures frown on males knowing much about what goes on during childbirth.
I also think that many anthropologists are a tad clueless about how much work goes/went into making objects that are not weapons.
My fav. was an anthropologist team who worked with the Hadza on food gathering. Since they didn’t want to bias their results by giving gifts that were food-related, they gave clothing, textiles and jewelry.
It took awhile for someone to point out that making clothing from plant fibers is very, very time consuming so gifts of poly/cotton clothes and fabrics likely frees up substantial amounts of time to be used for food gathering instead which might artificially inflate the calories per person gathered and the overall amount of food available for the group……
Without any knowledge or studies in social anthropology, it is what I would have assumed. Never alone. And let the most educated/informed/experienced person around assist. So as we have very educated/informed/experienced persons around – doctors – we should use them. Our ancestors would have. The poor afghani girls probably would too if their situation would allow it.
I think I remember Waris Dirie in her book Desert Flower writing about women from her clan and others around hers giving birth. They went behind some bushes on their own to give birth. Yes, so unassisted birth is done. But than she also writes, that sometimes women just didn’t come back. And no one made a fuss about it. That was just live. (Ok, they had the complications of FGM, that probably didn’t make birth easier…)
So this example together with lawyer janes example from the Piraha in Barzil seem to tell us, that unassisted birth is a practice among people, where being a woman is just not funny at all. Hmmm…
Throughout English history (and in countries that practice(d) English common law) “concealment of birth” has been considered a crime.
My theory which is backed up somewhat by the Birth Trauma groups I have been a part of goes something like this:
1. Bad experience having baby 1. “Failure to wait”, OB wanting to play golf or just horrible experience.
leads to
2. Pregnant with Baby 2. Scared of the same thing happening, Midwives either risk them out (in Europe) because of what happened previously or they can’t afford.
So they freebirth (not necessarily alone, perhaps with sister/mother & female friend).
Obviously Baby 2 could be 3, 4, 5.
I can understand this a bit because the more pregnant I get this time around, the more I want to run screaming from my Doctors.
So I dont comment a whole bunch, but in my lurking I have followed your story. I just wanted to chime my voice in your support. You have had a lot of horribly shitty stuff happen to you and I really admire all that you have done to advocate for yourself. I have nothing useful to offer you going forward except my most sincere hope that you feel well and have more compassionate care providers during any future hospital stays. All of my best wishes to you and your family.
You have to understand that it is more of a philosophy (or religion/belief system) for them than a rational choice based on evidence.
Dr. Amy has written extensively about home-birthers/free-birthers/natural childbirthers, so I do suggest you go through the archives here – search under “unassisted birth” or “home birth” – for more in-depth information.
As I understand it, this is primarily a performance of the mother’s defiance against and rejection of modern medical advice, authority, and technology. They practice the belief that “pregnancy is not a disease”, that natural is always preferable to (their vaguely-defined) “unnatural”, and a kind of hippie-dippie romanticizing of Mother Earth and Woman as Goddess.
I think these women know that 14 year old Afghani girls attempting to freebirths often die. I think the rationalization they give is “well, of course I’ll go to a hospital if there’s an emergency”. I think their real reasoning is “I’m privileged, that’s why I’ll succeed where the poor village girl doesn’t.”
I mean, they have other reasons – sanitation, overall health metrics, lack of education – that they will claim are the “real” reasons the girls die. If only those girls were better educated/informed, freebirths wouldn’t kill them! Hell I could see these dingbats blaming anxiety and fear of their living situation for their childbirth injuries and deaths. I don’t think they’re even up to the point of admitting that birth-related emergencies happen, though once the goalposts have been moved they might get there.
i don’t know about you but my education is pretty sketchy in the area of childbirth
That’s because you haven’t done your google research. If you had spent a few hours on one of the unassisted childbirth sites, you’d be educated too. (Or so the claim goes)
*snort*
“”I’m
privilegedbetter than dirty uneducated foreigners, that’s why I’ll succeed where the poor village girl doesn’t.”I remember with my second baby, a VBAC at a hospital: At one point after many not painful hours of labour, it suddenly became very painful. I hoped, that I could soon push. But no, the midwife told me, the contractions were as severe as if I should already have an opening of 8 cm at least. But there was no opening. The baby did not go down to the pelvis. So I got another C-section. Assume, that I would have tried this at home: For how many more hours would the home-midwife have let me in that pain, without any result? For how many hours would I have waited before deciding to go to the hospital if unassisted? And how the hell would I have managed to get in the car, get to the hospital (only 7 minutes if no traffic, so really really “privileged”), in the hospital, answer all the questions? And I was not even a real life-threatening emergency!
Of course hospitals are staffed and funded in a way that assumes HB and UC are fringe practices.
Much like anti-vaxxers who rely on herd immunity, the US HB and UC crowd is only able to rely on hospitals because they remain a tiny minority.
Privilege is priceless.
They’re sold the bill of goods that “we’re made to do this! There’s nothing women can’t do, your body won’t build a baby it can’t birth, we’re so powerful!”
It’s not a far leap from homebirth with a CPM, DM or LM, to ‘oh, well I can just research on the internet and do it myself!’
That’s a good point about the short leap. Homebirth midwives sell themselves on ‘holding the space’ and ‘no interventions.’ So why pay someone thousands to do less, when you can do almost nothing for free?
I’m due in November, and part of a mommy group online of moms due in November, and one woman went from “I want a home water birth!” to “What do y’all know about unassisted birth?” in the course of 1 hour and around 15 comments on an online thread. I’m sure she considered unassisted birth before, but the volume of positivity she got about homebirth in one thread led her quickly to “well couldn’t I just do it myself?”
I silently wished her luck and moved on, because sometimes you just can’t get blood from a stone.
Yeah, my newer group is pretty woo-prone, too. sigh
Substance abuse during pregnancy is the biggest motivator for avoiding prenatal care.
It doesn’t make sense, but the reason people choose to give unassisted is due to an errant belief that ‘interference is risky’ and therefore even having a midwife present is going to disturb your birthing vibes and therefore mess up your *perfect* birth.
It’s a faith-based decision, not based on logic or reason or science, but based on a feeling that there is some pure way to give birth – and that involves complete isolation from others. There are all sorts of theories thate these folks make up – about the perfect cocktail of hormones that occur when they’re undisturbed, or about how animals give birth alone, or how birth is as intimate as making love to your partner and therefore should be undisturbed.
They truly believe that they are making a safe choice. They are delusional. Maybe willfully delusional…. but I don’t think they believe anything bad is going to happen to them. They worship the cult of natural childbirth. If the birth gets effed up, then they weren’t *undisturbed* enough.
I don’t know all the possible reasons, but the for woman I knew that always did it, it was a combination of things. She was dealing with untreated fairly serious mental illness, her husband was abusive, they were poor and her mental illness and multiple small children to take care of resulted in her never getting around to filling out the Medicaid paperwork to get insurance, deeply religious/borderline cult.
Again, all those people who drive drunk and don’t hurt anyone really show up all those a-holes who think we need drunk driving laws, too, right?
And the brigade of anti-drunk-driving activists, with our dislike of promoting drunk driving as safer than sober driving.
I am so glad the baby is okay. All of the “losers” on this site cared about whether this stranger’s child was seriously ill more than, apparently, the child’s own mother. Thanks for the update.
My chest was super clenched up for this kid.
I’m glad this baby is okay.
Gavin Michael Brooks was born only a couple of weeks after my son. I watched that whole horrible story unfold with my newborn sleeping on my lap at my computer. Heartbreaking and I still think of Gavin often and how his parents deserve to have the experiences that I’m having at any given time.
Gavin Michael had a similar due date to my child. I think about him a lot and think the same thing. That his parents deserved to have their kid around the way I have mine
I don’t know about any hatred, but she did manage to scare the shit out of me.
I was so worried about that baby I dug out my rosary and prayed. Repeatedly. I prefer being able to actually do something like pick up the baby and run to the hospital, but my hands were tied on that one hence the rosary.
Perhaps Lisa is unaware of the most basic truth in this situation: There were exactly TWO people who had some power to intervene in the situation: the mother (in the case of her body and her daughter) and the father (in the case of the daughter).
Corollary to previous truth: Only one person can do the work needed to fight PPD. The mom needs to see a real medical doctor to discuss medication or therapy or both. Her husband can be supportive, her NCB enablers can recommend the herb du jour, but she’s gotta start the process.
I’m glad that her baby is okay. Truly.
It’s really hard to eat crow and admit that you were wrong. When I’ve had to admit my mistakes, it’s never been fun or easy. But I do try to admit when I have been wrong because it’s the right thing to do. So rather than moaning about how mean Dr. Amy is, it would be quite refreshing to see some introspection and reflection on the part of this mother, an admission that her own hubris could have killed her child. I saw another screenshot in which she was trying to figure out how a recurrent yeast infection throughout pregnancy (which she did not seek medical treatment for) could have caused this larger, more serious infection. Well, I’m wondering if she had bacterial vaginosis, since it’s symptoms can be very similar to a yeast infection. If untreated, that can cause preterm labor and serious uterine infection. She’s quite busy complaining about how she’s having a hard time getting over this infection, but fails to admit that her own decision to purposely forego prenatal care caused this entire scenario. I see no admission that Dr. Amy was indeed correct, and that her child was in serious need of medical care. And that is a very big problem.
Spitballing here, but couldn’t an untreated yeast infection also make her much more likely to have an untreated BV infection over time?
Yeast are really good at changing pH over time and the chronic inflammation of the vagina would lead to microtears and all sorts of other issues that compromise the physical barriers that keep serum and other bacteria-friendly fluids in the body while keeping bacteria out.
Also, is she still dealing with the vaginal infection after 6 weeks after delivery? That sounds hellishly uncomfortable along with being a recipe for uterine infection as well…..
I too think she actually had BV the whole time. It’s very easy to go on with it and it just be super annoying but not painful to you.
Leaving a yeast infection untreated for months just really isn’t plausible. It gets too painful and you’ll end up with thrush in your mouth and who knows where else.
BV is impossible to get rid of without strong antibiotics too, where most yeast you can just use otc meds.
Thankfully, I’ve only experienced two, but I never put up with YI for more than a couple of hours before I was running to the store for some Monistat! I found the misery to be on par with the horrible itchiness I had with hives from a serious allergic reaction to sulfa, except you know, I could scratch my hives.
Yup. I’ve had both BV and a systemic yeast infection, the latter probably brought on by an asthma medication. I had yeast down my throat, and it was ungodly painful. The BV was annoying, but you bet your behind that I took the antibiotics that my CNM prescribed to get rid of that too.
This is where seeing an actual Dr for a speculum examination and some swabs would help.
Thrush and BV might give similar symptoms, but someone with experience can easily tell them apart, and swabs will confirm the diagnosis and ensure that there isn’t a weird resistant bug.
Also, you know what gives you raging yeast infections? Diabetes.
Which is something a I test for in anyone with recurrent, prolonged or hard to manage YI.
Other things that can cause problematic abnormal discharge- STDs, retained foreign bodies like tampons, cervical cancer, hormonal imbalances, allergic reactions, irritant dermatitis.
And I’ve had more than one patient who thought she had Thrush but turned out to have either lichen sclerosis or vulval psoriasis.
This. I thought I just had a yeast infection during the late first trimester or my first pregnancy. I was due for my pap anyway, and as soon as the CNM got a look, she said that my cervix was red and irritable. She took a swab, and started me on an antibiotic (it was indeed BV). It cleared up pretty quickly and didn’t recur. At that time, I didn’t even know how serious it could be for both the baby and mom.
I was wondering that, too. As nehimomma mentioned, YIs are pretty unbearable and for most people, also a pretty easy fix. I’d imagine if some OTC cream didn’t fix it right up, I’d be running to my ob/gyn, a quick care clinic, Planned Parenthood, or someone begging for relief.
I believe that she was using garlic. And a bunch of other things. I didn’t even know that you could get tea trea oil in a suppository. https://www.facebook.com/BannedFromBirthPages/photos/p.1235612849835256/1235612849835256/?type=3&theater
Well, of course! Hate to give big pharma a few bucks for a real cure so let’s give big EO many bucks for nothing!
I… I… What? What the hell did I just read?
I’m also wondering how it could be a suppository when it’s oil… But I don’t think I want to know.
Do you think she meant a pessary? Not that that’s much better, but at least it makes more sense with the ‘burning the baby’s eyes’ comment.
Probably. But yeah, the very idea makes me twitchy.
Tea tree oil is probably a lot more useful on your hair than in your vagina…
Because she really needed a tea tree oil allergic reaction *there*… People do the damnedest things.
My husband likes the smell of tea tree oil. I have no idea why – I think it’s kinda gross, but I had some, so I thought, I’ll put 2 or 3 drops in my bath water. Hopped in and my legs were on fire. I have no idea why 3 drops to gallons of water did that to me and why just my legs (maybe I had shaved them and they had tiny cuts?) but I cannot imagine shoving it up my vagina in a lot more concentrated form.
I was really curious where you going with this, in combination with “shove it up your vagina” context of the comment to which you were responding…