How dangerous is homebirth? This dangerous.


Last April, in an op-ed in the NYTimes, I explained Why is American homebirth so dangerous?:

The problem is that there are two types of midwives in the United States. The first, certified nurse midwives, called C.N.M.s, are perhaps the best-educated, best-trained midwives in the world, exceeding standards set by the International Confederation of Midwives. Their qualifications, similar to those of midwives in Canada, include a university degree in midwifery and extensive training in a hospital diagnosing and managing complications.

The other, certified professional midwives, or C.P.M.s, fall far short of international standards…

This second class of poorly trained midwives attend the majority of American home births…

The finding that homebirth with a CPM has a infant death rate 3-9X higher than hospital birth of comparable risk women is remarkably robust. There has not been a single study that has showed American homebirth to be as safe as hospital birth.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Homebirth with a CPM is a form of Russian roulette, but it is the baby who takes the bullet[/pullquote]

The risk of neonatal death at homebirth is not evenly distributed as demonstrated in a new scientific communication by Grunebaum et. al., Planned home births: The need for additional contraindications.

The authors note:

The ACOG Committee on Obstetric Practice considers fetal malpresentation, multiple gestation, and prior cesarean delivery as the only absolute contraindications to planned home birth. The objective of this study was to identify planned home birth patients who may have additional contraindications.

The authors looked at a large number of births, 75,065 home and 1,098,700 hospital births. This chart makes it clear that other risk factors dramatically increase the risk of perinatal death at homebirth:


These findings are not surprising. Modern obstetrics is preventive care and preparedness. Those in higher risks groups are more likely to benefit from preventive care and preparation for emergencies since they are more likely to experience emergencies.

Homebirth with a CPM is a form of Russian roulette, but it is the baby who takes the bullet. Mothers are gambling that they won’t experience complications; if nothing happens, homebirth turns out fine. But if they guess wrong, they are far from the lifesaving measures that the baby desperately needs. Not surprisingly, the baby dies as a result.

Moreover, this study undercounts the risk. As the authors explain:

Our study shows that there are sub-groups beyond those listed by ACOG as absolute contraindications which are at significantly higher risks of NNM including nulliparous women, pregnancies ≥41 weeks, and women ≥35 years of age. Our data are likely an underestimate of the actual NNM outcomes at planned home births as patients transferred to the hospital with likely higher adverse outcomes are not included in the planned home birth outcomes. These significantly further increased neonatal risks in women with certain characteristics should be added when considering absolute contraindications for planned home births, and must be disclosed as part of the informed consent process when counseling patients considering a planned home birth.

The findings highlight that birth affirmations like “trust birth” and “your body was made to do this” are unadulterated nonsense and being “near” a hospital isn’t good enough. There is nothing trustworthy about birth; in every time, place and culture, it has been a leading cause of death among young women and THE leading cause of death of babies. Indeed the day of birth is the most dangerous day of the 18 years of childhood.

To the extent that women’s bodies are “designed” to give birth, they are designed to give birth in the teens and twenties, not over age 35. Moreover, just as a premature birth can be deadly, postdates birth can also be deadly.

Childbirth follows the exact same principles as the rest of human health. Prevention and preparation are the keys to good outcome, not pretending that bad outcomes won’t occur if you just wish hard enough.

American CPMs are grossly undereducated and grossly undertrained. They are not recognized as midwives and not allowed to practice in the Netherlands, the UK, Australia, Canada and all other first world countries. They are midwife wannabes who can’t be bothered to obtain the education and training of real midwives and babies die as a result.

Thinking about homebirth? Think again!

66 Responses to “How dangerous is homebirth? This dangerous.”

  1. Merrie
    February 14, 2017 at 11:25 am #

    Wow, that graph is just absolutely chilling. I’d love to hear the pro-CPM crowd explain that one (actually, no, I probably wouldn’t).

    • Heidi_storage
      February 14, 2017 at 1:19 pm #

      “Pshh, that’s, like, one more dead baby per thousand.”

  2. February 13, 2017 at 3:06 pm #

    My in-laws had their first infant grand-babies in 2016.

    My sis-in-law had persistent hypertension that was controllable with drugs but caused her son’s placenta to degrade severely enough that he needed to be delivered at 37 weeks by CS. She’s fine and her son is thriving. He’s the world’s fastest commando crawler and has started pulling up on furniture.

    A home birth would have killed her son. A midwife may have picked up on his heart-rate crashing during contractions, but being 30 minutes away from a hospital without being able to stop the contractions would have severely affected him.

    Modern medicine saved me and my son from any one of several horrific death options from severe pre-ecclampsia with HELLP. Spawn’s doing well in spite of being born at 26 weeks. He now has a variety of grunts he uses for communication and enjoys playing mind games with the nursing staff by setting off alarms randomly and stopping the alarm when the nurse has approached his crib, but has not actually changed any settings on his oxygen. (And I am so proud of my little dude…..)

    I’m pretty sure many (most?) homebirth midwifes would have killed me. Accidentally, to be sure, but I’d still have died since I had no symptoms of HELLP beside vague stomach pains – and not located on my right side at all – and a feeling of anxiety that I couldn’t shake.

    In our local graveyard, we currently have two graves in our family plot of my husband’s grandparents who lived long, productive lives.

    I walked up there today and was quietly thankful that we hadn’t become the most heart-breaking area of cemetery by adding graves for my 28 year-old sister-in-law, her son, 35 year-old me and my son.

    • Sue
      February 13, 2017 at 9:39 pm #

      Thank you, Mel. There’s nothing like perspective. Beats ideology every time.

    • Montserrat Blanco
      February 14, 2017 at 3:03 am #

      I am really happy to hear that you and Spawn are doing well. I hope Spawn Gets discharged soon.

    • joycnm
      February 16, 2017 at 9:14 am #

      I’m a home birth midwife, a CNM. I took a patient to the hospital 7 hours after she’d given birth. I didn’t know what was wrong with her, but the fact that she was writhing in pain from back pain wasn’t normal. The doctors at the hospital ignored her for 3 hours until she had a grand mal seizure and they finally diagnosed HELLP. I had her there in time. The doctors couldn’t diagnose her in time. Not all home birth midwives will “kill” you. Some try to prevent this and the doctors drop the ball. PS. She survived despite the inadequate “medical care.”

      • Guest
        February 16, 2017 at 9:37 am #

        You let her writhe in pain for 7 hours before recommending she go to the hospital? You let HELLP go on for 7 hours before you recommended she see a real medical professional? What kind of CNM are you? You’re a major part of this inadequacy, and you’re bragging that you had a hunch that the doctors just didn’t see because they ignore patients? Good grief.

        • Roadstergal
          February 16, 2017 at 12:43 pm #

          Seriously, the 3 hour ‘delay’ she bitches about is less than half of the 7 hour delay she supervised. And she didn’t have the perfectly good reasons of ‘understaffed for the demand, overworked, not set up for this’ that ER docs have.

          And suppose the ER had been able to see her patient before she seized? Would that have resulted in a delay in seeing someone hit by a car, someone with a heart attack, someone with a gunshot wound?

          That’s a really bad part of homebirth. Instead of situations happening in the place that’s best positioned and trained to handle them, they happen (only worse, due to delays in picking it up in the first place and then transport) in places that are supposed to handle emergencies that could not have been predicted. It hurts everyone.

      • Heidi
        February 16, 2017 at 9:51 am #

        Did you take her blood pressure at any time within that 7 hours? Did you do anything but watch her writhe in pain for that 7 hours before you finally took her to the hospital? Did she wait in the ER or an L/D floor?

        Most likely if she’d actually given birth in the hospital, she would have had frequent blood pressure checks and this would have been nipped way before seven agonizing hours passed. Can’t believe you think this had you coming out in a good light. The truth of the matter is YOU weren’t qualified to handle an actual complication.

      • myrewyn
        February 16, 2017 at 9:56 am #

        Oh god, I think your story proves the opposite point. If she had been already admitted for her delivery, she would have received immediate medical attention for her condition.

      • Daleth
        February 16, 2017 at 10:01 am #

        If you take someone to the ER in America and they’re not visibly bleeding to death, seizing, unconscious, or suffering from a broken limb, they’re going to wait for a few hours before they’re cared for.

        Not because doctors are ignoring them, but because the ER is full of obvious emergencies that have to be dealt with, as well as many non-obvious emergencies and non-emergencies that all have to be triaged so the nurses and doctors can figure out what order to see people in. That’s how ER’s work, and as an American healthcare professional, it is your job and your ethical duty to know that.

        Which means it’s your job and your ethical duty to, if possible, have a relationship with an OB who will see your patients stat, and if that’s not possible then you need to monitor the heck out of your patients both pre- and post-birth so that you can get them to the ER *immediately*. In other words, take their blood pressure at regular intervals, check their urine for protein (pre-e can develop after birth as well as before, though it’s rarer), etc.

        • Steph858
          February 18, 2017 at 10:22 am #

          Those are all good points about the possible reasons why joycnm’s patient wasn’t seen the second she entered ER, but I had a pleasant surprise the last time I visited A&E. My (then 1.5 year-old) son had tried to grab daddy’s freshly-brewed tea and ended up with a blistering scald on his wrist. I’ve spilt hot drinks down myself before and self-care was sufficient, but since my son was only just old enough to no longer be considered an infant and since none of my burns have ever been bad enough to come out in blisters, I took him to A&E. But in my mind, this was a ‘just in case’ visit and I expected to be waiting for quite a while (hours rather than minutes) as I thought we’d be one step up from someone coming in demanding an aspirin to treat their sniffles but below everyone else in the queue.

          But we were seen very quickly. First he was triaged by a nurse who, seeing that he was in considerable pain despite me having already given him calpol, gave him a dose of calprofen. She then asked if we wanted to wait in the general children’s waiting area, which had toys available, or if we’d rather wait in the treatment room, which came with a bed and privacy. Since it was 2am Sunday morning and we were all tired, and since I expected to be waiting for at least 2 hours if not 4, I chose the treatment room so we could at least get some sleep while we were waiting. But we’d just got comfortable (we were waiting maybe 10 minutes at most) when the doctor came in! Altogether, we were in and out of A&E in less than an hour, and most of that time was being treated rather than waiting.

          It helped that we went there when it was quiet (A&E isn’t usually very busy in the middle of Sunday night) and we were on the children’s ward (they aim to see children quicker than adults, even for equivalent levels of emergency). But still, I was very impressed at the speed with which we were seen for something I considered to be quite minor compared with other cases A&Es have to deal with.

          TL;DR: Don’t blame the ER, they don’t keep people waiting for the sake of it. Blame the idiot who turned a 3-hour wait (could have been much less if she’d already been on the maternity ward, BTW) into a 10-hour one.

          • Dr Kitty
            February 20, 2017 at 2:09 pm #

            There are good times to attend and ED, and bad times.
            Any time between 4am and 7am is usually a good time.

            The people who have been waiting all day will have been disposed of, and most of the minor injuries and less sick people will wait until morning to come in, while the drunks and bar room brawls will have been calmed down and stitched up.

            In my personal experience, if you arrive at triage at 6am with a systolic BP of 80, a fever of 39C, HR of 140 and an acute surgical abdomen you get 10mg of IV morphine, a litre of fluids and H&P by an ER doc within 10 minutes and a surgical review within an hour.

            ER bloods can take a few hours to come back from the lab and HELLP is diagnosed by blood tests, not psychic powers.

      • Azuran
        February 16, 2017 at 10:03 am #

        So… expected what? That if you came into a hospital out of nowhere all the doctors of the hospital would stop whatever they were doing and rush to her?
        You didn’t seem to think she was in any danger for 7 hours and expected immediate care?

      • Roadstergal
        February 16, 2017 at 10:50 am #

        You took on a home-birth without a relationship with an OB that would allow you to transfer care?

        You let your patient be in pain with no proper medical assistance or monitoring for 7 hours after birth?

        You expected her to be seen immediately in the ER without #1?

        You’re not doing the CNM homebirth model any favors.

      • EmbraceYourInnerCrone
        February 16, 2017 at 11:31 am #

        One of the things that people who give birth at home have to accept is that if something goes wrong they may be further from immediate skilled medical help than someone who delivers in the hospital. If you have your baby at home and you need an ambulance for instance, you may call 911 and end up waiting if all the ambulances are on a call. If you decide to go to the hospital because something seems wrong/off, you will have to wait to be seen unless you are having an obvious medical emergency. severe back pain is probably not going to be high up on the list of things that get you seen IMMEDIATELY. Additionally the ER docs are NOT experts in problems associated with pregnancy and birth. You need an OB for that…

        If one wants accessible medical over site and followup during and after giving birth, one should probably give birth in the hospital. If you choose not to you are accepting the higher risk that something may go wrong and you will not be able to get immediate medical attention.

      • The Bofa on the Sofa
        February 16, 2017 at 11:56 am #

        Not all home birth midwives will “kill” you.

        Well, it sounds like you sure as hell tried.

        But thank you for confirming something I have always said. We make a lot of distinctions between CPMs and CNMs here, and the general view is that CPMs are clowns and CNMs are legit. However, I have always modified that, especially when it comes to homebirths, in that those CNMs that do homebirths are nearly as bad as the CPMs. Granted, they have additional medical training, and therefore they have an advantage there, but it’s not the medical training or lack thereof, it’s the mindset. You may have that nursing degree, but you are just as reckless as any CPM clown.

        I’ve always made that argument, but thank you for coming here and demonstrating.

      • momofone
        February 16, 2017 at 12:55 pm #

        The “medical care” you should be referring to is what you provided, not what she received at the hospital. They saved her despite your incompetence.

      • February 16, 2017 at 7:59 pm #

        You are not making as strong a point as you think you are.

        1) You had no idea what was wrong with her. I had no idea what was wrong with me and neither did my husband. Now, I’m a teacher, he’s a dairy farmer and you….do home births.

        2) You had no particularly useful information to give to the doctors. Your patient didn’t have an elevated blood pressure (you did check her BP, right?) and you can’t do blood work at home so a recently postpartum woman has back pain after giving birth at home shows up with a CNM in tow. That’s not an emergency nor particularly uncommon.

        3) The doctors and RNs at the hospital did actually stop the seizures and treat HELLP. They were the ones who placed an IV of mag. sulfate and probably an additional anti-seizure drug to control the tonic-clonic seizure and prevent other ones. They had access to a blood bank if your patient started bleeding from lack of platelets. You had access to none of these – plus you had no idea what was wrong with her so you don’t get credit for saving her life.

        4) “Getting her there in time” is a cop-out. My non-medical degree spouse and I managed to get ourselves to the hospital in time, too. As a CNM who practices home birth, you have a much higher level of responsibility for actual patient care than “I managed to get her to a hospital when I realized she was in pain but had no idea what was going on.”

        Your self-described level of helplessness in this situation is making my point much more clearly than anything I could explain.

        • Squillo
          February 17, 2017 at 12:58 pm #

          Well put. It illustrates the fact that, whatever the failings of the medical system in general or a hospital/provider in particular, certain weaknesses are built into the homebirth model that make it less safe. In other words, in hospitals, safety failures are a bug not a feature. In homebirth, the opposite obtains.

        • swbarnes2
          February 20, 2017 at 8:17 pm #

          This seems like another case where the mother would have been better off with no midwife; she might have gone to the ER sooner . Taxi drivers can usually deliver babies fine, the one thing the midwife is there for is to recognise, if not treat, problems. This midwife is proud to have gotten paid to not do the one thing she was supposed to do.

      • joycnm
        February 19, 2017 at 6:27 pm #

        I don’t know why I try to have an intelligent conversation about obstetrics, maternity care, labor & delivery with people who know nothing about this except their own experiences and their friends’ experience. I was hoping to hear from just one person with 30 years experience in childbirth to say–“How did you know back pain was an emergency?” You know how I knew? I attended all this woman’s births. This was not normal. Back pain is not a sign of HELLP. I knew it was an emergency, the people in the ER did not. She would be dead if I’d left her to the medical people. I think the reason the medical people are so silent is because they know this is true. The lay people don’t know the difference.

        • myrewyn
          February 19, 2017 at 7:20 pm #

          So sorry nobody jumped in to stroke your ego.

        • Squillo
          February 19, 2017 at 8:57 pm #

          Serious question: do you think that maybe, had she been on an OB unit rather than admitted through the ER, she would have gotten effective help earlier?

        • momofone
          February 19, 2017 at 10:17 pm #

          “I was hoping to hear from just one person with 30 years experience in childbirth…”

          You realize you are commenting on the blog of an OB, with many commenters who DO have “30 years experience in childbirth” as OBs/GPs/CNMs, right? What you meant was “I was hoping people here would be dazzled by my insight and join me in a barrage of ‘screw the medical people’ comments and horror stories.” Which indicates total failure in knowing your audience, among other things.

          This poor woman, if she is smart, will stick with “the medical people” from the start if she decides to do this again. You and the people who think like you are a menace.

          • myrewyn
            February 19, 2017 at 10:31 pm #

            This is sort of what I meant to write but pregnancy induced insomnia and resulting fatigue made snark come out instead.

        • An Actual Attorney
          February 20, 2017 at 8:09 am #

          If it wasn’t a sign of HELLP, why should the drs have been looking for HELLP. Why did she have a back ache? Why was that an emergency? Are you saying that it was a secret sign, that you didn’t even know? But you were concerned, took her to the ER, and are now upset that drs didn’t figure out what this secret sign meant? When they had no history at all on her?

        • Daleth
          February 20, 2017 at 10:04 am #

          You know how I knew? I attended all this woman’s births. This was not normal. Back pain is not a sign of HELLP. I knew it was an emergency, the people in the ER did not.

          The Preeclampsia Foundation says back pain is a symptom of HELLP: “sometimes it may indicate a problem with the liver, especially if it accompanies other symptoms of preeclampsia.”

          Why do you, as a CNM with 30 years’ experience, not know that?

        • Azuran
          February 20, 2017 at 10:39 am #

          So….you knew it was an emergency and waited 7 hours?

        • Guest
          February 20, 2017 at 12:20 pm #

          Did you provide her blood pressure and heart rate to the admitting personnel? Did you tell them she had HELLP? Or did you dump her at the hospital with an intense backache and let things sort themselves out? What, exactly, did you do to provide care to this woman postpartum, what exactly happened to get her to the hospital, what exactly happened at the hospital? What was her blood pressure? What was it during or before delivery? Did you let a pre eclamptic mom deliver at home, whenever she happened to go into labor, with no monitoring of blood pressure, proteinuria, baby health stats, etc?! Did this mom realize how close she came to dying, and how much she and you risked her and her baby’s life? What the hell is the matter with you? Is health care a game to you?

          I had pre-eclampsia, and my only symptoms were high blood pressure and a high protein createnine ratio. I was monitored closely and delivered early, and my BP didn’t go down for 5 weeks after delivery, plus I may have mild kidney damage, and I was a stable, low-risk case. You failed this mom and her child spectacularly, and I’d bet you did it out of a mix of pride and greed. You got to be the expert, until your laziness had the possibility of real consequences, and you still got paid even though your care was totally and completely inadequate. You are dangerous.

        • February 20, 2017 at 1:16 pm #

          You keep claiming that you somehow saved her – let’s discuss that idea.

          What were her BP and urine protein levels at her last prenatal appointment?

          What was her BP when you initiated services during her delivery?

          What was her first BP after the baby was born?

          What was her average BP during the seven hours she was having “abnormal” back pain?

          What was her BP when you decided that transfer was a good idea?

          What BP did you report to the triage nurse? What urine protein level did you report to the nurse?

          You don’t get points for recognizing that back pain is unusual – after 7 hours none the less – when you failed to provide the most basic monitoring for pre-e, eclampsia, and HELLP syndrome: taking maternal blood pressure on a regular basis.

          • MaineJen
            February 20, 2017 at 2:11 pm #

            I’m thinking you’re going to get crickets for all of these questions. One of the “perks” of homebirth is that your midwife won’t keep bothering you with that pesky BP monitor all the time! And those useless urine tests, who needs those?

            As for the “mystery” of the severe postpartum back pain…one BP measurement (just one!!), would, I think, have cleared that mystery right up.

          • Dr Kitty
            February 20, 2017 at 2:41 pm #

            What are the chances of a multip with NO previous history of pre-eclampsia suddenly developing HELLP, do you think?

            As opposed to someone with a history of pre-eclampsia in several pregnancies which had been missed by the midwife?

          • myrewyn
            February 20, 2017 at 4:56 pm #

            The more I read the original story and then her response, the more I’m thinking Poe.

          • Amazed
            February 20, 2017 at 5:19 pm #

            You’re new here… She’s an old acquaintance of ours. She is as deranged as she seems. Last time, it was her whining how an OB she consulted by the phone told her to go with a postpartum patient to the ER because she thought ileus. She was furious that he didn’t have the woman readmitted to the L&D floor.

          • myrewyn
            February 20, 2017 at 6:08 pm #

            Ha, ok. I’ve read a lot of the archives and didn’t remember her name but good to know!

          • Azuran
            February 20, 2017 at 5:32 pm #

            I don’t think it’s a poe. It’s a lot like many homebirth stories we’ve heard about. A midwife who obviously didn’t know enough about what was going on or who wasn’t properly monitoring her patient. She let things go way further than she should have because she obviously didn’t know any better. Then when she finally decided to seek help, it didn’t go as she expected because she has no idea how any of this actually works.
            And then she’s trying to hide her own incompetence and shortcomings by blaming the hospital.

          • myrewyn
            February 20, 2017 at 6:49 pm #

            Apparently I was being overly optimistic then because I was having a hard time believing it could go so terribly wrong AND that the OP would have so badly misjudged the reaction she would get from her story here.

          • Roadstergal
            February 20, 2017 at 7:00 pm #

            I guess I think of it as – for every story we hear of a homebirth tragedy, there must be at least a hundred like Joy’s – near tragedies where they got away with it.

          • myrewyn
            February 20, 2017 at 7:20 pm #

            Good thing we have ER docs, I guess.

          • Merrie
            February 20, 2017 at 7:44 pm #

            I had my kids in hospital with CNMs. After the birth of my second, I was bleeding more than the midwife liked and she used cord traction to remove the placenta and it came out in pieces, so she did a manual extraction, which was not particularly pleasant, but life goes on… I posted on a Facebook group and a homebirthing friend posted that she had bled a lot after one of her births and was really weak for a long time but “at least nobody pulled on the cord”… Sounds like a near miss to me and she doesn’t see it that way at all, is just thrilled that nobody pulled on the cord, because that’s what matters.

        • swbarnes2
          February 20, 2017 at 3:14 pm #

          So you are admitting that if you’d seen this symptom in another woman, you would have done nothing?

        • Steph858
          February 21, 2017 at 11:02 am #

          Since you are clearly after a reply from a fellow woo:

          How dare you be so incompetent as a midwife! GOOD natural-birth-supporting midwives NEVER need to transfer their patients to hospital. If you REALLY knew what you were doing, you should have been able to cure your patient with nothing more than herbs and homeopathy. Sentencing a patient to Horrific Interventions by Evil Allopaths is the worst thing a crunchy midwife could ever do.

      • Amy Tuteur, MD
        February 20, 2017 at 2:35 pm #

        Of course you could have easily avoided all of that if you had secured OB back up before agreeing to deliver anyone at home. As soon as you became concerned that something was wrong (not seven hours later) you could have discussed it with the OB. If the patient needed to be transferred, the OB could have arranged a seamless transfer and the appropriate people would have been available as soon as she reached the ER.

        It is YOUR fault that the patient nearly died because you think it’s okay to practice midwifery without OB back up. You didn’t save this patient’s life; you are the one who risked it!

        • Herbert West
          February 22, 2017 at 11:50 am #

          do you have any stats on home birth vs hospital birth outcomes?

  3. Dr Kitty
    February 13, 2017 at 2:47 pm #

    Completely OT, how does that Anti Vaxx crowd respond to the Scandinavian studies that suggest maternal depression, regardless of treatment with antidepressants, is a risk factor for the development of Autism?

    • Empress of the Iguana People
      February 13, 2017 at 3:53 pm #

      …which is not a great thing to tell women who’re developing depression.

    • mostlyclueless
      February 13, 2017 at 5:03 pm #

      Interesting, do you have any links handy? The first thing that comes to my mind is that maybe autism and depression have some kind of common genetic basis that manifests differently depending on other factors, but I would bet the studies worked to account for that.

    • Sue
      February 13, 2017 at 9:51 pm #

      Do you mean BMJ 2013? “Parental depression, maternal antidepressant use during pregnancy, and risk of autism spectrum disorders: population based case-control study”

      The full paper is here:

      Interestingly, they found an association between maternal depression and/or antidepressant use (only in autism WITHOUT intellectual impairment), but not for paternal depression.

      It is not clear whether there may be an association with anti-depressant use, but they note a similar (Californian) study that showed an association with gestational SSRI use but not other antidepressants. However, it’s notable that SSRI use has skyrocketed at the same time as autism disagnoses. One could argue that better diagnosis and treatment are responsible for each phenomenon, separately.

      We do know that both depression and autism have strong familial tendencies. It may be that autism without intellectual impairment is also associated with depression.

      It would have been interesting to look at how many of the parents, themselves, had autism (with or without depression and antidepressant use).

      • Dr Kitty
        February 14, 2017 at 4:39 am #

        Yep, that’s the one.

        I think it is interesting, but obviously needs a lot more research.

  4. no longer drinking the koolaid
    February 13, 2017 at 2:06 pm #

    If you have watched “Victoria” on PBS, especially this week’s episode, Queen Victoria tried to prevent her first pregnancy. She clearly states that it is because “childbirth is dangerous”.
    Yes, she had 9 children, and received the best medical care, but she also understood that she and every other woman risked death with each pregnancy.

    • Karen in SC
      February 13, 2017 at 2:54 pm #

      Of course, the tragic death of her cousin Princess Charlotte in childbirth weighed heavily on her mind.

    • Madtowngirl
      February 13, 2017 at 2:55 pm #

      Indeed, it’s very interesting that people like to gloss over how dangerous birth was before the advent of modern obstetrics. My friends and I joke about how women used to live to the ripe old age of “died in childbirth.” It’s a sick joke, but it’s true – I don’t know what the exact statistics are, but many, many, many women died either in childbirth, or shortly thereafter. And this included rich, famous, women who had access to the best healthcare of the time – Jane Seymour, Catherine Parr, and Mary Forth, just to name a few.

      • Sheven
        February 13, 2017 at 4:22 pm #

        What’s amazing is how we still gloss over the danger. Sure, death in extremely uncommon in first world countries, but injuries are common. Incontinence, numbness in the genitals, pain for years, even hearing loss.

        • Sue
          February 13, 2017 at 9:54 pm #

          We gloss over the danger because we live in a world where we don’t commonly see the results of NOT having modern obstetrics/midwifery. Much like vaccination. Just the other day I saw someone argue – again – that we don’t need to vaccinated against tetanus because cases are so rare. Sigh.

          • Azuran
            February 13, 2017 at 10:36 pm #

            While it’s true that even without vaccination, tetanus wouldn’t be that common, (the CDC puts the incidence at around 3-5/100 000 between 1900 and 1930) OMG who wants to risk having tetanus????

          • Who?
            February 14, 2017 at 3:14 am #

            I’m absolutely fine with an adult, making their own decision, informed by whatever material they find most useful, to decide to avoid a tetanus jab for themselves.

            Where I get antsy is when they won’t allow their children, who have no power to help themselves, to not get the injection.

          • Juana
            February 14, 2017 at 1:31 am #

            It’s fascinating that those people’s knowledge of the world not only seems to span the last thirty years at the max (if even) timewise, it also ends at the horizon space-wise. Look at the atrocious maternal mortality rates in some third-world countries – that’s what you get when you don’t have modern obstetrics.

      • Amazed
        February 13, 2017 at 4:27 pm #

        My grandmother left her village to marry 200 miles away – here, this is a lot and in 1950s carless reality around here, it was even more, When she visited with her baby, a young neighbour wanted to know all the ghastly realities of my grandmother’s eclampsia. Turned out that because of kidney problems, she was advised not to get pregnant. She did. And she was now pressed by doctors and family into abortion. My grandmother’s happy ending might have been one of the things that encouraged her to keep the pregnancy. At her next visit, she came to know that a complication had developed and the mother had died. They saved the baby but neither the father nor the rest of the family wanted him. He ended up given for adoption.

        We’re talking 1958. Not even Jane Seymor’s times. That’s how dangerous pregnancy and childbirth used to be, even with the best medical care of a time not so removed from our own.

      • Liz Leyden
        February 13, 2017 at 4:30 pm #

        Charlotte Bronte died of hyperemesis gravidarum.

        • Kelly
          February 13, 2017 at 9:45 pm #

          Dang. I wondered about that in history. That is a horrific way to die.

    • Liz Leyden
      February 13, 2017 at 4:28 pm #

      Queen Ann ruled from 1704 to 1714. She had the best medical care. Her 17 pregnancies resulted in 7 miscarriages, 5 stillbirths, and 5 live births. Her only child to survive infancy died at 11.

    • MaineJen
      February 14, 2017 at 1:50 pm #

      Victoria is also the one who advocated strongly for pain relief during labor, right? (Which in those days was probably something like ether.)

      • EmbraceYourInnerCrone
        February 14, 2017 at 2:59 pm #

        She received chloroform for the births of her eighth and ninth children:
        (Victoria had 9 children in 17 years)

        “While the Queen and Prince Albert first showed interest in chloroform in 1848, no anesthetic was administered for her seventh delivery in 1850 of Arthur, the future Duke of Connaught. Such reservations disappeared in 1853 by the time her eighth delivery occurred (Prince Leopold). Dr. John Snow gave her chloroform, but used an open-drop method”

        Ether was a great invention but I personally loathed it ( non-stop vomiting after surgery, not fun)

  5. BeatriceC
    February 13, 2017 at 2:00 pm #

    I believe you’re missing the word “as” in this sentence: “Moreover, just a premature birth…”

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