Despite reports of rising maternal mortality, Consumer Reports is still obsessed with process

Top Priority

One of the most amazing things about writing for this blog is that no sooner do I mention something untoward or dangerous and someone rushes to demonstrate it.

Yesterday I wrote about the way that a low index of suspicion for pregnancy complications leads to maternal deaths. Today, Consumer Reports publishes a ham handed piece, Childbirth: What to Reject When You’re Expecting, by Tara Haelle that obsesses about process without giving any serious consideration to the only thing that really matters, outcome. It’s as if Consumer Reports rated cars by cup holders and interior upholstery instead of by crash worthiness.

Haelle starts with the usual framing:

It’s as if Consumer Reports rated cars by cup holders and interior upholstery instead of by crash worthiness.

Despite the benefits of a healthcare system that outspends those in the rest of the world, infants and mothers fare worse in the U.S. than in many other industrialized nations…

Infants in this country are more than twice as likely to die before their first birthday as those in Japan and Finland, and America lags behind nearly every other industrialized nation in preventing mothers from dying due to pregnancy or childbirth…

Why? There are no doubt many causes. But one likely contributor may be that medical expediency often takes priority over the best outcomes and evidence-based treatments…

That’s a brutal assessment requiring copious evidence to support it. Haelle and Consumer Reports provide none.

And in this setting in particular, that is inexcusable.

What is most ugly about this is that it ignores the fact that black women and babies are disproportionally affected, with death rates FOUR TIMES HIGHER than everyone else, far exceeding that of every other minority group,

We will never improve outcomes for black babies and women if we pretend that mortality is primarily a problem for privileged white women looking to craft a “birth experience.”

We will never reduce perinatal and maternal mortality as far as possible if we lie to ourselves about the real causes.

To my knowledge, there is NO EVIDENCE, zip, zero, nada, that perinatal and maternal deaths are caused by medical expediency. But that doesn’t stop Haelle or Consumer Reports.

They trot out the usual hobby horses for condemnation: the C-section rate, the induction rate, continuous electronic fetal monitoring, episiotomies, epidurals and sending babies to newborn nurseries.

These are processes, NOT outcomes. They affect the birth experience far more than they affect whether babies and mothers live or die. No matter. Consumer Reports and Haelle only mention death rates to imply that interventions cause death, not in any serious effort to prevent deaths.

Look at the reasons why mothers die:

IMG_2372

How is obsessing about process going to have an impact on the most common reasons for maternal death, cardiac and other chronic diseases? It isn’t.

What about infant mortality?

IMG_2383

How is obsessing about process going to have an impact on the most common causes of infant death, congenital anomalies, prematurity (generally extreme prematurity), and complications of pregnancy. It isn’t.

Though there is no evidence that medical expediency kills babies and women, there is considerable evidence that medical complacency, assuming that pregnancy is inherently safe when it is actually inherently dangerous, does kill.

As noted in the ProPublica/NPR report about maternal mortality:

Earlier this year, an analysis by the CDC Foundation of maternal mortality data from four states identified more than 20 “critical factors” that contributed to pregnancy-related deaths. Among the ones involving providers: lack of standardized policies, inadequate clinical skills, failure to consult specialists and poor coordination of care. The average maternal death had 3.7 critical factors.

California set out to reduce maternal mortality and the California Maternal Quality Care Collaborative created “tool kits” for providers:

The first one, targeting obstetric bleeding, recommended things like “hemorrhage carts” for storing medications and supplies, crisis protocols for massive transfusions, and regular training and drills. Instead of the common practice of “eye-balling” blood loss, which often leads to underestimating the seriousness of a hemorrhage and delaying treatment, nurses learned to collect and weigh postpartum blood to get precise measurements.

In other words, the CMQCC set out to raise the index of suspicion and insistuted drills to deal with emergencies, not offer false reassurance pretending they aren’t happening. The results are very impressive:

Hospitals that adopted the toolkit saw a 21 percent decrease in near deaths from maternal bleeding in the first year; hospitals that didn’t use the protocol had a 1.2 percent reduction. By 2013, according to Main, maternal deaths in California fell to around 7 per 100,000 births, similar to the numbers in Canada, France and the Netherlands — a dramatic counter to the trends in other parts of the U.S.

Sadly, the focus on process ahead of outcome is not limited to childbirth; it has been extended to breastfeeding and the results there have been even more disastrous.

The Baby Friendly Hospital Initiative, designed to promote breastfeeding (a process), has led to a large and growing number of DEATHS (an outcome). Aggressive breastfeeding promotion, including policies against formula supplementation and mandatory rooming in of babies in their mothers’ hospital rooms have led to an epidemic of infant brain injuries and deaths from dehydration, hypoglycemia (low blood sugar), and babies smothering in or fracturing their skulls falling from mothers’ hospital beds. No matter, the BFHI cluelessly touts breastfeeding rates as if that, in an of itself, is a measure of quality, while studiously ignoring and sometimes aggressively denying the entirely preventable deaths that result.

Process, in both childbirth and breastfeeding, does matter, just like cup holders and interior upholstery matter in cars. But outcome is far more important than process. Consumer Reports should stop pretending that childbirth is safe and the only thing we need to do to improve it is to decrease interventions. That doesn’t mean that we shouldn’t try to reduce C-section rates and the rates of other interventions, just that those efforts should take a backseat to reducing deaths.

  • Emma Hollis Hunter

    Alright, I’m going to put this right at the top so everyone can see it. There has been such an immensely negative response to my below comment. I stand by my reasonable expectation that, when a health care professional, be they MD, OB, LC, RN, RDN, makes statements about health and bodies, they be prepared not only to back up every statement they make with evidence, but to also be prepared to acknowledge the reality that scientific research is incomplete and our best evidence today we might realize to be entirely erroneous in 20 years. No health care professional should EVER make an un-challengeable statement without offering where the information came from, how the opinion was formed, and an accompanying disclaimer that others have differing views. And yes, this applies to myself. You’ll notice if you read back through the thread that I never once claimed to know the ultimate truth about maternal health, infant mortality, breastfeeding, or anything else. I know this is a blog where one can write whatever one wants, it’s not a medical journal, but as long as professional credentials are listed, any information should meet whatever criteria of quality would be expected of those credentials.

    As soon as my brief comment was responded to, my problem evolved from one hoping that in the future direct statements regarding infant mortality would be avoided unless accompanied by the thorough and thoughtful discussion the topic warrants, and became the concerns that the author and readers of this blog (and likely most other blogs, I’ll give you) are apparently entirely unable to allow a person to disagree with you, to ask questions, to have a differing opinion, without ganging up like an agressive high school cheerleading squad and attempting to bully that person out of the conversation. You made every assumption possible about me as a person and as a professional, most of which is erroneous. The only assumption I’ve made about you is that a) Dr. Amy would like to be held in high professional esteem and so would welcome an opportunity to reinforce her statements with evidence and professional opinion, and b) that you all have strong opinions about what women do with their bodies and the professionals who support them, and you’re unwilling to invite any conversation which would complicate your pre-established views. I stand by one of these assumptions.

    To Dr. Amy, as one commenter pointed out, I did put your name in quotations, which I recognize may potentially be interpreted as disrespectful. However, I ask that everyone also recognize that, in general, it is considered disrespectful to not refer to a MD by their official title which includes a last name, not first. I was unaware that you prefer the former. Also to Dr. Amy, though, I would ask that you reconsider your decision to stand idly by, reading along, as evidenced by your occasional reply, and enable your readers to attack the only person who dares disagree with your opinion. Having a thread full of defenders does not enhance the appearance of professionalism of either your blog, or your name listed as author. It does the opposite. Be the first to speak out and discourage your readers from being resistant to challenging opinions,as a confident and professional OB should.

    I will not respond to any responses to this comment, as I’m soooo bored of arguing about whether or not the opinions of an MD blogger should be separated from the evidence-supported information.

    I hope if we should ever encounter one another in-person we are able to have a constructive, non-internet conversation and learn from one another.

    • Amy Tuteur, MD

      In other words, you are a glorified tone troll.

      “A Tone Troll is a form of internet troll focusing on the tone of arguments. A Tone Troll will typically express great consternation and offense at the style of an argument, as a way of distracting from the actual content.

      This is done deliberately as a way to derail arguments; the Tone Troll prefers to muddy the issue by changing the subject diverts attention away from the merit of the argument itself and unto the specific words being used to advance it.”

      http://www.urbandictionary.com/define.php?term=Tone%20troll

      • Emma Hollis Hunter

        And you don’t even have an active medical license I just learned. Lol

        • The Bofa on the Sofa

          Wow, you just learned that? I mean, it’s not like she doesn’t say she left medical practice in her bio at the top of the page.

          You are a clever one, though, to figure it out.

        • Amy Tuteur, MD

          Typical tone trolling:

          The Tone Troll prefers to muddy the issue by changing the subject to divert attention away from the merit of the argument itself, which she Is incapable of rebutting.

        • Poogles

          “And you don’t even have an active medical license I just learned.”

          And…?

      • Emma Hollis Hunter

        And you don’t even have an active medical license I just learned. Lol

    • The Bofa on the Sofa

      I’m soooo bored of arguing about whether or not the opinions of an MD blogger should be separated from the evidence-supported information.

      No wonder it’s boring, you are arguing a strawman.

      The more important question is, how is this NOT evidence-supported information? All you’ve come up with so far is that there weren’t citations for the graphs. You are right, that type of criticism IS boring.

      Address the substance of the post. Address statements made like this

      We will never reduce perinatal and maternal mortality as far as possible if we lie to ourselves about the real causes.

      To my knowledge, there is NO EVIDENCE, zip, zero, nada, that perinatal and maternal deaths are caused by medical expediency. But that doesn’t stop Haelle or Consumer Reports.

      Do you disagree? Can you provide evidence counter to Dr Amy’s lack of knowledge?

      If you want us to “learn from each other” you actually have to say something helpful. You do that, we’ll listen.

      Save your epistemology blathering for some place else. Let’s talk about caring for babies and mothers.

  • Emma Hollis Hunter

    Disappointed in the lack of citations to support statements in this post.

    • Amy Tuteur, MD

      Any comments on the substance of the piece?

      • Emma Hollis Hunter

        I worry that it’s exactly this type of combativeness between MDs and Nursing/Lactation staff that will prevent the most effective and evidence-based practices from emerging into the mainstream.

        • The Bofa on the Sofa

          Thank you for your concern.

          Any comments on the substance of the piece?

          • Emma Hollis Hunter

            I think broad statements made my a medical professional without citations falls into the category of “substance.”

            And thank you for so efficiently demonstrating my point that no constructive discussion or change in policy will ever develop as a result of this and similar exchanges.

          • The Bofa on the Sofa

            I’ve deleted a long comment, and will just say: look at yesterday’s post. Sources of the data are there. Things like CDC good enough for you?

          • Emma Hollis Hunter

            I read your long comment as it was provided to me via email. To answer your question: No, one citation from one source or study implying one outcome will not “satisfy” me. Science requires the continuous reproduction and re-evaluation of data. To be clear, I won’t blindly accept statements or data from either side of the argument.

          • The Bofa on the Sofa

            So your problem is not that there is not a source, and that is just a dodge. I knew it.

            The graph Dr Amy shows above is the same graph that was in the ProPolitica article she discussed yesterday. Are you disputing the data? Do you have a source that suggests these are wrong? As noted, these are based on the CDC data.

          • Emma Hollis Hunter

            Well, my problem, after receiving defensive responses from a range of loyal readers, has now become this: who are you hoping to benefit? Are you hoping to convince moms that you’re right so they’ll make choices that protect them and their babies? Because, if so, this style of rhetoric-based argument will likely not be effective. Which leads me to the conclusion that the goal is NOT to improve outcomes for moms and babies, but to defensively and conclusively argue your point so as to secure your small piece of the internet and claim some victory against the families who didn’t heed your warnings.

          • The Bofa on the Sofa

            You came in plenty of combative, with nothing to back it up. Is that the way you hoped to change OUR minds?

            You have admitted that your problem was not actually the lack of citations, so you came in under false pretenses (you know, you could have started with “Do you have sources for this information that I could check out?” and you would have had a simple response. But no, you didn’t want that. It was about coming on the attack).

            What’s the goal? To demonstrate that the Consumer Reports article is based on a fallacy.

            Now, the thing I don’t understand is, why would anyone, other than the people at Consumer Reports, take that personally and/or take offense at that? So Dr Amy rips on the piece in CR. And? Why should that bother moms? What SHOULD bother moms is that CR is misleading them.

          • Emma Hollis Hunter

            Implied in my initial comment is the expectation that sources should have been included without the necessity to request them.

            And you’re misrepresenting my admission that my “problem” was not with the citations. It was. So I made one simple comment indicating such. Then I received multiple attacks in response arguing that a doctor, writing a blog presumably for families to read, should not be expected to support her statements with evidence as long as they agree with your own beliefs. My “problem” evolved as I came to better understand this particular online community.

          • Sue

            Emma – you’ve gone totally overboard, and it seems you’ve done this from reading just one post.

            There are many other citations and discussions of evidence on the blog, which you can find through the search function.

            There are two items illustrating data in the article itself, and more in yesterday;s article.

            So, it’s time to say “Oops, sorry, I was wrong. There is lots of evidence discussed on this site, I didn’t know that I had to look beyond this single article, but now I do.”

          • demodocus

            Personally, I come here in part to get away from Breast is Best, even if it drives you to fantasizing about suicide message a lot of us new mothers feel like we’re hearing. Since breastfeeding really does push me towards suicide, this is a problem for me. Not *you* breastfeeding, *me* breastfeeding. I don’t give a damn whether you give your kid human milk or formula

          • Emma Hollis Hunter

            I also don’t give a damn what infant-appropriate food a baby eats. Based on the extensive body of evidence available with regard to outcomes associated with breastfeeding, I’m not convinced that it is generally beneficial to infants in developed countries (if we were to include those in under-developed nations, particularly without consistent access to clean water, that’s a different story). Breast is best only if that is important to mom, in which case Breast-with-closely-monitored-feeding-patterns-growth-and-development is best. If a mom declines to initiate or continue breastfeeding, then bottle-fed-infant-formula-and-well-controlled-breast-engorgement is best. I think it’s the assumption that all lactation advocates are “breastfeeding nazis” that prevents moms from accessing the most appropriate, realistic, non-biased information and support, and I do acknowledge that the lactivist side doesn’t do their fair share of the work maintaining an open, evidence-based, and non-vilifying field. I suppose I was just hoping that this group, led and dominated by medically-trained professionals actively providing women’s health care, would offer the more professional, supportive platform rather than act as the equally vilifying counter-protest.

          • demodocus

            I was not yet visiting this blog and all the information I was getting from every source was that LCs are wonderful people and breastfeeding is freaking awesome. That first LC was the most arrogant person I’d yet met in healthcare. The next two were nicer but not particularly helpful, either. My son’s male pediatrician actually listened and helped us figure it out. And told us to top the poor kid up with formula until my milk came in and the fissures in my nipples healed. No one was helpful with my eventual oversupply. Its such a great problem to have!! That’s a quote from one of the LCs. It’s also why he spat up like the exorcist baby and cluster fed for 3 hours morning and evening so he could fecking get past the colostrum .
            And don’t you dare blame this group for my later PPD or my suicidal ideation. i never got happy hormones even with kid 1. BFing is a trigger and triggers are by definition, not particularly rational. Several of the regulars here have been keeping an eye one me, metaphorically patting my hand.
            If you want clinical, professional discussions, you should have either started with a different tone in your own postings here or gone to a site that’s intended to be a professional, clinical one.

          • Charybdis

            What we hope to accomplish is to make women at least AWARE that there are often issues with pregnancy and childbirth and breastfeeding and that not being cognizant of these potential issues and having a plan of action IF things are not going smoothly.
            Add to that the complete and utter contempt that the NCB/CPM/LC group has regarding medical providers giving advice: (Don’t listen to the pediatrician, you don’t need to supplement your baby, uric acid crystals (brick dust) in the newborn’s diaper is totally normal (it’s not), jaundiced babies are normal, the doctor isn’t using the “breastfed baby” growth charts, your milk is always *perfect*, supplementing with vitamin D is unnecessary, just up your consumption of vitamin D and K, etc), how are we supposed to react? When a baby is diagnosed with FTT because the mother is hell-bent on EBF and is cheered on by the lactivist brigade, to the detriment of her child’s health, that irks us. Irks most rational, pragmatic people as well.
            The goal IS to improve outcomes for mothers and babies and that involves presenting, discussing and accepting facts that can be unpalatable and yes, frightening, to people who have fallen hook, line and sinker for the tripe the lactivists/NCB groups peddle.

          • Emma Hollis Hunter

            Your assumption that all lactation professionals follow non evidence-based guidelines and avoid coordination with a pediatrician or other primary care provider is faulty. A mom shouldn’t have to choose between accessing the specialized assistance of a lactation professional for successful breastfeeding outcomes and adhering to the advice of her baby’s pediatrician.

            My primary argument here is that THIS rhetoric that vilifies “lactivists” perpetuates the inability of mom to have a cohesive, multidisciplinary team of health care and infant support specialists in order to ensure that what you described above would never happen to her baby.

          • Heidi

            Wow, that speaks pretty lowly of lactivists then. They don’t like how Dr. Amy talks so they throw facts out the window and flip her the bird and let babies starve? Is that what you are trying to say? How the heck does this blog post prevent a lactation consultant from working with a pediatrician?

          • Emma Hollis Hunter

            Umm….It’s becoming more and more evident how no other reader has questioned the source of any of the information in this or other articles.

            Please re-read my two paragraph comment, if possible without the preconception that any person who isn’t a follower of “Dr. Amy” hopes babies die, and let me know if you have any relevant questions.

          • Heidi

            You said it, not me. Or let’s say, that’s how I interpreted it. “My primary argument here is that THIS rhetoric that vilifies “lactivists” perpetuates the inability of mom to have a cohesive, multidisciplinary team of health care and infant support specialists in order to ensure that what you described above would never happen to her baby.” I did not at all say non-followers of Dr. Amy’s hope babies die. Quit lying.

          • Emma Hollis Hunter

            Well I will just feel mean and unfairly advantaged if I respond to this.

          • Heidi

            Okie doke. I think that’s considered a response by the way. But when you can get over feeling mean and advantaged, you can explain to me why you think this rhetoric that “villifies lactivists” perpetuates mothers not being able to get care that prevents deaths from dehydration, starvation and so on. I’m sorry, I think that’s a pretty crazy claim especially in regards to a piece primarily criticizing a Consumer Reports article about labor intervention and maternal mortality, but I’ll be here.

          • Emma Hollis Hunter

            Heidi, if you read to the end of the article, the author makes a very specific reference to breastfeeding. Also, the discussion evolved in the comments to include breastfeeding topics. If you look at the comments to which mine are replying, it likely will make more sense.

          • Heidi

            Still avoiding my question, I see.

          • Emma Hollis Hunter

            Which question would you like me to answer?

          • Heidi

            “But when you can get over feeling mean and advantaged, you can explain to me why you think this rhetoric that “villifies lactivists” perpetuates mothers not being able to get care that prevents deaths from dehydration, starvation and so on. I’m sorry, I think that’s a pretty crazy claim especially in regards to a piece primarily criticizing a Consumer Reports article about labor intervention and maternal mortality, but I’ll be here.”

          • Emma Hollis Hunter

            Okay, If lactation professionals and medical providers are unable to respect one another as a potentially valuable member of a team, then a mom is compelled to chose to listen to one or the other. If she’s received the impression that medical providers will be unsupportive or dismissive of her desire to breastfeed, she might choose to avoid any guidance from a medical provider, and instead to seek out only advice from a person who supports excusive breastfeeding, child-led weaning, etc. In this scenario, the isolation of the baby from other medical resources would prevent the baby from being diagnosed appropriately by his or her provider. If, however, the medical provider acknowledges lactation support from a trained counselor as a meaningful member of the maternal-child-health team, that lactation counselor would be far more likely to coordinate care with the doctor, and mom might be more likely to accept guidance from both, improving the opportunity for accurate infant feeding diagnoses and early interventions.

          • Heidi

            So even if some mothers are inclined to listen to one over the other, a lactation consultant should not be defying a concerned doctor. Even if an LC feels disrespected, one would hope she or he would put aside her personal issues and look out for baby and mother and not ignore weight loss, hypoglycemia, low urine output, jaundice, lethargy, etc. The issue as far as I can see are lactation professionals only supporting exclusive breastfeeding.

            And I’m going to have to strongly disagree that Dr. Tuteur bears any responsibility for starving or dying babies. I’ve been following Skeptical OB for over two years – before, during, and after my pregnancy. This blog is the reason I didn’t fall down the NCB rabbit hole and why I was able to greenlight formula supplementation when our baby experienced hypoglycemia despite round the clock breastfeeding. I still even tried to breastfeed.

          • Sue

            I have a simple question for you, Emma. Do you consider yourself to be a lactivist?

            (Tip: if not, then this article isn’t about you)

          • swbarnes2

            Because we can look at yesterday’s posts and see the sources. Other claims are from other posts on different days; if you had spent 1/20th of the time you’e spent defending yourself just searching the archives here, you’d have the answers you claim to seek.

          • Heidi

            Speaking of respect, putting Dr. Amy Tuteur’s name in quotes appears pretty disrespectful. Maybe that was accidental? Maybe you thought this blog was named that and didn’t intend to be disrespectful, but it is The Skeptical OB.

          • No one hopes babies die. We just know they do when people follow your advice and the advice of other lactation consultants, so we would like that to stop happening. We are not ascribing your actions to malice, we are ascribing them to ignorance.

          • Emma Hollis Hunter

            You have absolutely no knowledge of any advice I give to any woman. This, by definition, is a perfect example of ignorance. I didn’t come onto this site accusing Dr. Amy of performing medically unnecessary cesarean sections and episiotomies, did I now? With every additional post you readers prove my point for me.

          • That was overly broad, yes, for which I do apologize. But babies do die and/or are hospitalized when parents follow lactation consultants’ advice to ignore weight loss and lack of sufficient dirty diapers, and that is a problem.

          • Charybdis

            I didn’t say that they ALL did. The vast majority of the ones I’ve come across, both in person and on the vast reaches of the internet, DO exactly that. Hit up any of the breastfeeding support sites, Milk Meg, Kellymom, even La Leche League and you will hear these exact things. They will claim that they never said “never supplement, ever, for any reason”, and they probably didn’t use those exact words in that order. However, the oft-repeated choruses of “Nurse more! Cancel all your plans and just hang out, topless, with your baby! Offer the breast anytime the baby makes a whimper, even if they just got off the breast! It’s clusterfeeding! Reverse cycling is fine, never mind the fact that you don’t get good sleep because of night nursing! Your pediatrician doesn’t know anything about lactation, so don’t believe them when they suggest supplementing with formula. Don’t use formula, get milk from a milk bank. Or milkshare (wet nurse) or source your own breastmilk from other milksharing mothers”, etc, certainly lead one to believe that a “cohesive, multidisciplinary team of health care and infant support specialists” could not be formed.
            We have had LC’s/IBCLC’s post here with the most outrageous claims. “All babies NEED to lose weight in the beginning!” “Babies don’t need more that scant drops or mere milliliters (1-3) of colostrum for several days at a time”, “Brick dust in the diaper is normal, 7%=+ weight loss is normal and there is no danger with the weight loss”, “Don’t worry about the jaundice, it’s totally normal”, “it’s better to have your baby get an IV or endure multiple heel sticks for glucose tests rather than give formula after a nursing session”, “nipple confusion!”, “breastmilk is a living fluid!” “Insufficient breastmilk is vanishingly rare”, and the biggest whopper of them all: “So you’ve had a mastectomy. The milk can still leak out of your armpits, so there is no need to use formula!”.
            Inflating the benefits of breastfeeding (All the antibodies! Including those for measles, etc! Um, no. Passive immunity doesn’t work that way! Smarter, faster, stronger babies! Won’t get sick! Breastmilk is a magical, constantly morphing elixir that changes from minute to minute, depending on what your baby needs. It is always perfect and never deficient in vitamins or fat) while demonizing formula (TOXIC!! Fast food! Crap! Baby will be fat, lazy, stupid and possibly a criminal! No attachment to anyone) does not do anyone a service.
            There are only two ways to feed a baby: breastmilk and formula. They are both excellent ways to feed and nourish an infant. The scales may tip to one or the other, based on you and your baby’s needs. Use exclusively one or the other, or combo feed. But the “Breast is best” nonsense has got to stop.

          • Emma Hollis Hunter

            I don’t disagree with any of the points you make, and, as I haven’t shared your personal experience, can’t speak to how the lactation professionals you’ve encountered presented their opinions.

            This is where I feel my point with regard to breastfeeding is being missed: yes, it is true that on both ends of the spectrum there is unnecessarily specific and harsh guidance offered with regard to infant feeding. On one end, if you offer your infant a pacifier or a bottle instead of living with him attached to your boob 24/7 until child-led weaning occurs, you’re a horrible parent. On the other end, you’re foolish if you attempt to exclusively breastfeed, there’s absolutely no benefit, formula is no different than breast milk. Neither is true.

            Until an individual is willing to budge from either extreme, they are part of the problem and are contributing to the misguided argument that either method of feeding a baby is wrong.

          • The Bofa on the Sofa

            What is this other extreme you imply? Always give formula? I don’t think anyone has held that view since probably the 70s. Do you have anything more specific in mind about the other extreme position that won t budge, opposite the lactivists?

          • Emma Hollis Hunter

            I think the other extreme might be that breast milk is the same as formula and that accessing support from a lactation specialist in order to successfully breastfeed is unnecessary and potentially harmful.

          • If you want to breastfeed, it makes sense to see a lactation specialist. But if that lactation specialist sees a screaming, hungry baby who isn’t making enough dirty diapers and is losing weight and doesn’t sound the alarm bells, that’s a problem. Do we agree on that? Would you agree that the lactation consultant in question is harmful?

          • The Bofa on the Sofa

            I think the other extreme might be that breast milk is the same as formula and that accessing support from a lactation specialist in order to successfully breastfeed is unnecessary and potentially harmful.

            Doesn’t that depend on the LC? It is easily shown that there are lactation specialists who are dangerous.

            Moreover, this also begs the question of what makes a lactation specialist? How much is really known about breastfeeding (hint: not all that much; note that the LC advice often resorts to “breastfeed more”)

          • Emma Hollis Hunter

            Since human milk is produced large by a supply-and-demand system, some babies, especially those who might be jaundiced or premature and for whom the benefits a receiving breast milk are more pronounced, breastfeeding more is a reasonable recommendation in many circumstances. And I think one could easily make an argument that any professional with access to a person’s body is potentially dangerous. Obstetrician, dietician, personal trainer, lactation counselor. But it would be frowned upon and horribly misleading for me to go around claiming OBs or personal trainers are dangerous.

          • The Bofa on the Sofa

            Since human milk is produced large by a supply-and-demand system, some
            babies, especially those who might be jaundiced or premature and for
            whom the benefits a receiving breast milk are more pronounced,
            breastfeeding more is a reasonable recommendation in many circumstances.

            Unless, of course, the mother isn’t producing milk. Which often happens with newborns, as it takes time for milk production to start. Which is why many babies are jaundiced in the first place. So your solution to a baby who is jaundiced due to lack of milk is to … insist they get more breastmilk? Where is that breastmilk coming from?

            In many cases, supplementing with formula initially can help satiate the baby making breastfeeding easier when milk is available.

          • Who?

            What are the benefits of breastfeeding?

            What are the risks of formula feeding?

          • Emma Hollis Hunter

            It varies widely depending on circumstance, which is a primary reason why there’s truly no one best recommendation.

          • The Bofa on the Sofa

            A wise, regular contributor here has a saying: “All else equal, breast is best. However, all else is never equal.”

            You would agree that this is a fair reflection of your statement?

          • Who?

            So it’s impossible to say.

            Compelling.

          • Dr. Tuteur breastfed her four children. We’re all pretty clear on the benefits of breastfeeding- slightly lower risk of diarrhea and colds in the first year. That’s really about it- it’s not nothing, but it’s not much either. Of course formula is different from breastmilk, it’s just that the differences don’t really matter. And of course it’s not foolish to exclusively breastfeed- if it’s working and it’s what you want to do, go for it! It is foolish to push exclusive breastfeeding as the Best Option Evar when it isn’t, though. That’s all we’ve ever said.

          • Amy Tuteur, MD

            Funny, I sounds like you are projecting. You read a single post this blog. You didn’t like it because it caused cognitive dissonance. You wanted to discredit it to make yourself feel better and whined about lack of citations.

            Whom am I hoping to benefit? The literally millions of people who visit this site each year as well as the millions who visit the Facebook page. How about you? Whom I you hoping to benefit by commenting besides yourself?

          • Emma Hollis Hunter

            How have I demonstrated cognitive dissonance? I see you’ve responded to others who disagree with a post by diagnosing it, so I suspect it may be a go-to.

          • Emma Hollis Hunter

            And the only argument I’ve made is that medical claims should be well-considered, non-biased, thoughtful, and well-substantiated. I’ve made no medical claims myself or effort to discredit any statements made in this article, only arguments that it’s not well cited, and that the argumentative rhetoric that resulted in that observation isn’t convincing.

          • The Bofa on the Sofa

            And the only argument I’ve made is that medical claims should be well-considered, non-biased, thoughtful, and well-substantiated.

            In what respect is this not? The fact that she didn’t cite references in this post (oh my, they were in the day before’s!) doesn’t make it not well-considered, biased or not thoughtful. And while not “well-substantiated” the claims are substantiable.

          • demodocus

            Millions? Really? Cool. 🙂

          • The Bofa on the Sofa

            I probably account for 100 000 of those visits…..

          • demodocus

            🙂

          • I beg to differ. I am not currently a parent, though I hope to become one, and I am not in any medical field. I have learned a LOT reading through here about possible pregnancy, labor, and breastfeeding complications. I have every intention of breastfeeding any future offspring of mine, if I can, but I know enough now to know that if I can’t, it’s not a big deal. I wouldn’t have to feel guilty or broken because of it, I wouldn’t have to spend stupid amounts of money on it. I could just use formula if that’s how things played out, and that’s okay. That’s huge.

          • Emma Hollis Hunter

            You’re right, that is huge. At the same time, there are many moms to whom it is intensely personally important that they are able to breastfeed their baby, who don’t have the same relaxed yet informed perspective that you do. For those moms it’s important to provide access to unbiased support to help her find a path to whatever feeding method works to keep her baby fed while helping her find peace with whatever that feeding method turns out to be. When there’s overt verbal combat between “sides” on obstetrics and pediatrics, that’s a lot harder to achieve. Someone is likely informing her that she’s doing it “wrong,” if we’ve identified and are perpetuating that there is a “wrong.”

          • The Bofa on the Sofa

            For those moms it’s important to provide access to unbiased support to help her find a path to whatever feeding method works to keep her baby fed

            Who do you think is not doing that?

            Doctors who say, “It doesn’t hurt to supplement with formula, and it can be helpful when the baby is not getting nourished” or the lactivist who says, “Nurse all the time”?

            Which is unbiased information?

            Then again, who were the ones who created this message that breastfeeding is so important that women have to jump through extensive hoops in order to achieve that goal? Was that an unbiased message?

          • Emma Hollis Hunter

            I think this statement best embodies what concerns me about the article: “The Baby Friendly Hospital Initiative, designed to promote breastfeeding (a process), has led to a large and growing number of DEATHS (an outcome).”

            This to me does not demonstrate an intent to be unbiased, patient-centered, or evidence-based.

          • Amazed

            So, are you claiming that the BFHI has not promoted actions that have led to deaths? Because that’s the only way for the article to be biased, not patient-centered, or evidence-based.

            Are you claiming that BFHI has not led to deaths that could have been avoided otherwise? I’ll even go further and ask: are you claiming that BFHI has not led to near misses? Because that’s the only way to be truly unbiased: to count not only the tragedies that did happen but those who by the grace of God…

            Did such near tragedies take place, according to you?

          • Emma Hollis Hunter

            No more than I am claiming that formula feeding has never led to infant deaths. They’ve both occurred. Both feeding methods are necessary and appropriate. It’s the vilification of one method based on overly narrow criteria that is inappropriate.

          • Amazed

            You basically accused Dr Tuteur of lying. That’s what I was asking about. Nice dodging the question, though. I am pretty sure breastfeeding has killed children without help from BFHI which would be the more appropriate comparison for your formula feeding death. But please let me know when there is an UFHI (Unbaby Friendly Hospital Initiative) that has led to preventable deaths so we can compare.

            Unbiased? You demand unbiased? You’re practically screaming biased but since this post doesn’t cater to your LC biases, you scream how unbiased you are and how you’re just a poor compassionate provider whom those evil MDs battle relentlessly.

          • Emma Hollis Hunter

            Okay, so tell me, given all my comments in this thread, what am I biased against?

          • Sue

            What are you biased against? A medical blogger who presents evidence that you don’t agree with.

            You also appear to be biased against civil discussion. Instead of launching in with your “disappointment” about the “lack of citations”, you could ask “Could you post the sources of the graph and table please?”

            See the difference?

          • Amazed

            You are biased against anything that doesn’t support yout preconceived notions that there could not possibly be any harm from your work. You’re biased against MDs who warn that BFHI might be applied in a way that makes it deadly and dismiss them as combatative and competitive. You re biased because you insist everyone caters to you and hide it behind “it’s better for moms if providers are civil to each other!” but you don’t offer any consideration of other providers back because somehow, you being passive-agressive seems to be great for moms in your opinion.

            Should I go on?

          • demodocus

            Me: Breastfeeding makes me suicidal
            Her: Of course it doesn’t matter, except it’s only these meanies who convince you to that all LCs are mean.

          • The Bofa on the Sofa

            No more than I am claiming that formula feeding has never led to infant deaths.

            We know that using formula in an area with contaminated water is a problem. I have also heard of parents overdiluting their formula, and babies dying as a result. However, I wouldn’t call that a death due to formula, but moreso due to LACK of formula.

            Can you provide any other examples of a baby dying due to formula?

          • Emma Hollis Hunter

            Sure, here’s one :https://www.jscimedcentral.com/Obstetrics/obstetrics-2-1021.

            “Breast Feeding Associated with
            Reduced Sudden Infant Death
            Syndrome and Infant Mortality”

          • Yeah, but that’s because of the sucking- giving a baby a pacifier works just as well or better than breastfeeding in reducing SIDS. I’m not impressed.

          • Emma Hollis Hunter

            Don’t know about yours, but when my babies took formula, they sucked it out of a bottle. So if it was “because of the sucking,” wouldn’t it just be eating that reduced the risk?

          • I think most breastfed babies also get given the breast as a soothing method, so they spend more time there than just eating.

          • Poogles

            Exactly, “comfort nursing” is a huge thing among BF moms.

          • Sue

            Wow? They made that conclusion from this data set? What do you think of the scatter plot and where they put the “line of best fit” on page 2?

          • The Bofa on the Sofa

            http://jamanetwork.com/journals/jamapediatrics/article-abstract/2546142

            there is now emerging evidence that full compliance with the 10 steps
            of the initiative may inadvertently be promoting potentially hazardous
            practices and/or having counterproductive outcomes.

            In support of the claim that BFHI is leading to deaths, there is this

            http://jamanetwork.com/journals/jama/article-abstract/2571222

            Counseling to avoid the use of pacifiers in the newborn period is an intervention commonly used to support breastfeeding. However, evidence has been building that infant use of a pacifier may be associated with a reduced risk of
            sudden infant death syndrome, the most common cause of postneonatal death in the United States. The evidence review showed that avoiding pacifiers was not associated with any breastfeeding outcomes assed in the evidence review.

            JAMA references good enough for you?

          • Amazed

            At the same time, there are many LCs and BFHI hospitals to whom breastfeeding is more important than it is to the mothers. And some of them account for the preventable deaths Dr Amy mentions here.

          • No one here will tell any mom she’s feeding her baby “wrong”, unless the baby isn’t getting fed. That’s all that matters- the baby getting fed. That’s the whole point of “Fed is Best” lol.
            I’m not seeing where you think Dr. Tuteur is being mean to breastfeeding moms, I’m really not. What verbal combat is there, unless you think “Breast is Best” and “Fed is Best” are at all comparable. The former promotes one feeding method, while the other is exactly what you say you want- that women get support to feed their babies in the way that works best for them.

          • Sue

            “there are many moms to whom it is intensely personally important that they are able to breastfeed their baby” – often because of cultural pressure that they should feel it is so.

          • demodocus

            It was mildly important for me with my elder kid, but never “intensely” important. It was everybody else I encountered in the baby world who insisted it was okay that I barely made any colostrum while my kid was loosing 12% of his body weight before my milk came in. On day 5.

          • swbarnes2

            Is this for real? You are arguing that women are so completely driven by their emotions, that any attempt to give them facts and rational arguments is going to confuse and bewilder them? So doctors should just shut up so that LCs can make all those emotionally ninnies feel good about themselves and their choices?

            “Intensely, personally important” means “irrational”. Which would be fine, if not for the potentially dire health consequences of taking that intensely desired path when the evidence shows it’s not working. Far, far too many LCs will allow a woman to take her child down a dangerous road, because they too have an intensely, personally important desire, one might say “bias”, to keep supplementation rates down.

            44% of primips have no milk by day 3. According to the CDC WONDER database, that’s a little less than half of all babies. Letting a baby eat nothing for 3 days is fine for BFHI quotas about supplementation. (They expect a year-by-year reduction in supplementing. There are many evaluation criteria, but none of them reads “confirm that 80% of babies have been fed at least once before discharge”) Having some percentage of those babies readmitted to the hospital for feeding problems is also fine, because the BFHI doesn’t track or care about that. And you are going to argue that this creates absolutely no bias at all in the LCs responsible for carrying out BFHI policies?

            http://ajcn.nutrition.org/content/early/2010/06/23/ajcn.2010.29192.full.pdf

            https://www.babyfriendlyusa.org/get-started/the-guidelines-evaluation-criteria

          • Amazed

            Defensive? You write here like your typical paranoid LC despite being a RN and think people here are defensive? Get off your high horse and stop talking about consensus and respect. Your insults to the readers here are not so subtle.

          • Emma Hollis Hunter

            What makes you think I meant to be subtle?

          • Amazed

            I don’t know. Perhaps your insistence that you wanted a dialogue. I took you at your word despite knowing that you likely only wanted to make it all comfortable for you. In fact, you made this one blatantly clear when you placed the responsibility for making it work solely on the shoulders of MDs who had to bend backwards to acommodate your LC self, praise you and consider you a valuable colleague, with you not moving a finger on your end.

            Thanks for saying it clear, though. I appreciate hypocrits owning their hypocrisy.

          • Emma Hollis Hunter

            None of that has anything to do with subtlety. Also, I never said I practice as a LC. I said I’m certified. Your inability to objectively interpret any single statement or comment is what makes internet access for uninformed individuals to inaccurate information truly troubling.

          • Sue

            “this style of rhetoric-based argument will likely not be effective.”

            On the contrary – there is evidence that Dr Amy’s style is effective in various ways.

            It gives readers evidence-based information that counters the ideology of lactivism. Sometimes, reading this helps indivudal mothers (we know this, because they tell us) and other times it helps readers to rebut the misinformation in other discussions elsewhere (I know this, because I have done it).

            So, you are incorrect. It IS effective.

          • momofone

            You sound like a person who takes science and scientific evidence seriously. I’m curious about your science background–would you mind sharing it?

          • Emma Hollis Hunter

            Well, given most of the other responses to my comments, I’ll admit I’m incline to suspect this might be a trap, but I’m happy to share:). I’m a Registered Nurse, Certified Lactation Counselor, and soon-to-be Certified Childbirth Educator as well as Still Birthday Doula.

          • momofone

            Not a trap, just curious. Though it was pretty clear from your responses that you were a lactation consultant.

          • Emma Hollis Hunter

            To give some added perspective, I’m also a combo feeder by choice, and a 12-month-mom-led-weaner. 🙂

          • Sue

            AMongst other things, it appears this person doesn’t know much about blogs. The continuous reproduction of evidence is valued and discussed here, though not repeated in every single post.

            There’s a search function, and a lot of valid discussion of research findings. One need only take the time to look before launching in with a challenge.

          • Amy Tuteur, MD

            In other words, you have no substantive criticism that you can back up with scientific evidence. Not surprised.

          • Emma Hollis Hunter

            Not my blog, so not really my job. In the author’s defense, it is not her job to remain unbiased and professional in a blog post, just in her position as a provider of women’s health.

          • The Bofa on the Sofa

            Emma, you are responding to “the author.” It is HER blog. You are criticizing HER, and you admit that you have no substantive criticism.

            Thanks for the contribution.

          • Emma Hollis Hunter

            I don’t think you understand how internetting works….

          • The Bofa on the Sofa

            I have been internetting for 25 years, I understand it.

            Please explain your comment above, in response to Dr Amy Tuteur’s comment
            “In other words, you have no substantive criticism that you can back up with scientific evidence. ”

            You responded

            Not my blog, so not really my job. In the author’s defense, it is not her job to remain unbiased and professional in a blog post,

            When you refer to “the author,” to whom are you referring? I interpreted it as meaning the author of the blog post above, aka Dr Amy Tuteur.

            But to your point: no, it is not your “job” to provide substantive criticism. However, it is also not your job to come here and provide non-substantive criticism, but you chose to do it anyway. Not to speak for Dr Amy, but I tend to find substantive criticism more useful, but hey, it’s not your job…

          • Emma Hollis Hunter

            How is my initial comment not substantive?

          • The Bofa on the Sofa

            It didn’t address the substance of the post.

          • Amazed

            Are you serious?

          • Sue

            ‘I think broad statements made my a medical professional without citations falls into the category of “substance.” ‘

            First, this is a blog, not an article in a medical journal. Second, there are two figures containing information within the article. If you really had an interest in the sources, why not ask “can you tell me the sources of the figure and the table?” rather than just complaining about your disappointment?

            I would like to declare my disappointment in your style of engagement.

        • This is the fallacy of the mean- both sides are part right and part wrong, so obviously the correct solution is in the middle. Right? Wrong.

          That is not the case here. The “combativeness” you see is a woman who is tired of reading about women and babies dying due to medical negligence on the part of people who should know better. She is also angry that people are pushing for more medical negligence even though it hurts people!

          What would be an appropriate response in your mind to this? What is the perfect right reaction of “BFHI isn’t working and it is causing harm” that you will listen to, that can cause change without hurting lactation staff’s feelings? I’ll give you a hint: it doesn’t exist. We have to look at the data and follow it where it leads, even if that pisses people off. That’s how science works. And right now, the lactation (not nursing!) staff are letting their feelings get in the way of saving babies’ lives. That’s frankly unacceptable.

          • Emma Hollis Hunter

            Why do I feel like it’s someone other than the lactation staff who has strong feelings getting in the way right now?

          • MaineJen

            Yeah, preventable and unnecessary deaths provoke strong feelings in us. Who would have thought?

          • Sarah

            Why are you asking other people to explain why you feel something? If I were guessing, I’d go with your pre-existing antipathy to the idea that the behaviour of lactation staff might be problematic, but I have a feeling that’s not the response you were looking for.

          • Emma Hollis Hunter

            Why do I feel like you logged on here intending to blindly defend against anyone with critical comments?

          • Sarah

            Because of your own inherent flaws .

          • Emma Hollis Hunter

            Why do I feel like you’re the one projecting now?

          • Charybdis

            Don’t know. Why don’t you enlighten us as to why you feel that way?
            You keep asking us why you feel the way you feel. If you don’t know, we sure as hell don’t.

          • Sarah

            See previous response. Your feelz are not reliable evidence of anything other than what you are like, I’m afraid.

          • I dunno- should dead babies cause strong feelings or not? Strong feelings aren’t inherently bad, but they are if they get in the way of following the evidence.

            And right now, the evidence is that BFHI is hurting people. I’m open to evidence showing otherwise. Please provide it. I would love to see that it isn’t a waste of money that hurts people, because I’m all about efficient use of limited resources. Do you have that evidence available?

  • Lee Aldrich

    There is an important cause of maternal death missing here: the murder of the pregnant woman by her partner.

  • Eater of Worlds

    Has anyone contacted Consumer Reports and shown them with citations why they are wrong, and show how Haelle has bias in this (with citations, again, from what she’s posted and backing up what you claim)? So that they can make an article correcting themselves?

  • yugaya

    There’s more shite where that came from: http://www.consumerreports.org/c-section/cut-your-odds-of-having-an-unnecessary-c-section/

    “If your provider is unaware of the new standards, or is dismissive of them, you may want to find a different one.”

    If your science journalist is unaware of the new infant safe sleep standards, or is dismissive of them while running her mouth about infant mortality in USA, you may want to find a different one

  • Sarah

    Tara Haelle in bag of shite shocker.

    • yugaya

      *is

      • Sarah

        Lol. That would also work.

        • yugaya

          Yeah. I made the mistake of unblocking her on social media when she made a promise to write a no bullshit safe sleep article/blog/something/anything that could be a valuable, highly shareable resource for those of us interested in raising safe sleep awareness around the mommy internet. Still nothing.

  • Mad Hatter

    “Good reasons for induction… you’re at or beyond 42 weeks pregnant”? I thought only someone wanting a homebirth would a pregnancy to go that far. What kind of recommendation is that! I was flipping out last week because a friend told me her hospital wouldn’t do an induction before 41+2. I asked for an induction at 40 weeks and my dr was happy to schedule it since I had good bishop scores. I was miserable and the waiting game was stressing me out. 5 hours and we had a 8.5 lb baby.

    • demodocus

      wistful about petite babies. my 38 weeker was 8 3/4 pounds

      • BeatriceC

        My 36 weeker was 8 pounds, 8 ounces and 32 weeker was 5 pounds, 4 ounces. I cringe to think how big they’d have been at term.

        • fiftyfifty1

          wow!

        • Spamamander, pro fun ruiner

          Eeek!

        • demodocus

          One of the very few positives about OK and MK being preemies?

          • BeatriceC

            Pretty much.

      • Mad Hatter

        Exactly! I should add I was terrified of a big baby. That’s another reason why I was ready to be induced at 40 weeks!

      • AnnaPDE

        And let’s just add that the weight is only one factor — a head circumference of 14.9in is just as bad on a 8lb 5oz baby as on a bigger one. (Which is why mine didn’t even get to descend into the pelvis properly — basically got stuck pretty much at the top.)

        • demodocus

          Yes, this I also understand. They get it from their father and my father. Good thing I “won” the lottery here and can deliver my giant babies. I feel really bad for my bio grandmother giving birth to dad in ’47

          • Azuran

            I kinda ‘lost’ the lottery there. We make huge babies in my family, all well over 9lb. At 8lb 8oz my baby is practically considered small.
            We have big bones in the family. But my pelvis is somewhat narrow, so I couldn’t get my baby out.
            But I’d be lying if I said I wasn’t happy with getting a c-section and having c-sections for my future pregnancies.
            So I guess I ‘won’.

    • maidmarian555

      Here where I am in the UK they wouldn’t induce me until I was 12 days overdue. I did ask (more than once- I was enormous and utterly miserable) but was told that I absolutely wasn’t ‘allowed’ one ‘without a good reason’. I didn’t know the risks of going that far over and certainly wasn’t told by my midwife.

    • RMY

      This is insane, a good reason for induction is a doctor recommending it for health and well-being reasons, no matter how many weeks you are. Medicine isn’t always simple enough that every very general question has one right answer that is best for everyone.

  • Mel

    The thing that annoys me about these kind of articles is that a lot of people won’t make the connection that you are a “low risk first time mom” right up until you become a “high risk first time mom.”

    A blood pressure reading, a panel of blood work and a urine protein dip moved me from “AMA, but doing fine” to “We’re going to deliver your son in the two days – hopefully the steroids work, but we don’t want both of you to die”.

    Plus, I figure my doctor has a better bead on what’s the best way to handle delivery. Getting knocked up did not give me the equivalent of a medical school education plus a residency in OB/GYN.

    • TsuDhoNimh

      … you are a “low risk first time mom” right up until you become a “high risk first time mom.”

      Yes … and you have to assume that you could become high-risk rather suddenly.

      • And it can happen with each and/or every pregnancy.

        • Merrie

          I had two bog-standard pregnancies and two straightforward births up through third stage with baby #2, and then all of a sudden my body didn’t want to let all of the placenta go. My midwife did a manual extraction and brought it out in pieces. In another situation I could have bled to death. I was very glad I was in the hospital with a practitioner who knew what she was doing and had backup if needed.

          • Kelly

            I had two textbook pregnancies and then with the third, I developed cholestasis and then it took almost a good 20 minutes for the placenta to finally detach after birth. While I was induced quickly and I didn’t hemorrhage, without the help of medicine, I or my baby could have died at any point. Here is the really sad part about it too. Without medical help, it may have been a very traumatic labor and delivery but because of medicine, it was the easiest and most peaceful.

    • Azuran

      I was a ‘low risk first time mom’ up until I was in active labour.
      Everything was practically perfect, I had absolutely nothing wrong while I was pregnant, I’m healthy, My baby was perfect, it was correctly positioned. I went into labour at 39+4. It progressed very well up until it became time to push and it became evident that my baby’s head just wouldn’t fit and she was starting to have late decel.
      No amount of ‘you’re a low risk first time mom’ would have made my pelvis wider or magically shrunk my baby.

      • demodocus

        yup. I was AMA and overweight but everything was going fine, until my previously well behaved bp skyrocketed 4 hours after my water broke, before the pitocin. Good thing I was fat and old enough to have been considered high risk on principle.

      • This was why, in my time in the UK, we would not permit primips to be candidates for homebirth.

        • Sue

          Confirmed in the UK Birthplace study, where the first-timers had 3X neonatal death rate.

    • 3boyz

      Just in general, you’re low risk until you’re not. My first 2 pregnancies and births were perfectly normal and easy. There was no reason to assume the third wouldn’t be equally simple. And it was, right up until it wasn’t. I woke up one morning at 27 weeks with my thighs and sheets covered in blood. In the hospital I continued to bleed and bleed and bleed, and they were planning to deliver within a half hour, but then the bleeding slowed down and I stabilized and the baby’s vitals were fine, so they decided to wait and monitor for as long as conditions would allow. I ended up staying pregnant till 36 weeks. But tl;dr, all of my pregnancies were smooth sailing, including the one that ended up having problems, literally right up until the moment the problems started.

      • Gæst

        And also, you can feel just fine while everything is going haywire. I had preeclampsia with high bp and protein in urine, but those were only caught because of monitoring. I *felt* and *looked* fine, but I was not fine. Everything seemed fine, fine, fine – except it wasn’t.

        • Roadstergal

          I’ve seen my friends at the ends of pregnancies – how much can you trust your own subjective estimation of how you feel??

          • Kelly

            I agree. A lot of times you can feel fine but then once you feel better, you realize how bad you felt.

        • Mel

          I walked into the hospital at 26 weeks gestation because I thought I might be having weak contractions.

          I was having Braxton-Hicks contractions with no signs of my cervix dilating.

          On an unrelated note, taking my vitals signs alerted the CNM in triage that I had severe pre-e. The blood panel she took cued them into the fact that I had developed HELLP syndrome that had decimated my RBCs & platelets along with pre-e during the 10 days since my last perfectly normal OB appointment.

  • Gatita

    What happened to Tara Halle? She used to be a reasonable person but something went awry.

    • yugaya

      Dunno, I encountered her with those crap pieces on doulas and Oregon homebirth study in which she labeled the increased mortality in homebith based on her interpretation of the findings as “only slightly riskier” than giving birth in a hospital. I mean, of all the places, she made that kind of statement based on a heavily redacted study data for Oregon, a state with mandatory reporting and full data available that shows horrific intrapartum and perinatal mortality.

  • yugaya

    Did Tara Haelle mention how she is personally keen on *helping* USA infant mortality remain that high by promoting the deadly practice of bedsharing in adult bed in her book? No?

    Accidental suffocation is the number one cause of infant injury deaths, and half or more of all sleep-related infant deaths occur while babies are sleeping in adult bed. those deaths are in 9 out of 10 cases determined after a child death review to be preventable.

    https://www.cdc.gov/injury/images/lc-charts/leading_causes_of_injury_deaths_unintentional_injury_2014_1040w740h.gif

    This article is even worse than her previous ones written for Consumer Reports – same kind of junk analysis for mass consumption.

    • Heidi_storage

      Terrible. But how do people sleep with babies, anyway? I’ve fed the kid in bed, but even at my most exhausted simply couldn’t fall asleep with the baby suckling (which is a good thing).

      • demodocus

        I could, and did. When I bf’d we had to plan to bed share simply because it kept happening, in the freaking chair. With our daughter, Demo did the wee hours meal. I’d wake up about half way through for 10 seconds and be out again.

      • AnnaPDE

        A question of how worn out you are, really. Some kids actually wake up very soon after they notice they’re not snuggled up to a parent any more. (Especially when they’re on their back. On their side, snuggled up to a blankie, it’s happy sleeping for hours.)
        I really didn’t like to sleep in the same bed with my baby. But when it’s the choice between passing out with the baby in my arms sitting on the sofa at 4am, or with the baby next to me lying in a bed which has been at least prepared so there are no pillows or blankets close by and I’m lying down in a way that makes it hard (bordering on impossible without dislocating my own shoulder) to roll onto the kid, I know which one I’ll choose.

        • yugaya

          “and I’m lying down in a way that makes it hard (bordering on impossible without dislocating my own shoulder) to roll onto the kid,”

          That’s a nonsense claim. No position of the adult makes bedsharing safer. Also, sleep-related infant deaths in adult beds are not merely due to adult overlay: there’s 40 times increased risk of SIDS alone due to sleeping in adult bed even without bedsharing, 50% of all SIDS at peak age happening to babies who sleep in adult beds http://search.proquest.com/openview/5ce727dc89db07fc34cc0d9a0ce17f7c/1?pq-origsite=gscholar&cbl=30566 9, positional asphyxia, wedging, entrapment.

          “Some kids actually wake up very soon after they notice they’re not snuggled up to a parent any more. (Especially when they’re on their back. On their side, snuggled up to a blankie, it’s happy sleeping for hours.)” All babies will sleep *better* snuggled up to a blankie and on an unsafe sleep surface of adult bed that is far more comfortable than a bare, safe crib. But that’s because their arousal ability is compromised. https://apps.cce.csus.edu/sites/cdph/sids15/docs/StastnyKeens-PHN-34thCaliforniaSIDSConference2015.pdf

          “But when it’s the choice between passing out with the baby in my arms sitting on the sofa at 4am, or with the baby next to me lying in a bed”

          No, the choice is between falling asleep accidentally while feeding the baby ( there is guidance for parents on how to make that as safe as possible in the AAP 2016 Safe Sleep Update) and habitual, intentional placing of infants to sleep in adult bed and bedshare. The difference between the two is that accidental bedsharing in adult bed has been shown not to carry the risks of routine bedsharing. http://www.phac-aspc.gc.ca/hp-ps/dca-dea/stages-etapes/childhood-enfance_0-2/sids/pbs-ppl-eng.php#a38

          • moto_librarian

            I bed-shared a lot with our second, simply out of utter exhaustion. And knowing what I know now, I understand that we were lucky. I would never do it again, even if it meant sleeping on the floor next to the baby in a basket.

          • guest

            I was lucky with my second who refused to sleep in her crib, my husband and I were both home so we took shifts at night with her and were still able to get solid sleep. I was able to catch up on a LOT of TV during the night. 🙂
            Eventually, I convinced her to sleep in her car seat with it right next to my bed where she could see me all night and I could easily reach out and touch her. I okay’d it with her pediatrician first-while it came with a slight increase in SIDS risk, it was better than bed-sharing.

          • yugaya
          • Azuran

            I feel you. ‘safe baby sleeping’ does not appear to be appreciated by many babies. Mine had the same problem, getting her to sleep in a crib has been horrible. For the first month, my nights where pretty much feed the baby for 45 minutes, then spend another 1h-1h30 putting her to sleep and in her crib repeatedly. Whenever I succeeded, I was lucky if I could sleep 30 minutes before she woke up again.
            Whenever I managed to sleep, I would dream that she was crying, that I got up and brought her back to bed with me. Then I’d wake up in a panic thinking I fell asleep in my bed with the baby and I couldn’t find her (my bed being a perfect example of everything you shouldn’t do when cosleeping: very soft, covered with a very fluffy and heavy comforter, with huge pillows and a 110 pound dog that somehow always end up taking 75% of the bed and will actively resist and roll over on top of you if you try to push him away.)

            It got much better when we started using a baby sleeping bag.

  • Azuran

    ”Despite the benefits of a healthcare system that outspends those in the rest of the world”
    I always find it funny when people try to use the absolutely ridiculous cost of the American health care as some kind of indication that they have the best health care. And that clearly, more money means that you are having too much intervention.
    You outspend everyone else because you have a stupid for profit private health care system. Your system is practically the worst of the developed world, it’s super expensive and offers on average shitty coverage compared to other countries with public health care.
    Maternal mortality would probably drop significantly if you had a public system.
    While your politicians are whining that men shouldn’t have to pay for pre-natal care, here, everyone gets it. I you don’t already have a GP, the regional hospital where I live has the OBLIGATION to find a doctor for your pre-natal care and a pediatrician for every baby.

    • demodocus

      But socialism is evil and being able to see a doctor when your toe’s been ripped off is a privilege!

      • demodocus

        or so my uncle implies

        • Anne

          Not only your uncle- also the brainbox Miss USA winner!

          • demodocus

            I know, but him I can argue with at family get togethers

      • Azuran

        And of course, nobody dies because they don’t have access to healthcare.

    • JDM

      This too is their ignoring outcomes. What we see in comparisons of outcomes is that these other countries do as well or better than the US on almost all measures of healthcare, and for about 1/2 to 2/3 the money. By any sensible measure that’s doing far better.

      If Consumer Reports tested blenders and two did just as good a job, but one was half the price, would they say the more expensive one was better? Of course not; they’re failing to apply their own standards consistently.

    • Young CC Prof

      The City of New York analyzed all maternal deaths over a 5-year period. Pregnant women with no insurance were SEVEN TIMES more likely to die than women with private insurance, and five times more likely than women with Medicaid.

      The USA has great healthcare if you are rich. We get lousy outcomes because not everyone has access to it, which is seriously not OK.

  • fiftyfifty1

    I’m reviewing in my head every perinatal and maternal death I have ever personally known about as student, resident, or practicing doctor.

    The baby deaths were all either due to profound birth defects (“avoidable” only if families had chosen abortion) or would have been prevented by, wait for it….MORE technology–a timely induction or C-section.

    The one maternal death was a severe postpartum cardiomyopathy. It could have been prevented by, wait for it….MORE technology. It probably would have taken a heart transplant or perhaps a mechanical heart assist device that was not yet perfected.

    • FormerPhysicist

      I live in Boston, so I know about more near misses than deaths. including a severe postpartum cardiomyopathy. Yay interventions! Yay for amazing hospitals!

      It’s like my neighbors warned me that my last OB “likes to cut”. Yay, I needed a scheduled c/s (that turned into a rather rushed, unplanned one). I LIKED that she was comfortable with surgery and skilled.

      • Roadstergal

        Why on earth would you see a professional who isn’t good at all aspects of their profession?

        I mean, you can like to do something and be very good at it, and still have a sense of perspective on when to do it and when not.

        • Mattie

          I would be FAR more concerned if the doctor didn’t ‘like’ or wasn’t ‘good’ at vaginal birth? Like, a lot of doctors on delivery suite don’t have a ton of experience at ‘normal’ vaginal birth, because they don’t do it a lot…not true of US OBs generally, but I’d want my doctor to be skilled in all possible eventualities lol

    • MI Dawn

      I’ve unfortunately seen more than that, and my career spanned only 16 years.

      Maternal deaths: fat embolism, intrapartum hemorrahage from unsuspected DIC (that one was awful), sepsis from adult chickenpox.

      Perinatal deaths: birth defects, SIDS (in the newborn nursery), meconium aspiration, prematurity.

      The worst perinatal death, I’ll never forget…mom called OB with pain and bleeding. Told to come to the hospital immediately. OB arrived, OR staff on site (small community hospital, we didn’t have 24 hour OR). Pace, pace, pace. Where’s the patient? Pace more. Try calling her home number – this is pre-cell phones – no answer. Finally, 2 hours later, she arrives, in pain, but they’d stopped for food because she and spouse were hungry and she knew she wouldn’t be allowed to eat in labor. Baby had died in utero from placental abruption. Mom started bleeding out (the DIC above) and lost her uterus to save her life. First pregnancy. 27 years later, it still haunts me.

    • RudyTooty

      “I’m reviewing in my head every perinatal and maternal death I have ever personally known about…”

      I did this exercise last night myself, as one who has attended births in both low-resource (home, birth center) settings with midwives, and also in regional tertiary hospitals – and quite a bit in between (small rural hospitals).

      The list is striking and shocking.

      I’ll sum up:

      Reasons for death in the OOH setting – personally relayed to me by parties involved (the midwife, parents, or hospital staff who took over after transfer):

      1) Attempted home birth with baby in breech position (two specific accounts)
      2) Attempted home birth of twins (death of one twin in each case)
      3) Postdates FDIU 43-44 weeks
      4) Unknown “heart tones were ‘perfect’ and baby just came out dead’ (two)
      5) cord prolapse – term, planned home birth
      6) Maternal seizure, undiagnosed pre-e, causing late preterm death
      7) FDIU, full term baby, maternal high risk pregnancy, cared for by LM and planning OOH birth
      8) uterine rupture after planned labor after cesarean at home with midwife, neonatal demise (two)
      9) 8 week unexplained infant death r/t bleeding (newborn hemorrhagic disease??????)

      I know of many more deaths than these – but it becomes more of a ‘heard it through the grapevine’ thing – but NOTE: all of these cases came to me through someone I personally know – the midwives themselves, the parents, or healthcare professionals who were eventually involved after transfer.

      But – deaths occur in the hospital, too! Isn’t that the cry of the NCB crowd? Of the midwives who will take on any and all risky births in attempts to ’empower’ women?

      OK – deaths in the hospital (I personally cared for these people in some way – So I remember them, distinctly):

      1) 2) Extreme prematurity 20-22 weeks
      3) placental abruption, high risk pregnancy (pre-existing maternal conditions), prematurity
      4) severe IUGR, prematurity, HELLP syndrome
      5) severe IUGR, anhydramnios, prematurity, congenital defects
      6) vasa previa, PPROM, prematurity, FDIU prior to arrival at hospital
      7) abruption, prematurity, maternal diabetes

      Full term hospital deaths – I thought of some
      8) placental abruption at home, fetus in distress (bradycardia) upon arrival at hospital
      9) true knot in cord, postdates, FDIU presented in labor
      10) congenital heart disease (known), early neonatal death

      I don’t know what to say about these lists – and this isn’t a perfect scientific or statistically meaningful representation of anything, I understand that – but it’s striking, isn’t it? The comparison is stomach-turning, actually. The first list is the primary reason I don’t attend OOH birth any more. I could see the writing on the wall – I could see what was coming my way if I chose that path: unneccessary death and tragedy.

      But I’m pretty sure the data from MANAstats back this up.
      How do they sleep at night?

      • Merrie

        That first list makes me so mad… all those babies that are dead who did not need to be.

        #6 makes me think of a friend of my husband’s who had a seizure at 8 months pregnant. They did a c-section. Her daughter is in kindergarten now. Technology is great!

        • RudyTooty

          Technology is great.
          Technology saves lives.

      • yugaya

        “But I’m pretty sure the data from MANAstats back this up.”

        Of course they do. See, in their entire voluntarily reported 2004-2009 cohort there was “only” one twin homebirth fatality. You’ve personally witnessed more, and I’ve found a dozen through available disciplinary records for 2004 onward.

        • RudyTooty

          Well, my list isn’t scientific or statistically evident of anything. I’m not sure if those deaths occurred (the twin deaths) between the years of 2004-2009. If I remember correctly, these stories were relayed to me somewhere around 2006. So probably not likely in that specific cohort.

          To clarify – I have not personally witnessed these homebirth deaths – they have been personally relayed to me by people IRL who were directly involved. These are not deaths that I’ve just read about on the internet. That’s my point. None of these deaths made it to the ‘Hurt By Homebirth’ page or BabyCenter or Mothering. These are real people who live within a few hundred miles of me. All the midwives involved are still practicing. All are licensed. To my knowledge, anyway.