Sheena Byrom and the moral bankruptcy of UK midwifery

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Once again I have written a blog post about my revulsion at the deadly behavior of UK midwives, and once again a prominent midwife has rushed to demonstrate the truth of my words to the entire world: professional autonomy is more important to midwives than whether babies live or die.

It was only 4 days ago that I wrote about the latest Stunning indictment of UK midwives. According to The Guardian:

Sheena Byrom is the poster child for moral depravity in the face of preventable infant deaths.

The number of claims for brain damage and cerebral palsy has tripled in a decade, amid widespread monitoring failures …

The cases – often linked with a failure to monitor babies’ heart rates, to detect risks of oxygen starvation – fuelled maternity negligence claims of more than £1.2bn in 2015/16 [$1.5 billion].

The proximate cause is that UK midwives are not adequately trained in fetal monitoring, but the real cause is that UK midwives place process (“normal birth”) above outcome (live, healthy babies and mothers).

Just in case you thought I was exaggerating the immorality of a group of medical providers who place their personal philosophy above the lives they are ethically mandated to protect, midwife Sheila Byrom rushes to prove me right.

Byrom is the poster child for moral depravity in the face of preventable infant deaths. She has the unmitigated gall to defend the unethical behavior of midwives in privileging process over outcome by arguing that it is more important to preserve “normal birth” than human life.

In my piece I asked: how many babies have to die and how many billions of pounds have to be paid out before the morally repugnant, incompetently trained, self-dealing, deadly UK midwives are held to account?

Sheena Byrom, writing in conjunction with another deadly midwifery enabler, Soo Downe, answered: as many as UK midwives damn well please.

In Normal birth – a moral and ethical imperative, Byrom and Downe are attempting to rebut a piece in The London Times, Midwives told to stop pushing own agenda for natural births, which notes:

Midwives will be told not to use language that could push women into “normal” birth amid fears that babies are at risk because of a reluctance to ask for medical help…

A review into the deaths of 11 babies and one mother at the Morecambe Bay trust warned that a desire for normal birth “at any cost” was a contributor.

Outgoing head of the Royal College of Midwives (RCM) Cathy Warwick has met every new midwifery scandal with weasel words but no action. Speaking of the most recent scandals, Warwick offered more weasel words:

[I]f there were midwives who were pushing normal birth then we must have good governance process in place which will pick up that and make sure it doesn’t continue to happen.

Byrom and Downe also use weasel words:

Promoting normal birth while also maximising the wellbeing of mother and baby is therefore not a cult, or a professional project, or a conspiracy. It is a moral and ethical imperative, that should be supported by all of those with any interest in the wellbeing of mothers, babies and families, in the short and longer term. This includes professionals, journalists, politicians, health service managers, childbirth activists, and lawyers.

But no one is talking about promoting normal birth while maximizing wellbeing of mother and baby; the issue is promoting normal birth above maximizing wellbeing of mothers and babies.

Byrom and Downe present a graph that demonstrates a slowly rising C-section rate and ask:

And if there is a widespread problem where midwives ‘pursue normal birth at any cost’, why are the statistics below so stark? Surely, the opposite would be the case?

Which words in “claims for brain damage and cerebral palsy has tripled in a decade” and “maternity negligence claims of more than £1.2bn in 2015/16 [$1.5 billion]” are they having trouble understanding?

Byrom and Downe insist that “normal birth” is a moral and ethical imperative.


Medical ethics rests on four principles:

Respect for autonomy – the patient has the right to refuse or choose their treatment.

Beneficence – a practitioner should act in the best interest of the patient.

Non-maleficence – to not be the cause of harm…

Justice – concerns the distribution of scarce health resources, and the decision of who gets what treatment …

Do you see normal birth — or any specific procedure — among these? I don’t either.

The key to understanding midwives’ insistence on a procedure instead of an outcome is to recognize that when midwives say “normal birth” what they really mean is “anything midwives can do and nothing they cannot.” Promoting normal birth is really about promoting midwife autonomy.

In their first paragraph Byrom and Downe make it clear that this is really about midwives and their desires:

Yes, there needs to be learning from incidents, and development where needed. But blaming one professional group, or a particular type of birth, does little to improve any situation.

Actually, insisting that a professional group take responsibility for their own deadly mistakes does A LOT  to improve any situation.

I regularly spend time with student midwives from around the UK and beyond. They tell me they are worried about practising as qualified midwives, as, during their training, they hardly ever see women who have had a normal, physiological, straightforward pregnancy, labour and birth.

Midwifery is NOT supposed to be about meeting midwives’ needs; there is a moral imperative to meet PATIENTS’ needs.

Recent press reports add to the fear already embedded in maternity services. This fear is real in high income countries, and influences the decisions of women, mothers and families alike.

But the ethical provider SHOULD feel fear at the thought of preventable deaths. It is only the morally bankrupt who would counsel otherwise.

Byrom, Downe and Warwick have blood on their hands and the reason is very simple: they continue to promote THEIR interests — the process of “normal birth” (or, more accurately, midwife autonomy) — above safe outcomes for mothers and babies.

As long as UK midwives are allowed to indulge their desire to serve their own interests, babies will continue to die and the NHS will continue to pay out billions of pounds to grieving parents. That is truly immoral and unethical.

973 Responses to “Sheena Byrom and the moral bankruptcy of UK midwifery”

  1. Julie Russell
    October 9, 2017 at 5:18 am #

    I’m not sure how I ended up reading this blog, but I don’t care~this is a well-done article. As a high-risk OB patient, gravida 6, I fully agree with the author. These midwives are performing their jobs; but they literally have LIVES in their hands. There is nothing in this life that is worse than the death of your child, except losing your child and your wife at once, I guess. If I was a midwife, I would be worried about grieving parents who have nothing to lose finding out that my highest priority was not the safety of their child.

  2. rosewater1
    June 8, 2017 at 10:46 am #

    It really makes no sense to me . NCB advocates are EXACTLY what they profess to detest. They themselves shackle women into their idea of how birth must be. How if you don’t choose a natural waterbirth with a midwife, etc, etc, you are Doing It Wrong.

    And when they are confronted with their BS, they insist that no, that is not at all what they mean! They are telling us the TRUTH!

    The truth is…women who choose-CHOOSE-a medicated hospital birth-or a c/s-can actually be trusted to know what they are talking about. We are trusting these same women to raise the child to adulthood. But yet they have to be “guided” into making the choice for how the baby is born?

    It is paternalistic and condescending.

    I don’t expect what I wrote to change anyone’s mind because they don’t WANT their mind changed. The information isn’t just available for THEM. Anyone can read stories about the glories of unmedicated birth, or waterbirths, or anything else NCBers say is so wonderful. And if they decide after knowing the options that they don’t want that…respect that.

    • Jacob Bunton
      June 8, 2017 at 1:33 pm #

      No one is telling you how to birth your baby rosewater1.
      Choice – real choice – is what is important.
      That goes for BOTH the woman who requests a CS or a woman who requests a waterbirth – (and every other choice in between)
      Absolutely no one should feel threatened, belittled or judged for THEIR own choice. Certainly no one should be exposed to the abuse women have experienced when sharing how they wish to birth.
      Dr Amy Teuter and many others have been a part of this as I am sure other groups on the polar opposite ie. Natural birth movement have also attacked. This gets us no where.

      • rosewater1
        June 8, 2017 at 1:48 pm #

        Then why are you here? This post is full of you belittling and shaming and disrespecting other commenters who have told you that they do not agree with you. But no, you know better, and by God, you’ll keep telling us until we get it through our pretty little heads.

        And you’re doing it deliberately. You love the attention you’re getting here. Why else would you keep coming back.

        I’m 51 years old. But even when I was 15 I knew what patronizing sounded like.

        Save your sanctimony, Jacob. It’s wasted on me.

      • Heidi_storage
        June 8, 2017 at 2:01 pm #

        Could you try to spell Dr. Tuteur’s name correctly? It’s a bit distracting to see it spelled wrong in various places, and whether or not you intend it also communicates a certain lack of respect that you don’t bother to get it right.

  3. Amazed
    June 8, 2017 at 9:11 am #

    I’m putting this up here, so it won’t get lost in the comments.

    To Jason Bunton: Listen you fucking filth! If you can wax your lyrics
    about you great martyr – which is a sample size of ONE – one idiot and
    one woman lucky enough to have survived your care, you can at least
    acknowledge other people’s evidence of what happened to THEM.

    You’re all for anecdotes when they paint you as this great savior and your
    bullshit as the greatest thing ever but not when people tell you what
    happened to them, right? I mean the horror moto librarian LIVES every day because she had a glorious natural birth.

    Go fuck yourself.

    • yugaya
      June 4, 2017 at 5:05 pm #

      You’ve already posted that. It did not support the claims you have made ( lotus birth DCC in particular). Spamming now?

      • Jacob Bunton
        June 6, 2017 at 3:13 am #

        I did not mention lotus birth, you did, so you better research what it is. Cutting the cord after a physiological third stage (i.e once the placenta has birthed) is not a lotus birth.

        • yugaya
          June 6, 2017 at 11:38 am #

          “so you better research what it is”

          Ignorant AND arrogant in his ignorance. Here, RCOG definition: “Within a short time after birth, once the umbilical cord has stopped pulsating, the placenta has no circulation and is essentially dead tissue.”

          • Jacob Bunton
            June 6, 2017 at 4:40 pm #

            Do I have to spell it out to you yugaya? Geez. Your ignorance is blinding. Physiological third stage can happen in 10 mins, ok placenta now out, pick up a pair of scissors before you have a heart attack and cut the cord. Ok. We clear. This isn’t a lotus birth. No one is talking about lotus birth. Just you.

          • MaineJen
            June 7, 2017 at 9:00 am #

            Yeah, lotus birth. Hahaha! That’s just crazy.

            Now sea mammal birth, on the other hand…

          • Nick Sanders
            June 7, 2017 at 9:25 am #

            Hey buddy, my wife is a sea mammal!

          • Heidi
            June 7, 2017 at 9:28 am #

            Um, if mom is about to have a myocardial infarction, I’m really thinking she shouldn’t be having a “physiological 3rd stage” birth with midwives. Probably need quite a few specialists up there.

          • momofone
            June 7, 2017 at 10:19 am #

            “Your ignorance is blinding.”

            Well, someone’s certainly is.

          • yugaya
            June 8, 2017 at 5:04 am #

            ” Physiological third stage can happen in 10 mins”
            But those midwives that “know” wait a whole lotta longer, don’t they?

            From your earlier crap: ” Then awaits the birth of the placenta. The midwife knows it is not wise to mix active management with physiological third stage, as this increases risk of PPH.”

            The midwife WAITS. And WAITS. Often for hours, right? Because active management of third stage is ebil.

            I’m not sure at this point that you are even aware of how much ignorance you’ve displayed.

          • Jacob Bunton
            June 8, 2017 at 1:06 pm #

            Midwife waits for 1 hour

          • yugaya
            June 8, 2017 at 2:27 pm #

            “Midwife waits for 1 hour.”

            RCOG does not:

            Look buddy, it’s been fun to entertain the latest troll but the thought that you are in active charge of pregnant women and their care in childbirth is scary AF.

            Key recommendations regarding maternal deaths from hemorrhage in UK:
            – Antenatal care and abnormal results (Iron deficiency anaemia not only reduces the tolerance to acute haemorrhage but may also contribute to uterine atony because of depleted uterine myoglobin levels necessary for muscle action.)

            -Underestimation of blood loss in smaller women

            -Communication, Ownership, Leadership and Teamwork (the main problems identified with communication involved •disagreements in estimated blood loss in three women •lack of communication of concerns regarding blood loss in five women •not escalating to a senior when their condition deteriorated in two women)

            -Recognition of haemorrhage and the deteriorating woman.The severity of the situation was not recognised in11 women (61%).

            -Inadequate observations were a feature in seven deaths.

            – Abnormal observations were not escalated in five women

            So you go ahead and tell us more about how midwives will wait. And wait. We know. And we also know exactly how deadly that waiting is.

    • Amy Tuteur, MD
      June 4, 2017 at 5:06 pm #

      A link is not a response to a request for scientific information confirming your claims. State the claim that then quote the relevant passage from the appropriate scientific paper.

  4. Jacob Bunton
    June 4, 2017 at 4:24 pm #

    Dr. Amy Teuter why have you deleted my message as Spam? And the other awaiting approval? Am I ruffling your feathers

    • Amy Tuteur, MD
      June 4, 2017 at 4:36 pm #

      I’ve deleted nothing and I don’t see any of your posts as flagged or in moderation.

      • Jacob Bunton
        June 4, 2017 at 4:44 pm #

        That’s good, just checking! I saw something flash up deleted as spam.
        This tagline I get sometimes though is a bit annoying….’Hold on, this is waiting to be approved by The Skeptical OB.’ What exactly are you approving?

        • Amy Tuteur, MD
          June 4, 2017 at 4:46 pm #

          Everything is automatically posted immediately unless it contains a lot of links or scatalogical language. Then it is flagged for me to read; in addition, readers can flag comments that they find offensive.

    • The Computer Ate My Nym
      June 4, 2017 at 8:40 pm #

      You are making unfounded and highly emotional accusations. Perhaps that is because you realize you are in the wrong and are trying to defend your position in the only way you can: by becoming angry and defensive.

      • Jacob Bunton
        June 6, 2017 at 3:14 am #

        She’s done it before.

        • momofone
          June 6, 2017 at 9:05 am #

          Proof please.

        • Heidi
          June 6, 2017 at 10:02 am #

          Again, doubtful. Unless you’ve said something even more patronizing, offensive, or stupid, and at some point, enough is enough. Disqus doesn’t necessarily show every single comment and can get clunky.

        • yugaya
          June 6, 2017 at 11:39 am #

          Bullshit. None of your rubbish comments have been deleted.

        • Roadstergal
          June 7, 2017 at 4:21 am #

          Why on earth would she delete your comments? Just letting you blather on about your superior superiority in all things, while demonstrating with every post your profound ignorance about anatomy, physiology, the birth process, history, and the internet, is the best anti-Jacob Bunton PSA there could be.

        • The Computer Ate My Nym
          June 8, 2017 at 8:43 pm #

          That seems highly unlikely. I don’t think you’re thinking very logically about it. Why would Dr. Tuteur delete some of your messages at random when she’s shown herself willing to let you post here at all? A logical thinker would ask whether the posts that were deleted had some problem, i.e. links that held it up automatically per disqus policy. A modest person might wonder whether they had, perhaps unintentionally, violated posting policy, i.e. by using unacceptable language or advertising not consistent with the policies of the blog owner. Only an overly emotional man would jump straight to the assumption that he is being martyred. But so few men are good at things like logic and science. I expect you can’t help it.

          • Nick Sanders
            June 8, 2017 at 9:17 pm #

            Ouch! That was beautiful!

  5. Jacob Bunton
    June 4, 2017 at 3:26 pm #

    Dr. Amy why is the below comment awaiting to be approved?

  6. Jacob Bunton
    June 4, 2017 at 1:41 pm #

    A ‘safe birth’ is predictable
    A woman in spontaneous labour is quite predictable.
    The midwife knows that if the woman feels relaxed her labour will progress.
    To facilitate this relaxation the lights are dimmed, the environment is calm and private. The midwife knows the risks of disturbing a woman in labour and has faith that the woman will be able to birth her baby and if not the midwife knows when to offer assistance.
    For instance, if the woman is in the pool and her labour slows after 2 hours, the midwife can ask the woman to mobilise.
    When the woman wants to push, the midwife does NOT say you must wait til you are 10cm. The midwife explains, that when baby is close its an overwhelming feeling, you cannot help but push.
    When the woman is actively pushing, the midwife knows it is not safe to shout at her ‘push push’ and adopt the valsalva technique, as she knows that prolonged breath-holding decreases placental perfusion resulting in fetal hypoxia and decreased fetal cerebral oxygenation. It also increases the risk of 3rd degree tear, particularly if the woman is squatting in the pool.
    The midwife checks the pool and ensures the temperature is not more than 37.5 degrees because if too hot i.e 38.5 she/he knows it can cause problems for the baby.
    The woman is relaxed between (and often during) contractions, once it has passed the midwife gently asks her to move onto all fours or kneeling with her head rested on towel on edge of pool. The midwife knows there is a small risk of shoulder dystocia so she/he wants the woman to be in a position that best maximises the width and opening of her pelvis. The midwife also knows in this position the woman will find bearing down easier, experience less severe pain and will have a shorter second stage.
    The head is born.
    The midwife knows not to put her hands in the pool, as that risks stimulating the baby to breathe. She/he uses ‘hands off’ for delivery.
    The baby is born with the next contraction.
    The midwife (sometimes the mother) slowly and gently lifts the baby out of the water.
    The midwife knows that a woman is more likely to have an intact perineum or a small tear birthing in the pool but she/he knows how to suture a 2nd degree tear if needed.
    The midwife knows there is a risk of PPH (haemorrhage) so she puts the baby skin to skin, this aids breastfeeding and reduces risk of PPH. If she bleeds the midwife knows what to do just like the doctors, both have the same training in all obstetric emergencies.
    The midwife knows the placenta may fall out as the woman stands to get out the pool, so she provides a bowl and the placenta falls into it. If not, she asks the woman to empty her bladder. If she can’t the midwife offers an’ in out’ catheter. Then awaits the birth of the placenta. The midwife knows it is not wise to mix active management with physiological third stage, as this increases risk of PPH.
    Midwife does not disturb the mother and baby, and keeps the room calm and quiet as this facilitates oxytocin release for both the mother and baby, nor does she cut the cord. She waits until the placenta is birthed.
    From birth and until an hour post birth the baby is kept warm skin to skin with the mother, the midwife knows that babies can easily lose heat, so baby being skin to skin baby will copy the mothers temperature. Both are then covered in warm towels and blankets. This also helps prevent a PPH.

    • momofone
      June 4, 2017 at 1:46 pm #

      I can see how you may have missed my question about MRCS–it may have buried in the other comments–but I’d like to know what your thoughts are/how you handle it if the mother declines all of the above and requests a c-section.


      • Jacob Bunton
        June 4, 2017 at 3:14 pm #

        This is a good question.
        Now I need to be careful re: confidentiality.
        Many years ago I cared for woman x, I was studying at the time, so x became one of my continuity of care women. She had been in several foster homes, of these she was sexually abused in x of them. In the meeting with the midwife, woman x said she wanted a MRCS, the midwife replied ‘no, we don’t offer MRCS. Its against policy’ I protested on x’s behalf, ‘but surely it must be the woman’s choice!!’. The Midwife gave me a pitiful look and said ‘sorry, no’.
        I privately spoke with the midwife after the antenatal appointment and asked her ‘given this young woman’s history, don’t you think we should consider her wishes?’ The midwife eventually sighed and said ‘listen you can speak to the Head of obstetrics if you want, but she will also tell you its a no.’
        I arranged an appointment and x and I attended a meeting with Dr. x obstetrician and clinical director of the maternity unit. Dr. x spent hour an hour with us. First listening to x’s wishes, then Dr. x explained in detail the benefits of CS and a longer list the risks (to be honest I didn’t know there were so many risks, I thought it quite a common, straight forward procedure). Dr. x then explained the risks and benefits of vaginal birth. Throughout woman x insisted on having a CS. Dr. x replied ‘ok on one condition, you do some homework for me, go home and look at the research. Once you have done that we’ll meet again.’ Woman x I was now seeing regularly, attending appointments with her, we chatted a bit about birth, only if she asked me but mostly talked about everything non-related to birth music, shows on TV etc. She did ask me once though, how do women have an easy birth? I replied ‘I don’t know? I have heard from women that being in the shower helps, some say they were able to get in the flow more being on their own. I read also that bright lights can sort of wake you up, maybe more stressful I guess. I don’t know, sorry?’ We met Dr x 3 weeks later, woman x had made her decision she wanted a MRCS. Dr. x wasn’t happy bout it but accepted her choice, asked her to sign a consent form and the plan was made and a c-section date booked. 3 weeks later, I got a text message the night before woman x’s c-section booked for 6am the following morning. Woman x texts me ‘I am going to the hospital, can you come?’, I grab my keys, next text message I read running up the hospital stairwell, ‘midwife says I am fully.’ What the hell! I arrive on labour woman x is on the bed, semi-recumbent position. The midwife appears at a bit of a loss, she has not met woman x before, I explain in private woman x history. The midwife says ‘well I guess the choice is hers’. We both enter the room, I say to woman x, ‘you absolutely can still have a c-section if you want.’ The midwife nods in quiet agreement. Woman x looks at me and says ‘well I’ve come this far, I might as well do it.’ With the next contraction she starts spontaneously pushing and delivers a bonnie 8.8 pound beautiful baby. After the birth, I asked woman x what happened at home? I wanted to say ‘what the hell just happened!!!? but though we had become friends, I thought I should keep some level of professionalism. She just shrugged, you know how you said ’bout shower, keeping it dark..’ I vaguely remembered, ‘well I did just that.’ I replied ‘On your own??!!’ Yes in the bathroom, on my own. ‘Did you know you were in labour?’ I guess I knew something was happening. It was ok. I just figured it was braxton hicks.’ When did you realize it wasn’t!? ‘When I really really wanted to push.’
        Dr. x arrived just after the birth in a flurry of excitement. I’ll never forget that moment of Dr. x meeting woman x. She had my full respect, they both did.

        A year later, I was no longer in the country, woman x emailed me ‘I have good news I’m having another baby I’m x weeks and due x I’m going to go natural with this baby as well. It’s going to be a handful with two. Please keep in touch would love to keep in touch. As you were a big part of mine and baby x’s life.’

        Not too long ago, at a booking with a woman having her first baby she anxiously asked me if MRCS were possible at x hospital. I gently asked her, her reasons for requesting a CS. She replied ‘I have a fear of birth. I have done my research. CS is safer than vaginal birth.’ This woman was educated, she quoted me statistics, and spoke eloquently. I reassured her that though we wouldn’t normally routinely agree to an MRCS her wishes would be heard and respected. I excused myself for a few moments and asked the senior midwife, she told me, ” woman x, absolutely would not be allowed to have [MRCS] because she has no medical problem that would warrant it.” I explained to Francis that I had cared for a young mother in x and we had discussed her wishes of an MRCS with the Consultant obstetrician. Midwife x advised me to refer her to Consultant Midwife.

        At hospital x there is a clear referral pathway for all women requesting care outside the recommended guidelines. For example a VBAC wanting to use pool in the AMU, history of PPH over 1L wanting to use AMU, MRCS. Woman x met with the Consultant Midwife for over an hour and they together with also the Consultant obstetrician’s input discussed the risk and benefits of all options and a individualised plan was made and shared with the team.

        As follows:

        * Primary request for Caesarean for anxiety related to labour/birth outcomes

        I met with x ….. to explore her wish to have an elective Caesarean. We discussed and explored x’s thoughts, feelings and wishes. X explained…her reasons for this are:

        * Feels that an elective Caesarean is safer and more controlled than vaginal birth.

        * Nervous about getting postnatal depression (following her x’s experience) and feels this is more likely to happen with a complicated vaginal birth.

        * Concerned about instrumental birth and injury to her or baby.

        * Anxious about having vaginal/perineal trauma and this leading to problems with her bladder/bowel.

        * Researched her options and whilst her ideal birth would be a natural water birth she does not feel this is a reasonable/realistic outcome for her as she is concerned about being in pain and would likely opt to have an epidural.

        We addressed each of these concerns individually and discussed the advantages and disadvantages of vaginal birth and elective Caesarean section. I explained the reasons why we would strongly not recommend a Caesarean section without a medical indication for there is an increased risk of: thromboembolism, infection, bleeding resulting in hysterectomy, complications in subsequent pregnancies, anaesthetic and surgical complications (including potential bladder/bowel injury), increased length of hospital stay and recovery and baby being admitted to the neonatal unit for respiratory problems. We explored the potential medical benefits with a planned Caesarean section, such as a possible reduction in: abdominal and perineal pain during the birth and up to 3 days postpartum, vaginal/perineal trauma, early postpartum haemorrhage and obstetric shock.

        I explained that there is an increasing amount of evidence that suggests that exposure to the normal flora in the vagina that occurs during a vaginal birth is of benefit for life-long health. Whilst it is difficult to establish the true extent of this benefit the evidence suggests higher rates of childhood respiratory and gastro-intestinal illnesses, allergy, and also weight issues in individuals who were born by elective Caesarean section compared to those born vaginally or by emergency Caesarean section during labour.

        I explained that bladder and bowel injury is not exclusive to vaginal birth and can happen with Caesareans (although uncommon) and whilst most women will experience some bruising or tearing to the vagina/perineum with vaginal birth the majority of these heal well without complications. Only a small proportion of women will have a severe tear (third or fourth degree) and the majority of these also heal well without any ongoing or long term problems. I explained that occurrence rates of these types of tear vary; some studies suggest a prevalence of 3.8% with first time mothers and 2% of second time mothers and a recurrence rate of severe tears of approx. 7%. Whilst it is hard to predict what will cause a tear of this nature there are some associated risk factors such as:

        * Previous third/fourth degree tear

        * First baby

        * High birth weight

        * Shoulder dystocia

        * Advanced maternal age

        I explained that because it is difficult to absolutely predict it can be hard to prevent it from happening again, however there are certain practices which have been found to be beneficial when caring for the perineum such as:

        * To offer the application of a warm compress in the second stage of labour as this may reduce perineal trauma.

        * It may be appropriate and have some benefit to avoid standing birth positions and the use of the birthing stool in the second stage.

        I have shared with x our hospital/local figures regarding our Caesarean section, instrumental, normal birth and third/fourth degree tear rate. In addition I have provided x with and discussed with her the RCOG written information on Instrumental Birth and Caesarean section and the Birth Place Study Decisions leaflet (2014). We went through the key findings from the Birthplace Study (2011) including the likelihood of having a Caesarean in labour, instrumental birth, uncomplicated vaginal birth and having a baby being born with a poor outcome in each birth setting.

        X is aware that most women and their babies who are at low risk of complications recover well from birth however there are additional risks to consider for both her and baby with a Caesarean. In addition having a vaginal birth means she is more likely to be able to have skin-to-skin contact with her baby immediately after the birth and breastfeed successfully, the recovery is likely to be quicker and she should be able to resume her normal activities/drive sooner and subsequent births are likely to be more straightforward.

        We discussed how we can best support her in view of her fears and our recommendation, such as supportive birthing planning to seek solutions to certain elements that cause her particular concern, which she has after some thought over the weekend, declined with thanks. Whilst x understands the risks associated with having an elective Caesarean she feels this is the safest/right option for her and baby.

        On speaking with x today she reports she is feeling less anxious and is actually excited for the first time about the birth with the prospect of having an elective Caesarean.

        Please do not hesitate to contact me if you have any questions,

        With Best Wishes

        Yours sincerely

        XX Consultant Midwife

        Woman x met with the obstetrician a CS date was booked and she had her baby via MRCS on xxx.

        This is what I mean by informed decision making. And yes I absolutely do support MRCS, as I do any woman’s choice.

        • yugaya
          June 4, 2017 at 3:22 pm #

          “Now I need to be careful re: confidentiality.”

          Really? But you’ve already blasted identifiable confidential patient information all over the internet, why bother now?

          • Azuran
            June 5, 2017 at 9:34 am #

            He probably thinks that if he puts long enough comments everywhere, we are going to forget that he first came here arguing that neocortical whatever and artificial light was the cause of all childbirth complication.

    • yugaya
      June 4, 2017 at 1:58 pm #

      Epic citation fail. The Birthplace study in no way supports any of that nonsense, especially the fucking lotus birth type of DCC:

      “Midwife does not disturb the mother and baby, and keeps the room calm and quiet as this facilitates oxytocin release for both the mother and baby, nor does she cut the cord. She waits until the placenta is

    • Dr Kitty
      June 4, 2017 at 2:16 pm #

      I trained in the Coombe.
      I think you’ve forgotten one, very, very important thing.
      Patient satisfaction.
      Women like going into hospital and knowing that 14 hrs later, one way or another, they’ll be holding their baby.
      The Coombe had low CS rates, high VBAC rates, low rates of complications and the patients were highly satisfied. It was also all done with informed consent- women could decline AROM, pitocin, monitoring, epidurals etc. Few did though, because they listened to their friends and sisters and went with the recommendation to go with the advice of the team in the unit.

      Women do *not* like long unmedicated labours, and pushing for over 4 hours only to end up with forceps or a CS..

      I’m constantly horrified by the Postnatal discharges I get.
      Hugely prolonged first stage without augmentation, followed by prolonged second stage, followed by forceps and tears or emergency CS for foetal distress. They have had epidurals only very rarely.
      I see the women at six week Postnatal.

      They are low risk women being cared for by NHS midwives.

      They have been told by midwives during labour that baby was fine and that as long as baby was coping there was “no reason” to augment.
      That they were coping “really well” with labour, and didn’t need epidurals, which might slow things down even further.
      They usually only see an obstetrician at the very end of their prolonged second stage, when it’s all going pear shaped and it’s a decision between forceps or CS.
      They certainly never had a proper discussion about the risks/ benefits of augmentation or regional analgesia during their labours.

      They are damaged by the care they have received, because instead of early recognition that things are not going to schedule and steps being taken to ameliorate the situation, the attitude is that there *is* no problem. “Labour doesn’t have a schedule” and that doing nothing is the best way for everything just to naturally come right by itself.

      I bite my tongue, but I know those situations are due to midwifery ideology, not patient choice.

      It’s not the kind of care I would want for myself or anyone I. Aged about, because it actually looks like wilful neglect.

      • Dr Kitty
        June 4, 2017 at 2:24 pm #

        Sorry, “I would want for myself or anyone I CARED about”.

      • Jacob Bunton
        June 4, 2017 at 3:30 pm #

        I do not have the time now to fully reply, but just quickly.. how many waterbirths have you seen during your training? Are you ‘allowed’ to see waterbirths as a junior doctor? How many obstetricians have seen a waterbirth? How many Consultant obstetricians?

        • yugaya
          June 4, 2017 at 3:39 pm #

          Waterbirth – scam that a cult leader Russian psychopath came up with while having delusions of creating superior race because all children born in hospitals according to him are “disabled”.

          The same psychopath later went on to claim that he can cure things like paralysis and permanent brain injuries in children by what can best be described as waterboarding technique – submerging the terrified child over and over again until completely exhausted. When one mother watching the “treatment” from outside the water started
          screaming at him to stop, the guru sent her and her paralyzed son ( who was according to him “just starting to move”) off screaming after her that he cannot work with non-believers and that she should get used to having a sick kid.When asked by a journalist how he determines when a child has had enough of this “cure” he replied: “At that moment I get into an altered state ( of consciousness). I sense the limits and possibilities. It all comes down to whether you trust me or not.” He directly is responsible for multiple deaths of children whose mothers trusted him, both during births in his center and during such healing sessions.

          Yep, Charkovsky is right up your misogynist alley too.

          “I asked him at the begining where he had studied,” the father says, “and he replied that he had been born with the knowledge and discovered it over time. In retrospect, I am still happy and thankful that Igor was brought to work with our son. It was a type of energetic leap that made it possible for him to leave his body and die.”

          • yugaya
            June 4, 2017 at 3:40 pm #

            3:30- Charkovsky delivers the baby, and the baby is “fine”, and then the father goes into the next room and calls his mother and THE BABY STOPS BREATHING BECAUSE PAST PIPELINE PSYCHIC MATERNAL LINES AND BAD JUJU and the reality of unseen connections. Not because a bunch of cult lunatics are pretending to be capable of delivering babies.


          • yugaya
            June 4, 2017 at 3:42 pm #

            There are multiple testimonies by desperate parents who were tricked into taking their ill children to one of his seminars: “children would be after the session dragged to the shore sometimes vomiting salt water for hours, while some would just sit there terrified staring and not moving. Can you imagine an 8 month old child just sitting blankly without moving for 40 minutes, or a two year old screaming for several hours with a voice and vocal cords that have been
            burned by all the salt…” ( unofficial translation of a testimony of a participant of Elena Fokina seminar – the lady in the baby yoga videos that are insane enough on their own). She was Charkovsky’s lover, student and associate) The supposed mechanism how this waterbording cure works is the same one Charkovsky uses to explain the magic of waterbirth – those multiple submergions are supposed to once the child “breaks” and starts breathing under water
            trigger the cosmic mechanism by which the body will heal itself.


          • yugaya
            June 4, 2017 at 3:43 pm #

            The part when it went from Charkovsky’s lunatic experiments in Moscow in 1980 to USA and global is equally disturbing- one of the first pioneers of it was
            Gary Young ( of EOs fame), and he set up a waterbirth business in 1982. His own daughter died in 1982, another child was injured, and he had to skip town. His daughter was at the waterbirth that killed her submerged FOR OVER AN HOUR.

          • yugaya
            June 4, 2017 at 3:46 pm #

            I suggest google translate for this series of letters and articles that i found ironically in one of the books praising this lunatic, including by one of the top Russian OBs detailing the disasters they have witnessed that were directly attributable to Charkovsky, eleven waterbirth baby drownings during a single year … At the time when this was published Charkovsky already had several convictions and was claiming that he was not doing waterbirths. Russian health authorities were glad that he was no longer in the country and had escaped – to USA.

          • yugaya
            June 4, 2017 at 3:49 pm #

            “In Charkovsky’s view, as long as the umbilical cord has not been severed, the infant does not have to breathe through his lungs and can swim freely in the water. Afterward, too, when the infant is a few hours or days old, he should continue to be in the water as much as possible. In contrast to other methods that advocate the use of warm water to alleviate labor pain, in Charkovsky’s method, water is used to strengthen tolerance and endurance. Indeed, his method stipulates a preference for ice water, which will eventually make the infant a stronger and healthier person and strengthen the whole race.

            From the evolutionary point of view, Charkovsky maintains, man’s origins are in the water, like all living creatures. He says that humans were
            unfortunately pushed onto the land by “sea monsters” and thus imprinted with hydrophobia. The shattering of the physical taboos embodied in
            Charkovsky’s method is intended to invoke primeval memories and instill people with superhuman spiritual, physical and intellectual capabilities.

            Water births, according to him, are meant to make a significant contribution to human evolution – or, as he puts it, to create a “new race” of human beings. Furthermore, in the view of Charkovsky and his followers, infants who are born in hospitals are limited, even if they are described as being healthy.”

          • Jacob Bunton
            June 4, 2017 at 3:59 pm #

            I will read this section later. But regarding umbilical cord yes its easy to forget that the baby during pregnancy is actually in a sack of water. The umbilical cord keeps the baby alive. Birthing in water can therefore be a gentle transition in the world, the baby is kept alive by the umbilical cord and once taken to the surface, the cold air stimulates the baby to breathe. The baby will not breathe under the water unless stimulated, that’s why when baby crowning, Hands OFF, that is really really important.

          • yugaya
            June 4, 2017 at 4:01 pm #

            “The baby will not breathe under the water unless stimulated.”

            Jesus Christ you are as insane as Charkovsky is.

          • Jacob Bunton
            June 4, 2017 at 4:04 pm #

            Yugaya please this is embarrassing not for me but for you and you sadly don’t even know it. Yes babies are attached to the umbilical cord for a reason. Why aren’t babies drowning in utero?

          • yugaya
            June 4, 2017 at 4:09 pm #

            “Why aren’t babies drowning in utero?”

            Why are babies drowning in waterbirths?

          • yugaya
            June 4, 2017 at 4:13 pm #

            “There are several reports of death attributable to drowning resulting from poorly managed waterbirths and death, involving experienced midwives, in which asphyxiation and water-logged lungs made resuscitation of the infant difficult. The latter case led to the cessation of water births in Sweden.” …”multiple freshwaterdrownings attributed to underwater birth”


          • Jacob Bunton
            June 4, 2017 at 4:41 pm #

            This is important point you have raised yugaya.
            And topic for further discussion.
            If obstetricians are seeing one waterbirth if they are lucky. If mws during their training also see a limited number and mostly care for women with an epidural. Then who will attend the waterbirth? The overmedicalisation of childbirth, can result in a skill loss, and make birth dangerous.

          • Amy Tuteur, MD
            June 4, 2017 at 4:44 pm #

            Waterbirth is deadly nonsense promoted by midwives because they unable to place epidurals.

          • Jacob Bunton
            June 4, 2017 at 4:57 pm #

            OMG Amy just when I was beginning to have some respect for you. You are an ex-obstetrician, stay that way!

          • Nick Sanders
            June 4, 2017 at 4:58 pm #

            Why would anyone want your respect?

          • Amy Tuteur, MD
            June 4, 2017 at 5:00 pm #

            Please provide scientific evidence that waterbirth is safe; the scientific literature shows that it kills babies through fresh water drowning, water intoxication, cord avulsion and Legionnaire’s disease among other things.

            There is no primate that delivers in water. There is nothing natural about waterbirth. It’s just midwifery nonsense meant to disguise the fact that midwives aren’t capable of managing labor pain.

          • Jacob Bunton
            June 6, 2017 at 4:28 pm #

            This post is for you Dr. Amy.
            Its so far down the comments page most of your groupies won’t see it. Probably a good thing because they’d go ape shit!

            Primate – now that’s where you are going wrong. We in fact have more in common with sea mammals.
            Yes really!
            Human beings have traits not specifically human only. We often share with other mammals.
            You’d agree Dr. Amy that what makes human beings special is our huge brain mass.
            3 x that of chimps.
            Brain mass of dolphins 2 x that of chimps.
            *** Our brain mass similar to sea mammals ***

            Because of our huge brain humans have specific nutritional needs in terms of fatty acids, omega 3.
            *** Food – seafood chain***
            Most widespread nutritional deficiency is Iodine. Important for the synthesis of thyroid hormone and development human brain. You know this, so we agree right?

            American Thyroid Association (ATA) recommends all pregnant women take supplement of Iodine 150mcg. They say babies I.Q then increases by 1.22 after taking 150mcg . Those who eat from seafood chain only ones who have enough.


            *****Vernix caseosa******
            Babies covered in the stuff at term.
            Aquatic mammals also
            Full of cellular sponges and fatty acids
            “waterproofing” function of vernix, thereby preventing heat loss soon after birth
            Role is protective
            In case of sea/water immersion

            Mammals eat the placenta
            1970s took flight with women and today as you’ve probably heard some women choose placental encapsulation though there is no evidence for it.
            Almost universal among non human mammals

            ***whales and dolphins are exceptions, they do not eat the placenta ******

            Desmond Morris coined the term ‘Naked Ape’ in his book. Mammals are covered in hair
            **** Except sea mammals ********

            Humans have a layer of fat to get to fascia not with a gorrilla.
            **** Dolphins, whales, seals, like us have a layer of fat. *******

            We are not as unique as we think we are.

            Humans have a low larynx so we can breathe with our nose or mouth.
            ****** Same as sea mammals ********

            Vagina hymen
            Considered specifically human
            ****but in fact in sea mammals too****

            Was man more aquatic in the past?
            Marine chimp?
            Huge topic…even when you start exploring evidence 50000 years ago, colonising the pacific rim, geneticists say reached these areas Australia, Japanese archipelgo, Alaska etc via ‘coast’ not ‘corridors’. Not strange if you consider the sea level 20000 years ago was 130m lower. Means that between China, Australia, S.E Asia, Polynesia and Chile there were many islands.

            We at a turning point in our understanding of human nature. So much yet we are still to discover.

            Does this mean all women should have a waterbirth? No! of course not. Is epidural wrong. No! But to say there is nothing natural about waterbirth. Is misguided.

            (BTW thanks Amy for your comment about forceps and shoulder dystocia, appreciated).

          • Jacob Bunton
            June 6, 2017 at 4:34 pm #

            Waterbirth isn’t new. The indigenous tribes of Australia, the Amazon and other parts of the world have birthed in water for thousands of years.

            Tea tree lakes, in Australia for example was sacred to indigenous women as a birthing place. Tea tree has wonderful antiseptic qualities so the women were said to birth and wash in the tea tree infused water.

          • Roadstergal
            June 6, 2017 at 5:15 pm #

            Given the profound ignorance you’ve shown regarding what amniotic fluid is and how placentas work – not to mention your profound misogyny – I’m surprised you think anyone is going to give your water birth obsession a jot of credibility. Keep at it, though – you might turn a few more women off of it, which would be quite a plus.

          • Azuran
            June 6, 2017 at 5:37 pm #

            Oh sure, if an indigeous tribe does it, it must be the recommended path. The old noble savage trope.

          • Jacob Bunton
            June 7, 2017 at 3:32 am #

            ‘noble savage’ wow still a lot to learn young one. Recommend the ‘last hours of ancient sunlight’ by Thom Hartmann

          • Azuran
            June 7, 2017 at 8:36 am #

            I certainly have nothing to learn from a patronizing imbecile who think we are freaking sea mammals.

            And you can put your ‘young one’ up where the sun don’t shine.

          • Charybdis
            June 7, 2017 at 12:16 pm #

            Sideways. Along with the horse he rode in on.

          • Dr Kitty
            June 7, 2017 at 12:49 pm #

            “Young One” is a reference to the book.

            I don’t think we’d like it, judging by this review.


          • Roadstergal
            June 8, 2017 at 10:10 am #


          • June 6, 2017 at 5:52 pm #

            I doubt Amazonian women birthed in leech and piranha infested waters. I really, really doubt that.

          • Nick Sanders
            June 6, 2017 at 6:29 pm #

            Honestly, I’d be more concerned about candiru than piranha if giving birth in the Amazon.

          • Jacob Bunton
            June 8, 2017 at 6:47 am #

            “Everything is theoretically impossible, until it is done. One could write a history of science in reverse by assembling the solemn pronouncements of highest authority about what could not be done and could never happen.”
            ― Robert A. Heinlein

          • June 8, 2017 at 1:00 pm #

            Cute, but irrelevant. Citations or GTFO please.

          • Amy Tuteur, MD
            June 6, 2017 at 8:35 pm #

            Really? Then surely you have some scientific references. Please share them.

          • Jacob Bunton
            June 7, 2017 at 3:29 am #

            Indigenous and Western epidemiology are worlds apart….clearly

          • Roadstergal
            June 7, 2017 at 4:03 am #

            Ah, the old fall-back racist trope. As if the Indonesian, Chinese, Indian, and Native American scientists I worked with were somehow less competent to do the scientific method than Caucasians.

          • Jacob Bunton
            June 8, 2017 at 6:13 am #

            No one is saying that.
            Its about Western and Indigenous epistemology, how we see the world. Equally of value. Sadly the Western epistemology, world view dominates. That is a big mistake.
            And may be our undoing.
            See ‘Last Hours of Ancient Sunlight’ by Thom Hartmann



          • Roadstergal
            June 8, 2017 at 7:45 am #

            “It’s not _that_ racist mansplaining, it’s _this other_ racist mansplaining.”

            Much like turtles, Jacob Bunton is racist mansplaining all of the way down.

          • Heidi_storage
            June 8, 2017 at 8:15 am #

            Indigenous to what? Are we still talking about Australians? “Indigenous” people have different epistemologies, y’know. People indigenous to, say, Scotland have vastly different perspectives than do the !Kung.

          • Lilly de Lure
            June 8, 2017 at 9:59 am #

            Hmm – are you an aboriginal australian yourself? If not who the hell are you to tell us (or anyone) what their culture (or any other indigenous culture) can tell us? Like all cultures indigenous ones are made up of people who are perfectly capable of saying (or not saying) anything they like without the help of an outsider fetishing them.

          • Jacob Bunton
            June 8, 2017 at 3:04 pm #

            Who are YOU! To tell me what and who I am. ??
            I think maybe you should keep your mouth shut on this one.

            As to a previous poster who described indigenous culture as ‘primitive culture’ may I just say to you
            ‘You can’t say civilisation don’t advance… in every war they kill you in a new way.’

          • Lilly de Lure
            June 8, 2017 at 3:27 pm #

            I am someone who knows better than to hijack aspects of indigenous cultures (or rather plagiarise someone else who did so since you evidently don’t have the imagination to do so yourself) to try to protect a scientifically untenable position from criticism.

          • Jacob Bunton
            June 8, 2017 at 4:20 pm #

            And that’s about all know….

          • Jacob Bunton
            June 8, 2017 at 6:36 am #

            Your statement above perfectly highlights the stark difference between Indigenous and Western epistemology.

            Many would say there is much you don’t know.

            Modern obstetrics has been around for approximately 150 years, Australian indigenous culture for over 40 000 years.
            Your world view is a blink of an eye.
            Yet you naively follow it without due reflection or question.

            At every point of modern obstetrics, there has been a realisation that what is being done is wrong, or even dangerous.

            I guarantee you this Dr. Amy Teuter that there are practices being done and drugs being administered right now in obstetric units globally today, in the misplaced belief of doing no harm which will be discovered in the near or distant future (depending on how many brave souls there are to speak out and question the views of such a self important institution) that there are things being done in the name of safety which are doing harm, these practices will be stopped, just as they have in the past.

            We have not yet ‘arrived’.
            Despite all the claims of safety and the arrogance of the profession maternity services today is nothing to be proud of.

            It may well be time to listen to our Elders and their ancient knowledge and wisdom. They must have done something right.


          • Who?
            June 8, 2017 at 6:48 am #

            If you’re an example of an Elder with whatever, I’ll leave it for now, thanks.

            There are plenty of ‘brave souls’ such as yourself crying out against modern medicine, vaccination and climate science. Lucky for you there are plenty of fed up people ready to ignore reason for the sake of all their rights and freedoms. Secure knowing the safety net of modern medicine and science is there to catch them when things don’t go according to plan.

            Someone who is flogging their services as a birth attendant and thinks the reason waterbirth is safe is because a baby breathes through water in the womb is a disgrace.

          • Heidi_storage
            June 8, 2017 at 8:17 am #

            “They must have done something right.” Yeah, I bet their maternal/infant mortality statistics were amazing compared with ours.

          • Jacob Bunton
            June 8, 2017 at 3:28 pm #

            Yep they probably were.
            Until the rest of the world figured out how to dominate nature and everything and everyone else

          • Azuran
            June 8, 2017 at 3:41 pm #

            So, you have no proof, you just decided that they were, and are pushing some agenda based on some statistic you don’t even have.

          • Nick Sanders
            June 8, 2017 at 3:44 pm #

            Spoken like someone who can’t even conceive of the meaning of “red in tooth and claw”.

          • Amy Tuteur, MD
            June 8, 2017 at 9:49 am #

            That’s why indigenous Australian culture has such low perinatal and maternal mortality rates. Oh, wait, it doesn’t!

          • Jacob Bunton
            June 8, 2017 at 3:19 pm #

            Since white supremacy took over, children were stolen from their parents, laws, ‘aboriginal sacred law’ ignored and disrespected, lands where life, human and otherwise thrived was called ‘No mans land’ and taken away. Populations massacred….I don’t think I need to go further or speak to you, an American who country’s past is responsible for the mass murder and genocide of Native Americans.
            Nor have the respect to teach it in all schools.

          • Azuran
            June 8, 2017 at 3:45 pm #

            As horrible as history is, this has nothing to do with the safety of birth nor does it prove some ancestral safe way of giving birth.

          • Jacob Bunton
            June 8, 2017 at 3:22 pm #

            Aboriginal women still don’t have the right or choice to birth on their own lands. They are taken far away from their communities, weeks prior to the birth and are forced to give birth in high rise hospitals far from the earth.

          • Azuran
            June 8, 2017 at 3:44 pm #

            Well, first, how far from the earth they are does not affect birth in any way.
            And the treatment of aboriginal women is an entirely different story from how we should give birth. Yet I somehow doubt that birth police are kidnapping aboriginal women and locking them up in hospitals for weeks until they give birth.

          • Jacob Bunton
            June 8, 2017 at 4:17 pm #

            ‘how far from the earth they are does not affect birth in any way.’
            Maybe not for you, but it does if its your belief system. ….

          • June 8, 2017 at 4:45 pm #

            No, actually, it doesn’t. If you believe that you have to give birth while lying on dirt, but give birth in a hospital, you won’t get any additional complications. I agree that choice is vital- kidnapping women is absolutely never okay- but no, beliefs aren’t actually impactful on reality that way.

          • Azuran
            June 8, 2017 at 7:37 pm #

            Well, since birthing close to the earth does not MEDICALLY matter. Anyone who cares about this that much can either find another hospital with the labour ward on the ground level or birth at home.

          • AnnaPDE
            June 8, 2017 at 7:56 pm #

            My hospital is built on a steep hill, and its labour ward was ground level from one side and inside the earth from the other.
            Why do they even bother to have doctors on staff that close to earth, right?

          • Azuran
            June 8, 2017 at 8:58 pm #

            Clearly all my problems during labour where because the labour ward of my hospital was on the third floor.
            My water probably also broke before my labour started because the main floor of my house is slightly above ground level as well.

          • Daleth
            June 8, 2017 at 10:30 am #

            See, Jacob, to me, it doesn’t matter whether an idea is 40,000 years old or 150 years old or two weeks old. It matters whether the idea is true.

            And when it comes to ideas about health and medical care, all I care about is whether the idea actually in real life increases the chances of health and life, or increases the risk of injury/ill health or death. In other words, is the idea “X is better for pregnant women/newborn babies/etc.” true or not?

            You can cite all the colonialist, “primitive culture”-fetishizing birth-related mumbo jumbo you want. People who care about truth will ignore it and instead look up statistics on maternal, perinatal and neonatal morbidity and mortality in that culture/country. IF, and only if, those statistics are comparably good to ours, THEN truth seekers will consider more “fuzzy” measures of maternal, child and family well being.

          • momofone
            June 8, 2017 at 5:55 pm #

            So should we all forego washing machines and bang our clothes with a rock beside a river, since that’s how our elders, with all their ancient knowledge and wisdom, did it?

          • June 8, 2017 at 6:42 pm #

            My tiny great-grandmother (now deceased) would kick his ass for suggesting such a thing. Bubbe rather liked all the labor-saving devices that modern life came up with.

          • Who?
            June 7, 2017 at 3:45 am #

            ‘was’ being the operative word.

            I don’t think you’ll find too many people lining up to soak in the tea-tree lakes in labour. And you would not want a baby dropping in there anyway, if only because it can be diffficult to see the bottom.

            Though the lakes and surrounds are beautiful, and the water is pleasant.

          • Amy Tuteur, MD
            June 7, 2017 at 9:54 am #

            You regurgitate the same nonsense as other waterbirth advocates.

            “Historically Lake Ainsworth was an Aboriginal women’s water hole. It was sacred to indigenous women as a birthing place. Tea tree has wonderful antiseptic qualities so the women were said to birth and wash in the tea tree infused water.”

          • kilda
            June 7, 2017 at 11:17 am #

            yes, I’m sure the Australian indigenous people, living in one of the harshest, driest places on earth, were ALL about the waterbirth.

            Because when there’s only one source of water for miles to keep you and your whole group alive, squirting out poop, blood and a baby into it is an excellent idea.

          • momofone
            June 7, 2017 at 3:52 pm #

            And plagiarize their “work.”

          • Jacob Bunton
            June 8, 2017 at 5:43 am #

            Well done you did some research. Maybe you can now explore a little further…

          • momofone
            June 8, 2017 at 7:11 am #

            You didn’t “do research.” You read something you agreed with and stole the words of someone else and claimed them as your own. You have no credibility.

          • AnnaPDE
            June 8, 2017 at 8:46 am #

            Geez Jacob, have you ever been to Australia? Do you realise that indigenous Australians are reasonable people who like their babies to survive, and not just objects for romantic projections? Please stop spreading such myths.

            Most large-ish bodies of water around here are not where you want to give birth; in fact you think twice about wading or swimming in them. Crocs, sharks, jellyfish… take your pick of what you want to get killed by.
            As for in tea-tree lakes — my in-laws live next to one of the more famous ones, and I had one swim in it. Excellent itchy rash developed within minutes and stayed for days. Plus, the water is incredibly murky, definitely not where I’d want to be fishing for a newborn.

          • MaineJen
            June 6, 2017 at 5:02 pm #

            ………full wingnut. We have full wingnut.

          • Azuran
            June 6, 2017 at 5:23 pm #

            You do know there is a ‘recent comment’ section on the home page, right?

            XD seriously? You think we are closer to sea mammals???
            I mean, screw genetics, not a real science I guess

            Funny how we suck so much at actually knowing how to swim. And babies, I mean, just look at a baby, We’d need to hold their face out of water for months, if not years before they could figure out how to not drowns. And that’s without taking into account how we can’t sleep in water, and how we need HUGE amounts of sleep. And we are absolutely horrible at keeping ourselves warm in water, we die of hypothermia really quickly in water. I mean, come on, you even said that it was really really important to keep the water at a warm 37-38 degree for the birth. Where on earth is water consistently that warm? We are not freaking sea mammals, babies are not meant to be born in water.

          • Heidi
            June 6, 2017 at 5:42 pm #

            *****Don’t you mean we’d go “dolphin-shit”?*****

          • Nick Sanders
            June 6, 2017 at 5:43 pm #

            The only “sea mammals” without extremely thick coats of hair are cetaceans and sirenia, which spend their entire lives underwater. Meanwhile, far more aquatic mammals are covered in dense hair: otters, most pinnipeds, beavers, platypuses, etc. I can also think of a fair number of land mammals with less hair than humans: elephants, rhinoceroses, naked mole rats, pigs…

            And raw brain mass is meaningless, hell, brain to body mass ratio isn’t even that good of an indicator. Brain structure is far more important.

            Long story short, the aquatic ape hypothesis is bullshit.

          • momofone
            June 6, 2017 at 6:21 pm #

            I figure I’ll be ready to give birth in the water around the same time the dolphins start using the internet.

          • Heidi
            June 6, 2017 at 5:50 pm #

            I know you’re not the smartest dolphin in the ocean, but there’s a place where you can sort the comment order by best, oldest, or newest – it’s under the place where you get notifications. I’m guessing you’ve got it sorted by best and that’s why yours are all the way at the bottom. Geez.

          • Amy Tuteur, MD
            June 6, 2017 at 8:37 pm #

            All that bullshit isn’t going to divert anyone from the fact that primates don’t give birth in water and therefore THERE IS NOTHING NATURAL ABOUT WATERBIRTH. Thanks for showing that you have no evidence otherwise.

            I’m curious as to whether you have any insight into the fact that you’ve been repeatedly shown to be wrong and yet cling to the nonsense you were taught. Care to explain?

          • Jacob Bunton
            June 7, 2017 at 3:27 am #

            “All that Bullshit… ”
            Well moving on then.
            95% of the world thought the world was flat once….

          • Who?
            June 7, 2017 at 3:43 am #

            So-‘ape shit’ uttered by you is fine, but ‘bullshit’ utttered by Dr T is a problem?

            Tone trolling becomes you though.

          • Roadstergal
            June 7, 2017 at 3:58 am #

            You are just as ignorant of history as you are of biology. Flat-earth-ism has been a fringe belief since science was a thing. The ancient Greeks not only knew the earth was roughly spherical, they calculated its circumference to a high degree of accuracy.

            The scientific method works. You should try it sometime.

          • Jacob Bunton
            June 7, 2017 at 4:50 am #

            So should you.

          • Roadstergal
            June 7, 2017 at 5:14 am #

            “I know you are, but what am I” – when you’re digging for grade-school rejoinders, many people would take that as a sign they’re out of legitimate responses and should re-think their position. Not Jacob Bunton! He’s a MGTOW!

          • Azuran
            June 7, 2017 at 5:42 am #

            Yes, all that bullshit.
            This is nothing more than cherry picking. You decided that humans where somehow closer to Dolphin and then proceeded to name ways that they are similar, while ignoring the much longer list of how they differ, and the much longer list of how we are more similar to other primates. You also apparently decided that genetic is not a thing.
            Here are some things to add to your list of random things we have in common with random animals:
            -Parrots can say words
            -Cockatiels can become bald
            -Guinea pigs need vitamin c in their food or they get scurvy.
            -Chinese crested dog are hairless, but they have hair on their head.
            -A cow’s gestation is 9 months. they also have a cycle every month.
            -Bears can stand on their back leg.
            All of this means about as much as your stupid list.
            And just because some people thought the earth was flat doesn’t give your stupid ‘hypothesis’ any credibility.

          • Lilly de Lure
            June 7, 2017 at 2:37 pm #

            Oh goody – we can add history to the ilst ofthings you know nothing about.

          • Roadstergal
            June 7, 2017 at 4:09 am #

            “You’d agree Dr. Amy that what makes human beings special is our huge brain mass”

            Wow, we’re about 3x less special than elephants. We should emulate them and gestate for two years.

          • Charybdis
            June 7, 2017 at 11:03 am #

            Some of those “a baby KNOWS when to be born” and supporters of 41, 42, 43+ weeks gestation would be ALL OVER that.

          • momofone
            June 7, 2017 at 6:21 pm #

            But do they have waterbirths?

          • MaineJen
            June 7, 2017 at 9:26 am #

            I’ll bet you’re wishing that Dr. Amy deleted comments *now*

          • Jacob Bunton
            June 8, 2017 at 5:46 am #


          • momofone
            June 8, 2017 at 7:08 am #

            Because your idiocy is showing.

          • Amy Tuteur, MD
            June 7, 2017 at 9:38 am #

            Ahh, the discredited Hardy/Morgan hypothesis:


          • Charybdis
            June 7, 2017 at 10:07 am #

            So, tell me, does the Bimini Road lead to Atlantis or Mu? What’s Aquaman up to these days? Have the Deep Ones left R’lyeh and is Cthulhu still on the throne there?
            For the love of all that is holy, do you even HEAR yourself?

          • kilda
            June 7, 2017 at 11:14 am #

            does this have something to do with SpongeBob?

          • moto_librarian
            June 7, 2017 at 12:45 pm #

            Do gorillas or other higher order primates get in water to deliver? Because until that happens, claiming that humans should do it because dolphins is the most idiotic argument that I’ve ever heard.

          • Linden
            June 7, 2017 at 1:18 pm #

            All your bullshit analogies are nothing compared to the findings that, in the real world, water births injure and kill babies. You haven’t addressed any of the links that have been posted. Which leads me to think you are completely enamoured with your own theories, and don’t care a jot about women and babies and what keeps them safe.

          • Lilly de Lure
            June 7, 2017 at 3:25 pm #

            My previous post seems to have been eaten by disqus – basically even IF the aquatic Ape theory had merit (which it doesn’t) how does this help justify waterbirth for humans? If you look at how sea mammals give birth you will note that all of those species capable of doing so climb on to land to give birth. Whales and dolphins birth in water only because they can’t beach themselves without dying. Even Elaine Morgan never claimed we went as far along the aquatic route as that!

            Do you not find it peculiar that you are advocating as safe and natural a path that evolution never leads a species down until it literally has no other option.

          • Roadstergal
            June 8, 2017 at 2:52 am #

            Even dolphins get their newborns up to the surface to breathe right away.

          • Lilly de Lure
            June 8, 2017 at 7:14 am #

            Good point – they are also born predominantly breech (as were ichthyosaurs so it’s almost certainly an adaptation to marine life rather than an individual quirk) to minimise the risk of drowning. So basically, left to itself evolution does not agree that face first birth is safe because of the diving reflex – dolphins have a much better one of them than we do and evolution still takes steps to ensure that it is not needed during birth!

          • Daleth
            June 8, 2017 at 10:20 am #

            So, Jacob, thank you for sharing your views on the profound similarities between humans and dolphins, but I think you may be missing a subtle nuance here:

            Specifically, the reason that dolphins give birth in water is because they live in the ocean.

            We don’t live in the ocean.

            Let me know if you want a cite for that or if you’re willing to agree that a key difference between dolphins and humans is that dolphins live in the ocean and humans live on land.

          • Jacob Bunton
            June 8, 2017 at 2:57 pm #

            Evolutionary perspective – it was related to a different post.

          • Daleth
            June 9, 2017 at 10:25 am #

            If you want “evolutionary perspective,” consider that humans evolved by coming OUT OF the ocean and starting to live on land. There is nothing evolutionary about giving birth in a kiddie pool just because marine mammals similar to our remote ancestors live, give birth and die in the ocean.

          • yugaya
            June 4, 2017 at 4:45 pm #

            Mind the goalposts. Your previous claim: babies cannot drown during waterbirth. Those dead babies that drowned during waterbirths, that you have just buried twice with that statement, really have nothing to do with women getting epidurals.

            Btw I’m starting to get nauseated by your obvious hatred of epidurals, adequate and safe pain relief for women in childbirth and the way you are inserting that obvious hatred into every avenue of this conversation.

          • Dr Kitty
            June 4, 2017 at 6:03 pm #

            You stop promoting and offering dangerous things no-one has the skills to oversee in hospital any longer.

            Battlefield surgeons used to be able to amputate a limb in under 3 minutes- before the advent of anaesthesia and antisepsis.

            That skill has been lost, and no-one offers speed lower limb amputations any more. So sad, all those lost skills.

          • Heidi
            June 4, 2017 at 6:17 pm #

            Yeah, I’m really upset modern day barbers no longer perform dental work and surgery! That’s why you won’t catch me going to an actual surgeon should I require any. I’m gonna hit up the lady who cuts my husband’s hair and let her gain her skills on me.

          • Nick Sanders
            June 4, 2017 at 6:42 pm #

            I love this, you complain about interventions, use the term “overmedicalization”, while in the same breath talking about waterbirth as if it were some normal, natural thing that’s been going on forever and not knowing how to perform this particular piece of performance art as a “loss of skill” somehow.

          • June 6, 2017 at 5:50 pm #

            I recommend you compare death rates of babies born under modern medical conditions versus babies born without medical intervention. A baby born in the US has much better odds than a baby born in rural Somalia, Afghanistan, or Peru. Hell, a baby born in a hospital in the US has much better odds than a baby born at home in the US. “Overmedicalisation” of birth saves lives; there are no number of midwifery skills that can fix a transverse lie, pneumonia caused by meconium aspiration, or truly stuck shoulder dystocia. Only modern medicine can handle that.

            You know how we know how many babies women had in the past? We read their wills. Every time they got pregnant, they updated their will because they were likely to die. A lot of cultures don’t name babies until they’re a week, a month, or even a year old, because babies died that often. They didn’t want to get too attached in case the baby died. Again, only modern medicine fixed this. You’re suggesting we give up the one set of tools that has seen a massive increase in babies and mothers living instead of dying, because … why are you suggesting that, anyways? I’m still not sure. Something about natural, as if nature is a kind fluffy bunny instead of ‘red in tooth and claw’. As if everything we do as humans isn’t natural- we are tool users, so let us use our tools!

          • Jacob Bunton
            June 8, 2017 at 7:10 am #

            Someday the majority of women will not give birth in hospitals because they will realise that childbirth is not a disease.

            IF they have a disease for example, pre-eclampsia, cardiac, respiratory, liver disease other medical conditions etc..they will go to the hospital.

            Why is it America has some of the worst birth statistics in the modern world?
            Homebirth accounts for only 1% of birth so it cannot be due to that, can it?

            The Farm, Ina May Gaskin, has the best birth statistics for a midwife unit in the world. See spiritual midwifery text appendix

            Why this headline?
            **** Deadly Delivery: The Maternal Health Care Crisis in the USA****


            What is happening in America? It doesn’t make sense? It has all the latest technology, spends more on healthcare than any other country, has machines that go bing and medics knocking on doors , ‘just saying case I need to rescue you from an emergency in 5 hours time.’

          • Roadstergal
            June 8, 2017 at 8:11 am #


            Oh, you myopic little man. Women have been birthing outside of the hospital for most of recorded history. Women birth outside of the hospital in many places in the current day.

            Tell me, what is the perinatal mortality for birthing in vs out of hospital, in comparable risk groups?

            If you need a hint, Edith Rooks did a study on planned home vs hospital birth in Oregon, where the homebirth midwives are totally up your hands-off naturalistic fallacy waterbirth alley.

          • Azuran
            June 8, 2017 at 8:35 am #

            Childbirth has been the number one cause of death of young women for the entire human history. That changed with hospital birth. So no, you won’t be convincing the majority of us that it’s safe. Homebirth might be only 1%, but it already has a higher death rate so more homebirth means more deaths.

            As for why the USA has a higher death rate: They have, BY FAR the shittiest health care system out there. especially for women. Right now, they are still trying to make abortion illegal. They want to give companies the right to refuse to cover contraception. They are arguing that men shouldn’t contribute to paying prenatal care, they want to make pregnancy a pre-existing condition. And they don’t have paid maternity or parental leave.

          • Amazed
            June 8, 2017 at 9:24 am #

            The Farm. The Farm. Hahaha! The best statistics for a midwife unit? Perhaps. Self-reported, never viewed by an outside researcher because Ina May Let My Own Premature Baby Die Gaskin won’t allow it? Who cares!

            Was Ina May’s own, intentionally left without medical care baby in these stats?

          • Charybdis
            June 8, 2017 at 10:21 am #

            Stop. Just stop. Ina May Gaskin supports and encourages sexual abuse in her patients/clients. She is an abomination and is certainly NOT a person one should admire and emulate.

          • Jacob Bunton
            June 8, 2017 at 2:56 pm #


          • Heidi
            June 8, 2017 at 3:10 pm #

            “It helps the mother to relax around her puss if you massage her there using a liberal amount of baby oil to lubricate the skin. Sometimes touching her very gently on or around her button (clitoris) will enable her to relax even more. I keep both hands there and busy all the time while crowning … doing whatever seems most necessary.”

            “Sometimes I see that a husband is afraid to touch his wife’s tits because of the midwife’s presence, so I touch them, get in there and squeeze them, talk about how nice they are, and make him welcome.”

            -both IMG

            And I’m about to throw up now.

          • Jacob Bunton
            June 8, 2017 at 4:24 pm #

            Oxytocin – yes could have been worded differently I agree but I’m guessing she talking about release of oxytocin….. I understand your repulsion but I also get it. The sexual element of birth confronts you? Sheila Kitzinger book ‘Birth and Sex’ explains it

          • Heidi
            June 8, 2017 at 4:34 pm #

            Sexual assault – let’s be clear what that is. Yes, the idea of being sexually assaulted by my nurse or doctor sickens me. It really doesn’t matter how it was worded. This is IMG admitting to sexually assaulting women.

          • June 8, 2017 at 5:24 pm #

            IF YOU TOUCH SOMEONE’S SEXUAL ORGANS WITHOUT CONSENT IT IS SEXUAL ASSAULT! It cannot be more clear than that. IMG is therefore blatantly admitting to sexual assault on her patients, because she openly admits she does not ask for consent before doing any of that.

            If a woman finds birth to be sexual, fine, more power to her. If a midwife sexually assaults someone during birth, there is no word for how not-fine that is.

          • Charybdis
            June 9, 2017 at 10:25 am #

            You know what else is good for getting oxytocin into the system?
            Pitocin. No fondling, rubbing, tweaking, twiddling, massaging, etc. necessary. And you can regulate the dosage.
            Yes, there is a sexual element to childbirth; aspiring for it to be the most orgasmic experience of your life is just false advertising. You orgasmed during the birth of your child, or you found it an overwhelmingly sexual experience? Good for you. Not everyone will find it so and there is nothing wrong with that. Expecting everyone else to have that same experience is also wrong.

          • Azuran
            June 9, 2017 at 11:49 am #

            So, you think that it would be ok for OBs and nurses to start asking labouring women if they want him/her to masturbate them or fondle their breasts to help them with labour? You really think that such a thing is EVER appropriate for a health care provider?

          • Heidi
            June 9, 2017 at 12:06 pm #

            I’m under the impression, they generally don’t even ask.

          • momofone
            June 8, 2017 at 4:47 pm #


          • Charybdis
            June 9, 2017 at 10:17 am #


            Don’t let the head
            suddenly explode from the mother’s puss. Coach the mother about how much and
            how hard to push. Support the mother’s taint with your hand during rushes. It
            helps the mother to relax around her puss if you massage her there using a
            liberal amount of baby oil to lubricate the skin. Sometimes touching her very
            gently on or around her button (clitoris) will enable her to relax even more. I
            keep both hands there and busy all the time while crowning … doing whatever
            seems most necessary.


            Sometimes I see that a
            husband is afraid to touch his wife’s tits because of the midwife’s presence,
            so I touch them, get in there and squeeze them, talk about how nice they are,
            and make him welcome.


            I might want to have a
            cunt one day and a twat the next. On the third day I might decide that pussy is
            my favorite word.

            This is someone midwives need to emulate? Seriously?
            WTAF is wrong with you?

          • Sarah
            June 9, 2017 at 10:44 am #

            I feel dirty reading that. Not in the good way.

          • Azuran
            June 9, 2017 at 11:47 am #

            Each time I read this, I start feeling deeply tainted.

          • Heidi
            June 9, 2017 at 12:13 pm #

            I feel just as disgusted reading it as I have when older men when I was a teenager and in my early twenties would say sexually explicit stuff to me. Now that I’m older, I think those vulgar, creepy men know, women my age generally have enough confidence and experience not to put up with that shit. But then you can expect some creepy midwife to pounce upon you when your pain is so bad, you aren’t even sure what’s going on.

          • Sarah
            June 9, 2017 at 12:24 pm #

            No pun intended?

          • MaineJen
            June 8, 2017 at 11:40 am #

            FFS. Do you remember what the maternal and perinatal mortality rates were back when most women didn’t give birth in hospitals? They were abysmal. You want to go back to that?

          • June 8, 2017 at 12:37 pm #

            You know what else isn’t a disease? A broken leg. A heart attack or stroke. A gunshot wound. None of those are diseases. You think that hospitals only exist to treat disease?

          • Azuran
            June 6, 2017 at 5:57 pm #

            How could the ‘skill’ of water birth be lost? It’s not at all an ancient practice, it’s just a fringe midwife practice without any basic in actual medicine. In order to lose a skill, it first has to be one, and waterbirth isn’t.
            And really, putting asside the fact that waterbirth doesn’t actually require any particular skill (you really don’t need that much skill to assist an uncomplicated vaginal birth, and if there are complication, they get out of the pool so it’s not a water birth) who cares if the skill set required to do something dangerous is not maintained.
            I find it funny that you seriously think that OBs lack the skill to do waterbirth. They just don’t want to because it’s not a medically recommended practice.

          • Jacob Bunton
            June 8, 2017 at 6:43 am #

            Birth is an involuntary act.
            What else is an involuntary act?
            Is it medically recommended practice to watch how a person urinates?
            Sometimes it is and sometimes it isn’t.

          • Charybdis
            June 8, 2017 at 10:17 am #

            Oh, I think there are several voluntary acts that precede a birth and some of those are more deliberate than others (IVF comes to mind). The ‘how’ of birth is voluntary (vaginal, cs, medicated, unmedicated, choice of medication for pain relief, etc).
            I think you were maybe looking for the word “inevitable”. Because once you are pregnant, there are only two ways to get the baby out: CS and vaginally. There are modifiers under those choices, but there are only two ways to deliver a baby.

          • Roadstergal
            June 6, 2017 at 4:24 am #

            “Why aren’t babies drowning in utero?”

            Because they’re in the mom and the placenta is firmly attached to mom. As long as it is, oxygenated blood is passed to the baby. As soon as the baby is delivered, the placenta detaches and the baby no longer gets oxygenated blood from mom, and needs to breathe air.

            Sometimes, the placenta can fail when the baby is still in utero, which starves the baby of oxygen even in utero. So yes, the baby can die of lack of oxygen in utero.

            On the flip side, baby ‘breathes’ amniotic fluid, although it’s not getting oxygen from same, and can inhale any contamination – if it passes meconium, it can ‘breathe’ it in and have a life-threatening infection. Similarly, waterbirth babies have breathed in the stew of bacteria from various sources on delivery and died from the subsequent infection.

            This is basic stuff. Yet you don’t know it.

            And you also think amniotic fluid is just the same as water.

            It’s a sad state of affairs that you’re allowed within 30 meters of a pregnant woman.

          • Aine
            June 4, 2017 at 4:20 pm #

            “yes its easy to forget that the baby during pregnancy is actually in a sack of water.”

            Are you deranged?? If any of my care providers FORGOT that my baby was in a sack of amniotic fluid (not water), I’d want them disciplined, possibly struck off. Are you admitting you often forget basic biology? What else do you regularly and easily forget?

          • Jacob Bunton
            June 4, 2017 at 4:26 pm #

            This was not directed at you, of course care providers don’t forget this, but in clinic I get asked sometimes when baby born in water how does it breathe. Often the mothers remind their partners, ‘the baby is in water now silly’ and the partner laughs sheepishly and says ‘oh yeah, I forgot’. Yugaya comments seemed to reflect this, that’s all.

          • Nick Sanders
            June 4, 2017 at 4:30 pm #

            How does it breathe? It doesn’t. The lungs pump and all, but no respiration takes place, the baby instead getting it’s oxygen from the mother’s blood. Once the baby is outside the mother, this is no longer possible, for what I would have assumed to be obvious reasons until I read your drivel.

          • Jacob Bunton
            June 4, 2017 at 4:55 pm #

            I was about to say well said Nick. Until I unfortunately read your last sentence.

          • Roadstergal
            June 5, 2017 at 3:42 pm #

            Do you really think amniotic fluid is just water?

          • Amy Tuteur, MD
            June 4, 2017 at 4:39 pm #

            Perhaps you have forgotten or never knew that the baby breathes in amniotic fluid in utero. If you are so ignorant of basic neonatal physiology you should not be allowed to care for anyone.

            You are simply regurgitating the nonsense that you have been taught. It has no basis in science.

          • Jacob Bunton
            June 4, 2017 at 4:53 pm #

            We’ve covered this Amy move on

          • Amy Tuteur, MD
            June 4, 2017 at 4:54 pm #

            We’ve covered the fact that you are ignorant of basic neonatal physiology?

          • Heidi_storage
            June 5, 2017 at 9:58 am #

            Well, to be fair, yes, he has covered that over and over again, whether he realizes that or not.

          • Jacob Bunton
            June 7, 2017 at 4:49 am #

            Am I?

          • Roadstergal
            June 7, 2017 at 5:12 am #

            You sure are, Mr “babies breathe water in utero” Bunton.

          • Nick Sanders
            June 4, 2017 at 4:56 pm #

            She posted that before you posted your bullshit “covering”. Are you really so dumb you can’t read a timestamp?

          • momofone
            June 4, 2017 at 7:23 pm #

            “I don’t have an adequate response to this so stop pressing me about it.”

          • Amy Tuteur, MD
            June 4, 2017 at 4:43 pm #

            Immersion in Water During Labor and Delivery
            American Academy of Pediatrics Committee on Fetus and Newborn, ACOG Committee on Obstetric Practice

            “Although it has been claimed that neonates delivered into the water do not breathe, gasp, or swallow water because of the protective “diving reflex,” studies in experimental animals and a vast body of literature from meconium aspiration syndrome demonstrate that, in compromised fetuses and neonates, the diving reflex is overridden, whichleads potentially to gasping and aspiration of the surrounding fluid.”

          • Jacob Bunton
            June 4, 2017 at 4:53 pm #

            Yes correct. In COMPROMISED fetuses. This means babies may breathe in meconium for example while in the womb. This can happen and does happen on dry land with epidural. Yes this can happen in pool, so that why the fetal heart is auscultated, the waters once they break are checked to be clear, if there is thick mec or the FHR is non-reassuring then the woman is asked to leave the pool.

          • Amy Tuteur, MD
            June 4, 2017 at 4:57 pm #

            Uncompromised fetuses breathe in amniotic fluid ALL THE TIME. In fact, fetal lungs cannot develop properly in the absence of amniotic fluid — pulmonary hypoplasia

          • MaineJen
            June 5, 2017 at 9:45 am #

            Epidural has nothing to do with it. Stop lying.

          • Amazed
            June 5, 2017 at 2:10 pm #

            Even if your deranged ramblings held a grain of truth which they dont, then how, pray tell, do midwives, with all their superhuman knowledge you rave about in your gushing praise, happen to witness the birth of COMPROMISED fetuses?

            Midwife knows this… Midwife knows that… Midwife knows all… Ah, a tiny little speck midwife doesn’t know: baby is compromised, that’s why the baby dies. But don’t worry, baby was compromised anyway, nothing to see here, move on, move on! Oh and don’t forget to bring all the medical staff to witness the waterbirhs of all those umcompromised fetuses, so they can appreciate the beauty of waterbirth and not bitch about silly little things like preventable deaths.

            Jacob, you’re so full of shit that even your eyes are brown.

          • mabelcruet
            June 6, 2017 at 3:25 am #

            It’s like Anna Perch all over again, ignoring direct questions, gas lighting and repetitive statements of sheer drivel.

          • Amazed
            June 6, 2017 at 6:17 am #

            Did you HAVE to remind me?

            I had forgotten about her. I was happy having forgotten about her. And yes, now that you’ve reminded me, the resemblance is there.

            My favourite part is their genuine, IMO, trust that what they write is so powerful that it will magically convert us all right upin the spot, so Dr Amy just HAS to delete it.

          • maidmarian555
            June 6, 2017 at 6:37 am #

            I am 99.9% certain that Anna Perch was also a man.

          • mabelcruet
            June 6, 2017 at 7:26 am #

            My apologies-I should have flagged the post with a trigger warning!

          • Linden
            June 7, 2017 at 7:17 am #

            So these “compromised” fetuses must die?
            Seriously? You don’t think there is anything wrong with prioritizing a waterbirth above the well-being of a baby?

          • Roadstergal
            June 7, 2017 at 8:29 am #

            I think his argument is that modern obstetrics has lost the art of sitting around and doing nothing during the natural process of waterbirth, and that has infected the wootastic midwives who do waterbirth, which ends up with the fetus being compromised, which wouldn’t have happened if they had done more of nothing…?

            I’ll be honest, it’s tough to parse out.

          • Azuran
            June 5, 2017 at 4:05 pm #

            And how do you even know that birthing in water is more ‘gentle’ to the baby?
            Why do you even think that babies need gentler birth?

          • Heidi
            June 5, 2017 at 4:54 pm #

            Gentle is not the word that comes to mind when I think of vaginal birth – neither for mother or baby, regardless of land or water. I’m pretty grateful I can’t recollect my birth at all. Actually, I’m pretty grateful I can’t remember being stuck like a canned whole chicken in my mother’s womb.

          • The Bofa on the Sofa
            June 5, 2017 at 5:42 pm #

            Hey, when I see babies come through vaginal birth with come heads, I think, “Oh, that must have been gentle.”


          • Jacob Bunton
            June 6, 2017 at 3:19 am #

            Why do you think babies may need a gentler birth?

          • Azuran
            June 6, 2017 at 6:55 am #

            I don’t think that they do. You do.
            And if they actually did, a c-section would me much better than a waterbirth.

          • Jacob Bunton
            June 8, 2017 at 7:14 am #

            And contribute to the already sky rocketing obesity rates and type 1 diabetes…

          • momofone
            June 8, 2017 at 7:17 am #

            Sources? (Credible ones. Thanks!)

          • Roadstergal
            June 8, 2017 at 8:35 am #

            Yes, because it’s well-known that C-sections cause obesity and diabetes, rather than obesity and diabetes making it more difficult to successfully deliver vaginally and requiring more C-sections to allow women with genetics for same to successfully pass it on to their children with minimal damage.

            I mean, T1D having a genetic component? Who ever heard of such a thing.

            Similarly, the sun coming up in the morning generates my urine. How else can we explain my need to piss when it rises?

          • Jacob Bunton
            June 6, 2017 at 3:20 am #

            Primal Health Research Database

          • Azuran
            June 6, 2017 at 6:49 am #


            Wait, you are serious?


          • yugaya
            June 8, 2017 at 5:05 am #

            Like I said, he is as fucked up psycho about waterbirth as Charkovsky is.

          • Jacob Bunton
            June 8, 2017 at 7:29 am #

            Perinatal origin of adult self destructive behavior

            Birth record data were gathered for 412 forensic cases comprising suicide victims, alcoholics, and drug addicts born in Stockholm after 1940 and who died there in 1978 – 1984. Comparison with 2901 controls. Suicides involving asphyxiation were closely associated with asphyxiation at birth; suicides by violent mechanical means were associated with mechanical birth trauma; drug addiction was associated with opiate or barbiturate administration to mothers during labor.

            Jacobson B, Eklund G, et al.
            Reference: ACTA Psychiatr. Scand 1987;76:364-371


            What was that?
            You still laughing….me too
            Hahahaha yeah what’s the point in researching about what happens to us at the most critical time of our human development?
            Who’d think of such a crazy thing?
            What a waste of time?
            Now who’s up for a beer?

          • Nick Sanders
            June 8, 2017 at 8:09 am #

            Only 412 people over 6 years? That reeks of cherry-picking to me.

          • Roadstergal
            June 8, 2017 at 8:41 am #

            I’m trying to read the paper, but anything past the first page is $38 to access (because my institution only allows access to reputable journals). Screw that, a decent David Eddings book is $5 and is more entertaining fiction.

          • Charybdis
            June 8, 2017 at 10:04 am #

            No, no, no, Nick. That is the case load of a “very busy” midwife or two. And because it is from midwives, everything they say is the gospel truth.

          • Nick Sanders
            June 8, 2017 at 3:39 pm #

            I know you are snarking, but this isn’t even midwives, it’s suicide statistics. I don’t know how many people killed themselves in Sweden during those six years, but I’d bet dollars to donuts that it’s enough that you could get nearly any kind of correlation you wanted if you limited your data to just 412 of them.

          • Azuran
            June 8, 2017 at 8:41 am #

            Yes, I’m still laughing. Actually, I’m laughing even more.
            and no, the few hours of birth are definitely NOT the most important of our developments.

            Also, you might want to check if those who are born in water are more likely to kill themselves by drowning.

          • Roadstergal
            June 8, 2017 at 8:44 am #

            Oh, now that is an excellent point! If Jacob is right, that definitely follows. I was born on dry land, and I have no water phobia from early uncontrolled immersion – I’m a very good swimmer. These things are certainly causally connected.

          • Azuran
            June 8, 2017 at 9:16 am #

            I also wasn’t born in water, and I’m a good swimmer and I love water.
            Same goes for my sister, who could swim before she could walk.
            My baby wasn’t born in water either, and so far she loves taking baths
            So now we have N=4. So it’s definite proof.

          • Azuran
            June 8, 2017 at 8:52 am #

            And seriously, one study from 30 years ago has absolutely 0 scientific value.
            Reproducibility and repeatability are what is truly important when following the scientific method.

          • Heidi_storage
            June 8, 2017 at 2:04 pm #

            Honestly, this sounds a lot more like early 20th century psychoanalytic stuff than an actual, meaningful correlation.

          • June 5, 2017 at 6:14 pm #

            Actually, the contractions themselves can stimulate breathing- not always, but sometimes. And then those babies are breathing water, blood, and feces all at once. Yay!

          • Jacob Bunton
            June 6, 2017 at 3:19 am #


          • Who?
            June 6, 2017 at 4:26 am #

            Well, there’s water, with blood, faeces, maybe urine and who knows what all else, and a baby fully submerged.

            Come to that, even if the baby is pulled out before its first breath, it seems gross. Eye infections, ear infections. Yuck.

          • Roadstergal
            June 6, 2017 at 4:45 am #

            I posted links to actual case studies of babies actually dying of material inhaled during waterbirth. During those magic spontaneous hands-off VDs. The BMJ had a 1999 study that tried to do the Birthplace brush-off of dead and damaged babies in the abstract, but if you read the whole article, they have a 1.2/1000 perinatal mortality in this set of very low-risk pregnancies, and a high NICU admission rate for breathing/drowning/infection issues. “Of the 32 survivors, 13 required respiratory support (ventilation or continuous positive airways pressure or head-box oxygen) Fifteen of the survivors had lower respiratory tract problems, variously labelled as pneumonia, transient tachypnoea of the newborn, or “wet lung”; suspected aspiration; meconium aspiration; water aspiration; and “freshwater drowning” (1, who had hyponatraemia)).” Five of the babies had a snapped umbilical cord, because you can’t exactly manage that well in a waterbirth.

            But they’re probably just ‘compromised’ somehow, anyway. In Jacob Bunton’s world, either everything goes right, or the baby was somehow ‘compromised’ and meh, fuck ’em.

          • June 6, 2017 at 1:14 pm #

            Meconium aspiration is a thing

          • yugaya
            June 8, 2017 at 1:04 pm #

            Evidence that babies have died due to breathing in water as well as all sorts of other deadly stuff while waterbirthing has been posted for days. You haven’t addressed any.

            Here’s more: 2012 death of a baby born completely healthy in Canada that succumbed to bacterial sepsis 36 hours later which was attributed to home
            waterbirth: ” . It was inferred that the endotoxin-producing bacteria reached the alveoli during the birthing process with a possible source being the bath water in which the woman was immersed during labour. The cause of death was “perinatal infection by endotoxin-producing bacteria.” Recommendation that was made based on review of full autopsy report:
            ” The Canadian Pediatric Surveillance Program (CPSP) initiative collecting data on early onset neonatal sepsis should consider adding information regarding maternal use of water immersion during labour and delivery.”


            Fatal Legionellosis after Water Birth, Texas, USA, 2014:

            Deaths like this one in 2014 in USA have been documented all around the world in the past:

            “infant who developed severe pneumonia and disseminated adenoviral infection following water
            birth delivery to a mother with gastroenteritis. The infant’s infection was due to an adenovirus strain
            that has not been previously reported in neonates .In the present case,the neonate’s HAdV infection likely occurred by vertical transmission during the water birth since the mother had symptoms of gastroenteritis with defecation into the water bath immediately prior to delivery. She died shortly after being taken off ECMO (19 days of age).”

            There is also one maternal death recorded in UK that was associated with infection acquired during waterbirth (CEMACH report), but Jacob should be able to tell us more about that since he is the one peddling waterbirth as safe in UK.

          • Roadstergal
            June 6, 2017 at 4:48 am #

            Do you think a ‘gentle’ birth is important?

            If so, you definitely support MRCS, yes? What could be more gentle than being carefully lifted from the womb, with no juicer-style squeezing through an opening so small the baby’s skull bones have to shift and mould to make it out?

          • EmbraceYourInnerCrone
            June 6, 2017 at 3:02 pm #

            True! My brother was my mom’s only C-section baby, she said that unlike me and my sister the cone-heads, my brother had a beautiful round head and no squishing of his face.

          • Charybdis
            June 6, 2017 at 9:52 am #

            Yes, the umbilical cord keeps the baby alive IN UTERO, along with the placenta. What do you do during a waterbirth if say, the cord is short, too short to allow the baby to fully descend or to be expelled from the vagina? How about knotted cords? Nuchal cords? Prolapsed and/or compressed cords?
            How about failing placentas? Old ones with calcifications or small ones? Abrupted or partially abrupted ones? How do you address those whilst in the midst of a waterbirth? Or do you just ignore these potential issues because to speak or even think of them will introduce negativity and suddenly make that very thing manifest?
            Seriously. You have not satisfactorily answered anyone’s questions. Still waiting….

          • EmbraceYourInnerCrone
            June 6, 2017 at 2:59 pm #

            The baby is kept alive by the Placenta being still attached to the uterine wall, being attached to the umbilical cord itself isn’t going to help if the placenta is starting to detach or has detached.
            My daughter started breathing during labor, she also passed her first bowel movement and aspirated it. So where is your evidence that ” baby will not breathe under water”

          • Jacob Bunton
            June 4, 2017 at 3:52 pm #

            I think yugaya you are posting on the wrong site. WTF

          • yugaya
            June 4, 2017 at 4:00 pm #

            Really? Explain to me what is natural or physiological about waterbirth. I’ll wait. I’ve explained in great detail why it is a lunacy invented by a psychopath who hated women.

          • Jacob Bunton
            June 4, 2017 at 3:52 pm #

            Again. WTF. Check your source. RCOG. NICE guidelines. Cochrane Review. The Lancet. British Medical Journal. Primal Health Research Database. Are good resources to start with.

          • yugaya
            June 4, 2017 at 4:31 pm #

            Cochrane review did not include perinatal mortality as measure of outcome. When you exclude the dead babies, waterbirth indeed sounds like a harmless idea.

          • Jacob Bunton
            June 4, 2017 at 3:50 pm #

            What are you guys looking at? Check your source. RCOG. NICE guidelines. Cochrane Review. The Lancet. British Medical Journal. Primal Health Research Database. Are good sources to start with.

          • yugaya
            June 4, 2017 at 3:56 pm #

            I checked RCOG guidelines and they didn’t have any of that hands off breech you claimed was in them. I also checked the link you posted for that midwife knowz crap you posted but it didn’t have any of that lotus birth leave cord uncut until placenta delivers crap either. As opposed to that gaslighting of yours, you will find all the content I am quoting on the links posted, showing how that waterbirth you are selling is a lunacy invented by a bloody psychopath who openly hated women and knowingly killed babies during his waterbirth experiments:

            ” *He was not that into women*. Or babies: ” I think everything was OK in the very beginning, until he crossed a certain line. There is a certain boundary, you know. He crossed it. He stopped regarding babies as a self-consistent value; he made them a mere material for his experiments. He did not care anymore whether the baby survives… You shouldn’t make anyone your guru. Nobody forced the parents to give him their babies [for water trainings]. They gave him their babies without any doubts. I don’t know if they really had no doubts, however they did nothing to get their babies back
            from him. Another homebirth midwife, interviewed in a film about waterbirth, seconds this opinion:
            Reporter: Yulia considers Charkovsky to be an immoral person. In her opinion, he regards pregnant women and babies just as a material for his experiments, some of which are really dangerous for their lives. Yulia Postnova [homebirth midwife]: Probably he understands this deep inside himself,
            but he still tries, he goes on with his experiments. That’s what I call crime.”


        • Dr Kitty
          June 4, 2017 at 3:44 pm #

          Yes I’ve seen an “uncomplicated” waterbirth- colour me unimpressed. I can’t see any benefits at all.

          The only people, BTW, who don’t like junior doctors sitting in on normal low risk deliveries are midwives. Women and senior obstetricians are quite happy to “allow” it, midwives, not so much. I used to introduce myself to every single woman on delivery suite when my shift started, and pop in and out of the delivery rooms throughout the shift, because I didn’t want to be a stranger in case of an emergency. The women were quite happy- the midwives not so much.

          I’ve also seen a massive PPH and a bad shoulder dystocia after unmedicated, midwife supervised waterbirths, but of course I only arrived in the room after all the magical sparkles had already left.

          • Jacob Bunton
            June 4, 2017 at 4:12 pm #

            Dr Kitty I’m glad you had the opportunity to attend a waterbirth during your training, many have not had or been given that opportunity. I personally feel ALL birth attendants MUST see waterbirths, unmedicated births as well as medicated births and ELCS and EMCS. Otherwise you become skewed either way.

          • Dr Kitty
            June 4, 2017 at 4:16 pm #

            As I said. Saw it.
            Not impressed.

            Thought that women looked happier and more comfortable birthing on land, with epidurals.

            And babies certainly looked pinker and had higher APGARS when they weren’t delivered in water.

          • Jacob Bunton
            June 4, 2017 at 4:35 pm #

            First comment – true you entitled to your opinion.
            Second comment – its the woman/women who will tell you if she is happier not for you to presume or assume how she is feeling.
            Third comment – yes physiological birth doesn’t always ‘look’ comfortable
            Fourth comment – I need to clear something up which has been bugging me. I saw an earlier comment, I did not scream, bite etc, my epidural nicely in place. I was with a woman while I was training with epidural in situ and she was pushing, she said to me and the midwife, ‘I can scream if you like, that’s what they do in the movies.’ I asked her if she could feel anything. She said, ‘no’. FACT most women with a fully working epidural don’t scream, they are not in pain and appear comfortable. Ok, glad we cleared that up.
            Fifth comment – pinker true, poorer apgars in water NOT true. The last birth I attended was the usual 9 at 1 min, 10 at 5 mins, 10 at 10 mins.

          • MaineJen
            June 5, 2017 at 9:39 am #

            Hi, Jacob. I am an actual woman who has given actual birth. I had a “functioning epidural” both times, and it’s true, I wasn’t in pain while pushing. Is that a bad thing? I was very happy with how things went both times: short second stage, minimal damage, healthy baby.

            You don’t seem as interested in listening to actual women (at least, not in listening to the ones who disagree with you) as you are in advocating for unmedicated water birth.

            Are you an inflatable tub salesman on the side?

          • Heidi_storage
            June 5, 2017 at 9:54 am #

            Training for what? What are you, and why are you allowed near laboring women?

          • Roadstergal
            June 6, 2017 at 4:26 am #

            “women with a fully working epidural don’t scream, they are not in pain and appear comfortable.”

            Only in Jacob Buton’s world is this a _bad_ thing.

          • Dr Kitty
            June 6, 2017 at 5:28 am #

            Because to Jacob women should be making guttural noises, incoherent from pain, having their neo-cortexes fully stimulated. It might appear to be agonising pain to a casual observer, but it’s labour, and natural, and really much better for women.

            Women laughing, joking, knitting, drinking tea, sleeping and watching Neflix during labour because they have working epidurals and no pain are doing it wrong, missing out on something vital and damaging their babies.

            Did I miss anything?

          • Jacob Bunton
            June 7, 2017 at 4:47 am #

            Yes. You missed the part about Choice. I find it ironic that the only people telling women HOW to birth and NOT birth is you guys!! ???

          • Jacob Bunton
            June 7, 2017 at 4:48 am #

            I SUPPORT women WITH and WITHOUT an EPIDURAL.

            BTW Dr Kitty just a small important correction in ref to your above post of the woman.. ‘having their neocortex NOT fully stimulated’ is key.

          • momofone
            June 7, 2017 at 7:07 am #

            You still somehow managed not to address the MRCS/RCS question.

          • Roadstergal
            June 7, 2017 at 5:11 am #

            Then why have you been dodging Dr Kitty’s straightforward MRCS/RCS questions – an actual woman discussing her actual birth choice – for three days, while yammering up and down the thread on either side?

          • Jacob Bunton
            June 8, 2017 at 5:57 am #

            I thought I covered MRCS question – I assume this means Maternal Request for c-section. Here it is called ELCS via maternal request.
            We don’t use that term.

          • Mattie
            June 8, 2017 at 7:08 am #

            RCS is repeat section I assume, I don’t ‘know’ but it’s pretty easy to understand in context anyway.

          • momofone
            June 8, 2017 at 8:36 am #

            Here elective c-section is medically necessary but not emergent, so it is planned. Maternal request means not medically necessary but done due to mother’s wishes. RCS is repeat c-section.

          • Charybdis
            June 8, 2017 at 9:53 am #

            We don’t give a damn what terms you use. MRCS is a maternal request C-section, also called an elective C-section. “Elective” does not mean “unnecessary”, it means “scheduled” or “non-emergent”.
            So, now that that is cleared up, how about answering the questions about maternal request C-sections?

          • Daleth
            June 8, 2017 at 10:22 am #

            RCS means repeat c-section. In other words, giving birth via c-section after having already given birth to one or more previous children via c-section.

          • Jacob Bunton
            June 8, 2017 at 2:55 pm #

            Ok thank you.
            Yes RCS whats the problem? Fine. If a woman wants that, that is ok.
            It is recommended RCS after 2 or more C-section but if she wants one after a previous first, that’s ok.
            Some women ask for a VBAC vaginal birth after c-section.
            Hospital labour ward setting is recommended due to risk of scar rupture, and continuous electronic fetal monitoring (CEFM) also recommended.
            If woman wants VBAC, ok if not OK, if wants RCS ok?
            Sorry don’t understand the problem.

          • Azuran
            June 7, 2017 at 5:24 am #

            Oh but we totally agree that a woman has the right to water birth. What we don’t agree on is that hospitals have an obligation to allow and enable women to birth however they want on their birth ward.
            Some choices are just stupid, you can chose them, but they are still stupid, others have the right to call them out on their stupidity and don’t have the obligation to help you do stupid things.

          • Jacob Bunton
            June 8, 2017 at 5:54 am #

            Dr. Amy posted a link from AAP….”Facilities that plan to offer immersion in the first stage of labor need to establish rigorous protocols for candidate selection, maintenance and cleaning of tubs and immersion pools, infection control procedures, monitoring of mothers and fetuses at appropriate intervals while immersed, and immediately and safely moving women out of the tubs if maternal or fetal concerns develop.”

            I am glad to say that hospitals offering waterbirth follow these protocols.

            The abstract also states btw “Immersion in water has been suggested as a beneficial alternative for labor, delivery, or both and over the past decades has gained popularity in many parts of the world. Immersion in water during the first stage of labor may be associated with decreased pain or use of anesthesia and decreased duration of labor.”

            Thank you Dr Amy for the reference.

          • Roadstergal
            June 8, 2017 at 5:58 am #

            You do know the difference between ‘immersion in the first stage of labor’ and ‘waterbirth,’ don’t you?
            Oh, wait, this is Jacob Bunton we’re dealing with, so probably not. I’ll offer a summary in small words – the AAP and the ACOG do not support waterbirth as a safe practice (because it isn’t) that confers any benefits (because it doesn’t).

          • Who?
            June 8, 2017 at 6:20 am #

            ‘…suggested as beneficial…may be associated with…’


          • Charybdis
            June 8, 2017 at 9:49 am #

            But nowhere does it state that the facility is REQUIRED BY LAW to offer waterbirth. It states that they CAN offer immersion in the first stage of labor, but they are under no edict to actually do so.

          • Roadstergal
            June 8, 2017 at 10:06 am #

            The guidance he is quoting from actually recommends against waterbirth except in the context of a clinical trial. It’s only about immersion in early labor, and even at that, they’re very clear about maintaining high levels of hygiene, sufficient monitoring, and risking-out.

          • MaineJen
            June 8, 2017 at 1:31 pm #

            Well geez, every big hospital already does that. Some of the tubs even have jets, although the jets are not turned on if your water is already broken.

          • yugaya
            June 8, 2017 at 12:26 pm #

            Immersion in water during first stage of labour while adhering to rigorous protocols is NOT what you did – the patient in your care was contraindicated for a full on waterbirth that you enabled. It is also not that dolphin crap you are selling.

          • Jacob Bunton
            June 8, 2017 at 2:50 pm #

            Protocols were indeed followed at this hospital, according to the guidelines hb 98 and previous pph of 500ml, induction of labour with propess with 1 does only – eligible to birth in the Alongside midwife led unit, which is simply on labour ward but the rooms are designed differently and have a pool. It is not a question of care contraindicated but whether the care provider actually wants to provide care for that particular woman. Some have the relevant training and experience and others not as much, just like a junior doctor and consultant obstetrician. It is for the Consultant to teach the junior and vice versa, much learning is exchanged, the importance is care is safe and by a skilled professional with the relevant experience and knowledge.

          • yugaya
            June 8, 2017 at 3:00 pm #

            “Protocols were indeed followed at this hospital, according to the guidelines hb 98 and previous pph of 500ml,”

            RCOG again: “Active management of the third stage of labour lowers maternal blood loss and reduces the risk of PPH.
            Prophylactic oxytocics should be offered routinely in the management of the third stage of labour in all women as they reduce the risk of PPH by about 60%”.

            I’m gonna discard all your guesstimates on the basis of how many women in UK die from PPH each year because their midwives waited too long or underestimated the severity of their PPH.

          • momofone
            June 7, 2017 at 7:06 am #

            You seem to think “Choice” means having a waterbirth vs not having a waterbirth. I could not care less how someone else chooses to give birth (and frankly don’t understand why you do), but I care a lot about having some woo-based non-intervention foisted on women under the guise of giving them choice. If a woman wants to labor without pain relief, more power to her. If she wants to labor in a tub, so be it if it’s available. If she wants a pre-labor c-section, rock on. AMU/hospital/whatever/epidural/no epidural/Mongolian throat singing/what the fuck ever. The tub is not the point; choice encompasses much more than that.

          • Sarah
            June 8, 2017 at 10:14 am #

            There is no way you could possibly think that’s true.

          • Roadstergal
            June 8, 2017 at 5:37 am #

            It looks like we all missed the part where pushing on an undilated cervix is a great thing to be encouraged, as long as the woman doesn’t have an epidural.

          • Spamamander, pro fun ruiner
            June 7, 2017 at 12:47 am #

            Silly me, getting that epidural after 14 hours of pain, waking up at 4am because my water broke, and desperately wanting a nap. Surely being comfortable was a horrible thing!

          • momofone
            June 7, 2017 at 6:55 am #

            If you had only trusted your neo-cortex!

          • Jacob Bunton
            June 7, 2017 at 4:42 am #

            Who said it was a bad thing?

          • Dr Kitty
            June 7, 2017 at 3:08 pm #

            I’m going to assume you’re female and using a male pseudonym.
            Because I don’t really think that such a rarity as a male midwife would have actually posted all the potentially identifiable patient info you did.

            How did your labours and deliveries go, when you had your own babies?

            Just out of interest.

          • momofone
            June 4, 2017 at 6:05 pm #

            Clearly having seen a bit of all of the above has not kept your perspective from becoming “skewed.”

          • Charybdis
            June 4, 2017 at 11:13 pm #

            What is your fascination with waterbirth?

          • June 5, 2017 at 1:34 am #

            If you’re an OBGYN, you’ll see unmedicated, uncomplicated births as well as the ones that go wrong or the ones that are C-section (emergent or not). That’s because a lot of births are uncomplicated. We go to hospitals because there’s a chance something goes horribly wrong, and it’s best to be in a place with the equipment and professionals who can 1) figure out something’s wrong, 2) figure out what is going wrong, and 3) fix it.

            Waterbirth is a whole nother kettle of fish, because it prevents steps 1, 2, and 3 above plus introduces additional chances for things to go wrong. It’s a stupid, risky choice and one that I wouldn’t blame hospitals for banning. They don’t actually have to provide all options, only medically indicated ones or ones with reasonable risk/reward outcomes. A waterbirth gone wrong presents a huge liability risk and absolutely no benefit whatsoever to anyone.

          • MaineJen
            June 5, 2017 at 9:34 am #

            As you have become skewed in favor of unmedicated water births.

          • demodocus
            June 4, 2017 at 8:00 pm #

            lol, I had 3 students with my first, the ob’s resident, the student nurse, and the woman who my regular ob thinks must have been a more novice resident for a different doc. ETA, I saw ’em and basically thought eh, feck it. I’m busy.

          • MaineJen
            June 6, 2017 at 9:20 am #

            Exactly. I had zero problem with any students being in there. They’ve got to learn some time, and I had bigger things to worry about at that point.

          • KeeperOfTheBooks
            June 8, 2017 at 12:17 pm #

            Yup. One of the things I actually liked most about my first kid’s birth was the excitement and joy that I saw in the anesthesiology student who had come to watch. It was her first day of clinicals (residency? Not sure what it’s called for anesthesia students), and my kid’s birth was the first she got to see as a student. I didn’t mind at all–figured she had to learn sometime–and I still smile when I remember her coming by the next day to check on us and thank me again. And hey, I got to help teach a student how to be a good anesthesiologist! Pretty cool, in my book.

        • Dr Kitty
          June 4, 2017 at 4:02 pm #

          Jacob- BTW, question for you, since you’ve dodged the ones on MRCS.

          How many women have you cared for who have requested emergency repeat CS when they arrive in spontaneous labour after previous CS?

          How fast did their CS happen, or did they all change their minds and decide to VBAC after you spent some time with them?

          I had recurrent nightmares about going into labour before 39w with my second, and having midwives delay or deny my RCS, based on the attitude of several NHS midwives that my decision that under no circumstances did I want to attempt a VBAC, even if I arrived in active labour, was beneath contempt.

        • Nick Sanders
          June 4, 2017 at 4:28 pm #

          Who the fuck cares?

          • Jacob Bunton
            June 4, 2017 at 4:47 pm #

            Your perceptions may be skewed. Neither are safe. Balance is key.

          • Nick Sanders
            June 4, 2017 at 4:52 pm #

            No, accurate assessment is key. Objective analysis does not mean treating all things as equal, it means looking at the facts. And the facts show that even if standard hospital birth isn’t “safe”, it’s definitely safer than water birth or home birth.

          • yugaya
            June 4, 2017 at 5:48 pm #

            ” How many obstetricians have seen a waterbirth?” Seeing is believing? Gross.

            You were saying something about … skewed perceptions?

          • momofone
            June 4, 2017 at 7:08 pm #

            “Balance is key.”

            That’s ironic. You are a one-man waterbirth public service ad.

        • Dr Kitty
          June 4, 2017 at 6:15 pm #

          Want to talk about what I actually raised?

          That women don’t want what you think they want?

          They want fast, safe, deliveries that are as painless as possible.
          You aren’t giving them that.

          You aren’t even giving them what you promise- a magical earth-shattering transcendent experience.

          Sometimes midwives are giving women longer, more painful labours, more difficult deliveries, damaged and dead babies and a lifetime of health problems by refusing to intervene.

          You still haven’t said one word about that.

          • MaineJen
            June 5, 2017 at 11:01 am #

            Jacob Bunton is very concerned that your training may have been inadequate, Dr. Kitty.

            Great god, the balls on this guy.

          • Amazed
            June 5, 2017 at 12:08 pm #

            Well, he’d like to know that after he’s done providing them with the care Dr Kitty described, they’d get a good doctor, I suppose.

          • Roadstergal
            June 5, 2017 at 3:39 pm #

            It reminds me of something I read on Facebook. “If I only had the confidence of a middle-class white man!”

        • Roadstergal
          June 6, 2017 at 4:33 am #

          So, it’s been two days and you’re still posting above – but you haven’t had the time to ‘fully reply’ to Dr Kitty yet? Or answer any of her questions directly below?

        • moto_librarian
          June 7, 2017 at 12:39 pm #

          Yet you have plenty of time to post your rambling bullshit theories about birth. How interesting that you are incapable of engaging with those of us with the personal experience that invalidates your garbage.

          • kilda
            June 7, 2017 at 1:06 pm #

            yep. It’s the ever popular “I’m too busy/I have a life” gambit. “I’m too busy and important to respond to your arguments, but I totally have a really good answer to them. I’m just too busy to tell you it.”

          • Jacob Bunton
            June 8, 2017 at 5:28 am #

            I’m engaging with you librarian. I’ve asked you questions as I have others. I am one you guys are many. I am on the ground floor you guys appear not. Maybe research your own answers, open a book, read a scientific paper, open your mind, be awake.

          • Amazed
            June 8, 2017 at 9:16 am #

            You are not engaging with Dr Kitty, though. Why not?

            Scientific paper? From the man who can only repeat midiwife nonsense until he reaches ecstasy? You’re so funny.

          • moto_librarian
            June 8, 2017 at 11:38 am #

            You might want to look into time zones, Jacob. And this is indeed the first time that you have chosen to directly engage with me. I can assure you that I am quite capable of doing research as it happens to be my profession.

    • momofone
      June 4, 2017 at 2:25 pm #

      I’m curious–is there anything the midwife DOESN’T know?

      • Linden
        June 7, 2017 at 7:06 am #

        She must be actively trained in the art of not shouting “push!” It sucks all the oxygen out of the room, and reduces cerebral oxygenation in the baby. Very important training, that.

        • Charybdis
          June 7, 2017 at 10:52 am #

          Oh, and don’t forget to turn down the lights and reduce neocortical stimulation in the mother. Don’t talk to her and don’t, under any circumstances, touch or examine her because this is apparently VERY BAD.

          • kilda
            June 7, 2017 at 11:14 am #

            right. We can’t have ladies using their *brains* or their reproductive systems will stop working right because their poor little system just can’t handle it. How very Victorian.

          • Linden
            June 8, 2017 at 7:18 am #

            It’s like this sexist shite never goes out of style.

    • yugaya
      June 4, 2017 at 2:44 pm #

      “A woman in spontaneous labour is quite predictable.”

      I am so fucking glad that you weren’t my midwife for my “quite predictable” spontaneous second labour that went from 2cm to 4kg baby out in three contractions and in under five minutes. You would have probably still been too busy turning on the lights to see what is going on and/or sitting on your hands instead of actively managing a trainwreck into which my lovely spontaneous labour turned into in a matter of seconds. .

    • Platos_Redhaired_Stepchild
      June 4, 2017 at 6:49 pm #

      This is complete horse puckey.

    • Azuran
      June 4, 2017 at 9:01 pm #

      Piece of advice: If you have to AVOID stimulating a baby to breath, then you are doing something wrong.

      • Jacob Bunton
        June 6, 2017 at 3:18 am #

        While the baby is underwater you would stimulate it to breathe?

        • Azuran
          June 6, 2017 at 6:40 am #

          The point is that this baby should be born on land and should be stimulated to breathe.
          The fact that you are voluntarily birthing a baby in a situation where BREATHING is dangerous should tip you off that you shouldn’t be doing so.

        • MaineJen
          June 6, 2017 at 9:17 am #

          The baby should not be underwater. I would think that would be obvious.

    • June 5, 2017 at 1:43 am #

      Wow. So much bullshit to wade through, so little time. Suffice to say, being relaxed doesn’t automatically mean labor is going to go well, different positions work better for different women (since pelvises come in different shapes), pushing on not 10 cm can lead to seriously bad complications, midwives are notoriously bad at diagnosing 3rd and 4th degree tears and thus not getting women the care and repair they need which can lead to permanent damage requiring surgical repair, “faith” that a woman can give birth without assistance means dead women and babies since that’s not actually universally true, placentas don’t always ‘fall out’ and unmedicated manual placenta evacuation is apparently excruciatingly painful, there’s no good reason to not cut the cord (though there isn’t really a good reason to do so either- it’s a medically neutral choice), and skin-to-skin doesn’t prevent PPH.

      Also, being a tub of water means you won’t be able to actually measure how much blood is lost, so how will a midwife know if there’s been a hemorrhage? Oh right, she won’t, until and unless it’s so bad it’s impossible to ignore, so probably life-threatening. Not a win, not a win at all.

      • Daleth
        June 5, 2017 at 9:29 am #

        Also, being a tub of water means you won’t be able to actually measure how much blood is lost, so how will a midwife know if there’s been a hemorrhage? Oh right, she won’t, until and unless it’s so bad it’s impossible to ignore, so probably life-threatening.

        Yes, that’s what killed home birth activist Caroline Lovell.

        • mabelcruet
          June 5, 2017 at 3:53 pm #

          It’s also what killed Claire Teague, who bled to death when the independent midwife failed to recognise retained placenta after a homebirth. The midwife responsible, Rosie Kacary, said in her defence that at least Claire had had a lovely homebirth and the husband should try and remember that.

          • Linden
            June 7, 2017 at 7:03 am #

            The absolute heartlessness and irresponsibility of these people…

      • Jacob Bunton
        June 6, 2017 at 4:53 pm #

        “pushing on not 10 cm can lead to seriously bad complications”
        Evidence please?????

        This is what happens when lots of women have been cared for with an epidural then that same care is applied to women in spontaneous labour non-medicated, and are climbing the walls, panting and puffing, sweating and doing everything in their power not to push, even though every part of their being is telling them to, because a high and mighty birth attendant, call what you will, is standing over them saying, ‘No no no, you are only 7cm’.

        Lets be clear with an EPIDURAL YES wait. Anterior lip or 9cm? YES WAIT. Gone. Now what? WAIT for descent at least one hour+ Got the all clear. OK go.

        Dr Reed “I am yet to find any evidence that pushing on an unopened cervix will cause damage. I have been told many times that it will, but have never actually seen it happen. Borrelli et al. (2013) found no cervical lacerations, 3rd degree tears, postpartum haemorrhages in the women with an early pushing urge. A recent review of the available research (Tsao 2015) concluded: “Pushing with the early urge before full dilation did not seem to increase the risk of cervical edema or any other adverse maternal or neonatal outcomes.”

        • Amy Tuteur, MD
          June 6, 2017 at 8:39 pm #

          You need to cite the actual references along with the quotes.

          • Jacob Bunton
            June 7, 2017 at 3:24 am #

            How about you give the evidence Dr. Amy?

          • moto_librarian
            June 7, 2017 at 2:26 pm #

            So that 2013 study was limited to 60 participants. That’s hardly a robust sample size.

          • Jacob Bunton
            June 8, 2017 at 5:20 am #

            I know poor sample size. But you can do better can’t you?

          • moto_librarian
            June 7, 2017 at 2:27 pm #

            And seriously? The Tsao was an undergraduate research publication.

          • Jacob Bunton
            June 8, 2017 at 5:20 am #

            Yeah god forbid an undergrad! I know you can do better librarian. Come on share the evidence. Pushing on an undilated cervix when not quite fully, in spontaneous labour, the trauma it must cause, must be loads of evidence its quoted every day on labour ward.

          • momofone
            June 8, 2017 at 8:02 am #

            Do you even listen to yourself? She is telling you IT HAPPENED TO HER.

          • moto_librarian
            June 8, 2017 at 2:14 pm #

            At what point is research considered settled, Jacob? If there is overwhelming evidence that pushing on an undilated cervix can cause lacerations, why would they keep studying that? At some point, it enters the textbooks as a verified fact.

          • moto_librarian
            June 7, 2017 at 2:39 pm #

            But hey, these are great articles for me to pass on to colleagues who teach medical information literacy. It’s always good to have examples of poor research.

          • Heidi
            June 7, 2017 at 2:47 pm #

            I have heard about a similar protruding lip from a homebirth midwife friend. She described a finger like protrusion with a swollen satsuma sized bobble on the end. She massaged essential oils into and it eventually moved up out of the way.

            Ugh, I read this in that “article” and it made me feel dizzy and sick. I’ve had my cervix chemically cauterized, had my water broken and had it hit during intercourse, and just hell no.

          • Jacob Bunton
            June 8, 2017 at 5:17 am #

            Did you really read the article or just the comments?

          • Heidi
            June 8, 2017 at 9:51 am #

            The *author* of the damn article wrote that comment.

          • Jacob Bunton
            June 8, 2017 at 5:16 am #

            Great. Ok librarian, what is the evidence for pushing on on an unopened cervix, causing damage, for a woman without an epidural?

          • Charybdis
            June 8, 2017 at 9:44 am #

            How about her own personal experience? Or does that not count in your book? You seem to be all about anecdotal experiences when they support you and your way of thinking.
            She was pushing on an incomplete cervix and suffered a cervical tear. Or are calling her a liar?

          • moto_librarian
            June 8, 2017 at 1:50 pm #

            If there’s no evidence of harm, why is pushing on a undilated cervix listed as a risk factor for cervical lacerations in obstetric textbooks?

          • Jacob Bunton
            June 8, 2017 at 2:40 pm #

            You tell me?

        • Amy Tuteur, MD
          June 6, 2017 at 8:41 pm #

          Oh, right, you didn’t read the actual references; your quoted another UK midwife without attribution.

          • Jacob Bunton
            June 7, 2017 at 3:42 am #

            Of course I read the references.
            Spoon feeding….here we go again.

          • Heidi
            June 7, 2017 at 2:42 pm #

            Interesting that in all those comments, these hack midwives aren’t being all “hands off.” Yeah, they aren’t doing a true vaginal examination, which might actually provide useful information, but are MASSAGING women’s cervices with essential oil. How does this not encourage introducing bacteria and pathogens all up in there? How safe could rubbing concentrated plant oils where mucous membranes are be? FFS, douching with watered down vinegar is now known to be more harmful than beneficial.

          • maidmarian555
            June 7, 2017 at 3:05 pm #

            I have really sensitive skin and, frankly, wouldn’t apply even massively diluted essential oils to it as I could guarantee a fairly painful reaction within a very short space of time. The idea of having somebody ramming a load of them up my vagina into my cervix is…….excruciating. Can you imagine how much more painful it would be if that crap got into a tear? (Although, of course, what with all the fairy dust and dim lights one presumes they’d claim that tears wouldn’t happen in this scenario). Ouch!!!

          • Heidi
            June 7, 2017 at 3:13 pm #

            I once put 3 or 4 drops of tea tree oil in a full tub of water, hopped in, and it felt like someone had set me on fire. I don’t even think I had a chance to sit down to see what it felt like in more sensitive parts. It was excruciating and my legs were beet red for a while. So, nope, no birthing in tea tree lakes for me. And I would never put an essential oil in my vagina. I have a very short list of items that go there!

          • maidmarian555
            June 7, 2017 at 3:23 pm #

            I mean, that’s “Having a Vagina 101”. Don’t put weird substances up there! (Although having seen the articles this week warning women not to put wasps nests in, clearly there is a market for this insanity).

          • Jacob Bunton
            June 8, 2017 at 5:12 am #

            Did you actually read the article or just to comments?

        • AnnaPDE
          June 8, 2017 at 8:53 am #

          You know what happens in that case? For example ruptured cervix. My sister in law can tell you just how much fun that was. Oh and the kid was pretty flat too for a few minutes. (Her midwife hadn’t bothered to look properly and just said “yes, it’s fine, now push” even though as it turns out SIL wasn’t completely dilated.)
          So what about just shutting up instead of writing inordinate amounts of totally knowledge-free drivel?

          • Mattie
            June 8, 2017 at 9:01 am #

            Just to try and understand better, is this ‘directed pushing’ on an insufficiently dilated cervix, or like a woman just feeling an early pushing urge (as in an OP presentation triggering an early pushing urge) and her body starting to bear down but without her actively trying to push. (Did that make sense?)

          • AnnaPDE
            June 8, 2017 at 9:33 am #

            SIL felt a bit of an urge to push, but as a doctor herself, she obviously wanted to know if she was sufficiently dilated — she thought it was pretty painful and wanted to make sure. The midwife made some noises about not being a wuss, childbirth being painful and that it’s all great to push if she feels like it. Turns out it wasn’t and she should have taken the time to check properly instead of just taking a cursory glance.
            It probably also didn’t help that my niece had a 40cm head circumference. For the next two kids, despite the same size heads, SIL demanded proper measurement & second opinion before she started pushing, and had no tearing whatsoever.

          • Mattie
            June 8, 2017 at 9:43 am #

            That’s horrifying 🙁 god the pain! Your poor SIL

          • moto_librarian
            June 8, 2017 at 2:13 pm #

            I can say that for me, it was the uncontrollable urge to push. I had a “lip” left that she thought would resolve; apparently, it did not.

          • Mattie
            June 8, 2017 at 4:10 pm #

            Not liking cause I like, that’s awful! Must have been so painful 🙁 would an epidural or a stronger epidural have helped in that instance?

          • Jacob Bunton
            June 8, 2017 at 1:24 pm #

            Exactly, when a woman is unmedicated and in spontaneous labour follow the woman’s urge to push and it should be an overwhelming urge – NOT someone else saying ‘yes, its fine, now push.’ How the hell do they know? Makes no sense at all and can lead to complications as stated above.

          • MaineJen
            June 8, 2017 at 1:33 pm #

            You’re not listening. We’re ALL telling you there is often an overwhelming urge to push before full dilation. You’re still saying the same crap.

          • AnnaPDE
            June 8, 2017 at 8:13 pm #

            That’s the point. The urge to push has very little to do with whether the cervix is actually ready for it.

            My SIL felt like pushing. A lot. She still held back because her rational, knowledgeable mind knew that she should be waiting until fully dilated.
            And the midwife took her urge to push as sufficient indication that she’s ready, instead of actually checking. Because hey, who cares for centimetres when you can go off “feels like pushing”, right?
            So she just lied and gave the go-ahead for my SIL to let her body do what it wanted to do, and hey pronto, this wonderful intuitive approach was rewarded with a massive cervical laceration with lots of lost blood plus a kid who only made it thanks to NICU.

            But yeah, let’s see some more totally medically incompetent claims about what to “feel” during childbirth from someone who has no idea what having a uterus feels like.

        • Roadstergal
          June 8, 2017 at 10:03 am #

          Oh my! Borelli et al 2013 cites Saint Gaskin as saying pushing on an unripe cervix can lead to cervical trauma!

          What a useless paper. They relied on the judgment of the midwife as to when the woman had an ‘early pushing urge,’ no independent assessment. You can see the noise in the data by noting that EPU incidence varied from 2.3% to 20%, depending on the midwife.

          I’m no OB, but from the paper, it looks like they only noted dilation as measured by one single midwife. Dilation was 8-9 in about half of the ‘EPU’ diagnoses – and no note of how close to the ‘EPU’ time the most recent measurement was made (they hinted that it was between 30 and 90 minutes). In only 8 of the 60 cases did the midwife coach the woman to go ahead and push, rather than try to help them stop. This is a teeny tiny number to see any effect at all, and they did not break out those particular 8 cases in terms of outcomes (and there were some negative outcomes – assisted deliveries and tearing). We don’t even know, from the paper, if the 8 cases of ‘go ahead and push’ had the most dilation at the last measurement (were they among the 13 8cms, or maybe the 13 9cms? Did they include the women were intervention was given to ripen/induce after the measurement?) and were getting close to ‘favorable’ at the time of pushing. All we know is that the operative deliveries were concentrated in the women with the least dilation.

          The paper tells us nothing at all about pushing on an unripe cervix. Why did you think it did?

          I can’t find Tsao 2015 – you need to learn how to cite.

          • swbarnes2
            June 8, 2017 at 1:09 pm #

            Tsao 2015 isn’t in Pubmed, if that’s where you are looking. You have to just google. It’s like a thesis for a midwife student, I guess. It says right there “Peer Review Status : Unreviewed”

          • Roadstergal
            June 8, 2017 at 1:57 pm #

            Thanks! Silly me for thinking he would cite an actual paper.

    • MaineJen
      June 5, 2017 at 9:29 am #

      “The midwife knows that if the woman feels relaxed her labour will progress.”

      Then the midwife knows nothing.

      Not reading any further; you lost me right there.

    • Linden
      June 7, 2017 at 7:00 am #

      You know what, very little about birth is predictable. very little about pregnancy is predictable. And it is hilarious to read a man with these nonsense claims and generalizations about something that he will never experience.
      What helped me relax was the epidural that gave me pain relief. What made it possible to push was the little nap I got between 6cm and 10cm, completely pain-free. What helped my son’s cerebral oxygenation was not what midwives did or did not shout: it was the fact that his heartbeat was constantly monitored if he ran into trouble. It was the fact that there were medical interventions that meant I wasn’t laboring uselessly for hours on end.
      F*ck the birthing pool. F*ck elaborate breathing patterns. F*ck not disturbing the mother and baby (I almost died by choking on some toast, of all things. The nurses were magnificient in their rapid response. F*ck people who think PPH can be prevented by skin contact.
      F*ck this stupid magical thinking that kills women and babies.

    • moto_librarian
      June 7, 2017 at 12:37 pm #

      Would you like to know what can happen when you have the uncontrollable urge to push when you haven’t fully dilated? A cervical laceration. I began feeling the urge quite strongly at 9 cm., and that’s likely why I had that particular complication. But please, go on with your mansplaining.

      • Jacob Bunton
        June 8, 2017 at 5:29 am #

        Is this a scientific study? What was the sample size?

        • Linden
          June 8, 2017 at 7:15 am #

          Can you read? It happened to *her*

        • Roadstergal
          June 8, 2017 at 8:15 am #

          Hi, Jacob Bunton!
          I have a few follow-up questions.

          Are you still under the impression that amniotic fluid is actually water?

          Are you still confused about the mechanisms by which newborns can (and do) drown in water, as you questioned below?

          Are you still confused about the mechanisms by which newborns can (and do) aspirate birth tub water contaminated by pathogenic bacteria?

          Are you still confused about how a fetus in the womb gets its oxygen, and why that is no longer a viable source upon delivery?

          I just think this is useful information for anyone considering care with Jacob Bunton to have.

        • MaineJen
          June 8, 2017 at 9:13 am #

          It’s a thing that happened to a real, actual woman.

          • Jacob Bunton
            June 8, 2017 at 1:20 pm #

            I know, what I am trying to highlight to moto_librarian is that women’s individual birth stories are important, they do matter.

            In reference to my above comment and what caused a barrage of abuse from the above commentator, I was simply reiterating back to moto_librarian what she said to me.

            “So that 2013 study was limited to 60 participants. That’s hardly a robust sample size.” moto_librarian

            In regard to laceration, though moto_librarian may not wish to answer this on a forum…

            ‘When you were actively pushing was someone coaching your pushes. I.e telling you to push and how long?’

            ‘Did you have an epidural?’

            By no means am I undermining your experience.

          • momofone
            June 8, 2017 at 1:30 pm #

            “what I am trying to highlight to moto_librarian…”

            I’m fairly sure she doesn’t need you to highlight anything to her. You might try listening to what SHE is saying, though, just to try something new.

          • moto_librarian
            June 8, 2017 at 1:33 pm #

            Had you bothered to read anything else that I posted, you would know that the birth was completely unmedicated – SROM at 38+3, arrived at hospital dilated to 9 cm., pushed in every position imaginable, no heplock/I.V., even drank Sprite between contractions. Once I became utterly exhausted, the nurse did help me count to focus my pushing. My placenta delivered spontaneously 5 minutes after I delivered without the aid of active management. And then I began bleeding out.

            And before you decide to engage with me further, I have a suggestion for you. That delivery required a manual examination of my uterus in which the midwife was in up to her elbows, done without pain medication because there wasn’t time to run an I.V. Try sticking three of your fingers up your urethra and let me know how that feels. I’m fed up with this bullshit that labor and delivery pain is somehow different or special from other types of pain. It’s not.

          • MaineJen
            June 8, 2017 at 1:36 pm #

            Now, moto. Jacob is simply trying to educate you about your own experience! Aren’t you silly to think that you’d know more about it than him. /sarc

          • moto_librarian
            June 8, 2017 at 1:52 pm #

            Obstetric textbooks list pushing on an undilated cervix as a risk factor for cervical laceration, along with precipitous labor and cerclage. My delivery wasn’t truly precipitous, but I can say that I had less than six hours of active labor with contractions (My water had been broken for at least six hours before labor actually began).

    • moto_librarian
      June 7, 2017 at 2:19 pm #

      “The midwife knows it is not wise to mix active management with physiological third stage, as this increases the risk of PPH.”

      What the fuck does this even mean? Active management is designed to PREVENT PPH, you colossal idiot! We have reams of documentation proving that active management prevents women from, you know, dying, so how can anyone with half a brain make a statement like this?

  7. Jacob Bunton
    June 4, 2017 at 5:41 am #

    A ‘safe birth’ is predictable.
    An actively managed birth is quite predictable.
    The obstetrician knows the risks of his/her procedures, and has faith that he/she can handle them with another procedure, if necessary.
    For instance if the epidural he/she has given slows a mother’s labour, he can speed it up with pitocin. If that same epidural prevents her from pushing he can use forceps or vacuum. If this causes a third or fourth degree tear he can repair it. If the above results in a PPH he can manage that and if she still bleeds after everything else is done, he can perform an hysterectomy.

    • yugaya
      June 4, 2017 at 5:43 am #

      Really? Is this passive-aggressive attempt at “interventions cause complications” all that you have? We’ve seen better and funnier trolls.

      • Jacob Bunton
        June 4, 2017 at 12:50 pm #

        These were the words of an obstetrician not a troll

        • yugaya
          June 4, 2017 at 12:53 pm #

          Words of other people are usually quoted by decent folks. You in no way indicated in that comment that you were quoting someone.

    • Azuran
      June 4, 2017 at 6:11 am #

      Epidurals are 100% requests of mothers. It’s analgesia. Way to blame women.

      Pain is bad, everyone know it’s bad. It slows healing and makes recovery longer.
      In any other medical context, anyone who recommended that patients don’t use pain control would be considered horrible care provider and probably be fired.

      And no, only an idiot with horrible medical training would think that safe birth is predictable. You can never predict outcome of birth. Complications can always happen to anyone for no reason. You are a danger for your patients if you think you can predict their birth.

      • Jacob Bunton
        June 4, 2017 at 12:49 pm #

        These were the words of an obstetrician. I agree every birth is unique. That is true. But I also agree with this obstetrician births generally follow a pattern. No one is denying any women pain relief. What is being denied in some hospitals is the TYPE of PAIN RELIEF. There is pharmacological and non-pharmacological pain relief and BOTH should be offered. For example, Not epidural or nothing. That is cruel and inhumane.

        • yugaya
          June 4, 2017 at 1:00 pm #

          I don’t want non-pharmacological pain relief because it is nowhere nearly as effective and I find withholding adquate pain relief from women in childbirth to be a form of patriarchal abuse . You are free to start offering non-pharmacological pain relief as equal option to men with kidney stones instead. I mean, I’m sure there is a reason why passing a kidney stone hurts right? And besides, our bodies surely cannot grow a kidney stone too large. While you are at it, throw in some fear-pain cycle mansplainin’ too.

        • Amy Tuteur, MD
          June 4, 2017 at 1:13 pm #

          What an amazing coincidence that what you believe women want is what you want for women! Isn’t this more about what’s good for you than it is about what’s good for babies or mothers?

        • The Computer Ate My Nym
          June 4, 2017 at 2:28 pm #

          A number of pain relief options are offered in hospitals, including non-pharmacologic methods and non-epidural pharmacologic methods. This claim that it’s “epidural or nothing” is meant to scare women into accepting a painful, dangerous birth with an undertrained attendant. It’s a complete falsehood. An epidural is impossible in the home birth setting, but listening to music, soaking in the tub in the first stage of labor, walking between contractions, etc are available and encouraged in hospitals. Well trained midwives also work in hospitals, with OB backup immediately available if needed.

        • MaineJen
          June 5, 2017 at 10:01 am #

          Hi again Jacob. Actual woman, not an obstetrician. I actually wanted effective pain relief during labor, so I got an epidural and it relieved my pain, and I went on to have a lovely birth. At no point did I feel the need to climb into a tub. (Well, I was in a tub for the first part of labor, but it got annoying so I climbed out again. The end.)

          Real actual women do not care what Jacob Bunton wants.

        • Azuran
          June 5, 2017 at 10:46 am #

          No one is saying epidural or nothing. I was offered a huge range of useless natural ‘pain relief’
          However, I consider telling women to breath through it to be cruel and inhumane. In NO other medical setting would this be recommended.
          If my dentist had even asked me if I wanted to breath through my wisdom tooth extraction instead of having local analgesia, I could have sued him and make him lose his licence. And if I had refused local analgesia, he would have 100% refused to operate on me.
          Jesus I’m a vet, and not giving real proper analgesia to pets is malpractice.

          Women in childbirth are not forced to have any kind of pain relief they don’t want. They can breath, and hypowhatever themselves all they want, sit on a ball, yell, chant, crush their husband’s hand, have them give massages or whatever.
          But at some point you have to be realistic, very little non-pharmaceutical ‘analgesia’ techniques are actually significantly effective.
          And waterbirth IS potentially dangerous, so no, doctors and hospital are absolutely not required to offer it (although, a HUGE number actually do)

          • momofone
            June 6, 2017 at 9:27 am #

            “And if I had refused local analgesia, he would have 100% refused to operate on me.”

            I thought this might happen to me recently. I have a life-threatening allergy to local anesthetics. A couple of months ago I had to go the ED for the proverbial “worst headache of my life,” and after a CT scan showed no bleeding, the doctor said they needed to do a lumbar puncture to rule out subarachnoid hemorrhage. I said that was fine, but that I could not be numbed, and he was horrified. It took him a little while to find a nurse anesthetist who agreed to do it, and he did it reluctantly. I think it was harder on him than on me–he said he had never done it to someone who was numb and hoped he never had to again. Maybe I should have requested a tub?

          • Azuran
            June 6, 2017 at 10:20 am #

            Well of course there should be exceptions for actual medical reason that makes certain types of analgesia dangerous. (and possibly more research for a wider range of actually useful analgesia protocols.)

          • momofone
            June 6, 2017 at 11:34 am #

            Oh, definitely. I just was pointing out that even though I was consenting the doctor and CRNA were hesitant to act without analgesia.

    • Who?
      June 4, 2017 at 6:49 am #

      Do obstetricians know the risks of not performing procedures?

      Do you agree that those risks should be spelt out?

      • Jacob Bunton
        June 4, 2017 at 12:44 pm #

        When there is a shoulder dystocia mws and/or drs perform the procedure.
        In regard to a previous commentators post it is important to know what the risk factors are for shoulder dystocia, pph etc but professionals are prepared and skilled to manage any eventuality.
        When the woman is bleeding more than normal mw and/or dr intervene.
        If there is a severe tear requiring suturing it is sutured.

        • momofone
          June 4, 2017 at 1:03 pm #

          Can a midwife perform a c-section in an emergency (or because that’s what I choose)? Because if not, they’re not much use to me.

        • Amy Tuteur, MD
          June 4, 2017 at 1:14 pm #

          Apparently midwives don’t intervene when there are complications. That’s what the Morecambe Bay report found. The author was careful to note that the preventable deaths he investigated were NOT anomalies but the result of midwifery philosophy.

    • momofone
      June 4, 2017 at 12:10 pm #

      I notice that you come in and state several claims as fact, then completely ignore commenters’ responses to you. You seem to want to state your case, but not actually defend it.

      And just to address one claim you’ve made, regarding what “(t)he obstetrician knows,” the only accurate way to complete that sentence from my perspective is “a hell of a lot more than I do.” You and your claims are exactly why I would never allow a midwife near me; give me an OB any day–exactly because they can perform procedures. I’d much rather have someone with expertise doing so than some idealogue who sees my hemorrhage as a time to let me “go inside myself” or some other such bullshit. If I have a tear, you’re damn straight I want someone who can–and will–repair it. I don’t give a damn how you think other people’s experience of giving birth should go; if you want to suffer needlessly in search of some primal part of yourself, then figure out how to get pregnant and have at it. I’ll stick with a professional every time, thanks.

      • Jacob Bunton
        June 4, 2017 at 12:36 pm #

        Your response is emotive, means we are probably getting somewhere. You have reason to be angry. Read further and you will notice I do respond to most messages. Sometimes I post not directly to one person, as more than one person is saying the same thing. Midwives and Doctors can both prevent a haemorrhage, suture etc by the way I said nothing about ”going inside myself’, your words not mine. I argue for choice, fully informed CHOICE that means women who want a waterbirth but within a hospital (as opposed to freebirth at home) CAN. That means women who choose epidural can. It means women, all women, can equally choose how they wish to birth safely without being threatened, belittled, humiliated or that choice being taken away from them. Let me remind you BOTH midwives and doctors are professionals.

        • momofone
          June 4, 2017 at 12:39 pm #

          I’m not sure where you see us “getting,” but you are correct that my response is partly based on emotion. It angers me to read your comments about allowing/encouraging people to suffer because of your own ideology.

          I actually do not see your responding to most messages, but more of a drop-and-run kind of thing.

          I’m interested in hearing your thoughts about maternal request c-section. I’m assuming since you are such a champion of the woman’s choosing for herself, you must be quite a proponent of MRCS.

          • Jacob Bunton
            June 4, 2017 at 5:02 pm #

            I drop and run as you put it because I am busy. I have other demands on my time! i.e caring for and as you guys would put it ‘delivering’ babies. My time is limited. I am not retired like Dr Teuter. I engage when I can because I am interested in your thoughts.

          • momofone
            June 4, 2017 at 6:21 pm #

            Because you are interested in our thoughts, or because you want to proselytize? I don’t hear a lot of interest in listening, but I hear a lot of “let me explain this to you.” (I hate the word mansplaining, but that’s what I’m talking about.)

          • Nick Sanders
            June 4, 2017 at 6:44 pm #

            Maybe if you’re so busy, you shouldn’t be starting things you don’t have time to see through properly?

        • yugaya
          June 4, 2017 at 12:46 pm #

          ” I argue for choice, fully informed CHOICE that means women who want a
          waterbirth but within a hospital (as opposed to freebirth at home) CAN.” Bullshit. What you argue for and are actively enabling is going against medical advice as in a woman with history of PPH is never a good candidate for a waterbirth and waiting it out third stage in a low resource MLU setting. Your replies here are disturbing in a way that you are doing your best to imply that magic of dimmed lights and you acting out of your scope saved that woman from a complicated birth and bleeding out to death on the ward. It didn’t. Hundreds of thousands of women in developing world die each year far, far away from blue lights and all medical interventions during completely natural, physiological childbirth. If only they had someone like you holding the space, everything would turn out just fine!

          Blergh. Puke. You are the reason why reading MBRRACE reports makes me want to punch people.

          • Amazed
            June 4, 2017 at 1:36 pm #

            What he’s arguing for is the equivalent of the last part of treatment I got for a broken foot when I was eighteen. When I went to have the cast taken off, the doctor said I should come the next day for physiotherapy. I said, “Oh no! This is my first year at the university, I already missed two days, I intended to make the journey tonight. MUST I have this therapy?” “Well, not really, if you don’t have pain,” he said. I did not have pain… then, Two months later, a doctor at the university threw a fit over someone being this irresponsible not to tell me that EVERYONE should get the freaking therapy and it wasn’t done to relieve any pain you might have at the moment but for the future. I started treatment immediately but it was too late. I had YEARS of pain.

            That’s what you get when you treat patients like clients who should be made to smile and cross the line between “safely” and “pretended safely” , like Jacob does.

            Oh, and did I miss the part where it turned out that the first doctor was not an orthopedist but a freaking SURGEON? I’ll never know what the hell he was doing substituting for an ortho. But it’s amazing how much this “professional” situation resembles the one Jacob advocates for, isn’t it?

        • Azuran
          June 4, 2017 at 1:09 pm #

          Here’s the thing about medical choice: Not every ‘choice’ is valid and should be presented. Doctors have the obligation of presenting medically valid choice, not fancy ‘I’m a warrior’ choice.
          They have responsibility and accountability. The choices they provide are therefore medically sound choices.
          Water birth is not a proven safe and effective treatment, therefore no matter how much you like it, doctors are under no obligation to offer it as a valid choice. Just as they are not required to present other pseudoscience like homeopathy.
          If a woman doesn’t like what her doctor is offering, than yes, her choice are to either find another who does or birth alone at home. A doctor does not have to practice in unsafe ways because that’s what their patients wants.

          • Jacob Bunton
            June 4, 2017 at 3:45 pm #

            FACT: It goddamn is about CHOICE. It is the woman’s CHOICE. She is not an idiot! Or an incubator. Though some doctors and midwives might have the high and mighty attitude of ‘I know what is best for you dear’, she can make her own decisions. That is WHY it is important to
            1. Offer a real choice in the first place by
            2. Presenting the risks and benefits of both approaches
            3. From latest evidence

            FACT: Waterbirth is a safe option for most women and Cochrane Review proves it.

            FACT: Maternity services are under obligation to offer it.

            Did I really hear you say if she doesn’t like it…well she can birth alone at home? You seriously are telling me that if a woman asked you if she could waterbirth in hospital you would say no and tell her to freebirth!

            My God! Reading this, it is really beginning to make sense to me why America obstetric care is in such a mess right now. Yes you are right:

            FACT: Birth is dangerous for the majority of women right now…IN AMERICA!

          • momofone
            June 4, 2017 at 4:01 pm #

            I read this comment with interest, as what I’ve picked up from your comments has been heavy on the “I know what’s best for you women, if you’d just listen.”

          • Jacob Bunton
            June 4, 2017 at 4:08 pm #

            Sorry you thought that momofone. I guess it can sound like that at times and I apologise. It can be difficult presenting concepts that may not be readily ‘mainstream’… can I say that?…or accepted. Though waterbirth to be honest is pretty mainstream now in most parts of the Western world, i.e Australia, U.K, parts of Europe.

          • momofone
            June 4, 2017 at 6:11 pm #

            What is the deal with your fixation on waterbirth?

          • Roadstergal
            June 6, 2017 at 5:06 am #

            The most recent report I saw from the UK had 0.6% of deliveries as waterbirths. That’s ‘mainstream’?

          • Lilly de Lure
            June 6, 2017 at 5:09 am #

            Well, to be fair its mainstream over here to offer them and to extoll their virtues in antenatal classes – appaarently though us unenlightened UK ladies are yet to be convinced in large numbers.

          • Roadstergal
            June 6, 2017 at 5:11 am #

            Ooh, mainstream marketing, niche clients?

            I hope that’s a good sign, in terms of women over there getting decent information from _somewhere_.

          • Lilly de Lure
            June 6, 2017 at 5:23 am #

            To be fair I think its a bedrock of common sense more than anything else (if you had mass marketing of water birth in the states or anywhere else you’d probably have the same thing) – same as homebirth. It takes a certain amount of time and google fu training to be able to blind yourself to the obvious risks of both homebirth and waterbirth which are pretty obvious to the uninitiated (how hard is it to work out that babies can drown once out of the womb or that time is of the essense in an emergency). Most women, particularly if they go into their pregnancies unversed in the birth wars or birth woo generally, simply don’t have the time or inclination to self brainwash, an awful lot simply want to give birth safely to a healthy child.

          • maidmarian555
            June 6, 2017 at 5:39 am #

            I think this is also why, despite the fact community midwives are really increasing the pressure on pregnant women to go for either homebirth or an FMU that (as far as I know the last time I looked), most women are still choosing traditional labour wards for delivery. Certainly for me I didn’t even bother looking into it last time as I had no real interest in anything other than being as close as possible to actual doctors and operating theatres and a NICU ‘just in case’. It all became a fairly moot point anyway once they’d let me go 12 days over and I had to be induced but it certainly wasn’t something I was concerned about missing out on at all.

          • Dr Kitty
            June 6, 2017 at 7:32 am #

            All my low risk pregnant patients have the option of the following
            birth places:

            A FMU 20 miles from the nearest CLU
            A FMU 9 miles from the nearest CLU
            A FMU 2 miles from the nearest CLU
            An AMU one floor down from the nearest CLU, both of which are in a new building- all single ensuite rooms, with a level 2 NICU about 20min drive from my practice.
            An AMU and CLU in a very old building with a few single rooms, but mostly 8bedded bays for Postnatal women…but on the same site as the regional children’s hospital and tertiary NICU, again about a 20minute drive from my practice.

            We have over 100 births a year in our practice.
            In the last 3 years we have had 1 planned home birth, no-one opted for the FMU and it is a 50/50 split with women opting for new or old hospitals, with most starting in AMU in each unless induced or risk factors develop during pregnancy or labour.

            Women generally opt for the same place for second and subsequent deliveries as they did for the first.

            It’s not a lack of choice, it’s that women genuinely don’t want to risk giving birth at home or in the FMU, even when given lots of glossy brochures and having midwives expound the benefits to them.

            There are patients of mine who literally choose the 1950s hospital over the new one, just because they feel safer being beside the children’s hospital. Not because they are high risk, or have had bad experiences in the past, but because they value access to expert care over their own comfort.

            It’s not what all the NCB stuff says that they “should” want, and yet, it seems to be what they *do* want. I’m listening to my patients and what they are actually saying is that they value outcome over process.

          • Dr Kitty
            June 6, 2017 at 5:56 am #

            Extolling the virtues is correct.
            I have yet to see anything about the risks of waterbirths in NHS literature.

            Six case reports of fatality in ultra-rapid metabolisers were enough to have the MHRA ban codeine in all breastfeeding women in the U.K.

            We’ve had many, many more case reports of babies dying from having been delivered in water, and it is still not banned, because their is a vocal cohort of people like Jacob advocating for it.

          • Nick Sanders
            June 4, 2017 at 6:51 pm #

            FACT: Maternity services are under obligation to offer it.

            Nope, and yelling doesn’t change that.

          • Azuran
            June 4, 2017 at 9:17 pm #

            There is a limit to medical choice. I’m a medical provider, and there are rules to the things I can do and recommend. Same goes for human doctors.
            You CANNOT force a doctor to give you a treatment that has no medical benefits or might be harmful, no matter how much you want it.

            And yes, if she doesn’t want medical help, then she can go back home and do what she wants. She has the right to refuse care, not to demand any kind of dangerous care. And water birth being ‘safe’ (as long as baby isn’t born IN the water) does not mean that it’s appropriate in an hospital. What’s next? Birth in a completely dark room? Forcing everyone to be silent and talk in signs language? Bring your dog? Allow the ENTIRE extended family (like over 30 people) to stay in the room?All of those could probably be done just as safely as waterbirth, doesn’t mean hospital should allow such stupidity.

            And yes, If someone came with her dog in labour at my clinic and told me she wanted me to put her dog in a bath to birth her puppies I would absolutely tell her that if she wanted to do that, she’d be doing it at home and not in my hospital. And I’ve actually did turn down the ridiculous demands of a woman once. And in the end she refused to bring her dog in because I wouldn’t give her labouring dog the ridiculous treatment she demanded. And no, I don’t feel bad about it. She had the choice.

            BTW, I’m not american and I’m not an obstetrician. But if you wonder why birth is so dangerous in america, you might want to look in a mirror.

          • Amazed
            June 5, 2017 at 2:32 pm #

            FACT: While you and your fellow crazies go their merry way and lie and manupulate women to make them want what you want… yes, it is!

            Your surgeon equivalent left me suffering pain for years. I have little patience for self-congratulating dangers like you.

          • Heidi
            June 5, 2017 at 3:10 pm #

            We can’t hold doctors at gunpoint until they support all our decisions or else we’ll do something “even more dangerous.” You’ve not even explored the logistics of installing tubs and having the important equipment necessary to offer a less safe form of birth in our current delivery rooms. It would cost a lot of money that should be going towards more pressing matters, like providing general preventative care, prenatal care, screening and treating post-partum depression and other women’s healthcare. It’s such a complex issue that involves sexism, racism, poverty, pre-conception health issues and it’s just so very offensive you chalk it up to jacuzzis and dimmers. You are not American it seems and must have no concept of what’s really happening stateside. What are tubs going to do for women who had undiagnosed, untreated high blood pressure or type II diabetes when they became pregnant? What are tubs going to do for women who are killed by their partners post-birth? How are they going to treat PPD (I believe PND in your part of the world)?

            More on the logistics, how are we going to fund tubs (and then the transfer equipment for emergencies) and dimmers (dimmers actually are probably on most L&D rooms)? How are we going to be sure they are properly cleaned? We can’t use blow up tubs because those can’t be cleaned well. I’ve worked at a hospital. Housekeeping is already behind. The last thing they need is detail cleaning and sanitizing a labor tub. How many rooms do we close at one time to install a tub? What if a hospital can’t afford to lose even one room for construction? My hospital surely couldn’t spare a room. I barely got squeezed in for a, gasp, induction.

          • maidmarian555
            June 5, 2017 at 3:33 pm #

            He is high. I don’t know anyone that would take the ‘if you don’t give me a waterbirth then I’m going to freebirth at home’ route. I’ve had friends who have had waterbirths in AMUs (and one that did it at home- with midwives in attendance) and several more who thought they ‘might’ want one but when it came down to it didn’t- either because it wasn’t possible (no room available in the AMU or there were indications that there may be problems requiring the proper labour ward) or because they decided now that they were actually experiencing labour that they’d much rather have an epidural than a tub of warm water thankyouverymuch. It says an awful lot about him that he’s seems to sincerely believe that tubs and dimmers are more important than basic pre-natal care. It also makes me really worry that this loon is apparently allowed near actual pregnant women. His views are dangerous.

          • Heidi
            June 5, 2017 at 3:55 pm #

            I gave birth at a university hospital. I took my childbirth class at the hospital. I’d say there were around 13 couples there and only one was even considering the idea of a med-free birth but was still very open to getting an epidural if she wasn’t feeling it (I have no idea what she chose but if were to place money on it, I’d bet once the pain hit, she chose an epidural). The hospital balances safety with patient demands. Practically no one was choosing a walking epidural so they quit offering them. Makes no sense to offer something 1 in a 100 women even want to try and a considerable chunk of the ones who do try it regret not choosing something else. The anesthesiologist also mentioned they had experienced falls with them so while it is a little unfortunate the occasional woman who wanted a walking epidural could no longer receive it at that hospital, I still couldn’t see the justification for keeping them. Most women are fine with using the removable shower heads in the delivery rooms for pain relief during labor. In fact, I think most women in my area aren’t really that enthusiastic about going the “natural” route.

            I have to agree Jacob’s views are scary, especially since he is allowed to work with pregnant women. I can’t believe he bragged about the gamble he took with the patient the rest of his colleagues wouldn’t take on. He thinks we’d be impressed because he lucked up with his little game of roulette. It’s becoming apparent to me it’s a fetish for Jacob that he will take huge, dangerous risks to fulfill. It’s scary there was no oversight when he took the gamble.

          • maidmarian555
            June 5, 2017 at 4:17 pm #

            I also gave birth in a University Hospital. I’m lucky in that I live between two large cities so had a lot of choice when it came to where I would give birth. There are two hospitals, about the same distance from where I live, and two FMUs also. The hospital I chose has an AMU on the floor above the labour ward- I know several women who’ve chosen it precisely because they felt it gave a nice mix of the whole ‘fairy-lights, birthing pool, whale music’ experience, with an epidural or c-section just an elevator ride away if things went wrong. The reason I picked the hospital I did from all of the available options (and within a 45min car ride there were more) is because it’s a centre of excellence for fetal medicine and they have an exceptionally well equipped NICU. The likelihood was that if I gave birth anywhere else in the region and my son had been unwell is that we would have been transferred there. Of course I hoped he would not be unwell (and he wasn’t) but I felt much safer being there ‘just in case’. Many of my friends living around here have made exactly the same choice for the same reason. I don’t believe I know that many women for whom a lovely room would be more important on balance than access to the best possible care for their babies. It is really disturbing that this doesn’t seem to occur to him, and I really don’t think that what I’ve seen on an anecdotal level is somehow a vast misrepresentation of how most women actually approach birth- even when infinite choices *are* available to them, they just want what is safest for their babies. And access to pain relief. Birthing pools are really far down on the list of priorities and most of us wouldn’t notice if they weren’t available at all.

          • EmbraceYourInnerCrone
            June 5, 2017 at 4:05 pm #

            I honestly don’t get why he thinks “everyone” would want to deliver in a tub in a dimly lit room. I would prefer my health care providers be able to see if there is a hemorrhage, if my BP is going up, etc. And maybe I am a prude but being undressed and in a tub while possibly needing assistance or exams does not a appeal to me at all. Why he thinks that anything a patient “might” want the hospital HAS to provide is beyond me. The last thing I want is everyone bumbling about in the gloom…

          • momofone
            June 6, 2017 at 9:12 am #

            You know what else I want? I want monitors. For baby, for me, maybe even for visitors. I want every kind of monitoring we can have, and I want anyone who walks in to be able to see them from a mile away. So they can, you know, monitor.

          • OkayFine
            June 5, 2017 at 6:00 pm #

            Not arguing with your points at all and I’m surely NOT defending this daft person you are arguing with. But the way I’ve seen hospitals around our area handle birthing tubs is by using inflatable tubs. Those tubs come with a liner and each patient gets a new liner. I don’t know if they clean them on top of that but I would really hope so. Each tub is on a platform that can roll it from one room to the next and is filled from the tap in the bathroom. It IS a lot of work to get it set up, fill, empty, etc. I’m not sure who handles all the cleaning aspects but I’ve seen nurses and and midwives do most of the setup and draining.

          • Heidi
            June 5, 2017 at 6:54 pm #

            Interesting. I wonder if they can maintain temperature with them? Jacob was mentioning the importance of keeping it at a very specific temp.

          • OkayFine
            June 13, 2017 at 2:43 pm #

            When filling up the tubs, they put a single use thermometer in them. I’m sure the tubs cool off after a while but they start out at a specific temp range. I don’t know how they control that if the moms are in them for long periods of time.

          • Roadstergal
            June 5, 2017 at 3:32 pm #

            FACT: There are a fair number of women 100% uninterested in stewing in a tepid soup of dilute amniotic fluid, blood, urine, and feces, let alone dunking their newborns in it.

        • Nick Sanders
          June 4, 2017 at 1:21 pm #

          Please enlighten me how a midwife would prevent a hemorrhage, let alone treat a serious one.

          • momofone
            June 4, 2017 at 2:04 pm #

            Oh, Nick, don’t you understand?! Everyone knows hemorrhages can’t happen in the dark, or with warm blankets in use. Plus, Jacob said at least 13 times (!) that “the midwife knows” exactly what to do at every stage. Isn’t that reassuring?

          • demodocus
            June 4, 2017 at 2:22 pm #

            Not only is Jacob a midwife and self-help guru, he’s a psychoanalyst! Do you feel yourself on the edge of a breakthrough? /sarcasm

          • Jacob Bunton
            June 4, 2017 at 3:34 pm #

            What the hell!

        • MaineJen
          June 5, 2017 at 9:55 am #

          Well, I read your comment above about all the condescending blather those women who requested MRCS had to go through. Or is it only women who choose unmedicated water birth who shouldn’t be belittled, etc?

  8. Jacob Bunton
    June 3, 2017 at 3:52 pm #

    An obstetric emergency is handled in exactly the same way in any birth setting. BOTH doctors and midwives are trained in how to manage these situations.

    Shoulder dystocia which occurs in 1% of all births is managed exactly the same, regardless of birth setting. If in a pool the woman is asked to get out. Yet its occurrence is rare, as the woman at home or on AMU/FMU is usually low risk and on all fours, this in itself will open the pelvis, also as she leaves the pool this action in itself can be enough.

    Intrapartum risk factors for shoulder dystocia:
    – Induction of labour with drip of synthetic oxytocin
    – Synthetic oxytocin augmentation (to speed up contractions)
    – Prolonged 1st or 2nd stage
    – Operative vaginal delivery

    Post partum haemorrhage
    Again, all the above, are risk factors, and more likely to occur on a labour ward or OU (obstetric unit).
    When dealing with a PPH the first line management is the same regardless of setting.

    Hypoxia is more likely to occur when synthetic oxytocin is used. Its substantial increase in use since the 1970s could also perhaps account for the steep increase in claims being seen.

    Hands OFF a breech is first rule of thumb in obstetric guidelines.
    If no descent Lovesett manoeuvre will be used to release the arms.
    If on all fours or semi-upright likely delivery of head will not be a problem but there is a manoeuvre that can be done called the mauriceau-smellie-viet manoeuvre. Vaginal breech births are becoming very rare, and this is a posing a real risk to an important skillset being lost forever.

    I asked a caseloading midwife ‘how many emergencies have you had?’ She replied, ‘In 25 years of attending homebirths I have had two. We managed it at home ok, mother and baby were well.’

    Obstetrician John Franklin
    ‘Every doctor enjoys his intervention. That’s what his skill and training are for. Some think that nature is in constant need of improvement and others that nature can’t be trusted, but one kind of intervention leads to another and then the doctor is kept busy seeking remedies for his own actions.’

    • Nick Sanders
      June 3, 2017 at 5:53 pm #

      • Jacob Bunton
        June 4, 2017 at 3:31 am #

        At least you can laugh, because if you don’t you’ll probably cry.

        • Nick Sanders
          June 4, 2017 at 7:29 am #

          A six year old report on seven year old data, in which I notice no small amount of putting the cart before the horse. Is that really the best you can do?

          • Jacob Bunton
            June 4, 2017 at 12:41 pm #

            How about this?
            It is now more dangerous to give birth in America than it is in China, Saudi Arabia, and The United Kingdom according to the new study (2016). The U.S. is number 60 out of 180 countries for maternal deaths.
            If you think the USA maternal death rate is going to improve with the kind of attitude I’ve seen posted on this site then you are dreaming.
            Wake up America

          • yugaya
            June 4, 2017 at 12:51 pm #

            Only a disgusting misogynist will compare like that giving birth in industrialized world with giving birth in a country where women don’t have agency to make medical decisions during childbirth. Not to mention all those slave labour migrant women in Saudi Arabia with no rights whatsoever, many of them getting pregnant and giving birth while being held prisoners by their employers.

            You are quite a piece of shit to use that comparison.

          • maidmarian555
            June 4, 2017 at 2:19 pm #

            I have a feeling he’d much prefer it if we weren’t allowed to make our own decisions about our own bodies during labour and birth judging by the comments he’s been making here…..(unless, of course, we’re choosing to homebirth in the dark in a manky poo-infested paddling pool).

          • Nick Sanders
            June 4, 2017 at 1:16 pm #

            I don’t know about Saudi Arabia, but the UK has socialized medicine, and China has even more of those interventions you seem to think are evil than the USA does, a lot more. Especially C-sections. Last I saw, the Chinese c-section rate was roughly 55%. Maybe the USA should take a lesson from that.

          • FallsAngel
            June 4, 2017 at 1:58 pm #

            It’s a little hard to believe Chinese statistics on just about anything, as well.

          • yugaya
            June 4, 2017 at 2:03 pm #

            Previous round of such ignorant reports and articles cited Belarus for comparison. During dictatorship which resulted in average life span in that country crumbling, they managed to miraculously cut down maternal and perinatal mortality rates in a way that has never been documented anywhere else ever.

            Yeah, let’s compare birth care in USA with a country in which travelers are warned against seeking local medical care and where mortality data is obviously falsified.

            “Medical care in Belarus is neither modern nor easily accessible. Hospitals and medical facilities in Belarus are below Western and U. S. standards and lack basic supplies. Trauma care is well below U.S.
            standards; Belarus lacks the level of care and competence to deal with these injuries.”

          • The Computer Ate My Nym
            June 4, 2017 at 2:36 pm #

            Yes, it is. The US’s medical system is severely hampered both by lack of a universal health care system and by specific political efforts designed to increase the danger of pregnancy for women. Yes, you read that right: politicians in the US deliberately target organizations that provide ob/gyn care to women in the US and when they succeed, the result is much worse medical care and considerably higher maternal mortality. States with more aggressive efforts are those where the survival is the worst.

            Link is to a secondary source, but it provides further references to primary sources and a good summary of the problem, which is why I am using it in preference to a primary source.


          • Heidi
            June 4, 2017 at 2:45 pm #

            So are you saying the US needs to spend all our healthcare dollars on jacuzzis in our delivery rooms? Let’s not spend more on preventative care, birth control, reproductive health, food security, helping women get access to prenatal care or anything like that but all we need are jacuzzis and dimmers! America has a lot of room for improvement but spas in our L&Ds should be no where near the top of the list. Doesn’t do crap for women who relied on now shutdown women’s clinics for birth control and prenatal care.

          • Jacob Bunton
            June 4, 2017 at 4:20 pm #

            YES! There needs to be a choice. If you want epidural, you can have one. And that is a good thing. What about the woman who doesn’t want an epidural or maybe she is not sure, she thinks she will probably need one but would like to try the water first. Where is her choice! It doesn’t exist. This Heidi could be viewed as preventative care. The rest is important of course, but the birth itself has a huge impact on the woman, bonding with her baby, her family especially if her choice is denied and no meaningful conversation is taken place apart from ‘you can’t have it!’

          • Heidi
            June 4, 2017 at 4:30 pm #

            No it is not preventative care. And no, it should not be a priority. You are insane. Prove that our maternal mortality has anything to do with lack of water birth.

          • Amazed
            June 4, 2017 at 5:30 pm #

            Preventative care? Water birth is preventative care? I don’t know how things are in the USA but if someone tried to push waterbirth as preventative care HERE, I’d have much to say about the lack of staff to help patients who are immobile. That’s just an example that came to me immediately but I do remember how my father went to the hospital to lift my grandmother after her colon cancer surgery and carry her to the window. He stood there for a while, then placed her in a chair, then lifted her again and held her so she’d change positions. Sure, nurses turned her in bed and all but it would have been nice to have more people around so no one got, say, a back injury from manipulating her and/or injuring HER in the process. She was about 120 pounds then but they couldn’t handle her like a sack of potatoes, after all. And one of the thinly spread nurses was freaking tiny.

            Frankly, I can’t envision a healthcare system being this richly funded that waterbirth could ever be considered a reasonable weight on taxpayers’ money.

    • yugaya
      June 3, 2017 at 6:09 pm #

      “Hands OFF a breech is first rule of thumb in obstetric guidelines.” No, it is shit that killer birth quacks like Ina May Gaskin ( 1 in 11 mortality rate at The Farm for breech birth according to the report she authored) and Lisa Barrett ( three dead breech babies in less than two years) propagate.

      First rule of thumb in all current obstetrical guidelines is a CS for breech you idiot.

      • Jacob Bunton
        June 4, 2017 at 3:20 am #


        Google Clinical Guidelines for Breech

        Above are the guidelines from one hospital, all follow the same. Clearly you are not an obstetrician. Well at least I hope you are not!
        Management of Breech Presentation (March 2017)
        Cochrane Review

        • yugaya
          June 4, 2017 at 3:32 am #

          One hospital vs RCOG? Thanks but no thanks, I’ll take RCOG instead.

          “Women should be informed that while evidence is lacking, continuous electronic fetal
          monitoring may lead to improved neonatal outcomes. [New 2017]

          Where should vaginal breech birth take place?
          Birth in a hospital with facilities for immediate caesarean section should be recommended with
          planned vaginal breech birth, but birth in an operating theatre is not routinely recommended.

          Women should be informed that adherence to a protocol for management reduces the chances
          of early neonatal morbidity. [New 2017]

          Assistance, without traction, is required if there is delay or evidence of poor fetal condition.
          [New 2017]”

          …and so on. That lethal hands off breech idiocy is not mentioned even once in the source you are referencing. I don’t need to be an obstetrician to notice that, do I?

        • Azuran
          June 4, 2017 at 5:09 am #

          What are you even talking about? According to your own link, First rule of breech isn’t hand off.

          First rule is apparently: Try a version

          Second rule: If version fails, talk to women about the risk/benefits of c-section vs vaginal birth (and they say very clearly that vaginal birth has a 4x higher risk of death for the baby)

          Third rule: IF woman wants vaginal birth, make sure she is a good candidate, meaning: Prenatal testing.

          Then there is a LOT more blabla about risk/benefits and testing to make sure it’s safe

          Then Constant foetal monitoring is recommended and labouring in a hospital with access to immediate c-section.
          A lot more monitoring during the birth to make sure everything stays perfect.
          Then more talk about how your OB shoudl be skilled is diffent kind of manipulation.

          Where in there does it says that you should keep you hands off a breech baby any more than during a normal presentation?

          • yugaya
            June 4, 2017 at 5:16 am #

            Nowhere. But some MLUs in UK are so off the rails that this deadly hands off breech nonsense has been legitimized in lower level hospital guidelines.

      • Martha G
        June 4, 2017 at 10:03 am #

        Worryingly, here in the UK, I’ve seen a lot of midwifery ‘leaders’ advocating against a CS for breech, and are all for adding it to the list of high risk indications for which we should now be prepared to undergo natural delivery.

        ME? I’m adding this disturbing trend to the list of reasons I will never give birth in the UK (and since I’m resident here and not getting any younger, possibly never will at all). How ’empowering’.

    • yugaya
      June 3, 2017 at 6:11 pm #

      “Shoulder dystocia which occurs in 1% of all births is managed exactly the same, regardless of birth setting.”

      Ya, sure. Outcomes aren’t even remotely similar though.

      • yugaya
        June 3, 2017 at 6:17 pm #

        Also this from RCOG guidelines: ”

        6.3.1 How should shoulder dystocia be managed?
        Shoulder dystocia should be managed systematically (see appendix 1).
        Immediately after recognition of shoulder dystocia, additional help should be called.The problem should be stated clearly as ‘this is shoulder dystocia’ to the arriving team.”

        You carry a team in your pocket to homebirths?

        • yugaya
          June 3, 2017 at 6:22 pm #

          “Managing shoulder dystocia according to the RCOG algorithm (see appendix 2) has been associated
          with improved perinatal outcomes.

          Help should be summoned immediately. In a hospital setting, this should include further midwiferyassistance, including the labour ward coordinator or an equivalent experienced midwife, an experienced obstetrician, a neonatal resuscitation team and an anaesthetist.”

          You carry a neonatal resuscitation team that will respond in seconds in there as well? So the more accurate and honest statement would be that while in an OOH birth you will follow all the basic steps for management of SD that you would in a hospital, it is a birth setting where the full recommended response that improves outcomes is – impossible to achieve.

        • Jacob Bunton
          June 4, 2017 at 3:25 am #

          USA 1% of births are homebirth
          99% are in hospital
          Shoulder dystocia is rare 1% of all vaginal births
          More common on a labour ward
          – Induction of labour with drip of synthetic oxytocin
          – Synthetic oxytocin augmentation (to speed up contractions)
          – Prolonged 1st or 2nd stage
          – Operative vaginal delivery

          Alongside Midwife Unit – is exactly that. It is alongside the obstetric unit. It is on the labour ward just the rooms are designed differently, i.e more like a home away from home. It offers women, who are predominantly low risk, to use the pool if they wish.

          There are emergency bells in these rooms, if and when needed.

          • yugaya
            June 4, 2017 at 3:44 am #

            “USA 1% of births are homebirth
            99% are in hospital
            Shoulder dystocia is rare 1% of all vaginal births
            More common on a labour ward”

            Bwahahahaha. Please no parroting stuff you are clueless about.

            Incidence of SD at The Farm According to Ina May Gaskin’s own report for the period 1970-1995: 2.2%. In a LOW RISK cohort.

          • yugaya
            June 4, 2017 at 5:06 am #

            Latest MANA self-reported data in breech homebirth cohort: ” the absolute risks of and fetal/neonatal death (16.8/1000)”

            Lovely outcomes right? Same as in USA hospitals after 1960 when everyone was skilled at delivering breech vaginally and mortality was 1%-3% + severe maternal morbidity up to 50%. ”

            What’s the death rate for breech babies nowadays in hospitals? Oh right, in hospitals, that thing called evidence-based and medically recommended CS has annulled the increased risk of fetal/neonatal death that used to be associated with breech pregnancy.

            ” Vaginal breech births are becoming very rare, and this is a posing a real risk to an important skillset being lost forever.” I will take more alive, unharmed babies over a skillset that even under best of conditions ( according to you) is associated with mortality rates from half a century ago.

          • maidmarian555
            June 4, 2017 at 5:27 am #

            He’s totally missing the fact that women are *choosing* c-sections for breech babies because it’s safer for the baby. Of course, this is apparently less important than midwives and OBs being able to basically use these women and babies as practice so they don’t lose this ‘important skillset’. It looks like he might be UK based, I can only hope he’s doesn’t work in the hospital where I’m planning on having #2. Although it sounds like he wouldn’t want me as a patient anyway, considering I’m planning on another c-section. Which I am pleased about seeing as I don’t really want the people in charge of my care sharing personal details of my next birth online with total strangers.

          • yugaya
            June 4, 2017 at 5:30 am #

            Process over outcome mindset, especially troubling since the outcome he wants ignored so that he can practice NCB hands off breech bullshit is in year 2017 unacceptable rates of fetal/neonatal death.

          • maidmarian555
            June 4, 2017 at 5:44 am #

            He needs to talk to my MIL. My OH was born breech (in 1975). Back then, c-sections were neither as common nor as safe as they are now. Even so, they attempted a version 3 times because they didn’t *want* to deliver him breech. Each time he flipped and the final time it was too late for them to try anything else. She says the experience was terrifying. It really irritates me that they romanticise experiences and a past that simply didn’t exist for those who actually lived it. Also, I’ve had a couple of friends with breech babies. I know things can be different in the US with insurance considerations etc but here in the UK everyone I know was given a choice about how they wanted to deliver their baby. They chose c-sections. Because (funnily enough) the risks of losing their child unnecessarily far outweighed the risks of surgery for them and they didn’t give a fuck about whether the attending midwife was getting enough practice at delivering breech babies to ensure her skillset was maintained.

          • Who?
            June 4, 2017 at 5:35 am #

            You’re assuming the safety of mum and baby are the point.

            If you only realised that all Jacob’s feelings are the point.

          • Lilly de Lure
            June 7, 2017 at 3:04 pm #

            Indeed – the traditional skillset necessary for the correct use of birth hooks was lost centuries ago and I don’t think even the craziest traditional/ home birth advocate would lament the loss.

          • yugaya
            June 7, 2017 at 4:33 pm #

            Don’t give these fuckers any ideas. Ina May Gaskin lamented how a homebirth with placenta previa was entirely possible but she unfortunately never had the chance to attend one like some Dutch midwife a few centuries ago did.

          • yugaya
            June 7, 2017 at 4:37 pm #

            “Her statistics are remarkable in many ways: she records only 20 maternal deaths (5 — 7%), amazing”

            “It is significant that in only 4% of all the births were some kind of interference with manual manipulations necessary. In more than 95% the birth process was spontaneous.”

            Amazing achievement! 95% of births all natural! 5% dead women in childbirth!

            “Vrouw Schrader, like Louise Bourgeois and Justina Siegemundin, discovered on her own how to deal with placenta previa. “All three midwives came to the conclusion that the best way to handle these extremely dangerous situations consists of delivery the woman as soon as possible.” Frau Siegemundin did this by piercing the placenta with a needle to drain away the amniotic fluid, while Schrader and Louise Bourgeois concluded they had to remove the placenta first and perform a version and extraction immediately after that. Vrouw Schrader encountered her first placenta previa on her 661 st case and lost the mother. Almost exactly six hundred births later, she had her second placenta previa, executed her plan and saved the mother. The child had been dead for some days. All in all, she dealt with ten cases of complete placenta previa and only lost two mothers,”

            2 in 10 placenta previa maternal mortality! I’m sure Jacob has the sadz that the skill of vaginal placenta previa birth is lost.


          • Dr Kitty
            June 7, 2017 at 5:14 pm #

            Of course, this is when placenta Praevia was only apparent during labour when placenta was palpated through a dilated cervix, and provided the woman hadn’t already bled to death from an antepartum haemorrhage.

            Jacob seems keen to support maternal choice- would he agree to attend a woman with PP who refused CS?

            If not, clearly he believes there is a level of risk at which it is unethical for a HCP to acquiesce to a dangerous plan.

            I want to know where he puts that level.
            What is the risk of maternal mortality and morbidity and neonatal mortality and morbidity at which “supporting” a woman is no longer ethical?
            Hard numbers.

            If there is no level of risk which ought not to be supported, then Jacoob needs a swift refresher in the NMC code of practice.

          • June 7, 2017 at 5:22 pm #

            Well, 20% mortality rate is better than 100% mortality rate, but still completely unacceptable when you could just go to the hospital and get a freaking C-section!

          • Lilly de Lure
            June 8, 2017 at 5:20 pm #

            Oops, my bad – never underestimate crazy! SMH

          • Charybdis
            June 8, 2017 at 10:48 am #

            Where’s Mel? She could give some information on having to use obstetric chains or a “come along” during cow birth.
            Or maybe a fetatome. Those are some mighty gentle interventions there.

          • Charybdis
            June 4, 2017 at 11:35 am #

            We have one regular poster here whose first child was premature and she experienced shoulder dystocia. You cannot, absolutely cannot predict the incidence of shoulder dystocia in any pregnancy. It happens with large babies, small babies and premature babies. It happens in spontaneous labor, augmented labor and induced labor. It happens if a woman is in a tub/pool, free to walk around and change position, on all fours, squatting, or confined to bed with an epidural. It happens with no pain relief, IV/IM pain relief and epidurals. It happens in home births, midwife-led units and hospitals.
            Women who cannot control their pushing can suffer perineal tears. Women who can control their pushing to a certain extent can suffer perineal tears. Women who have perineal massage, etc to “prepare” the perineum can tear. Anything from relatively minor first degree tears to devastating third and fourth degree tears. Episiotomy, while not a standard, regular occurrence these days, is an option to prevent/manage the potential for perineal tears. Cervical tears can also happen with uncontrolled pushing on an incompletely dilated cervix. All of which cannot be predicted with any certainty during labor.
            Things can be going along swimmingly, right up until they aren’t and you can be considered “low risk” right up until the shit hits the fan. Then, time is of the utmost importance in dealing with whatever the issue is. Prolapsed cord, placental abruption, uterine rupture, amniotic embolism, shoulder dystocia, and other cord issues (short, nuchal, knotted, etc) need to be addressed immediately.
            Then, if you are of the “breech is just a variation of normal” mindset, you have to deal with potential head entrapment, nuchal arms, cord prolapse.
            How do you deal with/address these points when they come up? Or do you not mention them at all because that is somehow encouraging interventions?

          • Charybdis
            June 4, 2017 at 11:35 am #

            We have one regular poster here whose first child was premature and she experienced shoulder dystocia. You cannot, absolutely cannot predict the incidence of shoulder dystocia in any pregnancy. It happens with large babies, small babies and premature babies. It happens in spontaneous labor, augmented labor and induced labor. It happens if a woman is in a tub/pool, free to walk around and change position, on all fours, squatting, or confined to bed with an epidural. It happens with no pain relief, IV/IM pain relief and epidurals. It happens in home births, midwife-led units and hospitals.
            Women who cannot control their pushing can suffer perineal tears. Women who can control their pushing to a certain extent can suffer perineal tears. Women who have perineal massage, etc to “prepare” the perineum can tear. Anything from relatively minor first degree tears to devastating third and fourth degree tears. Episiotomy, while not a standard, regular occurrence these days, is an option to prevent/manage the potential for perineal tears. Cervical tears can also happen with uncontrolled pushing on an incompletely dilated cervix. All of which cannot be predicted with any certainty during labor.
            Things can be going along swimmingly, right up until they aren’t and you can be considered “low risk” right up until the shit hits the fan. Then, time is of the utmost importance in dealing with whatever the issue is. Prolapsed cord, placental abruption, uterine rupture, amniotic embolism, shoulder dystocia, and other cord issues (short, nuchal, knotted, etc) need to be addressed immediately.
            Then, if you are of the “breech is just a variation of normal” mindset, you have to deal with potential head entrapment, nuchal arms, cord prolapse.
            How do you deal with/address these points when they come up? Or do you not mention them at all because that is somehow encouraging interventions?

          • Chi
            June 4, 2017 at 8:53 pm #

            Why are those more things more common on a labour ward? Umm cos MAYBE those things are only AVAILABLE on a labour ward??

            As far as I’m aware, home birth midwives (particularly CPMs which we all know are shit) do NOT have the ability to prescribe/carry drugs. MAYBE they can have Pitocin, I don’t know, but the fact of the matter is that by the time that they get to the point where the drugs are necessary, the patient has either been transferred to a hospital anyway, or it’s too late for it to make any difference.

            How freaking dense ARE you? You are the worst sort of mainsplainer who thinks he knows more than a FEMALE obstetrician.

            Birth is straightforward, until its not. It is a PROCESS. The outcome SHOULD be a healthy and alive mother and child. But because you idiots are obsessed with birth being ‘natural’ people buy into the propaganda and babies (and sometimes mothers) DIE.

          • June 5, 2017 at 2:05 am #

            1% is not rare. It is, in fact, terrifyingly common. There were ~4,000,000 million births in the US last year. 1% means 40,000 shoulder dystocias. We know that babies born at home have a 450% higher mortality rate than those born in hospital- and the most common complications are stillbirth and shoulder dystocia. If all of those 40,000 shoulder dystocia babies were born at home, how many thousands would die? How many more thousands would be permanently maimed? And would you be okay with that?

    • Azuran
      June 3, 2017 at 9:09 pm #

      Funny, first rule of breech for my cousin was: C-section before labour starts.

    • Daleth
      June 5, 2017 at 9:23 am #

      “Intrapartum risk factors for shoulder dystocia [include]… Operative vaginal delivery”

      Are you really that ignorant? What you just wrote there is that forceps or vacuum delivery is a RISK FACTOR FOR (i.e., potential cause of) shoulder dystocia. That is almost unbelievably ignorant. Operative delivery is an attempted SOLUTION to shoulder dystocia.

      • Amy Tuteur, MD
        June 5, 2017 at 9:42 am #

        Actually forceps is a risk factor for shoulder dystocia and is not a treatment. The reason forceps is a risk factor is that they are often used in an attempt to deliver a baby who may be too big to fit. Forceps is not a treatment because forceps are only used to deliver the head.

        • Daleth
          June 6, 2017 at 7:22 am #

          Oh, I see what you mean. Thanks. Still, isn’t it potentially misleading to say forceps are a risk factor? Generally, “X is a risk factor for Y” suggests causation: diabetes is a risk factor for SD because diabetes can make babies too big, previous SD is a risk factor because whatever caused the previous SD could simply be a feature of mom’s pelvis or her tendency to grow huge babies so it could easily recur, etc.

          But operative delivery isn’t causative at all; in cases where it’s associated with SD, operative delivery is actually *being caused by* the excess size of the baby or the problematic shape of mom’s pelvis, right?

          I guess I don’t like the “risk factor” phrasing because usually that phrase (1) suggests causation and (2) suggests a solution (i.e., if you have this risk factor, here are some preventive measures we should consider: elective CS, having an OR ready or having you labor in the OR in case an emergency CS is needed, etc.). But by the time you’re using forceps or a vacuum it’s too late to take any preventive measures.

      • Dr Kitty
        June 5, 2017 at 9:43 am #

        Daleth, you’re jumping in too fast here.

        Big head, may mean big shoulders.
        A baby with a head that is too big to fit and needs forceps or vacuum to be delivered, has an increased risk of shoulder dystocia because once the head has been pulled out, it may be the case that the shoulders get stuck.

        OVD is not a solution to SD, because forceps and vacuum only deliver the head, not the shoulders.

        For once, in this specific thing, JB is correct.

        Of course, in certain situations where SD *is predictable*, i.e. Women with DM, where the risk of shoulder dystocia approaches 10% (not 1%, 10%), it is reasonable to inform the woman of the risk, and that CS delivery reduces that particular risk to zero.

        A recent UK case found that NOT advising women of the risks of SD, because you worry they will choose CS if you do is negligent malpractice.

        • Azuran
          June 5, 2017 at 10:21 am #

          But then it becomes much more complicated than the ‘forceps causes SD’.
          If anything, the thing that caused the need for the instrumental delivery probably also cased the SD. Basically a huge baby that requires forceps to deliver the head is more likely to have bigger shoulder and have SD.
          So then what exactly is Jacob advocating for?
          Instrumental deliveries aren’t done routinely for fun. If you need instrumental delivery for the head, it seems unlikely that it’s going to pass any easier in the kind of natural birth that Jacob is recommending. And if it does end up passing, the baby still probably has a higher risk of SD regardless of how the head passed.
          So then, should we just jump directly to C-section without every trying instrumental delivery?

          So he’s basically saying ‘Avoid instrumental delivery because it raises risks of SD’ But that’s not being honest.

          • Dr Kitty
            June 5, 2017 at 3:29 pm #

            It’s the relative CPD requiring OVD that’s the risk.

            The solution is not to try to get women with big headed, big shouldered babies that have difficulty being delivered to deliver without instruments in water.

            That just means a higher chance of a very prolonged second stage, a more compromised baby and having the SD underwater an hour or two later, instead of after forceps on a bed earlier.

            SD is a bony impaction.
            Relaxation, reiki, whalesong, acupuncture, homeopathy soft lights and someone knitting in a corner will not change the dimensions of a woman’s bony pelvis, because that isn’t how bones work.

            Requiring induction or augmentation and prolonged first and second stage may be markers for a too big or badly positioned baby trying to get out of a too small or oddly shaped pelvis.
            They are likely correlated with SD rather than causative factors.

            Which means that all you get if you *don’t* augment is obstructed labour instead of SD, NOT an uncomplicated NVD like Jacob supposes.

        • Daleth
          June 6, 2017 at 7:08 am #

          Thanks for educating me… now there’s a phrase you’ll never hear from Jacob Bunton and his ilk.

    • Azuran
      June 5, 2017 at 10:29 am #

      ‘In 25 years of attending homebirths I have had two’
      That is such a bullshit and worthless thing to say.
      Knowing how many emergency someone had in a certain time gives you no real information about the risk. It really depends on what kind of practice you have.
      How many births a year does she do?
      What are her risk out factors?
      When does she transfer during labor?
      How many transfer did she have? (and what happened to those transfer after they reached the hospital)
      Basically, what she’s saying isn’t that birth is safe, more like, in 25 years, she failed to properly risk out or transfer someone twice. It is possible that those were totally unpredictable, and in that case, her patients are lucky that she was able to handle it.

      • Heidi
        June 5, 2017 at 10:48 am #

        He is not even a bit consistent in what he’s arguing for. He thinks in the US we should offer water birth in the hospital because otherwise, a woman might choose homebirth. But you think homebirth is safer than hospital birth, Jacob, so what’s the big deal, huh?

  9. Jacob Bunton
    June 2, 2017 at 1:47 pm #

    On Wednesday I cared for a woman expecting her second baby.

    Parity 1 – 2015 Spontaneous vaginal birth (SVB), 4040gr, EBL 500ml – waterbirth in a AMU (alongside, consultant obstetric unit, midwife – led unit)

    Last iron count Hb 98 (iron count above hb 105 after 28 weeks is normal)

    Now 41 weeks – Induction of labour offered for 1 episode of reduced fetal movements (FMs). Reports presently good FMs.
    Induced with Propess only, contracting regularly and strongly.
    VE 3-4cm. Approaching active labour.

    Wants to use AMU, have waterbirth and physiological 3rd stage (birth placenta herself)

    My colleagues said they wouldn’t have taken her.
    Her risk was intermediate clinically and she also had social risk factors.

    What about women’s choice?
    What do we do? Abandon her? Force her?

    I agreed to her using the AMU. I asked her about the baby’s movements several times throughout her labour, she told me baby was moving a lot.
    I discussed her wishes for the birth of the placenta and explained increased risk of bleeding with an induction, and also Hb 98 and previous PPH 500ml, active management recommended. She understood the risks and wished to have a physiological 3rd stage. I explained if bleeding too much after birth I will have the injection of syntocinon 10 I.U ready (and also I had within reach cannula pack and catheter) just in case . The woman was happy to go to active management if needed.

    I then let her be. Just listening to the fetal heart intermittedly with a sonic aid, immediately post contraction for a full minute every 15 minutes, and occasionally asking her about her baby’s movements. She immersed herself in the warm water and sighed a sigh of relief. She said ‘ah I love it’. She had her mother with her and though they had seen the room before for her first, they again both said how beautiful and relaxing it was and that the calm environment makes all the difference.

    3 hours later she birthed her baby in the pool and had a physiological 3rd stage, birthing her placenta 10 mins later with an estimated blood loss of EBL 350ml. Her baby latched herself within 15 mins of the birth and though she had bottle fed her first she thought she’d give breastfeeding a go since baby had breastfed so easily.

    Would it have been a different outcome if she had birthed on Labour ward?

    This, my colleagues did agree on, replying ‘Absolutely!’

    • Charybdis
      June 2, 2017 at 2:34 pm #

      Would you have been so accommodating if she had asked for a CS?
      And different isn’t necessarily “better”. You said your colleagues wouldn’t have taken her on, so….. why did you? You felt obligated to do so? Someone had to do it, so why not you? You felt you could manage a potential train wreck just fine, especially since the mother was amenable to some of the woo you favor?
      This is where the hindsight is amazingly clear. Everything turned out just fine, but what if it hadn’t? What if there was shoulder dystocia? She was still in the tub of water…how would you get her out, or would you get in? Nuchal cord, knotted cord or short cord? What is the protocol for that while in a tub/pool of water? How do you get an accurate (or as accurate as estimates can be) measurement of blood loss in the water?
      She just got lucky in the giving birth roulette, that’s all.

      • Sarah
        June 2, 2017 at 3:28 pm #

        Yeah, but she had a physiological 3rd stage and she’s breastfeeding. Those things are what really matters, let’s be honest.

        • Charybdis
          June 3, 2017 at 10:45 am #

          That and the dim light and water. How silly of me.

    • maidmarian555
      June 2, 2017 at 2:39 pm #

      Did you ask this mother whether it was ok to spread her story all over the Internet? I can tell you’re keen to brag about how well it went but as a medical provider you have no business sharing the personal stories of others. If I found out my midwives were putting my birth story out there without my permission, I would be furious. It’s totally unprofessional.

      • Lilly de Lure
        June 6, 2017 at 5:45 am #

        I really wouldn’t worry – judging by his other posts I’m guessing he’s as much a medical provider for actual labouring women as I am an astronaut. My money says he’s getting these stories from blog posts and/or his own imagination and his only experience of natural childbirth is watching youtube videos.

    • swbarnes2
      June 2, 2017 at 2:42 pm #

      And if things had gone horribly wrong, you would not be telling this story. You only tell the good stories. We care about the not-good stories. You would put them down the memory hole.

    • June 2, 2017 at 2:43 pm #

      This is supposed to be meaningful how? Congrats, you told us how informed consent works- she knew the risks of what she chose to do (if you explained the risks of intermittent or no monitoring to her, at least), and chose to do it anyways.

      How does this have anything at all to do with 1) how you would treat a woman who wanted a MRCS, 2) how much bullshit you’ve spewed to us about lights, cortical stimulation, pain relief, and so forth, and 3) whether this woman’s labor is at all meaningful for anyone else’s experience?

      If she had bled out, if the baby had taken 10 hours and been born with severe hypoxia, would you still have shared this with us? Or would you have “forgotten” you presided over an avoidable disaster?

    • Dr Kitty
      June 2, 2017 at 5:54 pm #

      What was the Postnatal HB?

      See, I don’t trust EBL in water, and if it’s under 80 she needs transfused.

      You did check HB after delivery, didn’t you?

      And pro-tip- if people can identify you and you location, and if you put out details like a para 1 delivering at your AMU on Wednesday just past, , well your patient may well be identifiable to people in your community. Not cool.

      If you want to post anecdotes, you need to anonymise better or seek patient consent to post.
      Do you not know this?

      • Dr Kitty
        June 4, 2017 at 7:19 pm #

        Which is it?
        No Postnatal HB?
        Postnatal HB ok?
        Postnatal HB not ok?
        Don’t know, don’t care, no longer my problem now she’s not in my unit and we “achieved” the magical warerbirth?

        And if your response is “the AMU protocol is that we don’t do a Postnatal HB if the EBL is less than 500mls”-then that is evidence of negligence if you choose to apply it to a woman with an antepartum Hb of 98 and EBL in water.

        • Jacob Bunton
          June 7, 2017 at 4:58 am #

          Thank you Dr Kitty for spelling out what we already know and practice. Hospital evidence based guidelines are there for a reason? Do you have any at your hospital? Or is it a free for all? Protocol was followed, FYI postnatal Hb normal.

          • Dr Kitty
            June 7, 2017 at 9:58 am #

            Normal lower limit for HB in women is 115.
            You said her baseline as 98 and she lost 350mls.
            Where did the extra blood come from to get it above 115?

            Or by “normal” do you mean “not low enough to require transfusion, just low enough to cause dizziness, fatigue and shortness of breath and to require oral iron for at least four weeks”?

            Not the same thing.

          • Jacob Bunton
            June 8, 2017 at 5:42 am #

            Would you prescribe iron tablets if a woman came to you in antenatal clinic without symptoms of anaemia and had a Hb below 115 but above 105?

            The blood volume doubles in pregnancy so the iron level dilutes.

            Also FYI Hospital guidelines were followed, women at this hospital are eligible to birth in midwife led unit with a Hb 85 and above.

            A large British study, involving more than 150 000 pregnancies found that the highest average birth weight was in the group of women who had a haemoglobin concentration between 8.5 and 9.5.


    • Who?
      June 2, 2017 at 7:04 pm #

      What kind of different outcome are you talking about? Are you insinuating the baby would have been less well?

      Or do you mean that your more cautious colleagues would have perhaps intervened differently from what you considered appropriate?

      Just because you are okay with supporting patients to take risks doesn’t make you a better care provider.

      This is classic process over outcome.

    • yugaya
      June 3, 2017 at 7:13 pm #

      Whoa what an unethical brag. I hope you are reported for this.

    • momofone
      June 3, 2017 at 9:33 pm #

      So you went against professional consensus and want to boast about the outcome because you see it as a reflection of your superior “knowing” and skill, rather than the pure dumb luck it was.

    • moto_librarian
      June 7, 2017 at 12:54 pm #

      I hope you are censured for this. Your grasp of confidentiality may be more limited than your understanding of birth itself.

  10. Zizi
    May 30, 2017 at 2:31 am #

    For a split second, I read the headline as “Sheena *Easton* and the Moral Bankruptcy of UK Midwifery.” Thank God I was mistaken.

    Anyway, this is certainly a different picture than the one we Yanks get when we tune in to “Call the Midwife” on PBS.

    • demodocus
      May 30, 2017 at 7:35 am #

      Well, Call the Midwife *is* set some 60 years ago. Most of us regulars and Dr. T herself were either kids or not yet twinkles in their parents’ eyes.

      • EmbraceYourInnerCrone
        May 30, 2017 at 11:23 am #

        I am not British so I don’t know for sure, but during the post-WWII period that Call the Midwife is set weren’t all midwives required to be actual nurses/get their RN first? I don’t think that is the case any longer?

        • Mattie
          May 30, 2017 at 11:35 am #

          Yep, it used to be a nursing training course (didn’t have to be a degree) and then an 18 month conversion. Now most midwives just do a 3 year midwifery degree.

          EDIT: The 18 month conversion does still exist, although last I heard there was talk of phasing it out

          • EmbraceYourInnerCrone
            May 30, 2017 at 11:45 am #

            I think that’s kind of a bad idea because shouldn’t they really understand more than just delivering babies? Lots of people have other health issues in addition to being pregnant and those affect their pregnancy, or pregnancy makes their other issues worse.

          • Mattie
            May 30, 2017 at 2:31 pm #

            Yes and no, midwives learn how to manage certain problems that might need alternative management in labour for example, but most women with complex medical needs alongside their pregnancy won’t be ‘midwife led’ they’ll be consultant led care or shared care, where their medical needs are being monitored by an OB and the pregnancy stuff (routine bloods, antenatal checks etc…) will be done by the midwife. Most places will have a series of protocols for managing common things like diabetes and pregnancy or heart conditions and pregnancy, which the midwives will learn. Anything too complex shouldn’t be dealt with by just the midwives.

          • Mattie
            May 30, 2017 at 2:31 pm #

            at least that’s what it was like where I was lol

          • mabelcruet
            June 2, 2017 at 3:48 pm #

            Strictly speaking, yes, that’s what should happen. Unfortunately there are some midwives who feel that they can cope with maternal conditions that should be risked out. In my experience, I’ve dealt with a number of stillbirths (as a paediatric pathologist) where, on review, the midwife either failed to recognise an emergent clinical issue or failed to assess the clinical situation and refer accordingly. This isn’t just me-this exact scenario has underpinned most of the recent inquiries like the one in Cumbria.

            Certain midwives have a mind set that they can cope with anything, view referral to medical obstetrics as a ‘failure’ and consequently hold onto cases that they shouldn’t. I work with some amazing midwives and they are incredibly hard working, dedicated professionals. They are as horrified as I am about issues like Cumbria, but they are being badly let down by their college.

            The Royal College of Midwives fails utterly to deal with this situation, instead pushing the mantra of normal birth as the be-all and end-all, rather than looking at why a small number of midwives develop this dangerous recklessness that risks tarring the profession. The behaviour of the Royal College of Midwives is abhorrent: hounding and bullying loss parents, refusing to accept the findings of independent enquiries, refusal to address the issues, and taking almost 10 years to investigate the behaviour and actions of midwives whose actions and inaction led directly to the needless death of infants.

          • Mattie
            June 2, 2017 at 4:38 pm #

            Oh yeh, absolutely! But unless we can prove that all the bad midwives are direct-entry then it’s not an issue of their training route, but of their own personal ideology. I’m not sure how we could ‘remove’ the potential students who have that harmful view, maybe some kind of psychometric test as part of the application process.

          • mabelcruet
            June 2, 2017 at 5:10 pm #

            I’ve got no answers. My impression from following the inquiry into Barrow-in-Furness was that the so called Musketeer midwives were all older and had been in post for years so it’s likely they were nurse trained first. I don’t know how much of the ill placed confidence is personal ideology, and how much is embedded in their training, or how much is facilitated by RCM leaders bleating about midwives being the guardian of natural births but becoming strangely silent about deaths, both maternal and infant (as Dr Tuteur keeps saying-valuing process over outcome). I strongly suspect that we are only beginning to see the full impact of this ideology with clusters of baby deaths being reported in Shrewsbury and Telford, Kilmarnock, Caithness, Homerton in London, and Oldham. There’s bound to be others.