This homebirth story proves just how f**king privileged natural childbirth advocates are


Nothing demonstrates the incredible privilege and mind boggling self-absorption of Western, white natural childbirth advocates than the belief that giving birth at home is an accomplishment.

The (undoubtedly privileged) folks at Sammiches & Psych Meds credulously report this mother’s unassisted homebirth, This Home Birth Story Proves Just How F**king Strong Moms Are:

Women like Marissa who have homebirths are not f**king strong, they’re just f**king privileged and they dont’ even have the decency to acknowledge it.

In the photo, Marissa looks gorgeous – you would never guess she just endured a 36-hour, drug-free labor …

Then what? When the magic moment was upon them, Marissa trusted her body and let it do the pushing as she sat on the toilet after attempting to remain in bed and couldn’t because it “felt too ‘unnatural.’” The head descended and as she felt that uncomfortable ‘ring of fire’ feeling, she stood up, held onto a towel rack and delivered her baby.

Marissa boasts:

“I’ve never felt so powerful and accomplished in my entire life. Our bodies are truly amazing!!” Ain’t that the damn truth!

No, it’s not the truth; it is so selfish and clueless as to be ugly.

Why isn’t birth an accomplishment for the hundreds of thousands of women do the exact same thing every day, or die trying as in the image above from Afghanistan? Those are black women, brown women, poor women. They have no choice but to labor in excruciating pain at home without possibility of relief and die in agony if the baby doesn’t fit, or bleed to death from massive hemorrhage, or suffocate, racked by the seizures of eclampsia. Just how f**king strong are they?

According to NATO of Canada:

Afghanistan has the highest infant mortality rate in the world with 117.23 deaths per 1 000 live births! The maternal mortality rate is the 22nd highest in the world with 460 deaths per 100 000 live births. This is certainly an improvement from 1 400 deaths per 100 000 live births in 2008 when the Taliban was in power, but it is not nearly enough of an improvement.

Are Afghan women empowered by birth? Hardly, but they don’t count because the “accomplishment” is not giving birth and surviving. It’s having access to excellent health care and state of the art pain relief and then refusing it.

How about the women who are permanently disabled by childbirth? How about Esther?

Esther gave birth to her second child, Manuel, less than one year ago. She was encouraged to stay at home to deliver the baby, where she labored for three days with the help of a traditional birth attendant. Fortunately, she gave birth to a lively baby boy. However, after four days she noticed she was leaking urine and was unable to control it…

Her husband decided that he couldn’t tolerate the smell of Esther in the house, so he left her and went away to Uganda with their cattle. Her in-laws asked her to leave the house and so she was forced to return home with her mother.

Esther “trusted her body” exactly the same way that Marissa did. If anything, her experience was much more difficult because it lasted longer and she had no choice but to endure it. How f**king strong is Esther? How powerful and accomplished is she while leaking urine into her vagina from an obstetric fistula?

Oh, right, we’ve already established that black, brown and poor women from developing countries don’t accomplish anything by giving birth without medical care because it is the refusal of medical care that’s the “accomplishment” not the birth itself.

Lest you think that maternal morbidity and mortality are problems only in the developing world, reading the ProPublica/NPR series on US maternal mortality should set you straight. The most recent piece is How Hospitals Are Failing Black Mothers:

Researchers have found that women who deliver at these so-called “black-serving” hospitals are more likely to have serious complications — from infections to birth-related embolisms to emergency hysterectomies — than mothers who deliver at institutions that serve fewer black women…

ProPublica did its own analysis …

We, too, found the same broad pattern identified in previous studies — that women who hemorrhage at disproportionately black-serving hospitals are far more likely to wind up with severe complications, from hysterectomies, which are more directly related to hemorrhage, to pulmonary embolisms, which can be indirectly related…

This is not the developing world, and it isn’t the world of rural poverty.

We found, for example, that SUNY Downstate, where 90 percent of the women who give birth are black, has one of the highest complication rates for hemorrhage across all three states. On average, 34 percent of women who hemorrhage while giving birth at New York hospitals experience significant complications. At SUNY Downstate, it’s 62 percent.

Just how f**king strong are those black women suffering hemorrhages, hysterectomies and death?

Oops, I forgot; they don’t count because they’re black and many are poor. In order to be “f**king strong, you must be white, privileged and have easy access to the highest quality medical care.

Many people have professed themselves to be shocked by the ProPublica/NPR series, but there’s nothing new there. Black women have been dying in the US for lack of high risk obstetrical care for decades.

Why has no one been paying attention? Because the provision of obstetric care has been warped by the natural childbirth industry of privileged white women. They believe that when it comes to obstetric care “less is more.” They believe that refusing obstetric care is a sign of power, when, in reality, it is nothing more than a sign of privilege.

Black women don’t fit that narrative. For them, less isn’t more; it isn’t even enough to save their lives.

Their tragedies have been ignored. The public health discussion has been dominated by those who decry the C-section rate and the rate of other interventions, the obsessions of the privileged.

Homebirth is the designer handbag of birth. Owning a designer handbag doesn’t make a woman powerful or accomplished; it simply a sign of status for those women who already have power and privilege. Women like Marissa are not f**king strong, they’re just f**king privileged and they don’t even have the decency to acknowledge it.

  • doula123

    This bs is why I’ve stopped doing any for-profit doula work whatsoever; I will now only doula for women in addiction or recovery from, as part of my wider work with recovering addicts. I see my doula role here as simply being a hand-holder for women in an incredibly vulnerable state who often have no-one. I WILL NOT give any kind of advice. I naively went into doulaing believing it was a great thing – and found myself in the middle of the NCB and lactivist cults Dr Amy talks about. It makes my blood boil. Other doulas hate me because I don’t think breastfeeding is all that and epidurals rock…during my own three day agonising induction last year I firmly believe my eventual epidural saved me from full blown PTSD. Why would any woman try and withhold pain relief from another? Its barbaric. The medical system isn’t perfect by any means – especially here in the UK where its deliberately underfunded, but if I needed medical care during birth I’d want a fully qualified medical practitioner not some woo NCBer telling me to ‘trust my body’.

  • Danielle Elizabeth

    I couldn’t finish reading. There is a clear difference between a home birth and an unassisted birth. Learn that first, then try to rewrite the article.

    • swbarnes2

      Sure. Caroline Lovell likely would have summoned an ambulance to save her life if there had been no midwife urging her to sit in her birthing pool and bleed to death.

      The homebirthing midwife sure made a life or death difference there.

    • Box of Salt

      Danielle Elizabeth, what would you call a deliberate decision to birth a baby at home? Or is it only a “home birth” if someone got paid to watch the mother do it?

      • Who?

        To be fair there could be knitting involved, or the consumption of catering supplied by the labouring mother.

        And you don’t want to end up unfairly equating the activities of a birth hobbyist with those of say a taxi driver, who gets drawn into the drama and might end up actually helping out.

        • Eater of Worlds

          Don’t forget the eating of cinnamon candies and blowing your cinnamon breath on the mother (either on her face or on her crotch, thoughts vary as to the best place) to stop hemorrhaging.

    • Allie

      Yeah, that was the whole point – the difference between the choice to refuse obstetric care and the lack of it altogether. Perhaps you should finish the article before commenting.

      • Platos_Redhaired_Stepchild

        its a troll just ignore it

  • Amazed

    Ha! My SIL looked just as gorgeous immediately after Amazing Niece was born. Full face of makeup that had lasted through labour and further, wide grin and so on. Incidentally, she had the all natural birth these women sing praises to but she wasn’t boasting about her amazing body. She was all, “OMG, I’ve got a baby, I’ve got a BABY, she’s here, can you believe it and ouch, this hurts, who would have thought that I could actually push 3.40 kg through this, oh it hurts but she’s so beautiful, oh, she’s here…” Almost as if she were hypnotized by the living breathing thing that had been in and was now out. Silly SIL, did not even realize how amazing her body was. She even forgot she was freaking hungry because she had been careful about how much she ate the last few days, lest she needed a CS that she absolutely did NOT want but still… might have needed it.

    • Danielle Elizabeth


    • The Vitaphone Queen


  • Vulcan Has No Moon
    • guest

      That was a hard read…especially the OB’s linked online journal. An amazing read, but a difficult one.

      Thank you for posting.

  • KRP

    I bet you had the BEST bedside manner when you were practicing. Thank god youre only writing these days.

    • The Computer Ate My Nym

      Yeah, don’t you just hate it when your doctor tells you the truth about the risks and benefits of a course of action? I do! Especially when it contradicts my pre-conceived ideas.

      • LaMont

        The tone police – they only show up when you’re perfectly right about things but they want to complain anyway.

    • Empress of the Iguana People

      Actually, I bet this is her internet persona, not the one she used back in the day.

      • FormerPhysicist

        My last OB was SO blunt and I adored her for it. It also allowed me to talk honestly with her.
        OB: Strict bedrest. Only get up to pee.
        Me: Not going to follow that, have two toddlers and have to get to this wrap-up meeting at work. What’s the real risk and a reasonable solution?
        OB: Can you live with yourself if you have a miscarriage while ignoring medical advice? Can you telecommute into the meeting? What movies can you watch with toddlers? You can play candyland lying on the couch if you have a coffee table.

    • SporkParade

      The way she writes, her bedside manner is a lot better than my OB’s, and I adore my OB. Then again, that’s because my first priority is having an OB who respects patient autonomy, not one who gives warm fuzzies.

    • Eater of Worlds

      You know, the doc has addressed this. When she wrote “nicer”, her posts were ignored and her message was not spread. When she wrote directly and without padding any of her words, people responded. She saved many women from home birthing when they were extremely poor candidates even if they were attended by midwives with real education. I really don’t think she gives a crap that you think she’s too abrupt with her words, because she’s saving lives and educating women and men.

  • Jessica

    Dr. Tuteur, thank you for writing this and for doing it in a way that doesn’t pull punches. A great many women here should use the privilege they are blessed with to ease the burden of childbirth for others through charity. I was very lucky to have a gifted team take care of me through both pregnancies, both c-sections, and after the births of my children. I can’t imagine having to do it without the knowledge and skill of a good medical team.

  • Jessie

    You’re comparing apples and oranges here.

    Women in third world countries don’t have access to comprehensive prenatal checks that would cause them to risk out of home birth should they be in a first world country. For those with a low risk pregnancy, birthing at home with a qualified midwife present is at least as safe (if not safer) than a hospital birth.

    Whether you’re in Afghanistan or America and you happen to be one of these low risk women birthing at home, you are likely going to feel those strong empowering emotions at the birth of your baby.

    Just because you don’t personally hear about Afghan women telling their empowering home birth stories doesn’t mean they don’t have them. Just that you aren’t privy to their social networks and media.

    Yes, we are privileged with high level prenatal care in the first world. No, this is not a reason to detract from the positive hormone-led feelings of empowerment that a mother will experience at birth. Whether that birth is at hospital or home, you’re allowed to feel empowered! And you’re allowed to tell people!

    My point is: Instead of being upset and perceiving homebirth as a flagrant unthankfulness for the medical technology at our fingertips, you should see it as the RESULT of the wonderful medical technology at our fingertips. Because without comprehensive prenatal checks with this technology, homebirth statistics in first world countries would be a lot closer to those of third world countries.

    • Amy Tuteur, MD

      Have you read what I wrote? You seem to have utterly misunderstood it.

      • Jessie

        You clearly state: “… it is the refusal of medical care that’s the “accomplishment” not the birth itself.”

        And as I said above, home births don’t refuse medical care – in fact the majority embrace it with comprehensive prenatal checks and the attendance of qualified and experienced midwives.

        You’re equating a surprise unassisted home birth with a standard, low risk, medically supervised homebirth. And then you are comparing a standard, low risk, medically supervised homebirth with mothers dying in Afghanistan because of a lack of appropriate and compassionate prenatal care.

        Apples and oranges.

        • LaMont

          So your medically supervised homebirth can protect you from hemorrhages, eclampsia deaths, and the suffocation of an unmonitored fetus that gets a sudden cord-related issue? Damn, I didn’t realize CPMs had X-ray vision, this is a true breakthrough! (Also, “surprise” births tend to be relatively fine because those parents seek out medical care ASAP. It’s the planned homebirths that go pear-shaped because it’s all about avoiding getting proper care.)

          • Jessie

            Wow. So many vitriolic replies. As I’m pretty sure you can see from my post, I am not against medical technology and advances at all, but the science shows it’s perfectly safe to have a homebirth if you have a low-risk pregnancy; and if you do so, you will have a lower rate of potentially adverse interventions than you would otherwise encounter in hospital.

            I’m not sure what’s so difficult to understand here.

            Those are facts.

            I suspect a lot of the above responses are a symptom of the severe medicalisation of birth prevalent in American culture.

          • Amy Tuteur, MD

            But the science does not show homebirth to be safe; it shows it to be dangerous. Do you realize that the death rate from homebirth is 1300% higher than the death rate from SIDS?

          • Jessie

            If you want to convince me with death rates, you’ll need to compare homebirth death rates with hospital birth death rates. Not homebirth death rates with SIDS death rates.

            This is the apples and oranges thing again.

            And according to the study I posted earlier, adverse outcomes of home births actually occurred at a lower rate than adverse outcomes of hospital births. Which wouldn’t mean good things for your SIDS comparison.

          • swbarnes2

            It takes an honest person 60 seconds to look in the CDC-WONDER database to compare deathrates by birthplace (hospital vs anywhere else). Hospitals have better stats on comparable populations even counting home birth disasters that end in the hospital. 5 seconds to set the filters right…death at less than 27 days, mom aged 20-34, baby 37-41 weeks, between 2500 and 5000 grams….shows the death rate is 2x higher outside of hospital. CNMs not in hospital…2x the rate as CNMs in hospitals. Other midwives not in hospital, even higher.

            This took about a minute to find. We’re you unwilling to spend 60 seconds to find the facts? Or did you know these numbers, and pretend you didn’t?

          • Kim

            Three years ago a widely-reported study in the UK said that home birth was safer than hospital birth in low-risk women and as a result NICE has taken to recommending home birth for that group. I have my doubts about the wisdom of that, but the salient point here is that the safety of home birth will vary from country to country, because of differing medical systems.

          • Amazed

            There is one common thing, though: the question is HOW much more dangerous homebirth is. There is no question if it IS more dangerous. It simply is, all over the world.

            The study you refer to looked not at homebirths that took place but the homebirths of only the fittest women, the lowest-risk, the ones who according to theory but not practice are actually good candidates for homebirth. IOW, the study compared real hospital birth to fantasy homebirth and then claimed to speak for all homebirths.

          • UK statistics are not good, and getting worse.

          • Amazed

            I suppose it’s so gratifying to find a study and cling to it. But there is one little detail: in every Canadian study, many homebirth deaths are excluded on the grounds of midwives not writing correct entries and downright missing information in the records. IOW, on technicalities. It isn’t as if there aren’t homebirth deaths in abundance. It’s just that if a Canadian midwife kills a baby with her incompetence, this death isn’t in the studies if she has, say, failed to record mom’s blood pressure.

            There are many studies claiming to have found homebirth safe. All of them biased. Netherlands – sure, death at home (midwives) the same as death in the hospital (midwives). A little detail: both at home and in hospital, midwives only take care of low-risk women and lo and behold, obstetricians who only take care of high-risk women get better outcomes. IOW, home is only as safe as hospital when you’re low-risk enough for imcompetent Dutch midwives to attend you. You’d better be high-risk and get a hospital with an obstetrician.

            The UK: homebirth as safe as hospital birth! Sure, if you take homebirth as it should be ideally practiced and not like it is in the UK. In real life conditions, obstetricians win, hands down. Additional support for this: the horror of Morecambe Bay and the revelation that it was far from the only case,

            Nowhere, not in a single place in the world, is giving birth with a midwife safer for a woman than giving birth with an obstetrician,. High-risk women – yes, naturally. :Low-risk women – also safer with physicians as proven by each and every study that doesn’t intentionally seek to uplift homebirh, like the one you cited. Janssen is a well-known homebirth advocate, famous for her scrambling to get “good” studies.

          • Empress of the Iguana People

            I’m getting tired of apples and oranges thing. You -can- compare them. They’re both round fruits that grow on trees and are usually a warm color when ripe. They start from pretty smelling white flowers and can be used to bake cakes or be juiced. They are both acidic, though one is more so than the other. They also have been heavily bred so they don’t much resemble their wild ancestors, originally in Asia.

          • Sue

            Jessie – you are out of your depth here. Go away and read the UK Birthplace study, then come and talk to us about the 3X excess mortality in the HB group. We could also discuss how they only reported excess deaths, and didn’t even report injury and disability.

          • Who?

            At home, you have a zero likelhood of any intervention, since there is no one to administer it. That’s really easy to understand.

            Whether a particular intervention might have had an adverse outcome-or might have saved someone’s life or brain-is irrelevant, since it was not available.

            It’s all about sliding doors-choosing to give birth at home closes off a whole lot of life and brain and health saving options. It does this by eliminating the possiblity (or as you would categorise it, the ‘risk’) of ‘interventions’.

          • Amazed

            If you want to convince us, you’ll have to do better than going all grand with “science shows”. Cite studies. Only, please, don’t bother with your hero Janssen’s first one.

            Severe medicalisation of birth had led to vastly superior outcomes but no, it’s bad because… medicalisation. You don’t even realize how full of privilege you are.

          • Empress of the Iguana People

            What’s wrong with medicalizing? It gives us the best chance of everyone being alive next week.

          • rosewater1

            No, it is NOT perfectly safe. Homebirth won’t ever be perfectly safe, no matter how low risk the mother, because of the delay in getting help if something goes wrong.

          • Sue

            ”I’m not sure what’s so difficult to understand here.”

            Jessie – are you being intentionally ironic?

            Go away and do obstetrics training and deliver a few hundred babies, be held to account for the outcomes, as Dr Amy has, then come back and share your understanding of ”potentially adverse interventions”.

            Then, also, read the article, which is about the ridiculous idea of “trusting your body” in childbirth.

          • sdsures

            “Wow. So many vitriolic replies.”

            Wait a second, let me fix that for you…

            “Wow. So many uncomfortable medical facts I can’t refute with only platitudes and appeals to emotion. I better say they’re all hurting my feelings with vitriol, because I haven’t got any medical facts to back up my homebirth-is-best argument.”

            There, fixed it.

          • Amazed

            So you aren’t American but you’re sure everyone who writes here and opposes your unsubstantiated view is. We’re all Americans and we’re all brainwashed by the severe medicalization of birth prevalent in “our” culture.

            How very… convenient.

          • Krystle Dolbow

            Obviously you don’t know anything about homebirth in the US. I highly recommend reading these.

            Overview with links to more detailed information and sources cited.

            Why international homebirth studies do not apply to the US

          • Namaste

            Excuse me while I pick myself off the floor from laughing. Those sources, to be blunt, are shit. If I had used them in an undergrad level paper, I would have failed the assignment. Come back when you have peer-reviewed empirical studies published in established and reputable medical journals.

          • Empress of the Iguana People

            Yeah, if memory serves, that cleveland basketball player was on the phone with 911 when his partner had the baby. The EMTs arrived shortly afterward.

        • Box of Salt

          Jessie “a surprise unassisted home birth”

          Did you click on the link? It wasn’t a surprise unassisted. The author of the piece relates that the mother planned to birth at home from the moment she found out she was pregnant.

          Apples and oranges indeed. To me, every word of that piece (including the doctored obscenity in the title) says “haha, mean hospital folks, here’s a lady who’s better than you! Everyone should admire her!”

          The author is framing some lady’s desire to stick her tongue out at modern medicine through a planned unassisted birth in feminist language.

          Admire away, Jessie. This lady was lucky.

        • The lowest of low risk labors can become a fatal one for mother or baby or both in a matter of a few minutes. It is insane to be in a place that cannot provide the very best care available immediately, on the erroneous assumption that “low risk” means “no risk”.

          I have delivered babies in the home, in a system that had the best (then) midwives, very strict protocols for vetting who was a suitable homebirth candidate, an excellent backup for emergency transfer, and still, in one instance, when the “axe dropped unexpectedly”, we were damn lucky to avoid catastrophe — and would never have been so close to a maternal death if we had been in hospital.

        • Allie

          No she isn’t. Read the article.

    • MaineJen

      Because midwives and home birthers in first world countries can *definitely* be counted upon to adhere to strict prenatal testing and risking-out criteria, right?

      MANA’s own data show that even IF you are a low risk mother in America, your baby is still many times more likely to die at home birth. Because CPMs don’t HAVE risking out criteria, or best practices, or any accountability at all. If something goes wrong, the mom and her baby are left twisting in the wind, just as they would be in Afghanistan. That doesn’t sound empowering.

      • Jessie

        Hi MaineJen,

        Perhaps that may be the case (I am not in America so don’t know).

        But it doesn’t have to be that way and certainly isn’t so in many other first world countries.

        Here’s a comprehensive and recent research article from Canada showing planned home births to have a reduced rate of adverse perinatal outcomes in comparison to physician-attended hospital births:

        • LaMont

          This is because the high-risk pool NEED the hospital. If you’re so much lower-risk (and a properly-vetted group of homebirthers should be), your numbers shouldn’t be identical to a higher-risk group such as hospital birthers, they should be MUCH better. The fact that they’re not means that homebirth makes your low-risk birth *as risky* as a high-risk birth in a hospital. Comparing homebirths only to low-risk hospital births reveals that apples-to-apples, with all controlled, your homebirth decision made your birth MUCH riskier than it needed to be. Enjoy your reflexive defiance of medicine when your child has preventable brain damage.

          • Box of Salt

            LaMont, Jessie is just reflexively defending her own vision of homebirth, regardless of the details of the actual story.

          • lol why is there an argument on whether we should take the risk or not?! Undeveloped countries still do not have the advanced medical care that we do and steal must deal with any complications without medications, which usually led to death ****when there are complications. We have the amazing luxury of great medical care in case something should go wrong and to make the process go smoothly and we argue about whether we should take advantage of our fortune or not.

          • Empress of the Iguana People

            Part of the problem is that if there is an issue during labor, being 5 minutes from the hospital could still be enough time for your child to die. And here in the US, homebirth midwives sometimes just dump the laboring woman at the ER who now has to fill in paperwork and all kinds of stuff.

          • Amazed

            Less than 10 minutes for YOU to die. I’m so lucky to still have a mom. Sure, the hospital fucked up by not checking properly after she gave birth to a giant baby au naturel but they were able to fix their mistake because she was there when she started bleeding almost to death. Do homebirth midwives always have the time to fix their mistakes before someone dies?

          • Kris

            This is what I always say to people. You try holding your breath for “just five minutes”…and that’s assuming whoever is attending the birth knows the instant something goes wrong and has a car running.

          • rosewater1

            if the hospital is 5 minutes or less away, wonderful. But then mom and baby still have to be assesed, a code/emergency called…and the clock keeps running. That time could be the difference between irreversible brain damage for the baby-and life or death for either or both.
            If you call rolling the dice by choosing to home birth taking advantage of fortune, you have a strange definition of fortune.

        • comment was to lamont

        • MaineJen

          Wow, so…a population of truly low-risk, young and healthy women who have been consistently monitored and tested during pregnancy suffer *fewer* complications? Who’d a thunk it??

          My point was, women who home birth in the US, by and large, are NOT properly monitored or tested. CPMs are not supervised, are not required to be hospital affiliated, are not qualified to perform ANY testing incluing GBS screening or blood glucose screening.

          The mom goes into the birth completely blind. Baby is breech…WHOOPS. Mom is bleeding out from a hemorrhage…WHOOPS better call 911 and hope they get here in time! Where are her medical records? WHOOPS CPMs don’t keep records, silly! What for?

          It’s a shit show over here.

    • Box of Salt

      Jessie “Because without comprehensive prenatal checks with this technology,
      homebirth statistics in first world countries would be a lot closer to
      those of third world countries.”

      I think that’s part of Dr Tutuer’s point here.

    • Amazed

      Homebirth midwives in first world countries scaremonger mothers into thinking that the wonderful medical technology is The Enemy. They see good outcomes as happening despite technology and not because of it. And no, not just American.It happens all over the world.

    • Danielle Elizabeth

      Perfectly written. Couldn’t have put it better myself. How an MD doesn’t have this knowledge but acts like a be all know all is beyond me.

      • Amazed

        How someone who isn’t a MD can imagine that they have any knowledge even remotely comparable to an MD’s is beyond me. You happen to know that when your precious homebirthers run into troube, they rush to the hospital and the MD, don’t you?

        But I imagine it makes you feel better to read something on the internet, then keep reading on the internet, and finally fancy yourself superior to an MD, with their years of knowledge and more years yet of experience into the very matter of saving mothers and babies among whom are, yes, homebirthers. Most of them incredibly ungrateful to the people who saved their lives and thanking profusely the ones who endangered them in the first place. How did they endanger homebirthers’ lives? Why, by edging them to give birth at home.

        Get off your high and uneducated horse and have some freaking respect for the people who fix homebirth messes.

      • Claire Secrist

        I guess she should be amazed that she wrote something that meets standards so exactingly bullshit, that even you could not say it better.

      • Sarah

        That says more about you than anything else.

    • Russell Jones

      “Just because you don’t personally hear about Afghan women telling their empowering home birth stories doesn’t mean they don’t have them. Just that you aren’t privy to their social networks and media.”

      Ah yes, secret knowledge – the hallmark of many a religion.

      • kilda

        yes, I’m sure Afghan women, married off without their consent, pregnant at age 14, forced to labor without medical care, feel super empowered. I mean when I think empowerment of women, Afghanistan is the first place that springs to mind.

        • Kris

          Yes. It’s a utopia for empowered women.

    • Allie

      “For those with a low risk pregnancy, birthing at home with a qualified midwife present is at least as safe (if not safer) than a hospital birth.” This statement is categorically false.

    • Sarah

      Did you really just tell someone they wouldn’t know whether Afghan women have empowering stories because they’re not privy to the social networks, whilst also saying that they likely feel these strong empowering emotions at birth? You can’t have it both ways. Either those of us who aren’t giving birth in Afghanistan (and you’d have said if you had) aren’t qualified to speak about women who do, or we are.

    • SporkParade

      Hi! My husband was born in a country with very iffy obstetric care. (He only survived birth because he happened to be born at the top hospital in the country’s capital.) No one in his family talks about how empowering giving birth is. Painful? Yes. Dangerous? Yes. Traumatizing? Yes. Empowering? Hell no. Because there’s nothing empowering about having no choice but to have an unmedicated vaginal delivery.

    • Petticoat Philosopher

      One of my best friends had a low-risk pregnancy and could have easily been approved for homebirth if she had desired it. Thank God she didn’t, as nobody could have foreseen the knot in the umbilical cord. Thanks to an emergency C-section, she has a healthy daughter. If she’d given birth at home, she’d likely have a dead one.

      For reasons like this, it’s very difficult to find an actual qualified midwife that will attend homebirths.

    • doula123

      Yet true NCBers deplore any type of technology or prenatal checks…Its not BIRTH that’s empowering, its surviving it. Birth is indeed beautiful…its also incredibly fucking dangerous. And the issue with NCBers is they do not encourage any woman who has given birth to feel empowered – quite the opposite.

  • PeggySue

    Dear Marissa, Having an adrenaline rush does not really mean you’re strong.

  • Rachel

    How did you manage to make this about race. You’re a despicable woman

    • Dana Hackett


    • MaineJen

      How else to you explain the high incidence of serious complications at hospitals which serve predominantly black and brown mothers? Those mothers all “just happen” to live near bad hospitals? Or they are being underserved, as they have always been underserved in this country? Get a clue.

      • Claire Secrist

        They don’t think black and brown women count. They just don’t. They aren’t too keen on certain white women either.

      • Isabel Eljaiek

        I agree with you, institutionalized racism is at blame, severely, for the disproportionate rates of serious complications experienced by black and brown mothers. No doubt. How does this connect the content of a woman sharing her birth story?

        • Amy Tuteur, MD

          She wasn’t sharing her birth story; she was boasting about her “achievement,” something black, brown and poor women around the world do every day because they have no choice. If it’s not an achievement when an Afghan teenager does it, it’s the height of privilege to pretend it’s an achievement when a white woman in the industrialized world does it.

          • PeggySue


      • Kelly

        These women are facing the same problems as someone who gives birth at home face which is a lack of interventions.

    • Box of Salt

      So, Dr Amy is “despicable” because she interrupted your cheerleading for some nice white lady in Ohio by bringing up the fact poverty and race are factors in maternal mortality and morbidity rates? I’m sorry.

  • Dana Hackett

    You shouldn’t be so proud of the US’s infant mortality rate with our fab medical interventions(which are proven to be the CAUSE of many additional problems).

    • MaineJen

      How would *fewer* interventions have saved the poor woman in the photo at the top of the page? How would *fewer* interventions have improved Esther’s situation?

      • Dana Hackett

        Medical interventions taken place when there is no need actually creates complications. Medical interventions used properly and only when actually medically needed can be life saving, but using them haphazardly as we do in over privileged countries, creates dangers where they otherwise wouldn’t be.

        • Cartman36

          Dana, as I tell my toddler, just because you state something with conviction doesn’t make it true.

          • Empress of the Iguana People

            Are you saying the trolleys downtown *aren’t* having conversations with us?!?

          • Kris

            That is some wisdom right there.

          • Kris

            That is some wisdom right there.

        • MaineJen

          What dangers could be created that are worse than obstetric fistula? Or death?

          No need. Clearly you are unfamiliar with the US health system. You cannot order a tylenol without a diagnosis code. Interventions are not done for no reason.

          Fistulas are more likely to happen from protracted/stalled labor. Guess what helps with stalled labor? That’s right, the dreaded pitocin.

          Ever hear of CPD? Breech? Abruption? Know how the mom and baby both survive those situations? Yes, the dreaded c section.

          Privileged women getting too many interventions are not the problem. The problem is underprivileged women getting too few interventions.

          Get. A. Clue.

        • Amy Tuteur, MD

          You seem to be making my point for me. I wrote that the emphasis on reducing C-sections and interventions, the obsessions of privileged white women, are keeping poor women of color from getting the care they need. The idea that C-sections or interventions are dangerous was just made up by the natural childbirth industry for the simple reason that they can’t profit from them and they demonize anything they can’t sell.

        • The Computer Ate My Nym

          Oh? What interventions do you consider dangerous and in what circumstances? Who should decide when an intervention is not “used properly” and “medically needed”?

        • rosewater1

          Where did you get your medical degree? You seem pretty certain that interventions are used haphazardly all the time? Explain, please.

        • Funny. Except for one small phrase–“as we do in over privileged countries”–your post is exactly correct. I don’t know which countries are “over privileged,” but I know that in my own, very wealthy country many women don’t have enough interventions to keep them and their child healthy. Also, I’ve never had my doctor decide to give me a medicine or other intervention because her Facebook page was so boring.

      • Dana Hackett
        • Cartman36


          This is an opinion piece. Please tell me you have more intelligence than to come in here and paste a link to an opinion piece and think you made an valid argument. Lol

        • Amy Tuteur, MD

          That’s not a journal; it’s a Lamaze publication. Judith Lothian is just shilling for the natural childbirth industry. She has absolutely no idea what she is talking about.

    • Cartman36


      We have a much more diverse population than places like Finland and we don’t have socialized medicine.

    • Cartman36

      No, interventions are not proven to be the cause of many additional problems. You have bought the natural birth industry lies hook line and sinker.

    • Claire Secrist

      Another moron who doesn’t know the difference between infant and neonatal mortality.

    • LaMont

      So the fact that cardiovascular problems and other pre-existing issues are causing these deaths, not C-sections, somehow means it’s the medicine that’s the problem? Tell it to the woman whose story just went viral, who died of eclampsia when she couldn’t get access to proper care. Freaking hell.

    • Amazed

      First rule here: don’t talk rubbish and expect to be taken seriously. You START with rubbish, aka howling about INFANT mortality rate to an obstetrician.

      Homebirth murderer in waiting, or a privileged woman trying to find fulfillment in what her body can do? What are you?

  • aurora

    Call me harsh and crazy but if you are going to refuse medical care and put the safety of your child at risk for your “perfect home birth” then you should have zero access to any kind of medical care then. You want to give birth naturally like they do in these war torn third world countries? Ok then do so authentically like these woman do. Women that would do ANYTHING for a hospital and caring educated doctors and nurses..but no you pick and choose…

    • Claire Secrist

      They’re only okay with interventions when they’re on the goddamned bring of death. Then if the ER docs and nurses can’t work miracles digging out of a preventable disaster, it’s just another reason to hate hospitals. But really, they hate doctors until they’re totally fucked. Then they have utter faith that hospitals can alter the laws of physics and biology.

    • mabelcruet

      One of my colleagues in a former department was very outspoken about a similar issue-we work with childhood cancer specimens. The way that childhood cancers are diagnosed and treated is very much along national and international protocols-over many years treatment regimes have been developed based on a lot of multi-national studies and research. For any child with cancer, the parents are asked to consider allowing tumour tissue to be used in research (ethically approved and sanctioned nationally-there are so few childhood cancers annually that we need to pool all cases from the whole of the UK-same in USA and around Europe).

      This is the tumour tissue once its been removed from the patient, not experimenting on the patient. Childhood cancers are far more survivable than adult cancers, for many reasons, and we continue to improve year on year. The children now surviving wouldn’t have done so 20 years ago, and its only through families giving consent for the use of the tissue for research that we have these good success rates. Children being treated currently are benefiting from the consent of families in the past. The vast majority of parents readily agree-this is the tumour tissue once its been removed, and otherwise it would be disposed of (after diagnosis). However, some parents refuse to allow this-I don’t know why, I can understand refusal for entering the actual patient into a trial, but the tissue that would otherwise be disposed of? My colleague was very much of the opinion that if parents refused to consent, they shouldn’t be benefitting from the skills and knowledge of those clinicians who had used the research/protocols to guide their work. If they were going to refuse to help other families, they shouldn’t be treated by the specialist team.

      There is a similar argument in organ donation-if someone refuses to be an organ donor, then they shouldn’t be allowed to accept an organ from someone else should they need one. Only those people on the organ donation register should be allowed to get a transplant.

      Whenever I get students, we discuss ethical issues like this. There’s no easy answers-the utilitarian view point is the simplest (greatest benefit to the greatest number of people) but that overrides personal autonomy. Patient autonomy is a fairly concrete part of medical care-we can advise and guide, and provide the evidence, but its up to the patient to decide if the treatment etc is acceptable to them. Where I have a personal issue with it is when that autonomy impacts on another individual, but unfortunately, the law doesn’t accept the fetus as a separate entity. We had a case in the UK where a woman refused a section, even though her baby’s life was in danger, so the hospital got a court order declaring her incompetent and she had a section against her wishes. Her baby survived, but the woman sued the hospital for assault and that was upheld.

      • maidmarian555

        I think the issue is in that situation that whilst it’s the parents refusing to donate, if the child was subsequently refused the best treatment on that basis that’s…problematic. I get where your colleague is coming from but in my (uneducated) opinion, a child shouldn’t suffer (and potentially die) because they happen to have selfish parents. I was thrilled when I had my second baby and was able to donate my placenta to a research project. I don’t get why people wouldn’t want to donate tissue they have no use for!

        The measure of a decent society is how well we treat the worst of us. I guess that applies to selfish twats just as much as it does to convicts.

        • mabelcruet

          I agree completely-when I did clinical medicine (not for very long, I escaped to the lab within 2 years of qualifying), I worked in a very small rural hospital, and we would have the same people being admitted every few weeks, the smokers who got repeated exacerbations of their chronic emphysema, repeated chest infections etc, and privately I’d be thinking ‘what is the point of us all doing XYZ if you’re not even going to bother making any effort to stop smoking?’ But as you say, in a decent society we treat each other properly. The fact that they sometimes don’t take advice and do what they want to despite it not being in the best interests of their health doesn’t devalue them as a person, and shouldn’t prevent them accessing the same level of care.

      • Kerlyssa

        As I understand it, consequentialism doesn’t ignore individual autonomy, it rather doesn’t hold it as an absolute good. In cases where individual autonomy leads to bad results, the benefits of autonomy are still weighed.

        I don’t see anything particularly utilitarian about denying care to children whose parents refuse to donate tissue if sufficient donations exist elsewhere, or if greater harm is caused by denial of care than is gained by the bullying tactic. It sounds more like an issue of fairness, or am I misunderstanding what you mean about utilitarianism?

        • mabelcruet

          No, I wasn’t linking the suggestion of treating patients differently depending on their choices to any particular ethical theory. Obviously, this was a purely theoretical discussion-all patients are treated appropriately regardless of their personal choices about research, but it was always interesting seeing the student reactions and opinions when we discuss this sort of issue.

          Given that we have socialised medicine in the UK, everyone is entitled to the same level of care, regardless of income, and my impression was that many students seemed to believe, at least initially, in some sort of transactional code of behaviour-if you benefit, you have to contribute.

  • guest

    Dr. Tuteur starting the year off with a strong post. Thanks for speaking up.

  • Empress of the Iguana People

    Fundamentally healthy people are going to be shocked when their bodies eventually let them down. It’s inevitable. Sometimes I have to remind my self to be more sympathetic when a newly blind or hearing impaired adult starts to express their grief and anger over their eyes or ears failing them. These well-off white women have no clue.

    • namaste

      I lost a good chunk of my mid-range hearing when I was in my early 20s, and apparently my highs and lows were what one would expect to find in someone three times my age. Am I upset about it? Hell no! It’s like having superpowers! Sound when I want it via hearing aids, peace and quiet when I want that, too. I have my own volume control. It’s the best thing ever!

    • sdsures

      As a chronic illness patient, I say, “HEAR, HEAR!”.

      • Empress of the Iguana People

        *that* is a bad pun, young lady. Go sit in the bad girl chair!

        • sdsures

          What is?

          • Empress of the Iguana People

            “hear, hear” when I was talking about being deaf in one ear! ;-p

          • sdsures

            Evidently, I need more coffee. #derp

    • Kris

      They are shocked. I’ve had several post-birth discussions with low-risk people who had things go wrong: “How could this happen?”
      These things happen. In my limited experience over the last decade or so, the only times the code button was hit/life was in danger were in low-risk births.

      • Empress of the Iguana People

        Aye. it’ll take others longer, but it’ll happen.