Australian midwives use tiny, unblinded study to claim quackery could save millions

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Ever notice that most midwifery “studies,” like those of chiropractic or homeopathy come to the same conclusion? It’s always something like this: “we studied ourselves and we are the cure for everything!”

The latest midwifery “study” from Australia is destined to be a classic of this type. According to the headline in The Age, Childbirth program reduces caesarean rate, could save health system $97 million a year:

The study on which this cost analysis is based is tiny, unblinded and involves quackery.

Lead author Dr Kate Levett, now at the University of Notre Dame Australia, has conducted a cost analysis follow-up study, published in BMJ Open, that found antenatal education could reduce the rates of medical interventions during childbirth and therefore save the healthcare system up to $97 million each year.

The team multiplied the average saving of $808 per woman with the number of women giving birth for the first time in Australia each year – 120,000…

There’s just one problem. The study on which this cost analysis is based is tiny, unblinded and involves quackery.

The original study, published in 2016, is Complementary therapies for labour and birth study: a randomised controlled trial of antenatal integrative medicine for pain management in labour.

Midwives mobilized quackery — acupressure, visualization, massage and yoga — and found it is the cure for everything!

There was a significant difference in epidural use between the 2 groups: study group (23.9%) standard care (68.7%; risk ratio (RR) 0.37 (95% CI 0.25 to 0.55), p≤0.001). The study group participants reported a reduced rate of augmentation (RR=0.54 (95% CI 0.38 to 0.77), p<0.0001); caesarean section (RR=0.52 (95% CI 0.31 to 0.87), p=0.017); length of second stage (mean difference=−0.32 (95% CI −0.64 to 0.002), p=0.05); any perineal trauma (0.88 (95% CI 0.78 to 0.98), p=0.02) and resuscitation of the newborn (RR=0.47 (95% CI 0.25 to 0.87), p≤0.015)…

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The results are nothing short of astounding! Epidural use dropped from 68.7% to 23.9%; unassisted vaginal birth rose from only 47% to 68.2%; the C-section rate dropped from 32.5% to 18.2%; Pitocin augmentation dropped from 57.8% to 28.4%.

How did these miracles occur? It was so simple any midwife could do it!

The tools used were:

Visualisation—four guided visualisations rehearsed through the courses and given to participants on a CD to practice at home;

Yoga postures—five postures and movements practiced to encourage relaxation, physiological position for labour, opening of the pelvis and downward descent of the baby;

Breathing techniques—four breathing techniques were introduced: soft sleep breaths for relaxation between contractions; blissful belly breaths (BBs) which were used during contractions for pain relief; Cleansing Calming Breaths used following contractions during the transition period of labour; and the gentle birthing breath (GB) which was for use during the second stage of labour and encouraged descent of the baby avoiding active pushing and protection of the pelvic floor;

Massage—two techniques were shown to partners: the endorphin massage used between contractions, which is a soft technique and encourages endorphin release; and the stronger massage which is used during contractions for pain relief and focuses on squeezing the buttock, especially the piriformis muscle, to interrupt pain perception;

Acupressure which uses six main points for use during labour selected from a previously published protocol. These focus on hormone release for labour progression, augmentation of contractions, pain relief, nausea and positioning of baby;

Facilitated partner support uses the concept of working with pain and instructs partners to advocate for the labouring woman, promoting her oxytocin levels and minimising her stress with actions and techniques which are supportive for the birthing woman, and gives time for facilitated discussion and rehearsal by couples during the course.

Usual care consisted of the hospital-based antenatal education course routinely available at each hospital…

Extraordinary claims require extraordinary evidence and this study is both tiny and unblinded.

It involved only 176 women. And although the authors claim that the study was blinded, blinding was impossible since the study group employed techniques that only they had learned. It was easy for midwives to determine which group received the specialized training and consciously or unconsciously treat them differently (for example, allowing the control group to receive epidurals while pressuring the study group to avoid them).

There were more problems than tiny sample size and unblinding.

A comment submitted in response to the paper noted:

The findings are contradicted by existing research on epidurals and C-section rates:

It seems to us that the study was designed to assess both pain control and unnecessary medical intervention. Epidural use as analgesia was used as a surrogate measure for failing pain management during labour. Whilst the use of surrogate endpoints can be highly problematic,the authors justify its use in this case due to its role in initiating the ‘cascade of interventions’. They describe that as epidural rates increase, so do the rates of instrumental births and other associated unnecessary medical interventions.

Whilst reviews cited by the authors have shown instrumental deliveries may increase, the same high-quality evidence shows epidural blocks neither increase the overall caesarean rate nor adverse neonatal outcomes…

Levett et al assume that epidural blocks are used when other pain management strategies fail. We question whether this is a true reflection of how epidurals are used in practice. Epidurals can be placed early in labour, which allows for the use of blocks with fewer side effects however delivery suite personnel and other factors occasionally delay administration. As such the rate of epidural block may more accurately represent women’s antenatal attitudes to pain relief during labour rather than the pain they experience. Previous studies have assessed attitudes towards analgesia and the birthing process as a baseline characteristic between groups.

The findings are contradicted by existing research showing that epidurals increase the rate of operative vaginal delivery:

Despite approximately three times the epidural rate in the control group there was no significant difference in the instrumental delivery rate. Epidural analgesia increases instrumental delivery rate by approximately 1.4 times. Given the differences in epidural rate between groups, the magnitude of this effect would be expected to be detectable with this sample.

Notably women in the study group felt they had significantly LESS control over the birth process suggesting that it was the midwives who determined whether the patients received pain relief and interventions, NOT the patients.

Finally, the findings are contradicted by multiple studies on complementary methods in childbirth that show that none of the methods employed relieve pain or reduce interventions.

So what are we to make of this study? Not much. It claims that quackery dramatically reduces epidural and C-section rates but the tiny sample size, unblinded nature of the study (and the fact that study participants felt they had less control over their births) and well as anomalous findings suggest that the study itself if meaningless.

Despite the ever-desperate desire of midwives to promote themselves and their nonsense, midwives are not the cure for everything.

  • joe

    As an Australian I apologise for this stupid study, it is another blight on my country renowned for many medical innovations but these is terrible.

    • The readers of this blog who come from all over the world can attest that quackery, poor science, and substandard care are international phenomena.

      • Sarah

        Yes, would that this were a solely antipodean issue.

  • Karen in SC

    This reminds me of a study used to justify a new interstate route to Myrtle Beach SC, saving 20-25 minutes. A small group was considered and found to spend an extra buck or two in that time interval and that was extrapolated to a boon of millions of dollars to the economy of the area.

  • Squillo

    It would be useful to directly compare effectiveness and patient satisfaction between groups. The study looks at rates of epidural use, but what about patient request for epidural anesthesia? A portion of the experimental group may have requested epidural anesthesia and didn’t get it, either because it was too late, an anesthesiologist was unavailable, epidural was contraindicated, or for some other reason. Cost savings analysis is great, as far as it goes, but it doesn’t tell us much if the effectiveness of the intervention isn’t adequately assessed.

  • Sue

    Readers might be interested in some deeper info about the Aus “National Institute of Complementary Medicine (NICM)” and its director, Alan Bensoussan, who was a co-author of the paper.

    This blog is run by a former researcher at that institute, who became critical of the methods used and left.

    https://frankvanderkooy.com/2016/02/19/the-national-institute-of-complementary-medicine-australia-what-are-they-up-to/

    https://frankvanderkooy.com/2016/02/19/the-national-institute-of-complementary-medicine-australia-what-are-they-up-to/

    • lsn

      Why the hell are they getting NHMRC funding? God I despair some days…

      • Who?

        That is a very good question, and I think a pretty respectable queue of people with the same question is forming.

        What universities are agreeing to to keep their funding is not funny. At all.

  • Sue

    It was interesting to go to the initial study, in BMJ Open:
    http://bmjopen.bmj.com/content/6/7/e010691#ref-17

    There are many things to note in the assumptions and methodolgy. A few examples:

    First, note the third and fourth co-authors: Bensoussan (head of an “integrative medicine” research unit) and (our friend) Dahlen.

    For the claim “Integrative medicine approaches and complementary medicine (CM), in particular, may offer increased options for pain relief in birth”, the reference is to the Cochrane Review of “Complementary and alternative therapies for pain management in labour”, which found “Acupuncture and hypnosis may be beneficial for the management of pain during labour; however, the number of women studied has been small. Few other complementary therapies have been subjected to proper scientific study.” Acupuncture has a growing body of evidence for not being active beyond placebo. So, no – the reference does not support the efficacy of “integrative medicine approaches.”

    Then, the entire treatment model was based on a system using “Acupressure techniques” – which, again, is not evidence-based.

    The nature of the intervention was a two-day course, based on “She
    Births® course and the acupressure for labour and birth protocol” designed by someone called Nadine Richardson. From the course’s site: “Nadine Richardson is a mother and has been a childbirth educator, labour assistant (doula) and prenatal yoga teacher for over 20 years. She is the director of The Birthing Institute and creator of the She Births® program.

    She Births® is her own holistic and evidence based birth course for pregnant couples that was developed within her local community of Bondi Beach, Sydney. After many years of attending births, influenced by her medically trained family she became inspired to develop a more comprehensive preparation for birth that made a real difference.”

    So, her qualifications are that she is a mother and doula and teaches yoga, and has “medically-trained people in her family.”

    And, (guess what) – she had a difficult first labor! “When my son was born I have to say, like many women do, the experience of labour shocked me! Even after 12 weeks of birth education I felt like my partner and I were not prepared with tools or knowledge to navigate the intensity and complexity of birth, or, for the greater challenges that came along afterwards.”

    The course makes claims to be “the world’s only scientifically verified childbirth education program” – “Combining evidence-based and holistic techniques”. The entire “scientific claims” are based on the BMJ Open paper.

    The primary outcome measure was the rate of Epidural use – which is strange, as they claim it is an advantage that the methodology reduced the number of women accessing this very effective pain relief measure.

    The study claims that it showed “the effectiveness of the CTLB study, based on the She Births Antenatal Education Program and acupressure for labour protocol36 for first-time mothers, by showing an absolute reduction of 45% and a relative reduction of 63% (RR=0.37, p<0.001) in epidural rate in the study group compared with controls."

    So, a relatively small unblinded study that was associated with a reduction in the number of women accessing a very effective pain relief measure. Huh?
    Why is that a good thing?

    It's likely, as others have said, that the birth attendants understood who was in the "intervention" group and did not offer epidural.

    We also don't know whether the intervention group was discouraged – either implicitly or explicitly – from seeking epidurals or other interventions. It would not be surprising if they were.

    Let's hope the copyright owner of this weekend course doesn't make a fortune based on a poorly conducted study.

  • The Computer Ate My Nym

    One thing I note about the table: It shows the unadjusted results. But the groups appear to be different: different median age, income, provider, etc. So where are the adjusted results? Also, that’s a really high rate of perineal trauma, especially high grade perineal trauma. What’s up with that?

    • Anna

      Oh don’t worry about that, no-one actually reads the studies! Midwives can just tell women whatever they like and they’ll believe them. If you question, you just get blocked and banned. Easy. I was debating with a couple of midwives recently and they were lying through their teeth, after I proved a couple of lies wrong and their hypocrisy in saying that an evidence based peer reviewed article was not evidence but their anecdotes were I was politely asked to remove myself from the group. When I refused I was banned.

      • joe

        Don’t worry Anna, here on the S.S. BLOCKBANNED we always have room for one more, welcome aboard. Off topic, my first girl friend was Anna.

    • Eater of Worlds

      I’m sure they didn’t even notice the trauma because someone was squeezing their ass to take their mind off the pain. It’s like that old joke about your body part no longer hurting because someone hit you in the head with a hammer.

  • Sue

    Publishing a study including “Acupressure which uses six main points for use during labour selected from a previously published protocol. These focus on hormone release for labour progression, augmentation of contractions, pain relief, nausea and positioning of baby” as a piece of science seems a bit paradoxical.

  • fiftyfifty1

    OT: Another Duggar daughter (this timeJoy-Anna) has attempted homebirth but has ended up with CS.

    From People:
    “As planned, Duggar went into labor at home, but after 20 grueling hours, her midwife determined the baby was breech and she was rushed to the hospital where she underwent an emergency C-section….[…]…Finally, the couple, who married last May, welcomed “huge” Gideon, who weighed a whopping 10 pounds, 3 ounces.”

    So the homebirth midwife missed both breech presentation and extreme macrosomia. Confidence expiring, no?

    • The Computer Ate My Nym

      Undiagnosed gestational diabetes?

    • momofone

      I also cringed when I read the part where she said they “only” lived about 30 minutes from the hospital in case of an emergency.

      • Lilly de Lure

        Whenever I hear this “I’m only . . . minutes away from hospital” malarkey I always want to ask – can you hold you breath for that long? Because in the event of your needing to get there fast your baby might have to!

    • Mel

      For those who are counting the homebirth records of the three Duggar sisters who have delivered so far:
      1st birth (Jill) : Fifty hours of labor at home after broken membranes with possible meconium staining followed by 20 hours of hospital TOL before an ultrasound showed a big breech baby. C-section of a 9 pound, 10 oz baby boy who was both alive and healthy in spite of the best efforts of the Duggars….
      2nd birth (Jessa): 40+ hours of labor at home followed by the vaginal birth of 9lb 10oz baby boy. Postpartum bleeding is severe enough that Jessa needs a transfusion the next day.
      3rd birth (Jessa) Four hours of labor produces an 8 pound 11 oz boy. This is the ONLY successful vaginal home birth without morbidity so far…
      4th birth (Jill) The Duggars have kept really quiet on this birth. Jill labored for 40 hours (at home? in a hospital?) and had a C-section. The pictures released look familiar to NICU parents – but her husband only admitted that his son had been admitted to the NICU for two weeks in a tweetstorm a few weeks ago. Pictures from Instagram accounts of family friends show that the baby came home from the NICU on oxygen and a medical grade monitor…
      5th birth (Joy’s): Recapped above.

      Tl:dr: Five births. One home birth with no complications. Two missed breech positions leading to C-sections. One home birth with severe postpartum bleeding. One NICU admission (which I suspect was due to an attempted HBAC but I have no proof of.)

      If anyone knows Jinger Duggar Vuelo, can they convince her to save time, money, her life, and her baby’s life by going to the hospital when labor starts?

      • Ozlsn

        Or at the very least to get actual antenatal care? Ultrasounds are supposed to be for more than tk give the information for a gender reveal party FFS.

        • Who?

          It defies belief that undiagnosed breech at term can be a thing in a first world country almost twenty years into the 21st century.

          • LaMont

            There’s a lot that defies belief about the Duggars in this century.

          • But the Duggars are doing their best NOT to live in the 21st century! I think they’d be happier in the 18th: no C/S, no antibiotics, no analgesia or anesthesia in labor, all babies born at home, nearly 50% of children born alive dead by 5 years of age, life expectancy was short enough that many women never reached menopause — husbands often married two or three times after previous wives died in childbirth…
            The Wonderful Old Days when all the sisters were chaste and the brothers were valiant. Amen.

          • Tigger_the_Wing

            It was unlikely enough when it happened to me in 1982. It should be unheard of these days.

          • maidmarian555

            Happened to a friend of mine fairly recently. It was her second baby and she’d been telling her community midwives something about the baby felt off but had the brush off. Luckily she ran straight to hospital when she went into labour and it was picked up. My community midwife with #1 told me a ‘funny’ story about how she’d been attending to a labouring woman and only realised the baby was breech when the bottom of said baby became visible. She was definitely a moron tho (and worked for a different Trust than the hospital I gave birth in so I knew she’d be nowhere near me in the day thank God).

          • Tigger_the_Wing

            Good grief. My midwife only acknowledged that mine was breech when his feet came out. I’d been in hospital for ten days by that point, and told her that the baby (my second) had somersaulted overnight; but she insisted that was impossible since the OB had written that the head was engaged the previous evening, so I must be mistaken.

            One of my head-down twins turned sideways during labour, so it most definitely isn’t impossible.

      • Sarah

        Gosh, they aren’t having the best time of it are they?

        I didn’t know about Joy’s but have wondered what Jill will do with the next one/s. VBAC after one is one thing, after two is another altogether.

        • Mel

          Jill needs to seek OB care during her next pregnancy. A VBA2C is possible if she’s a good candidate, but it requires giving up her dreams of an all-natural, intervention free home birth. It involves an epidural, lots of monitoring and delivering in or near an OR in case of rupture.

          If she skips OB care and continues the HB route, she’s at frightening high risk of a uterine rupture and delivery of a dead or severely compromised baby and potentially bleeding out herself.

          • Heidi

            It looks like both Jill’s babies where nearly 10 lbs. I wouldn’t personally want to vaginally birth them. It makes me hurt thinking about it.

          • BeatriceC

            I have this sinking feeling that one of the Duggar women is going to wind up losing her life, or her baby’s life, or both, during one of these births. You know they won’t use birth control, even after multiple CS, so the risk of death just keeps going up.

          • Heidi

            I have the same sinking feeling.

          • Tigger_the_Wing

            We can only hope that she surreptitiously asked the surgeon to tie her tubes whilst she was already open. I don’t know much about them, but from what I’ve read I can’t imagine that she’d have been allowed to make that decision openly.

          • Mel

            Jessa’s probably not using BC because she conceived right after her marriage and her two boys are a whopping 15 months apart.

            Joy-anna got pregnant on her honeymoon and gave birth 10 months later so she hadn’t had time to use BC.

            Jill got pregnant right after she got married – but there’s a solid two year gap between her boys. While her MANA license isn’t worth the paper it is printed on, she did have to learn that the wonders of VBAC require a 18 month to 2 year gap between babies. I wonder if she used NFP or something similar to space her babies. OFC, she might have just had a normal spacing with out using protection.

            Jinger probably used birth control. She was married a year and change before getting pregnant. She’s also breaking all sorts of cult rules by wearing pants, shorts and sleeveless tops.

          • B.E. Miller

            Jinger’s hubby used to be a soccer player, so I would assume he knows how to unroll a condom. Plus he’s secular enough that he would have no problem paying for birth control. (Now I’m remembering my mom’s best friend’s church. At her church, it’s like all the newly wed couples go on birth control right away. It’s completely accepted, despite the church being one of those more conservative ones where the women don’t wear jewelry and long skirts.)

      • StephanieA

        They clearly have some big baby genes in that family.

        • BeatriceC

          You know, I’m not so sure about that. Their mother had normal sized babies. I’m wondering if lack of adequate prenatal care is resulting in untreated gestational diabetes. I may be mixing people up, but I thought their mother had GD with a number of her pregnancies.

          • StephanieA

            Ah, you may be right. I don’t follow them closely, just saw how big all their babies have been so far. I’m guessing with their homebirth attempts they probably haven’t had great prenatal care either.

      • B.E. Miller

        Would Jeremy Vuelo let her give birth at home? Or would he prefer his wife to be at least in a birthing center, where there would be easy access to a hospital if things go sideways?

        The QFers are all into that “wifely submission” stuff. In this case, Jinger not having a home birth because “hubby said no” would be okay. I’m just really curious as to what he would say.

        He has a church. Maybe if enough people went and left him ‘concerned messages’ about the previous Duggar daughters’ births, and voiced our concerns about Jinger.

        Link to his church website…
        https://www.gcclaredo.com/blog

        • Mel

          I don’t know much about Vuelo – but he was much older and had much more life experience than any of the other three husband that Jim-Bob found for his daughters. I suspect that if Jinger said she wanted to give birth in a hospital he’d support her in that choice. I also think that if Jinger said she wanted to home-birth, he’d probably be ok with that, too.

    • Ozlsn

      There is a lot of suspicion that the homebirth “midwife” was her sister Jill who is firstly not registered to practice in the state they were in and secondly really should not be the primary midwife for her sister. I do not get this family’s aversion to actual antenatal care at all.

      • LaMont

        Fanatical belief in god requires placing “having children” in his hands, because a pregnancy is NOT a health condition. It is a spiritual creation of another human being, and ONLY god controls that. Not humanity. Want to conceive? Leave it up to god. Want to carry to term? Leave it up to god. Want to deliver safely? Leave it up to god. How many times in the Bible does god “reward” good women with fertility, or punish bad women with infertility? It’s sickening.

        • Steph858

          I never understood why those shouty pro-life folk waste their time protesting outside abortion clinics. How many *wanted* babies have died because the mother couldn’t access proper obstetric care? If you really want to save babies’ lives, how about focusing on that? And if you’re the type who prefers to try to change things by shouting at people you disagree with rather than taking positive steps towards improving the world, why not picket those midwives/duolas whose incompetence and/or obsession with ‘natural’ birth has killed babies? If abortion is murder, surely a risky homebirth which results in a dead baby is at the very least manslaughter. Where are the ‘pro-life’ people campaigning to make homebirth illegal because it ‘kills babies’?

          • LaMont

            Also, what about medical advances to aid in implantation (ages ago I saw a fertility researcher give a *fascinating* talk about this and how she’s worked with infertile couples specifically on the implantation step)? What about preventing unviable fertilizations from happening, or miscarriages of potentially viable fetuses? If a fertilized egg is a person, then failure to implant and early miscarriage is just as prevalent, if not several times more prevalent, than abortion.

          • Tigger_the_Wing

            Indeed, research has shown that up to 60% of fertilised eggs either fail to implant, or are miscarried in the first few weeks. Many of these would have been much-wanted children.

            For someone who allegedly pro-life, God kills a hell of a lot of unborn babies. Way, way more than any women, with or without the help of pharmaceuticals or doctors, could.

          • Empress of the Iguana People

            Both my children’s twin blastocysts disappeared after making their little pockets. I never asked if the pockets remained throughout or if they were just absorbed after the 6 week confirmation us.

          • Tigger_the_Wing

            My daughter’s twin died early in pregnancy, but her placenta continued to grow. I didn’t deliver it but because I wasn’t believed to be having the problems I knew I was having (this was 1984, when ultrasounds weren’t exactly sophisticated), I was sent home where I almost died from PPH.

            Modern screening has demonstrated that twins are conceived far more often than the birthrate would suggest.

          • Empress of the Iguana People

            Mine are IVF, but I believe it. Considering the miscarriage rate seems to be pretty high in general.

          • MaineJen

            What about that clinic (I forget where it was) whose freezers failed recently, and hundreds of eggs/embryos were lost? Where oh where are the pro-life protesters??

          • Empress of the Iguana People

            There were 2 in the US. One i think was in California, the other was in Cleveland. Not the one my extra embryos are stored in

          • swbarnes2

            The same place all the “pro-life” protesters are in Flint, where lead poisoning killed hundreds of fetuses and embryos.

          • Dr Kitty

            Ask pro-lifers if a fertility clinic was on fire, and you can only save one thing would they run in and grab a canister with 2000 frozen embryos, or the 3 month old baby sleeping in the car seat in the company daycare.

            If they grab the embryos, at least their internal logic is consistent, even if it makes them monsters.

            If they think saving one living baby from an actual fiery death trumps saving 2000 embryos from painless destruction, they already believe on some level that sparing already born people from actual pain trumps the “right to life” of an embryo.

            I have found it a useful thought exercise.

          • Who?

            It is, but many of the folk involved probably think the frozen embryos are an abomination so no problem there.

          • FallsAngel

            One was in Cleveland, Ohio and another was in California.

        • Ozlsn

          And yet when they are in danger of losing the baby and/or the mother they suddenly find medical science.

          There is a part of me that just wishes they would go all the way – if you can’t conceive then God doesn’t want you to have children. Don’t go and get tested for stuff as one of the daughters did so you can have children. If you’re labouring and unable to deliver a breech 8lb baby then God obviously wants both of you to die. Why are you thwarting his will by having a c-section?

          (No I don’t seriously want any of these women or their babies to die. I want them to get antenatal care so they can make informed decisions and stop going for home births followed by emergency procedures.)

        • Mel

          The funny thing is that infertility in the Bible is generally just one of those things about life that sucks. Even the story of Leah and Rachel’s relative fertility has a moral of “Sometime God does nice things for wives who have the special hell of not being their husband’s favorite wife.” The Old Testament seems like there’s an infertile woman in every 5th chapter or so and it’s not attached to any personal blame.

        • B.E. Miller

          Now I’m reminded of Steven Anderson, who says that male gynecologists are perverts, and that pregnant women should just “put their trust in God”.

          But what happened when his wife Szuszanna had health issues with her 8th pregnancy? He took her to a male gyn/ob. Now I’m trying to remember if she had to have one twin aborted. (I know one twin died.)

          So his female followers are just supposed to Trust God, but when it’s his wife’s health that’s on line, he sought out modern medical help for her.

          • Who?

            I have a suspicion that Mrs Anderson may not be quite the shrinking violet she implies.

            Or perhaps Mr Anderson wondered who would look after all those kids if he wasn’t around, and didn’t fancy starting afresh with a girl the age of his oldest son, which is likely where he would have found himself.

            Only one twin survived, I don’t know the mechanism but Mrs A strongly asserts that the one who didn’t survive was not aborted.

          • You will be astonished to learn that Mrs. at least is antivax.

          • B.E. Miller

            Nope. I know she’s antivax. Her tenth kid was actually born in the hospital, and she turned down some vaccine they offered her before she and baby left.

            Hey, baby death is ordained by God, don’t ya know? *sigh*

            Her ninth baby, Chloe, had a tongue tie issue where she was basically starving because baby could not feed properly. Tongue tie was not solved for like 6 months.

          • Mimc

            She blamed the prenatal vitamins for the tongue tie and refused to take them in the next pregnancy if I remember correctly.

      • BeatriceC

        But even the family matriarch got actual medical care! We can debate about the wisdom of having so many kids, but at least she had an actual OB.

        • Sarah

          Yeah. And it ‘worked’ for her in that she was able to give birth to a helluva lot of live children. If the goal for her daughters is to emulate that, you’d think they’d follow her example.

          And these are some pretty bad stats for a group of women who are early 20s and healthy BMI. I guess there might be some complication/s we don’t know about, but one has to wonder if some of the EMCS could have been VBs had they been in hospital with skilled providers. I mean, was Joy-Anna ever counselled about ECV for example? Assuming the baby didn’t just flip during labour like they have an unfortunate tendency to…

          • Lilly de Lure

            Its just a thought but simply looking at the reported size of the babies involved I’m wondering if gestational diabetes could have been a factor? Given their limited antenatal care is it possible they were simply never tested for it and so never had the chance to get it under control?

          • Sarah

            I wondered that too.

          • They probably don’t worry about things like that. GDM control is probably regarded as unnecessary and simply a way for Big Medicine to intervene unnecessarily. Bet they didn’t test for GBS, either.

          • The chances of a successful ECV with a baby over 10 lbs is zero, IMO.

          • Sarah

            Which brings us to the possibility of undiagnosed GD due to inadequate antenatal care again! Either way, there could be any number of reasons why it might not be appropriate, including maybe just not wanting to which is a very good reason, but it’s still a discussion that ought to have been had with a suitably qualified provider.

        • swbarnes2

          I think the parent’s didn’t start out Quiverful, but the girls all grew up that way. I think that’s the difference. I bet the parents got regualr public schooling as well. The kids have grown up in this hot house cut off from normal people and normal ideas.

      • mabelcruet

        It’s God’s will I suppose. They don’t need antenatal care because whatever happens was meant to be, and they would be intervening against God’s intentions for the baby.

        Not having a dig at Christians or any religion, most people of faith that I know are perfectly sane and reckon God gave us brains and the will to use them, so medical interventions are perfectly fine, but this Quiverfull movement is frankly odd.

    • MaineJen

      I can’t believe the media is following this family at all, any more. Their whole lifestyle is bullshit. It’s predicated upon “protecting” their children from the influences of the sinful outside world…well, they failed to “protect” their own daughters (including poor Joyanna) from abuse at the hands of their own brother.

      As for this birth…”…after 20 grueling hours, her midwife *gave up on the planned breech homebirth she’d known about from the beginning and decided to go ahead with anyway* and she was rushed to the hospital *where she should have been from the beginning*” Fixed that for you.

      As you can tell, I have NO PATIENCE with these people. None.

      • Heidi

        I wish they’d stick to recipes for tater tot casserole and homemade laundry detergent. I was under the impression Mama Duggar sought conventional OB care for her 20ish pregnancies. I don’t understand their newfound obsession with homebirthing.

        • The Bofa on the Sofa

          They gotta up their game to keep the ratings up

        • Lilly de Lure

          They’ve got deeper into the crazy as time went on – kind of like the parents went to a normal school but christian homeschooling is the only way to go for the kids (hence the reason why, if you listen, the kid’s use of English is significantly less sophisticated than that of their parents). Officially I think they go the homebirth route because they regard that as less likely to result in a c-section which would put a dent in their chances of a double-figure brood. Hasn’t worked so well for this generation I guess, but that’s the theory.

          • Heidi

            I always hoped at least one of them would denounce this crap. I suppose there’s still a few of them not adults yet so maybe one will break away.

          • Lilly de Lure

            I have a vague daydream of the younger ones breaking out en masse and going on to form a successful Death Metal outfit. I’m strange that way.

          • EmbraceYourInnerCrone

            Me too, but it would be like Old Order Amish kids leaving the church. They would probably be mostly shunned by their whole family, and for someone who grew up with ONLY their family as friends and had to have every decision, from what to wear, how to style ones hair and who to marry, it would be completely terrifying.

          • StephanieA

            Right. And if I recall correctly, Michelle used birth control when they first got married. She miscarried, they blamed it on the birth control and decided to ‘have as many kids as god would give them.’

          • Heidi

            Yes. I’m not sure why they think the last pregnancy ended in miscarriage. You’d think the last one would have blown their “God is punishing for using birth control” theory out of the water.

        • maidmarian555

          Is tater tot casserole a thing?! That sounds super-grim…..

          • Mel

            Enjoy. It sounds like my version of hell from the sheer amount of lactose….

            http://www.duggarfamilyblog.com/2011/10/duggars-tater-tot-casserole.html

          • maidmarian555

            Yeah I don’t think I’ll be rushing to make that. Yuck!

          • MaineJen

            Too many potatoes for a low oxalate diet! I’m with you!

          • The Bofa on the Sofa

            Tator tot casserole is traditionally a layer of ground beef, smothered with carrots, peas and cream of celery soup. Sprinkled with tator tots on top. Bake for probably 45 minutes to cook the beef.

            You can add cheese into the sauce, according to taste, but it’s cheap and easy.

          • maidmarian555

            It sounds a bit like a cottage pie. But with soup (?!) and tater tots instead of mashed potatoes. Produce is pretty cheap here so I don’t think it would occur to anybody to replace potatoes with tater tots. I had horrible visions of some kind of stew with tater tots floating in it….

          • The Bofa on the Sofa

            Nah, nothing sophisticated. It’s pretty much the shortcut version of cottage pie. Tator tot casserole is generally cheap (main cost is a pound of hamburger) and easy, and it feeds a lot.

            We aren’t talking fancy cuisine, here, we are talking ways to feed 20 kids on a budget.

          • Heidi

            Potatoes fresh are cheap here, probably quite a bit cheaper than frozen tots but they don’t float around. It’s condensed soups and the tots are on top so they still get crunchy I think.

          • maidmarian555

            Well I can see the appeal of no-prep cooking. Although, tbh, if you’ve got 20kids it’s not going to take long to get some spuds peeled and chopped. I’ve always found American food to be either delicious or totally confusing. This falls into the latter category for me.

          • Heidi

            But fresh spuds just don’t have the delicious crunchiness, slightly but yummy seasoned taste of tater tots! The starch added and the fact they are already par-fried prevent them from getting soggy. Now the Duggar version does seem bland, but I think there’s some cooks who get it right.

          • mabelcruet

            The tater tot casserole sounds very odd to us English folk! Cottage pie with a dauphinois topping is lovely-same ground beef and veg but topped with slices of potatoes layered with dabs of butter and topped with grated strong cheddar. If you leave the skin on you get lovely crispy edges.

          • maidmarian555

            Yes this I can absolutely get behind! I think it’s the soup that’s really bothering me. I sort of understand crunchy tater tots but the soup bit has utterly blown my mind.

          • Heidi

            Canned condensed cream soups, while awful as soups you’d eat as is, make delicious gravies in recipes sans all the work involved.

          • maidmarian555

            Haha! I can see you’re passionate about this. I’m guessing it’s partly a cultural divide gong on here (and I freely admit us Brits are not famous for our delicious cooking). I will take your word for it but I don’t think we’re going to have tater tot casserole on the menu here any time soon (although if we do make it to the States for a road trip- unlikely under the current administration but it is on our list of things-we’d-like-to-do, I shall be sure to give it a bash).

          • Heidi

            Not really passionate about it.

          • maidmarian555

            But I’d be able to buy proper tater tots. You can get them here but they’re not anywhere near as good as the ones I had in Canada (which I assume are more like the ones more widely available in the States).

          • Heidi

            Never been to Canada so I don’t know. But McDonald’s hash browns are pretty much a rectangular tater tot assuming they are universal. But Ive never officially had tater tot casserole but had something similar, hash brown casserole. Mine is a diced onion, a can of cream of mushroom “soup” (no one dilutes it and eats it as soup. It kinda takes the place of a bechamel in American cooking.), a container of sour cream, and a lot of shredded cheddar, and frozen hash browns mixed all together, dumped in a casserole dish and topped with more cheese and buttery corn flakes or crackers. It’s kinda like a way to serve a baked potato with all the fixings but in a casserole. I’ve only had or made it for funerals and holidays.

          • maidmarian555

            I watched a thing on tv recently where they had a group of Americans and Brits and got them to try fast food from either side of the pond. Pretty much everyone agreed the American fast food tasted better but it’s because over here, they use way less additives etc because of EU regs. Even the French fries had different ingredients. I’d assume this would translate to frozen potato products like hash browns and tater tots etc, which is why ours tend to often be the sort of thing you might feed to your children who will only eat bland food but not the kind of thing you’d try and combine with other stuff for a proper family meal. They just don’t taste that great. Or the versions we get here don’t because they have made them healthier I guess (this is not always a great thing when it comes to flavour). My OH does make a great pasta dish that includes a can of condensed chicken soup so I do sort-of understand using it as a kind of intense-flavoured sauce. It’s actually quite interesting learning about things that might be other people’s go-to cheap, quick, easy meals for families. I’m really not into the idea of chucking evaporated milk into that original casserole tho. I can’t imagine why adding that level of sweetness to it would make it any more palatable! Surely more cans of soup would make it go just as far for the same money if it’s about bulking it up?

          • Heidi

            I wonder if evaporated milk is here what it is there? Our evaporated milk is just that, no sugar added. Sweetened condensed milk however is sweet.

          • maidmarian555

            It could well be that I am getting my canned milk products mixed up.

          • Charybdis

            You should try Army’s curly fries…crunchy and spicy on the outside, soft and fluffy inside. I occasionally get a monster craving for them.

            And McDonald’s fries have NOT been the same since they stopped frying them in tallow. The same way Coke Classic is NOT the same as old Coke.

          • The Bofa on the Sofa

            Last week, I had Mcdonalds near my hotel by the Zurich airport. My conclusion: it sucked just as bad as McDonalds in the US

          • maidmarian555

            I have to say I did not like the McDonalds I had in Paris. Which is odd because French food is generally (in my experience) really good. The sauces were strange.

          • The Bofa on the Sofa

            My hamburger had coleslaw on it. I have encountered worse, of course.

          • Eater of Worlds

            Evaporated milk is just that. Are you thinking of condensed milk, which is sweetened? https://en.wikipedia.org/wiki/Evaporated_milk

          • Eater of Worlds

            *slinks in* I eat Campbell’s cream of mushroom soup as actual soup. *slinks out*

          • Heidi

            I tried once out of desperation. I dunno, it’s not that it tasted bad but I think the texture was too much for me after a few bites in. I have a thing for canned Vienna sausages.

          • I lived in the UK for a year, and ate in the maternity hospital cafeteria and the food was surprisingly tasty, if a bit heavy on the carbs. Much British cooking is unfairly maligned, IMO.

          • maidmarian555

            Some of it really isn’t. Although I am pleased to say the fashion for boiling your vegetables until they are mush appears to be long gone.

          • FallsAngel

            I doubt if you’ll find it on a restaurant menu. If you go to Minnesota, someone might invite you to their house for it. I believe it’s quite popular there.

          • B.E. Miller

            If you’re in Minnesota, they don’t say casserole, they say ‘hot dish’. I’m not sure why…..

            But have fun if you decide to visit the states!

          • The Bofa on the Sofa

            Yeah, it’s just easier than a white sauce

          • In Israel, thank heaven, we don’t have canned soup. Takes me all of 10 minutes to create a white sauce soup base, with dozens of variations.

          • FallsAngel

            It’s like a “white sauce”, e.g. flour and milk. It’s a binder for the casserole.

          • Eater of Worlds

            Yeah, it’s more like gravy, the condensed cream soup.

          • Heidi

            Here in the South, we do hash brown casserole. It’s actually delicious. The Duggar tater tot casserole seems a bit one dimensional taste-wise to me as it’s just cream soup, ground turkey, and tater tots basically. But I guess when you are trying to feed 20+ people on a money and time budget, cheese is a luxury.

          • The Bofa on the Sofa

            Hash brown casserole is good. The key is the onion, that brings good flavor.

          • Heidi

            That, and the sour cream adds another layer of flavor, and the crunch from the topping is good too.

          • MaineJen

            “Oh a budget,” please. How many years did that stupid TV show run? They have money to burn.

          • Heidi

            I assume these recipes were before the TLC stint.

          • EmbraceYourInnerCrone

            Exactly!!: https://www.romper.com/p/all-the-duggars-net-worths-because-fans-want-to-know-the-numbers-behind-the-duggar-empire-7541578

            “When 19 Kids and Counting was still on the air, Jim Bob and Michelle were reportedly raking in $25,000 to $40,000 per episode, according to Babble. Before their reality TV income, Jim Bob made a decent living selling used cars and dabbling in real estate, according to The Richest.”

          • MaineJen

            *incoherent rage*

          • Mad Hatter

            I make it with lean ground beef, brown the beef, mix in an equal amout frozen mixed veggies (thaw first) and cream of mushroom soup, put slices of swiss or pepper jack cheese on top, then add the tator tots. Or you can use sliced potatoes. Their version sounds really gross! Wtf do you need evaporated milk for???

          • One would think that persons like the Duggars would eschew processed foods, maybe even grow their own. More nachural, doncha know?

          • swbarnes2

            Trusting in nature like that can be expensive. Trusting in God is usually cheaper. I’m pretty sure the Duggars ate cheap. Their vanity did not demand adherence to some lofty food standard.

          • FallsAngel

            I would guess the evaporated milk is in place of the cream of mushroom soup.

        • JDM

          Ratings. Folks get bored with the same ol’ same ol’. Gotta juice it up this time around.

          Sadly though, although I’m speculating, I am not joking.

      • The Bofa on the Sofa

        they failed to “protect” their own daughters (including poor Joyanna) from abuse at the hands of their own brother.

        But “sexual abuse” is not a sin of the “outside world.” Shoot, it’s friggin biblical (see Lot and his daughters – even if you read the story as written, they abused him; of course, what makes more sense: that two daughters each got their father so drunk that he could not protest and took advantage of him to get themselves pregnant? Or the guy was a drunken child abuser who molested his daughters and got them pregnant?)

        • B.E. Miller

          Yeah, like we’re supposed to believe that a drunk man past 60 managed to get an erection (while drunk) and that’s how his daughters ended up pregnant.

          I’m agreeing with you, BTW. It’s more likely that he’d been abusing them for years, they just happened to have ended up pregnant because he wasn’t ‘careful enough’ and he made up the story that they got him drunk.

      • Ozlsn

        You are placing an awful lot of faith in the midwife… personally I don’t think she had a clue the baby was breech before labour started, or quite possibly afterwards.

        • Merrie

          That would be my guess as well. How many HB stories do we read that contain that element? Way too many.

          When I went through L&D triage I got a quick ultrasound to make sure the baby was head down, but that was only in one out of my three births. Is that standard?

        • Then she was an incompetent midwife who should not be allowed to practice.

          • Merrie

            Odds are she was a CPM and therefore that’s kind of a given. Ick.

          • Bugsy

            But she has 3000 hours of experience!

          • Oddly, I’ve never calculated my hours of experience, but rather the number of births I’ve attended.

          • Bugsy

            I think it was the number of hours that I read w/ respect to her experience. Either way, it just seemed strange to me that someone with so much “experience” would completely miss ID’ing a large breech birth.

          • Gene

            Interesting. Never thought of this. How do you calculate “hours”? Just the time you spend with someone in labor? Afterwards? Is it every prenatal visit? Time spent “studying”? Time spent shadowing another incompetent homebirth midwife?

          • Who?

            If they do it in six minute units they can exceed 24 hours on a long day!

          • I think that it is probably very subjective. Even noting the number of births I’ve attended leaves out a great deal of antenatal and postpartum work I’ve done with women I didn’t ultimately deliver. But probably the best way to gauge experience is by the number of births.

            No homebirth midwife, no matter how well educated, can achieve the statistics of a midwife based in a hospital: it’s physically impossible and the demand just isn’t there. I’ve written before that, in a midsized unit delivering 300-350 babies a month, that comes out to approx. on an average of 10-11 births per 24 hours, and if midwives are working 8 hour shifts, of which there are three in a day, that means a full-time midwife will quite possibly be involved with 2-3 deliveries per shift, working 5 shifts a week, which means [again, very roughly — I once coped with 14 deliveries with only one other midwife and two nurses’ aides in an 8 hour period!] anywhere between 500 and 750 deliveries A YEAR.

            Even if there is a demand, no homebirth midwife can manage more than a maximum of one or two a week, and indeed is more likely to see one birth a month or even less. So a midwife is likely to be able to point to between 12-15 deliveries per year, or a maximum of about 50 -60 if she has massive stamina and enough clients.

    • The Bofa on the Sofa

      after 20 grueling hours, her midwife determined the baby was breech

      What the fuck?

      Hint: my wife’s OB knew that her baby was breech even before labor started. The goal was to go do the c-section without having to go through labor. Didn’t work, because she went into labor early, but as soon as they established that her water was gone, the baby came out. 12 hours of labor, and I won’t call it grueling, but I don’t want to suggest it didn’t hurt. Twas not an “emergency” c-section, though.

      It’s always better to prevent emergencies, than to respond to them.

    • swbarnes2

      I’m guessing that 20 hours + breech does not by itself necessitate an emergency C-section? So either the report is wrong, or something else went wrong??

      • Mel

        Well, we’ll know pretty soon when TLC shows the birth. The Duggars are not good at communicating clearly and openly so we’ll see how much the TV film matches the released story.

        • swbarnes2

          I wonder if the breech was detected when a foot came out. I’m betting that would be an emergency situation that many homebirthers would recognize as such.

          • Don’t know whether it was a footling breech. But abdominal palpation [Leopold’s Maneuvers] done by an experienced practitioner [which this midwife obviously wasn’t] should have determined that the baby wasn’t vertex, and even without ultrasound, an estimate of the weight could probably have indicated macrosomia.

            I know. I began practicing before ultrasound or EFM, and I know what one can determine without any equipment more than one’s hands. And some intelligence.

      • Gene

        “Emergency” is the only acceptable type of c-section. The “I wanted a vaginal birth, of course, but I NEEDED an emergency section” excuse. Nothing like those lazy to-posh-to-push unmothers.

        • Daleth

          Hey, thanks for sharing your opinion on what millions of women you don’t know should do with their own bodies! Is there anything else that you’d like to weigh in on even though it’s absolutely none of your business?

          • Gene

            Err, Daleth, you know that was sarcasm, right? I couldn’t care less how a baby exits the mother as long as both are healthy.

            There is a very strong trend to excuse a section. That vaginal birth is the ideal and a section was performed only due to extreme circumstances. Hence the, “Oh, but MINE was an EMERGENCY”. I’ve had women apologize to me for having a section (or not breastfeeding their babies (I’m a doc). It’s truly bizarre.

            Anyone want to take bets on TLC showing laboring at home then the narrator (or whoever) talking about the rush to the hospital for the EMERGENCY section?

          • Daleth

            Sorry, couldn’t tell it was sarcasm. No tone of voice online.

        • Mimc

          It seems like some people call any unplanned c-section an emergency c-section. At my hospital they made a distention but I’m not sure everyone does.

      • Primip breech is an indication for C/S. Macrosomia [baby over 9 lbs] is an indication for C/S. Lack of progress is an indication for C/S.

        A century ago, Joy-Ann and her son would be currently mourned by the Duggar family and residing in a graveyard.

        • swbarnes2

          It’s an indication among sane professionals…not necessarily this midwife, or this family. And it’s hard to say what 20 hours of “grueling” labor means…average for primips is 18 hours total, right? Though most people would not call the first several hours grueling…were the family exaggerating a bit, or was she having contractions every few minutes for hours and hours?

          I guess my point was, if she had her first contractions 20 hours prior, and the kid was breech, I would think the doctors would not do an emergency C-section, just a fast one; that there would be time to, say, do the bloodwork for the epidural, do the epidural, wait for it to work…45 minutes delay, maybe? But an emergency C-section implies that they didn’t want to wait; so probably GA, and a classical cut to get the kid out pronto.

          Worse chances for VBAC after emergency C-section than a planned one, due to the cut, right?

          • Mimc

            I had an emergency c-section. There was no time for epidural, waiting for my OB, or even consent forms (they got verbal consent while rolling me into the OR). But they still did a low cut. So emergency doesn’t necessary mean a classical cut.

          • Sarah

            Same here, mine is very low. Below the knicker line.

          • Mimc

            Mine too. It’s a little crooked some the OB was in a hurry to get my baby out and on the support he needed. But that won’t matter once the hair grows back.

      • Pcogale

        I am finding that any sort of labour that ends up with a C/S is an emergency. So a booked C/S who SROM’s before her booked C/S date but not contracting is still a C/S. It’s a bug bear of mine. It’s still an elective C/S but done a little bit earlier. As for gruelling labour for 20 hours. I would hazard a guess and say some of that was early labour. For some women they think they are in good solid labour…. for hours…. but their cervix hasn’t started to dilate. Sometimes you can miss a breech if it’s a hard bum. But usually if there is any question, that someone will run a quick U/S to determine head position. Mind you there was one situation where an OB thought the baby was head down and confirmed with an U/S to make sure it was head down – it was. But a few hours later during a VE, it was determined that the baby was bum down. Turned during the induction. The OB said she was so glad she did do that U/S and it was definitely head down otherwise she’d be second guessing herself! But I suspect that they worked out it was bum down after the first VE…. many hours later.

    • 20 hours of labor to diagnose breech??????

      I wonder what sort of antenatal care she had, if any. But, of course, God will save!

    • Bugsy

      I’m glad someone else posted this. I have no medical training beyond what I read in this blog, and when I heard the details of her birth, all I could think was “how the heck did they miss a breech position of a baby who, by all intensive purposes, appeared to be incredibly large to a layperson?”

      I’m sure Joy-Anna’s son’s birth will be pumped up as evidence that midwives make the right decisions in getting moms to the hospital when needed, but all I keep thinking is that the whole thing was incredibly negligent and that Joy was in bad hands. In both of my pregnancies (non-macrosomic babies), my OBs were able to determine easily that the babies were head-down from about 30 weeks onwards. I have trouble believing that Jill, the sister/midwife, is truly competent by any means.

  • Mel

    I wonder how much the “out of control” feeling that the experimental group felt came from going through all the work of learning six different groups of techniques that will supposedly make labor pain completely manageable – only to find out once they were in labor that contractions hurt like hell.

    That would have scared the snot out of me because I would be having to ad-lib while dealing with pain…which is not one of my strong points.

  • Mel

    The saddest part is that blinding this study would not have been hard at all.

    Midwife A teaches the antenatal class with whatever techniques they can teach ahead of time. Midwife A also teaches L&D nurses to score patients for use of each of those techniques.

    Data coordinator B notifies nurses when a study patient is in labor – without knowledge of if the person is study or control.

    When participants are in labor, L&D nurses score each participant as having used/having not used each technique as well as type of analgesic used and outcomes.

    Statistician C crunches the numbers in the insane resulting data set.

    • AA

      I assume that the Australian midwifery system may be set up more similiarly to the UK midwifery system in that midwives are primarily staffing the L&D ward rather than nurses. If the Australian system is set up similarly to the UK system, the Midwife A role should be completed by someone who doesn’t work in the wards of the hospital where the survey is taking place; otherwise, it would be impossible to keep the system masked as Midwife A would likely care for the study participants and be unmasked.

      • Casual Verbosity

        I think this is the case in Australia. Many of our midwives are actually nurses as well (although this balance is changing with the introduction of specific midwifery undergraduate degrees), but I do believe our L&D wards are primarily staffed by midwives. So yes, Midwife A would need to be completely removed from the hospital environment in order to semi-blind this study. However semi-blinded is the best status this could ever achieve. Even if you didn’t know a woman was involved in a study, if she comes in using massage and acupressure, that tells whoever is caring for her that she’s into alternative pain management and will affect the kind of treatment she receives. Thus, this woman is far less likely to be offered an epidural in the first place and more likely to be counselled away from one if she asks, regardless of the midwife’s knowledge of her study condition.

        • Mel

          Oddly enough, I don’t think having it be semi-blinded is as much of a problem as long as all of the participants are treated as a continuum of natural birth practices compared to delivery outcomes.

          The problem from one of the assumptions of the original study: that the women in the control group were not using breathing techniques, acupressure, massage, visualization or whatever. The issue is that humans are more than capable of doing outside research on techniques they want to use in labor prior to delivery and outside of the antenatal class at the hospital.

          I’m willing to bet there were women in our theoretically better semi-blinded study who were slotted into the control group who showed up with Hypnobabies tapes and tennis balls for accupressure and got extra pressure to go all natural. Likewise, there are probably women in the experimental group that didn’t do all six of the trained techniques no matter how much they believed in it.

          The best solution is to track the usage of the techniques during labor and the outcomes of interest and use some more complicated statistics to look at the differences between techniques and outcomes. The study is insanely underpowered for that – but, hey, the original study is a POS at the design level so we’ve improved it….slightly.

          I’m curious how this got through human research committee with such sloppy design.

  • maidmarian555

    Am I reading it right that almost 70% of the women in both groups that had a vaginal birth suffered major perineal trauma (3rd/4th degree tearing or episiotomy). Is that average? Are all of those things equivalent in terms of potential for long-term injury or is it odd that they’re lumped in together? I mean, that seems high to me but I have no idea how common those things generally are. I appreciate this could just be because the small study size means everything is junk. I also wonder how they could even think of categorising that many women with that severity of injury a ‘success’ (other than they hate c-sections a lot more than vaginal injuries).

    • Heidi

      That seems weird to me too. Why would an episiotomy be lumped in with 3rd and 4th degree tearing unless the episiotomy ripped further during birth and the woman did have 3rd or 4th degree tearing?

      • maidmarian555

        It’s actually quite alarming looking at that because it’s dawned on me that I genuinely don’t really know about these things. Despite having an attempt at a vaginal birth. It really hammers home that you’re not warned about these kind of injuries or their frequency at all. I am totally clueless and I really shouldn’t be.

        • Heidi

          Those numbers are not similar to other things I am reading. I think 3rd and 4th degree tearing in first time moms is more like 3%. I am pretty clueless about how to read this study.

          • maidmarian555

            Having a butt massage during labour makes a episiotomy more likely? I guess that wasn’t the result they were looking for……

      • maidmarian555

        You know, I’ve been looking at the actual study and I think they might have done it to obfuscate results that might not be particularly positive. They claim the difference in major trauma is insignificant but the results for any trauma at all make the results for the magical woo course look much better. I’m no scientist but I do know about writing reports and manipulating data if you want to show a particular outcome. Seems to me, if there’s a big difference in some of the data that you want to hide, you just mash it in with something else and voila! It vanishes. If 3rd and 4th degree tearing is really high in either group compared to average birth stats, whilst people like Hannah Dahlen (who is currently waiving this nonsense about on Twitter like it’s the most important scientific breakthrough ever) won’t care about that, they are savvy enough to know it’d be picked up as a massive negative by pretty much everyone with any medical knowledge of birth and suddenly their study isn’t just junk, it’s junk that doesn’t help them push their agenda because nobody sane is going to support methods that result in major injuries. I can’t find anything in that study that explains why they’ve put all three measures together as one outcome. It’s just completely brushed off. I can think of any good reason for that.

        • Ozlsn

          I wondered that too. The way their data is presented in general feels… well, I had trouble working out who was considered a NVB and who wasn’t just for starters, and this is something that should be fairly defined I would have thought. I could not work out where some of their numbers were coming from, and I normally don’t have that problem with papers. (I may also be tired, there is that!)

          Also their demographic breakdown is quite odd – there are significantly more very high income women in the study group than the control group, which makes me wonder a bit about their recruitment process.

          But lumping 3rd and 4th degree tears in with episiotomy is frankly weird – I would have expected a table (even if it was only in the supplemental online data) breaking down the numbers a lot more than “oh, anyone who had any tearing or episiotomy – don’t worry the numbers don’t change if you break it down.”

          It would be interesting to see the raw data, that’s for sure.

    • Anne

      Data from one Australian state (Victoria) from 2015-16 cites a 6.5% incidence of 3rd or 4th degree tears for primipara in public hospitals (lower for multiparous women and primipara in private hospitals); so episiotomy rates would have to be > 60%. I don’t know how to explain this. New scissors?

  • aurora

    Omg let women have their epidurals and their elective c sections! I just can’t understand the obsession with going backwards to cave man times. If you want your crack massaged great but don’t take away the choice not to!

    • Zornorph

      Hey, I’m all for knocking women over the head with my club and dragging them back to my cave!

      • yentavegan

        !?….!

        • Zornorph

          Sigh…Poe’s law.

      • The Bofa on the Sofa

        What we’re gonna do right here is go back, way back, back into time.
        When the only people that existed were troglodytes…
        Cave men, cave women, Neanderthal, troglodytes.

        Let’s take the average cave man at home, listening to his stereo.
        Sometimes he’d get up, try to do his thing.
        He’d begin to move, something like this,
        “Dance…dance”.
        When he got tired of dancing alone, he’d look in the mirror,
        “Gotta find a woman, gotta find a woman, gotta find a woman, gotta find a woman”.
        He’d go down to the lake where all the women would be swimming or washing clothes or something.
        He’d look around and just reach in and grab one.
        “Come here…come here”.
        He’d grab her by the hair.
        You can’t do that today, fellas, ’cause it might come off.
        You’d have a piece of hair in your hand and she’d be swimming away from you (Ha, ha)

        This one woman just lay there, wet and frightened.
        He said: “Move… Move”.
        She got up, she was a big woman, big woman.
        Her name was Bertha, Bertha Butt, she was one of the Butt sisters.
        He didn’t care. He looked up at her and said,
        “Sock it to me, sock it to me, sock it to me, sock it to me, sock it to me
        Sock it to me, sock it to me, sock it to me!”.
        She looked down on him.
        She was ready to crush him, but she began to like him.
        She said, “I’ll sock it to ya, Daddy”.
        He said, “Wha?”.
        She said, “I’ll sock it to ya, Daddy”.
        You know what he said? He started it way back then
        I wouldn’t lie to you
        When she said, “I’ll sock it to ya, Daddy”
        He said “Right on! Right on! Hotpants! Hotpants! Ugh… Ugh… Ugh”.

        Jimmy Castor Bunch

  • PeggySue

    Blissful Belly Breaths? I’m afraid my blood pressure just shot through the roof. This is such garbage.

    • LaMont

      Yeah. The fact that people consider birth a spiritual *as opposed to* medical situation is bananas. Be as spiritual as you like, but don’t turn your unverifiable beliefs into policy.

      • PeggySue

        AGREED. Plus, how are you supposed to “belly breathe,” to say nothing of doing so Blissfully, when your Belly is Contracting? There seems to be a logistics issue.

        • LaMont

          Magical thinking. *Decide* to be blissful! Just make it happen! My cranky, atheist ass is just so annoyed at all of this. I’d be more willing to accept it if they didn’t package it as female empowerment. THAT is some hateful nonsense.

        • The Bofa on the Sofa

          Steve Martin – “I had a friend taking singing lessons. Her coach, 84 year old man – last gut in the world you think to be weird – but listen to this. He kept wanting her to sing….from her DIAPHRAGM.”

          “I mean, that would take years to learn that, wouldn’t that?”

    • Charybdis

      Since when do bellies breathe? Is THAT what the belly button is for? Belly breathing? Or some sort of snorkel for the baby in-utero?

      Do they even HEAR themselves?

  • Tigger_the_Wing

    If anyone had grabbed my buttock during a contraction, they’d have got a black eye.