File Hannah Dahlen’s latest paper under D for Duh!

Three wooden blocks spelling "Duh!".

What if I told you that people who take insulin are more likely to develop blindness than those who don’t?


Blindness is a known complication of diabetes and insulin is a treatment for diabetes. It’s the diabetes that causes blindness NOT the insulin.

The real issue is whether diabetics who take insulin are more or less likely to develop serious complications than those who don’t.

How about if I told you that people who have heart transplants have a shorter lifespan than those who don’t?

The critical issue, which the authors did not bother to address, is whether those who got the interventions did better than if they hadn’t gotten them.


If you need a heart transplant you are very sick indeed and your other organs might have been damaged by your weak heart before you became got an available organ. It’s the underlying disease that created the need for the transplant that caused the shorter lifespan NOT the transplant itself.

The real issue is whether those who need heart transplants and ultimately get one live longer than those who don’t.

Along comes Hannah Dahlen to tell us that those babies who need childbirth interventions have more bad outcomes than those who don’t.


But that’s not how Dahlen spins it.

On The Conversation, Dahlen writes.

Medical and surgical intervention during birth continues to rise in much of the world. Nearly one in three women who give birth in Australia have a caesarean section and around 50% have their labour induced and/or augmented (sped up with synthetic hormones).

Our new research, published today in the journal Birth, found babies born via medical or surgical intervention were at increased risk of health problems. These include short-term concerns such as jaundice and feeding problems, and longer-term illnesses such as diabetes, respiratory infections and eczema.

You remember the “journal” Birth, right? That’s the one owned by Lamaze International, the organization that makes its money by convincing women that childbirth interventions are bad. Although they routinely charge $38 dollars for 24 hour access to one article, they’ve conveniently made this one free so everyone can learn about the “dangers” of childbirth interventions.

But childbirth interventions are like insulin or heart transplants; the people who need them will often die without them. The real issue is whether those who need childbirth interventions do better or worse without them.

How did Dahlen and colleagues answer that question? They didn’t even bother.

In a paper of 11 pages in length, buried near the very end, is the single most important sentence in the paper:

…[W]e were unable to control for confounding by indication since the underlying reasons for the provided medical and operative birth interventions were unknown.

And that renders the results of this study 100% meaningless!

But that doesn’t stop Dahlen.

We found:

Babies who experienced an instrumental birth (forceps or vacuum) following induction or augmentation had the highest risk of jaundice and feeding problems needing treatment in the first 28 days

Babies born by caesarean section had higher rates of being cold and needing treatment in the hospital for this compared to babies born via vaginal birth

Children born by emergency caesarean section had the highest rates of metabolic disorders (such as diabetes and obesity) by five years of age

Rates of respiratory infections, such as pneumonia and bronchitis, metabolic disorders, and eczema were higher among children who experienced any form of birth intervention than those born vaginally.

Wow, they really had to slice and dice the data to make up something ominous.

And even Dahlen acknowledges that most of those results are entirely expected:

Forceps and vacuum birth, for instance, can cause bleeding and bruising in the baby’s scalp. These blood cells break down, releasing bilirubin that causes the skin to look yellow, which signals jaundice.

Babies born by caesarean section are more likely to be cold because the operating theatre is cold. Despite recommendations for the baby to be placed on the mother’s chest as soon as possible, this doesn’t always happen.

What she should have pointed out — but deliberately did not — is that babies born by C-section are often rescued from medical problems like fetal distress which necessitated treatment in the NICU.

What she should have pointed out — but deliberately did not — is that children born by emergency C-section are more likely to have mothers who are diabetic and obese (both of which are therefore more likely in offspring).

What she should have pointed out — but deliberately did not — is that large data sets are vulnerable to p-hacking.

Researchers look for statistically significant differences between two groups. Then they announce them as “findings” without acknowledging that any large dataset looking at multiple outcomes is bound to have random statistically significant differences that are coincidental and don’t represent real outcomes. Indeed, by definition using a p value of less than 0.001 means that almost 0.1% of the differences that appears to be statistically significant are actually due to chance and don’t represent a real finding at all.

How do you guard against p-hacking? The most important way is to recognize that it is always a possibility when analyzing large datasets; in other words, it is wrong to conclude that every statistically significant result in such an analysis is a real result.

Despite having found found NOTHING AT ALL, Dahlen proceeds to spin elaborate theories about her “findings.”

Reasons for the increased risk of longer-term problems are much less clear, but there are a couple of interesting hypotheses.

The first key theory is based on epigenentics: that life events affect how genes function and are passed on to the next generation.

Labor and birth exert a positive form of stress on the fetus, which impacts on the genes responsible for fighting off bugs, weight regulation and suppressing tumours. Too little stress (no labour and elective caesarean section) or too much stress (induced/augmented labour and instrumental birth) could impact the expression of these genes.

The second key theory is the extended hygiene hypothesis. This suggests that vaginal birth provides an important opportunity to pass gut bacteria from mother to baby to produce a healthy microbiome and protect us from illness.

If we have an unhealthy microbiome, we may be more vulnerable to infections, allergies, diabetes and obesity.

Dahlen doesn’t even asked the single most critical question.

Just as the key question for insulin and heart transplants is whether those who received it did better than they would have if they hadn’t received it, the key question for birth interventions is whether those who received them did better than they would have if they hadn’t received them.

Dahlen didn’t bother to look because that would have produced entirely different results than the demonization of interventions that drives contemporary midwifery theory.

File Dahlen’s latest paper under D for “Duh!” as well as D for “demonization.” It is not science; it’s ideology masquerading as science and it isn’t even very well disguised.

141 Responses to “File Hannah Dahlen’s latest paper under D for Duh!”

  1. Tanya Strusberg
    March 29, 2018 at 11:46 pm #

    Except the journal Birth is NOT published by Lamaze International. It is an independent peer reviewed journal.

    Check your basic facts before publishing.

      • Tanya
        March 30, 2018 at 1:45 am #

        I know for a fact that this is an independent peer reviewed journal that is highly respected internationally. It is not published by Lamaze (Wiley is the publisher) and it has nothing to do with Lamaze International.

        I’d also like to point out that Professor Hannah Dahlen of the University of Western Sydney is a highly respected academic whose research has been published internationally. The axe you grind is wearing ever so thin these days “Dr” Tuteur…

        • Amy Tuteur, MD
          March 30, 2018 at 2:20 am #

          Lamaze also gives it members half price subscriptions to Birth.
          I’ve been writing about the fact that Birth is published by Lamaze for many years. No one from the journal has ever denied it even after they scrubbed mention of Lamaze as originally appeared.

          It isn’t much of a journal. It’s just a place for natural childbirth advocates to publish papers that they couldn’t get into a more reputable journals. It also has an ideology and has publicly proclaimed that it will not support anything that contradicts that ideology.

          Hannah Dahlen may be respected by other midwives and doulas who believe her radical ideology but the rest of the world has no clue who she is and certainly doesn’t believe the nonsense she spouts.

        • momofone
          March 30, 2018 at 10:42 am #

          Oh, let me fix that for you–it’s Dr. Tuteur. No scare quotes needed. 🙂

        • The Bofa on the Sofa
          March 30, 2018 at 11:15 am #

          It is not published by Lamaze (Wiley is the publisher) and it has nothing to do with Lamaze International.

          Are you denying the statement in the picture posted that says that it is “Published on behalf of Lamaze International”?

          How can you claim given that, that it has “nothing to do with Lamaze International.”? It says it straight out.

          • MaineJen
            March 30, 2018 at 11:20 am #

            What are you going to believe, Bofa? Your own eyes? Or Tanya?

          • Anna
            March 30, 2018 at 11:26 pm #

            She is a “birthprepreneur” though. So I dunno, Harvard trained obstetrician or made up mispelled qual. Its hard to choose really.

        • MaineJen
          March 30, 2018 at 11:18 am #

          So you are explaining the screenshot of the ISSN and publisher…how?

          • The Bofa on the Sofa
            March 30, 2018 at 11:30 am #

            Fake news.

        • Sarah
          March 30, 2018 at 11:36 am #

          I imagine most of us here have a number of things we’d like to point about ‘Professor’ Dahlen…

        • Who?
          March 31, 2018 at 5:25 am #

          Yes, Prof Dahlen is an academic. How ‘highly respected’ she is might rather depend on the company you keep.

          Wylie publishes all kinds of stuff online, of varying provenance and quality.

        • H1N1
          March 31, 2018 at 6:59 am #

          Sure. Link to your ‘highly respected academic’ using defamatory language against doctors with a proven track record in publishing ACTUAL evidence.

          Not sold on that pedestal you choose to put her on.

          • mabelcruet
            March 31, 2018 at 5:18 pm #

            In that editorial/opinion piece, she is very keen to point out that the Kirkup report was ‘on’y’ into failings in one hospital but as a result, all midwives were being vilified. She deliberately and cynically attempted to limit the impact and downplay the seriousness of the issue, but that’s exactly what I would expect from a woman who holds protecting the status of midwives and pushing natural birth ahead of patient safety. This is a woman for whom dead babies don’t matter.

            Dr Kirkup actually made it very clear that this wasn’t an isolated problem, that this was one of a series of major issues in many hospitals and he had no doubt this pattern would be repeated again and again. Barrow-in-Furness triggered a nationwide enquiry into midwife led care, she forgot to mention that bit. It wasn’t a one-off, exactly like Kirkup said: Barrow-in-Furness, Shrewsbury and Telford, Countess of Chester, North Manchester and Royal Oldham, the list goes on, multiple infant and maternal deaths that could have been avoided. We need to do better, and we won’t until the midwives stop doubling down and stop denying their protectionist attitude and victim mentality is a part of the problem. I work with some amazing midwives doing their best in hideously understaffed and underfunded centres, and they are being badly let down by their college and by so-called ‘leaders’ like Caroline Flint who continue to propagate the ‘them and us’ attitudes and insist on protecting natural birth at the expense of mothers and babies.

        • March 31, 2018 at 7:47 am #

          Your assertion about the journal is incorrect. Most society-owned journals are in fact published by a for-profit publisher, such as Wiley, Elsevier, or Wolters Kluwer (LWW). Lamaze lists this journal in their list of professional resources (along with their monthly newsletter):

          The journal’s Wiley page also lists Lamaze on its “Society” page:

          Also, knock it off with the scare quotes for Dr. Tuteur, who does in fact hold an MD (although not a current license). That’s annoying and does not further your argument at all.

        • Heidi
          March 31, 2018 at 12:31 pm #

 There Tanya. Two minutes of homework. Did my research.

    • Charybdis
      March 31, 2018 at 11:36 am #

      Wikipedia is not considered a citable source; hell, my eighth grader knows that. You, not so much.

      • Tanya
        March 31, 2018 at 11:49 am #

        That image that Dr Amy posted earlier is doctored. All ANY ONE OF YOU needs to do is Google the journal, call Wiley (the publisher) and confirm for yourself if you don’t believe me. Your own blind faith of believing everything this woman writes on her blog and taking it as gospel, shows a profound lack of critical thinking on your part and everyone else who has jumped down my throat. Seriously. I challenge each one of you to DO YOUR OWN HOMEWORK. Look up the journal. Contact the publisher, contact the editor in chief and ASK THEM!
        Lamaze International only publishes one journal; the JPE (Journal of Perinatal Education), which it proudly promotes as a publication of Lamaze International. There is simply no reason whatsoever for Lamaze to secretly hide the fact that it produces a journal it doesn’t. That’s just ridiculous. Bottom line – all I’m asking is that you take some responsibility for your own fact checking. If you don’t believe me, that’s fine. You have no idea who I am. But that also doesn’t mean you have to believe every thing Amy Tuteur says is correct either.

        • Charybdis
          March 31, 2018 at 1:58 pm #

          And you have no idea about who we are either. You are correct in saying that Wiley is the publisher of Birth journal. Wiley publishes a ton of things for a wide range of people, companies, societies, etc. Doesn’t change the fact that they published the Birth journal ON BEHALF of Lamaze International and that members of Lamaze International are entitled to a discounted subscription.

          So, technically you are correct: Lamaze did not publish Birth journal themselves. They paid a professional publisher to do it for them since publishing is not Lamaze’s strong suit. Lamaze controls the content, not the publisher. But attempting to claim that the publisher is cranking things out willy-nilly with no oversight whatsoever. Try again.

        • mabelcruet
          March 31, 2018 at 4:46 pm #

          Please don’t shout, its rather impolite. When assessing the paper in question, its irrelevant who owns that particular journal. Regardless of ownership or publishing house, that paper is abysmal-I would be ashamed to put my name to a paper as shoddy as that one. The lead author has essentially twisted and tortured her data until it matches her pre-conceived and pre-planned conclusions, it has no objective merit whatsoever, its misleading, its unscientific and it should be withdrawn.

  2. Sue
    March 27, 2018 at 12:33 am #

    Here’s yet another thing that puzzles me about that study (aka number-crunching exercise): since they say they got the diagnoses from matched hospital data, up to five years of age, where do they get the diagnosis “hypothermia” from? What baby goes to ED to be diagnosed with “hypothermia” (unless they are immersed in icy water – another thing altogether)?

    What DEGREE of hypothermia, and did it lead to any adverse outcomes? If not, why report it?

    Looks like a bad case of data mining.

  3. fiftyfifty1
    March 26, 2018 at 7:37 pm #

    OT: Yet another inane opinion piece from Neel Shah MD in the latest JAMA. He bemoans the closing of rural obstetric units claiming that the driving factor is poor reimbursement for obstetric care by insurance companies. Does he not have a clue? Even if the reimbursement doubled, it still wouldn’t help. There has been a huge demographic shift. There just aren’t enough births anymore in many rural areas to provide a position for an OB. And then he goes on propose a solution: midwives + telemedicine. What?! Is he planning to coach these midwives step-by-step over Skype when “low risk” pregnancies turn out to need an emergency CS after all? Will he also coach them how to numb up the abdominal skin with novocaine so they can make the incision? Here’s a pro tip: pregnant women are older, heavier, and with more chronic conditions that ever before. Family sizes are small so more women are nullips. The combo means that A LOT of women are going to need interventions including CS. This means they better deliver in a place that is up and running for CS. This means there needs to be a full surgical nursing team, an anesthesia team and an OB (or rarely a general surgeon or a FP with surgical training.) You ain’t gonna get this in the middle of nowhere, and you can’t Skype it in.

    • guest
      March 26, 2018 at 8:54 pm #

      I agree that women are better served, and particularly higher-risk women, in larger, better equipped OB units in urban hospitals.

      I also can see that the barriers to traveling 20,30, even 60 miles, is not the hardship that it once was when rural community hospitals were established, and where they still serve a rural population.

      But here’s my question – should all rural OB units be shuttered – leaving wider swaths of rural areas without designated OB services? Could smaller critical-access hospitals combine OB services, and consolidate – so they’re aren’t many small, low-volume OB units, but a moderate volume, busier unit with more staff and resources? What is a reasonable distance to travel to get to an equipped L&D unit?

      There is no rule that says that women of childbearing age can’t live in remote rural locations (and they still do!) How do we best serve this population? Would requiring hours of travel (70-80-90 miles or more is easily imaginable) if smaller hospital OB units were closed be in the best interests of rural pregnant patients? Are there too few of these people that they don’t matter?

      What’s the ideal system of care? What role, if any, could smaller hospitals play in providing care during labor and birth for a rural population? What’s the farthest a pregnant woman could be reasonably expected to travel in labor for care?

      • fiftyfifty1
        March 26, 2018 at 9:50 pm #

        Unlike Dr. Shah, you are asking great questions and generating useful ideas! Could there be some way that the government could determine which hospitals should be critical access for OB, and then find a way to help fund them and, more important, staff them (and by staffing this means not just the doctor able to do the CS, but also the nursing staff, anesthesia staff, etc.)

        I think of the rural county where we vacation. It has a critical access hospital that receives some government subsidies. But even so, they recently stopped doing deliveries. The nearest hospital that does deliveries is now 1.5 hours north into Canada, or 2 hours south to the nearest American city of any size. But the hospital was doing fewer and fewer deliveries due to demographics. Even if insurance reimbursement doubled, they couldn’t have made it work. What good is double the money if you do only one delivery a month? They have trouble recruiting any doctors, much less a CS-capable doc, and this is despite the fact that the town is a beautiful vacation spot with great restaurants, culture, etc. Shah’s idea of midwives with Skype would not help at all. They already have family physicians who can, and do, provide prenatal care. It’s the delivery services that they can’t staff for, specifically the CS capability. The government would have to step in in a big way. And maybe they should just as you suggested. It’s a complicated problem, but Dr. Shah just proposes simplistic answers.

        • Ozlsn
          March 27, 2018 at 12:02 am #

          All of this is something that is a repeated topic of discussion in Australia, even with a government funded rebate system and government funded hospital networks. Rural and remote populations are difficult to provide specialised services for, including obstetric services. The hospitals where I and my siblings were born no longer do deliveries, partly as a result of difficulty attracting and retaining obstetricans, partly because of limited resources and lower numbers of deliveries means they are focusing more on the needs of an aging population. In practice it means that women in those towns are now travelling about an hour to the nearest regional hospital, and if the pregnancy becomes high risk being transferred to the major metropolitan hospitals which are up to five hours away in my not-very-big state (and much further in the big states.)

          • Anna
            March 27, 2018 at 7:19 pm #

            Maternity groups are campaigning for VBAC in tiny rural hospitals. Of course they will take precisely zero responsibility if one goes wrong. I do think it sucks for rural women though and I personally think if they can’t do a crash section or handle obstetric emergencies they shouldn’t be handling any births at all. I haven’t got any useful answers to the problem but I don’t think “demanding” high risk options is the way to go.

          • lsn
            March 29, 2018 at 2:53 am #

            Of course they are *sigh*. I have many thoughts on how my state could improve access to services, but they do require the cooperation of the federal government and AMA so… yeah, tricky. I certainly don’t have a problem with VBAC in a hospital equipped to deal with things going pear shaped, but most of the rural hospitals now really don’t have that capacity. Even the regionals have to look at emergency transfer when the baby requires more than SCN care, or the mother needs a high level of care.

        • Roadstergal
          March 27, 2018 at 1:07 pm #

          It’s definitely an issue with all services. You just can’t have a rural unit staffed to handle complicated pregnancies – just like you can’t have them staffed to handle radiation therapy, eg.

          I think it would help to de-stigmatize term induction. Not only is it healthier for women and babies, but it lets rural women plan a short stay near a proper hospital…

    • Amy Tuteur, MD
      March 26, 2018 at 10:27 pm #

      So obstetric care isn’t a money maker after all.

    • Sue
      March 27, 2018 at 12:34 am #

      Does Dr Shah provide obstetric services in small remote hospitals?

  4. BeatriceC
    March 26, 2018 at 5:45 pm #

    I am currently hanging out in a children’s hospital with YK, as he’s hooked up to a video EEG for the next 46 hours and 15 minutes. Ms. Dahlen probably thinks that his neurological issues are because he was born via CS, not because he was born at 24 weeks.

    • March 26, 2018 at 7:20 pm #

      Hope he’s doing okay.

      • BeatriceC
        March 26, 2018 at 8:14 pm #

        Thanks. He’s fine for the most part. Sleeping at the moment because he didn’t sleep last night on account of nerves. MrC is in with him right now. I’ve gotten myself involved with a group that helps resettle Middle Eastern refugees, mostly families on Special Immigrant visas (they grant those to people who’s lives and the lives of their families are endangered because they helped the US government in some way or another.) Many of these families have daughters who have not had the benefit of formal schooling, and are, of course, struggling a bit in middle and high school. I volunteer as a math tutor. I left to go to a tutoring appointment and the last word I heard was that he fell fast asleep. I’ll switch again with MrC later tonight.

        His neurologist ordered this test because of a couple of incidents and a whole lot of possible incidents that sound an awful lot like absence seizures. Nothing showed on the regular 1 hour EEG, but because he’s a former 24 week preemie, her index of suspicion is high and she wanted this 48 hour test. And frankly, this is pretty much the worst long term possible consequence of his prematurity. Considering that the survival rate of 24 weekers 15 (nearly 16) years ago was so incredibly low, and almost all of those that did survive have significant long term issues, I’m not at all upset if this does turn out to be seizures. That’s really not a huge deal compared to what could have been.

        • MaineJen
          March 27, 2018 at 8:28 am #

          2 things: You are doing good work with the refugees, and my heart goes out to your little one! (I know, at 15 he’s probably not so “little,” but you’re his mom so he’s a little one always!) I’ll be thinking of him today!

          • Empress of the Iguana People
            March 27, 2018 at 5:24 pm #

            My grandfather informed us at my wedding that we’ll always be his baby, and so will our babies. lol.

        • StephanieJR
          March 27, 2018 at 9:42 am #

          Hope that everything goes as well as possible with your son, and the lives of the students continues to improve.

        • Tigger_the_Wing
          March 27, 2018 at 1:02 pm #

          My second, the one who was an emergency forceps delivery, was only a month early, but he too had absence seizures (called ‘petit mal epilepsy’ back then), possibly as a result of being deprived of oxygen for a while. Although my instinct was to rush over to him as soon as he started one, what appeared to him to be me teleporting instantly across the room actually confused him, so I learned to be patient and stay where I was until he started to come online again. He outgrew the seizures by puberty, and hasn’t had one since (he’s 35).

        • Empress of the Iguana People
          March 27, 2018 at 5:22 pm #

          And hooray for MrC stepping up. 🙂 Must be equal parts worrisome and tedious as all get out for everybody.

    • Sarah
      March 27, 2018 at 2:50 am #

      It’ll be because you hatted him. Hang in there though.

  5. Amazed
    March 26, 2018 at 3:23 pm #

    Is she for real?

    This is what I’m getting, and please correct me if I’m wrong: this friend of mine who could, in theory, had a baby with her partner as soon as she decided that she wanted one, but in practice it didn’t work out, so she got pregnant a few milder interventions and a IVF later. She’s an older first-time mother currently in the hospital because they can’t get her blood pressure to stay permanently normal (she was warned that there was a risk for pre-eclampsia). So, if her baby needs to get out now, two weeks before she enters her eight month, every problem that she has will be because of interventions. Right. Yeah.

    Please send some good thoughts her way. She’s very scared, she’s physically unwell, and the baby is what you can expect of a not quite-in-the-eight-month baby.

    • momofone
      March 26, 2018 at 3:37 pm #

      I’m glad she’s in the hospital. I hope she feels better soon and all is well with her baby.

      • Amazed
        March 26, 2018 at 4:25 pm #

        I hope so very, very much! Well, we can always find a shoe box and a dropper to take care for the baby in and feed her with (Hannah Dahlen would approve, I suppose) but I really prefer highly unnatural technologies and I’m glad my friend is “enjoying” them. No need to say, if the baby needs to get out soon, it isn’t likely to happen in the “natural”, baby-led way.

    • Sue
      March 27, 2018 at 12:27 am #

      Sending best wishes for the best possible outcome.

    • Daleth
      March 27, 2018 at 10:10 am #

      Wishing them the best possible luck. 30 weeks is early but well past the riskiest bits. She’s in the best place she can be and they should come through just fine.

      • Amazed
        March 28, 2018 at 8:15 am #

        Thank you. She had the very “asshole doctors” scenario but she didn’t pack her bag and headed back home. She went to see the doctor who had done her IFV (in the same hospital) with her complaints, the head of the hospital got involved, her course of treatment was revised and today, she’s back home, blood pressure normal and all else *fingers crossed*.

        The thing is, the asshole doctors might have fucked over her treatment and certainly fucked up with their attitude but they still saved her when she arrived there with blood pressure skyrocketing. And their suboptimal treatment still kept her stable before their superiors intervened and changed it to optimal. What would have no interventions done for her?

        For the record: the experience had done nothing to change her opinion that she wouldn’t touch homebirth with a long pole.

    • lsn
      March 29, 2018 at 2:55 am #

      Best wishes to her and hope they can keep the BP stable as long as possible.

  6. fiftyfifty1
    March 26, 2018 at 3:14 pm #

    “The first key theory is based on epigenetics….”
    Here is a rule of thumb: Anybody who bases a theory on epigenetics without being an *actual scientist who specializes in epigenetics* is full of bullshit.

    • Roadstergal
      March 26, 2018 at 3:24 pm #

      Also, anyone who uses the word ‘theory’ to refer to a wild-ass hypothesis needs to go back to college.

    • Sue
      March 27, 2018 at 12:29 am #

      Lots of weird “theories” in that article, like babies experiencing “insufficient stress” in the birth process to be prepared for life. Cos the sort of stress that makes you poo in your own meconium is exactly what you need to start life!

      • Roadstergal
        March 27, 2018 at 1:13 pm #

        I mean, we can put C/S babies through a trouser press, to give them some of the ‘positive’ vaginal birth stress. Or just squeeze them really hard between dad’s legs.

  7. mabelcruet
    March 26, 2018 at 3:13 pm #

    Slightly off-topic, but the Royal College of Midwives continues its ducking and diving, trying desperately to evade any responsibility for the mess it presides over. Jeremy Hunt, the Health minister, has recently announced an independent investigation into how the RCM behaved over the Barrow-In-Furness cases (highlights included a loss father being bullied relentlessly online by RCM officials, and the RCM spending quarter of a million pounds to track him on social media, and taking more than 8 years to begin looking into individual midwives who presided over infant and maternal deaths).

    So, how does the RCM respond? First they say they want to be open and transparent, and then they present new plans that will enable the majority of fitness to practise hearings to be held in private, behind closed doors with no outside observers. I think they need to have another look at the meaning of transparency.

    And in other news, Sarah Page, the RCM head responsible for the fitness to practice regulation for the last few years has been quietly moved on, before the independent investigation gets going.

    And James Titcombe continues to be trolled by midwives-currently he is being criticised for daring to hold a conversation with Kirstie Allsopp (a UK TV presenter and business woman who is very vocal about having had C sections and refusing to be upset about it).

    As he says, the fish starts to rot from the head, and the RCM president Jackie Smith remains the rotting brain of the college (she was the idiot who accidentally sent Titcombe an email intended for someone else in the college bitching about him and how did he have time to write such long emails and letters. And then Byrom/Milli Hill complained about Mr T publishing the email and bullying Smith). Honestly, you couldn’t make it up.

    Open and transparent. Aye, right.

    • Spamamander (no mall bans)
      March 26, 2018 at 5:17 pm #

      There really should be a special place in Hell for people who harass Mr. Titcombe and other loss parents.

    • Anna
      March 27, 2018 at 7:20 pm #

      I hope that the investigation results in some changes at the RCM and I hope it doesn’t take so long that the story has faded from public memory by the time it happens.

      • mabelcruet
        March 28, 2018 at 3:31 am #

        The poor man is now being serially trolled by a person on twitter using the name Jimmy breastbrush, accusing him of lying, bullying, physically threatening midwives in Barrow in Furness, collusion with the secretary of state to destroy midwives, lying about the circumstances of his sons death-its relentless. JT has reported it to police and twitter but no action has been taken. But the far more awful thing about it is that this breastbrush user ‘follows’ several of the midwives who have been most involved with, or responsible for the abuse JT has faced, and not one of them has made any comment about the lies and insults he is getting hit with.

        • Anna
          March 28, 2018 at 4:51 am #

          Thats just bloody awful. You can be sure the midwives know about it and one word from them could stop it.

  8. Heidi
    March 26, 2018 at 2:20 pm #

    Somehow it seems, all my Facebook friends are either pregnant or just had a baby. I’ve seen two emergency C-sections after lengthy attempts at vaginal birthing and both pictures of the babies, the babies were wearing oxygen and had brief stints in the NICU. So yeah, I doubt those babies were placed on their mother’s chest right away. I suspect they had to be whisked away and the mother may have also needed some medical care. The truth is if they had chosen an elective C-section, there’s a really good chance those babies wouldn’t have needed oxygen or urgent medical care and could have had that skin to skin the birthies have such a hard-on over. I’m not saying that in a judgmental way at all towards the mothers. I didn’t choose a C-section myself. I lucked up and vaginal birth but with induction intervention worked out for me. I’m just saying if you think skin to skin to stay warm is that important, then I’d suppose the best way to ensure that is elective C-section. I’m also pretty sure the situation that required an emergency C-section was a negative stress on the baby but not so much the C-section itself. Of course, I also don’t buy that “negative” or “positive” stress has any meaningful impact on genes or gut bugs.

    • Roadstergal
      March 26, 2018 at 2:35 pm #

      Seriously. The real comparison is prelabor C-section vs attempted vaginal birth for comparable-risk pregnancies.

      If you’re putting an attempted VB that goes south into the C/S category. you’re giving people the wrong information. And I’ve mentioned before, but it’s a vicious cycle. People use this kind of BS to scaremonger women away from C/S, so they stick with the VB plan until things get _really_ bad because they’re so scared of C/S, which makes the stats for C/S look worse. Rinse and repeat.

      • Casual Verbosity
        March 26, 2018 at 6:03 pm #

        It’s similar to the way that adverse outcomes caused in a birth centre or home birth environment get counted towards the hospital’s statistics if the case is transferred. The lifesaving procedure or institution gets to cop the blame for the problem.

      • Valerie
        March 26, 2018 at 9:15 pm #

        Right. Nobody gets to decide between having a CS/induction or a spontaneous vaginal birth: it’s between an intervention or “wait and see” because a successful vaginal birth is not guaranteed. So really, they should have compared an elective CS or inductions group to an expectant management group, which may include stillbirths, emergency CSs, instrumental deliveries, etc.

    • maidmarian555
      March 26, 2018 at 3:28 pm #

      I do find the current insistence that skin-to-skin whilst being stitched up in theatre is ‘absolutely essential and everyone can have that’ is a bit troubling to me. I firmly believe if it’s possible and safe to do so and it’s what the mother wants to do then that’s one thing. But there’s very little discussion of how uniquely vulnerable you are and may feel in that situation. I was already exposed from the waist down to a room full of people, having my top half exposed and having a midwife standing over me fussing and helping me hold my baby whilst I couldn’t move would have been horrible. I also bled out a bit and it made me feel violently nauseous (both time) and got the shakes (with #1 only). My OH was snuggling our children and I was able to focus on talking to the anaesthetist until they sorted these things out and I felt better again. These things came on very suddenly. It just seems like a slippery slope where we’re heading towards a point where it’s not enough to have a c-section,you must also have the same pressures of vaginal birth with a *perfect* c-section with skin to skin, dim lighting, super-delayed cord clamping etc etc. Both times I did skin to skin in private, in recovery within an hour of giving birth so we did it, just not immediately. I’m glad I didn’t have that additional pressure.

      • Heidi
        March 26, 2018 at 3:38 pm #

        I had a non-complicated vaginal birth so I did skin to skin. Thankfully, I was asked if I wanted to do it before I gave birth and I agreed to it. I am pretty neutral about it having experienced it firsthand. I would do it again if everything went smoothly, but nothing magical happened. My baby still had hypoglycemia (which they claim skin to skin somehow prevents) and my milk never did get the message it was supposed to really come in despite breastfeeding right away and often.

        • Casual Verbosity
          March 26, 2018 at 4:04 pm #

          I’ve always felt like the skin to skin argument was at least slightly misconstrued. At the very least you need to acknowledge the possibility that being a candidate for immediate skin to skin means your baby had better outcomes to begin with than those who couldn’t receive it.

          • Roadstergal
            March 26, 2018 at 4:16 pm #

            Exactly this. If your kid is stable enough to do skin-to-skin, they’re probably doing pretty well – and if they have anything minor and self-limiting, STS will get the credit for ‘fixing’ it.

        • maidmarian555
          March 26, 2018 at 4:16 pm #

          I did enjoy it with my children but (being totally honest) at that point they’d been cleaned up and had a nappy on so I didn’t get peed all over (which has happened to several of my horrified friends). I think also because we were in recovery, everything was done so I didn’t have any immediate worries (rightly or wrongly) about what was going to happen next or if we were both actually ok. It was just a nice, peaceful, calm moment. I have no idea about the health benefits or lack thereof but I do know in theatre I *wanted* them to be properly checked over (especially my son) before we got to have cuddles to be sure they were ok and I also know it was really special for their father that he got to hold them first. It just seems to be a way to get the midwife (who I don’t even remember being around for either procedure- I mean, they were there but it was the OBs and the anaesthetists I interacted with) to be more involved in what should actually be an intimate moment for the family.

          • Christine O'Hare
            March 26, 2018 at 5:24 pm #

            Very similar story for me. Had C-section, I actually was having a panic attack so once baby was out they drugged me up. Husband went with baby and I came to as they wheeled me back into my room and the first thing I saw was my husband doing skin to skin with the baby. Once I was awake enough, I did skin to skin with her and it was lovely. But was incredibly special for dad and baby to have that time. And yeah, I’m really good with her having a diaper on by the time I got to hold her 🙂 But not doing skin to skin with her immediately has had no detrimental effects for her, me, or breastfeeding.

          • maidmarian555
            March 26, 2018 at 5:42 pm #

            When my son was born they lifted him up and lowered the screen so we could see him and he immediately started peeing! They whipped that screen back up super-fast and I am so glad they managed to catch it because otherwise it would have gone right in my face as I was completely immobile. Not quite the magical moment I’d been told meeting my baby would be!

          • mabelcruet
            March 29, 2018 at 3:34 pm #

            But that’s a great story to tell his future spouse!

            My newborn nephew managed to pee on the cat. His nappy was being changed on the kitchen table (disgusting, I know!) and he peed in a perfect arc right over his shoulder and it landed on the cat. Poor thing looked terrified (cat, not baby)

          • maidmarian555
            March 29, 2018 at 4:02 pm #

            Ha! I have so many pee and poop stories. The only time I’ve ever heard my OH actually scream was caused by my daughter firing poop at him during a particularly unpleasant nappy change.

      • Jen
        March 26, 2018 at 5:25 pm #

        I’ve had 2 maternal request cesarean deliveries. Both times the nurses wanted to hand me the baby for skin to skin. I adamantly declined both times. My husband was sitting right next to me, perfectly able bodied. No idea why I was thought to be a better choice to hold the tiny newborns while I was actively being stitched up and feeling woozy from major abdominal surgery.

        • mabelcruet
          March 29, 2018 at 3:31 pm #

          Plus paternal hairy chests might help baby regulate their temperature better, kind of insulation. And it gives the baby something to hold onto when they are doing the breast crawl up to the nipple…

          I wonder if anyone has looked at thermoregulation in babies who go skin to skin with (probably) non-hairy mum, versus skin to skin with (hairy and non-hairy) dads. It would be a perfect study for the Christmas BMJ!

      • Gæst
        March 26, 2018 at 11:27 pm #

        I did not have skin-to-skin contact with my babies until a week and a half after they were born (for whatever reason, it was discouraged while they were in the NICU). I dare anyone to come at me with claims of how this harmed my children – I will rip them to shreds. Not only was it unsafe for me to try and hold twin preemies while extremely groggy and lying flat on my back while being stitched up, it was also completely unnecessary. They were EBF, they could not possibly be more bonded to me. They were warmed with blankets and incubators. I’ve had people try to claim that my son has asthma because of the c-section, but nope. The surprising thing is that my daughter *doesn’t* have asthma. I have it, my mother has it, and my great grandmother had it – and all of us *were* birthed vaginally.

    • mostlyclueless
      March 26, 2018 at 6:58 pm #

      Well, sometimes you don’t know that you’re going to have a horrible fucked up labor ending in emergency c-section. Speaking from experience. Surely you aren’t suggesting that every single pregnant person on earth schedule a c-section to avoid the possibility of an emergency c-section…?

      • Casual Verbosity
        March 26, 2018 at 7:08 pm #

        That’s not what Heidi is suggesting at all, rather that one can’t truly choose a vaginal birth; you can choose to attempt a vaginal birth, but that may still result in an emergency c-section. If you like your outcomes to be more certain (not completely certain, but more certain), a pre-labour c-section is the way to go.

      • Heidi
        March 26, 2018 at 7:38 pm #

        See Casual Verbosity’s response. I don’t think all women should have elective CS unless all women want elective CS. But it’s not fair to lump in elective and emergency CS together and make generalized statements about C-sections. Because of course a person with a baby that was in peril during labor that resulted in an emergent CS isn’t going to get to be put on their mom’s chest. They are going to be whisked away. I place absolutely no stock in immediate skin to skin anyway so I just know I would never choose an elective CS for that purpose. I vaginally birthed because there were no contraindications in my case and it lined up with my priorities. If something emergent happened, and it could have, I wouldn’t blame myself for not having had an elective C-section.

        • mostlyclueless
          March 27, 2018 at 12:43 am #

          It sure sounds like you’re blaming the moms who had complications relating to their emergency c-sections for not preemptively choosing elective c-sections.

          • Heidi
            March 27, 2018 at 7:57 am #

            To you.

          • Heidi
            March 27, 2018 at 9:44 am #

            Since I have access to a computer now, here goes. Dahlen is the one who made the absurd claim that a negative impact of a C-section was that babies were less likely to do immediate skin to skin. She is the one demonizing emergency C-sections when the outcome would have been possibly a dead baby. Per Dahlen, “We were unable to control for confounding by indication since the underlying reasons for the provided medical and operative birth interventions were unknown.” She is also giving credence to ideas that have no scientific backing, such as “negative” stress causing epigenetic changes. I am not the one giving her “wild-ass hypotheses,” to quote Roadstergal, any stock. I am saying if Dahlen really thinks immediate skin to skin and negative stresses are the actual cause of negative outcomes versus the issues that led to an emergency C-section or instrumental birth, then she should be all about elective C-sections because statistically one would be more likely be able to do immediate skin to skin, they would skip risking an instrumental vaginal birth, and other risks would be lessened.

  9. Sarah
    March 26, 2018 at 2:11 pm #

    I’ll be filing it under D for Dickhead.

  10. Roadstergal
    March 26, 2018 at 1:50 pm #

    I’d love to get her in a room and ask her to explain epigenetics, using her own words.

    The salad would be delightful.

    • Gæst
      March 26, 2018 at 11:28 pm #

      Don’t forget to bring dressing.

  11. crazy mama, PhD
    March 26, 2018 at 1:10 pm #

    I would argue that an association between C-sections and certain medical issues is a sign that the system is working correctly; i.e., higher-risk situations are being appropriately identified and CS are mostly being performed when the situation is higher-risk (as opposed to CS being pushed on everyone the way natural birth fanatics like to claim).

  12. The Bofa on the Sofa
    March 26, 2018 at 12:49 pm #

    Interestingly, they can’t do a controlled study. Because it would be unethical to withhold c-sections from those cases where they have been done. Therefore, they can’t compare to a “didn’t have a c-section” control.

    • Roadstergal
      March 26, 2018 at 1:48 pm #

      I mean, they did it for breech birth – and the results were pretty shockingly Not In Favor Of Vaginal.

  13. Empress of the Iguana People
    March 26, 2018 at 12:46 pm #

    Also, more blind people have had eye surgery than sighted people.

  14. Squillo
    March 26, 2018 at 12:40 pm #

    It would be great to have more good research examining the long-term effects of interventions. It would be even better to have more good research on predicting which mothers and babies really need interventions.

    • March 26, 2018 at 12:51 pm #

      The main issue I can see is survivorship bias.

      Bluntly, the “no intervention” group is always going to look better on paper than the “intervention” group because failure to intervene will eventually lead to dead babies who disappear from follow-up research.

      Conversely, the intervention group is going to contain people like me, my twin sister and my son. We’re three people in two generations with moderate or severe neurological or respiratory outcomes that “ding” the intervention group – but we’re alive and thriving.

  15. anh
    March 26, 2018 at 12:04 pm #

    So, apparently my c-section caused my daughter’s Spina Bifida and not the other way around. Glad that’s clear now 🙂

    • Tigger_the_Wing
      March 26, 2018 at 9:41 pm #

      How is your daughter doing?

      Since a mild form of spina bifida runs in my husband’s family, I really wanted a C-section if it had been detected in any of mine, to protect them. As it turns out, the only one who inherited it was so mild he wasn’t diagnosed until he was twelve years old, despite that pregnancy having more many more scans than my previous one (I had none at all for the first two; they weren’t available).

  16. momofone
    March 26, 2018 at 11:29 am #

    So today is the eleventh anniversary of my absolutely wonderful c-section. My son was born at 38+3 due to placental degradation and an old mother who had spent almost 2 decades trying to have a child. I truly shudder to think what the outcome might have been had we had to wait until 39 weeks, or even longer–or, heaven forbid, for him to decide to “come earthside.” Thanks to my OB, and his skill, I spent this morning celebrating and then ruining my son’s day/life rather than mourning the loss of the most precious person I can imagine. I could not care less if he had asthma, or was obese, or diabetic; I am grateful that I get to figure out how to navigate his pre-teens and alternately be his favorite person and the biggest obstacle to anything good in his life. 🙂

    • StephanieJR
      March 26, 2018 at 2:53 pm #

      Happy birthday, son of Momofone! And very merry unbirthday to you, Momofone!

    • Amazed
      March 26, 2018 at 3:19 pm #

      Happy birthday, kid!

  17. CSN0116
    March 26, 2018 at 11:17 am #

    “Labor and birth exert a positive form of stress on the fetus, which impacts on the genes responsible for fighting off bugs, weight regulation and suppressing tumours.”

    What in the actual fuck.

    • March 26, 2018 at 12:38 pm #

      Infants being eaten by insects is a major cause of childhood mortality in Dahlen’s world, apparently. The little tykes need to be armed and ready to smush, crush and eat the insects before the insects get them.

      • Ozlsn
        March 27, 2018 at 6:11 am #

        Well she is in Australia. The insects that survive the spiders and other creatures are pretty tough. Some of those Sydney cockroaches could probably carry off a newborn…

        • Tigger_the_Wing
          March 28, 2018 at 7:36 pm #

          Carry off a newborn? That’s nothing, cockroaches in Adelaide could carry off the parents. 😉

          (Waiting for the anecdotes from Melbourne, Brisbane and Perth. The cockroaches in Canberra are all on Capital Hill.)

  18. mabelcruet
    March 26, 2018 at 10:53 am #

    D for dense. D for dumb. D for dolt. D for deficient. D for despicable. D for dopey. D for daft.

    Over on twitter, the usual suspects are all twittering about what a wonderful paper it is. My cat knows more statistics than that lot.

  19. mabelcruet
    March 26, 2018 at 10:46 am #

    There she goes again with the long words she doesn’t understand. Epigenetics. Yes, its a huge, fascinating and potentially revolutionary field of research, and there are some very interesting results. But to say ‘Don’t have a C-section because of epigenetics’ is absolutely ridiculous.

    Take a baby in utero in distress, abnormal CTG, maternal pyrexia, whatever. We know that baby is at a real risk of brain damage, even death. Balancing a very real and immediate risk against a possible but nebulous and not quite understood potential long term risk which may or may not turn out to be real and may or may not turn out to be significant, but we don’t know yet is frankly stupid. But that’s what she’s doing-spouting long, sciency words to frighten parents with absolutely no idea what she’s bleating about, and its all to serve her ultimate purpose, which is to keep women in the midwife realm and out of the hands of obstetricians, because you know, obstetricians are all knife-happy butchers who just cut you for no reason.

    • mabelcruet
      March 26, 2018 at 10:48 am #

      I apologise for the appalling sentence structure and punctuation in the above post. I’m caffeine deficient.

    • March 26, 2018 at 12:46 pm #

      I felt like the first six weeks that Spawn was in the NICU was filled with neonatologists warning me that we had were facing the following choice:
      a) Choose a medical intervention to avoid a horrible, terrible, no-good, very bad complication that would really mess up a major organ system in Spawn ….but it might cause a mild to moderate delay when he was a toddler.
      b) Do nothing and hope the insanely disturbing potential complication resolved itself.

      I had no problem choosing a because I really doubted that the studies that found the delays had done good, solid case matching. Mainly because a good number of babies who developed the scary complications didn’t survive long enough to be measured as toddlers.

      • Ozlsn
        March 27, 2018 at 6:22 am #

        When my son hit two I remember thinking “oh yeah, there were things that might be a problem that we’d start noticing at this age” and it felt surreal. When we were making the decisions two was an unimaginable eternity away – and suddenly there we were. And I had no idea what was normal any more, so noticed nothing out of the ordinary – he had oxygen tubing, a feeding tube, could sit up, all totally routine as far as I could tell. Took me until we started seeing more mainstream and term kids the same age (ie after he was off oxygen!) for me to realise that he was perhaps not doing some of the same things they were, and to wonder if that was what they’d been meaning… he wasn’t that far off the kids in the early intervention groups, so another variation on ‘normal’.

  20. MaineJen
    March 26, 2018 at 10:37 am #

    “Higher rates of being cold?” Now I’ve heard everything. Talk about “duh”

    • momofone
      March 26, 2018 at 11:44 am #

      Well, you know how it goes–cold leads to a cascade of interventions–skin-to-something-other-than-skin, blankets, hats! Where does it end?!

      • MaineJen
        March 26, 2018 at 12:12 pm #

        “Studies show that being in a cold room leads to higher rates of sweater wearing. Women who wear sweaters are no longer shivering. Shivering is what our bodies were made to do!!1! Let’s call for a return to physiologic shivering.”

        • mabelcruet
          March 26, 2018 at 12:51 pm #

          Now I’m conflicted. Wearing sweaters is an unnatural intervention. We should be promoting natural methods-lets ban all hair removal, no waxing, no shaving-stay hairy, stay warm!

        • Gæst
          March 26, 2018 at 11:32 pm #

          I have actually seen it argued that you can lose weight by not wearing a sweater – because if you’re cold, your body expends more energy. Which, yes, but….

      • Gæst
        March 26, 2018 at 11:31 pm #

        Well, in that case c-sections lead to higher rates of cuteness! Hats make neonates so adorable!

        • Sue
          March 27, 2018 at 12:42 am #

          Actually, not having to have your head squashed to get out CAN lead to higher rates of cuteness!

          • Gæst
            March 27, 2018 at 7:43 am #

            That too!

          • MaineJen
            March 27, 2018 at 8:34 am #

            My poor stepson had such a cone head in his newborn pictures, from trying to make his way out of a bicornuate uterus for hours (ended in a c section, thank goodness!). Still cute though!

  21. March 26, 2018 at 10:27 am #

    What really annoys me is the media reporting breathlessly that “Interventions cause problems!” when that is so obviously not what the stinking study found! That single sentence–“…[W]e were unable to control for confounding by indication since the underlying reasons for the provided medical and operative birth interventions were unknown” means that the paper should have been shot, buried in an unmarked grave, and never spoken of again, not circulated by credulous (and lazy) reporters.

    • Ozlsn
      March 26, 2018 at 3:36 pm #

      None of them read the paper. They read and reported the press release.

      Frankly the fact that that article was published in an “academic” journal is appalling. A half decent reviewer should have ripped it to shreds.

      • Amy Tuteur, MD
        March 26, 2018 at 5:58 pm #

        It’s not really an academic journal. It’s published by Lamaze, which carefully hides that fact.

        • Amazed
          March 26, 2018 at 7:15 pm #

          Let alone the fact that The Conversation seems to be something like Hannah Dahlen’s personal cheerleading page but they repeatedly refused to publish the professor who treats (and often fails) to help women in the aftermath of lovely non-interventional births when they realize that their perineal trauma isn’t going to disappear if they squeeze their legs together for the next 20 years or so as the Dahlens of the world undoubtedly tell them.

          • Sue
            March 27, 2018 at 12:43 am #

            TC does seem to be a big outlet for Dahlen. Interestingly, she never responds to questions or comments. And her cheer-squad often come over to the comments section.

          • Anna
            March 27, 2018 at 8:16 pm #

            THIS! She lets alarming clangers sit on her FB page too and never answers back. Recently there was one on the WHO report on maternity care and a registered midwife (I looked her up on the AHPRA register) posted “so how do we stop intevetions!?”. Yep, thats how she spelled it! After what happened in the UK nothing has been learnt. Can she not see that other midwives look up to her and misconstrue her message to mean that it is midwives mission to “stop interventions”? She’ll stop to comment back to someone “thanks lovely” or “you too” or whatever. She could take 2mins to respond to a message like that saying “well, lets not throw the baby out with the bath water, interventions are often necessary to ensure the safety of Mother and baby”. Midwives go out into the community thinking that they must prevent interventions and when it goes to shit where is Hannah Dahlen then? She’ll be claiming witchhunt and fake news I suppose.

        • mabelcruet
          March 27, 2018 at 2:26 pm #

          The problem is though, there are genuine obstetricians and paediatricians who are claiming this is a robust quality paper published in a proper peer reviewed journal (Umesh Prabhu, Reena Aggarwal in particular-having heard her speak a a conference a couple years ago I thought she was fairly sensible but obviously not). They seem to have swallowed the whole ‘interventions are evil and this paper proves it’ line completely-James T is cutting and pasting sections of the paper about confounders and risks of over-interpretation and they are still denying there are any problems with it.

          • maidmarian555
            March 27, 2018 at 4:18 pm #

            They aren’t recognising that their position, education and privilege means that they can actually read that study, understand the holes in it and move on. The damage the headlines in the media do is far-reaching. Mums who are pregnant now will just get the message that interventions are ‘bad’ and this may cause them to delay consent to needed interventions during birth or feel traumatised because they do consent to them and are therefore ‘risking damage’ to their baby (and that feeling is powerful). Many of us (myself included before I stumbled across this community) don’t have the tools, inclination or necessary education to get past whatever headlines we happen to absorb whilst pregnant, and that’s the entire point of this study. Hannah Dahlen doesn’t care if she is personally responsible for an injury, death or causing trauma as a result of this. Just as long as unmedicated vaginal birth is kept on its magical pedestal, she doesn’t give one fuck about the personal consequences this may have for individuals because she won’t have to deal with it.

            It’s really easy for an educated doctor to look at it, see the study’s limits are ‘obvious’ and not take the results to heart. Not so easy for a normal mum to skim past a headline saying ‘Interventions during birth cause millions of horrible problems for your baby’ and not internalise that message.

          • Anna
            March 27, 2018 at 8:07 pm #

            Excellent comment. I keep trying to “figure out” Hannah Dahlen, Rachel Reed, Sheela Byrom, the RCM, the ACM and their fan girls. Its becoming more and more obvious to me that they just do not give a fuck about women and babies. They only care about advancing midwifery care (over team care) and homebirth. Its obvious to me NOW but it certainly wasn’t when I was in the thick of it. I’m not a stupid person but I’m not scientifically trained so I took the words of trained professionals, the studies they presented showing me homebirth was safe and the media that agreed with them. One of the key elements in my decision making was the idea that hospitals do loads of unnecessary and harmful interventions. I was presented the argument that homebirth has far lower rates of interventions and true complications are vanishingly rare. So I thought I was trading off a sort of 1 in 10,000 type risk of a complication at home for the almost certainty of unnecessary and “harmful” interventions in hospital. Asthma, diabetes, obesity, lower IQ blah blah blah the list goes on and on. On the other hand, you’re told by the registered health professionals you’ve hired to care for you that ruptures never happen in homebirths because they don’t make you lie on your back and be “stressed”, complications like abruptions, cord prolapses, cord compression, dystocias are caused by interventions is what I was told so naturally if I avoid interventions I won’t have a complication. When you listen to these women and follow their advice and it goes wrong they no longer want anything to do with you unless you are going to play the denial game. So the loss parents get “stupid selfish bitch” from the mainstream and “angry, bitter, delusional trying to find someone to blame” from the community you trusted and believed in.

          • Amy Tuteur, MD
            March 27, 2018 at 9:00 pm #

            They exist in an echo chamber on social media. They never face engage with anyone who disagrees with them.

          • maidmarian555
            March 28, 2018 at 10:39 am #

            The way they (often quite openly) treat and speak to loss parents is shocking. I think there are certainly some within that movement who seem to believe that a few avoidable deaths are acceptable collateral damage. Of course, that’s because those avoidable deaths tend to happen to other people and their children, I do not know how some of them sleep at night.

            I had a pretty eye-opening run-in with some of them whilst I was heavily pregnant with my daughter. Hadley Freeman (Guardian journalist) was tweeting about c-sections and I tweeted that I was really grateful I was having one for my breech baby as I didn’t know how she was getting out safely otherwise. Milli Hill appeared out of nowhere, telling me I didn’t ‘need’ to have a CS for a breech baby, there were lots of ‘options’ and she knew it was ‘really scary’ (DM me hun). I firmly (but politely, which I’m not always on Twitter) pointed out this was an elective section that was booked before I knew my daughter’s position, that she was not a candidate for a vaginal birth as she was wedged down one side and no part of her was anywhere near my pelvis, that I was happy with my choices and as this would be my second CS, I really wasn’t scared. The next thing I know, the thread is being continued by a whole bunch of midwives all talking about vaginal breech and/or gentle cesaereans and a whole bunch of other nonsense I’d been clear I wasn’t interested in. Someone else pointed this out and and was promptly told that they weren’t talking *to* me anymore, they were just having a very interesting discussion about these things. Whilst continuing to tag me. And talking about me. It was really surreal but it cemented my view that they really don’t care about individual women and babies. It’s all about the birth. It’s all about the midwives. These are people who are supposed to be good at caring for mothers and yet they couldn’t even manage basic manners or to be respectful of me as a human being who’d made my boundaries clear. It was also alarming they felt so comfortable telling me what I should do when they knew nothing about me or my medical history. They’re a dangerous and irresponsible bunch.

          • Heidi
            March 28, 2018 at 12:12 pm #

            Jeeezus! I don’t even really have words for that.

          • maidmarian555
            March 28, 2018 at 1:42 pm #

            The best bit was the plethora of #withwomen and #listentoher hashtags, used seemingly without one shred of self-awareness as they continued to ignore my insistence I did not want any of the many things they seemed to think I was in desperate need of. Midwife twitter is batshit.

          • Heidi
            March 28, 2018 at 9:32 pm #


          • Anna
            March 29, 2018 at 1:53 am #

            They must all follow the same handbook. Aussie midwives and NCB advocates are trying to co-opt the #metoo movement and Hannah Dahlen is using the #enough hashtag which Im pretty sure is for raising awareness of violence against women. Fine if she is talking about actual violence against women but she has used that hashtag to moan about homebirth midwives being audited.

          • Anna
            March 30, 2018 at 1:18 am #

            I’m so glad I’ve never bothered with Twitter. Facebook is bad enough but I think theres something about Twitter that brings out the worst in people.

          • Anna
            March 28, 2018 at 9:16 pm #

            Ugh. As if we don’t have enough of them here Homebirth Australia imported Milli Hill for their recent conference. What are her qualifications exactly? Self appointed expert? She had a home birth so she knows better than everyone else and can give medical advice online without any background info? I see it time and time again. These acolytes of the big wigs who pop up to tell women they don’t need to listen to medical professionals. If someone tries to assert themselves then yep, they all start to pile on. I’ve had it happen to me a few times. I’ve tried to talk about my loss and I’ve had uni lecturers and leading homebirth midwives try to shut me down with incredibly callous comments. Then that comment will get 20likes. People who know nothing about what happened to my daughter will try to say the same thing could happen in hospital. Well theoretically it can but its very very rare. People will continue the conversation around me, like “some women just don’t want to accept responsibility” – then I ask “are you blaming me?” and they say “oh, no we’re not talking about you” “who said blaming?” shit like that. In the public groups and pages they let the minions do the talking but you know who’s pulling the strings behind the scenes.

          • maidmarian555
            March 29, 2018 at 2:17 pm #

            Sitting outside it, you can see that what they’re deliberately doing is encouraging mothers to come into direct conflict with their actual care providers. Drive a wedge between a mother and the people responsible for her care and she’s not going to have a ‘perfect’ birth experience (particularly if she’s been told she absolutely needs and can have a whole host of things that not all hospitals are even equipped to provide). So for her next birth, she’s going to buy all their books, their essential oil blends, the birth balls etc etc etc. She’ll probably birth at home or in an MLU, thus creating business for midwives. If it’s her second baby, there’s statistically a good chance she’s going to have a better birth anyway but ofc, they get all the credit for that. If she doesn’t, they hope she’ll try again even harder next time or just quietly go away. If she doesn’t just go away, they frame her upset as internal anger, guilt and emotional issues that they take absolutely no responsibility for. They directly encourage mums to take unnecessary risks and insist they invest emotionally in things that just aren’t required. But if things go wrong, it is entirely the fault of that mother. If she can’t cope with quiet dignity, that’s all on her.

            I saw Milli Hill say to James Titcombe the other day (on a thread about Dahlen’s ‘interventions are ebil’ paper) that he was just looking at it ‘through his lens’. He’s a loss parent. How the fuck else can he look at scaremongering about interventions? It was utterly tone deaf, I’d have said something but as I’ve upset her several times in the last month and dealt with the subsequent and inevitable dogpile I didn’t bother. I was also not really up for another book pitch (seriously, question anything she says and she’ll tell you she didn’t actually say the thing she definitely did say and you should buy her book to understand what she actually means).

            I’m so sorry for how you’ve been treated by that community. I see how they behave on social media and it is not ok. They don’t look after the people that are harmed by their misrepresentation of the truth. I really hope that things change. You’re really brave for speaking out against them, but every time you do and people see how they react, that does expose them for what they are. There are always people watching on Twitter, I do not doubt your comments have likely helped others.

          • kilda
            March 29, 2018 at 3:26 pm #

            >>he was just looking at it ‘through his lens’.

            wow, is that vile. So basically he’s biased for letting a little thing like his *dead child* color his opinion. Wow.

          • maidmarian555
            March 29, 2018 at 4:13 pm #

            Here’s the thread. She’s a delight. Idk how the fuck you start lecturing a loss parent on positive birth experiences but that’s exactly what I think she did here….


          • kilda
            March 29, 2018 at 5:09 pm #

            I think she’s accusing him of mansplaining here. Like as a man he should shut up and let women tell him what they want. Actually, she wants him to let Milli tell him what women really want, which according to her is a dimly lit room.

            So basically he has no right to an opinion, because he’s a man. Never mind the fact that he lost a child to this nonsense, which means he has more right to an opinion than almost anyone.

            Plus, I will never understand these people’s obsession with having dim lighting. It’s a birth, not a romantic dinner.

            Me, I would not want a dimly lit room. I’d want trained people there who can help if needed, and I’d want them to be able to see what they’re doing.

          • maidmarian555
            March 29, 2018 at 5:23 pm #

            Yeah she does a lot of mangling feminist theory to attempt to support her position. James Titcombe absolutely has a right to an opinion and he’s also an expert in patient safety. That’s his fucking job. And despite his emotional and practical expertise, he chins nasty comments like that all day every day with such dignity. I really was floored by the lack of awareness when she made that comment, it’s nasty, I don’t have any other words for it.

            She’s obsessed with dimly lit rooms, her latest obsession is telling CS mums they absolutely need a dimly lit theatre too. Ofc, she neglects to mention the big, silver, reflective lights the surgeons use so they can see to operate on you in theatre. Where even in a well lit room you can watch the reflection of them cutting you and sewing you back up if you glance upwards. A dimly lit room would enhance that. And possibly cause some distress if you weren’t ready for it. But then, a distressed CS mum is more likely to buy Milli’s book, isn’t she?

          • Anna
            March 30, 2018 at 1:16 am #

            Wow! Thats just foul. In her mind, all women want the empowerment and it just comes with a healthy baby because it did for her. She can’t concieve of the idea that birth isn’t as easy for everyone as it was for her and thinks that women will want the empowerment and the dimly lit room even if it means their baby doesn’t make it. She also gaslighting here, trying to suggest that Titcombe’s son died because the room wasn’t “dimly lit” and the birth “uninterupted”. So you see its a convenient way to get rid of dissenters. If your baby died, its because you let a Dr into the room. Seen it all before. Its Carla Hartley, Gloria Lemay, Indie Birth, Batshitwyfe – all the extremist “thought leaders” without a single certificate between them. It is odd that women who have done years and years of study allow themselves to be led by people with precisely ZERO qualification to do so. I can’t quite figure that out, but I suppose as long as they’re tooting the same horn they tolerate it. Hill is trying to frame Titcombe as mansplaining and her response as feminism (this is JF’s modus operandi) but its not feminist – its just sexist. I think James Titcombe knows a million times better than her whats at stake and that a birth experience means FUCK ALL if the baby dies.

          • Ozlsn
            April 3, 2018 at 7:10 am #

            Caroline Lovell died partly because the room was dimly lit and her idiot midwives couldn’t see that she was bleeding out into a wading pool ffs. This dimly lit thing – seriously at what point does this become Quiet Birth as in Scientology?

          • Anna
            March 30, 2018 at 1:00 am #

            I get this a lot. Yeah, you know what, I am biased! Putting your child’s cold body into a coffin will colour your view somewhat. I’m trying to let people know how quickly all that “trust birth” garbage crumbles to pieces, how little fucking candles and empowerment mean when you realise you traded your babies life for it. I don’t think theres any way I’ll ever feel that I can atone for what I did – but maybe if I can stop just one other person from making the same mistake my beautiful little girl won’t have died for absolutely nothing.

          • Anna
            March 30, 2018 at 12:56 am #

            Wow! You are absolutely bang on again. I’m so glad to read these comments because there are times I’ve started to question myself thinking maybe I am just bitter and trying to foist blame on someone else or trying to “ruin it” for everyone else. I’ve actually had comments to that effect. “Just because your baby died doesn’t mean your opinion is the only one that matters” and “why do you want to ban home birth just because your baby died” (I’ve never said I want to ban it, nor do I have the power to). I think they have to believe that “babies just die” a lot to explain away the high number of home birth deaths. They have to believe that a few deaths are either collateral damage or “fake news” or the cracks in the cognitive dissonance will become too deep. I saw some screen grabs recently from a discussion on LB and this horrid doula whose had a few deaths under her “care” posted that LB is being terrorised because women don’t want to “take responsibility for their bodies”. I don’t think they can see how cruel they are being and how they really contradict themselves constantly – “your body knows what to do” then “its your fault your body failed” – “we’re not blaming women” but “its women’s responsibility to educate themselves”. I did educate myself according to their terms, but somehow its my fault that neither my body, nor my daughter’s “knew” what to do when distress came on quickly and without warning. I’m not surprised that Milli Hill is spruiking her book. Shes been doing it on Hannah D’s FB page too. One of the women that has attacked me most angrily online is a midwife that does hypnobirthing courses. I dunno if you know of Indie Birth in the US but their guru leader has started selling MLM hemp oil. Of course its OBs that just want your money. I’ve also seen threads from Aussie midwives saying that OBs should be prosecuted for “practicing midwifery without a license” for attending low risk births. Its laughable but it’d be a lot funnier if these women didn’t have the lives of women and babies in their hands.

          • mabelcruet
            March 29, 2018 at 3:44 pm #

            Milli Hill is a self-described birth junkie. So obviously, that makes her supremely well qualified to comment on all aspects of maternity care. She is a bottom feeding scum sucking uni-neuronal bully who epitomises the dangerous and vile behaviour that this group of (mostly) women revel in. She’s offensive, cruel, bullying, and spiteful. She’s a cheerleader for dangerous practices and a ringleader for the most despicable behaviour I’ve seen on Twitter. She’s not worth engaging-she’s the shit on the shoes of Twitter, so just scrape it off.

      • Mishimoo
        March 26, 2018 at 6:47 pm #

        A half decent reviewer should have ripped it to shreds, but leaving aside who publishes Birth (Lamaze International), there is genuinely an issue with predatory journals in academic publishing at the moment. Anyone can get anything published in a ‘peer-reviewed’ journal as long as they’re willing to pay. It’s quite frustrating.

        • March 26, 2018 at 7:32 pm #

          It’s one more obstacle to the lay public’s ability to understand medical research.

          • Mishimoo
            March 27, 2018 at 2:32 am #

            Yup! And it’s incredibly annoying as well.

    • Kelly
      March 26, 2018 at 5:28 pm #

      It leads to baby showers where you contradict the information the host is trying to give out during a game of baby Jeopardy. I have to say she probably hates me now but I never have to see her again. But you know, women’s bodies are made to give birth, and interventions such as c-sections and inductions are way over done…

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