Happy New Year and thanks to my readers for another banner year!

The Skeptical OB had 1.5 million visits this year and 2.9 million page views for an increase of 67% over 2012.

According to WordPress, in 2013, there were 292 new posts, growing the total archive of this blog to 1,215 posts.

The busiest day of the year was June 12th with 27,412 views. The most popular post that day was Would you hire this midwife?.

 

These are the posts that got the most views in 2013 were:

• Vaginal weight lifting 5 comments December 2008
• Vaginal tears 353 comments February 2012
• Would you hire this midwife? 292 comments June 2013
• Baby dies because mother refused newborn vitamin K shot 401 comments January 2013
• Lawsuit 792 comments January 2013

A special thank you to the 5 most active commentors:

•  The Bofa on the Sofa   1726 comments
•  KarenJJ                        1349 comments
•  Bombshellrisa               1277 comments
•  Dr Kitty                        1164 comments
•  auntbea                       1014 comments

The most commented on post in 2013 was The narcissism of lactivism with 1103 comments.

As I said last year, I would put The Skeptical OB up against any blog on the Web as having the most articulate, the most intelligent and the most compelling commentors of all.

Thank you also to the many, many people who wrote to me privately, sharing their experiences, questioning my views and offering interesting links. I am especially honored that several professional homebirth advocates have been in private communication, despite the fact that I have criticized them in print and they have criticized me. Even though we disagree, sometimes quite profoundly, they trust that they can seek my opinion about medical issues or aspects of homebirth practice that unsettle them.

I know that many homebirth advocates dismiss what I write without even reading it. To those people I say: you (perhaps especially you) are welcomed to this site with open arms. I am grateful to have the opportunity to inform you about the real risks of homebirth. It’s up to every woman to make her own decision where to give birth, and this blog offers information that you cannot get anywhere else outside the scientific literature.

The blog is not perfect. It is a one person effort, from the writing to the coding, and sometimes that shows. There is no editor and I am terrible at proof reading my own work. I occasionally make math mistakes. I try to correct any mistakes as soon as they are pointed out to me and the mistakes are never an attempt to mislead. I am trying to present the most accurate, most detailed and most up to date information on homebirth and other areas where parenting intersects with pseudoscience, and I fervently hope that I am usually successful in that effort. To the extent that I am not, it is not for lack of trying.

Thank you again to all my readers. Happy New Year!

Sincerely,
Amy

Homebirth had a perfect record in 2013.

Not a single scientific paper or set of state, national or international statistics showed homebirth to be safe!

And, of course, the Midwives Alliance of North America (MANA), the organization that represents homebirth midwives, continued to hide its own death rates.

1. New CDC statistics, same old increased homebirth death rate. The dramatic increase in homebirth death rates has been remarkably consistent over the years.

Keep in mind that these statistics dramatically undercount the real rate of homebirth death. Why?

a. All homebirth transfers are included in the MD numbers. That means that any deaths that occurred after the mother was transferred to the hospital are in the MD group and not in the homebirth group where they belong. This is important because we know that many homebirth deaths occur because even being “10 minutes from the hospital” is not close enough to save a baby in a life threatening emergency.

b. Intrapartum deaths are not included in these statistics at all, because those babies don’t get birth certificates. All those homebirths where dead babies drop into the hands of unsuspecting homebirth midwives (“the heart rate was just fine a minute ago”) are not noted here.

2. Oregon releases official homebirth death rates, and they are hideous.

You may recall that back in August 2010, Melissa Cheyney, the Director of Research for the Midwives Alliance of North America (MANA) and also the head of the Board of Direct Entry Midwifery, rejected a call by the State of Oregon for access to the MANA homebirth death rates for Oregon. As a result, the State decided to collect the statistics themselves. They turned to Judith Rooks, a certified nurse midwife and midwifery researcher who is known to be a supporter of direct entry midwifery, to analyze the Oregon homebirth statistics for 2012.

As Rooks regretfully acknowledged:

Many women have been told that OOH births are as safe or safer than births in hospitals…

But out-of-hospital births are not as safe as births in hospitals in Oregon, where many of them are attended by birth attendants who have not completed an educational curriculum designed to provide all the knowledge, skills and judgment needed by midwives who practice in any setting.

The death rate is horrific, even AFTER Rooks inappropriately eliminated the death of a baby at homebirth who had congenital anomalies. Since the hospital group contains congenital anomalies, it is not appropriate to remove them the homebirth group.

3. How have professional homebirth advocates responded to the Oregon data. By and large they have ignored it since they can’t refute it or defend it. Jennifer Margulis (whose husband is a lay member of the Oregon Board of Direct Entry Midwifery) did try, however with the stupidest excuse for homebirth deaths ever:

Oregon has some of the safest best homebirth stats in the country IF YOU DON’T COUNT PORTLAND …

Duh. Homebirth is apparently very safe if you just remove the dead babies from your calculations. And what reason does Margulis provide for removing Portland from the calculations? None, of course. She hoping that homebirth advocates are stupid enough to be persuaded by that inane excuse, or, worse still, perhaps she actually believes that it is a valid excuse.

4. New analysis from Arizona shows — yet again — that homebirth triples the neonatal death rate.

What did they find?

Pooled results indicated that homebirths attended by midwives were associated with increased risks for neonatal deaths [pooled OR (95%CI): 3.11 (2.49, 3.89)]. There were no significant differences in outcome of home or hospital births attended by midwives for the other child health measures.

Homebirth increases the risk of neonatal death by a factor of 3 or more.

For mothers, homebirth poses a much lower risk of interventions and the complications that may arise from those interventions. But that advantage is purchased at the price of increased risk of neonatal death, demonstrating yet again that much of obstetrics is preventive medicine, designed to prevent neonatal deaths … and that’s exactly how it works. Give birth at home and you are twice as likely to avoid interventions, but three times as likely to end up with a dead baby as the result.

5. On the international front, the results are much the same. Dutch midwives struggle to avoid accountability for high perinatal death rate.

According to a leading professor of midwifery:

Maternity care in general in The Netherlands has come under scrutiny by governments, media, the public and care providers themselves after two consecutive European Perinatal Statistical Reports ranked The Netherlands among those with the highest rates of perinatal and neonatal mortality compared to other members of the European Union (and Norway) …

… We have learned that infants born to women of low risk whose labour started in primary care with midwives had higher rates of perinatal death associated with delivery compared to those beginning labour in secondary care …

Ank de Jonge, the leading apologist for Dutch midwifery, attempts to avoid responsibility for the high perinatal mortality rate, but actually finds the opposite. After restricting the analysis to term births, de Jonge found that the Netherlands has one of the worst perinatal mortality rates in Western Europe, although now they have the sixth worst rate, instead of the third worst rate.

In other words, de Jonge confirmed that there is a serious problem with perinatal mortality in the Netherlands including the perinatal mortality rate at term. She confirmed that there is significant evidence that Dutch midwives bear responsibility for the Netherlands poor perinatal mortality rate.

De Jonge tried again in another paper that utterly misrepresents her own findings.

6. De Jonge is at it again, slicing and dicing data in yet another unsuccessful attempt to show that homebirth is safe.

De Jonge compared the number of women who SURVIVED severe complications at homebirth to the number of women who SURVIVED severe complications at hospital birth. She didn’t compare the number of women who EXPERIENCED severe complications in each place. And she didn’t compare how many women DIED at each place. Without that information, de Jonge is not entitled to conclude anything.

Severe maternal morbidity is an appropriate measure of safely ONLY when death rate is zero or nearly zero. If the death rate is not zero, that MUST be taken into account in assessing safety. My Letter to the Editor of the BMJ regarding this inexplicable oversight was published the same day. de Jonge and colleagues have responded, and what do you know, the maternal mortality was NOT zero.

Fewer women in the homebirth group experienced severe acute maternal morbidity, but that’s nothing to crow about if one of them died and might have been saved in the hospital.

7. Elsewhere, Australian midwives boast about terrible homebirth death rate.

Setting a new standard for cluelessness, Australian midwives are proudly presented the results of a publicly funded homebirth program, a program that has a homebirth death rate 5X higher that of term hospital birth.

During the 5 years of the study, there were 1807 women who intended, at the start of labor, to give birth at home. 83% had a homebirth, 52% in water (I have no idea why they mention this except to check women’s performances against the midwifery ideal.) The transfer rate was 17%. The C-section rate was 5.4% and the neonatal death rate was 2.2/1000. That’s more than 5X the rate of 0.4/1000 found in a 2009 report on birth in South Australia.In addition, 2 babies suffered hypoxic ischemic encephalopathy (brain damage due to lack of oxygen).

And that probably undercounts the deaths and complications because reporting was voluntary and only 9 of 13 program directors responded.

8. Ironically, Save the Children illustrated US neonatal death by using a CPM attended homebirth. The organization (?unwittingly) used a photo that I recognized as a CPM attended homebirth death that was almost certainly preventable.

In other words, the face of first day death in the US is preventable death at homebirth.

9. The most important paper on homebirth published in 2013 showed that homebirth increases the risk of a 5 minute Apgar score of zero by nearly 1000%!

Grunebaum et al. found:

Home births (RR 10.55) and births in free-standing birth centers (RR 3.56) attended by midwives had a significantly higher risk of a 5-minute Apgar score of zero (p<.0001) than hospital births attended by physicians or midwives. Home births (RR 3.80) and births in free-standing birth centers attended by midwives (RR 1.88) had a significantly higher risk of neonatal seizures or serious neurologic dysfunction (p<.0001) than hospital births attended by physicians or midwives.

The Grunebaum paper is well done and extremely difficult to undermine. There is simply no question that the data shows that homebirth raises the risk of a 5 minute Apgar score of 0 by nearly 1000%. The authors’ decision to use the 5 minute Apgar score of zero is truly inspired. Other research shows that homebirth has an appalling rate of intrapartum death, and not just any intrapartum death, but totally unexpected (“the heart rate was normal right up until the baby was born”) death. This is almost certainly due to failure to monitor babies appropriately during labor. The decision to use the 5 minute Apgar score of 0 means that we are looking at severe intrapartum compromise, almost certainly resulting in death.

Most professional homebirth advocates have ignored it, but not MANA. They’ve published a “critique” that contains at least one bald face lie and many more untruths.

10. And how about the death rates of MANA’s own members? Melissa Cheyney continues to spews BS to justify hiding them.

On October 24, ahead of the MANA13 national conference, Cheyney claimed that the MANA statistics cannot be released without the approval of an IRB (institutional review board). First, MANA itself has published almost all the data from the database EXCEPT the death rates. Second, while IRB approval could be required for publications based on the data, IRB approval is not required to read and review the data.

As recently as September 29, Wendy Gordon claimed that there were no articles in press, but on October 24, Cheyney suddently announced there are two papers on the MANA statistics that will be published in the Jan/Feb 2014 issue of the Journal of Midwifery and Women’s Health.

I’m sure that Cheyney will do something to hide the hideous death rate at CPM attended homebirth. I’m so sure, in fact, that if I’m wrong, I will publicly apologize to Cheyney and donate $100 to the MANA stats project.

It’s a win-win for me. If I’m wrong, and Cheyney publishes the number of homebirth deaths compared to the total number of attempted homebirths, I’ll finally have access to the data. If I’m right, I’ll save $100 and I’ll be able to say that you heard it here first that MANA would try to hide the many homebirth deaths at the hands of their members.

 

Be sure to read the companion piece 2013: The year in homebirth deaths and disasters.

As the end of the year approaches, it is time for the grim task of recapping the deaths and disasters from 2013. The toll of homebirth deaths and disasters, almost all presided over by homebirth midwives, is, above all, a shocking indictment of the second, inferior class of American midwives known as CPMs (certified professional midwives).

The list is much too long:

1. Thank goodness I chose homebirth for the shoulder dystocia that nearly killed my baby (UK disaster)

2. Yes the baby died, but my homebirth midwife was awesome

Another homebirth, another dead baby, another loss mother proclaiming that her midwife was really, really nice to her.

In this particular case it is not clear whether the baby would have survived had the mother been under the care of an obstetrician, since the baby may or may not have had congenital anomalies; but there is no question that the baby would have had a much better chance of surviving if her mother had had appropriate care for a postdates pregnancy and an ultrasound that had revealed any potential problems that might have been addressed in a timely fashion.

3. No, homebirth did not save your baby, either

The idea that a homebirth saved this baby’s life is ludicrous on its face. C-section is the life saving treatment for a worrisome velamentous cord insertion because it reduces the risk of perinatal death to near zero, not homebirth, which guarantees the baby’s death if the blood vessel is torn.

4. Another devastated homebirth loss mother

Another homebirth, another shoulder dystocia, another dead baby and another homebirth midwife who will never be held accountable for presiding over the preventable death of a beautiful baby girl.

5. Homebirth baby dies of virus contracted during waterbirth

An infant who died following a home waterbirth into a pool containing her mother’s virally contaminated diarrhea.

6. Actually you did lose your uterus because you chose homebirth

The basic story is very simple and the fault is very clear. She had a history of previous C-section, went against medical advice in choosing homebirth, ruptured her uterus, had her baby’s life save and her life saved by a repeat C-section and lost her uterus and wound up in the ICU on a ventilator having received multiple transfusions.

Does she take responsibility for her decision to choose high risk homebirth? Are you kidding? It’s everyone’s fault but hers.

7. 20 years of presiding over homebirth deaths

Barbara S. Parker, 55, faces three felony counts of practicing midwifery without a license. These charges stem from three August deliveries.

The first was on Aug. 2nd when Parker took a woman to an Auburn hospital when she was having trouble delivering her child. Then on Aug. 3rd Parker helped a woman deliver a baby that wasn’t breathing and had no pulse. That child later died at the hospital. Then a few days later, on Aug. 7th, Parker was helping a mother deliver twins and the second infant was only partially delivered and had to be taken through cesarean section. According to court papers, the second child did not survive.

8. Empty arms, broken heart, another homebirth death

I lost my son … in Feb 2013 at 40 weeks 2 days during delivery, the last pushes killed him official cause was cord prolapse. The hospital staff tried everything possible to revive him for 26 minutes after his birth but he never came back to us. He was 8lb’s 6oz and absolutely perfectly beautiful. I miss him, my arms ache, my heart hurts, my breasts ache every time I am around a baby …

9. Unlicensed midwife arrested for homebirth death AND for prostitution; homebirth advocates hold fundraiser

It’s almost as if homebirth advocates are trying to advertise their moral bankruptcy. They couldn’t care less how many babies die at homebirth, why they die at homebirth and who pretends to be a midwife.

I’m referring of course to the case of Rowan Bailey. She allegedly represented herself as a licensed midwife even though she uncredentialed and unlicensed. She has been jailed for allegedly presiding over an intrapartum death at homebirth … In addition, she was arrested last month for prostitution. What are other homebirth midwives doing in response? They’re raising money to “free” her, of course.

10. Another homebirth, another brain injured baby, but the midwife was awesome

How many times have we heard this story before?

Awesome homebirth midwife? Check.
Ignoring risk factors? Check.
Midwife with no idea until the moment of birth that the baby was in distress? Check.
High tech, extraordinarily expensive treatment to prevent further brain damage? Check.
Permanent brain injury? Check.

11. Homebirth kills mothers, too

My husbands cousin passed away today while giving birth. She was 24, beautiful, had just graduated with her masters in engineering, and was getting married. She was due may 15th. She went into labor today. She had a home birth and midwife. She bled to death on the way to the hospital that was 8 minutes away. Her daughter is alive…

12. Another maternal death: How the quest for the idealized birth experience continues to kill

The story is simple and straightforward. A pregnant woman was facing a C-section because all the obstetricians she consulted advised her that vaginal delivery might result in the death of one of her twins or herself. She decided to ignore their warning and gave birth at home unassisted. She died of a massive postpartum hemorrhage.

13. Mother eating her words; baby fighting for her life

I did have my twins … at home. I wrote a recent post about What would the world be like without hospitals. I had to eat my words this last week because my second baby had prolapse cord and has been in the hospital since birth fighting for her life. [She ultimately died.]

14. Sam, a victim of homebirth

Sam’s parents brought charges against the midwife in the Texas Board of Midwifery. The Board acknowledged that she had failed to immediately transfer Sam’s mother despite evidence of abruption. The punishment? Six months probated suspension.

Sam’s family, including two older sisters, took him home and loved him … and got lots of love in return.

Sam ultimately died due to aspiration. The autopsy ruled that it was directly related to his labor/birth injuries.

15. A mother looks back at her daughter’s postdates death

Our daughter was stillborn at 42 weeks 3 days. She never opened her blue eyes. She never cried. She never nursed at my breast or grabbed her daddy’s finger with her chubby hand, but she was still born, and she deserves to be remembered forever.

Why was she born at 42 weeks and 3 days? Because her mother wanted to avoid another C-section after 2 previous C-sections, so she chose homebirth. [Correction: Not a homebirth death because the mother had planned to deliver in the hospital. Her baby died after two days of intermittent labor at home, before the mother went to the hospital.]

16. On the other hand, maybe the midwife is a monster

The homebirth midwife presided over a neonatal death at homebirth of a VBA3C mother in Utah, administered Cytotec to induce or augment labor, and delivered the baby using a vacuum extractor; in addition a massive postpartum hemorrhage occurred.

17. Homebirth killed my baby; I’m still in favor of it

I actually did have a midwife at my homebirth and sadly my baby died. He was born still. We couldn’t find his heartbeat and then just didn’t get him out fast enough (had to transfer to hospital and have a csec) it was an attempted vbac. Even after that situation, I am still for home birth. (just not for me) If one of my daughters decided to have a HB I would be all for it …

18. Homebirth means never having to say you’re sorry

One week ago I lost heart tones on our little girl at 9 cm. We rushed to the hospital but we weren’t on time and they did a cesarean. Because of a long labor (4 days) and not dilating (transition for 15 hrs) the dr told me I shouldn’t labor again. However, I’m planning on having another baby as soon as I can and would like a home birth.

19. You nearly killed the baby, but you think the NICU abused him?

Took castor oil at 41&2 and had contractions 2-3 min apart starting at 10 pm until I delivered the next day, Friday 7/26, at 5:15 pm. My first labor was only 12 hours, start to finish, so this really shocked us all… Delivered that way [half squat] with my midwife supporting my perenium. It is a boy! He was lifeless & they had to work to get him to pink up. He had apgars of 5/6/8 but swallowed fluid, had retractions in his abdomen, & would stop crying.

He spent several days in the NICU where the mother claims he was “traumatized.”

The NICU traumatized the baby? How about his own mother who nearly killed him for no better reason than bragging rights. She hired a midwife so incompetent that she had no idea she was about to deliver a lifeless baby. She labored at home without adequate monitoring. She let her baby spend hours nearly asphyxiating. She insisted on delivering far from the people and equipment that could have resuscitated the baby faster and possibly prevented a long NICU stay.

20. Classic homebirth screw-ups lead to yet another homebirth death

Another day, another baby who didn’t have to die at homebirth.

According to The Irish Times: “A couple who prepared for what they hoped would be an idyllic home birth by lighting candles and playing soothing sounds on their stereo ended up devastated when their baby was stillborn, an inquest heard today.”

21. Homebirth midwives: bringing third world causes of childbirth death to the first world

South Carolina has suspended the license of a free standing birth center and two of its midwives because of an intrapartum stillbirth.

22. Don’t blame yourself, blame your homebirth midwife

After 6 hours of pushing, not only was I in pain and tired but she hadn’t moved and there was meconium running down my leg which indicated that she was in stress. My midwife was still checking her heartbeat and it was a little slow. They had me lay on one side and have oxygen and that seemed to help her heart but it wasn’t helping anything else. At that time I told my midwife I was done. I couldn’t do it anymore. She tried to lift my spirits and say I COULD do this but I told her I did not want the encouragement. I was tired and I didn’t want to be in pain anymore. I wanted the hospital…

By the time they opened me up, she didn’t have a heartbeat. She was covered in meconium and the umbilical cord was wrapped several times around her neck and body. They tried rescusitating her for 15 minutes but she never made it.

23. But the baby’s heartrate was fine right before it dropped nearly dead into the homebirth midwife’s hands

Yet another baby has been placed at risk of significant brain damage and possible death because the clueless homebirth midwives didn’t understand how to diagnose fetal distress.

*****

Think homebirth is safe? So did the mothers in these 23 accounts.

Think homebirth is safe? Read the 23 stories and think again.

 

Be sure to read the companion piece 2013: Homebirth papers and statistics.

I am angry.

Why? Yet another baby has been placed at risk of significant brain damage and possible death because the clueless homebirth midwives didn’t understand how to diagnose fetal distress.

The story of baby Thaddeus-James is depressingly familiar:

… Our son was born floppy and unresponsive just after noon today. Throughout the birth his heart tones were good for the most part, although there were certain positions he didn’t seem to cope well with. It appears that there was a trauma in the last few moments–perhaps cord related. Full CPR was initiated practically immediately by my two wonderful midwives. He didn’t respond until about 20+ minutes into resuscitation…

And, as we’ve come to expect, the mother believes the midwives, the ones who actually bear responsibility for failing to anticipate this disaster, are just awesome:

His heart rate was checked very frequently, and the last check was 2-3 minutes before birth and still strong and in the normal range. It was with Doppler, so we could all hear it. After that, we lost it for those last few minutes, so that was when the abruption likely occurred. I am now praising God that our placenta stayed attached as long as it did. That He gave me wonderful health care providers who immediately jumped into action and saved my son’s life. For the tray I bought at a bargain store that ended up being used as a firm surface to put him on for the chest compressions. For the emergency responders who didn’t give up on my son and rushed him to safety. For living in a time and place with amazing medical care…

That’s right. We live in a time of amazing medical care, yet homebirth advocates continue to deprive their babies of this care until AFTER they are nearly dead and their brains have been permanently injured.

Why would a baby fall nearly dead into a clueless homebirth midwife’s hands?

The mother insists:

… [T]he most likely cause of the acute trauma that occurred in the last moments of his birth was a placental abruption (premature separation of the placenta).

That, not to put to fine a point on it, is bullshit.

Let’s leave aside for the moment the fact that the mother had NO signs of placental abruption. Babies do not go from fine one moment and nearly dead the next. It takes a long time, sometimes hours, for a baby to die of an abruption.

But you know what does cause a baby to have an excellent heartrate and then drop dead or nearly so into the midwife’s hands? A clueless homebirth midwife who thinks that fetal distress inevitably produces a bradycardia (low heart rate).

As I’ve explained in the past, the fetal heartrate monitor provides much more information than listening to the heartrate.

For example, this tracing shows a baby in serious trouble:

Surprised? You might be if you thought that a fetal heart rate tracing supplied the same information as intermittent auscultation (listening) with a doppler. But electronic fetal monitoring provides a wealth of information that cannot be obtained by listening, and that allows for a more comprehensive view of fetal well being.

This is a tracing with limited beat to beat variability and subtle late decelerations.

Notice what you don’t see:

You don’t see a bradycardia, a sustained period of abnormally low heart rate. That’s because bradycardia is often a terminal event. Most babies can tolerate long periods of significant oxygen deprivation before they die, and they may not have any bradycardias until immediately before death. On this tracing, there is never a single moment when the heart rate is outside of the normal range, but the baby is nonetheless suffering from serious oxygen deprivation.

This is almost certainly what is happening in hours before a dead or nearly dead baby drops into a homebirth midwife’s hands. The midwife may be intermittently listening to the baby’s heart rate, but unless she is listening for long enough AND frequently enough AND exactly at the right times AND can distinguish subtle changes in heart rate, she will be blissfully unaware that a baby is dying right in front of her.

Homebirth advocates and their midwives who insist that the baby’s heart rate was “fine” until just before delivery are completely wrong. The baby’s heart rate was not fine; they just couldn’t tell what was happening because they only listened intermittently.

And because they couldn’t tell, the baby pays a hideous price.

Baby Thaddeus-James received state of the art medical care, including cooling his brain to reduce brain damage. He was recently warmed up.

Despite the blessing of getting to hold him 3 times today, there appears to be a significant set-back tonight, as it looks now like Thaddeus-James may be having seizures. We are all very concerned about him. Please pray for him…

Seizures indicate the likelihood of significant brain damage, brain damage that didn’t have to happen and almost certainly would not have happened in a hospital, because:

1. The signs of oxygen deprivation would likely have been diagnosed with electronic fetal monitoring.
2. A C-section or vacuum might have been recommended to prevent further oxygen deprivation.
3. A team of resuscitations experts would have been standing by to perform immediate advanced resuscitation with intubation.
4. An additional therapy could have been initiated sooner, instead of waiting for transfer to the hospital and hospital evaluation, all of which takes precious minutes. During those minutes the baby’s injured brain continues to swell, and brain damage may actually increase over that present at birth.

Thaddeus-James’ mother is right about one thing though. We live in do live in a time and place with amazing medical care. Too bad Thaddeus-James didn’t have immediate access to it because his parents chose homebirth.

I believed that I had plumbed the nadir of reprehensible anti-vax behavior with my recent posts on the lactation consultant who recommends lying to patients about her vaccination status, and who asserted that the recent outbreak of polio in Syrian refugee camps in the result of deliberate infection by UNICEF personnel.

But, alas, I was wrong. Some anti-vax nuts have sunk even lower.

At the cesspit of alt health nonsense known as Mothering.com, Geotrouvetout writes:

I am mostly against vaccination with a few exceptions. I live in MA where it is possible to get an exemption for school admission but I’d think it would be more durable to simply have a fake. I’d love to see examples and get tips.

In my country of origin, I’ve had a doctor signing on for me without actually vaccinating but that will be harder here and I signed another one myself. It was very easy and worked, it’s just a paper booklet. If a stamp is needed, it’s easy to have one made over the internet for cheap…

Is s/he trying to forge vaccination records for school? Actually it’s even worse:

The baby will go to daycare at 3 months and vaccination starts at birth here with Hep B (which we will reject) and 2 months with DTaP, which I may do later if I do it. The issue with the exemption is that it needs to be renewed yearly. Once you have a fake it’s a no worries pass that does not expire. Also should we need to move, some States do not allow exemptions. It would also prevent any fight with the day care and schools that my not be so understanding with having a non vaccinated child in the house.

I guess if you don’t care about increasing your own infant’s risk of death from an easily preventable disease, why would you care about killing other people’s infants?

And who could deny that lying is ever so much easier than taking responsibility and accepting the consequences of telling the truth?

This is right up there with lying about having cancer so you can raise funds from unsuspecting people.

No, I take it back. This is worse. The cancer lie merely deprives the innocent of their money; the vaccination lie can kill their babies.

Fortunately, some members of Mothering.com balk at the idea of lying.

I disagree with what you are doing. What kind of example are you setting for your child to lie and falsify documents? Granted, your child is a baby now, but eventually if you keep needing to turn in vaccination records they’ll figure it out. Are you going to tell your child they are not actually vaccinated when they get older? Or are you going to lie to them as well? What if they tell someone they are not vaccinated? Are you going to teach them to lie and say they have had their vaccinations? Also, it seems like you could have a lawsuit on your hands if it ever comes out that you falsified documents that could potentially put other people’s kids at risk…

Another expressed her reservations more succinctly:

I think faking vaccination records is ill-advised, unethical, and potentially harmful to other people in your community. I think it’s reasonable for people on the “I’m Not Vaccinating” forum to have strong, negative reactions to fraud. It’s “I’m not vaxing”, not “Immoral Weasels – Support Only.”

But then there is this outrage from Taximom5:

The decision to lie to protect one’s child from a high risk of harm is exactly what many Jewish parents in in the 1930’s and 1940’s did; they obtained fraudulent documents identifying their children as Aryan in order to protect them from harm, and sent them to live with Christian families.

Edit: some posters are accusing me of equating vaccinations with genocide. This is not the case. The Jewish parents who sent their children away to live in safety as Christians had no idea that the death camps even existed.

Imagine that. They accused her equating vaccination with genocide when she was merely equating vaccination with wholesale murder. So glad she explained that subtle distinction.

Mothering.com deleted the most strongly worded condemnations because, as Cynthia Mosher explains:

…[T]here have been some responses that were really out of line. I have removed the posting privileges to this thread for a few people because of their posts and will also be issuing them a warning. It is not cool to insult and attack a member, no matter what you think of their opinions or actions.

That’s right. It’s totally cool to lie about your baby’s vaccination status thereby risking the lives of other infants and children, but it is totally uncool to insult a member for doing so.

Who is Geotrouvetout? It is easy to figure out with a minimal amount of sleuthing, given the clues of Massachusetts resident, immigrant, parent of an infant/now toddler and knowing that geotrouvetout is French for geocaching.

I congratulate Geotrouvetout for achieving a lowlife trifecta: stupid, selfish and unethical.

I couldn’t imagine it was possible to think less of the anti-vax brigade, but I was wrong. Thanks, Geotrouvetout for setting me straight!

What is it with natural parenting advocates and lying?

Homebirth advocates recommend lying to your obstetrician about planning a homebirth.

Homebirth midwives advocate lying to their patients about what medications and procedures they administer during labor.

A lactation consultant advises lying to new mothers about her vaccination status.

Now Sarah Pope, the Health Home Economist recommends lying to your pediatrician about feeding your children raw milk.

Sarah, whose nutrition credentials include a BA in economics and a Master’s in government administration (from an Ivy League institution!) has this to say:

You see, it is very risky to ever tell your Pediatrician, or any doctor caring for your child for that matter, that you feed your child raw milk. Whether that child is a baby, toddler, or adolescent, the American Academy of Pediatrics is becoming more and more hostile toward raw milk by the day and you risk having the Pediatrician tattle to Social Services if you choose to feed your baby or child this wonderfully healthy, traditional food that has nourished humans for millenia [sic]…

Can you believe it? Your conventional Pediatrician would rather you feed your baby GMO frankenformula never proven safe for human consumption instead of a homemade, nourishing formula made with raw milk from pastured cows or goats.

According to Sarah:

Pediatricians should be given information about what you do in your home on a need to know basis only.

And apparently they don’t need to know when you are putting your children’s life in danger by feeding them disease laden natural products.

Here’s what those evil folks at the American Academy of Pediatrics had to say about raw milk:

… [C]onsumption of raw milk or milk products has been associated with a fivefold increase in toxoplasmosis among pregnant women; listeriosis associated with high rates of stillbirths, preterm delivery, and neonatal infections, such as sepsis and meningitis6; and E coli O157–associated diarrheal disease and hemolytic-uremic syndrome, primarily among young children. Between 17% and 33% of all cases of invasive disease attributable to Listeria monocytogenes in the United States occur among pregnant women, unborn fetuses, or newborn infants, a 13- to 17-fold increase compared with the general population. Complications include a 20% risk of spontaneous abortion or stillbirth, with two-thirds of infants developing neonatal infection, including pneumonia, sepsis, or meningitis.

Silly pediatricians. Toxoplasmosis, listeria and E. coli O157 are natural. Pneumonia, meningitis and sepsis are natural. What could be harmful about anything natural?

Who would know better than Sarah, a Nutrition Educator and Chapter Leader for the Weston A. Price Foundation, a foundation devoted to the teachings of a dentist from the 1800’s?

Sarah offers this helpful disclaimer:

The information on The Healthy Home Economist ™ is provided for informational purposes only. It is not intended to substitute for the advice provided by your doctor or other health care professional. You should not rely upon or follow the programs or techniques or use any of the products and services made available by or through the use of this website for decision making without obtaining the advice of a physician or other health care professional. The nutritional and other information on this website are not intended to be and do not constitute health care or medical advice.

So be sure to ask your pediatrician whether you should lie to him or her before you do.

And who would think that offering recipes for baby “formula” made with raw milk constitutes medical advice?

What could happen if you don’t lie to your pediatrician about feeding your child raw milk (beside the fact that your child could get violently ill, spend days in hideous pain with severe vomiting and diarrhea, and die)?

Consider the recent nightmare of Alorah Gellerson of Brooklin, Maine who made the mistake of telling a doctor about the homemade raw goat milk formula she proudly and carefully made for her healthy, happy, three-month old son Carson.

Social Services quickly same knocking at the door after the doctor reported Alorah and threatened to take Carson away and put him in foster care unless Alorah switched to store bought commercial formula.

Imagine that! Social Services wanted to take Carson away for no better reason that to spare him a painful illness, hospitalization and even death. The nerve of those people.

Why might pediatricians and Social Service personnel be conspiring to prevent you from feeding your children disease laden milk? Sarah doesn’t say.

Why might Sarah Pope, the Healthy Home Economist, be promoting raw milk, which could kill your child?

Sarah does say:

In order for me to support my blogging activities, I may receive monetary compensation or other types of remuneration for my endorsement, recommendation, testimonial and/or link to any products or services from this blog.

Surprise! Sarah links to the products needed to make raw milk “formula.” So she ends up with money if you feed your baby raw milk “formula.” You merely end up with a violently ill or dead child.

Hi. My name is Ima Frawde, CPM. The initials after my name stand for “certified professional mammarist.” I am an expert in normal breasts.

I don’t know about you, but I am sick and tired of the hegemonic, patriarchal, male medical system that is constantly telling women that their breasts are “broken” and need to be scanned regularly to detect breast cancer. Breasts are designed perfectly.

Are we suppose to believe we’re inferior to squirrels, cows, rabbits and elephants? We have about 5000 species of mammal and we’re encouraged to believe that we’re the only one that needs routine mammograms. How did we managed to get along for thousands of years before mammography? If breast cancer were really that dangerous, we wouldn’t be here as a species.

It’s not a coincidence that my comments sound similar to those made by Ina May Gaskin on Feministing. Ina May is my hero. Everything she says goes double for me (heh, heh, heh, just a little breast humor).

Why should you listen to me? As a CPM (certified professional mammarist), I am an expert in normal breasts. In fact, certified professional mammarists are trained specifically to manage breast health at home. In order to obtain my certification, I had to meet rigorous standards; I was required to submit a portfolio of 20 breasts examined within the home (right and left breasts are each counted separately). Plus I had to observe examination of an additional 20 breasts done by my preceptor. That means I had contact with 20 separate women before I began practicing on my own!

How did routine mammography become so popular? As my friend Ina May says, it’s all the hegemonic, patriarchal medical system “which views women’s bodies as defective designs and allows for profit to be made from women’s fears of their own bodies.”

In fact, it is fear that causes breast cancer. How do we know? Primitive women don’t get breast cancer. Think about it. All those charities in Africa are soliciting money for malnutrition, infant mortality, maternal mortality, and obstetric fistulas. Have you seen even one commercial for an African breast cancer charity? That proves it.

What? You don’t believe that fear causes breast cancer? You mean you deny that there is a mind-body connection?

Once you understand that fear causes breast cancer, you can see why trusting breasts is the best way to ensure good outcomes. Having a routine mammogram in unnecessary when you trust breasts. Mammography has a high false positive rate, and those false positives lead to a cascade of unnecessary interventions like breast ultrasounds and breast biopsies, not to mention undermining women’s faith in their own bodies.

But you shouldn’t think that certified professional mammarists reject technology. Far from it. If we feel a breast mass and it gets bigger despite breast affirmations, cranio-sacral adjustment, blue and black cohosh, garlic and Hibiclens, we refer women to breast cancer specialists. Since breast cancer is very, very rare, particularly in low risk women, we have very low referral rates.

Are we always correct? Unfortunately, no, but some women are just meant to die from breast cancer. They probably would have eventually died in the hospital anyway (it might have been 10 or 20 years later, but the principle holds true).

We’re also working on developing our own technology for identifying early breast cancer. We are creating our own mammography equipment. Even as we speak, several groups of women are currently fabricating mammography machines to our own specifications; they are knitting them from steel wool!

Our machines will have two major advantages over conventional, Western, allopathic mammography machines. First, they won’t involve painfully compressing women’s breasts, and second, they don’t use ANY radiation at all. As soon as the mammography machines are fully knitted, we plan large qualitative studies comparing the experience of having a mammogram with a knitted machine vs. a conventional machine.

You might be wondering why we are bothering with mammography machines at all. In answer, I will paraphrase anthropologist and midwife Melissa Cheyney:

The rituals of home breast care are not simply about assuring personal transformation via the transmission of counter hegemonic–empowering value —although many women certainly described their experiences this way. Home breast care rituals, are also self-consciously political in their intent. As the popular bumper sticker “Mammarists: Changing the World One Breast at a Time” suggests, home breast care is a performative medium for the promotion of social change.

This piece is satire. It first appeared in January 2012.

I can tell you that anti-vaxxers are profoundly ignorant conspiracy theorists, but it is far more powerful to illustrate it with the idiocy spewed from an anti-vaxxer herself.

This comes from the crowd of cretins on the Mothering.com Vaccinations Board. In response to a request for more information about the polio outbreak among children in war-zone in Syria, MaggieLC has this to say:

I don’t know how accurate the reports are, that much paralysis sounds really high! It takes months or a year for the original symptoms and inflammation of Polio to calm and at least a year to know if a child will be paralyzed. (My dad had Polio in the 1940s, absolutely no paralysis, no iron lung, no lasting effects, but was in bed for around 6 months so our family is quite familiar with it.) Of course in the majority of cases, Polio presents as a really bad upper respiratory infection (it’s how my dad’s and everybody elses in the 1930s and 40s started) and never goes beyond a respiratory infection so MANY cases go undiagnosed.

Really? Thousands of paralyzed victims of polio, including President Franklin Roosevelt, would disagree.

Basic ignorance; nothing special there. But then comes the kicker:

Also, these camps are not clean, people are packed in together and human waste is flowing through the streets, AND SO they use Oral Polio Vaccine which is ALIVE and is excreted in the stool for up to 6 months after vaccination! Using LIVE polio vaccine will only INCREASE polio rates in the area because anyone who is exposed to the stool of children who are getting the vaccine are being exposed to LIVE POLIO. Why would they do this? A ploy to “show how dangerous it is not to be vaccinated?” Sounds like the intentional exacerbation of events…

You heard it; UNICEF is deliberately causing polio in Syrian children to demonstrate how dangerous it is not be vaccinated!

Who is this clown, anyway? As it happens, she is the lactation consultant who cheerfully advises lying to her clients about vaccination status. I thought that was the vilest anti-vax garbage that I had ever read, but in just a few weeks MaggieLC has managed to surpass herself with what may be the vilest anti-vax rant ever.

What motivates absurd conspiracy theories like this? Cognitive dissonance. The reality, apparently unacceptable to MaggieLC, is that reduced rates of vaccination have led to a polio outbreak.

The World Health Organization has declared a polio emergency in Syria.

After being free of the crippling disease for more than a decade, Syria 10 confirmed cases of polio in October. Now the outbreak has grown to 17 confirmed cases, the WHO last week. And the virus has spread to four cities, including a war-torn suburb near the capital of Damascus. According to NPR:

The Syrian government has pledged to immunize all Syrian children under age 5. But wartime politics is getting in the way. And the outbreak is expected to grow…

Most cases have occurred in children less than 2 years old, who were born in Syria after the war started and missed their routine vaccinations, he says.

But, but, but MaggieLC “knows” that the fact that polio has nearly disappeared and the polio vaccine had nothing to do with it. How can she reconcile that with what is actually happening? By resorting to inane conspiracy theories, of course:

Read the information. Polio Is mild disease 99 per cent of the time. People with low immunity have been known to GET Polio and die from coming in contact with the feces of pp who have been recently given the oral vaccine.

Do you think biological warfare is not being practiced? …

So there you have it, folks. UNICEF is practicing biological warfare on little Syrian children by giving them an oral vaccine that will deliberately spread the disease, and resulting paralysis, not prevent it.

That’s crazy even in the crazy world of Mothering.com. When others demanded evidence for her vile accusation, MaggieLC had this to say:

Don’t tell me what to do.

BLOCK!

She blocked the questioners so she could pretend they don’t exist.

When you are a vaccine rejectionist reality is such a bummer!

Darcia Narvaez is at it again.

You may remember her as the author of the “Sanctimommy Manifesto,” a wholesale substitution of her personal preferences for actual science. The Notre Dame psychology professor is blithering yet more nonsense about what babies need and in the process falling victim to a paleofantasy of infancy.

Her latest screed, Ten Things Everyone Should Know About Babies, is filled with nonsense from beginning to end.

Narvaez starts with this “insight”:

Have you noticed all the stressed babies? Maybe one in 30 I see has glowing eyes, which I take as a sign of thriving.

Dr. Narvaez, you really need to get out more or get new friends and acquaintances. It is horrifying that you live in a dystopian world where 29 out of 30 babies are stressed out. The rest of us, however, live in the real world with healthy, happy babies who grow into healthy, happy, well adjusted adults.

And what’s with the glowing eyes? Perhaps you have babies confused with kittens and puppies whose retinas do indeed reflect light and appearing to be glowing.

Narvaez is a big fan of paleofantasy. According to Professor Marlene Zuk, author of the book Paleofantasy: What Evolution Really Tells Us About Sex, Diet and How We Live explains:

It is striking how fixated on the alleged behavior of our hunting-and-foraging forbearers some educated inhabitants of the developed world have become. Among the most obsessed are those who insist … that “our bodies and minds evolved under a particular set of circumstances, and in changing those circumstances without allowing our bodies time to evolve in response, we have wreaked the havoc that is modern life.” Not only would we be happier and healthier if we lived like “cavemen,” this philosophy dictates, but “we are good at things we had to do back in the Pleistocene … and bad at things we didn’t.”

Indeed, according to Narvaez:

Babies are social mammals with social mammalian needs. Social mammals emerged more than 30 million years ago with intensive parenting (a developmental nest or niche). This is one of the many (extra-genetic) things that evolved other than genes. This developmental nest is required for an individual to develop properly. Intensive parenting practices for babies include years of breastfeeding to develop brain and body systems, nearly constant touch and physical presence of caregivers, responsiveness to needs preventing distress, free play with multi-aged playmates, and soothing perinatal experiences. Each of these has significant effects on physical health.

What a bunch of baloney! Are we supposed to believe that all mammalian offspring have the same needs? Are we supposed to believe that the needs of mammals have not changed from those of prehistoric marsupials? Are we supposed to believe that human babies need the same things as rat pups?

Moreover, adults are also mammals with social mammalian needs and, as far as I know, those needs do not include advice from psychology professors since neither professors nor psychology existed 30 million years ago. Should we therefore conclude that we would be much better off in the absence of professors and psychology?

Just in case you missed the evidence that Narvaez is making it up as she goes along, she helpfully offers this ludicrous observation on our hunter-gatherer ancestors:

They are much wiser, perceptive and virtuous than we humans in the USA today.

The myth of the noble savage!

Narvaez expounds:

Of course, every human community is not perfect but when you provide young children with their basic needs, they are less aggressive and self-centered.

How do we know that? Because ancient peoples were peace loving environmentalists and war did not occur until the 20th Century, right? Wrong! Primates, including humans, can be violent and vicious, engaging in everything from domestic abuse of females with roving eyes, to bloody territorial battles, to actually EATING other primates. Sounds really virtuous, doesn’t it?

Not surprisingly nearly everything that Narvaez writes is the product of her fevered imagination and has no basis in science.

My personal favorite is this bit of nonsense:

Culture does not erase the evolved needs babies have. Babies cannot retract their mammalian needs.

Actually, culture modifies nearly everything. Culture includes houses, central heating, birth balls, baby slings and nursing bras.

Moreover, evolution did not stop 30 million years ago, or even 30 thousand years ago. To claim that contemporary infants are exactly the same as infants 30 million years ago or even 30 thousand years ago is bizarre. Adults are different in many ways than they were 30,000 years ago: they can digest lactose, carry genetic resistance to malaria, and behave quite differently. There’s no reason to imagine that while adults evolved, infants stayed exactly the same.

In fact, infants are not terribly different from Dr. Narvaez herself. Does she live like our ancestors from 30 million years ago? Is she walking on all four limbs, swinging naked in the trees and reproducing endlessly? No, Narvaez walks on two feet, does not climb trees on a regular basis and is childless. Clearly she hasn’t met her own mammalian needs. Should we conclude, therefore, that by wearing clothes, going to college and writing for Psychology Today that Dr. Narvaez is one of those:

… whose health and sociality are compromised (which we can see all over the USA today with epidemics of depression, anxiety, high suicide and drug use rates). Such mis-raised creatures might do all right on achievement tests or IQ measures but they may also be dangerous reptiles whose world revolves around themselves…[?]

Possibly. Fortunately it should be easy to determine:

All we need to know is whether her eyes glow!

Below are the characteristics of two types of pain relief in labor. Guess which one is favored by midwives.

If you guessed “B,” you’d be wrong.

True, it is easily adjustable, non sedating, has no impact on memory or oxygen levels and crosses the placenta in miniscule amounts if at all. But it’s the dreaded epidural and it’s bad, bad, bad.

“A” is, in fact, favored by midwives and used extensively by midwives around the world at home and in the hospital. Indeed, many midwives believe it is perfectly compatible with natural childbirth despite the fact that it is most certainly a drug, marketed by a pharmaceutical company, is difficult to dose effectively, causes sedation and impaired memory, and readily crosses the placenta in large amounts where it sedates the baby.

Shocked? You shouldn’t be. Drug “A” is nitrous oxide and American midwives are clamoring for its use.

A new patient handout prepared by the Journal of Midwifery and Women’s Health expounds on the virtues of nitrous.

… Many women in Europe and other countries, such as Canada and Australia, use it to help cope with pain in labor. It is so common that in some countries as many as 8 in 10 women use nitrous oxide to help with labor pain. Women in these countries have been using this method of pain relief in labor safely for many years. Nitrous oxide hasn’t been used as often in the United States, but that is changing.

The handout acknowledges that nitrous produces altered consciousness and distorted memory, but apparently does not consider that a problem. The handout glosses over the impact of nitrous on the baby:

Nitrous oxide is the only pain relief method used for labor that is cleared from your body through your lungs. As soon as you pull the mask away, the effect of breathing the gas is gone within a few breaths. No extra monitoring is needed for you or the baby because you are using nitrous oxide. If you did get too sleepy, a monitor to check your oxygen levels might be placed on your finger. Nitrous oxide is safe for your baby, so if your baby’s heart rate is being checked intermittently (off and on) rather than continuously (all the time) with a fetal monitor, that is still okay…

Midwives are apparently unconcerned that nitrous crosses the placenta easily and in large amounts, producing sedation and altered consciousness in the baby. In fact, it would be quite accurate to state that nitrous “drugs” the baby whereas epidurals do not.

What’s the impact of nitrous on breastfeeding and newborn behavior? That’s not clear because very little research has been undertaken on the impact of nitrous on the newborn.

So by every parameter we can measure, nitrous has far more impact on women and babies than an epidural, yet nitrous is “good” and epidurals are “bad.” What accounts for this paradox?

It’s simple: midwives can administer nitrous, but lack the skills and training to administer epidurals.

All the pious wailing about the effects of epidurals are nothing more than hypocrisy. It really makes no difference to midwives whether women use “drugs” in labor to relieve pain, even if those drugs limit ability to move in labor, alter consciousness, impair memory, decrease oxygen levels, readily cross the placenta and sedate the fetus … just so long as they can administer the drugs.