I recently came across a perfect example of sanctimommy literature. It’s a classic because the author has no idea what she is talking about (of course), deliberately makes a false analogy, is incredibly judgmental and is falling all over herself to demonstrate her natural mommy cred.

I’m referring to this piece: What if someone suggested morphine to help your newborn sleep? by Kristin Dibeh, who amazingly believes she is qualified to write about childbirth because she is a childbirth educator.

She starts with typical first world privilege and self-absorption:

I knew that birth was possible without drugs, and that if my baby sister can do it under the circumstances she was coping with, so can anyone.

Duh! Of course birth is possible without drugs. Who would think otherwise? 100% of women who existed prior to 1850 gave birth without pain relief, and around the world most women give birth without pain relief each and every day.

Kristen goes on to excoriate women who opt for epidurals during labor.

I knew that I wouldn’t use an Opiate or a Caine derived drug BEFORE I was pregnant, so it confused me as to why people would be so shocked by the idea of NOT using controlled substances when there was a baby inside me. It still confuses me, actually…

Her “confusion” might be cleared up if she learned something about physiology and pharmacology, but that’s obviously too much to ask, so let me make it simple.

There is nothing dangerous about medical use of opiates or ‘caine anesthetics. If Kristen wants to tolerate the pain of a broken bone or a 3rd degree burn without morphine, she’s welcome to do so. If she wants to tolerate the pain of a root canal without novocaine, she’s welcome to do so. But that doesn’t justify pretending that opiates or ‘caine local anesthetics are dangerous.

The same thing applies to pregnant women. Both opiates and ‘caine anesthetics are safe in pregnancy, too. There is no reason for a pregnant woman who breaks her leg or sustains a severe burn to forgo morphine, and there is no reason for a pregnant woman undergoing root canal to avoid novocaine.

These medications are also safe for babies. Were a baby to be experiencing severe pain (from surgery, for example) opiates are perfectly appropriate to treat that severe pain and local anesthetics are appropriate for local procedures that require pain relief.

In other words, physiology and pharmacology tells us that opiates and ‘caine anesthetics are safe for use in non-pregnant women, in pregnant women, and in babies. Hope that clears up the confusion.

Let’s address the deliberately misleading and outlandish analogies.

If you took your baby home and he or she appeared to be in pain, would you give the baby…would you even consider giving your baby the likes of morphine? epinephrine? fentanyl? stadol? bupivicaine? chloroprocaine? lidocaine? The are all in the class of Opiates or Caine derived drugs. Would you give them to your baby short of ABSOLUTE medical necessity once they are in your arms?

If my infant had severe pain, you bet I’d be giving him or her opiates or ‘caine anesthetics. You’d have to be a monster to refuse to treat severe pain in an infant.

And here’s a helpful hint: Treating severe pain IS an ABSOLUTE medical necessity. What other reason is there to use analgesics and anesthetics?

The above list of drugs are serious, you wouldn’t dream of giving it to your baby the day after your baby is born unless the risk of giving it, outweighed the risk of not giving it.

Wrong! I’m not sure what Kristen imagines the “risks” of not treating severe pain in infants to be, but we give babies (or anyone) pain medication not because the “risk” of leaving the pain untreated outweighs the “risk” of treating it. We give pain medication to relieve pain, PERIOD. We don’t encourage burn patients to do without morphine even though that’s what our ancestors did. We don’t encourage people to do without novocaine during dental work because that’s what are ancestors did. So why should we be wandering around berating women for having pain relief in labor, for no better reason than because our ancestors avoided it?

Of course, the santimommy heart of the piece is the title:

What if someone suggested morphine to help your newborn sleep?

Is anyone suggesting giving morphine to anyone who is not in pain? You wouldn’t give morphine as a sleep aid to ANYBODY, so why ask if you would give it to an infant? Because the question reinforces the sanctimommy self-satisfaction, which, of course, is what this piece is all about. Good mothers would never drug their infants to sleep with morphine so why would a “good mother” allow opiates injected into her epidural space to relieve your own agonizing pain? How about because one thing has nothing to do with the other?

Imagine if we asked sanctimommies:

Would you feed a newborn a kale smoothie the day after it was born?

Think about the risks of doing that, everything from aspiration to severe GI pain. So if you wouldn’t feed a newborn a kale smoothie, how can you justify drinking one while you are pregnant?

No doubt a sanctimommy, in her own defense, would point out that a pregnant woman drinking a kale smoothie is very different from a newborn drinking a kale smoothie; the mother digests and metabolizes the kale so the baby doesn’t have to do so; that the placenta is not a sieve so that the kale itself does not get into the baby’s bloodstream; and that the chemical components of the digested kale are safe for babies.

Guess what? The same principles apply to the opiates and ‘caine anesthetics in epidurals.

Let there be no mistake about the inevitable conclusion: the fact that a woman refuses an epidural does NOT make her a better mother than someone who has one. What determines the quality of a mother is how she raises the child, not what she does to treat severe pain while pregnant.

If you don’t want to have an epidural, don’t have an epidural. But if you think that marks you as a good mother, think again. It merely identifies you as a gullible consumer of natural childbirth propaganda.

Hi, folks, we at the Extreme Sports Network are proud to be reporting from this year’s World Championship of Childbirth. We’re especially fortunate to have world renowned childbirth expert Ima Frawde, CPM here with us as a commentator.

Ima, tell us about competitive childbirth.

Ima Frawde, CPM here. I want to start by thanking the Extreme Sports Network for inviting me to comment on this very important event. Many people may not know about competitive childbirth, but it’s an obvious outgrowth of our understanding about birth. We used to think that childbirth was about having a healthy baby and a healthy mother, but we now realize that birth as a piece of performance art whose goal is to perfectly replicate birth in prehistoric times.

I like to think of the sport as akin to rhythmic gymnastics. In rhythmic gymnastics participants are judged on how closely they execute a variety of stylized moves and how closely they mimic each other. In competitive childbirth, the judges evaluate each mother for how closely she executes the pre-approved moves of competitive childbirth and how closely she mimics childbirth in prehistory as imagined by a bunch of high school graduates thoroughly ignorant of both obstetrics and history.

The competition involves 3 phases. Competitors are awarded marks in each area: each competitor receives risk points, the object being to enter the arena with as many pre-existing childbirth risks as possible. Basic individual risks —breech, twins, postdates, VBAC —- receive small numbers of points. The key in this phase of the competition is to combine risks for bonus points. Bonus points are also awarded for women who willingly expose their babies and themselves to above average risks —- like a history of a previous stillbirth, intrauterine growth restriction, or a history of postpartum hemorrhage. pushing for more than 6 hours, ignoring thick meconium, or failing to monitor the fetal heart rate for hours at a time.

The strategy in this phase is come as close as possible to killing your baby and yourself without actually dying. No, there’s no point penalty if your baby or you actually die, but you can’t brag about the award if you don’t live to see it.

The second phase, which we’ll be watching today, awards style points for how closely the competitor mimics childbirth in nature as a imagined by a bunch of ignorant clowns. Style points are awarded for prolonged latent phase (regular contractions for two or more days BEFORE labor really starts), arrest of labor lasting 6 hours of more (extra style points for going over 8 hours), and pushing for more than 6 hours (extra style points for pushing more than 12 hours). Style points are also awarded for how much food a woman consumes during labor (it doesn’t matter if she vomits it up later), how much time she spends in the fecally contaminated birth pool, and how many herb preparations she consumes. Bonus points are awarded for pushing for more than 6 hours, ignoring thick meconium, or failing to monitor the fetal heart rate for hours at a time. Giving birth in creative place, such as in the Amazon rainforest or on top of Mount Everest also merits bonus points. Additional bonus points are awarded for being accompanied by animals like dolphins or sharks.

The final phase awards points for defiance of authority, but don’t thinks it’s merely about refusing postpartum interventions meant to protect the health of your child. Competitors are judged both on the seriousness of withholding those interventions; as you might expect, refusing the vitamin K shot, which could result in the baby bleeding into its brain and sustaining permanent damage, gets more points than refusing the eye ointment, which might only lead to blindness. Points are also awarded for bizarre childbirth practices attributed to indigenous peoples but actually made up by white women like lotus birth or eating the placenta. Additional bonus points are awarded for tricky maneuvers like attempting to breastfeed a non-responsive baby, or breastfeeding while in hypovolemic shock due to hemorrhage.

The winner of the competition is determined by adding together risk points, style points and defiance points. The winner has the satisfaction of knowing that she met the highest standards fabricated by a bunch of ignorant clowns.

Wait, what? The baby? Oh, yes, a live baby can be an unexpected bonus of the competition, but that’s hardly a requirement, especially because many women enter because they want to experience a “healing” birth after a previous loss (of the competition, silly, not the previous baby), as opposed to wanting another child. There’s so much more to childbirth than whether the baby lives or dies!

The prize? Thanks for reminding me. The winner receives a golden pessary and a lifetime supply of Depends, which is going to come in very handy when she develops urinary incontinence after the inevitable uterine prolapse.

What do the runners-up receive. They receive the consolation prize failing to meet the high standards of the competition: a lifetime supply of guilt!

 

This piece is satire.

Dear tech and legal journalists,

In January of this year, I filed a lawsuit in Federal Court in an attempt to protect my blog, The Skeptical OB, from being hounded off the web by someone who doesn’t like what I have to say, and who was raising money and soliciting followers in an express attempt to do just that.

I had no idea that abuse of the Digital Millennium Copyright Act was a topic of profound interest in both the tech and legal communities and therefore I was quite surprised to see the case reported in these venues. I am very grateful that others recognize the potential for abuse of the DMCA, but I’m a bit concerned that many have dismissed the underlying issue as unsavory or petty. It is anything but.

I’ll concede that the proximate cause of the lawsuit, the picture of the finger seen round the world is both unsavory and petty, but that should not confuse people. The underlying dispute is about censorship, whether purveyors of pseudoscience should be allowed to censor critics when they cannot counter the scientific evidence that the critics present.

I’m a Harvard educated, Harvard trained obstetrician gynecologist who has spent my entire professional life attempting to ensure safe childbirth for babies and women. I am a respected expert on the issue of homebirth, writing for Time.com, Salon.com and The New York Times among other places, and quoted widely.

I am very effective at what I do; it’s not that hard to be effective when the scientific evidence is on your side. I merely present it in a way that lay people can understand. And in doing so, I threaten a multimillion dollar industry of childbirth paraprofessionals such as homebirth midwives, doulas and childbirth educators.

The scientific evidence on safe childbirth is so clear that no professional homebirth advocates would dare debate me in an open forum, despite multiple offers on my part to do so. Rather, they have attempted to censor me.

As far back as 2007 doulas and homebirth organizations sent multiple complaints to the Massachusetts Board of Registration in Medicine (they were dismissed), and as recently as within the past several months, the American Congress of Obstetricians and Gynecologists has received multiple letters from homebirth activists demanding that I not be allowed to speak at a forthcoming ACOG district conference where I am a featured speaker.

While my experience may be the first time that a homebirth critic has been targeted, this is hardly a unique experience for those who fight to correct the misinformation of people who profit from pseudoscience. From Simon Singh, PhD, a critic of chiropractic who was sued for libel, to Dr. Paul Offit, who has tenaciously countered the misinformation of the anti-vaccination lobby and has required a bodyguard for protection from threats against his life, physicians and scientists who debunk pseudoscientific misinformation with scientific evidence routinely face efforts at censorship.

When it comes to the misinformation from the homebirth lobby that threatens the lives of babies and mothers, I’ve found that sunshine is the best disinfectant. Exposing the deaths of babies at homebirth, the efforts of homebirth midwives to escape culpability for injuries and deaths and the misinformation that leads women to choose homebirth in the first place, I’ve found that there is no better antidote than scientific evidence.

My critics obviously agree that there is no better antidote than scientific evidence. That’s why they can’t debate me and why they want to silence me instead. One homebirth activist hit upon filing multiple false DMCA notices against me as a tool for censoring me from the internet. If an activist can do that to me, what’s to stop purveyors of pseudoscience from attempting to use the DMCA to shut down the free flow of information about climate change or evolution? Nothing, unfortunately.

Don’t be fooled by an obscene photograph. This isn’t about a personal dispute and this isn’t about homebirth. It’s hard to debate when science isn’t on your side; how much easier then to censor instead.

You really have to hand it to homebirth midwives. Who else could resurrect third world causes of childbirth death in the first world?

Like their ideological soulmates, the vaccine rejectionists, they imagine re-enacting the “olden days.” And just like the vaccine rejectionists, who are single handedly bringing back, measles, whooping cough, and other vaccine preventable diseases that routinely killed children in the “olden days,” homebirth midwives are bringing back intrapartum stillbirth.

Intrapartum stillbirth is the death of a baby during labor. It is extraordinarily rare in the US today. A woman who shows up at a hospital in labor with a live term baby is almost certain to give birth to a live baby. Not so in the third world. Asphyxia (lack of oxygen) during labor is a leading cause of death in countries where women lack access to hospitals and obstetricians. Why? Because birth attendants in the third world have no way to tell if a baby is not receiving enough oxygen in labor and no way to fix it by C-section or forceps even if they could tell.

Similarly, homebirth midwives also can’t seem to tell if a baby is not receiving enough oxygen in labor, and when and if they do figure it out, they lack access to the obstetricians, anesthesiologists and operating rooms that could easily save the baby’s life.

Consider these two cases of homebirth death recently in the news:

1. ‘Perfectly healthy’ baby boy suffocated in womb:

The baby’s parents, Sarah Williams and Emmet Heneghan, had given evidence the previous day. Mr Heneghan described the scenes from that night in their home in Louisburgh, Co Mayo, in May 2011 as “farcical” as the baby’s heartbeat began to fade.

He had suggested that they go to the hospital, but the midwife’s car would not start so they had to travel in his.

Ms Williams also gave evidence that a doctor had told her that if they had left for the hospital earlier, her son would be alive.

Self-employed midwife Christina Engel, of Ballinrobe, Co Mayo, said she called the hospital to declare an emergency transfer as soon as she noticed the foetal heartbeat decelerating.

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

The woman, who arrived about 9:43 p.m. Aug. 29, was 8 centimeters dilated by the next morning, according to a 7:15 a.m. exam, the documents said.

Then between 6:05 and 6:53 p.m. Aug. 30 [11 HOURS later!], the baby’s heart rate dropped from the 130s to the 110s while in utero. Just before 7 p.m., the documents note that “oxygen was applied at 10 liters per minute via a face mask.” But no physician was consulted, the documents said.

Around 7:30 p.m., the midwives took the woman to the hospital in her own vehicle, without consulting a physician or calling for an ambulance, documents said.

The midwives contacted Piedmont Medical Center and told them they were “en route with a mother that has fetal intolerance to pushing, meet us downstairs,” documents said.

When they arrived, a cesarean section was performed, and the baby was born without a heartbeat. Hospital personnel tried to revive the baby but were unsuccessful, state documents said.

Another third world cause of death is lack of access to someone with knowledge and equipment for advanced resuscitation:

3. The story of a blogger who is “pursuing healthy living.”

Finally, after 1 ½ – 2 hours of pushing, her head was coming out. I wasn’t sure she was really coming until they told me to reach down and grab her. She was still pink at this point. I reached down and grabbed her (under her arms I think) and started to help pull her out. They told me later that the moment that I grabbed her was when her coloring and muscle tone suddenly changed. They had never seen a baby’s color change so quickly before. She went from pink to white/blue, and she fell limp. I remember her head falling to her shoulder as I was grabbing her. From the sudden change in color and muscle tone, Sara knew something was wrong. As I pulled out most of her body, Sara took her from me and immediately started trying to get her to breathe.

What is it with these homebirth midwives and their refusal to call an ambulance?

During the pregnancy, Sara had explained that in case of transfer, she just drives to the hospital and calls ahead so they know she is coming and what is going on. If she called an ambulance instead, we’d have to wait for them to get to us, THEN drive to the hospital, so just driving herself gets the emergency to the hospital faster. (Not to mention that ambulances cost $$$$$.) It was also night time and we only live a mile from the hospital in a small town, so there should be virtually no traffic and she could drive quickly.

And, as usual, the mother refuses to take responsibility for her choices. In this case, apparently, its God’s fault:

It is hard to describe, but I genuinely felt peace at that point, that it didn’t really matter whether my baby lived or died or had complications, because I knew that whatever the outcome was, would be the way God wanted it to be. He wouldn’t make or allow this situation to happen if it weren’t for a reason. If God wanted her well, He would provide the miracles for her to live. If she died, then that was what was intended for her. God wouldn’t let something happen that was not the plan. Things were happening the way they were for a purpose. So I didn’t need to worry.

And once again, the drive to the hospital, in the midwife’s car turns into a farce:

On their way to the hospital, they hit a dip in the road too fast, which triggered some sensor in the car, shutting off all the electronics, and thus shutting down the car. Somehow, the BlueTooth was still working though, and they called 911. Sara had my baby in the towel and they started running (without shoes on, I might add) to the hospital. The 911 dispatcher had tried telling her to wait in the car, but she told them the policemen could catch up with her, as she was NOT waiting… After running maybe 1/3 of a block, a policeman picked them up and drove them the last 3 blocks to the hospital…

The end result:

When my baby arrived at the hospital, the doctors and nurses administered CPR and tried 3 times to intubate her. They gave her 3 doses of adrenaline/epinephrine, but couldn’t get a good heartbeat. At one point, they could get a heart rate of 60 (and it fleetingly even went up to 80), but it wasn’t a full open-close valve action…It was really just a flutter, forcing the heart to move without really beating. The heartbeat that they did get was short-lived and she never took a breath…

Dr. Pedi then tried breaking the news to DH that there wasn’t anything else they could do and that she was gone…

These are anecdotes to illustrate the point, but hard data shows the extraordinary epidemic of third world deaths at first world homebirth.

In March of this year, Judith Rooks, CNM released the most comprehensive homebirth statistics ever collected in the US.

The overall all rate of perinatal death at planned homebirth with a LICENSED midwife was 800% higher than comparable risk hospital deaths. While the rate of intrapartum death of term babies in hospitals is so small that it is effectively zero, in just one year alone three (out of 1235) babies dropped into a homebirth midwife’s hands unexpectedly dead … just as often happens in the third world.

Homebirth increases the risk of neonatal death because homebirth has resurrected third world causes of death in the first world.

Way to go, homebirth midwives!

Good, old Hannah Dahlen. I can always count on her to say something idiotic that gives us insight into hijacking of midwifery by biologic essentialists. Those are the women who think a woman’s vagina, uteri and breasts are more important than her intelligence or her comfort.

You remember Dahlen? She’s the spokesperson for the Australian College of Midwives who has given us such gems as:

A common concern with water birth is that the baby could try to breathe underwater and drown. But healthy babies have what’s called a diving reflex (or bradycardic response), which causes the infant to hold his breath when under water. The reflex is stimulated via the the infant’s facial skin receptors, which detect the water and inhibits breathing.

Sorry, Hannah, the diving reflex works only in COLD water. Anyone with a modicum of obstetric knowledge knows that babies are happy to aspirate warm fluid. That’s why they do in utero to expand their lungs and practice breathing before birth.

And, my personal favorite:

While the birth of a live baby is of course a priority, perinatal mortality is in fact a very limited view of safety.

Really? On what planet would that be?

Apparently that’s the way it is on Planet Midwifery where Dahlen and her colleagues reside, a through the looking glass world, where the acme of childbirth is not a healthy mother and healthy baby, but, rather, an unmedicated vaginal birth.

What’s Hannah come up with today?

Dahlen is incensed that any woman might value avoiding a lifetime of urinary and fecal incontinence over the ultimate achievement of unmedicated vaginal birth.

Dahlen, in a comment to the Australian newspaper WAToday, is responding to speech by Dr. Peter Dietz who is a urogynecologist. That means that he spends his professional life in large part repairing the damage from vaginal births. Dr. Dietz told a recent meeting the Royal Australian and New Zealand College of Obstetricians and Gynaecologists that women are suffering substantial pelvic floor damage in the quest for natural birth, because vaginal birth carries a risk of 30 per cent to 50 per cent of substantial pelvic floor damage.

Major pelvic floor damage can result in years, if not a lifetime, of misery. It can mean being unable to hold urine and feces, being unable to leave the house because of embarrassment and being unable to have sex.

But apparently on Planet Midwifery, that’s far less important than having a baby transit your vagina.

According to Dahlen:

There is no doubt pelvic floor injuries are a threat to the health of child-bearing women. It is imperative we continue research in this area and work to make birth safer. But women need comprehensive information that goes beyond the pelvic floor when considering the pros and cons of vaginal birth versus caesarean section.

Umm, Hannah, you apparently do not realize that we have “done research” in this area and the research shows that vaginal birth is the single biggest risk factor for pelvic floor damage.

But who cares about something as trivial as incontinence, right?

Dr. Dietz also criticized the effort to reduce epidurals, calling it, correctly, “reprehensible and anti-Hippocratic.”

Dahlen responds with this bit of nitwittery:

There is no intent to deny a woman an epidural if she wants one; we need to ensure they are not used unnecessarily.

Wait, what? They’re giving epidurals to people who aren’t in pain?

That can’t be what Dahlen means. After all, epidurals are widely used in other areas of medicine like general surgery, orthopedic surgery and management of chronic pain. Dahlen doesn’t mean those people. I’m sure she thinks it’s just fine to use epidurals ease surgical pain or cancer pain. No, Dahlen thinks it is “unnecessary” to treat childbirth pain.

Why? Because it might lead to something other than the pristine unmedicated vaginal birth so valued on Planet Midwifery.

And then there’s this, infinitely more revealing about contemporary midwifery than it is about anything else:

Dr Dietz’s statement that ”human childbirth is a fundamental biomechanical mismatch, the opening is way too small and the passenger is way too big,” provides a real insight into why the caesarean section rate may be so high in this country.

If health professionals truly believe this, then what chance do women have to feel confident in their bodies and their capacity to give birth?

Because on Planet Midwifery, the most powerful force isn’t gravity, it’s magical thinking.

Earth to Planet Midwifery: do you hear me?

Listen carefully:

There is NO SUCH THING as an unnecessary epidural. Childbirth epidurals are always and only given to women who have so much pain that they want one.

A midwife has NO BUSINESS deciding whether a woman “deserves” to get an epidural. We have a word for that behavior; it’s paternalism, and it’s reprehensible and un-Hippocratic.

Confidence has no more impact on a woman’s ability to have a vaginal birth than it has on her ability to have a child of a desired gender.

Women need to understand that midwives like Hannah Dahlen do not have their interests at heart. How could they when they don’t care if babies die, when they don’t care if women become incontinent and when they don’t care if women are in agonizing pain? Midwives like Dahlen care about one thing only: themselves and their associated ability to maintain control over patients.

Midwives aren’t as capable of obstetricians at saving babies lives; hence “perinatal mortality is in fact a very limited view of safety.”

Midwives can’t prevent pelvic floor damage by performing C-sections; hence incontinence pales in importance to vaginal delivery.

Midwives can’t perform C-sections to save the lives of babies in distress or deliver babies who are too large to pass through the pelvis; hence they pretend that it is doctors’ and patients’ “lack of confidence” in women’s bodies that keep midwives from ensuring a vaginal birth for every patient.

The questions for women are these:

Do you want to give birth on Planet Midwifery, where your vagina is more important than your brain, where your pain is ignored and where you are blamed if you do not achieve the ideal unmedicated vaginal birth? Or do you want to live in the real world where people care about whether your baby lives or dies, whether you are rendered incontinent, and want to ease your agony, not celebrate it? It’s up to you to decide.

Laura Helmuth has a fascinating series on longevity of at Slate Magazine. Yesterday’s installment was about maternal mortality. The title, The Never-Ending Battle Between Doctors and Midwives. Which Are More Dangerous?, is somewhat awkward, but the piece itself is fascinating.

She recounts the history of obstetrics, including the early 20th Century when doctors’ desperate desire to do something about maternal and perinatal mortality outstripped their understanding of their own tools.

Things got worse as obstetricians started professionalizing and coming up with new ways to treat—and often inadvertently kill—their patients. Forceps, episiotomies, anesthesia, and deep sedation were overused. Cesarean sections became more common and did occasionally save women who would have died of obstructed labor, but often the mother died of blood loss or infection… Women giving birth in hospitals were at greater risk than those delivering at home. Disease and infections spread more readily in hospitals, and doctors were all too eager to use surgical equipment.

She includes a graph of maternal mortality similar to those I have posted in the past.

Doctors began to use their technology more judiciously and new discoveries led to a massive and sustained drop in maternal mortality (and a comparable drop in perinatal mortality).

Doctors cleaned up their acts, too. A series of reports in the 1940s linked high death rates to improper medical procedures. Training improved, and doctors abandoned the most dangerous techniques. Complications from C-sections declined steadily. Medical researchers now rigorously evaluate success rates and risks of new techniques and drugs…

Improved maternal survival eventually did turn into one of the great public health and medical achievements of the 20th century—it just took an unconscionably long time. The good news today is that, globally, maternal mortality is continuing to decrease. More women are surviving childbirth, and that’s a big reason—and one of the most joyful reasons—why lifespan is continuing to climb in the 21st century.

Not surprisingly, as technology drove down rates of maternal and perinatal mortality, women flocked to hospitals to give birth. Midwifery has never really recovered.

But midwives have fought back, mainly by pretending that the massive decreases in maternal and perinatal mortality didn’t actually occur, and that childbirth was always as safe as it is today.

Helmuth notes:

The midwives and doctors, though—they’re still tangling. Midwives accuse doctors of endangering women by continuing to perform too many unnecessary procedures. Doctors accuse midwives of allowing pregnant women and newborns to die of preventable deaths.

She uses homebirth as a case in point:

The main battlefield today is over home births. About 1 percent of women in the United States choose to give birth at home. Counterintuitive as it may sound at first, they often cite safety concerns—they’re worried about unnecessary procedures if they give birth in a hospital.

Helmuth has an awesome takedown of homebirth midwives in general and Melissa Cheyney in particular:

Melissa Cheyney is an anthropologist at Oregon State University as well as a home-birth advocate and midwife. She reports that women who choose home birth “value alternative and more embodied or intuitive ways of knowing.” Home-birth advocates say women are better off giving birth in a comfortable environment, letting nature take its course.

I’m personally opposed to letting nature take its course—nature will kill you. And “intuitive ways of knowing” is just a flowery term for “ignorance.”

Helmuth appears to unaware of the confirmatory data from Oregon that shows that planned homebirth with a licensed midwife has a perinatal mortality rate 9 times higher than comparable risk hospital birth.

In the end, it’s obstetricians for the win!

But when you take a world-historical look at childbirth, it’s not midwives and cozy home births that get credit for making maternal death such an unthinkable outcome today. One of the great victories of modern times is that childbirth doesn’t need to be natural, and neither does the maternal death rate. It’s modern medicine for the win. Doctors may have killed a lot of women in the first part of the 20th century, but they can save your life today.

I’m pleased to report that the judge agreed with our arguments and those of the Electronic Frontier Foundation/Digital Media Law Project of Harvard Law School and denied Gina Crosley-Corcoran’s motion to dismiss my lawsuit. The case will be going forward in Massachusetts.

EFF makes the valid point that even a two-week improper removal of lawful speech from the public domain “‘causes significant injury . . . where time-sensitive or controversial subjects are involved and the counternotification remedy does not sufficiently address these harms.’

And:

Because, for present purposes, “a knowing and material misrepresentation” is adequately pled, defendant’s motion to dismiss is DENIED.

You can read the full opinion here:

https://dl.dropboxusercontent.com/u/27713670/Tuteur-20130910_Court_order_denying_motion_to_dismiss.pdf

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.

Too bad they thought candles and music constituted a perfect birth. Personally, I think a live, healthy baby makes a perfect birth and candles and music be damned.

What happened? The story follows the usual homebirth disaster script:

1. A long labor:

On May 23th, 2011, she awoke with abdominal cramps. Ms Engel arrived at about 11.30am. She again arrived at about 6pm and at about 10.30pm told her she could see “the top of the child’s head, his black hair”.

At around 12pm she said to the midwife that she felt it was taking too long, and just after 1am she said it again that she couldn’t get the baby out.

2. Lack of appropriate fetal monitoring and resulting in the “sudden” loss of the baby’s heartbeat:

The midwife told her to push harder but at about 1.30am the baby’s heartbeat had changed and she could not get a reading.

3. The father who insists that they should take the mother to the hospital.

… [H]er partner, suggested it was time she go to the hospital and the midwife agreed…

He said that at approximately 12.30am or 1am he turned off the music. The mood intensified. He saw and heard the baby’s heartbeat diminish and he had enough of what he was seeing and said straight out: “let’s go to the hospital”.

4.The failure to call an ambulance.

5. Delay in getting to the hospital:

However, the midwife’s car would not start and they had to transfer oxygen into her partner’s car. The three of them drove to the hospital in Mr Henaghan’s car.

By the time they got to the delivery suite it was 3am. Staff did an ultrasound on the baby and could not get a reading. The baby was stillborn at 3.23am.

6. The frantic attempts of hospital staff to resuscitate the baby, attempts that ultimately failed.

7. The midwife’s regrets:

[The mother] said that in the hospital immediately after it was clear that Kai had died, Ms Engel [the midwife] said she would never do a home birth again as long as she lived and kept saying “I am so sorry, I am so sorry.”

8. Failure to appropriately monitor the baby’s heart rate:

There was an “unfortunate absence” of foetal heart monitoring records in the medical notes.

9. The midwife changing her story and denying culpability:

In evidence today Ms Engel denied stating in the hospital after the stillbirth she would never do another home birth and also denied being reluctant to transfer her patient to hospital.

She also said she had carried out regular heartbeat checks during the attempted delivery and denied her car was unreliable, stating the problem starting it had been “transient”.

10. The classic exchange of the “birth experience” for the life of the baby:

[The father] said his girlfriend wanted to go down the route of having as natural a birth and pregnancy as possible and contacted Ms Engel, the only local midwife in Mayo. She only wanted to go to hospital if it meant the baby’s birth was at risk.

[He] said: “As part of Sarah’s natural birthing plans she had organised some music or sounds on the stereo to be played, some candles to be lit.

“Every aspect of the house was set out in the way she wanted it for the day of the birth.”

Too bad she didn’t worry more about the health of the baby, and less about an idyllic homebirth.

When it comes to having zero insight, it’s really hard to beat homebirth midwives. They are so totally clueless about how their own behavior comes across that homebirth midwives like Wendy Gordon, CPM, MANA (Midwives Alliance of North America) executive, can actually write an inadvertently hilarious blog post like this: Why ALL Midwives Should Care About What’s Going On With Midwifery International.

I wrote recently about the charge leveled at Midwifery International, an organization that promotes medical tourism of homebirth midwives. To her credit, Gordon acknowledges that she exploited women of color in the developing world in order to get “catches.” But, of course, she excuses herself because “she didn’t know” how truly exploitative it was. Sorry, but that’s not an excuse.

And why didn’t she know she was exploiting poor women of color in the third world? Because of her “white privilege” that blinded her to the reality of what she was doing. The irony is that her desire to turn her birth junkie hobby into a money making exercise (“birth junkie privilege”) blinds her to the fact that homebirth midwives are exploiting white women in the first world, and in exactly the same ways.

I’ve taken Gordon’s excuses and just changed a few words to illustrate how homebirth midwives exploit privileged Western white women.

Consider:

It is Wendy’s birth junkie privilege that says a homebirth advocate’s story — even when it remains untold — is always more believable than the obstetrician …

It is Wendy’s birth junkie privilege that helps her to believe that women need homebirth midwives more than homebirth midwives need clients …

It is Wendy’s birth junkie privilege that says that the tone used by obstetricians is offensive (“My OB Said What??!!”), so she can dismiss what they’ve said …

It is Wendy’s birth junkie privilege that says that her beliefs about what is unethical trump those of doctors and medical ethicists .., while the ethical concerns of the babies and mothers being harmed by homebirth midwives are not addressed at all.

It is Wendy’s birth junkie privilege that says that homebirth midwives get to decide what and who is to be believed. Hence the deleting and banning of dissenting opinions or even actual facts from every homebirth website, blog or message board.

It is Wendy’s birth junkie privilege that makes her believe that her truth is The REAL Truth … and that anyone who disagrees should “educate” herself

It is Wendy’s birth junkie privilege that permits her to think that she gets to determine when REAL harm is done … Hence the rallies to support homebirth midwives who have presided over deaths instead of investigations into their conduct.

It is Wendy’s birth junkie privilege that tells her that there will be no consequences to sweeping aside the voices of homebirth loss mothers who express that harm is being done to them …

It is Wendy’s birth junkie privilege that allows her to decide who, if anyone, she will be accountable to, which generally means no one … Hence the refusal of MANA, her organization, to release their own death rates.

And my personal favorites:

It is birth junkie privilege that permits homebirth organizations like Wendy’s organization, MANA, to silence dissent by deleting curious questions from their Facebook page; … to keep recruiting and pretend as if there is “nothing to see here” while sending out a newsletters that makes no mention of the issue at hand.

It is birth junkie privilege that refuses to examine the possibility of another version of the truth other than her own; that will actually lash out at those who dare to speak up about scientific evidence and turn the tables back on them, making herself and her colleagues out to be the real victims. It is birth junkie privilege that says that the real damage done here is to the good reputations of the homebirth midwives, and that this concern for the reputation of homebirth midwives supersedes the harms being done in communities where homebirth midwives practice.

Birth junkie privilege assures Wendy that there will be no adverse impact to homebirth midwives if they just walk away from deaths and injuries at their hands. The folks at MANA (Melissa Cheyney, Geradine Simkins and Wendy Gordon among others) just continue to wave their hands, avoid the conversation with the community, and hope that this blows over quickly so that they can all just get back to making their money. It is certainly uncomfortable to have to think about the complexity of this and the deeper training issues that need to be addressed within homebirth midwifery …

And when Wendy and her colleagues exercise that ability to turn their backs and walk away without consequence, to go back to their daily struggles that are already hard enough, and leave this mess for someone else to sort out, then we have opted to once again leave their patients to bear the brunt of their profession’s problems. When MANA is not only allowed to be completely unaccountable to the communities that they purport to serve, but are openly bullying them in front of the professional leadership for speaking about being harmed (or holding “human rights” conferences to whine that homebirth midwives are persecuted), they highlight a major, major problem for the entire homebirth midwifery community.

Wendy Gordon willingly exploited women poor women of color in the third world to benefit herself. She says she’s sorry and she didn’t understand, but I don’t see her making any effort to provide restitution to the women she used and may have harmed.

In fact, what I see is a woman willing to say “sorry” when she’s wrung what she needed from poor women of color in the third world, then pivot on a dime to exploit well-off white women in first world countries to wring the money and the prestige that she wants out of them. No doubt she’ll say she’s sorry when MANA is forced to acknowledge that they’ve hidden their death rates all along, and the CPM is abolished. In the meantime she’ll take what she wants and ignore those she harms. I wonder if she’ll eventually blame it on her birth junkie privilege.

Proponents of “alternative” medicine often disagree profoundly on treatment methods. Sick? In pain? Try this homeopathic remedy that contains no active ingredients. Stick needles into acupressure points. Wear magnetic foot pads to pull the toxins out of your body.

But on one point all proponents of alternative medicine agree. Since the source of all your troubles is a weak immune system, the key to treating and preventing all illness is “strengthening the immune system.” Indeed, this belief is so widespread, it appears that the only people who don’t subscribe to it are people who actually know something about the immune system, doctors, immunologists, microbiologists, etc. The idea that disease can be treated and prevented by “strengthening the immune system” depends on a profoundly flawed, almost cartoon like, view of the immune system itself.

The immune system is tremendously complicated, involving as it does innate cellular immunity and humoral (antibody) immunity. Multiple poorly understood organs make up the immune system. Anyone actually know what the spleen is for? And how about lymph nodes and bone marrow? Those are also quite complex. It is the interactions of these types of immunity, within the various organs of the immune system and throughout the body that determine whether and how we can fight off disease.

The alternative medicine view of the immune system is cartoon like in its simplicity. The individual components of the system, and their specific functions are never discussed or even mentioned. Too complicated. The cascade of events that occurs when the body’s outer defenses of skin or other tissues are penetrated by a foreign substance is completely ignored. Also, too complicated.

Instead, the immune system is conceptualized as a unitary entity that it either weak or strong. If you get sick, your immune system must be weak. In order to prevent illness, or to treat it once it occurs, you must “strengthen” your immune system. And how do you do that? The way you do everything in alternative medicine: you eat the right foods, and take vitamins and supplements.

But, of course, illness is not caused by a weak immune system. The specific mechanisms of illness depend on the specific causes. One possible cause is a failure of innate cellular immunity to find and destroy bacteria that penetrate the barrier of the skin. Another possible cause is the inability of the humoral (antibody) system to create antibody fast enough to overwhelm a viral invader. Instead, the invader gets a tremendous head start before the body can fight back and the virus overwhelms the host. Yet another factor is the presence or absence of various immune system organs. For example, it is well known that removal of the spleen leaves people particularly vulnerable to infection by the pneumococcus bacteria.

In every case, the disease results from a complex interaction between the disease causing agent and a specific component of the immune system. Moreover, there is no evidence that nutrition, vitamins or supplements can do anything to change the balance in these interactions, since the fundamental problem is not malnutrition, or vitamin or mineral deficiency.

It’s not as though we don’t know what a truly weakened immune system looks like. Chemotherapy (which preferentially kills fast growing cells) and certain disease like AIDS, knock out one or more components of the immune system, rendering people more susceptible to disease. If enough of the immune system is compromised or destroyed, the individual becomes vulnerable to infections that would otherwise be harmless or never occur in the first place.

In addition to ignoring what a weakened immune system looks like, and imagining that nutrition is the source of “strength” of the immune system, advocates of alternative medicine have another naïve belief about the immune system. They appear to think that the immune system can be overwhelmed by too much information. Ignoring the fact that each individual faces hundreds, thousands or more immune challenges each day, alternative medicine afficianados argue that vaccines, particularly those designed to immunize against more than one disease at a time, “overwhelm” the immune system, particularly what they imagine to be the “underdeveloped” immune system of small children.

Ironically, the truth is exactly the opposite. Vaccines are one of the few things, if not the only thing, that can strengthen the immune system by giving it a head start against a microscopic invader. Humoral (antibody) immunity takes time to ramp up if the body has never seen the invader before. It’s as if the body can’t start making weapons until it has already been invaded. Vaccines act like a picture of the enemy. Vaccines allow the body to “see” what the invader looks like before the invasion, and to stockpile weapons for the coming fight. When the assault ultimately occurs (when the person is exposed to the disease), the counterattack can begin without delay, and therefore it is much more likely to be successful.

As a general matter, a detailed understanding of system function is not necessary for lay people to understand what the system does. People do not need to know about all the different clotting factors to understand that blood should clot when you are cut and that something is wrong if it doesn’t clot. No one would invoke the idea of a “weak” clotting system to explain why a hemophiliac is bleeding to death, and no one would recommend eating the right foods, or taking vitamins or supplements to treat hemophilia.

Ordinarily, a detailed understanding of immune system function would not be necessary for lay people to understand what the system does. Unfortunately, a detailed understanding of the immune system has been replaced with a cartoon like caricature of the immune system, leading lay people to believe that it is either weak or strong, and that it can be strengthened by eating right. It is this cartoon like view that makes lay people vulnerable to the claims of alternative medicine practitioners and, therefore, this cartoon like view must be changed.

This piece first appeared in December 2009.