The doubtful father’s guide to homebirth

Today, I’d like to address fathers, specifically fathers whose wives are trying to convince them to give their approval to homebirth.

You were expecting all along that your wife would give birth to your baby in a hospital, but then she watched some movie by that girl who was in “Hairspray” and that convinced her that homebirth is just as safe or even safer, and so much more spiritual.

You are doubtful. You’ve asked her how homebirth could be safer if you are far from help if something goes wrong in childbirth. You wonder if someone who is not a doctor and who shuns technology can keep your wife and precious baby safe. You are dubious that a woman whose main professional qualification is her vow not to “interfere” could possibly provide anything that a laboring woman and her baby needs.

I have two things to tell you:

First, you are right and your wife is wrong.

Second, don’t back down because your child’s very life may depend on your insistence that he or she get the best possible medical care.

You are right that it cannot possibly be safer to deliver far from the help you need in an emergency. Your wife insists that the “research” that she has done proves otherwise and wants to “educate” you. Be very wary.

Do you really need to learn about a movement whose main thought leader is washed up talk-show host Ricki Lake? No you don’t, but your wife insists that there are professionals who have done scientific research showing homebirth is safe. Professionals? Hardly. Ina May Gaskin is a “self-taught” self-proclaimed “midwife” who has NO EDUCATION OR TRAINING in midwifery, nursing or medicine. One of her own children died at a homebirth and she refused to seek help for that baby and watched him die.

Henci Goer is a self-appointed “expert” in childbirth research, yet she has no advanced degree of any kind, not in medicine, not in nursing, not in science and not in statistics. And she is only an “expert” to her followers. She doesn’t teach in any university, doesn’t practice in any hospital, and doesn’t serve on expert panels.

These three woman, who don’t have a single relevant credential between them are the “thought leaders” in homebirth advocacy. Not surprisingly, they have no idea what they are talking about. For regardless of what they say, all the existing scientific evidence, all state and national statistics show that homebirth increases the risk that a baby will die. The increase is in the range of 200% or more. In fact, the latest statistics from the CDC show that planned homebirth in 2007 with a homebirth midwife (often called a certified professional midwife, CPM, or licensed midwife, LM) had a newborn death rate more than 7 TIMES higher than low risk hospital birth.

Death at homebirth isn’t rare; it is all too common. Read the birth stories at Hurt by Homebirth. One of the many moving stories is written by Wren’s dad, Josh.

It’s now been a year since our beautiful boy Wren was born, lived, and died. At first, I was surprised at just how few people knew about Group B Strep, and I latched onto it as a “cause” that could bring some meaning for me to the events that transpired. However, it quickly became obvious that it wasn’t GBS that was the real problem… although our friends and relatives hadn’t heard of it, it is well-known throughout the medical world, and the reason there isn’t much heard about it is that we have a completely safe, 99.8% prevention method for it.

It eventually dawned on me that real smoking gun in this situation was our decision to do a home birth. My wife had gotten interested in home birth partly through seeing “The Business of Being Born” and because she didn’t like going to hospitals. She really just liked the comfort of being at home. I was skeptical about the risks at first, but after we went to a couple different providers around Los Angeles, I came up with a mental model that made me comfortable with the idea: home births were like whole foods!

Which brings me to my second point, don’t back down when your wife tries to convince you that homebirth is safe. You may be the only person standing between your baby and brain damage or death.

Your wife may be seduced by self-proclaimed midwives whose primary goal is receiving their fee. They will do what they know how to do (which is pathetically little) and then insist that anything they can’t do is “unnecessary” and hinders the birth “experience.” Don’t believe them when they dismiss risk factors as meaningless, ignore obstetric standards of care or pretend that there is always “enough time” to get to the hospital.

Don’t be fooled into thinking these women are real midwives. In the US, real midwives have a college degree in nursing and a master’s degree in midwifery. These women (CPMs and LMs) may have nothing more than a high school diploma, if that. That’s why they are not eligible for licensing in the UK, the Netherlands, Canada, Australia or ANY country in the first world. They don’t meet the basic standards of education and training required in ALL other industrialized countries.

This baby is your child too, and his or her protection is your responsibility. Yes, your wife may have her heart set on a homebirth, but she also has her heart set on raising a live baby, and homebirth diminishes the chance that your baby will survive childbirth.

As Josh explained:

You don’t know what “really good” midwives are. The ones we picked are licensed by The California Medical Board and certified by the North American Registry of Midwives. They are CPMs, LMs, MPHs, and LLCs. They’d been in business for decades and delivered thousands of babies. It turns out that … they actually have no medical training…

Overall, I just feel like a fool. My entire focus throughout the pregnancy was on the labor, the delivery, [my wife’s] experience, and maybe the first few minutes after birth. Once he had ten fingers, ten toes, and a lusty cry, I figured we were in the clear.

I was wrong, and our poor defenseless baby boy Wren paid for my ignorance. I thought I had everything figured out, I thought we would glide right through it all, I thought we were so cool.

Don’t let your child become a homebirth statistic or a sad story on Hurt by Homebirth. You are right that homebirth is not safe and it is important for you heed what you know to be true. Your wife may be disappointed that you do not approve of homebirth, but that is nothing compared to the lifelong heartache both she and you will endure if your baby dies at home because the emergency treatment he or she needed was too far away to make a difference.

277 Responses to “The doubtful father’s guide to homebirth”

  1. MinSeip27
    March 26, 2020 at 1:19 pm #

    I think the author may have heard wrong information about Ina May Gaskin’s own baby “dying at a homebirth” and her “watching him die,” implying a cold and callous attitude about the death of her baby. According to Wikipedia, the death of her baby was prior to her career (or ministry) as a midwife, and before her community “The Farm” was even in existence. Apparently the death of her child was what fueled her passion for a different way to give birth.

    From Wikipedia:

    “Before The Farm:
    In the 1960s, Ina May gave birth to her first child in which the physician
    used forceps. The experience was so unpleasant for her, that she
    searched for a better way for this to happen. Before The Farm was
    established, her husband Stephen was leading a speaking tour caravan in
    1971. This tour was based on his philosophical seminars in San
    Francisco. It was for the first time on this tour that she helped a
    woman in childbirth.[3]

    This birth was just the first of many on this journey; even Ina May
    gave birth for the second time. On March 16, as the caravan was
    traveling through Nebraska, Ina May went into labor. The baby, who they
    named Christian, was born prematurely by 8 weeks, and died the next
    day. She was not allowed to keep the baby, and law enforcement made her
    bury the child in Nebraska.[4] Her own personal experiences fueled her interest into midwifery and safe childbirth.”

    I have no connection with Ina May Gaskin, but I do feel strongly that we all be more careful about verifying our sources before publishing. It’s not hard to do here in the information age.

    • swbarnes2
      March 26, 2020 at 6:47 pm #

      The baby required medical help to survive. His parents chose to deprive him of that both by giving birth away from a hospital, and by refusing to take him to one after birth.

    • rational thinker
      March 27, 2020 at 7:01 am #

      Wikipedia is written by ordinary lay people for the most part and anyone can become a contributer and write what they want. Most likely the stuff you read on there about her was probably taken from her own books, which are filled with self promotion. Also her husband’s “philosophical seminars” were more accurately him trying to start his cult on the farm. He is known for being a cult leader.

      Dr. Tuteur never writes or makes claims without proof, and if she does write something that turns out to be false she retracts it immediately and apologizes. The same cannot be said about all Wikipedia articles.

      “I do feel strongly that we all be more careful about verifying our
      sources before publishing. It’s not hard to do here in the information
      age.” – I suggest you follow your own advice.

    • Dorothy O'Neil
      January 17, 2021 at 4:18 pm #

      This is an extremely bias page where only one way of thinking is accepted. To try and explain anything and expect someone to consider what you are saying may possibly be true, is impossible. There’s lots of strong arming, sadly but common when someone fears their way of thinking, living, and doing things is superior to everyone else. Yet, even though they know they are superior, they can’t leave it at that, they have to exaggerate and bully until everyone bows down to their truth.

      • January 19, 2021 at 8:40 pm #

        Ah yes, the bias of pointing out that a woman who had a premature baby die at homebirth who would have lived in a hospital should not promote homebirths because, you know, she has close and intimate knowledge of the dangers of homebirth.

        The fact that The Farm came after the death of her son makes it all the more appalling. She knew what could happen and she did it anyways. The person you responded to accidentally confirmed everything Dr. Tuteur wrote.

  2. Crystal
    November 21, 2019 at 4:48 pm #

    Yet AGAIN you are trying to go against NATURAL parenting. Not surprising. You clearly hate women in general for the things you post. I for one didnt even know Ricki Lake had a home birth. How dare you assume what research a woman has done prior to deciding on a home birth. There have been 57 studies completed by individuals more educated and more qualified than you on the safety of home birth versus hospital birth. I’ll let you read them yourself but you aren’t going to like the evidence.

    Now I’m sure you won’t even be willing to look at these two sites which have links to 17 studies because you think you know everything but atleast I tried.

    I sincerely hope no one listens to your drivel.

  3. Emily West
    December 12, 2018 at 10:30 pm #

    I would like to draw attention to the universal right of patient autonomy. It is not a husband’s body that is giving birth. He is not ‘allowing her’ to give birth. It is the mother’s body, her birth. And it therefore her choice. That this is lost in many birthing experiences in hospital by women feeling coerced, and bullied, and physically assaulted is the reason why many women actually completely abandon pregnancy care altogether and free-birth or have a high-risk birth at home. Informed consent, and evidence based information ideally is given, and women can choose for themselves when, where, and with whom they give birth. The outcome is not your responsibility, it is not the husband’s responsibility, it is the mother’s responsibility. If a woman is okay with taking the risk of having a home-birth, having been given the information, so be it. Recommending that a certain course is less risky, sure. Calling someone crazy and dumb just shoots you in the foot when she doesn’t come in to the hospital at all, or develops post-partum depression because she felt violated, and unheard.

    For interest’s sake – here is a study done in Canada which determines home birth is as safe as hospital birth for low-risk women (and this includes pregnancies that went into 42 and 43 weeks – which in some areas would constitute a pregnancy as ‘high-risk’)

    Outcomes associated with planned place of birth among … – CMAJ

    I am not saying the stats are wrong here, on Dr. Amy’s part. The United States has a lot of variation in terms of integration of health care, emergency services, and the different legislation around Midwifery and licensing varies across the country. This is a problem obviously, and should be improved for safety’s sake. Home-birth breech is going to be significantly more risky most anywhere in the world, even with the best-trained Midwives. I really think there needs to be more to the question than what is ‘safest’ but also, who has the right and responsibility to be making the call on where and how to birth (Hint – it’s the woman who is giving birth.)

    • Who?
      December 13, 2018 at 1:08 am #

      You are right, of course about female bodily autonomy.

      However, just as it isn’t dad’s fault if mum chooses to homebirth, it surely isn’t the doctor’s fault if mum chooses to homebirth. Saying that the doctor called mum ‘crazy and dumb’ and so it’s the doctor’s fault that the baby died due to the homebirth, misses the point. If it’s mum’s right and responsibility to choose, then let’s have her own that, not blame those who advised something different for not doing so sweetly enough or in a way she was ready to hear.

      The baby is a volunteer in all this. It’s disrespectful to the dead to let the living, who put them in the box by their choices, off the hook.

    • Daleth
      December 13, 2018 at 9:41 am #

      Yes, patients have the right to autonomy — but are you saying that you think pregnant women should be able to exercise that right without it having any impact on their relationship/marriage? Why? If your husband got cancer, his treatment choices would affect you emotionally, financially and in every other way. And that’s not even a situation that involves a third person/your child. That’s just your husband and his own body.

      If he refused to listen to your concerns and insisted that his autonomy gave him the right to do whatever he wanted, even if it meant you were going to end up a widow when a different choice on his part would keep him alive, or even if it meant you guys would be ruined financially, that would have a pretty negative impact on your marriage. You have a stake in his decisions. He has the right to make them, but his decisions will affect you, so of course you have the right to tell him that and ask him to reconsider.

      And the fact that you have rights doesn’t mean you get to exercise those rights without any consequences. We all have freedom of speech, but if you use it to spout racist Nazi ideology and insane conspiracy theories, you’re going to lose a lot of friends; even your kids will lose friends, because many parents won’t want their kids around you.

      So yes, a pregnant woman has autonomy and thus the right to home birth or to refuse medical care. But the choices she makes are going to affect her husband/partner, her unborn child, and any other children she has. If she takes a risk that her husband was really uncomfortable with her taking, and the baby dies or is injured as a result, that’s going to seriously mess up their relationship and the entire rest of their lives. Her choices affect other people. Those people have a stake in her decisions and every right to tell her they wish she would make a different one.

    • Amazed
      December 13, 2018 at 11:08 pm #

      Really? I mean, really? Let’s say that I leave for a few days and my husband is the only guardian responsible for our child during my absence. Let’s say that he gets the child and himself into the car after having a good drink and gets into an accident that cost our child some injuries. Do you think I should smile and kiss him, and croon he was a good boy who did nothing wrong? Do you think that the fact that it was HIS responsibilty to be, well, responsible, is going to make me feel better? Since I’ll have to, you know, suffer the consequences.

      I find your shooting in the foot option baffling. I’ve seen it many times before and it always leavs me baffled. If poor fragile mamakins is such a delicate flower that she’d take the option of putting her child at increased risk of injury and death because someone said her idiotic choices were idiotic, there is something seriously wrong with mamakins (who is going to have a child so she kind of needs to stop behaving like one.) This logic sounds like Dr Amy should care SO very much about the baby the mother is ready to throw under the bus for her own satisfaction. It’s incredibly selfish. Dr Amy should not care about a baby more than their own mother does.

  4. etomaria
    June 4, 2016 at 8:30 pm #

    The States?

  5. etomaria
    June 4, 2016 at 8:28 pm #

    I’ve seen those types, but I’d hardly classify all women who have “crunchy” tendencies or preferences as the type that you have. I tend toward the natural, especially in diet-related questions, but my husband’s thoughts and opinions are THE deciding factor for me. I take that stupid, stupid, glucose test or prick my finger 6329 times in a several-week period when he thinks that it’s safer that way. We had an induction when I had gone two full weeks past the due date with one of our kiddos because he felt more comfortable that way. Not everyone fits in your box, and I know PLENTY of women who feel similarly to how I do. Only a handful that fit your description. Also, what exactly is “rabidly” pro-life? How can you be rabidly opposed to abortion? ALSO also, “Interventions are never easy, but the results are worth it.” — another blanket statement that is not always true. Many doctors recommend interventions to avoid liability issues! I’ve had doctors tell me that if I would like I can be induced as early as the day after a due date. Why the hell should I be making that call?? Where is the indication, where’s the necessity?? That’s NOT “but the results are worth it”, because it’s as much catering to the whims of the “ohhh, I’m sooooo pregnant and uncomforrrrrrtable, soooooo many weeeeeks” mother as a homebirth is! Come on now, don’t just say things like that and expect them to fly!

  6. etomaria
    June 4, 2016 at 8:19 pm #

    Seems like you’ve read very little about them and judged very much. Perhaps they have husbands that care how their wives feel about the births of their children? Mine does. I’ve discussed the matter with him a zillion times and, so long as whichever method meets the criteria he’s concerned about, he’s okay with several different variants. He doesn’t have a specific preference past, really, safety. (And we’ve have had all our babies in hospitals, and only this time around are considering a birth center minutes from the hospital, though maybe just the hospital again.) But the POINT is, we both respect each other’s opinions and still several options are open. What ‘women who moan all over the internet’ are you even referring to?

  7. etomaria
    June 3, 2016 at 2:47 pm #

    Here’s the thing, from not-a-doubtful-dad, about homebirths versus hospital births. I have personally yet to jump on the homebirth bandwagon, because of risk concerns and most of the things you point out in this post, BUT this isn’t a clear-cut case of bad homebirths versus lovely, wonderful hospital births. In the States, from what I’ve seen (not all of them of course, but Michigan, California, Texas, and Alaska, on-base and off), there lacks a middle ground for a normally progressing pregnancy with no indication of complications or risks. EVERYTHING is liability-based. When I ask questions, generally “Why…?” questions, I get back almost every, single time one of two responses:

    1) Because that’s what everyone does/because that’s hospital policy.
    2) Because our liability insurance requires we do it this way.

    (Or the ever-delightful “you know this is a matter of YOUR BABY’S HEALTH, right?” which isn’t even an answer)

    What is that??! Is that a respectful discussion of the options that outlines the risks and benefits and explains the doctor’s decision? No, it isn’t close. When I have no risk factors for gestational diabetes and I want to know if I can have an alternative to flooding my body with sugar water to see how it deals and I hear what amounts to no reason or just doubt as to how fit of a mother I will be if I don’t put the baby’s good before all, even though we have yet to establish that this is in the baby’s interests, I lose faith in those people. I have had one midwife, on-base, and one OB, off-base that have actually taken the time to have these discussions with me, but that’s out of probably two dozen nurses, midwives, and OBs that I’ve seen (one of the fun parts of military prenatal care is you end up with whoever’s free ;] ). Generally the attitude is sort of irritation that you, a non-medical professional, might not wholly trust them, who have gotten some kind of medical education.

    Perhaps rather than making fun of women (the wives in your post here are portrayed as morons) who really would like the ideal combination of safety and security a hospital provides along with doctors that both respect that they are actual people, not robots that blindly take direction, and won’t just take whatever measures “because liability”, “because others”, or “because yes”, but because the risks and benefits have been examined and indicate them, you could also suggest to your peers that they work WITH pregnant women and realize that, whereas they are the educated experts, these are the pregnant women WITH WHOM they are working, not to whom they are dictating.

    And before someone goes nuts because SOMETIMES there are emergencies and action needs to be taken before a calm, nice discussion can be had, that’s not what I’m talking about. I personally acknowledge the possibility of something going wrong (that’s why I’m in the hospital, and really it’s the only reason, all the above considered!) and do what’s necessary to accommodate it. I’m talking about routine prenatal care and births that happen as they should without real issues.

    • Who?
      June 4, 2016 at 10:05 pm #

      It’s great you’re thinking ahead on this. I’m going to assume-despite the tone of your second-last para, which is straight out of the ‘all my rights’ playbook of homebirth-that you are serious.

      In terms of risk, insurance companies are really good at crunching the numbers. They know exactly, based on the information they have, what risk looks like.

      If an insurance company won’t allow their insured to do something, it’s because they can’t price that risk-that is, the likelihood of the risk event happening is nowhere near zero, and the cost if it does is extremely high. Why would anyone want to expose themselves, or a baby who has no say, to a risk like that?

      If it wasn’t birth we were talking about, what is the level of risk you would be prepared to expose a helpless volunteer to for the sake of your physical experience? When you know the answer to that question, you will have your answer about birth site choices.

      • etomaria
        June 4, 2016 at 10:46 pm #

        I’m not sure what playbook I’ve taken my tone from, because there is no chosen tone, nor is there a playbook. Ignoring the concerns that motivate people to seek care elsewhere doesn’t make them go away. So I guess I’m not sure how to respond to that. Mostly those two paragraphs were my point in responding, that when doctors are ready to discuss care with their patients in a respectful, thorough manner, those patients will not feel like they’re being treated like a bunch of morons and told to do it this way because they were told so or get out. I personally have been told by my doctor basically that he’d let me know when something was non-negotiable for him, but will nonetheless, in an effort to bring me/us on board as well as opposed to jist asking for agreement, have a discussion of WHY he views the benefits as far outweighing the risks. I think that this is the correct approach. What I’ve seen in this post and experienced largely has not been that. It has been “well, because we’re the medical professionals, and this is what we do, that’s why”. Yes, of course. That’s why we’re here in the first place, and is undisputed. But it does not pertain to the specific decision at hand. When I asked my pediatrician why the chicken pox vaccine was necessary in his understand, when I grew up in a generation without it and never heard anything bad, and he says “you’re the Russian interpreter, if I want to translate something into Russian, I’ll ask you and trust your translation, I won’t go out and try and learn Russian and do it myself”, that doesn’t actually address the question. It just explains why we have doctors and why most go to them, something I wasn’t asking and don’t dispute.

        ANYWAY. I don’t follow your question, who is the helpless volunteer akin to, the baby? I, philosophically speaking, don’t think it’s proper to or even possible to eliminate all risk. Generally I don’t want the baby to die, if avoidable, or end up with debilitating conditions, if avoidable. I guess I’d have to think or research more fully to answer better than that. I THINK we will probably go to the hospital, despite all the nonsense from the doctors, for the potential benefits if needed, for that exact reason. It would just be really nice if the doctors understood that most parents, when trying to understand the necessity of given procedures, etc., are doing it out of concern for their kids. I had to go get my first son out of the stupid warmer EVERY SINGLE TIME the nurses came in to check him out. He was born 8 lb, 8 oz, so that was quite frequently, because he was “big” and they wanted to check his glucose often. About every two hours. There was no reason for him to stay on the warmer, as his temp was holding fine with me. There was a reason for him to stay with me, as we were having a little trouble getting nursing down. When I asked each time for him back, they said “oh, when we’re done, we’ll give him to you, there’s no reason for him to be there right now” and left the room, so I had to go retrieve him each time. This is an example of the irritation and negative effects that comes/could come from doctors (nurses) doing as they happen to do for convenience. I don’t think they were purposely malicious in their intent, but they assumed what I was concerned about wasn’t worrying and acted accordingly. It’s these things that seem very important when there is a lack of other serious things. And this is why people seek care elsewhere. I’m sure the whole bulletproof mentality isn’t foreign to you and doesn’t need explaining?

        • Who?
          June 4, 2016 at 11:26 pm #

          I’m glad you’ll likely go to the hospital, despite the inconveniences you perceive. It’s disappointing you imagine there would be any malice in anything a professional did for your wife or baby, or that they are motivated by anything other than wanting the best health outcome for mother and baby. That attitude is the homebirth playbook, which you may have internalised without being aware of it.

          I understand the best health outcome for mother and baby can be different from the best outcome for a person who is bent on having the experience someone has told them they should have, or could have, or are entitled to.

          If it sounds too good to be true, it probably is.

          Good luck.

          • etomaria
            June 4, 2016 at 11:45 pm #

            Okay well, I was initially writing to the woman who initially posted. The purpose was to assist, theoretically, in explaining WHY many woman choose the homebirth route. I’m not interested in debating whether you find their rationale reasonable or correct, I actually would be surprised if most of the people that frequent this site did. That’s exactly why I posted, to explain from the point of view of someone who really wants to go with a homebirth for all the things I could avoid with it, but also as someone who hasn’t been actually convinced by those niceties that it’s safer. If you want to listen, I think that’s great (I’m not actually sure what you do for a living, if you’re also an OB, then especially great, if you’re not, alright, maybe it’ll assist in a dialogue as opposed to an angry debate), but if you don’t, that’s obviously totally okay too. I tried to reexplain what I meant in my second comment, along with why brushing off my actual concerns as something “from their playbook” isn’t helpful, but I don’t have much more to say than what I put in the first place. (Oh, and to restate, I said that I did NOT think the medpersonnel do what they do with malice, I think it’s in fact because they often have the attitude that they shouldn’t be bothered with what the patients want)

          • Who?
            June 5, 2016 at 12:17 am #

            Many women who have lost babies at homebirth have come here and shared their experiences, and their rationales for their choices. They bitterly regret having lost the chance to have their babies survive. Others, who occasionally post here, are of the view that their babies would not have survived anywhere, the outcomes of their decisions are not their responsiblity, and Dr T is mean.

            I don’t mean to brush off your concerns about giving birth in hosptial, but it is wrong to think I don’t know what they are. They aren’t original, which doesn’t of course stop them being genuine. Some of your language, and the way you express concerns, is the same language as militant homebirthers use to strike fear into anyone in range. Perhaps using it the way you do makes you seem more aggressive than you seem to actually be.

            You might be happier with doctors who will spend time answering your questions, I’m sorry you seem to have struck a crop of non-communicative ones. Doctors are only human, as most of them would acknowledge. I’ve rarely struck doctors like those you seem to find all the time, and I can see it would be frustrating.

          • etomaria
            June 5, 2016 at 12:27 am #

            Aha, I see. Perhaps the language is at fault. I was legitimately trying to explain why I think that posts such as the above are the opposite of helpful in winning, so to speak, back women who have gone over to the homebirth side. If it’s already known, I suppose I wonder why these posts are written, unless it just isn’t a priority, in which case I’d disagree, but that’s allowed. Anyway, yes, frustrating indeed 😐 Maybe because most were military!

          • Who?
            June 5, 2016 at 12:45 am #

            I think the goal is to encourage people to talk about the issues, and it seems to be working.

            There are a number of regular contributors who came to fight with Dr T and ended up changing their views about homebirth and medical care in pregnancy, because, whether or not you care for her tone, Dr T is all over the facts.

            There are many blogs where people write sweetly about this, and noone reads them.

          • etomaria
            June 5, 2016 at 12:51 am #

            Oh, well good deal then.. I personally have one of those difficult personalities that resents being ordered around, so it’s generally my husband who’s the voice of reason when it comes to things I don’t care to do, but the doctor thinks I should. (See above ;]) So her style rubs me the wrong way, and it so happens that I’ve only read posts light on facts and evidence and heavy on sarcasm or condescension. I suppose I could have read more prior to posting..

            For what it’s worth though, I haven’t come across these sweet-sounding blogs, this one is what’s at the top.of my search results, save for all the natural-type sources encouraging the opposite. Anywayyyyyy, I suppose my point here in posting had already been accomplished, so I’ll say no more :]

          • Who?
            June 5, 2016 at 1:56 am #

            Good luck with it all.

            For the more sweetly toned websites, have a look at the sidebar, or at the Navel Gazing Midwife, who writes about her work and experiences, and talks about some of the issues in the homebirth community in the US.

        • Beth
          June 6, 2016 at 1:48 pm #

          “you’re the Russian interpreter, if I want to translate something into Russian, I’ll ask you and trust your translation, I won’t go out and try and learn Russian and do it myself”,

          Yeah, that’s an example of a pretty nonhelpful response from the doctor. That kind of defensive reaction may indeed have to do with the fact that the doctors you’ve seen have been mostly military. I’m guessing that tends toward a mindset of “don’t question my authority.” (not that civilian doctors can’t be like that too but I’d bet it’s more common in the military. Yes, some patients can be difficult, but also some doctors forget that communicating with the patient and answering questions is part of the job.

    • CSN0116
      June 4, 2016 at 10:45 pm #

      Why do you state that you’re a non doubtful dad, but write as a pregnant female? I’m really confused…

      • etomaria
        June 4, 2016 at 11:35 pm #

        I didn’t say I was a dad, but I suppose it could be perceived as I’m a dad, just not a doubting one? Is that what you thought? I just meant that I am not the addressed audience, which was doubtful dads. I’m indeed not a dad at all. I’m also not a “female”, jeez, are we back in basic training, I’m a pregnant woman/wife..

        • CSN0116
          June 5, 2016 at 8:41 am #

          Yes, it is written as if you’re a father, but not one doubtful about homebirth.

          Honestly, your writing is obnoxiously flowery. I had a hard time following, so I just needed to clarify that you were at least female first. Your feelz rants make 3% more sense now.

          • etomaria
            June 5, 2016 at 3:29 pm #

            As to most of what you say, okay, don’t read it! I didn’t say “Hey CSN0116, here’s what I think, please respond.” If it’s helpful, this exchange is going nowhere, so I’ll stop answering, you can go ahead and put the last word. I didn’t mean to get into debates persay, I thought maybe a conversation, but not the anger that I’ve seen so far.

            (Re: female, it’s an adjective; dictionaries have recently added it as a noun due to widespread misuse of it as a noun, but that’s not what it is)

    • Nick Sanders
      June 4, 2016 at 11:50 pm #

      I want to know if I can have an alternative to flooding my body with sugar water to see how it deals

      An alternative such as what? And why?

      I’m talking about routine prenatal care and births that happen as they should without real issues.

      And without tests and precautions, how exactly do you expect to know if a birth is going to “happen as [it] should”?

      • etomaria
        June 5, 2016 at 12:07 am #

        Such as fruit that contains the same amount of sugar, though I think that’s only rarely accepted, or the finger-prick glucose meter. Why? The one-hour challenge isn’t even reliable, and it’s not even the final test, it’s a preliminary deal.. Besides that, because I avoid sugary drinks as it is, why would I take one for that when there are alternatives? Hardly the point of my comment though.

        Re: tests and such, I think you’re either misunderstanding what I was saying in that paragraph or looking at those words out of context. I’m first of all not disputing any tests. I generally, when I attempt to discuss them (with my doctor, not with people on blogs), am looking for the reasons why they’re recommended for my pregnancies.. And I’m certainly not arguing them here, not in the comment, and not otherwise. Not something I’m an expert on, not something I’ve even opposed to, and not something I’m interested in. But back to the original paragraph, I was saying that I think respectful pro/con discussions should be had and would go a long way in helping those who feel their preferences/even their right to know what’s involved with procedures indicated for them are being ignored by their doctors because they’re not qualified to discuss it intelligently.

        • guest
          June 5, 2016 at 12:23 am #

          Well, it’s sort of like how I avoid taking antibiotics until I’m sick. I also avoid taking tests for medical problems I most likely don’t have. But all that changes if I AM sick, or there’s a risk of a condition developing.

          I also would have liked my doctors to talk to me with more detail. But recognized that I am just one person – my level of comprehension is A) not the same as everyone else’s, and B) not fully known to my doctor. If you want a doctor who caters to your exact preferred level of detail and bedside manner, you know how you get that? Hire your own private physicians. When a doctor has to deal with constantly rotating individuals from the general public, however, they are going aim for language anyone can understand, and a level of detail that won’t overwhelm people. And this is a NECESSITY for them.

          • etomaria
            June 5, 2016 at 12:32 am #

            Why do you say it’s a necessity? I can’t understand what reasons would make it so. I am suggesting they answer the questions posed to them, which would indicate what the person knows/wants to know/etc. Seems reasonable to me. I haven’t worked as an OB, but I really don’t see what would be an obstacle to that. Most of my appointments don’t go over 15 minutes even with questions!

          • Charybdis
            June 5, 2016 at 12:01 pm #

            It sounds as if you don’t like the level of detail of the answers the doctor gives you. If you *want* a hyper-detailed answer to every single question you are asking, and you are asking a metric shit-ton of questions, then you need to get yourself a private physician who will be willing to go into the insane detail you insist upon. Or go to med school and become the kind of doctor you fantasize about.

            It sounds as if you go into a medical appointment with a chip on your shoulder and loaded for bear because the doctor *won’t* explain anything to you and doesn’t answer your questions. You sound like the grown-up version of a toddler asking “why” to every single thing anybody says. “We need to schedule your GD test” “Why?” “Because we need to determine if you are providing an abnormal amount of nutrients to the developing fetus.” “Why?” “Because it can cause the baby to grow too large and therefore increases the chance of complications during delivery.” “Why?” “Because it increases you chance of tearing/pelvic floor damage and shoulder dystocia.” “Why can’t I eat fruit, it has sugar in it?” “Because the Glucola is standardized to a known level of glucose and is what is used for the test because that is the sugar measured when blood sugar is measured. Glucose is classified as an aldehyde and fructose is classified as a ketone, so even though they are both “simple sugars”, they have different molecular structures.” And on and on and on.

            Wanting to understand and know more about what is happening to you and why the doctor is advising certain tests is a good thing. But to dissect every single thing that comes out of the doctor’s mouth and analyze it to death, well, “ain’t nobody got time for that.”

          • etomaria
            June 5, 2016 at 3:22 pm #

            Ha, okay. Well it’s more along the lines of “and at the next appointment you’ll take your glucose challenge test”, “oh, not something I can skip?”, “well you have no risk factors, so I’m not personally worried, but for liability we have everyone take them”. Then I either take it or I ask if I can use a glucose meter or I refer back to the midwife I had at the previous base who told me skipping it was not an issue because I had no factors. When you get one medprof that says skipping it is okay, though you’d assumed taking it was non-negotiable, and then the next says it’s mandatory tho nothing has changed risk-wise, unless you just are accustomed to not thinking, you wonder why. And then when you get “cuz liability” and “I’m not personally worried’, you think that the doctor operates mainly on what liability demands though it is not what he thinks is necessary. Is this really that hard to figure out? Are all you all that out of touch with how these things go? It sounds like you’re jaded to patients. Like schoolteachers that don’t care about their individual students, but are teaching to the tests. Argue what you want, but my point here isn’t to convince you. If you don’t want to try and understand what I’m saying OR if you already objectively understand but don’t agree with the validity or whatever, fine. Nothing I can do to change that, though I thought it was worth a try in case the former was true, that you hadn’t known why women were going to homebirths.

            Anyway, as far as old, I just happened on this the other day, thought I’d put my comments. I’m hardly the first to do so, so I’m not sure why you seem to dislike them. Don’t read or respond if you don’t like what I’m saying, but I’m not here in the comments to convince or be convinced. It was just the publicizing of information.

          • etomaria
            June 5, 2016 at 3:33 pm #

            Sorry, I got your and “Amazed”‘s comments confused, you didn’t say anything about old posts, so that part of my answer isn’t meant to respond to you but her/him.

          • Heidi
            June 5, 2016 at 3:46 pm #

            Gestational diabetes can happen to absolutely anyone. A few things might slightly increase your risk, but I don’t know any decent OB that wouldn’t have you do a glucose tolerance test. This is coming from someone who had a very low A1C at 12 weeks, passed the one hour but just by a point, took the 3 hour and failed. Now, I didn’t have to work too hard to keep it under control. Simply skipping large servings of carbs and not binging on sweets kept my blood sugar perfectly in range, but I knew not to do those things so I never put baby or I at risk. If I’d just tested with a glucometer for a week or two, neither I nor the doctors probably would have figured it out. There’s a reason they do glucose tolerance tests.

          • etomaria
            June 5, 2016 at 3:54 pm #

            This isn’t why I posted, to debate the glucose tests, but because this is the first time I’ve ever heard your particular claim, I’m curious.. Where did you get that the glucose meter wouldn’t have caught it or isn’t a good check? I have never met an OB that says that! I actually have heard the opposite, that it’s more reliable, but most people don’t like it because it’s pretty inconvenient. (For the record, because this is the internet, I am writing not with a sarcastic/you’re an idiot tone, but a surprised one) (If that’s helpful)

          • Heidi
            June 5, 2016 at 4:07 pm #

            How many OBs have you personally met? The GTT works because it is a certain kind of sugar that has a certain glycemic index. There’s difference between fructose, sucrose, glucose, etc. I don’t know the exact differences but this is why most doctors insist on the GTT.

            I say this because I tested my blood sugar for weeks without getting one out of range until over a month after I was diagnosed. My fasting was always between 62 and 72, I could eat carbs and desserts and MOST of the time I was absolutely in range. But I got brave a time or two and ate more carbs than I had been and not balanced by protein and fat and I’d get one out of range. Now it wasn’t that hard to eat half a serving of potatoes as opposed to a whole potato and make sure to eat a protein with it, but I knew to do it. I knew I was technically diabetic and I knew this would be best for my baby and me. I could have skipped the 3 hour test because it was only highly recommended after I barely passed the one hour and told myself I was most definitely not diabetic, and not been taking small and easy precautions and who knows what would have happened. I got a couple of extra growth ultrasounds that insurance paid for. It wasn’t a big deal at all, but it could have been.

          • etomaria
            June 5, 2016 at 4:21 pm #

            A couple dozen. Hardly all, but a good amount. This is our fifth baby, sixth pregnancy, and the first three were on base where you see a new OB practically every time you go in! And then a new one for the birth! ;] Then with the fourth kiddo I went to three different offices before finding the one we stayed with through the birth, but also was seen on base as a vet due to some ridiculous insurance requirements insisting you take advantage of any other insurance you might have, so I was doubly cared for I guess. This time I’ve been being seen at a birth center by a nurse and their midwives, but not sure we’ll stick with it because of the concerns with out of hospital birthing. Even if we wanted to I think that the very late babies we have would put me out of range, so to speak, of their capabilities, unless we wanted a homebirth, which we do not. ANYWAY! I’m not saying that I’m the expert due to experience with many OBs, just that they all have been totally okay with the glucose meters and have said that, if the challenges came back high, we’d end up going with a meter for regular tracking, so it was entirely reliable. Not sure why they said that, didn’t ask actually, maybe they were mistaken? I understand why fruit isn’t cool, they did explain that, I get why the drink is used, as it’s standardized and such, but I hadn’t heard anything about it being MORE accurate than regular testing after every meal and on an empty stomach each day. For what it’s worth, our OBs have all known that we keep carbs pretty minimal (and avoid sugar), excepting vegetables. Maybe that’s why they were okay with the meter, because our eating habits were pretty in line with what they’d require? Do not know.

          • Heidi
            June 5, 2016 at 4:25 pm #

            Did they require you to test your whole pregnancy? I can understand why they’d be okay with that because that’s what happens when you actually get a GD diagnosis.

          • etomaria
            June 5, 2016 at 4:31 pm #

            No, just from about 26 to 28 weeks. So I suppose, considering what you and someone above said about the meter not catching stuff, my question would be (well two questions) why they follow up with someone who DOES have gestational diabetes by assigning a meter, and then whether, if the person was able to avoid huge insulin peaks by eating well and such that the meter showed them not going over their established (by the doctor that is) threshold, would that mean that they were effectively mitigating the risks? Like, yes they have gestational diabetes, but they’re controlling it well enough as evidenced by the meter to keep negative effects from happening? Or not necessarily? And if no, what’s the point of the meter at all?

          • Heidi
            June 5, 2016 at 4:51 pm #

            I’m not sure exactly what you are asking. They use a meter to see how they need to manage the diabetes. Some people like myself are controlled with diet, in fact a pretty liberal diet. Some people can be diet controlled but need a stricter diet. Some people it is not a matter of healthy eating but they need insulin, possibly to take once or twice a day or they may need to do insulin shots. One, it’s really hard to have that much control over your fasting blood sugar. If fasting is creeping up, they probably need to intervene medicinally. Also, as the pregnancy goes on, generally the more insulin resistant a person becomes so the meter can help catch that, too. That’s why many OBs test for GD between 24-28 weeks and re-test around 36 weeks if they passed the GTT the first time.

            Also, we’re all unique. The meter shows each individual what spikes them. Woman A may be able to eat white bread but finds even a spoonful of brown rice spikes her glucose. Woman B may be able to eat cake with no problems but has a spike from a small corn tortilla.

          • etomaria
            June 5, 2016 at 5:17 pm #

            Hm. Not sure how to rephrase.. Let’s say you have a woman who has gestational diabetes, undiagnosed. She and her doctor agree they’ll use a glucose meter instead of the drink challenge test(s) to determine whether she has gestational diabetes. She checks her fasting glucose daily and her post-meal glucose whenever she eats/three times a day. If it never spikes above a normal amount, then would it be correct to say she’s effectively controlling the diabetes, just happens to not be on purpose? That, provided she always eats this way, she won’t have any diabetes-related complications that would have been avoidable? For example, I took my readings like that for two weeks and my numbers were always on the low side, so would it be correct to assume that, provided I didn’t go changing things up, I could safely continue to eat that way, whether or not the test had caught the diabetes? Or is there something else that would have been done to manage the diabetes besides just diet? Seems like insulin injections would only be for more extreme cases, whereas your case wouldn’t have warranted it? Or am I wrong there? Basically, can glucose meters give false negatives practically speaking.. It appears they can not catch a case, but if you’re managing it effectively enough that it misses it, wouldn’t that mean that the end goal, the effective management, is already there?

            Not sure if that makes more sense or less..

          • Heidi
            June 5, 2016 at 5:33 pm #

            Not exactly, no. Because the further along you get while pregnant, the more insulin resistant you become. If you only test for two weeks and never bothered with the GTT, you could actually not be managing it anymore. You wouldn’t know for sure.

          • etomaria
            June 5, 2016 at 5:40 pm #

            Ah, I see. But the three-hour test always catches it?

          • Heidi
            June 5, 2016 at 6:00 pm #

            I’m sure not always. However, I do not the exact failure rate, or if that’s something we could ever know for sure. But I know the standards have been tweaked to catch the most women and get the best health outcomes. For example, passing for the one hour used to be 140. Now most OBs have the cut-off at 130.

          • swbarnes2
            June 5, 2016 at 4:56 pm #

            You can’t look at a person’s health record and say “They can’t have GD”. If the midwife said that it was safe for you to skip it, then she was misinforming you. Is it possible she had financial reasons to avoid risking you out of her care?

            Responsible health care providers want the 1-hour test because you can’t fudge the results like you could if you were at home.

            You also, despite your protests, don’t seem to understand what the glucose test is. It’s a SCREEN. It is NOT supposed to be diagnostic. No test can have a zero false positive and false negative rate, a screen is designed to have a very low false negative rate, and the trade-off is a high false positive rate, which is okay, because all that means is you take another better test. That fact that is has a modest false positive rate doesn’t make it “unreliable”. As long as it has a low false negative rate it is perfectly reliable screen.

          • etomaria
            June 5, 2016 at 5:50 pm #

            That midwife was one on staff at David Grant Med Center at Travis AFB, so I do not believe that would have been her motivation. I was active duty at the time and she was employed by the government, so I think money was literally never considered ;]

            I understand the purpose of a screening IN GENERAL, but I did not understand why you couldn’t just take the three-hour test right away, because I am under the impression (mistaken?) that it’s the same drink, just a three-hour wait.. No? And I THOUGHT that the glucose meter was as accurate as all of the above, so didn’t see why the insistence of one over the other. And I see now that the midwife shouldn’t have said that, but then I hadn’t had so many conflicting responses, so assumed she knew what she was talking about. It was after all the conflict that I started asking a bunch of questions, hoping to determine the actual truth and not sure how else to do so. Add in a bunch of friends who insist OBs are the devil and you’ve got a recipe for not having any idea what to think. Info overload and all that. My solution was sort of making them prove it. Annoying to the OB, I’m sure.

          • swbarnes2
            June 6, 2016 at 3:08 am #

            How did you go from not wanting to take the test at all to wanting to take the FAR more inconvenient version? You said you wanted to avoid the whole “sugary drink” entirely. Basically, you are asking “why screen?” Screening is a basic medical concept, not unique to pregnancy at all.
            A glucose meter is obviously a very accurate measurement of what your glucose is at the time you take it. But a person can, intentionally or not, screw up the CONTEXT of those readings. And the context is as important as the raw data. Maybe you take a unit home, and eat better on those days then you usually do. Maybe you oops, forget to measure an hour after eating so you measure an hour and a half later. Maybe you measure after three meals, and just report the best score to your doctor. (There was a homebirther here who’s midwife told her to measure her blood pressure three times a day, and she admitted to taking it a bunch of times, and only reporting the best results.) The virtue of the 1 hour test is that if you drink all the glucose drink, you can’t cheat yourself into a false negative on that test. And the false negative rate is low…if your body can handle that kind of sugar spike, it can handle a normal meal.
            Doctors routinely think about all this stuff. From what you’ve posted…you don’t, and it’s not clear to me that it’s the job of your doctors to give you “Screening vs. diagnostics 101” or “Pitfalls of patient compliance” education.

          • Amazed
            June 5, 2016 at 5:08 pm #

            You were claiming that your questions were always brushed off, so you didn’t get them answered. Then, you claimed that even with your questions, it never took more than 15 minutes for your appointment to be over. I wasn’t sure if you did or didn’t receive replies.

            As to your midwife, we have a poster here who had GD to the max. She was slim, so midwife decided there were no risk factors. “I’ll eat glass if you have GD,” she said when advising her to decline the test. Pity that the mother didn’t hold her to it when she had her induction with a placenta that was basically turning to stone already.

            Fiftyfifty1 who gave you such a detailed answere about the test is a doctor. IIRC, since the glucose test made her sick, she tested herself at home. But she made it clear that 1 hour test was superior.

          • etomaria
            June 5, 2016 at 5:39 pm #

            I explained above that I’ve had a military midwife and a regular OB who haven’t minded the discussions. The rest haven’t cared for it. Therefore I have had appointments where I have discussed stuff and appointments where I haven’t much. Even the ones where we have talked over things have been kept to 10-15 minutes, as that’s all they really have. I don’t see what’s unclear, but maybe that will clarify it for you.

            As to my midwife, I can see from what others are saying that she probably shouldn’t have said that, but, and I’ll try and explain once more, I am using the glucose test thing as an illustrative example. I have always either done it or the extended finger pricks. I have not refused except that one time when I was told yeah skip it. The POINT is Doctor A said always, Doctor (Midwife this time) B said for you skipping is fine, Doctor C said always for everyone because of liability concerns, Doctor D said I’m cool with you skipping it if you make a concession elsewhere. With those answers, how would one NOT start wondering what the decision-making process is and why and asking questions? See what I’m saying, or still no?

          • etomaria
            June 5, 2016 at 6:05 pm #

            Bah, tried to edit, accidentally clicked cancel. Basically I didn’t see your last two paragraphs and I wanted to say that yes, I thought that the superiority evident in the posts I’ve read is all too often present in many OB-patient exchanges and that changing that would be helpful. Appears as though any insight I thought may have been new here is not indeed new, so roger. Will not comment on that any more. Still here because of the stuff others have said (re glucose test, didn’t know these things before) or to clarify misunderstandings.

          • Nick Sanders
            June 5, 2016 at 6:09 pm #

            but, and I’ll try and explain once more, I am using the glucose test thing as an illustrative example.

            It’s extremely illustrative. But what it is illustrating isn’t excessive medical fussiness or uncommunicative doctors, but your lack of understanding and overall attitude towards medicine.

          • etomaria
            June 5, 2016 at 6:18 pm #

            What it illustrates is that when doctors say different things about the same thing, patients start trying to figure out why. And, when not given answers by some, going to those who ARE willing to back up their answers with evidence, even if it later turns out to have been not evidence at all, as in the case of some claims by some midwives or many claims by many midwives, or whatever it is.

          • Who?
            June 5, 2016 at 6:31 pm #

            I think you’re right-the unscrupulous (or ignorant) step into the space left by the busy. It must be hard to pick all that apart. Not to mention that as we know more, we do better, and the way things are dealt with changes between pregnancies, so there’s that also.

          • Amazed
            June 5, 2016 at 7:35 pm #

            Yes, I can see what you mean. The problem is, you sounded a lot like some posters that come here to inform us how evil and unneeded tests are because they aren’t natural and their trusted provider said so. The effect was heightened by the fact that you have switched OBs all too regularly. In your case, it was because you were on the move but since we didn’t know it at first, it looked like you doctor-shopped until you found the one who told you what you wanted to hear. Again, that’s because what most people who come here repeating what you basically said do. When I see it, I automatically decide we have a “natcherel”-minded person here since military is relatively less common around this site. And I enter “no nonsense” mode with often lead to being rude. Sorry for making the wrong assumptions AND being rude.

          • Irène Delse
            June 6, 2016 at 5:33 am #

            This. Liability can indeed be a shorthand for “Not all risk factors are obvious, that’s why we do tests”. And if insurance companies are good at one thing, it’s crunching the numbers and coming out with relative risks for disease X or complication Y.

          • guest
            June 6, 2016 at 12:16 am #

            Well, see, there’s your basic problem: You’re ranking the medical expertise of a midwife and an MD on the same level. The whole reason Dr. T and other groups like this exist is because CPMs (and occasionally even bad CNMs) are going around giving medical advice they have no business giving – because they’re ignorant of the science-based reasoning behind things like the glucose challenge. But because they have those letters after their names and there’s such a push to glorify midwives’ expertise in “birth” over and above doctors, you see a contradiction when a doctor says “you need this” and a midwife says “you don’t need this.” Spend some more time reading this blog, and you’ll see it again and again. Midwives are giving out dangerous and false information to patients – more than one is willing to give their patients a pass on the glucose test (and others) but it’s dangerous. And an MD knows that.

            And for the record: I used CNMs for my prenatal care and delivery of my high-risk pregnancy. I was just lucky enough to get the good ones who work *with* doctors instead of against them, so I also had an MFM evaluating the high risk elements of my pregnancy, and I gave birth in a hospital. I’m not against midwives. But the ones who say it’s okay to skip the GD test are dangerous fools.

          • Irène Delse
            June 6, 2016 at 5:27 am #

            And with one kind of provider giving advice above their level of competency, some patients are encouraged to “go shopping” for the advice they want. Sure, sometimes it’s a good idea get a second opinion, but not with someone who has a less broad knowledge of medicine.

          • Amazed
            June 5, 2016 at 12:57 pm #

            It’s a necessity because you’re pregnant. You sound very immature when you ask things like, “Why are they necessary for MY pregnancies?” For all that any woman is different, there are certain tests that are necessary for all to establish that you remain low-risk (or not). The basics of your body aren’t this different.

            By the tone of your posts, I can imagine how you posed your questions. A mountain of them. About every little thing. And if the doctors never answer when you only want to get informed, how do you know that your appointments don’t go over 15 minutes with questions? Does your doctor answer your questions or not, after all?

            Oh and I also saw your comments under other old posts. Sorry but you sound about as competent armchair psychologist as you are an armchair obstetrician. Dr Amy isn’t preaching to the choir. She’s reaching fence sitters and yes, she is reaching them. We’ve had more than one woman who was spared a tragedy because she came here when she wasn’t sure and chose to listen to Dr Amy and science. We even have mothers who have had homebirths and were converted! So no, your glee is misplaced.

          • etomaria
            June 5, 2016 at 3:38 pm #

            I’m not sure what you mean about my appointments.. I know they’re 10-15 minutes because I was at them and that’s how long they took. Shorter when the doctor doesn’t care to discuss stuff, about that long with the ones who have. They come in, measure, check heartbeat, ask about movement, explain what’s expected next or that I should do between now and the next appointment, and ask if I have questions. And I’m out in 15 minutes.

            Also not sure what misplaced glee. I don’t even know where I was gleeful. I’m glad the meat of what she’s saying is not completely ruined by the way in which she says it. Good deal. I think she’d reach more people if she wasn’t as ridiculous as she has been in the few posts I’ve seen. Maybe not, maybe. Maybe she’s not always like this. Whatever. My point in posting was to suggest it.

            Oh, and my question “why is it a necessity?” was about why it’s a necessity to come up with some standardized language that most will understand instead of just telling the patient what’s up and answering anything that comes up. It seems like just waiting and seeing if there even are questions, and then if so what kind, would tell them everything they need to know about how to discuss stuff.

          • guest
            June 6, 2016 at 12:08 am #

            Because worse than glossing over detail for you (but providing a clear course of action: take this test where you drink glucola), far worse is talking so far above someone’s level of comprehension that they go home not understand what it is they are supposed to do. Doctors have to communicate with patients in a way that ensures the vast majority will understand, and they must do so quickly given the constraints of our healthcare system. The more you pay out of pocket for your doctor, the more time they can afford to devote to just you – hence my comment about private physicians. You’d like to think your doctor can talk to you for five minutes, realize you’re educated, fluent in English, and intelligent, and adjust his or her level of detail to suit you, and in fact most of them do that, often unconsciously. But there’s a limit to how far they can go – a patient might *seem* to understand highly specialized language – or a complicated discussion of the pros and cons and mechanisms of a glucola challenge, but in fact the patient understands very little but is putting on a front so as not to disappoint the doctor/avoid embarrassment (this is a real phenomenon).

            Honestly, you sound like a high maintenance patient who wants private medical care from a public health system. It would be nice if we all decided to pony up the tax money to provide that level of care to everyone, but until we do, we can’t.

          • etomaria
            June 6, 2016 at 12:17 am #

            Alrite, dude, persist in your “it seems”s. That’s fine with me. I’ve posted for a reason, discovered that it was in fact unnecessary, gotten some good info in the process, and pretty much have no reason to continue a ridiculous argument about what seems to you to be the case. If it’s easier for you to also drop it when you assume I’m a purposely high maintenance annoying patient that has their health care covered by the public (??), go ahead.

          • guest
            June 6, 2016 at 12:29 am #

            I’m not the only one who reads you that way, I saw after I wrote this comment. You’re a personality type (as evidenced by your writing, some people are different in person than in writing, but many are not). You asked a question about *why* doctors had to speak the way they did, though, so I don’t see why it’s inappropriate that I wrote to give you an answer. But imagine you’re on a tight schedule to see X amount of patients a day (where X is a higher number than you’d like) and then you get one who insists on knowing allllll the details about everything, even when the details aren’t necessary to understanding the course of action the doctor is recommending. This type of person is never satisfied, is furthermore the sort most likely to leave negative evaluations at every venue they can find to do so, and they get the doctor behind schedule so that every other patient after High Maintenance Patient has something legitimate to complain about. If your nurses and other health care providers seem annoyed when you ask questions (as you’ve said), I imagine this is why. Do I KNOW with absolute certainty? Of course not. But you might consider it if you want to improve your experiences.

          • guest
            June 6, 2016 at 12:31 am #

            And I’m not a “dude.” I don’t personally get annoyed when people mistake “guest” for a dude, but since you went off on someone else for making the same mistake about you, I thought I’d point that out.

          • etomaria
            June 6, 2016 at 1:38 am #

            I didn’t intend “dude” as a sexed noun. I don’t know a neutral variation for dude.


            Alrite, personoverthere, persist in your “it seems”s. That’s fine with me. I’ve posted for a reason, discovered that it was in fact unnecessary, gotten some good info in the process, and pretty much have no reason to continue a ridiculous argument about what seems to you to be the case. If it’s easier for you to also drop it when you assume I’m a purposely high maintenance annoying patient that has their health care covered by the public (??), go ahead.


            I didn’t like, really, the linguistic aspect; just is a pet peeve of mine.

          • guest
            June 6, 2016 at 10:59 am #

            You got good information, but the argument is ridiculous? Look, no one’s making you respond to me. I never said you were “purposely” high maintenance. But you might consider high maintenance patients as part of the puzzle of “why do medical doctors do this thing I don’t like” whether you believe yourself to be one or not (though I reiterate: your writing suggests that you are one). As for taking umbrage at my statement about “public” healthcare, I think you misunderstood. Anyone who participates in health insurance is participating in “public” healthcare. I didn’t mean Medicaid/Medicare or national healthcare coverage specifically, although though also count. But if you are not paying your medical bills 100% out of pocket (and very few of us are, if we can help it) then you are relying on “the public” to help reduce your costs. I’m not judging any person who uses or doesn’t use such a healthcare system – but it’s a notable feature of insurance-based AND national healthcare systems that doctors working in them have a high patient load and limited time per patient. That’s ALL I meant by that.

          • Who?
            June 6, 2016 at 12:59 am #

            It’s surprising that what you took from fiftyfifty1’s thoughtful and thorough explanation is that the glucola challenge is unnecessary for you.

          • etomaria
            June 6, 2016 at 1:19 am #

            I didn’t take that from it.. What I meant was that my purpose on posting was to provide insight into why many seek out homebirths as an alternative and provide a suggestion for minimizing that. I discovered that you all apparently know everything I wanted to say and I wasn’t going to change things. I got good info on the glucose test and why some OBs are impatient in their relating to patients. Why assume the bad instead of asking what I meant?

          • Who?
            June 6, 2016 at 2:34 am #

            You’re right, I apologise.

        • Nick Sanders
          June 5, 2016 at 1:36 pm #

          Such as fruit that contains the same amount of sugar

          It is quite impossible to standardize the amount of sugar in fruit, even if we just count all the fructose, sucrose, and assorted less common saccharides as “sugar”, especially so if we’re talking about the level of precision needed for a medical test. No two plants have the exact same genes, growing environment, etc. No two fruits on the same plant get exactly the same flow of sap, the same amount of sun, etc. And even then, no two experience the exact same transport conditions: temperature, humidity, and so forth. This may all sound trivial, but when it comes to medical evaluations 0.1mg can make a difference.

          Why? The one-hour challenge isn’t even reliable, and it’s not even the final test, it’s a preliminary deal.

          It’s fast, cheap, and effective at telling whether the more expensive and involved tests are needed or not.

          Besides that, because I avoid sugary drinks as it is, why would I take one for that when there are alternatives?

          Because it’s not about sugary drinks, it’s about measuring your whether your body can control your blood sugar when stressed.

          Re: tests and such, I think you’re either misunderstanding what I was saying in that paragraph or looking at those words out of context. I’m first of all not disputing any tests.

          Whether or not you are doing so with your doctors, I quoted you doing so here.

          And I’m certainly not arguing them here, not in the comment,

          You rather clearly were.

          But back to the original paragraph, I was saying that I think respectful pro/con discussions should be had and would go a long way in helping those who feel their preferences/even their right to know what’s involved with procedures indicated for them are being ignored by their doctors because they’re not qualified to discuss it intelligently.

          The reason I picked out the sections I did, is because “Waah, sugar water!” shows to me that, qualified or not, you don’t seem willing to discuss it intelligently.

          • etomaria
            June 5, 2016 at 3:12 pm #

            Still not interested in debating it. Notice that in the rest of what I wrote I indicated I went with the glucose meter and couple weeks of a finger pricks. Both more reliable than the sugar drink and unaddressed by your angry responses. You can pick and choose whatever you want to make me say whatever you can argue with, I don’t mind really, but it doesn’t really accomplish anything that I can see. Anyway, because I’m so unwilling to discuss it intelligently, we’ll stop. Easy enough.

          • etomaria
            June 5, 2016 at 5:54 pm #

            Er, at least I thought more reliable. Appears not the case, however.

          • Nick Sanders
            June 5, 2016 at 5:59 pm #

            Wow, if you think I’m angry, I can’t imagine what you would think if I actually raised my voice.

          • etomaria
            June 5, 2016 at 6:10 pm #

            Okay. Many people seem irritated indeed. And as to your specific comments, if not angry then at least willing to make fun of something I said seriously. Maybe angry was an inaccurate word, I’m not quite sure which would be apt for “Waah sugar water”. I used an example as an illustration of a general trend and you not only ignored the main point and the fact that despite disliking it I did it, you changed my words to “Waah sugar water”. I can only assume you’re aiming to end any normal discussion..

    • fiftyfifty1
      June 5, 2016 at 10:51 am #

      “flooding my body with sugar water to see how it deals ”

      This is a common misconception about the gestational diabetes test. Women figure “This test measures how a person deals with drinking soda (or eating a bunch of sugar)”. They figure that since they don’t drink soda or eat candy etc. that they don’t need the test and that the docs are knee-jerk ordering a test that doesn’t apply to them as individuals. It arises out of a fundamental mistaken belief about diabetes in general: that it is a disorder caused by consuming too much sugar.

      In reality, what doctors are testing when they order the Glucola is her individual metabolic response to insulin resistance. The placenta (in all women) produces a substance that causes some level of insulin resistance. During pregnancy, a certain amount of insulin resistance is necessary so that calories will be transferred to the fetus, not just stored by the mother. But some pregnant women have an exaggerated insulin resistance response to the placenta, pushing them over into gestational diabetes. This can happen whether you have insulin resistance to begin with due to obesity or aging, or can occur due to genetic factors (such as a family history). But sometimes the placenta provokes an exaggerated response even in women with no risk factors whatsoever. If this happens to a woman, she is at risk of abnormal transfer of nutrition to the fetus *whether or not* she drinks sugar or eats candy. Babies can be too big, or paradoxically too small. They are more likely to die in utero toward the end of pregnancy or suffer from problems after birth. This is why every woman is tested.

      My best friend in medical school was a gestational diabetic. Very slender, exercised, ate organic home-cooked non-processed food. She never would have known had she not had the testing. Finger-stick tests wouldn’t have shown it as she was always normal fasting and after many meals. And fruit juice response is unpredictable because of limits on fructose absorption. Lactose and starches are also unpredictable due to need for enzyme conversion before absorption. In contrast, a standard glucose dose is ideal because everyone can absorb glucose.

      • demodocus
        June 5, 2016 at 4:48 pm #

        Thanks for the more in depth description! I knew diabetes was more than just eating too much sugar, and that glucola was used because it’s standardized, but wasn’t sure where to look or if i wanted to bother searching good sites from poor ones for the sake of a passing question.

      • etomaria
        June 5, 2016 at 5:30 pm #

        Aha. Yes, ditto on thanks for the explanation.

        • Who?
          June 5, 2016 at 6:13 pm #

          Glad to see you found fiftyfifty1 who knows all about it, and could answer your question.

          Good luck with the baby.

          • etomaria
            June 5, 2016 at 6:25 pm #

            Thanks :]

    • Glittercrush
      June 5, 2016 at 2:00 pm #

      So someone here I think shared a story a long time ago about their prenatal care. I will have to paraphrase since I cant find the original. But the gist is this mother was unhappy with the amount of time and attention she was getting from her OB. She confronted him at an appointment and asked him why he didnt spend more time explaining things to her and discussing daily care like approproate diet and what not. The OB explained to her that he knew that she understood healthy eating and had resources outside of his office to answer those questions. He said that a great deal of his time was spent with less fortunate patients, explaining to young pregnant teenagers that cigarettes and gummy bears were not a good breakfast. That many women in his care did not know or have access to many basic things people like that mother took for granted. So yes, it sucks that the doctors dont take a lot of time to discuss the reasons behind those fundamental tests. A short explanation can help to settle nerves about things you dont understand. But doctors have a lowest common denominator they must help. Women who desperately need these tests but dont understand scientific words or reasoning behind them. So doctors must speak to that common denominator. I dont want to sound harsh when I say this, but I cant think of a gentler way to put it. It sounds like you are looking for ego stroking. For the doctor to praise your intelligence for asking the right questions and making tough choices. But remember that you are one of many women that the doctors must care for. And that those doctors do recognize your ability to find information outside of their offices, so they dedicate more of their time to women who cant.

      • etomaria
        June 5, 2016 at 5:27 pm #

        Oh. I’m not offended, but I don’t think that’s why I’m asking. Maybe because of all the stupid propaganda out there things are blown up out of proportion, but what it is, I believe, is an attempt to have someone who I think probably can easily wade through it all tell me what’s up, but also what he uses to decide what’s up at least briefly. I haven’t ever found an OB that I know we’ll enough to be able to just trust, they’ve almost always been new to me, and I’ve encountered things like the glucose test, where one lady says “Hey skip it” and the next says “Hey no way”. Then you get the extremes, the nurses who just make fun of you for asking and the midwives who insist it’s harmful. And then you’re like whaaaat is going on, where is the actual answer, how will I know when I find it, so you subject everyone to many questions in order to have them prove it. Or that’s been my reaction I guess. Maybe not everyone’s.

        • Beth
          June 6, 2016 at 12:05 pm #

          I think what you’re saying is that doctors (and other practitioners) don’t always take the time to answer patient questions, or don’t answer them very well, and this can lead to patients who are frustrated or mistrustful. And yes, sometimes one practitioner will tell you one thing and another something different, which makes it more confusing for you as a patient.

          I’m in a different field, not OB, but if I got a similar question (“why do I need this test or medicine when I have no risk factors for X and won’t it just cause Y problem…”) I take the time to talk it through with the patient. Which can include answers like “We need the test because a lot of people can get this disease even with no risk factors” or “that other test you’ve heard of isn’t a good fit for your situation because xyz.”

          I am lucky that I’m in a practice where I am allowed to take the time with patients to address their questions properly. Many doctors aren’t. And some doctors just are better than others at communicating. But I do agree that any doctor should be willing to answer questions (within reason – if you want an hour long discussion about it, schedule another appt) and if they don’t, I recommend looking for another doctor.

          • AllieFoyle
            June 6, 2016 at 1:38 pm #

            I agree. You ought to be able to ask your doctor to explain things you are unclear about or don’t understand.

            I wondered the exact same thing about the gestational diabetes test, never got an explanation about why it was necessary, couldn’t understand what benefit there could be to drinking an amount of sugar that I would never otherwise ingest to see if I had a condition I was unlikely to have that would be treated by following a diet and exercise plan less stringent than what I already did, so I ultimately declined it — a decision which was readily accepted by the CNMs providing care at my hospital’s practice. If a provider had taken two or three minutes to say what fiftyfifty just explained, I’d probably have taken it.

            There is absolutely nothing wrong with having questions or wanting to understand the reason a treatment is being recommended (except perhaps in life-threatening emergency situations). Medicine is not an exact science and it is eminently reasonable to want to understand your situation and all the options available to you, as well as the costs and benefits associated with each course of action. Having questions does not make you a bad or difficult patient.

          • swbarnes2
            June 6, 2016 at 2:02 pm #

            Severe diabetics have to inject themselves with insulin to keep their blood sugar levels down. So no, you were not necessarily already doing what you would be told to do if you were diagnosed. Also, if your fetus was measuring between 4500 grams and 5000 grams, a GD diagnoses changes the context of that measurement, and would have changed the recommended care.

          • AllieFoyle
            June 7, 2016 at 4:59 pm #

            But the point was that no one told me that, even though I was asking questions and was unsure about the necessity of the test. I might make a different decision now, but only because people here took the time to explain it. I still think it was reasonable thing to question, and I don’t see why any decent practitioner wouldn’t be able or willing to have a short conversation about it. That’ s just part of providing care.

    • LibrarianSarah
      June 5, 2016 at 10:20 pm #

      Having “no risk factors” (or more accurately few risk factors) for
      something isn’t a guarantee that it won’t happen to you. There thin
      people who have diabetes, non-smokers with lung cancer, and men who have breast cancer. Just because you don’t have a family history of diabetes and have a healthy diet doesn’t mean you won’t get gestational diabetes. My mom had “no risk factors” for GD but she still got it…twice. And untreated GD is A LOT worse for the health of you and your baby than “flooding your body with sugar water.”

      I am not sexually active. I never plan to be sexually active. I still have an annual pap smear because I still have a cervix.

      • etomaria
        June 5, 2016 at 10:52 pm #

        Short response, as I’ve already responded to most of what you say below: I brought up gestational diabetes and the tests and what I’ve been told and what I’ve done to illustrate the point that conflicting things are heard from different doctors and that leads to questioning patients who are essentially demanding proof of everything their doctor says. Most doctors can’t/won’t prove everything, so people go to those who will or who claim to. Especially when the doctors who are declining to discuss/prove are condescending in their refusal. I wanted to recommend being tolerant of it, as it’s the info-over-saturated age we live in as opposed to purposeful obnoxiousness on the part of the patients, but it appears that this suggestion has been made and heard and heeded by some and not by others. Beyond that, and back to the glucose tests, I understand the point of it and the comparative danger of the actual disease going undiagnosed and untreated, therefore have tested for it in some way with all but one kiddo, during a pregnancy when I was TOLD that due to a lack of risk factors, I wasn’t going to be required to do it. I hadn’t requested skipping it even, until AFTER that pregnancy, thinking that the test was only for those who had risk factors. I think that’s all.

    • MaineJen
      June 6, 2016 at 10:01 am #

      So mentioning concerns for you child’s health is disrespectful? Really?

    • Daleth
      December 13, 2018 at 9:55 am #

      EVERYTHING is liability-based

      Liability is a legal term. I’m a lawyer, so let me translate it into English: “liability” means “people getting hurt or killed.” A hospital is only liable if a patient gets hurt or killed. A hospital’s liability insurance policy only has to pay out money if a patient gets hurt or killed.

      Insurance companies know more than anyone else about risk. That’s why they set rules like, “This car insurance policy requires you to never loan the car to anyone under 25.” (That’s why car rental places usually won’t rent to drivers under 25–their insurer won’t let them because they know that statistically drivers under 25 are much more likely to have accidents.)

      Medical liability policies have rules too — basically the rules are, “You have to do as much as reasonably possible to avoid preventable deaths and injuries, or else we won’t cover you.”

      So when a doctor or nurse says, “We have to do X because our liability insurer requires us to,” that means “we have to do X because if we don’t, patients will be hurt or killed.” In your own individual situation that might seem unfair, because you’re healthy and you’re confident that you won’t be hurt or killed. But the hospital treats thousands of patients a year, and if they did what you’re asking them to whenever a patient asked, some of those thousands of patients would be hurt or killed.

      • etomaria
        December 13, 2018 at 12:50 pm #

        I am familiar with the concept.of liability. The part you are neglecting is that insurance companies seek to reduce their responsibility (e their *liability*) by any means possible. If they can require caregivers do certain tests or require certain procedures because those things have even the tiniest likelihood of a an outcome wherein they do not pay (ie no one being hurt of killed), they will of course have no qualms insisting upon it, it’s not their treatment being handled, why not require it? The problem is it is not up to, it should not be allowed to be up to, insurance companies to make these choices. People are not managed assets or liabilities, they are people, and people make these calls in conjunction with their specially-educated-for-this-purpose doctors or whomever.

        (Also: of course some would choose the/a non-recommended course of action, and they should then be told “I believe/the evidence shows it’s somewhat/very likely that this choice you would like to make is not in your best interest or could lead to X negative effect(s) or death, are you sure you are prepared for that?” If the patient is and this is a serious enough matter, a waiver of liability (ie responsibility, note, not harm or death) can be discussed and signed or the doctor can say that they do not feel they are not able to do their job in protecting the patient and on thar basis would not like to work with them further.)

        • Daleth
          December 13, 2018 at 9:49 pm #

          The part you are neglecting is that insurance companies seek to reduce
          their responsibility (e their *liability*) by any means possible.

          Yes. Insurance companies use any means possible to reduce the number of people who get injured or killed. They do whatever they can to make sure that as many hospital patients as possible survive their hospital stay and go home healthy.

          Wait. I just realized you’re saying that’s a bad thing.

          Also just realized you’re saying that insurance companies “should not be allowed” to do that. What should insurance companies do — just provide insurance, even to hospitals that are killing patients? Really? Even if we ignore how completely unethical that is, do you realize how much money that would cost? Insurance would be unaffordable unless our already exorbitant hospital bills got massively MORE expensive. Should hospitals just not have insurance, then? Wait–then people who got injured by medical mistakes would have no way of getting compensated for that.

          I understand how appealing it is at first glance to “just let everyone choose how risky their medical treatment should be,” but it sounds like you haven’t really thought through all the consequences of that.

          • etomaria
            December 13, 2018 at 11:36 pm #

            Conversing with you people is tiresome. Liability does not mean harm or death, it means responsibility for something, in this case responsibility for harm or death. So, if we stick to the meaning of the word, not the made-up-by-you meaning, then we find that they are always seeking to minimize their RESPONSIBILITY for potential harm or death, not seeking to minimize harm or death. If insurance companies were able to come up with a way to avoid any liability (responsibility) but not minimize any risks, theyd be cool with this, provided people would continue to pay them. So I guess reread what I said with the actual definition of liability in mind? And I dont have a good solution for you, actually, besides gping back to muuuuuch smaller models of healthcare, even though I do not know how this would work, ie how to bring it about. As it stands, the system is so huge that it requires oversight in the form of liability insurance and many other things. Dunno. But that is not or should not be the driving force behind which treatments or procedures or what have you are chosen.

          • Who?
            December 14, 2018 at 1:27 am #

            You keep talking about things like you have suddenly come up with new ideas.

            Of course insurance companies would love to sell policies they will never have to pay out. Selliing something valueless for value is the free market wet dream. That’s why smart people review and negotiate insurance policies and are careful to not lie or misrepresent and so void the policy when they take it out.

            Going smaller with the care model means fewer experts, because only big centres, with big budgets, and that see a wide range of cases, including all the hard ones that get funnelled to it, can create and maintain experts. Which will put an end to the need for insurance, since once expertise has been lost no one will be capable of doing anything tricky enough to need insuring. Actually it would put an end to a lot of testing too, since if there is no one to review the results and suggest treatment/management strategies, there will be no point testing.

            If you find us tiresome, feel free to go elsewhere.

          • etomaria
            December 14, 2018 at 1:36 am #

            It appears as though you are attributing your own thoughts to what I’m saying. I don’t think any of this is new, as a matter of fact, I think it’s obvious, which is why it is surprising to not have it acknowledged. Also, tiresome things can sometimes be worth the effort and sometimes not. If, despite multiple explanations of the same thing, it is always misunderstood or misconstrued, I will indeed “go elsewhere”. I dont think I have responded to these posts for a few years actually.. suddenly an email showed up. I guess hope springs eternal that I will be able to adequately convey what it is I know to be the case in such a way that, even if you all do not agree with me (I doubt this will happen), you will at least understand why people who disagree think the way they do. Or I suppose I assume they think like I do, so I guess maybe I should be more accurate and say that the hope is you will at least understand why *I* think the way I do, which I also hope is somewhat helpful in terms of understanding the others who choose/think/decide differently than you.

          • Who?
            December 14, 2018 at 2:09 am #

            I think we agree that insurance companies are rapacious corporate citizens who put their shareholders’ interests before their policyholders’. We disagree I think on how widely understood that is and how to manage it.

            Just because you think waivers have value to insureds doesn’t mean they do. Doctors are not alone in this, any policyholder who has done their homework and is fully informed, and who seeks to limit their potential liabilty to their patient/client/customer with a waiver knows that it might not be successful, or fully protective. I can imagine situations where a poorly-drafted waiver could in fact avoid the policy (see rapacious corporate citizens, above).

            I think we agree that people should be able to refuse care if they wish to. Where I think we disagree is in our understanding of what might happen then.

            I think we agree that alternative care-providers can be a solution where a patient doesn’t want to take a doctor’s advice.

            Practically, for example in a small town, that might not be possible. In that case the doctor might, as a matter of professional ethics and responsibilty, maintain a relationship they would prefer to not be in rather than see a patient go altogether untreated.

            Emergencies are interesting though. A doctor cannot simply ‘walk away’ from an emergency. The risk for the doctor is if they follow the patient’s wishes (as they must, with a conscious patient who apparently has decision making capacity) and a non-optimal outcome is achieved, the patient can sue the doctor, saying the doctor wasn’t clear enough about the risks, didn’t take the time to hear through what the patient had to say, or any number of other grounds. This puts the doctor, the insurance company and the patient through years of expensive angst via legal proceedings and everything that goes with them.

            Your example about an end of life terminal illness is an extreme that has nothing to do with pregnancy and birth, where, usually, the desire is for everyone to be alive and well at the end.

            I acknowledge that a living baby and healthy mother isn’t everyone’s goal-many homebirthers put their experience above all else-and that I don’t understand.

            I also don’t understand why you don’t use more paragraphs.

          • etomaria
            December 14, 2018 at 2:31 am #

            Typing on my phone. I try and forget.

            And my.grandma was a general example to show that motives can be whatever. I will give better ones if youd like pregnancy-related ones.

            We do not care whether our babies are born with Down’s syndrome, so we do not test for it. I think, but totally might be wrong, that mortality rates are higher for babies with Down’s, so maybe first testing then an abortion would, to some, be adviseable as the most effective way to lower risk of harm/death. I would say, I see what you are saying, but I am not doing it because I disagree with your premise and an prepared to acccept the consequences.

            Let’s see.. we have turned down hearing tests (not OB, but in the hospital) if it seems obvious the baby reacts to sound because we are prepared to deal wih subpar hearing if it comes to it, ie dont see a benefit in the testing besides just the knowledge, which will come in time.

            Another non-pregnancy one, I have not been immunized against HPV because the risk factors arent there or I dont find the small amount of risk compelling.

            I mean, anyone could have any reasonfor choosing/declining a procedure, so it’s hard to say. But in the end, they make that call, hopefully along with their doctor. Hopefully not them ignoring their doctor’s expertise and hopefully not their doctor ignoring them. But when insurance companies get in the mix, it’s a sign something is broken.

            I do get what you say with the why, esp in emergency situations, and I agree that this is very regrettably the case, but that doesn’t mean it should be the case! I do not envy doctors being caught between what is and what should be and (hopefully) trying to balance them.

          • etomaria
            December 14, 2018 at 2:31 am #

            I try *to put paragraphs in* and them forget.

          • Who?
            December 14, 2018 at 3:30 am #

            Thank-you for responding, I’m really interested in the persepective you bring.

            My question is, though, what if knowing before time would help the baby have a better life? For instance, if you were to have a Downs baby, it might do better with a team ready on hand to assist with the delivery and ensure the baby got care and treatment-even surgery-in a planned rather than emergent setting.

            Similarly, knowing if your baby has a hearing deficit early will help with ensuring their speech and comprehension is as good as it can be, rather than finding out down the track they are missing certain things that will affect their future.

            I see pregnancy a bit like I see driving-most of the time it’s all good, no problem, but sometimes it goes bad and occasionally it goes catastrophically wrong.

            People like me stick to the speed limit, service their vehicle regularly, and set out in good time so as not to feel the need to rush. I plan my journeys so I know where I’m going and don’t have to be reading the map while driving along. I don’t drive within 12 hours of any alcohol consumption.

            Others speed; they drive a car that isn’t properly maintained, on tyres that have seen better days. They are in a rush. They drive with a drink, or two, or ten, on board.

            Do they have accidents more often than people like me? I couldn’t say. Difference is, if I do have an accident, I know I’ve done my best to avoid and mitigate it. Same with pregnancy. Stay healthy, try to eat right, etc, etc. But also let people who have seen the worst pay attention to things I don’t know about and help me avoid an accident I don’t (and couldn’t have) seen coming.

            I don’t see insurance companies as bad, just as another thing to be mindful of. They make all kinds of things possible that we otherwise wouldn’t have-potentially risky life saving medical treatments being only one.

          • etomaria
            December 14, 2018 at 11:11 am #

            Here I agree, but I think that what is reasonable and adequate for mitigating potential problems driving to be straightforward, whereas it is not always so in birth. Often the things that MAY bring a potential benefit also carry risks in themselves. Perhaps not always risks, but sacrifices and sometimes significant sacrifices.

            I suppose this is true with driving, like seatbelts are annoying maybe or not drinking is maybe not one’s preference, maintenance costs money.. tho, we will not always opt for full coverage if we deem the risks to be small or the loss manageable. I think living one’s life such to mitigate all medical risks associated with pregnancy to the maximum extent possible would be impossibly burdensome. Yes, even if life hangs in the balance. I suppose if I were SO worried about risk, I would not choose to be sexually active and so avoid any pregnancy.

            Life is fraught with risk, I am willing to take certain chances. My solution is to discuss these re: pregnancy firstly with my husband, he always gets veto power, it is after all his child, and then with the doctor(s). Sometimes (often) in the opposite sequence, so he might benefit from the doctor’s expertise/suggestions.

            But there is a decently wide range of choices one can make in accepting/declining care without, I think, being reckless or foolhardy. I think doctors tend to come down very conservatively, which is probably good, at least in the recommendation/suggestion of treatments. It may be unhelpful if it becomes insisting their rec is THE only responsible choice. Hard to give exact answers here, that is the problrm.

          • etomaria
            December 14, 2018 at 2:39 am #

            Re homebirthers, this is why we keep having hospital births despite the friction caused by seemingly different perspectives, the how-can-we-manage-this-inherently-dangerous-condition-called-pregnancy and the pregnancy-is-a-normal-fact-of-life-that-generally-goes-fine perspectives. Probably you will not like my idea that it ‘generally goes fine’ but I will leave it open to criticism anyway. Anyway, the point is that we have decided that we are willing to do certain things we’d rather not because the potential and certain benefits in an emergency outweigh the potential risks and certain discomfort in a hospital birth.

          • Daleth
            December 14, 2018 at 10:15 am #

            Liability does not mean harm or death, it means responsibility for something, in this case responsibility for harm or death

            Yes, liability means responsibility for harm or death. So when a hospital says it’s trying to reduce liability, it means it’s trying to reduce harm or death that the hospital is responsible for (a.k.a., harm or death caused by the hospital).

            You still think that’s a bad thing? Hospitals shouldn’t try to reduce the number of deaths or injuries that they cause? Huh. I’m not sure I follow you.

            Side note just so we’re clear on what we’re talking about: medical professional liability insurance “provides coverage to physicians and other medical professionals for
            liability arising from disputed services that result in a patient’s
            injury or death.”

            You’ve said that reducing the number of patient injuries or deaths caused by doctors “should not be the driving force behind which treatments or procedures or what have you are chosen.” I disagree — if I’m at the hospital, I want the #1 goal in the doctor’s mind to be, “How do I help this woman go home alive and well?”

          • etomaria
            December 14, 2018 at 10:49 am #

            I dont really know how else to say it, but it keeps being misunderstood. I am saying seeking the reduce LIABILITY for harm/death shouldn’t be the driving factor. Seeking to reduce liability and seeking to reduce harm/death are not indeed synonymous. The driving factor should be health and thriving, the doctors should be seeking to help the patient(s) have good health and thrive thus. That is all. Nothing more to say, really. If you think I am saying something different, I can only suggest reteading what I have said. Or perhaps reading Who?’s comments, which have quite a bit of the same.

          • Amy Tuteur, MD
            December 14, 2018 at 3:14 pm #

            Can you give us an example where seeking to reduce liability is NOT seeking to reduce harm/death?

          • etomaria
            December 14, 2018 at 4:34 pm #

            Sure. To continue the years-old diabetes test discussion, one example was when the doctor says that they do not think I am at risk for gestational diabetes but want me to take a test for liability purposes, to check the box that it was done (maybe they are just telling me they think I am not at risk because they think it sounds nice? But if it is not true, why say it? And if it is, why test?).

            So in case that one is invalid because the bit about my risk is just a platitude, then when I am told that my pregnancy is low risk, NSTs and ultrasounds look good for breathing and fluids, no specific dangers are present but they would really prefer that we induce no later than one week post-due-date because it could be safer. (I am not arguing that it isn’t potentially safer by at least certain metrics and for certain people in certain pregnancies, just that they on the one hand say they cannot give me a specific reason with me and this baby but still would rather we induce earlier than most of my babies have been born when labor started spontaneously).

            Maybe there are more examples, but that is what’s coming to mind.

          • Amy Tuteur, MD
            December 14, 2018 at 5:20 pm #

            But that’s reducing liability by reducing complications and deaths. I’m looking for an example where doctors reduce obstetric liability WITHOUT reducing risk of complications and deaths.

          • etomaria
            December 14, 2018 at 7:07 pm #

            I was talking about insurance companies insisting on certain practices so as to minimize their liability in the event of a suit.

            Perhaps we are discussing different things. My comments, unless I have gotten sidetracked from what I was originally saying (but I don’t think so), were about how often it seems that maternity care is driven by whatever the doctors feel they must do to satisfy whomever is providing their liability insurance.

            I do not think that satisfying companies looking for the most profit is an appropriate goal for medical care. I think that the health of the patient, independent of liability requirements from insurance companies, which are in turn based on whatever the companies think will result in their being less liable to pay a claim, should be the goal.

            This is why I gave you the examples I gave you. And I don’t think that they are “reducing complications and deaths” if they truly can’t cite a danger we’d be avoiding by making a particular choice. IE when they press to induce a week after the due date despite saying that they believe all is in order and will continue to be.

          • Amy Tuteur, MD
            December 14, 2018 at 8:06 pm #

            It is ALWAYS about reducing complications and deaths because liability is incurred only for complications and death. When people complain about defensive medicine, they mean that the chance of a bad outcome is low, but it is never zero. Remember, insurance companies have to pay for the extra tests and procedures. They only mandate them when they judge the savings from reduced liability is greater than the expense of tests. There is simply no situation in which providers or insurance companies mandate anything that doesn’t reduce liability by increasing safety.

          • etomaria
            December 14, 2018 at 9:36 pm #

            If this is the case, it should be pretty simple to elaborate to the patient the risks being mitigated, shouldn’t it?

          • Amy Tuteur, MD
            December 15, 2018 at 9:51 am #

            It is. Natural childbirth advocates call this “playing the dead baby card.”

          • etomaria
            December 15, 2018 at 11:22 am #

            Not quite sure what youre getting at unless you mean “the baby might die”. When it comes to OB treatment, I know what I have gotten and maybe what friends have gotten. In mine, as I have said, my doctors have NOT said that the baby would die, they have said that there is no specific danger we would be avoiding by waiting for spontaneous labor to start or by inducing. But they have nonetheless preferred to, suggested, or pushed to induce, depending on the timeframe. So perhaps your risk applies in certain (many even) cases, but it didnt for me, yet the mindset was still induce induce induce. There waa no reason for this, based on what they said. If you are so arrogant as to tell me that there was a reason, there probably can’t be much more discussion. You would be either assuming you know more than my doctors about how my pregnancies should have been handled, that I am mistaken or not being truthful when I tell you what happened, or that how you operate is how everyone operates. Not really anything I can respond well to. My point was that this experience seems to be common based on what friends have said about their births, and if so, indicates the tendency to do something that has inherent risks based on the hope that it lowers risk but without that necessarily being the case. That’s what I see as problematic. If you insist I am mistaken, I have to fall back on my particular experience because, alas, I was not present at others’ births, and just know what theyve said.

          • etomaria
            December 14, 2018 at 10:49 pm #

            Also, again, the patient’s thoughts and preferences should be taken in account, not just how can risks maybe be lowered at any cost, including increasing risk. For example, an induction may heighten risk, or it may lower it. No one knows the future, so no one can say. There are risks associated with induction, are you saying that an induction done at approximate due date plus seven days is always lowering risk? Or just that it is done with the hope that it is lowering risk? I have personally been offered the option of and sometimes pushed to induce several times after my due date came and went, sometimes they offered immediately, sometimes they pushed a few days past, sometimes they made suggestions like many NSTs in exchange for waiting a few days, but never has anyone said, without my inquiring or requesting, that we should go past my due date +7, despite the fact that I have never had any indications of risk. Therefore I would suggest that the induction was an attempt to lower liability by choosing a route with heightened risk.

          • Who?
            December 14, 2018 at 11:54 pm #

            Patient preference is a different metric from risk. A patient may prefer a dead or severely damaged baby now to a csection, which they believe may limit their family size in future. Not a choice I understand, but a choice a person might make, for sure.

            In your example, what are the increased risks of induction?

          • etomaria
            December 15, 2018 at 12:14 am #

            As I understand it, most frequently labor coming on stronger amd quicker than either the mother’s or the baby’s body is equipped to handle it resulting in increased likelihood of fetal distress and cesarean (and the accompanying risks of surgery), uterine issues, higher likelihood of tearing. The possibility the chosen method of induction will progress to additional methods if it doesn’t take entirely but does enough to be past the point of no return. If it is done via breaking the bag of waters, infection and likelihood of cesarean, etc. I also think I recall more serious + rarer risks, but don’t remember them specifically. I could look them up. From personal experience, but only anecdotal, I have had issues with parts of the placenta being retained and much blood loss with both of my inductions but not with any of my non-induced births, though this maybe coincidental?

          • December 15, 2018 at 8:33 am #

            You have been misinformed as to the risks of induction. I do not blame you overmuch–when I had my first, I believed that, too–but then the evidence began to mount that induction at or beyond 39 weeks does NOT increase the risks of cesarean or neonatal morbidity, and it actually helps prevent neonatal mortality. None of us can comment on your experiences with retained placenta, but to match your anecdote, my induction was the nicest and pleasantest of my births.

          • etomaria
            December 15, 2018 at 11:24 am #

            I will see about finding sources. None of my OBs have told me that these risks were imagined.. You are really claiming that pitocin doesnt sometimes cause uterine overstimulation? It doesnt sometimes cause fetal distress? That rupturing membranes doesnt heighten risk of infection??

          • December 15, 2018 at 11:56 am #

            Who are you responding to? Not me, because I made one basic claim–that inductions at or after 39 weeks reduce the incidence of adverse events–and provided a few studies that backed up my claim.

          • etomaria
            December 16, 2018 at 12:02 am #

            Yes, I am responding to you. I said “inductions have the risk of uterine overstimulation and fetal distress, cesarean, and infection” (essentially), and you said “You have been misinformed as to the risks of induction.” As you didn’t specify anything further other than “it does NOT increase the risk” I reposed the thing it seems you are saying. Are you NOT claiming my understanding (= that induction in its various forms carries risk of uterine overstimulation or fetal distress and cesarean, and infection) is incorrect?? Also, are the studies in a different comment? I see no studies in your post. Also, will respond in a different comment in a second as to studies/statistics versus individual care, if you’re curious.

          • December 16, 2018 at 8:39 am #

            I showed in the comment beginning “Your example (induction) is a bad one” that induction decreases adverse outcomes compared with expectant management. I provided links to studies backing this statement up. I have never stated that induction is without risk, because no intervention is without risk–however, in the case of induction, as in the case of many interventions, the risk of waiting is GREATER than the risk of inducting.

            To use a more extreme example, there are risks to vaccinating–primarily anaphylaxis–but these risks are tiny, orders of magnitude smaller than not vaccinating.

            I would never state that the use of a seatbelt is risk-free–people could be trapped and harmed by the seatbelt–but seatbelts prevent far more injuries and deaths than they cause.

          • Who?
            December 16, 2018 at 3:48 pm #

            Just to round this out, not intervening is also a choice, and carries risk, which is, across a population, a greater risk than the proposed intervention, which was induction.

            ‘Leaving nature to take its course’ is today a choice. And aren’t we lucky that’s the case?

          • Amy Tuteur, MD
            December 15, 2018 at 9:52 am #

            You’re “understanding” is wrong.

          • etomaria
            December 15, 2018 at 11:27 am #

            Your response is unhelpful. (Also my understanding is simply my understanding, adding unnecessary quotes only serves to add snark, whiiiiiich was one of my initial reasons for posting however many years ago, that a condescending attitude toward possible dissenters is useless and working against your professed goals as expressed by commenters, “reaching fencesitters”.)

          • Amy Tuteur, MD
            December 15, 2018 at 11:31 am #

            Unhelpful or not validating? My point is that you have no idea of the relationship between liability and safety. … and you keep demonstrating that over and over again. Your “understanding” of the situation is not based on facts, just on personal beliefs unsupported by facts.

          • etomaria
            December 15, 2018 at 11:58 pm #

            Unhelpful as it doesn’t correct anything or even DO anything constructive. I meant what I wrote. I choose my words as carefully as I can.

          • etomaria
            December 16, 2018 at 12:19 am #

            Yeah, I see all of this (except your conclusion, but all of the six points) being true.

            Here is the thing. Medical professionals, in my understanding of their profession, are responsible for the meeting of the statistics (the statistical norm, the broader tendencies and trends in people across the globe or at least willing to be studied, the mean, etc.) and the individual. They are responsible to know the general populus and what is safe and what is recommended and what the best move would be in X situation and in Y situation, from a health standpoint (increasing overall health and well-being), and offer that advice as someone educated in those things. They are responsible to temper their recommendations with whatever that individual’s SPECIFIC circumstances are.

            I will admit in advance that my forthcoming analogies leave something to be desired, I am not a doctor. But anyway. It would be weird to tell a drug addict whose weight is too little to eat better/more when his problem is his drug use. Granted, eating well/more is a key to a healthy weight FOR THE GENERAL POPULUS WHO ARE NOT DRUG ABUSERS. But this guy is a drug abuser. So of course you use that info to decide how to fix his problem.

            Another example, my dad is 62, he has recently started undergoing colonoscopies. There are, from what he says, two types. One covers about 25% of the intestinal tract (I think?) and catches about 95% of potential problems. That is what he did the first couple times. No one in his family had a history of colon or intestinal cancer, his tests were in good levels, etc. Then it was discovered his younger brother (by a year or two younger) had colon cancer along with a whole list of other cancers. His younger brother recently died from all of those having gone untreated. From then on, the variables had changed, he now undergoes the more thorough colonoscopies because his circumstances indicate his risk is higher and justify the increased risk of the more thorough procedure. SOOOOOOOO, the doctor took the statistics (colonoscopy type 1 catches most of the issues and carries nearly no risk, colonoscopy type 2 carries risks of intestinal perforation etc. yet discovers more potential issues) and the individual (first the individual had no additional risk factors, thus meaning there would be no incentive to subject him to additional risk, now we see that the individual’s circumstances have changed and he is at an increased risk, therefore the more invasive, riskier procedure is justified by the risk of something being missed by the less risky, less thorough procedure). Again. Statistics meet individual, doctor tailors care.

            I personally was born three weeks past my due date, my sister was four weeks late, my husband was four weeks late, etc. I have had children born at 41+, 42, 41+(almost 42), 41+ (almost 42), and 42+ weeks, all healthy, healthy mother, healthy baby, no meconium, no placental issues, no issues at all. Knowing all this, why would a doctor take the statistics saying that for the general populus induction at 39 weeks is best and apply them to my specific case? Actually, in the end, they are generally willing to trade increased monitoring for waiting for spontaneous labor, to a point (two weeks past my due dates). If they are okay with this, WHY the pressure to induce? Why the resorting to general statistics that seem to differ at least a little in my individual case?

            Statistics cannot reasonably determine every care decision, they can’t. I mean, I guess you’re free to try and make them in your personal practice. I would not employ a doctor who did. (For what it is worth, I do in fact pay for my health care, out of pocket, in cash, so I do not expect the general population to cover my ideas, as discussed elsewhere in this thread). If this is our difference, I guess here is where we say to each his own and stop arguing about it.

          • Who?
            December 15, 2018 at 8:01 pm #

            Whether or not ‘fencesitters’ will get the vapours due to Dr T’s quotation marks, her point stands-that your understanding about the effect of inductions after 39 weeks is wrong.

            The incorrect homophone gave me the vapours, but I freely admit that is my issue that I very bravely have mostly got past.

            After 39 weeks, the decision to induce, across the population, leads to ‘better’ outcomes ie more babies born alive and well. As we know, not all pregnant women think that an alive and well baby is an optimal outcome. Some accept some risk/sacrifice/inconvenience to themselves to give the baby this overall improved outlook. Still others want to walk a line between scheduling an induction and letting nature take its course.

            As Rudy Tooty has thoughtfully outlined, the decision to refuse advice/care can have repercussions that aren’t immediately obvious, at least to the patient.

          • etomaria
            December 16, 2018 at 12:24 am #

            I responded above (actually below I think) if you’re interested

            I don’t think people are only divisible into the groups “do everything the doctor suggests with barely even a question” and “those who wouldn’t mind their babies dying”. False dichotomy.

            Also, I have to say, it does get old always hearing in response to concerns or questions a shocked “but don’t you CARE about your BABY and his HEALTH?!”

          • Who?
            December 16, 2018 at 1:17 am #

            I suggested three categories, not two, but let’s not quibble.

            Also, I didn’t say ‘but don’t you CARE etc…’ though I can’t fathom why a person wouldn’t care.

            Our difference might really be about what words mean. I feel that when you talk about ‘understanding’ what you really mean is ‘belief’. You believe that, overall, your babies would not do better delivered closer to 39 weeks rather than later. Your belief is based on the fact that you had later babies that did well. You have no way of knowing that.

            Both my babies came, without intervention, at 40 weeks plus 10 days, back in the day when 42 weeks was the hard stop. No one knows whether my babies (or yours) wouldn’t have been even more fabulously well and healthy delivered earlier. The fact they were all okay certainly doesn’t prove it’s bad advice for your doctors to give you now.

            If your understanding (or belief, we won’t quibble) is so fragile you can’t bear to hear a word in opposition, it might be time to soberly reflect on it.

          • etomaria
            December 16, 2018 at 1:34 am #

            Gotta say I am surprised that you might intimate that I’m overly sensitive considering how many words in opposition I have been hearing. And somehow I am alive and fine.

            Also, re: babies and whether they’d have been fine or not, I am not contending they wouldn’t, I am simply saying that the doctors have indicated that they see no increased risk in waiting and that competes against the risk (however small) in induction. If they see no risk in waiting for me specifically and my babies, then why risk the [we’ll call it miniscule for argument’s sake] potential issues with induction? For real, I would like to know why? Again, are you thinking they are just placating me by saying they don’t see any reduced risk in our waiting?

          • etomaria
            December 16, 2018 at 1:39 am #

            And and and, I didnt mean YOU were saying “but dont you care about your baby??” I mean that is the response almost anyone gives when you question the need/advisability of a procedure. Just another logical fallacy/avoiding the question, not an actual answer. I put that because you have been inferring that the alternative to your methods is not particularly worrying whether the baby is alive and healthy. I am saying that perhaps (even very likely) the person is precisely wanting a healthy baby and therefore thinks they must take their health choices seriously and know why they are doing what they are doing, if they are going to do it.

          • December 15, 2018 at 8:30 am #

            Your example (induction) is a bad one.

            “…is [induction] always lowering risk?” The correct question is “Does inducing beyond (or even at) term cause or prevent more neonatal and maternal morbidity and mortality?” The answer to this latter question is that it prevents more adverse outcomes:


            Dr. Tuteur wrote a post discussing this matter a couple of years back:


            Your doctors weren’t trying to “heighten” risk–the idea of preventing liability by “heightening” risk is as absurd as saying you’re trying to avoid getting wet by jumping into a lake.

          • etomaria
            December 16, 2018 at 3:49 pm #

            I didnt say they were trying to heighten risk, jeeez, I said they were apparently heightening it.

            Approximate conversation goes like this:

            Doctor: so, you’ve hit your due date, let’s talk about induction options
            Maria: okay, when were you thinking?
            Doctor: anytime really
            Maria: is there a benefit to inducing versus waiting? All of our other kiddos have been late. I’m kind of worried about inducing labor before they’re ready
            Doctor: well so far all looks to be good, you never know though, something unexpected may happen
            Maria: is there something particular you think will happen?
            Doctor: no, not at the moment, there are indeed generic possible risks, but all looks well with you and the baby so far, if youd like we could schedule an ultrasound and NST in a week to monitor everything and then go from there
            Maria: oh, sure

            So if there was something the doctor was trying to avoid, I would expect it to be referenced. When it is NOT, as has been my experience so far, my logical conclusion is there is no additional risk to waiting. There is however a risk associated with induction. Therefore we would appear to be introducing risk. Being as the doctor knows how my births go, I would assume he is qualified totruthfully tell me whether waiting is dangerous. It sounds like you all are saying that there is no conceivable situation in which someone’s risks in inducing (past 39 full weeks) are greater than their risks in waiting. I do not understand how that fits with my experience.

            Because it appears that induction is offered/pushed in situations where, according to what the doctor says, there is no great risk in waiting, I then wonder why they would offer/push it. Habit? Or if what you all are saying is true, and I am underatanding everything right, WHY would they not say “no matter what your individual specifics are, the balancing of risks will always come down in the favor of induction, but if you personally are prepared to deal with the consequences of waiting, the difference in induction risks and waiting risks is comparatively small and so you are not increasing your risks very much by waiting, it’s something I perspnally am comfortable with you doing. However as you progress past your due date and get farther, the difference in those risks.steadily increases and at two weeks past it jumps significantly. So I would not be comfortable with you waiting past then” Or am I misunderstanding what you’re claiming?

          • Who?
            December 16, 2018 at 4:42 pm #

            How is that first conversation ‘pushing’?

            Doctor suggests something, you ask a few questions, you both agree to hold off.

            Around here we call that being alive, perhaps I’m missing something?

            If what you want is softer soap, go back to the doctor market and find one who talks like you suggest is appropriate. At 38 weeks pregnant I would have been asleep half a dozen lines in to that final spiel you propose from the doc. Lucky I happen to be standing up, it nearly made me doze now!

          • etomaria
            December 16, 2018 at 4:54 pm #

            Well my actual phrasing is very past the point. I have had it vary, some have been as chill as that, some have been less willing, the general formula is induction being brought up, risks inquired about, no risks elaborated, deciding to wait. Until two weeks past, and then it goes induction brought up, risks inquired about, risks elaborated, induction scheduled.

            Why is it even offered if it isn’t the best option? That is what I am asking!! Why would a doctor offer a course of action not warranted by the situation? Why would they prefer it if it isnt necessary? And if it is necessary, why would they not ever specify something along the lines of what I suggested??

            And you seem to really like this idea of my being easily offended. I just want straight talk. I would prefer it not be condescending, but so long as it is factual I can deal with the doctor simplifying things for me. I dont want evasive answers like “well because it’s better” when I ask for specifics aa to how it’s better or how the alternative would be worse, but that’s hardly the same as being easily offensive.

            Your would have fallen asleep bit doesnt really change anything. Perhaps if you were so inclined to falling asleep you also wouldnt have asked questions that would have been answered in such a way. But either way, no bearing on the CONTENT of what my suggested answer is. It could be as simple as “right now the risk [of placental failure or fetal death] in waiting is only slightly higher than inducing, so go ahead and wait if you want, but at two weeks past the risk will be much higher and then waiting is irresponsibly risky in my professional opinion”

          • etomaria
            December 16, 2018 at 4:59 pm #

            We are getting caught up in why or whether my doctors have advised properly. The point of the entire introduction of my experience was to illustrate how I came to consider that the driving force behind medical decisions is what insurance companies want. When a procedure is suggested, offered, pushed, and the doctor is unable to explain why that procedure is the best risk-wise, then one comes to the conclusion (or I would think they would come to the conclusion) that sometimes medical decisions are driven by something other than simply safeguarding health.

          • Who?
            December 16, 2018 at 5:01 pm #

            What is better will be different for each individual patient. Learning that an ‘early’ induction is a safe and reasonable choice is information that some people will find useful.

            You didn’t, that’s fine.

          • etomaria
            December 16, 2018 at 5:06 pm #

            Ah. So it isnt a matter of it always being the best option, it is just the doctor presenting a possibility?

          • Who?
            December 16, 2018 at 5:25 pm #

            You’re a little obsessed with absolutes-‘always’ and ‘best’ in one sentence?

            Induction might be ‘best’ because then the family can be sure baby will be in the photos at great-grandma’s 70th birthday party; it might be ‘best’ to leave baby alone because then it’s likely to be inside and no one can hear it scream at great-grandma’s 70th birthday party. If the doctor advises either is fine, mum gets an easy choice. If the doctor has a strong recommendation, mum takes or leaves it, ideally realising the doctor is just doing his/her job, not trying to run mum’s life. That’s being a grown-up.

            Doctors advise and recommend. Adults take responsibilty for themselves and their decisions.

            The metrics of risk are part of their advice; patient wishes, as Rudy Tooty thoughtfully explained, should be respected, even when they are, objectively, dangerous.

            And yes, horrible insurance companies’ risk metrics help doctors figure out risks.

          • etomaria
            December 16, 2018 at 5:38 pm #

            Ill let you have the last word. Childish and absolutist I will be then.

          • Amy Tuteur, MD
            December 15, 2018 at 9:52 am #

            Yes, induction lowers the risk of perinatal death. That’s the point!!

          • Daleth
            December 16, 2018 at 12:59 pm #

            The driving factor should be health and thriving, the doctors should be seeking to help the patient(s) have good health and thrive

            Yes, I totally agree. And that’s why doctors seek to help the patients not get injured or killed. That’s kind of the baseline for “health and thriving,” isn’t it.

          • etomaria
            December 16, 2018 at 3:31 pm #

            Glad we’ve gotten that sorted. Insurance companies’ ideas to reduce their financial liability are not the goal.

          • Daleth
            December 17, 2018 at 10:47 am #

            Insurance companies’ ideas to reduce their financial liability are not the goal.

            It depends. If an insurance company tries to reduce its financial liability by providing less coverage or giving itself more ways to get out of the contract, that’s bad.

            If an insurance company tries to reduce its financial liability by requiring doctors to do what the scientific evidence shows will reduce death and injury, that’s good. But this approach is, for some reason, exactly what you’re complaining about.

        • Who?
          December 13, 2018 at 10:24 pm #

          Of course insurance companies seek to reduce the amounts they have to pay. That’s how they make a profit, which, last time I checked, is the reason they exist. And is by the way perfectly legal.

          Insurance companies don’t make decisions for people-they are part of the framework of care. If you want to go outside the framework, by all means do so.

          Waivers are very often disputed by the people who sign them: ‘you didn’t tell me hard/often/insistently enough about the risk’. Not worth the paper they are written on. Insurance companies don’t love them for that reason. Just like the ‘Danger: do not enter’ sign is a handy admission of liabilty for the time someone does enter.

          If an insurance company refuses to insure a particular risk, you know it is either for something very likely to happen, or likely to be catastrophic if it does happen, or both. Why would you not want to avoid that thing?

          • etomaria
            December 13, 2018 at 11:43 pm #

            I dont know why someone might, too many variables. I can give one example. My grandma was 84 and probably had somewhat advanced cancer by the time she went in for some pain or another and was sent for a scan. During the scan she was asked to raise her arms above her head, something which turned out to cause much pain to her. She decided that she would rather skip the scan. When she was of course told that the scan was necessary to determine further treatment, she replied that she was okay with dying, that she felt she lived a long, full life. Of course not everyone would feel this way and they of course may choose as they desire. But whose else but hers is that call? Hers and and doctor’s based on what they are aiming to get from treatment? She hadnt initially decided she hadnt wanted treatment, only after she started it and discovered what it would cost.

            Also, if a waiver of useless, termination of care works. I have had OBs who have suggested waivers (for example when I choose two weeks of glucose monitoring versus a one-hour test) for my choices, so I was operating on the assumption they are accepted. If my OB felt I was too much of a risk, I would assume he/she would tell me that such a relationship would not work and how they expectes me to change or that they would no longer ase me.

          • etomaria
            December 13, 2018 at 11:43 pm #

            See* me

        • RudyTooty
          December 15, 2018 at 11:47 am #

          Hi etomaria,

          I think I understand some of what you are trying to say … generally … I think you are asking about incorporating patient preference into their care – specifically around maternity care. I am a CNM, and patients often choose our practice because they are looking for a model of care that will be individualized to their preferences and desires – as long as they are low-risk.

          I love the concept of respecting each patient’s every wishes – and I wish I could!

          I have a duty to provide care that is adherent to professional standards. I have to present it as a standard of care, and I do work with patients who refuse these interventions. I cannot force a patient to undergo any test or procedure that they do not want. If a patient is actively dying in front of me, consent is assumed, and I do have a duty to protect the lives of my patients.

          In the case of something like a required/recommended glucose test, the harm is not immediate or apparent in that moment.

          I used to think that a patient can just choose parts of the healthcare they are receiving, and I could document that they ‘chose’ certain parts of their care, and not others, and that that would protect my professional license, and the institution where I am employed – but now I see it differently.

          The patient is free to make decisions – for any reason – for good reasons, for bad reasons, they can be well -informed or misinformed, we have to respect their decision to consent or not to a treatment.

          Health care professionals have a legal and financial duty to provide a standard of care, to inform all of our patients of the potential outcomes of refusing care – and even if the patient refuses, we have to demonstrate that we did everything within our power to adhere to that standard of care.

          It is not a level playing field. That’s not to say that healthcare professionals should be disrespectful toward patients, and we should not use coercion or deception to get patients to comply. But we are held to legal and professional standards. We will be held professionally and legally responsible for poor outcomes of our patients.

          Some healthcare providers operate very much from a factory-assembly line, cookie-cutter style of practice – some institutions adhere to this model more than others. Patients can feel very put-off by this type of care -they want to be involved in their care, and they want to feel like they have a choice and a say in what happens to them.

          I think the issues you bring up are important to keep in mind, because seeking the ‘middle ground’ and not finding it in a hospital setting is part of what drives patients to home birth. Which is much more dangerous.

          • etomaria
            December 16, 2018 at 5:04 pm #

            If I recall that was my initial point, I assumed that Dr Amy was at a loss to understand why people might go with homebirths. I discovered as we went along that most people understand this (the lack of personalized care/attention) but that for various reasons they either neglect it or find it unreasonable/impossible to provide. But then I guess many tangents branched off. But yes all in all I think that you explained what I was trying to say. I still maintain the doctor is the go-between between the generic data and the individual person, at least in the kind of doctor-patient relationship I expect, and that this is frustratingly hard to find. But not much more to say beyond that.

  8. sdsures
    April 29, 2016 at 9:22 pm #

    More dads need to be made aware of the dangers of HB. Dr Amy does a great job, but it’s mostly geared towards moms and future moms. How can we help more dads be prepared to defend their child’s right to be born safely?

  9. Elaine
    November 29, 2015 at 11:03 am #

    It would be nice if Dr. Amy used her considerable energy and expertise to make hospital births safer and more evidence based instead of belittling women who look at relative risks and opt for “first do no harm”.

    Readers might want to look at

    NOT a HB website–so relax. Not insulting or sarcastic to anyone. Author is a PhD/ RN who posts links to peer reviewed articles

    Talking to mothers who have delivered in the past year here in a major metropolitan area, nurses and doctors going against even ACOG regulations is distressingly common.
    C-sections not only increase the mother’s risk of death, they also have long term health implications for the child.
    OB’s love c-sections because their risk of being sued is vanishingly small (also they are quick and the pay is higher). C sections are most likely to happen just before shift change–kind of erodes trust. Lobby insurance to pay only 20% of usual fee if delivery is by c-section, and see whether the number of “medically necessary” c-sections changes.

    Here’s an analogy–when someone chooses elective surgery (stent, hip replacement, etc.) they know there is a risk of long term damage or even death, but believe the small risk of immediate death is outweighed by probable long term health and quality of life. Sometimes this calculation is based on false statistics or inadequate evidence, or lack of sufficient personalisation. But we don’t accuse everyone who makes these risk trade offs of being suicidal and stupid.

  10. Medwife
    September 25, 2015 at 5:03 pm #

    “The women who go to the hospital? That’s bravery.” You know, I agree with this. Many people are scared of hospitals. Maybe their only experience of hospitals has been of being ill in one, or seeing a sick loved one there. Some people have never been in one at all and there is huge fear of the unknown. People are afraid of needles. It’s brave to go anyway, and women with those fears who face them down and go to where their babies have the best chance of coming through birth safely have my utmost respect. I try my very best to make the hospital as friendly and safe-feeling as possible with them in mind.

  11. Leah
    September 20, 2015 at 11:23 pm #

    I had a horrible experience giving birth in a hospital. My friend, however, just attempted a home birth and her baby died. The baby would not have died in the hospital. Hospitals may be unpleasant, but at least my daughter is alive. I watched my friend cry for her lost child and I can tell you should would do anything, ANYTHING, in the world to have her baby back. That agony will be with her forever. If you have a home birth, you risk living her nightmare. Sure, babies can die in a hospital, too, but at least you don’t have to live with the guilt that you added unnecessary risk.

    • MJ
      September 21, 2015 at 12:07 am #

      Oh Leah, I am so sorry that your friend lost her precious baby.

    • The Computer Ate My Nym
      September 21, 2015 at 7:18 am #

      I’m sorry for your friend’s loss.

    • Daleth
      September 21, 2015 at 10:00 am #

      I’m so sorry for your friend and her baby.

    • Christina
      September 25, 2015 at 3:17 pm #

      Very very sorry about your friend. I had an emergency c-section at the hospital recently and even though I wouldn’t say the experience was pleasant (what surgery is pleasant, right?), it meant my baby came out safe, alive and well, which is all I could have asked for. I’d never trade my baby’s life for the ‘experience’ of home birth (and all the risks associated with it) and I’d have chosen the ‘unpleasantness’ of a c-section any time over an all-natural, no-interventions delivery if it ensured my baby’s life, health and well being 😉

  12. Harry Edgar Pitcher
    June 15, 2015 at 4:49 am #

    So……how Do You answer this doctor?….among the many studies suggesting that in low risk pregnancies the risks are actually slightly higher with hospital births…….

    • SporkParade
      September 21, 2015 at 1:44 am #

      The article lost me when they claimed that interventions in hospitals are responsible for high maternal mortality rate in the US. If you look at what women are actually dying from during childbirth in the US, it’s all chronic medical conditions that were exacerbated by the stresses of pregnancy and childbirth, often because the dead mothers are black and/or poor and didn’t have access to primary healthcare before becoming pregnant. These are cases that require MORE medical attention, not less.

      Oh, and the study they cite has waaaaaaaaay overlapping confidence intervals, meaning that they didn’t *actually* prove anything. This isn’t surprising given that perinatal mortality is measured as per 1,000 births and maternal mortality is per 100,0000, and they only looked at 28,000 births.

    • The Computer Ate My Nym
      September 21, 2015 at 4:09 am #

      A lot of the outcomes that were better were indicators of how the pregnancy was going, not of how good the care was. For example, birth weight <2500 grams is clearly related to the risk of pregnancy, not to the quality of care at delivery. There weren't enough cases to really say anything about true bottom line measure, i.e. neonatal survival (the confidence interval was huge.) I also note that they made a lot of exclusions, including quite a number of situations that would have been considered "low risk" for home birth and that they didn't say anything about how often transfer to the hospital occurred. It seems extremely likely that the pregnancies in midwife care were lower risk than those under OB or hospital midwife care. Finally, the study is in Canada and says nothing at all about care in the US.

    • The Computer Ate My Nym
      September 21, 2015 at 4:17 am #

      Sorry, two other points: First, they didn’t cite “many studies”, only one. This study was simply too small to draw any conclusions. They based the claims on less than 10 events in almost all cases. The only thing that it proves is that low risk is low risk.

    • Christina
      September 25, 2015 at 2:44 pm #

      ‘Low risk’ doesn’t really mean much, as you never know what can happen until the very end. I’m the perfect example of that: under 30, ideal BMI at the beginning of pregnancy, healthy diet and exercise, no chronic health problems. Pregnancy was smooth and complications-free, baby’s and my tests were all great the whole way, and I carried to term (went into labor on my own the day after my due date, didn’t need pitocin, and labor progressed nicely on its own). My pregnancy and labor were the definition of a low risk pregnancy and low risk labor. Fast forward to the pushing stage of my delivery, where baby’s heart rate dropped to the 60s and failed to rise back up for several minutes, while oxygen levels also started to tank. Fetal distress caused by pushing and continuous contractions, and nothing in my pregnancy or earlier labor stages could have predicted or prevented that development. It was the first time I saw my OB (a generally laid back doctor who had been completely reassuring throughout my pregnancy and very supportive of my plans for a vaginal delivery due to my being low risk) seriously worried, and this is when I knew things were serious. I ended up having an emergency c-section which thankfully allowed for my baby son to come out early enough for him to be stabilized by the medical personnel and suffer no long term complications, brain damage or even death by this sudden and unforseen turn of events. I could honestly say my hospital delivery was traumatic. It was traumatic because, had I not chosen to have the care of an obstetrician and go for a hospital birth, had I bought into this home birth culture that is huge in the city where I live, my son would likely not be here today or we’d have been left with a child with severe brain or neurological damage. And this is very traumatizing to think about – how close we came to disaster despite my otherwise perfect prognosis, and how, had it not been for the doctors, nurses, neonatologists and other medical staff at the hospital who worked tirelessly on getting the best outcome for me and my baby using the best technology available to them, the outcome of my story could have been vastly different.

      • Who?
        September 25, 2015 at 7:41 pm #

        I’m glad it went well in the end. It is traumatising to think about near misses, and it must have been very scary to see the doctor looking worried.

        Hope you recover quickly.

    • Fallow
      September 25, 2015 at 3:38 pm #

      You going to come back to respond to these answers you’ve gotten? Or did you think a link was going to blow people’s mind so much, that nothing more needed to be said?

  13. Angelfish
    December 12, 2014 at 1:57 pm #

    I just found this on the Vancouver BC midwives guideline pages: Identifying Early‐Onset Group B Strep Disease: SOGC recommendations state that neonates of GBS‐colonized women who received ≥4hours of antibiotics should be observed in hospital for 24 hours, and neonates of GBS‐colonized women who received <4hours of antibiotics should be observed in hospital for 48 hours. Many midwifery clients opt for early discharge from hospital and/or homebirth despite being colonized with GBS, making 24 or 48‐hour observation impossible. In this case, the community standard in Vancouver is to educate parents about the following signs and symptoms of early‐onset GBS infection and to assess the baby at home in the first week.
    • Respiratory distress, specifically grunting
    • Fever or inability to thermoregulate
    • Seizures
    • Inability to nurse or difficulty feeding
    • Lethargy
    • Stiffness or extreme limpness
    I can't believe that home diagnosis of meningitis or sepsis by a non-medically-trained parent is the choice some parents are making! If their baby actually got to the point of having the symptoms described, it would still be pretty hard to save them in a hospital. Frightening.

  14. IndieThinker
    November 24, 2014 at 7:04 pm #

    How outdated and discriminatory can you be, Doc?

    “Today, I’d like to address fathers, specifically fathers whose wives are
    trying to convince them to give their approval to homebirth.”

    As if the only women who choose homebirth are married, and if so, then to men?


    • LibrarianSarah
      December 11, 2014 at 9:15 am #

      So because single and lesbian mothers exist, we have to pretend that fathers don’t? No where in this essay was it said or implied that only married straight couples exist or are important. She just targeted her post to a specific audience.

  15. Googagaga
    September 6, 2014 at 8:47 pm #

    Just for the record, it’s not always the woman pushing for the home birth. My husband was born on the farm under the care of one of Ina May gaskin’s midwives and is very phobic of hospitals. He watched the movie “the business of being born” and it fed his phobias even more. He convinced me to try a home birth with our first child, and luckily we ended up transporting to the hospital (my decision) and the child is fine. I am currently pregnant with my second child and am getting an extreme amount of pressure from my husband and people in our community to go for a home birth. Just like you describe on this website, I have received constant mom-shaming for what I want. This is why I was dismayed by this article since you seem to normally be supportive of mothers’ choices. It’s just a rude article all-together, and I don’t think it’s useful to try to pit partners against each other on such a sensitive topic.

    • Sara M.
      October 19, 2014 at 1:39 pm #

      My heart goes out to you as you prepare for birth. I hope you are able to have the baby in the hospital and you can find a friend or two who is able to support YOUR choices.

  16. disqus_ealSxkOnJn
    April 30, 2014 at 10:33 pm # “Low-risk women in this cohort experienced high rates of physiologic
    birth and low rates of intervention without an increase in adverse
    outcomes.” The full article is available for free. It’s far from the only article of its kind, of course.

  17. resaurus
    February 11, 2014 at 11:40 pm #

    I’m almost certain that living room floors (or most other areas of the house save the bathroom!) are not graded to hold that much weight over that much space. I’m not a carpenter, engineer or construction site inspector…but I don’t think that’s safe. Maybe someone can chime in?

    Here’s my back-of-the-envelope math: Figuring that home water births happen in kiddie pools anywhere from 66″ inches to 90″ in diameter, that’s between ~1000lbs and ~2400lbs!!! plus the weight of at least one human (weight calculcated using pools rated at 127 gal and 311 gal, respectively, with 1 gallon fresh water equal to about 8 lbs).

  18. L. Garvey
    February 2, 2014 at 8:04 pm #

    This article relies on ad hominem arguments and anecdotes, without providing science about homebirth or midwife birth. How can you begin by saying, “You are right and your wife is wrong.” Wow. Now that you’re in every husband’s pocket, maybe you’ll pull out some facts to do more than stroke his pride? Guess not. You should give some credit towards the woman who is carrying this baby for nine months. Women have been bearing and birthing children since the species began, long without intervention of hospitals and doctors. Now that we’re in a society that understands hygiene and the detailed science of birth, the chances are even better that a child will be born safely. Will your wife need a doctor? Maybe. All men and women should do their research, weighing personal comfort versus chance of complication, but DO NOT MAKE YOUR DECISION BY THIS WEBSITE. Read articles that present this debate with facts, not extreme and insulting prejudice. Good luck with the information gathering, and I pray that your childbirth is a safe one.

    • etomaria
      June 3, 2016 at 3:02 pm #

      Basically the crux of my problem with the post. It APPEARS that most of this site (okay, okay, I’ve only read three articles. but all of those!) is meant as a preaching-to-the-choir, rant type of thing. No-one is going to be won over by obnoxious superiority, which is all I’ve seen so far from Dr Amy/Dr Tuteur/however is proper. I initially ended up here sincerely looking for information. I ended up here a second time having forgotten how ridiculous it was the first time, again, in a sincere attempt to get information. Both of those times I was treated to very little information (except maybe in the COMMENTS), but a lot of disrespect (as someone who might ever consider a route that Dr Amy would not) and general pissiness. It seems that the idea that regular people, pregnant moms particularly, might want to understand their care and participate in it, but have a hard time wading through the sea of misinformation. Just like the vaccines debates. I want to do the best for our kids, but there’s SO MUCH OUT THERE that you get overwhelmed. In the end, if you can find a doctor you can trust, it makes it so much easier, but if you’re going with a random doctor because you’re new to the area or whatever and you happen to have been exposed to anti-vaccination stuff, then it’s totally normal and natural to wonder and want to know. And so many doctors are just opposed to the conversation at all, let alone a respectful thorough one. This, in my experience, generally results in the inquirers writing off the doctor’s opinion and going with the anti-vaccination crazies. Point being, you’re not actually going to make a real change this way.

  19. aimie
    January 24, 2014 at 11:45 am #

    this is disgusting and how any man can comment on this well really you dont deserve to watch a baby brought in to the world leave it to the ”idiots” eh?? the same ”idiots” who’s body has grown this baby for 9months and has stronger love and instincts than you will EVER know! ill informed and clearly you are the idiot in this

    • Storm
      April 25, 2014 at 12:17 am #

      That is incredibly sexist to say a man will never bond with a baby. By your reasoning adoptive mothers must not love their babies as much as someone who gives birth. I’m adopted, my partner is adopted and I find your comments disgusting.

    • LeighW
      June 5, 2016 at 8:49 pm #

      There are plenty of women out there who get pregnant, give birth, and have zero love for that child.

      Your argument is invalid.

  20. Kate B
    December 9, 2013 at 12:44 pm #

    That’s definitely true in the UK. Women are either classified as midwifery-led care or consultant-led care.
    There are very strict protocols for identifying any elevated risk, and when this happens, women are transferred to consultant-led.;
    Consultant-led women generally have to give birth at hospital, wheras midwifery-led women have the choice of a hospital, freestanding birth centre or a birth centre attached to a hospital.
    The birth centres here seem very different to in the US though – they are staffed by nurse midwives with very stringent protocols for referring to hospital if necessary.
    My local hospital, for example, has an attached midwife-led birthing centre. This means women can be transferred to the consultant-led delivery suite very quickly – it’s literally an elevator ride away – if they decide they want an epi or anything starts going wrong. The birthing centre is very homely, with pools in every room (although these are used for pain relief, not birthing), birthing balls, beanbags, adjustable lights, double beds, cd players etc Etonox (gas and air) is available for pain relief. Partners are allowed to stay too, and lots of privacy is granted after baby is born. I think this is a really good homebirth compromise and I’d be hard pressed to find any problems with safety when midwifery-led birthing centres are run like this, with access to an OB on hand.
    The consultant-led suite isn’t too bad either.They have pools in lots of the rooms there, including a ‘high risk’ pool, which allows for women being continuously monitored. They’re very good about asking if you want to hold the baby/put baby to breast straight away after birth, try using different positions, have skin-to-skin, delayed clamping etc

  21. kreception
    October 7, 2013 at 12:31 pm #

    “homebirth diminishes the chance that your baby will survive childbirth” how is this factually true??

    • Poogles
      October 7, 2013 at 12:45 pm #

      There are medical services and treatments that are not available at home that dramatically increase a baby’s chances of surviving should an emergency arise. By being farther from things like an OR and a NICU, the chances of having a poor outcome (like death or permanent disability) from an emergency are much higher. Since most emergencies cannot be predicted beforehand, you increase your chances of everyone coming out healthy at the end if you are somewhere where emergency treatments are immediately available (not a 10+ minute ride away).

      • MRR
        December 11, 2014 at 5:53 am #

        Most emergencies CAN be spotted in time. What you say is just false.

        • Young CC Prof
          December 11, 2014 at 8:47 am #

          Some complications can be spotted in time. If your midwife recognizes what’s wrong and doesn’t ignore the signs! One tragedy described on this site occurred because a mother had meconium-stained liquor and went 12 hours with no progress at all before midwives transferred! Other problems happen much too quickly.

          If you really want a home birth, ask your midwife what her transfer rate is. With first-time mothers, it should be at least 20%, second-time mothers, around 10%. She should send you to get all the same tests an obstetrician would, and should “risk out” if results are abnormal. And look up something called a “partogram,” it was designed by the World Health Organization as a guide for out of hospital birth. If a woman progresses slower than the partogram indicates, it doesn’t necessarily mean she needs a c-section, but it means you do need to start traveling toward the hospital promptly, so she can be examined with higher technology.

        • Poogles
          December 11, 2014 at 2:12 pm #

          Just because you insist it is so, does not make it true. Tell me – which emergencies can be “spotted in time” (and what counts as “in time?)

          Because I can think of a few off the top of my head that can NOT be spotted far enough in advance at home to get to the emergency services needed before injury or death occurs – cord prolapse, severe PPH, shoulder dystocia, cervical laceration, hell even fetal distress most of the time because US homebirth midwives do not properly track the fetal heartrate and have no ability or equipment to do tracings (which are the only way to pick up on some types of distress).

      • Michelle RNC -ob
        April 28, 2015 at 7:49 pm #

        Which emergencies are you referring to? Abruption? Hemorrhage? Prolapsed cord? How many minutes do you think you have? When these emergencies occur in labor and delivery, on a patient already admitted, with an Iv who is rushed down the hall and delivered within minutes, we get a baby who is barely alive who needs full resuscitation by the neonatologist standing by. Now, picture that at home. First call 911, wait for ambulance, then we need to get mom on the stretcher then somehow down the stairs, start Iv once they get to ambulance. Then ambulance ride to hospital where there is an admission process to get you into the system, type and cross your blood and then finally operate on you. What are your chances your baby will still have a heartbeat? You don’t know what you don’t know. I would love to know what they (midwives) tell their patients about transfers. I’ve been a labor and delivery nurse since 1997. Expect the unexpected!

        • Poogles
          April 29, 2015 at 7:32 pm #

          “Which emergencies are you referring to? Abruption? Hemorrhage? Prolapsed cord? How many minutes do you think you have? When these emergencies occur in labor and delivery, on a patient already admitted, with an Iv who is rushed down the hall and delivered within minutes, we get a baby who is barely alive who needs full resuscitation by the neonatologist standing by. Now, picture that at home.”

          Exactly, I agree completely – this was the point I was making.

  22. Marie Smith
    August 11, 2013 at 5:33 am #

    “Ina May Gaskin is a “self-taught” self-proclaimed “midwife” who has NO EDUCATION OR TRAINING in midwifery, nursing or medicine. One of her own children died at a homebirth and she refused to seek help for that baby and watched him die.”

    Mind blowing, absolutely mind blowing.

    My first baby and I both would have died had I insisted on using a midwife and had a delivery outside of a hospital. When things go very wrong, they can do so quickly. Thank God I had a very experienced OB-GYN who took quick action.

  23. Shona
    July 3, 2013 at 1:45 pm #

    One-sided indeed. My first child was born in a hospital, no complications, completely natural birth (i.e. no painkillers of any kind), so for my second pregnancy my husband and I decided to go with a team of midwives. They mentioned homebirth, so my husband and I discussed it. Ironically enough, he had decided before me that homebirth would be the better option for us and needed no convincing whatsoever! My baby girl was born at home with my husband and two midwives in attendance (my mother and two year-old daughter were playing in another room). Oh, and to top it all off, it was a water birth. Am I an idiot? No. A narcissist? No. I am a down-to-earth, realistic, practical woman who chose to look at all the facts, from both sides of the controversial story, and made a conscious decision with my husband. I suggest anyone considering homebirth do the same.

    • The Bofa on the Sofa
      July 3, 2013 at 1:58 pm #

      Last night, I went out to the bar with a bunch of friends from work, and had a few drinks and a good time. When it came time to go home, I could either leave my car there and get a ride from a cab, or drive home. I called my wife, and she and I decided that, since she needed the car early this morning, it would be better for us, and cheaper, if I just drove home. I did it, and made it home perfectly safely, with no incidents at all. Of course, I was careful, I was sure to wear my seatbelts, and I had the headlights turned on (it is very well known that drunk drivers often forget their headlights and don’t wear their seatbelts, so I wasn’t careless like them). Am I an idiot? Narcissist? No, I am just a realistic person who chose to look at ALL the facts about drunk driving, and not just rely on what is on MADD’s website. Did you know, for example, that in my 8 mile drunken drive home last night, I was about 50 times less likely to die than you were in your homebirth? Shoot, the chance of even getting a ticket or in an accident was less than that of your baby dying. Them’s the facts. I’m sure that you are happy to support my decision to drive drunk, which was, very clearly, the best for me and my family.

      • The Bofa on the Sofa
        July 3, 2013 at 1:59 pm #

        PS I didn’t really do that, of course, but the statistics are correct.

  24. MK
    April 29, 2013 at 2:21 pm #

    Wow. Thanks for the random catch phrases. Too bad there are no facts to back them up. Here’s one 700% higher death rate at home. Regardless of your preference for “intervention”….your final and closing statement is a lie.

  25. Whitney
    March 24, 2013 at 6:00 am #

    wow. A lot of these comments are one sided and insulting. To call women idiots or stupid for wanting or doing a homebirth is absolutly uncalled for. I have met and talked to many women that have given birth in a hospital and their stories are horrific, and some are not. To say that homebirth kills is a great over exaggeration and to me sounds like someone who does not have all the information. 300-700% increase in death to homebirth, where did this person get this information? I think this debate needs to get down natural birth and how the birth system in the hospital is flawed. A natual birth on your own time with out intervention is very hard to stick to when you have nurses and doctors in your face wanting to go home and injection pitosin and stadol and epidurals commonly without discussing the whole picture of pros and cons to these meds are. Its not about buying into The BOBB, its about making an informed choice for your family and gathering all the information out there and not gathering it from a one sided man whose first line is “you are right and your wife is wrong” It doesnt sound to me like an open minded discussion from both parties went on there. When i buy something off of amzon I look at the 3 star reveiws because i feel like those are the people who will give you the pros and the cons of the product. And the same with birth, find someone who will give you the pros and the cons on going to the hospital, clinic, or staying at home. Each option has its list of challenges and great rewards. just be aware of everything and please dont take to heart people that will call a pregnant women and idoit or saying that a midwife has less training than a house maid!

    • March 24, 2013 at 7:11 am #

      Ironically, the latest ACOG statement on c-sections has some people puzzled because certain risks to mother and baby are actually LOWER for a c-section as opposed to a vaginal birth. People who considered themselves educated are puzzled and honestly surprised.

      I look on with wry amusement because anyone who had looked closely at ALL of the data already knew this. The conclusion is that the surprised people either hadn’t looked at all of the data, or didn’t look very closely.

      The sad reality is that even under the best conditions (previous VB, two properly trained and educated midwives, strict risking out and transfer criteria) that home birth is more risky because of the lack of resources to deal with emergencies. In the United States, home birth is often done less under than ideal conditions with a predictable increase in injuries and deaths.

      It’s numbers, data, evidence. All the awesome birth experiences will not change those numbers or bring a baby or mother back to life.

  26. March 24, 2013 at 5:58 am #

    wow. A lot of these comments are one sided and insulting. To call women idiots or stupid for wanting or doing a homebirth is absolutly uncalled for. I have met and talked to many women that have given birth in a hospital and their stories are horrific, and some are not. To say that homebirth kills is a great over exaggeration and to me sounds like someone who does not have all the information. 300-700% increase in death to homebirth, where did this person get this information? I think this debate needs to get down natural birth and how the birth system in the hospital is flawed. A natual birth on your own time with out intervention is very hard to stick to when you have nurses and doctors in your face wanting to go home and injection pitosin and stadol and epidurals commonly without discussing the whole picture of pros and cons to these meds are. Its not about buying into The BOBB, its about making an informed choice for your family and gathering all the information out there and not gathering it from a one sided man whose first line is “you are right and your wife is wrong” It doesnt sound to me like an open minded discussion from both parties went on there. When i buy something off of amzon I look at the 3 star reveiws because i feel like those are the people who will give you the pros and the cons of the product. And the same with birth, find someone who will give you the pros and the cons on going to the hospital, clinic, or staying at home. Each option has its list of challenges and great rewards. just be aware of everything and please dont take to heart people that will call a pregnant women and idoit or saying that a midwife has less training than a house maid!

    • March 24, 2013 at 6:34 am #

      Hospitals do need to reform a lot of their methods, especially in cases where things are clearly going well. They have already made good strides in this direction over the past few years, though.

      And this blog certainly does not act at all respectful toward those who are interested in natural childbirth and homebirth. That old saying about catching more flies with honey than vinegar is completely ignored here.

      *However*, I’m telling you as someone who has two kids who were attempted homebirths, and even had Ina May Gaskin stay overnight in my home once, that I do think those statistics are correct, or pretty close. Now, very few babies die in the hospital, so even when you increase the rate of death by 300% or even 700%, you are still going to see the vast majority of homebirthed babies live. But personally, I’ve come to the conclusion that the risk is higher than I’d be comfortable with if I had it to go back and do over again.

      • March 24, 2013 at 8:58 am #

        Personally, I have no respect for those who choose homebirth. I think they are either naive, have bought into an completely phoney ideal, or have managed to convince themselves that they are personally immune to risks. I have even less respect for those who push it. I might have sympathy for those who are so afraid of hospitals they cannot cope, and certainly for those who have economic reasons for risking it. And I regard aspiring birth goddesses as completely deluded, to be avoided at all costs.

        I do respect people’s right to make bad choices, and would accept that if their minds are made up, neither honey or vinegar are likely to be effective.

        • March 24, 2013 at 2:17 pm #

          I think there is some percentage that is persuadable through “honey”, but none is being offered. (Well, I guess I just tried to offer some.)

        • April 4, 2013 at 9:05 am #

          Wow, Lizzie… such stereotyping and lack of respect! Bad choices? Personally, I know only one mother, and one child, who’ve died post childbirth in the last decade. The mother died of a blood clot after a C-section [she’s one of those 2.2% in 100,000 stat]. The baby died after being delivered in hospital, never able to breathe on her own despite the best efforts of a medical team. Yet I know many women who’ve given birth at home with no adverse effects on themselves or their babies. I’m not advocating homebirth as the best choice –however, think before you judge others’ beliefs. They may be, like mine, based on the reality and the understanding that life is not safe –as a general rule– and hospital birth is not necessarily the answer. There is no risk-free choice. A great read on this:

          • April 4, 2013 at 11:09 am #

            I have already owned the lack of respect. Stereotyping? Maybe. Fact is, I don’t know anyone who has CHOSEN a home birth personally. My sister had one, but not from choice – and it didn’t go well. I do read assiduously here and elsewhere the reasons people give for wanting one, and they do not make me feel respectful. I would definitely fail to be convinced by an argument that rested on “Life is not safe…”, though of course I accept that as a truism. I am only too aware that hospitals don’t offer guarantees either, but agreeing that there is no risk free choice doesn’t mean I can see any sense in adding to the risks.

            I read your link – and take the point that CS can add some risks – though it does say that one of the greatest, thromboembolism, could be reduced. Abstracts are never very satisfactory – what this one doesn’t say is what the maternal mortality, not to mention infant mortality and morbidity, would be if the CS rate was reduced. (I would have been a casualty for a start, and so would my daughter) The stats from times and places where it is not available are not that impressive.

  27. Gator
    February 25, 2013 at 2:38 am #

    Yes, women have given birth at home for thousands of years. They have also died giving birth at home for thousands of years. Women do have the right to choose, but it’s a Claytons choice when the information and ‘research’ they’ve been given is flawed.
    And I would bet that the hospital horror stories are more to do with the womens ‘feelings’ about her birth experience rather than the actual damaged/dead babies from the home birth horror stories.

  28. Cheryl
    February 18, 2013 at 8:28 am #

    CNM,CPM,LM,Lay Midwife, Traditional midwife. While I agree our professions need to be clearer about the backgrounds and distinctions among us, the Doc misses it completely by defining us “in her view”. Hopefully her readers are intelligent and doing their own research. The best source for information about CNM’s is As a CNM, know that CNM’s are trained and educated to do home birth as well. Many are not comfortable and do not support it, but contrary to the Doc’s spewing of misinformation, homebirth is safe when screening, regular prenatal care and birth are provided by a qualified birth attendant and precautions are taken to promote safety and transfer in a timely manner if needed. It is the infrastructure for transfer that is the problem, not the place of birth. And get it right, CNM’s do homebirths as well. See: for a great video about a CNM practice that does birth center and home birth with CNM’s.


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