Let’s review: Twelve things you shouldn’t say to Dr. Amy … unless you want to appear very foolish

This piece has received more comments than any other I have written, 1000+ and counting. It first appeared 2 years ago, but rarely a week goes by without someone asserting one or more of the following in the comments sections. Clearly, some people need a review.

It seems like every day a new visitor parachutes in to this blog and attempts to “educate” me. Inevitably, the visitor finds that almost everything she says is false. Indeed, almost everything she thinks she “knows” is false. So to spare these visitors embarrassment, and to reach those who are attempting to “educate” me on other blogs, I have compiled the following list. Here’s what you should not say to me, and why you should not say it.

1. The US does very poorly on infant mortality.

Infant mortality is the WRONG statistic. It is a measure of pediatric care. That’s because infant mortality is deaths from birth to one year of age. It includes accidents, sudden infant death syndrome, and childhood diseases.

The correct statistic for measuring obstetric care (according to the World Health Organization) is perinatal mortality. Perinatal mortality is death from 28 weeks of pregnancy to 28 days of life. Therefore it includes late stillbirths and deaths during labor.

The US has one of the lowest rates of perinatal mortality in the world.

2. The Netherlands, which places the greatest reliance on midwives, has low mortality rates.

No, the Netherlands has, and has had for some years, one of the HIGHEST perinatal mortality rate in Western Europe. It also has a high and rising rate of maternal mortality. The Dutch government is deeply concerned about these high mortality rates and a variety of studies are underway to investigate.

A study published in the BMJ is early November 2010 revealed and astounding finding. The perinatal mortality rate for low risk women cared for by midwives is higher than the perinatal mortality rate for high risk women care for by obstetricians!

3. Obstetricians are surgeons.

I never understand how anyone has the nerve to say this to me. I AM an obstetrician. No one knows better than I what obstetricians are or are not. I went to college. I went to medical school. I spent four years in obstetric training. I delivered thousands of babies. I have cared for thousands of gyn patients. That some doula who is a high school graduate thinks that she can possibly know more than I about the nature of obstetricians defies belief.

Obstetricians do surgery as part of their practice. That does not make them surgeons. If it did, ophthalmologists and dermatologists would be surgeons too, since they do surgery as a routine part of caring for their patients. Is anyone seriously suggesting that you cannot go to an ophthalmologist for an eye exam because he or she will recommend unnecessary surgery?

4. Homebirth is safe.

No, all the existing scientific evidence and all national statistics indicate that homebirth triples the rate of neonatal death. Even studies that claim to show that homebirth is as safe as hospital birth, like the Johnson and Daviss BMJ 2005 study, ACTUALLY show that homebirth with a CPM has triple the rate of neonatal mortality of comparable risk women who delivered in the hospital in the same year.

The Midwives Alliance of North America (MANA) is well aware that homebirth is dangerous. That’s why they are hiding their own mortality rates. They spent almost a decade collecting information on more than 18,000 CPM attended homebirths, announcing at intervals that they would use the data to show that homebirth is safe. So why haven’t any of us seen it?

The data is publicly available, but ONLY to those who can prove they will use the data for the “advancement” of midwifery. MANA is quite up front about the fact that they will not let anyone else know what they have learned. Obviously, if homebirth had been anywhere near as safe as hospital birth, they would be trumpeting it from the mountain top. It does not take a rocket scientist to suspect that their data shows that homebirth dramatically increases the risk of neonatal death.

5. Homebirth midwives are experts in normal birth.

This one always makes me laugh. Experts in normal birth? That’s like a meteorologist who claims to be an expert in good weather.

I guess they’re trying to make a virtue of necessity. Homebirth midwives know virtually nothing about the prevention, diagnosis and management of pregnancy complications. That’s a problem when you consider that the only reason you need a birth attendant is to prevent, diagnose and manage complications. You don’t need any expertise to catch the baby and make sure it doesn’t hit the floor. Ask any taxi drive; he’ll tell you.

6. Childbirth is safe.

No, childbirth is INHERENTLY dangerous. In every time, place and culture, it is one of the leading causes of death of young women. And the day of birth is the most dangerous day in the entire 18 years of childhood.

Why does childbirth seem so safe? Because of modern obstetrics. Modern obstetrics has lowered the neonatal mortality rate 90% and the maternal mortality rate 99% over the past 100 years. What has the contribution of midwifery been to lowering those mortality rates? Zero? They’ve invented nothing, discovered nothing and tested nothing that has had any impact on perinatal or maternal mortality.

7. Childbirth used to be dangerous but that is only because sanitation was poor and women were poorly nourished.

No, the great advances of sanitation occurred in the 1800’s and the early years of the 1900’s. Not surprisingly, this had a big impact on deaths from infectious causes. However, rates of perinatal and maternal mortality did not begin to drop appreciably since the late 1930’s and the discovery of antibiotics. In the intervening years, easier access to C-sections, epidural anesthesia, newer and better antibiotics, blood banking, and neonatology led to dramatically lower mortality rates.

8. C-section increases the risk of maternal and neonatal death.

No, women who die in pregnancy are most commonly women with serious pre-existing medical illness (heart disease, kidney disease) or serious pregnancy complications (pre-eclampsia). C-sections are often done in an effort to save the lives of these women. Sometimes it is not enough. The C-section is what is known as a “confounding factor.” Both the C-section and the death can be traced back to the mother’s health status; the C-section did not cause the death.

MacDorman and colleagues have attempted to show that C-sections for “no indicated risk” increase the neonatal death rate. Their papers have been roundly criticized because they used birth certificates, not hospital record. Unrelated investigations of birth certificates have shown that, while they are highly reliable for data like weight and Apgar scores, they are highly unreliable for risk factors. Indeed, unrelated studies have shown that up to 50% of women who have serious medical illnesses like heart disease, have those risk factors missing from the birth certificate.

9. Induction harms babies.

No, induction lowers perinatal mortality. The yearly CDC data on births shows that as the induction rate has risen, the rate of late stillbirth has dropped by 29% and the neonatal death rate has not increased.

10. If childbirth were dangerous, we wouldn’t be here.

This represents a profound lack of knowledge about evolution as well as a profound lack of knowledge about childbirth. Evolution does not lead to perfection. Evolution is the result of the survival of the fittest, not the survival of everyone. Human reproduction, like all animal reproduction, has a massive amount of wastage. Every woman was born with millions of ova that will never be used. Every man produces billions of sperm that will never fertilize an ovum. Even when a pregnancy is established, the miscarriage rate is 20%. That’s right. One in five pregnancies dies and is expelled and yet we are still here. Human reproduction is perfectly compatible with a natural neonatal death rate of approximately 7% and a natural maternal death rate of approximately 1%.

11. US maternal mortality is rising.

Despite a rather histrionic political report from Amnesty International making that claim, US maternal mortality is not rising and has even dropped in both of the past two years. Why does it look like it has risen? Because the standard death certificate has been revised twice in the past two decades in order to more accurately capture maternal deaths. The new death certificate has revealed maternal deaths which otherwise would not have been counted. It is not clear that maternal deaths have increased; it’s merely that reporting of those deaths has improved.

12. Women are designed to give birth.

Women are not “designed”: they have evolved and evolution involves trade offs. Babies with big heads tend to be more neurologically mature, so having a big neonatal head has evolutionary advantages. A small maternal pelvis makes it easier for a woman to walk and run, providing her with an evolutionary advantage. Those two advantages are often incompatible. The woman with a small pelvis may have been able to survive by outrunning wild animals, but when it came time to give birth, she was more likely to die because that small pelvis could not accommodate a large neonatal head.


The above statements have two things in common. First, they are wrong. Second, they are passed back and forth between natural childbirth advocates who “teach” each other they are true. That’s why it is impossible to become “educated” by reading natural childbirth books and websites. Most of their information is flat out false, and they are entirely insulated from scientific evidence. Natural childbirth advocates make up their “facts” as they go along. They don’t read the scientific literature. They don’t interact with science professionals. Indeed, professional natural childbirth advocates take special care to never appear in any venue whether they might be questioned by doctors or scientists. They know they’d be laughed out of the room. That’s okay with them as long as there is a large pool of gullible women out there who will believe them and buy their products.

It is important that those who are parachuting in to “educate” me understand that they literally have no idea what they are talking about. Most of what they think they “know” is factually false. And they demonstrate that every time they write one or more of those twelve statements.