A black box warning on homebirth

Homebirth midwives ought to be required to include this on informed consent documents:

Homebirth black box warning

An earlier version of this black box warning appeared in a previous post in March 2011.

238 Responses to “A black box warning on homebirth”

  1. araikwao
    February 28, 2013 at 6:32 am #

    OT: doctorskeptic.blogspot.com has a current post on underestimating risks&overestimating benefits of c-section. He’s normally great but I think he might have put too much weight on the Cochrane reviews this time? Wondered if some more well-versed in relevant current literature wanted to weigh in?

  2. February 27, 2013 at 11:46 pm #

    My lurking wife asked me to inquire as to the intended purpose of this blog.

    • Alenushka
      February 28, 2013 at 1:03 am #

      As a reader I felt that this blog makes people stop , think and evaluate their assumptions.

    • anonymous
      February 28, 2013 at 7:09 am #

      Like you, your lurking wife would know this easily if she READ the blog.

    • I don't have a creative name
      February 28, 2013 at 7:58 am #

      I think it’s to fight against pseudoscience.

    • Allie P
      February 28, 2013 at 8:58 am #

      To provide a scientific counterpoint of actual research and stats to the vast morass of woo-woo bullshit about childbirth permeating the web, as well as a place for medical providers, loss moms, and other people fed up with the dangerous homebirth movement in the US to vent, and, in hte particular case of homebirth loss moms, to share stories that have been silenced and deleted elsewhere.

      Troll’s still around, huh? Was wondering why the most average post on this blog lately has hundreds of comments.

    • yentavegan
      February 28, 2013 at 10:05 am #

      Alan, i accidentally tripped into this blog by a link from a natural birth website that wanted to alert others to the dangerous propaganda being spouted by Dr. Amy.
      Having been steeped in the woo for 25 plus years I have been enlightened, and humbled and educated by what I have read on this blog.
      I am a volunteer lay leader in an internationally well known breastfeeding support organization. The facts i have learned by reading Dr. Amy have enhanced the way I share information concerning birth interventions.

  3. Natalie
    February 27, 2013 at 8:14 pm #

    One of my first pharmacology lectures in medical school my professor abbreviated black box warning as “bbw”.
    Well, as is common when we don’t know an abbreviation, we google it.
    I recommend not googling bbw in a lecture hall. I got quite the education, but it sure wasn’t what I was looking for 🙂

    • Frequent Guest
      February 27, 2013 at 8:20 pm #

      Of course I had to go and google BBW. LOL Honestly, not as bad as I was afraid it would be! 😉

      • auntbea
        February 27, 2013 at 8:21 pm #

        Yeah. I was disappointed.

        • Frequent Guest
          February 27, 2013 at 8:37 pm #

          Then click on the image search. And turn safe search “off”. 😉

          • auntbea
            February 27, 2013 at 9:04 pm #


      • Natalie
        February 27, 2013 at 11:13 pm #

        haha. it’s was only bad because the images popped up and I was in the middle of lecture with my dean sitting 2 rows behind me. Oops.

    • Charlotte
      February 27, 2013 at 8:56 pm #


    • yentavegan
      February 28, 2013 at 10:12 am #

      great, now I can’t unsee what I just saw.

  4. RN Student
    February 27, 2013 at 7:24 pm #

    Slightly OT: I discovered this blog several months ago, and have been a regular reader ever since, though I don’t comment often. For several years I assisted a DEM with homebirths, but left after becoming increasingly dissatisfied with the level of care that was provided. Now I’m in nursing school, graduating in May, and am thrilled to have just landed a job in the OB unit at a Magnet status hospital! The unit has a high risk antepartum section, in-house 24 hour anesthesia and OBs, and a Level III NICU beside the OB unit. CNMs are also part of the team for the low risk women who prefer midwives. So excited to be joining a high quality team of health care providers!

    • theadequatemother
      February 27, 2013 at 7:51 pm #

      congratulations on the new job!

    • Frequent Guest
      February 27, 2013 at 7:55 pm #

      How wonderful, congrats!

    • Bombshellrisa
      February 27, 2013 at 8:46 pm #

      That is great!

    • Charlotte
      February 27, 2013 at 8:57 pm #

      Congrats on the new job!

    • yentavegan
      February 27, 2013 at 8:58 pm #

      This is good news!!

    • Sue
      February 28, 2013 at 12:07 am #

      Wonderful, RN student. Well-balanced professionals like to work in teams. renegades who think they know it all are the ones who get into trouble.

  5. February 27, 2013 at 4:04 pm #

    There should be some variation on this warning provided, I agree.

    But Dr. A., you admitted on Slate that you don’t actually know what the mortality stats are. You simply suspect them of being high, and not without reason. But that does not give you standing to deliver a Voice of God pronouncement about a tripling of risk.

    • TiffanyEpiphany
      February 27, 2013 at 4:23 pm #

      The tripling of risk comes specifically, I believe, from the Johnson and Daviss BMJ 2005 study. She discusses the bait and switch in her voiced-over ppt:


      (I copied the URL link at the time where she discusses it; it’s worth watching from the beginning,though…also available in the right margin up near the top: “Thinking about Homebirth? Watch This Video!”)

      What none of us know is the mortality stats from MANA: http://www.skepticalob.com/2009/11/homebirth-midwives-dont-want-you-to.html

      The MANA database contains the largest number of planned homebirths (27,000?), and would really help the homebirth cause if they would release their death rates, that is, if these rates reflect favorably upon homebirth.

      Since MANA has released other stats from their data but not the death rates, it raises suspicion about the true safety of homebirth.

      • February 27, 2013 at 5:00 pm #

        I could quote a real epidemiologist on why determining the precise risk of home birth in the United States is nearly impossible. Actually, I will: “It’s all but impossible, certainly in the United States,” says Eugene Declercq, an epidemiologist and professor of public health at Boston University, and coauthor of the CDC study that found the number of U.S. home births has risen slightly, to still less than 1 percent of all births. One of the challenges is that “the outcomes tend to be pretty good,” Declercq says. “So when Tuteur says no study anywhere has found this, it’s a crock. There are studies that have found good results.”

        • February 27, 2013 at 5:02 pm #

          Dr. Amy responded in the comments, seeming to admit much more uncertainty than she does in posts like this “black box warning”:

          So let me offer a public challenge to Gene Declercq:

          Now that you know a database of tens of thousands of births already exists, it will be possible for you to “nail down” the death rate at US homebirths. When can we expect you to call MANA and find out the death rate and share it with the rest of us?

          • KarenJJ
            February 27, 2013 at 6:07 pm #

            Nobody is uncertain that MANA is not releasing the statistics.

          • February 27, 2013 at 6:34 pm #

            Uncertainty regarding her previous confidence and precision regarding the magnitude of the increased risk.

          • Karen in SC
            February 27, 2013 at 7:53 pm #

            Alan, I would challenge you to go back and read, in chronological order, all of Dr. Amy’s posts of 2012 and this year. Or further back. Be advised, that she switched commenting systems around Oct 2012 (or possibly earlier) so posts before that time have comments that are all jumbled up.

            Then let us know what you think about the Black Box warning.

            Also, I have never read about any babies in the US or developed countries dying from being formula fed. I have read of tragic instances where exclusively fed BF babies did die from failure to thrive (aka starved to death) when the mothers mistakenly thought nursing was enough.

          • February 27, 2013 at 8:10 pm #

            All you are saying is that “formula feeding” is not listed on any death certificate. Neither is “transfat consumption” but it still has a substantial death toll.

          • Sullivan ThePoop
            February 27, 2013 at 9:38 pm #

            Yes, but formula feeding does not.

          • February 27, 2013 at 10:05 pm #

            Again, AAP, WHO, HHS, NIH say otherwise and I trust their word over yours, sorry.

          • The Bofa on the Sofa
            February 27, 2013 at 10:11 pm #

            Again, AAP, WHO, HHS, NIH say otherwise and I trust their word over yours, sorry.

            No you don’t. You don’t actually trust the word of the AAP. You have demonstrated that you decide what you want more or less baselessly independent of their recommendations, and only “trust” them if they agree with your preconceived notions.

            Make no mistake, it’s classic loon behavior, and we have no problems recognizing it.

          • February 27, 2013 at 10:34 pm #

            Funny, I could have sworn I sneered at pacifiers with my oldest two, then reversed course and bought them for my younger two solely due to the AAP recommendation.

          • Karen in SC
            February 28, 2013 at 8:57 am #

            I never even considered the AAP recommendation for pacifer use. Wow, I didn’t even know they had a position. Now, I might have taken the opinion of orthodontists, but the same issues may occur for thumbsucking. I was a thumbsucker and didn’t need braces.

            Since I didn’t care to use my nipples in each and every comfort situation ( and it’s impossible when driving), I thought pacifers were great. My second child never took to them, but happily was not a very fussy child.

            We are a very pragmatic group. Whatever works, do it. You are not going to ruin your child with formula, pampers, pacifics, playpens, strollers, etc.

          • The Bofa on the Sofa
            February 28, 2013 at 9:37 am #

            We are a very pragmatic group. Whatever works, do it. You are not going to ruin your child with formula, pampers, pacifics, playpens, strollers, etc.

            And so is the AAP, of course.

            Despite all the recommendations and whatnot, ask an actual FAAP about these things some time They’ll tell you, do what works for the most part.

            The key is folks who are Fellows of the AAP understanding what I mentioned above, about how all things are never equal. They absolutely understand that despite the recommendations, circumstances can change the balance of the equation.

            Funny the discussion of white bread. The current link to the dietician’s blog on the right is to a write-up about “9 things dieticians say never eat” or some such spam that is going around. It includes don’t eat white bread. Read what she says (an actual dietician): it’s all nonsense. Yes, dieticians know darn well what is “best” and the recommendations, but they also know how important some things are. It’s NEVER about “Never do it,” it’s about proportion.

            People like Alan point to something the AAP says that they like and then get all militant about following it, but if you actually ask the members of the AAP, they would never suggest that in the least.

            Ask a pediatrician about formula vs breastfeeding. You know what they say? Ho hum. Breastfeeding is best, but if you don’t do that for some reason, then formula is fine.

          • February 28, 2013 at 12:22 pm #

            It is due to an apparent protective effect against SIDS, although the mechanism of the protective effect (if it is real) is unknown.

          • thepragmatist
            February 28, 2013 at 2:49 am #

            You are confused, Alan. The WHO is talking about women and children in developing countries without access to clean water, where yes, the introduction of formula, especially during war, famine, or natural disaster, could be certain death.

            Last year, as far as I know, 11 infants in the USA died from poisoning due to tainted or incorrectly prepared formula. So we do actually know the answer.

            My infant developed FTT. He would’ve died WITHOUT formula, or at the least suffered from malnourishment. I am so grateful for formula. There is nothing wrong with formula, and he got plenty of breast milk, too. But there are many in my community who deride me because they think I should’ve got a milk donor instead and fed him someone else’s breastmilk because that’s the WHO recommendations DURING A NATURAL DISASTER IN A DEVELOPING COUNTRY. I can promise no baby ever got HIV or other communicable diseases from formula, but they could from shared milk with strangers, peer-to-peer.

            Dr. Amy’s position on breastfeeding is pragmatic.

            If the USA wanted to increase breastfeeding rates, instead of berating FF mums, they could try instituting maternal leave policies. Even then, breast feeding isn’t best for everyone: if it negatively impacts anyone in the mother/infant dyad then it’s not worth it, considering we have an alternative that is safe (despite those 11 deaths– which could’ve been avoided through better education. Do not feed powdered formula to a newborn, use ready-made formula, and you will avoid the risk of exposing the newborn to the bacteria associated with formula related deaths.)

            I’m all about a healthy dose of pragmatism. There is nothing pragmatic about militant lactivism.

          • February 28, 2013 at 3:51 pm #

            Where does AAP, WHO, HHS, and NIH state that formula is responsible for deaths?

          • February 28, 2013 at 4:14 pm #

            Look upthread.

          • DaisyGrrl
            February 27, 2013 at 9:01 pm #

            My mother breastfed me exclusively for four months. I was diagnosed with failure to thrive and was colicky for those four months. Finally my mom gave me a bottle. She said I took to it so quickly and looked so relieved to finally have enough to eat that I never went back to the breast.

            While I had other issues later in infancy/childhood that the breastfeeding or lack thereof may have played into, I wish my mother had had the confidence to supplement with formula from the start. I personally suspect I would have been much healthier had it not turned into an all or nothing proposition.

        • Captain Obvious
          February 27, 2013 at 5:22 pm #

          Slate article is July 2012. Dr Amy has written about the Colorado stats and others studies since then.

        • auntbea
          February 27, 2013 at 6:55 pm #

          Declerq teaches in a school of public health, but he is not a member of the epidemiology faculty, nor is he an epidemiologist by training. Now granted, he may have taught himself what he needs to know, but so can Dr. Amy. Why are his epidemiological insights any more “real” than hers?

          But let’s say for argument’s sake he is a real epidemiologist. While that means he is likely to know more than the average non-epidemiologist, it is not a guarantee. There are crap scholars in every discipline. The only to way to really know whether he knows what he is talking about is to read his work. And his work is very VERY obviously flawed.

          • February 27, 2013 at 7:10 pm #

            Can anyone seriously dispute that Dr. A. has an axe to grind?

            And no one ever seems to notice that I am not whatsoever disputing the almost metaphysical certainty that homebirth is riskier than hospital birth. I am pointing out that Dr. Amy claims to have a precisely quantified measure of how much greater the risk is, but then must retreat from those claims when confronted.

            Meanwhile she takes a far more quixotic and far less nuanced position on breastfeeding than I do on homebirth, insisting that no one has ever died from not being breast-fed. Never mind the AAP, NIH, WHO, HHS: they are all wrong and she is right, trust her.

          • auntbea
            February 27, 2013 at 7:16 pm #

            So what if she has an axe to grind? Don’t you?

            Your argument seems to consist entirely of citing authorities who disagree. How do you know they are right? How do you know Dr. Amy is wrong?

          • February 27, 2013 at 7:44 pm #

            I don’t insist that a multitude of esteemed professional and public health organisations at the top of their fields, like the AAP, WHO, NIH, and HHS are wrong, and I am right. I don’t even deny that hospital births are less risky than homebirths.

            And even my apparently most controversial position of all, against white bread and other refined carbohydrates, has a prestigious pedigree:


          • auntbea
            February 27, 2013 at 7:53 pm #

            You still have not answered my question. How do you know they are right?

          • February 27, 2013 at 8:07 pm #

            I don’t know. For all I know, I am the only living person in the world (per Descartes, I do know that I exist in some form, at the very least), being kept in some sort of “Matrix” virtual reality tank–but I rather doubt it, and choose to believe that you, and the rest of the world, exist too. Living a non-solipsistic life requires that not everything can be proven beyond doubt; some things have to be taken on faith, made axiomatic if you will.

            I choose to believe that the most preeminent experts in a field–and particularly agglomerations of expert opinion–are authoritative until convincingly proven otherwise. If you wish, you can choose to believe the word of one retired physician over all those expert sources. But then does that make you much better than the crunchy people who refuse to listen to any empirical evidence and instead place their faith in risible “woo”?

          • auntbea
            February 27, 2013 at 8:14 pm #

            I don’t believe the word of one retired physician. I — and I would bet a number of other readers — came Dr. Amy’s site long AFTER coming to the realization that the breastfeeding party line was logically, methodologically and statistically in error. And I came to that conclusion by reading the studies myself.

            And the fact is that while Dr. Amy may be one of the more outspoken and easy to find advocates of that position, she is hardly the only one. Again, just because you have not read these studies does not mean they do not exist.

          • Esther
            February 28, 2013 at 8:22 am #

            Yep. I might add that another reason I know AAP policy statements can be less than objective is because before the previous one came out (in 2004 or 2005), I’d gotten wind the committee was going to use Kathy Dettwyler’s crappy “natural age of weaning is 2.5-7” paper as a reference. When I emailed a member of the committee to inquire if this were true and if so, why were they including such an unsicentific reference in a respectable policy statement, the answer I got was – the AAP has an interest that women nurse for longer. If women are led to believe that the natural age of weaning is at several years old, they might not think that 9 months is an awfully old age to wean at. i.e., it was included for political reasons (and thankfully, removed in the most recent statement).

          • Esther
            February 28, 2013 at 8:23 am #

            Sorry, just checked the email. It was written in late 2002.

          • Anonomom
            February 28, 2013 at 9:03 am #

            What’s wrong with Kathy Dettwyler’s paper?

          • Esther
            February 28, 2013 at 9:53 am #

            Just about everything. The paper takes all kinds of developmental benchmarks in the animal kingdom (eruption of teeth etc.) as markers corresponding to when various animals wean and attempts to determine a range in which humans would ‘naturally’ wean if we were guided only by biological instincts (as if biological instincts should trump everything else – which is complete nonsense). However, several times in her calculations she comes up with ranges of figures, some of which estimate cessation of BF at less than a year – which she, conveniently, throws out. Her figures also don’t correspond to the actual age of weaning seen in primitive cultures and historical evidence (the actual range is more like 1-5.5 or 6 years in these cultures, with a mean of less than 2.5 years. Historically some babies may have been weaned or mostly weaned at less than a year).

            The picture starts to get clearer when you consider Dettwyler is the type of person to tell women on Facebook and other fora that if they don’t plan to breastfeed, they shouldn’t bother having children…

          • disqus_61tNDsHTqn
            February 28, 2013 at 1:39 am #

            Damn, and i thought _my_ comments were self indulgent. S

          • February 28, 2013 at 2:15 am #

            Please elabourate.

          • Captain Obvious
            February 28, 2013 at 10:11 am #

            So you thought there was WMD in the Middle East too? They had the “most preeminent experts in a field–and particularly agglomerations of expert opinion–are authoritative until convincingly proven otherwise. If you wish, you can choose to believe the word of “whoever” over all those expert sources”

          • February 28, 2013 at 12:33 pm #

            Hard to fully parse your comment given the grammar and failure to close quotes.

            WMD in the Middle East? Highly likely in Syria, almost certainly in Israel. Presumably you meant Iraq circa 2003. No I did not believe that to be the case, and as I recall there was considerable disagreement on that score. UN inspectors had not found any, and it was blatantly obvious that Bush/Cheney were hellbent for leather, damn the torpedoes, regardless of the facts.

          • Anonomom
            February 27, 2013 at 9:01 pm #

            Ok, but none of that implies that not a single slice of white bread ever crosses a person’s lips. It doesnt make any sense to be pro homebirth and anti- minor white flour consumption. One less than ideal meal has never killed a person. Homebirth has.

          • Certified Hamster Midwife
            February 27, 2013 at 9:31 pm #

            “One less than ideal meal has never killed a person.”

            People die of choking all the time!

          • February 27, 2013 at 10:00 pm #

            One meal was not the issue. But are you familiar with the philosophical conundrum about how many grains of rice are in a heap?

          • anonymous
            February 28, 2013 at 7:12 am #

            Like the concept of the straw man, this is an idea that sounds very sophisticated and novel to people who aren’t very educated. And by educated, I don’t mean Google U.

          • Sullivan ThePoop
            February 27, 2013 at 9:36 pm #

            I just spit wine out on my husband’s keyboard, thanks a lot. There is not one single thing controversial about being against white bread and other refined carbohydrates. It is actually quite the trendy thing to be.

          • February 27, 2013 at 10:04 pm #

            You must have missed the firestorm that arose from my mention of it.

          • Susan
            February 28, 2013 at 12:25 am #

            No one thinks white bread is healthier. We thought it was rude to bring your own food so your nuclear family could survive a trip to the in laws. Actually, I don’t think Amy ever said formula feeding was as healthy as breastfeeding either. I think she is saying that formula isn’t as unhealthy as breastfeeding advocates often make it out to be.

          • The Bofa on the Sofa
            February 28, 2013 at 12:31 am #

            ALL ELSE EQUAL

            white bread is not preferable to alternatives


            breastfeeding is better than formula


            all else is never equal

          • February 28, 2013 at 2:10 am #

            Not the in-laws, my own family. Not that it really matters but just FTR. The in-laws were the antagonists in the breastfeeding story.

          • KarenJJ
            February 28, 2013 at 6:45 am #

            Alan should go and spend some time in France and Italy and truly enjoy some refined carbohydrates. yummm…. Along with a big glass of red and a few shots of espresso afterwards.

          • anonymous
            February 27, 2013 at 8:04 pm #

            Read. The. Blog.


          • February 27, 2013 at 8:13 pm #

            You have a nice day too.

        • Frequent Guest
          February 27, 2013 at 8:08 pm #

          Wow, what a horribly written article. My sisters in high school write better essays than that.

    • Dr Kitty
      February 27, 2013 at 4:24 pm #

      Alan, the tripling of risk doesn’t come from the the MANA stats, it comes from other (reliable) sources including, IIRC, CDC.

      Most of us think the MANA stats are going to be much, MUCH worse than a trebling of risk.

    • Amy Tuteur, MD
      February 27, 2013 at 6:15 pm #

      Just curious, Alan: why should we listen to anything you have to say? Do you have any specialized knowledge in science, statistics or medicine? Have you read the relevant scientific literature in its entirety (or at all)? If you don’t have specialized knowledge and if you haven’t read the relevant literature why do you think your opinion is worth anything?

      • February 27, 2013 at 6:38 pm #

        Is this your standard for all commenters here? Or just those who don’t uncritically swallow and regurgitate whatever you feed them? I was not aware that I had stumbled into a closed session of a professional conference (again, though, I also don’t recall your answering whether you have published anything in a peer-reviewed journal in this millennium).

        • Amy Tuteur, MD
          February 27, 2013 at 7:12 pm #

          In other words, you can’t think of any reason why we should listen to anything you have to say.

          • February 27, 2013 at 7:35 pm #

            No, I don’t agree that this is a reasonable paraphrase of my comment. I saw what you did there, though, ducking my question. Is this comment section intended only for the use of board-certified clinicians and published academicians? If so, you’ve got a lot of clearing out to do, it would appear to me.

            Odd btw how often you comment on my comments, given that you claim to consider them so insubstantial as to be beneath your contempt. Apparently you feel threatened by my commentary despite the fact that you “doth protest too much” to the contrary. 😉

          • Karen in SC
            February 27, 2013 at 7:47 pm #

            I don’t think she’s threatened, Alan. There are several posts on this blog analyzing data from states that collect statistics on homebirths and from the CDC. Dr. Amy has also critically reviewed published studies. She links the original material so those that wish to verify data may do so. That the risk is triple has been written about and back up by data.

            The fact that MANA has data from thousands of births and not reported death rates is chillingly true. Even though the information would be self-reported and as such be subject to bias, we don’t know the numbers. What do you infer from that?

          • February 27, 2013 at 7:58 pm #

            I infer that they are likely hiding something, most likely a discomfitingly high death rate, and have never said otherwise.

            Unlike Dr. Amy, or the Southern Baptists, or the GOP, I don’t reflexively insist everything my rhetorical antagonists say must be wrong.

          • anonymous
            February 27, 2013 at 8:03 pm #

            Alan, the data and methods by which Dr. Amy arrived at her estimates can be seen throughout this blog, It’s easily searchable and some of the entries are “stickied” to the right of the comments. Intelligent people take the time to read the work of the people they debate with. Her reasoning is spelled out extensively here, if you will take the time to seek it out and read it.

          • February 27, 2013 at 8:12 pm #

            Sorry, didn’t Dr. Amy tell you? I am not an intelligent person.

          • Certified Hamster Midwife
            February 27, 2013 at 9:30 pm #

            “Intelligent” and “wrong” are not mutually exclusive.

          • February 27, 2013 at 10:02 pm #

            Good point: Dr. Amy does seem intelligent, and I respect the imprimatur of a Harvard degree.

          • anonymous
            February 28, 2013 at 7:10 am #

            You are so unintelligent that you assume I wasn’t implying that myself, without Dr. Amy’s input.

          • February 28, 2013 at 12:18 pm #

            Not familiar with the concept of sarcasm, I see.

          • Durango
            February 27, 2013 at 8:18 pm #

            Lol, Alan, you are not the broad-minded dude you fancy yourself.

          • February 27, 2013 at 8:28 pm #

            Oh yes I am. 😛

          • Durango
            February 27, 2013 at 9:49 pm #


        • February 28, 2013 at 3:58 pm #

          I think the question is why you feel you know more than the people who have read the studies you refer to and are familiar with the positions of the AAP, WHO, and NIH that you are misrepresenting in your posts. I’m not sure why it would be relevant whether ANY of us have published; the question is the familiarity with the body of knowledge in question which you seem to a) lack and b) refuse to recognize in anyone else.

  6. TiffanyEpiphany
    February 27, 2013 at 3:18 pm #

    The homebirth topic is what brought me to this site/blog in the first place. I was well on my way to planning a homebirth for my second child, due in late July, since my first birth was so “traumatic” in a hospital.

    If 2 out of 3 babies who die at homebirth could be saved in a hospital, then it’s truly an irresponsible decision to have a homebirth. That should take the hot air out of any know-it-all homebirther’s head. It did for me.

    True, undesirable effects happen in hospital births. But what’s important here is not to run away from hospitals but to develop self-advocacy skills while adjusting one’s focus on the life and health of the baby, not keeping the focus solely on the birth experience itself. Plus, if a baby dies in the hospital, a mother can rest assured (if that’s even right to say) knowing that it truly wasn’t her fault.

    Unfortunately, most (2/3) babies who die at homebirth didn’t have to die, and sadly the blame falls ultimately on the mother who chose to have a homebirth, not to mention all the CPNs, DEMs and traditional midwives among others furthering the homebirth movement. This is why awareness and true education is so important…because lots of homebirthers think that they’re doing the right thing for them and their babies when in reality they are setting themselves up for unnecessary tragedy (which is inevitable tragedy all the same, regardless of how probable).

    • February 27, 2013 at 4:50 pm #

      “If 2 out of 3 babies who die at homebirth could be saved in a hospital, then it’s truly an irresponsible decision to have a homebirth.”

      Dr. A has not provided proof of that assertion, but let’s accept it as accurate for the sake of argument (I don’t dispute that the risk is higher at home by some proportion). Let’s also assume for the sake of argument that the AAP cited figure is correct, and formula feeding, compared to six months exclusive breast-feeding, increases infant mortality by 30%. Does that make formula feeding an irresponsible decision? Or does your threshold for “irresponsible” lie somewhere between 30% and 200%?

      And is relative risk really all that matters? Or should we consider how small the baseline risk is to begin with? I mean, personally I would be more afraid of a 10% increase in cancer risk then I would be in a 500% increase in risk of Ebola. Point being, the mortality risk from formula feeding is still very small; as is the mortality risk from homebirth, even if both are significantly (using that word in the technical, scientific sense) higher by some proportion than the alternatives.

      All that said, I don’t deny that a significant number of people in the NCB community (but certainly not all) have a pie-in-the-sky attitude and a very ascientific one. There needs to be more information provided, from a balanced perspective. The demonising that goes on on both sides is not however helpful.

      • Amy Tuteur, MD
        February 27, 2013 at 5:15 pm #

        “formula feeding, compared to six months exclusive breast-feeding, increases infant mortality by 30%.”

        There’s no evidence to support that claim.

        Indeed, no one can point to even a single death attributable to formula feeding, let alone an increased rate of 30%.

        • February 27, 2013 at 5:40 pm #

          Again, the reader can decide whether to believe you or the AAP:

          “It has been calculated that more than 900 infant lives per year may be saved in the United States if 90% of mothers exclusively breastfed for 6 months”

          But either way, you miss my point as I was offering a conditional, hypothetical proposition: “assume for the sake of argument” that both claims (your “black box” risk warning, and the AAP’s warning in its policy statement) are accurate, what then?

          • Amy Tuteur, MD
            February 27, 2013 at 6:01 pm #

            I reviewed Dr. Bartick’s study, The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis, when it was published in 2010. My assessment?

            “…Using highly fanciful methods, Bartick and Reinhold “estimate” that the US could save 900 infant lives and $13 billion if 90% of US women breastfed. These numbers are grossly misleading since not even a single US infant death (let alone 900 per year) has ever been attributed to not breastfeeding and since the purported savings are primarily the “lost wages” of the 900 dead infants…”

            Bartick and Reinhold’s argument is only theoretical anyway because, as the ARHQ report on breastfeeding found, “one should not infer causality” between breastfeeding and improved health outcomes. Indeed Bartick and Reinhold’s paper is just another weak paper based on research plagued by confounders.

          • February 27, 2013 at 6:31 pm #

            You imply the case rests entirely on one study. But there are a plethora of citations in the statement about increased risk of various health conditions associated with not breast-feeding. Some of which (pneumonia, asthma, leukemia) certainly carry an inherent mortality risk; then there is SIDS, which of course is 100% fatal.

          • Captain Obvious
            February 27, 2013 at 6:49 pm #

            You have evidence that formula feeding leads to SIDS, leukemia, pneumonia, and asthma?

          • auntbea
            February 27, 2013 at 7:01 pm #

            And causally related to boot! It is a secret treasure trove of some of most groundbreaking studies in public health!

          • fiftyfifty1
            February 27, 2013 at 8:08 pm #

            What do you make of the Belarus study? Are you more willing to trust it based on its design?

          • auntbea
            February 27, 2013 at 8:17 pm #

            Also…you sure about that SIDS risk? http://www.bmj.com/content/310/6972/88

          • February 27, 2013 at 8:27 pm #

            Anyone can cherry pick studies. In fact, this is what some of the crunchy “woo” crowd does to keep themselves from admitting risks that are in fact there based on the preponderance of evidence. Hence my preference to privilege policy statements and literature reviews by the most authoritative and esteemed organisations.

          • auntbea
            February 27, 2013 at 8:49 pm #

            Yes, AAP and WHO make their decisions based on the consensus, which is based on the preponderance of evidence. However, fact — which may or may not be related to the consensus — is based on the preponderance of GOOD evidence. A study that is not well-designed is worth nothing. A study that is well-designed is not balanced against the findings of previous poor studies — it negates them.

          • Sullivan ThePoop
            February 27, 2013 at 10:08 pm #

            In the case of SIDS it is not about cherry picking studies, it is about common sense.

          • Spamamander
            February 27, 2013 at 6:06 pm #

            I just read the entire linked policy statement, and did not see anything that indicated a specific number of infants would be “saved” by exclusive breastfeeding. I’m quite willing to admit between just come off of a 5am-2pm shift and fighting a migraine that I might have missed something, but that certainly didn’t pop out at me anywhere.

          • cellist
            February 27, 2013 at 6:33 pm #

            Get some rest if you can – migraines are hideous 🙂

          • TheHappyPappy
            February 27, 2013 at 9:54 pm #

            Nevermind, you did provide a link. You still aren’t arguing very convincingly, though. Keep trying!

          • The Computer Ate My Nym
            February 28, 2013 at 11:51 am #

            There’s a bit of a fallacy in this comparison. Anyone can go to the hospital to give birth-and if they can’t, there’s a major social problem. Not everyone can breast feed successfully. Yeah, breast feeding may have some benefits (though note that the relative risk for most conditions is not hugely reduced and some confidence intervals include one), but a baby who is malnourished due to exclusive breast feeding with poor milk production is at a significant risk of a number of problems, including dying in the immediate future.

          • February 28, 2013 at 12:38 pm #

            Hey, a logical, well argued response–cool.

            So what about people who never try to breastfeed? There are still far more of those than there are homebirthers.

        • Sullivan ThePoop
          February 27, 2013 at 10:03 pm #

          He might have gotten that statistic from here or from someone who got it from here http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812877/ since 1.3 fold is around 30%. Although the only increase in deaths were from SIDS or injuries not from infections at all.

      • Sue
        February 27, 2013 at 5:16 pm #

        Alan – a bit of misunderstanding with the statistics there. And the “proof” (detailed analysis of the studies) has been discussed many times here – I’m sure you can find it if you look.

        Let’s start with the large UK Birthplace study. It showed 3X excess mortality in HB for the babies of first-timers, DESPITE tight risking-out, 40% transfer rate and hospital-affiliated MWs (ie with tight controls for confounders).

        Any mortality from formula feeding is related to a small excess in infections – which is under the influence of many confounders. FOr example, influences like household smoking, exposure to childcare and older sibs in the house have a GREATER influence on infection rates than the method of feeding (although BF does have a small and temporary protective effect).

        SO, on the one hand we have a one-off occasion (birth), in which the home situation (ie lack of resusc teams, skill and equipment) directly causes the death of the newborn (and sometimes the other)>

        WIth BF, we have one risk factor amongst many for infections. It is the infections that cause injury – not the milk. The infections are caught from other people – they are the cause of death.

        See the difference?

        (Would you say that having other siblings in the house kills babies?)

        • February 27, 2013 at 5:47 pm #

          Your reasoning is contradictory, inconsistent, and facile. Recently Dr. Amy posted about a baby who died after a water birth. Why not argue the same thing: it was the virus that caused that baby’s death, not the homebirth or water birth?

          One can even make the same arguments about cigarette smoking: there is always some other specific cause attributed to the death, such as emphysema or lung cancer. That hardly lets tobacco off the hook, from any reasonable person’s point of view (leaving out tobacco executives here).

          • TheHappyPappy
            February 27, 2013 at 9:52 pm #

            I don’t see any contradictions or inconsistency in her statements and they’re certainly not facile. Actually, she’s acknowledging that the causes of infant death from infection are varied and impacted by multiple factors, while you are being facile in reducing it down to one thing; formula feeding.
            Also, you haven’t provided any links to back up your statement that the AAP says formula feeding carries a %30 increased risk of death. I searched for it and I couldn’t find that statement anywhere, so I would really appreciate it if you could provide that link.
            You know I kind of liked you to begin with, Alan, but you’re not acquitting yourself well here. You obviously have an agenda of “educating” us with shoddy evidence and conflicting arguments. I used to be pro-homebirth and very supportive of CAM, but then I got new information and my opinions changed. If you can make convincing arguments and provide sufficient supporting evidence, I will change them again. So far, you are failing at that.

          • February 27, 2013 at 10:17 pm #

            I have no interest in convincing you or anyone else to have a homebirth, nor do I deny that it is almost certainly more risky than delivering in the hospital. I support good faith, balanced efforts to provide more information about those risks to prospective homebirthing parents, And support good faith efforts to bring greater and more consistent professionalism to the field of midwifery. I only argue that not all midwives should be judged by the shoddy performance and qualifications of the worst among them, and that while homebirth using a qualified midwife is riskier than hospital birth, it is a risk parents are entitled to take, not on the level of magnitude to be equated with child abuse or neglect.

            My intention when discussing breast-feeding is to reason by analogy, not to insist that everyone must breast-feed.

          • KarenJJ
            February 28, 2013 at 6:34 am #

            “I only argue that not all midwives should be judged by the shoddy performance and qualifications of the worst among them,”

            Judging by your comments over the past few days, you’re not just arguing that.

            That said, nobody’s against midwives. My mum did her midwifery training back in the 70s. I’m against anyone representing themselves as a midwife that doesn’t have the recognised qualification and a current registration. Similar to doctors, if someone’s practise of midwifery no longer meets professional standards then they should lose or hand in their registration.

          • KarenJJ
            February 27, 2013 at 11:44 pm #

            “Your reasoning is contradictory, inconsistent, and facile. ”

            In what way? Are we discussing the 3x mortality rate or are you now switching to breastfeeding? The UK birthplace study was very interesting I thought.

          • February 27, 2013 at 11:47 pm #

            I illustrated in the remainder of the comment you are quoting from.

          • Sue
            February 28, 2013 at 12:30 am #

            No, Alan, you didn’t illustrate at all.

            Please show me which comments I made that were “contradictory”,” inconsistent” or ” facile”.

            I’ve already corrected your misunderstanding of causation above.

          • Sue
            February 28, 2013 at 12:26 am #

            No, Alan, you don’t get it.

            Formula feeding doesn’t cause infections. Cigarette smoking does cause emphysema and lung cancer.

          • February 28, 2013 at 2:07 am #

            You are being disingenuous or obtuse. I will play your silly nitpicking game this time:

            The prestigious alphabet soup organisations I keep referring to take the official position that the evidence strongly points to a link (in developed countries including the U.S., and after carefully controlling for potential confounding cofactors like education level, income, etc.) between failure to breastfeed (which of course necessarily means formula feeding) and a greater incidence and severity of a number of infectious diseases.

            Obviously this does not mean the infant formula created the infectious agents through Aristotelian abiogenesis. It simply means that, unsurprisingly, the immune cells in breastmilk do have an actual function–fighting off infections. Why would you expect otherwise?

          • Sue
            February 28, 2013 at 11:20 pm #

            Alan, you’re arguing from a position of blissful ignorance.

            Unlike you, I’ve read the actual papers on health outcomes in developed countries – including the detailed methodology and findings. I don’t just accept what organisations say – I work in health care and I am involved in policy-making, and trained in critical review of research – whether it be in breast-feeding, trauma management or stroke management. IN association with six months of exclusive breast feeding, there is a SMALL decrease in the number of respiratory infections in the first year of life.

            The purported associations with long-terms outcomes like asthma or any cognitive effects are far from solid, and much more strongly influenced by other confounders like heredity.

            I am being neither disingenuous nor obtuse – I just know what the results are.

            If you want to disagree, get some good studies that look at outcomes, talk us through them. You don;t have to be paid to do that – the rest of us do it because we want to out of intellectual honesty. And don;t be embarrassed if you don’t have the skills – it takes a lot of training and practice to keep up critical review skills of medical literature. I’m off to a two-day course next week – and do this at least twice annually. You?

          • February 28, 2013 at 11:34 pm #

            “I don’t just accept what organisations say”

            But you want me, and anyone else reading, to accept what *you* say, solely based on your assurance that you have it figured out better than the world’s preeminent health organisations do. Do you not get how preposterous that sounds?

            ETA: The same goes for Dr. Amy–this is exactly what I find so ironic and hypocritical about her stance.

          • Sue
            March 1, 2013 at 1:37 am #

            No again, Alan – I don’t “say” anything – I;m just letting you know what the data shows.

            Take a hint: look up the actual studies, what they tested, how they tested, and what they showed. You will find that six months of exclusive breast feeding, in a wealthy society, has convincingly been shown to reduce the (already low) incidence of respiratory and gastro infections amongst infants in the first year. Most of the infants got NO infections – whatever they were fed. And “respiratory infections” includes upper respiratory tract infections – aka “colds”. And confounders, like whether there were smokers or older sibs in the house, or exposure to child care, made more difference than the type of feeding.

            I didn’t DO this research, but I have read it in detail.

            As far as recommendations of organisations go, do you have a view on the role of thrombolysis in stroke, or the place of interventional cardiology? Those topics also have position statements that may not reflect the research findings either.

            Again, I didn’t do the original research, but I have to evaluate its significance well enough to decide whether to recommend it to patients.

          • Box of Salt
            February 28, 2013 at 11:17 am #

            since you’ve posted a link to this interesting press release, I’m going to challenge you to a short (maybe 2 or 3 sentences) summary of what you think it says.

            I’m sure the full paper is available now, given that the press release is from 2008, but I’m not even asking you to dig up the full paper from Journal of Immunology. Just summarize the press release.

            I’d also like to challenge you to find out exactly how long a mother can expect the passive immunity through breastmilk to continue to work for the baby, considering that breastmilk is ingested and digested and what you know about the structure of antibodies.

            And, as a final, extra special challenge, why don’t you dig up the full paper (search the journal and figure out which paper it is; pubmed may or may not help you with this), and tell me what the authors actually did (I admit it’s not in my field, and it will probably take me some time to figure it for myself).

          • February 28, 2013 at 12:36 pm #

            If you pay me, I’ll give you a dynamite writeup. I don’t do spec assignments for free.

          • Box of Salt
            March 4, 2013 at 3:05 am #

            4 days late – does that make me 4 dollars short? – I finally found your reply.

            Big surprise, you didn’t even bother to look up YOUR OWN reference.

            I looked it up on my own time; why is your time worth more than mine?

            I learned something reading it. Will you?

      • Captain Obvious
        February 27, 2013 at 5:17 pm #

        After all your expert dissertation about how the absolute risk is so small that the little increase in relative risk is probably not worth the anxiety, you still brought your own food for a one week visit to your family because of your fear of how eating poorly would affect your overall health. ;-(

        And Dr Amy has provided much information about how she came up with the 2 out of 3 babies statement. Homebirth in America is as Homebirth in America does. The Hurt by Homebirth site gets criticism about how those losses are due to poor decisions by Homebirth midwives but not to Homebirth? How can you separate the two if that’s how Homebirth is practiced? Taking on high risk moms with previous cesareans, breech, twins, post dates, AMA, and FTM are all cases of preventative deaths. Records from the State’s registry (Colorado etc), the CDC, and published studies have all demonstrated a higher mortality rate for Homebirth. Dr Amy has many threads discussing these stats, have you not seen them?

        • anonymous
          February 27, 2013 at 8:06 pm #

          I love you, Captain.

          • auntbea
            February 27, 2013 at 8:16 pm #

            Don’t tell Captain’s wife! Unless you are Captain’s wife, of course.

          • anonymous
            February 28, 2013 at 7:16 am #

            I am married, too. I just meant it in a blog way. 🙂

          • Siri
            February 28, 2013 at 2:23 pm #

            Mind you, I love Aunt Bea too. And Lizzie Dee. In fact, most of you regular contributors. (Soppy moment). Xx

          • Siri
            February 28, 2013 at 2:21 pm #

            I always thought Obvious was a woman! I mean, women can be captains, right? Anyhow, I love her/him too, very much indeed. His/her presence improves any discussion. X

      • auntbea
        February 27, 2013 at 6:59 pm #

        The fact that you have not read the articles where Dr. Amy supports these assertions does not mean that they do not exist.

        • Kalacirya
          February 28, 2013 at 12:08 am #

          Something about this fellow really reeks of mansplainin’ to me.

          • Durango
            February 28, 2013 at 12:32 am #

            Nah, he’s just another arrogant ignorant fool.

          • Kalacirya
            February 28, 2013 at 12:36 am #

            I feel like we get a rinse-repeat of this type of person every month or so, I’m having deja vu. Someone comes in (it’s always a man), is strangely critical of everything, only tangentially interested in the subject matter of the blog, but still seems to agree with most of the salient points brought up here. Then that person goes on to comment endlessly in argument with others. I think he just gets off on argument.

          • Durango
            February 28, 2013 at 12:48 am #

            Ya think? 🙂
            Well, that and proving to himself how smart he is, how superior his powers of reasoning are to the people of every website he visits. He got kind of excited at the thought of being banned by both TFB and Dr Amy, which would have provided him even more proof that he is exactly in the right.

          • Kalacirya
            February 28, 2013 at 1:05 am #

            I wouldn’t think it so weird if it didn’t seem like it was the same exact man every time. LOL

          • February 28, 2013 at 2:27 am #

            Sounds like I need to meet these guys. Care to link me to some comments?

          • February 28, 2013 at 2:27 am #

            Well, but c’mon: that would be impressive.

          • Bombshellrisa
            February 28, 2013 at 1:06 am #

            Usually around the time of the full moon.

          • Guestl
            February 28, 2013 at 1:35 am #

            I’m with y’all, but I am cutting him some slack because he’s a Deadhead. Don’t hate.

          • February 28, 2013 at 2:26 am #

            Right on, peace. 🙂

          • anonymous
            February 28, 2013 at 7:15 am #

            I am cutting even less slack on those grounds.

          • Siri
            February 28, 2013 at 2:39 pm #

            And passive-aggressive too, rapidly turning good ol’ aggressive when provoked in the slightest…

      • Sullivan ThePoop
        February 27, 2013 at 10:00 pm #

        I cannot agree that formula feeding causes a 30% increase in infant mortality. Injury has nothing to do with feeding and is most likely some kind of confounder and it doesn’t make sense that putting infants to sleep on their back would reduce the incidence of SIDS by 95% when formula feeding apparently causes a 50% increased risk. Sorry, that doesn’t make any logical sense.

        • Sue
          February 28, 2013 at 12:33 am #

          Agreed, SUllivan. The “back to sleep” campaign has reduced the incidence of SIDS (SUDI) dramatically. Doesn’t seem to be much about what the baby drinks.

          • February 28, 2013 at 7:15 am #

            It’s my understanding “back to sleep” didn’t actually reduce SIDS. Instead, SIDS is no longer given as a cause of death as often. Investigators and medical examiners spot accidentally suffocations and rebreathing deaths now and these are not labeled as SIDS deaths.

          • Sullivan ThePoop
            February 28, 2013 at 9:14 am #

            Where did you acquire that understanding?

          • Siri
            February 28, 2013 at 2:37 pm #

            I’ve heard that too; that the same number of babies are lost, but the deaths are categorised differently. It has potentially big implications for the ‘back to sleep’ campaign, especially as most parents report babies sleep better and longer in the prone position, meaning b2s implies a parental sacrifice of sleep. Can’t remember offhand where I heard it, sorry!

          • Sue
            February 28, 2013 at 11:27 pm #

            SOrry, RT and Siri – not true. That is contradicted by a fall in the all-cause infant mortality rate (deaths are not being re-classified – there are just less of them). I’m looking at Australian Bureau of Statistics data that confirms this.

            If you think the SIDS (SUDI) deaths are being re-classified, what are they re-classified to, and what are the rates?

          • Sullivan ThePoop
            March 1, 2013 at 2:21 pm #

            Well, here is what I found. In the US we have used the same definition of SIDS since the 1970s. The problem is with coroners and what they believe to be the cause of death because the definition is not really tight enough, but that also has not changed since the 1970s. The incidence of SIDS was already declining before the back to sleep initiative. Putting infants in the supine position all the time seems to have some unintended negative effects like less slow-wave sleep which might interfere with normal development and in parents who do not give their infants sufficient tummy time (probably full-time baby wearers) to make up for the lack of prone sleeping there are significant motor delays.

            Another interesting thing I found was that bed sharing also decreases the amount of slow-wave sleep.

            Anyway here is an interesting free review article about it. http://pediatrics.aappublications.org/content/116/5/1245.full

  7. guest
    February 27, 2013 at 3:01 pm #

    I followed the link someone posted. I read this. Does a third of the baby’s blood get squeezed back into the placenta during birth, and that’s why delayed cord clamping is necessary??? http://yourbirthcoach.com/2011/10/25/lessons-from-my-birth/ There’s more, but just the confidence of that assertion stood out to me.

    • guest
      February 27, 2013 at 3:02 pm #

      Sorry, that was you, Jenna. Thank you for the link.

    • Poogles
      February 27, 2013 at 5:50 pm #

      Delayed cord clamping is not *necessary*, but is perhaps mildly beneficial to certain neonatal populations (preemies, I think?). The “1/3 of the blood volume” claim doesnt’ make much sense when you realize that, in the womb, there has to be enough blood to “fill” the baby, the cord and the placenta simultaneously, so not all of that blood is meant to end up in the baby anyways – it would be a larger volume of blood than needed.

  8. Mrs. W
    February 27, 2013 at 2:47 pm #

    A couple of typo’s but I think everyone planning a Homebirth should be made aware of those facts.

  9. Jenna Brown
    February 27, 2013 at 12:21 pm #

    Someone please educate the educator here before her advice kills somebody http://yourbirthcoach.com/2013/02/20/vaginal-birth-better-for-breech/?utm_source=iContact&utm_medium=email&utm_campaign=Your%20Birth%20Coach&utm_content=

    • Bombshellrisa
      February 27, 2013 at 12:37 pm #

      “Dr. Nancy is a prenatal and pediatric chiropractor, childbirth educator, and doula” Ok, now please tell me where she is hiding the MD that would make her qualified to be doling out medical advice. This is an example of a bad doula!

      • February 27, 2013 at 2:18 pm #

        I can’t hear “childbirth educator” without immediately suspecting the person of being woo.

        • Playing Possum
          February 28, 2013 at 2:21 am #

          If the female body is designed to give birth without intervention, why do they need an educator?

          • February 28, 2013 at 2:31 am #

            Some women take exactly that leap of logic and go for unassisted childbirth. I don’t think that is a good idea at all, and have aroused ire from some on the crunchier side of the aisle by saying so.

      • mollyb
        February 27, 2013 at 2:23 pm #

        My medical terminology instructor is a chiropractor and insists we all refer to her as “doctor”.

        • Durango
          February 27, 2013 at 2:44 pm #

          My quack Anatomy & Physiology instructor was also a chiro, though we called him by his first name. He was full of teh woo, and I complained to the college when he spouted antivax nonsense. He was also a moron.

          • Ceridwen
            February 27, 2013 at 4:50 pm #

            Didn’t happen to be in Daytona, FL did it? My husband’s older brother is a chiro who teaches A&P there. He’s not a woo-filled as my husband’s dad (also a chiro) but it’s still pretty bad and makes me cringe a bit every time I think about it.

          • February 27, 2013 at 5:55 pm #

            My A&P instructor was a Naturopathic “Physician”, and insisted that we call him “Dr”.

          • KarenJJ
            February 27, 2013 at 6:17 pm #

            For people that are so against the ‘medical establishment’ they sure are quick to borrow their terms to give them the legitimacy of the establishment.

          • Bombshellrisa
            February 27, 2013 at 9:09 pm #

            Yep, always wanting the rewards without being willing to go through the process….My parents go to a chiropractor who likes to impress people with the fact that he went to medical school. He says when he saw “how much they did surgery on people” he knew he didn’t want to be a medical doctor. I wonder about that story, after all, if he didn’t think doctors were approaching health care in a way that treated patients correctly, why does he think it’s good to tell people he trained to be one of those people?

          • Durango
            February 27, 2013 at 5:57 pm #

            Sadly, no. There are probably more quacky A&P teachers out there than our two…

          • Sue
            February 28, 2013 at 12:43 am #

            Probably ‘cos the competent clinicians are out there practising.

        • Natalie
          February 28, 2013 at 12:00 am #

          when they write their name as “Dr. Jones” instead of “Jones, MD” or “Jones, DO” it means they know they don’t possess letters they are proud of or that make them qualified.

      • auntbea
        February 27, 2013 at 6:23 pm #

        Somewhat on topic for this particular thread: I am moving universities, from one with an excellent medical school to one without. If we have a second baby there, we will be delivering the local regional hospital/medical complex. I noticed that two of the seven OB’s are DO’s, instead of MD’s. Is that something to be concerned about?

        • theadequatemother
          February 27, 2013 at 7:57 pm #

          We don’t have many DOs in Canada (no DO schools so we only get your expats) but I would imagine the DO OBs have still done an entire OB residency so it probably wouldn’t concern me. Are DOs very philosophically different from MDs? The few I’ve met haven’t been so.

          • Frequent Guest
            February 27, 2013 at 8:03 pm #

            My husband applied to both DO and MD programs, and I visited two DO schools with him. The DO schools we visited did venture a bit into the woo (using chiropractic-esque “adjustments” and “manipulation” to treat ailments, etc.) but other than that, they receive the same scientific and medical training as MDs. I would not be concerned, most DOs I know are not woo-y at all. Of course there are bound to be some, but you run that risk with all health professionals to some extent.

          • auntbea
            February 27, 2013 at 8:21 pm #

            Can I ask why he applied to both? Essentially I am trying to figure out why, other than the woo, someone would choose to be a DO rather than an MD.

          • Frequent Guest
            February 27, 2013 at 8:40 pm #

            Well, in his case, he was applying to the DO programs as safety schools. (He had a very high MCAT score, but an average GPA, and wanted to make sure he got in somewhere.) DO programs are generally less competitive than MD programs. That said, I truly think he would have gotten a great education at any of the schools we visited… I don’t want anyone to think I am disparaging DOs, because I’m not! 🙂

          • Natalie
            February 27, 2013 at 11:30 pm #

            the first year I applied I applied to both. I interviewed at both MD and DO schools. I got wait-listed at 3 MD schools and 2 DO schools.
            The next year I applied I only applied to DO schools. The reason being, I liked the people more. The school I chose to attend has a family feel. We share study materials, we take notes for each other and bring each other soup if one of us gets sick.
            The MD schools I interviewed at (so I can’t speak for all) were much more competitive. I have always had the philosophy that if you need to tear someone else down to be successful, you’re doing it wrong.
            I figure these people will be my colleagues, my family’s doctors and my doctors, why not help each other so we can all be the best physicians possible?

          • Natalie
            February 27, 2013 at 11:34 pm #

            I want to be very clear about the manipulation DOs do compared to chiropractors. Some of the techniques may be similar, but the philosophy behind them are VERY different.
            Chiropractors think all of the body’s health and disease is due to subluxations of the spine. So they pop the spine. First of all, who pops something that is subluxed?!
            DOs recognize physiology and disease processes. They prescribe medications and aren’t treating the spine as the holy grail. For example, if you came in with whiplash they would give you a muscle relaxant, pain meds and a neck brace- but also possibly some light manipulation on the neck to help the soft tissues relax.
            That being said a lot of DOs never use the manipulation they learn. I probably will a bit, because all of my friends and family like receiving it. Not sure if I’ll use it on patients, I guess it depends on what I end up doing for a specialty.

          • February 27, 2013 at 11:53 pm #

            It is interesting that the manipulations appear increasingly to be a vestigial feature of osteopathy, defining osteopaths tribally but not methodologically.

          • Natalie
            February 28, 2013 at 12:34 am #

            It depends on the individual. Honestly, the way some of them talk about A.T. Still they make us sound like a cult. And if A.T. Still saw what osteopathic medicine has become, he’d be rolling over in his grave.

            He (the founder) was very much against all “medicines” believing the body could heal itself.

            Luckily the profession grew with the science of modern medicine.. realizing that’s a nice theory (and works sometimes), but if that were the case there would be zero morbidity and mortality.

          • February 28, 2013 at 2:13 am #

            Yeah, I just find it very interesting because I can’t think of any other case where a sort of woo group ended up becoming so mainstream with just vestiges of their woo-ness. The chiropractors and naturopaths must be envious (or maybe they just see the osteopaths as sellouts).

          • Natalie
            March 1, 2013 at 1:34 am #

            So funny. I overheard a naturopath talking about her former classmate saying:
            “well he has gone totally conventional now. he work’s with a DO and they even do botox”
            Ha! and then there’s some of the MDs who see DOs as “woo” I guess we’re just a happy, crunchy, in-between.

          • March 1, 2013 at 12:22 pm #

            A nice sweet spot, good call.

        • February 27, 2013 at 8:50 pm #

          Three of my four children were delivered via C-section by a DO. All three had excellent Apgar scores, and their mothers healed very quickly.

        • Sullivan ThePoop
          February 27, 2013 at 10:18 pm #

          My primary care physician is a DO and she is great. I have only been going there for about 2 years. I had to switch doctors because the one I had for many years is friends with my mother and would not stop telling her things.

        • Natalie
          February 27, 2013 at 11:25 pm #

          I’m going to be a DO. I have a bachelor’s in chemistry, a masters in public health and will attend 4 years of medical school with a curriculum almost identical to an MD school.
          Our first two years are classroom based, two years of clinical rotations. I will take the same USMLE (board exams) as MD students. I will apply to MD residency programs.
          The main difference is we get an extra class in “osteopathic manipulation” which basically means I can crack your back as good (I would argue better) than a chiropractor and can give you an awesome massage.
          Some DO school advertise as more “holistic” but by holistic it usually means more humanistic. We don’t learn naturopath stuff or homeopathics or acupuncture.
          I’m glad I went to DO school, but mainly because it’s in Oregon and I like the people teaching me, it could be DO or MD.

          • auntbea
            February 28, 2013 at 10:02 pm #

            Can you please tell me what diagnosis would be treated with an awesome massage? Because I think I may be coming down with that.

          • Natalie
            March 1, 2013 at 1:31 am #

            EVERYTHING is better with a massage 🙂 (unless you’re acutely ill, then you may die from lack of appropriate care)

        • Sue
          February 28, 2013 at 12:45 am #

          Both MDs and DOs can go on to do the same postgraduate training. Once they have completed OB residency, they are essentially the same product.

      • yentavegan
        February 27, 2013 at 9:15 pm #

        Those aren’t credentials, they are the punch line to a joke.

    • Yammy
      February 27, 2013 at 1:33 pm #

      “I use the word ‘patient’ in quotes because pregnant women should not be
      referred to as patient since they are not generally ill or in need of
      medical attention.”

      Oh mother of facepalm.

      I think a veterinarian would be more qualified.

      • AmyP
        February 27, 2013 at 2:00 pm #

        “I think a veterinarian would be more qualified.”

        Of course.

        • February 27, 2013 at 2:17 pm #

          I’d much rather have a vet than ANYONE who believes that birth is to be trusted.

        • fiftyfifty1
          February 27, 2013 at 8:17 pm #

          A veterinarian, a dentist, a nurse, an EMT, a 5 year old with a cell phone. These are all people I would rather have attending me than a CPM.

      • Bombshellrisa
        February 27, 2013 at 2:15 pm #

        I would trust a vet more, as I have never had one insist that breech birth is safer

      • Susan
        February 27, 2013 at 9:10 pm #

        I have always felt the client v patient stuff was total hogwash. I think having a patient implies a higher level of obligation than having a client.

        • Dr Kitty
          February 28, 2013 at 4:28 am #

          “Service User” is the one that the mental health teams like, personally, not a fan of that, nor of client.

          To me, anyone I owe a professional duty of care to is my patient. end of. It is not a judgement of how sick or well they are, it is a reminder of the relationship between us. End of.

          • Sue
            February 28, 2013 at 11:32 pm #

            My state went through the “patient” vs “client” thing in the 1990’s – led by the then-state government. Patients didn’t like it. They felt it trivialised their needs.

      • Box of Salt
        March 1, 2013 at 12:29 am #

        “not generally ill”
        Neither is anyone going in for any check up – they’re still patients.

    • Bombshellrisa
      February 27, 2013 at 2:19 pm #

      “I had my first exposure to natural birth in chiropractic college and since those early experiences and during my first pregnancy, I poured my heart and soul into learning everything I could about birthing naturally . I ate, slept, and drank this world, and as a result of being immersed in it for 10 years , I’m now considered an expert in this field, so I’m well qualified to help you.” This comes from her $2 special report “6 reasons why natural birth is better for your baby” http://yourbirthcoach.com/your-birth-coach-video-of-birth-best-birth-prenatal-class-childbirth-courses-resources/video-of-birth-best-birth-prenatal-class-6-reasons-why-a-natural-birth-is-better-for-your-baby/

      • Aunti Po Dean
        February 27, 2013 at 2:42 pm #


      • Lilly de Lure
        February 27, 2013 at 4:26 pm #

        “I ate, slept, and drank this world, and as a result of being immersed in it for 10 years , I’m now considered an expert in this field, so I’m well qualified to help you.”

        Am I the only one suspicious that she does not elaborate on precisely who is doing the considering?

    • Mac Sherbert
      February 27, 2013 at 3:20 pm #

      What could any possibly say? She totally fails to mention in her post that the article she refers to doesn’t say vaginal is better for ALL breech births!

    • TiffanyEpiphany
      February 27, 2013 at 3:32 pm #

      Dear Jenna,

      Why do you think her advice is going to kill somebody? I am all ears.


      Tiffany, mother of one and a would-have-been homebirther for the second one on the way

      • Yammy
        February 27, 2013 at 5:01 pm #

        OH! I know! *raises hand*

        See: any one of the many blog posts by Dr. Amy recounting the preventable loss of newborns due to the reckless decision of their mothers to have a vaginal breech birth at home.

        And that quacks like Nancy here never seem to mention “death and permanent disability” as risks of vaginal birth in contrast to C-section.

        She also links a news article, not directly to a study. Bonus: The article she links even mentions a half a dozen cases where a vaginal breech birth should definitely not be attempted, and that an OB should be present for a vaginal breech birth…because it is UNSAFE.

        Yet some probably won’t notice the omissions here and attempt a vaginal breech birth at home because this quack thinks it’s the best. And then, sadly, we’ll probably read about it on this blog after things go south.

        • February 27, 2013 at 5:12 pm #

          Yeah, a breech HB is insane, no question. Same goes for home VBACs.

          • Bombshellrisa
            February 27, 2013 at 6:40 pm #

            I always wonder about the midwives who can’t tell the baby isn’t head down and say the baby flipped during labor. Same goes for the midwives who offer hbacs. Saw a home birth transfer after very long labor-the woman was not upset with the midwives who let her labor for two days, she was mad at the doctor who went to do a cervical check and was greeted with a little foot sticking out and said a C-section had to be done.

    • Sue
      February 28, 2013 at 12:42 am #

      She also says – under the title Vaginal Birth Better for Twins:

      “Vaginal birth should always be considered the safest mode of delivery unless there is clear evidence suggesting otherwise. ”

      Um – there is clear evidence suggesting otherwise.

  10. I don't have a creative name
    February 27, 2013 at 12:12 pm #

    OT: What do people think of this? http://www.snopes.com/politics/business/aspartamemilk.asp

    I think I hate it. Why in hell should they be excused from labeling milk as having such ingredients in it?

    • Sullivan ThePoop
      February 27, 2013 at 1:04 pm #

      They do have to label the milk as having such ingredients, they just don’t have to say it is reduced fat or reduced calorie and that is if the petition passes.

      • I don't have a creative name
        February 27, 2013 at 1:59 pm #

        You know what, you’re right; I somehow glossed over that part in my mind as I was so grossed out by the thought of aspartame being in milk. Bleh.

    • LovleAnjel
      February 27, 2013 at 3:41 pm #

      They’re talking about chocolate milk and the like, not “regular” milk. By people’s reactions, they shouldn’t think chocolate milk can be called milk, either. Chocolate dairy beverage? The brown stuff?

      • I don't have a creative name
        February 27, 2013 at 3:42 pm #

        They are???? Damn my reading comprehension sucks today.

    • February 27, 2013 at 4:21 pm #

      Huh, you can link to specific snopes articles now?

    • Amy
      February 27, 2013 at 7:07 pm #

      Well, the website wouldn’t let me copy the quote directly…and I’m too lazy to rewrite it. But why they even offer flavored milk in schools is beyond me. OF COURSE young children are going to choose strawberry or chocolate over plain. I don’t know why they can’t just offer the kids white milk or water. That way it’s a win-win whichever they choose.

  11. February 27, 2013 at 10:39 am #

    From Jeevan:
    couple of hours after the above patient came in, a young lady was
    wheeled into emergency. She was dead. It did not need much of a history
    for Dr Johnson to make a diagnosis.

    of a little girl who just turned two yesterday, she experienced severe
    abdominal pain at 3 AM today early morning. She had missed her periods
    by 2 months. ”

    Don’t post your diagnosis – if you think you know what it was, check his blog. I am confident that most of the readers will get it right the first time.

    • I don't have a creative name
      February 27, 2013 at 11:34 am #

      I got it right.

      I am so thankful for wonderful Jeevan and the work he does in India. It’s so badly needed. I will never take for granted how fortunate I am to live in a country with such advancements in medicine, and in a city with easy access to several excellent hospitals.

    • Aunti Po Dean
      February 27, 2013 at 12:31 pm #

      How incredibly tragic, woman of childbearing years presents in severe abdominal pain….first thing to do is pregnancy test
      it must have been an agonizing death!

      • February 27, 2013 at 2:16 pm #

        I’m of the opinion that if a woman presents with severe abdominal pain and no other explanation presents itself, a pregnancy test is the next obvious step.

        • Aunti Po Dean
          February 27, 2013 at 2:47 pm #

          yes my point exactly Anj its hard to believe that they missed such an obvious next step isn’t it?

        • Amy Tuteur, MD
          February 27, 2013 at 3:13 pm #

          The 1st law of gynecology:

          All women are pregnant until you prove that they’re not and all pregnant women have an ectopic until you prove that they don’t.

          • KarenJJ
            February 27, 2013 at 6:20 pm #

            That was my guess from Anj’s post given the 2 months possible duration and severe abdo pain. I was checked for it myself at one stage.

          • Susan
            February 27, 2013 at 9:11 pm #

            Wish you had been my sister’s OB.

    • Yammy
      February 27, 2013 at 1:43 pm #

      I don’t want to say I “love” this blog given how awfully tragic some of the stories like this one are, but wow it is incredibly fascinating and eye-opening. I would never have discovered it if not for commenters here linking to it, so thanks.

  12. February 27, 2013 at 10:14 am #

    And on the next page of informed consent should be their personal philosophy of childbirth. Buyer beware of “trust birth” and “variation of normal.”

    • theadequatemother
      February 27, 2013 at 12:18 pm #

      agreed…I’m also very wary of hospitals running QI projects myopically aimed at reducing the C-section rate.

      • Mrs. W
        February 27, 2013 at 2:57 pm #

        The time to reduce the c-section rate is not when women are in labour at the hospital….but I guess encouraging women to have babies younger and to lose weight before they get pregnant might be a little less than palatable….

        • Ceridwen
          February 27, 2013 at 4:56 pm #

          My experience reading at places like babycenter suggests that many women cannot even tolerate their doctors bringing up their weight *during* the pregnancy. Let alone before it. Most of them appear to consider weight a completely off-limits topic, even for the people they are seeing for medical advice. And they are quite certain that their docs are bringing it up just to be mean/rude to them and that any amount of weight gain is just a “variation of normal”.

          Granted, it’s tough for me to comment on the weight issue since I’ve spent pretty much my entire life underweight (seems to be a genetic predisposition of mine) and am still struggling to gain weight even during late pregnancy. But if anything I wish my doc would discuss the potential medical implications of my weight gain (or lack thereof) MORE, not pretend like it doesn’t exist for fear of offending me.

          • Mrs. W
            February 27, 2013 at 6:07 pm #

            It’s sad really – like a big elephant in the room. There’s lots of other problems with aiming to reduce CS rates – one of my biggest issues with it is the assumption that the alternative to CS is desirable. Trading CS for reduced patient satisfaction (if declining maternal request), increased incontinence, increased disability, increased death, etc. seems like a bad trade to me.

          • February 27, 2013 at 7:26 pm #

            Increased death? You sure about that?


            The growing rate
            of maternal deaths in this country is a
            significant and deeply troubling prob-
            lem. The US maternal mortality ratio has
            doubled in the past 20 years, reversing
            years of progress. Increasing cesarean
            deliveries, obesity, increasing maternal
            age, and changing population demographics each contribute to the trend.

            In 2008 the cesarean delivery rate reached another record high—32.3% of all births. There is a community not far from my home in which 45% of the newborns are delivered via an abdominal incision. Let me be very honest. This increase in cesarean delivery rate grieves me because it seems as if we are changing the culture of birth. While it is certainly true that a physician has a contract with an individual patient, our specialty has a covenant with our society.

            The College’s new guidelines for VBAC are expect- ed to help address the rising cesarean rate, making trial of labor after cesarean an option for more wom- en. Our Committee on Practice Bulletins-Obstetrics worked tirelessly to review data and evidence, in- cluding the 2010 findings of the NIH Consensus Development Conference on Vaginal Birth after Ce- sarean[…]

            While the re- cently enacted health care reform law will expand access to prenatal care, research is critically needed to under- stand how our nation can drive down maternal and infant mortality and pre- maturity rates. Effective research based on comprehensive data is the key to developing, testing, and implementingevidence-based actions. Other countries have devel- oped robust approaches to maternal mortality and the US should follow their lead.

          • Frequent Guest
            February 27, 2013 at 7:43 pm #

            “In 2008 the cesarean delivery rate reached another record high—32.3% of all births”

            Yes, but many of those are elective repeat cesareans. IIRC, the c-section rate for first time moms is something like 11-15%.

          • Captain Obvious
            February 27, 2013 at 8:41 pm #

            ACOG recommended the same I the 90’s to promote VBAC and decrease the cesarean rate. After increased uterine ruptures and neonatal mortality, the 2000’s made many doctors, hospitals, and malpractice insurance companies not too thrilled with continuing those guidelines. Now with ongoing cesarean rate increase, ACOG proposes to do more VBACs??? Like politicians, major organizations don’t learn from past mistakes. Our society has more infertility multiple gestations, more women pregnant after 35, more obese women pregnant, and more women with medical problems getting pregnant. You quoting ACOG or AAP just shows us you believe what you are told. You don’t work in medicine, you don’t understand the literature, yet you parrot recommendations from political agendas. Now trying to prevent the first cesarean with limiting elective inductions in primiparous women with no medical issues has a chance to help decrease the cesarean rate. Now comes the lawyers TV ads asking if you or a loved one has had a baby die from a TOLAC, call their law firm.

          • disqus_61tNDsHTqn
            February 27, 2013 at 9:24 pm #

            I assume Mrs. W was talking about neonatal death, not maternal. – S

          • February 27, 2013 at 9:57 pm #

            OIC. But aren’t both important?

            When I see the head of a professional organization advocating for its members to receive less financial compensation, I tend to give that more weight than a lot of other pronouncements s/he might make.

          • February 28, 2013 at 6:05 am #

            Alan, do you really prefer this kind of bland policy statement to research which presents a more complex picture? The first sentence is enough to put me off.

            It is depressing and scary that women still die in childbirth, but I don’t find myself reassured by statements like “we know very little about why.”

            Wouldn’t it be a good idea to find out a bit more about why, before insisting that replacing CS with VBAC is the answer? No-one is going to defend those “unnecessary” CS if they really are unnecessary (a bit difficult to be sure about that) – but what are the actual numbers of women who die as a DIRECT consequence of CS with no other factors – and has anyone ever died of an ill-advised VBAC?

            Here in the UK research is published on maternal deaths – leading causes in the last report sepsis and pre-eclampsia. There were, apparently, 106 maternal deaths caused directly and solely by pregnancy, and 155 caused by other factors, like poor care, poverty, and existing health conditions. Even if infection is more likely following a CS, is reducing CS the priority – or getting better at dealing with/preventing infection?

            http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2010.02847.x/pdf Saving Mothers Lives

          • auntbea
            February 27, 2013 at 9:03 pm #

            Wait, did you just refer to obesity as “the big elephant in the room”?

          • Siri
            February 28, 2013 at 2:47 pm #

            Mine is a naturally slim, sometimes (eg when stressed or upset) underweight elephant. An elephant with its skinny jeans falling down around its ankles.

          • yentavegan
            February 27, 2013 at 9:23 pm #

            C/sec save lives. c/sec saved my 2 babies from life threatening exposure to active herpes lesions at the time of delivery. I do not believe that I am in the minority, I believe that many women and their doctors opt for a c/sec rather than run the risk.

          • theadequatemother
            February 28, 2013 at 8:36 am #

            I bring up weight when it is pertinent to the discussion of the risks of various anesthetic options.,,,haven’t had anyone get mad at me yet but I mostly have to do it with patients who are already coming for surgery and who see themselves as “sick.” The general public perception is taht anesthesia is a very risky endeavor so that helps too – they put a lot of weight* on what I have to say.

            *unintentional pun…but I left it because I like a pun.

        • T.
          February 28, 2013 at 8:33 am #

          Having babies younger… eh. May be the best for babies, but not very good for mothers.

Leave a Reply

You must be logged in to post a comment.