Homebirth advocacy is based on many myths and lies and one of the biggest lies is that homebirth advocates take responsibility for their decisions. They take responsibility for nothing. If anything goes wrong they blame everyone but themselves even when it is obvious they are the ones to blame.
Consider the following story, Elodie: Caesareans are NOT benign interventions from the blog Humanize Birth, replete with the typical ignorance, hubris, denial, and lack of gratitude that is the hallmark of homebirth advocacy.
The basic story is very simple and the fault is very clear. She had a history of previous C-section, went against medical advice in choosing homebirth, ruptured her uterus, had her baby’s life save and her life saved by a repeat C-section and lost her uterus and wound up in the ICU on a ventilator having received multiple transfusions.
Does she take responsibility for her decision to choose high risk homebirth? Are you kidding? It’s everyone’s fault but hers.
I did not lose my uterus because I chose to birth at home. I lost my uterus because I underwent a caesarean that could most probably have been avoided with my first birth. I lost my uterus because our medical system does not trust women to know best when it comes to having their babies. I lost my uterus because our medical system thinks women’s bodies can’t birth without interventions…
Actually, Elodie, you did lose your uterus because you chose homebirth. YOU chose it. YOU ignored medical advice. YOU pretended that the most feared complication of vaginal birth after Cesarean wouldn’t happen to you. YOU were spectacularly wrong and you paid a high price, although it could have been much higher still.
Why did you choose it? Because YOU chose to privilege the blather of other laypeople like those of ICAN and Hypnobabies instead of the advice of medical professionals. YOU were more interested in bragging rights to a vaginal birth than whether your baby would live through the experience. YOU, YOU, YOU!
YOU chose to believe that your virtue as a woman resides in whether or not a baby passes through your vagina. And YOU still think that your virtue as a woman is bound up with your experience of birth. YOU write:
I am a survivor. I am a fighter. I am strong. I birthed two babies through my belly.
You didn’t survive; you’re life was saved by others with far greater knowledge and skill than you possess.
You weren’t a fighter. You were unconscious and lacked any control over what happened.
You weren’t strong. You survived only because of surgeons, anesthesiologists, nurses, blood bank technicians, blood donors, a ventilator, respiratory therapists, ICU nurses, EMTs, and tens of thousands of dollars of other people’s money.
You did give birth to two children through your abdomen, but you could have done that far more easily, with far less trauma, far less risk to your baby’s life and far less risk to yours if you had chosen an elective repeat C-section.
But that would have required something that apparently you and other homebirth advocates don’t possess: accurate knowledge of childbirth and a willingness to place safety above bragging rights.
After YOU ignored medical advice, and YOU were saved by the evil medical system that you deplore, the least you could do now is take responsibility for YOUR decision.
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Seems totally legit. NOT.
I’m extremely grateful for my prenatal care & emergency c-section deliveries. 100-150 years ago, I would have died before the end of my first pregnancy. Instead, I have 3 beautiful now teenagers with little to show for their prematurity other than the expected developmental delays. I developed very severe HELLP Syndrome. By 30 weeks with my first, I was very sick. I’m very grateful to my ob/gyn & the L&D team who sprang into immediate action even though my husband & I were stunned, dazed into a paralysis of confusion.
Congratulations on your healthy family.
True or false? Cesarean section at least somewhat minimizes a woman’s fertility to four pregnancies. Women don’t like to be told how many babies to have so avoiding a first one is key. Some women are against birth control ( like Catholics or quiverfulls) so finding yourself pregnant with an over used uterine scar would be scary!
Yes, it is more difficult to have a large family if you need a c-section the first time, and the risks of pregnancy and birth increase as the number of c-sections goes up. But so what? A substantial portion of women (at least 5-10%) simply can’t deliver live normal-sized babies vaginally. With c-sections, you can have those 4 kids and live to watch them grow up, instead of being buried with the first one.
Modern medical technology allows almost all women to have some children if they choose to, with a near-zero risk of death. It does not allow all women to have 10 children with little or no risk. That’s just reality. I have sympathy for women who want more children than they can have, but honestly, how much are we supposed to respect a religious teaching that rejects birth control even when further pregnancies pose an unacceptable health risk to the mother? (The vast majority of Catholic women do use birth control, by the way.)
I am so so glad Dr. Tuteur is here as a lone voice of reason. Why aren’t there more of you? I am amazed at how little skepticism there is regarding home birth and the entire New Age-y trends surrounding birthing and child-rearing. I can’t tell you how many friends I have who want to do home births. Out of five in the past few years, only one went well.
No one died but the others had to be rushed to the hospital. The most extreme home-birther among them refused the hospital even though the baby had a bowel movement inside her and came crashing through her body before she was dilated, leading to her passing out in a pool of her own blood while her midwives caught the baby who almost landed hard on the floor. A potential disaster. And what does my friend say? Thank God I was doing a home-birth, because they would have done a c-section in the hospital.
What is happening to women’s brains? We are lucky to be living in times where we can avail ourselves of modern medicine and science, and where the medical establishment finally values women enough to want to reduce our pain and difficulties. How tragic that women think it is empowering to give that up, and instead write in pain at home while risking their wellbeing and life.
What the f*%@? I’m no advocate of homebirth, but there’s no need to bash this woman.
There is every reason to verbally bash this stupid woman.
pretend you are the kid that could have died from her choice. pretend you are them, grown up, and listening to this story. pretend hearing your mother blame everyone but herself for the decision that very nearly killed you.
We all screw up. What someone does about their own mistakes is a very good measure of a person’s integrity. Her reaction was to retroactively blame the person who performed the first c-section, pretending that she had some kind of inalienable right to make decisions about the 2nd birth as if the first c section had never happened. Its ridiculous. You can regret agreeing to a c-section while still taking it into account when deciding what to do about the next pregnancy, yeesh.
Me and my daughter are UR after VBAC attempt survivors. (In fact, my girl turns 3 on the 5th.)
The big difference? I didn’t “try that at home”. I tore in a similar fashion to Elodie, but because I was in the hospital at the time, the doctors, nurses and techs had everything they would need in close proximity to deal with my rupture.
I still have my uterus, amazingly enough. I looked over my records and sometimes can’t believe they managed to sew me back together, but they did. AFAIK, everything still works, although we aren’t eager to give pregnancy another shot to find out definitively.
She can demonize doctors and real nurses all she wants, but…..for any true L&D professionals reading this…..thank you for all you do. Both me and my husband are grateful beyond words.
This made me tear up. Thank you for sharing your story.
Love the “don’t try this at home” poke. It says everything.
Oh goodness. I’m a biomedical science student, and I come to Dr. Amy’s blog every day for inspiration in my quest to become an OB/GYN.
Off topic. Has anyone read the most recent The Learner? Wow. Today’s cases: 1. Eclampsia death 2.obstructed labor at home leading to ruptured uterus, bladder and bowel necrosis 3. cord prolapse leading to fetal demise followed by infected uterus wherein Jeevan has to decide between surgical birth vs. craniotomy and extraction of the dead baby.
Trust birth!!!
A friend is in Uganda at the moment, her recent FB update contained the immortal words “catgut sutures which kept breaking, and no sooner was the baby out, then the power failed”.
Some people have no idea how lucky they are.
Also, did you catch the fact that the “traditional” treatment of obstructed labour is abdominal massage, which damaged the poor woman’s bowel so much that pus came up her NG tube?
Not just “trust birth” but “trust the ancient indigenous wisdom of the East”…didn’t work out so well.
In the village where I did an elect as a medical student, the local infertility treatment involved leaving out a bowl of milk at full moon for the cobras to eat (snakes/milk, very phallic). Not a good way to get pregnant, but a great way to get a snake bite.
I’m going to put this here, because I don’t want it lost in a stream of comments.
The day I have to rely on a “fine grained actuarial analysis” before I can green light a treatment my patient that i believe is in their best interest will be the day I no longer believe medicine is worth practising.
I work in a system where I CAN focus on the patient in front of me and what they need, where we can make decisions based on their unique circumstances and where I don’t have to think constantly about the bottom line.
It means that I can see four patients with low mood and the exact same PHQ9 score, recommend CBT to one, an SSRI to another, suggest the third reads a self help book and contacts her trade union and make an urgent referral to a psychiatrist for the fourth.
People do not fit comfortably into boxes and you have to do your best for the person in from of you, not some “idealised” patient. That is practising holistically, that is provided patient centred care, and that is what makes my job rewarding and interesting.
Oh but think of the money would could save under Alan’s System! We’d have people not trained in medicine deciding exactly what someone is entitled to, even predicting birth by the sounds of it, and charging for any extras. As he says below this is not about risk (or the patient) it is about money.
And I love this comment Dr Kitty.
Because trained actuaries are free to the system, or at minimum cheaper than not authorizing the occasional extra couple hundred dollars.
Actuaries, and the tables and reports they produce, already play a huge role in deciding what will and will not be paid for and at what price. This is being accelerated under Obamacare, as it should be. Your comments sound like they come from a time capsule buried in the 1950s.
Apparently anger and automatic spellchecker are not happy bedfellows. Sorry some of the above is garbled, I hope you can get the sense, even if not expressed properly.
Hear hear.
We can no longer AFFORD IT.
As someone with a disability (multiple, actually), I find you extremely offensive. I can’t contribute financially, but that doesn’t mean I have no worth as a person or that treating me is not worthwhile. I would argue WE CAN’T AFFORD to treat people who are ill or disabled poorly or to decide who has intrinsic value or not. We treat people as best as we can because every person, no matter what you may think, contributes in their own way. You do realize that Hitler’s motivation for the T-4 program was EXACTLY this kind of attitude. http://en.wikipedia.org/wiki/Action_T4
I don’t think Godwin’s Law applies when you’re actually sounding like Hitler… *facepalm* Try to follow what you’re suggesting to its logical outcome.
I thought Alan wanted Canadian style healthcare and now he is against the taxpayer funding anything that he himself considers to be unnecessary. Did I miss something? I really think this guy is just making arguments for the sake of arguing and seeing how annoyed people will become.
Ding ding ding.
You’re right. I thought he was only on here to argue that we were painting all midwives with the same ‘incompetent’ brush and he was here to stand up for the good ones, but instead he’s keen on asserting his man-thority everywhere because he has a high IQ and therefore we should listen to him.
I think the high-IQ might be a bit of a stretch.
If you would care to bet me enough to make it worth my while, I would be glad to provide proof. Hundred bucks? You can take up a collection.
I have met a lot of people who have very high IQs. Common sense doesn’t necessarily follow.
I agree but it sure comes out a winner in stopping an argument. “Hey you’re wrong because I’m very very smart and got a great score on a standardised test” beats an actual reason any day. We were sure shown up.
“I got a great score on a standardised test …in high school.”
I was a star student in kindergarten…and I still have the certificate to prove it. So Ha!
I’m quite smart. And , sadly, frequently wrong. Maybe I am just smart enough to know that telling the rest of the world what to think based on my own idiosyncratic opinions is not likely to impress or convince.
I am not trying to stop any argument, only defending myself against those trying to stop the argument by painting me as a halfwitted member of the uncredentialled hoi polloi who does not have the right to participate in the debate.
I don’t recall any IQ claims. I do recall a claim of a 1600 SAT. Which makes me wonder why he think anyone would care.
I presented those only to defend myself against smears that I was some dumb yokel who did not understand fractions. Ad hominem to be sure, but ad hominem often is more effective than we might wish.
And in what decade did you take that SAT?
And are any of us college admissions officers currently considering your application?
Come on box of salt, don’t all smart, sucessful and self assured people you know feel the need to defend their intelligence to a group of random strangers on the net by bragging about their scores from standardized tests they took years ago?
Which poster said that women who are determined to brag about their giving birth sans pain meds are the ones that haven’t achieved anything else? Bragging about your SATs when you are an adult who presumably has had the chance to achieve something else must be the equivalent
I know some academics who put their SAT and GRE scores on their cv’s. Perhaps not surprisingly, these tend not to be highly published academics.
I don’t claim to be a published academic, or even a college graduate. I do defend myself as having more than my share of raw intelligence, which is germane to my qualifications to debate on a message board. Other credentials would apply if I were applying for a job, but I am not.
Raw intelligence is not a substitute for knowledge.
You’d be all set if we were competing against each other on solving Rubik’s Cubes, but we,re not. We’re reading, reviewing and analyzing scientific evidence. If you haven’t read it, all the raw intelligence in the world is not going to make a bit of difference.
Because only those with credentials can read or acquire knowledge. Got it.
(FYI, I have never solved a Rubik’s Cube, LOL.)
I’m starting to have my doubts about your raw intelligence claims. Please try to concentrate on what I wrote: if you haven’t read the scientific papers, you aren’t qualified to discuss them. That has nothing to do with having a degree.
My offer of a bet is open to you too. , You’ve got plenty of money: you can even hire a professional psych examiner to administer the IQ test.
You have missed the point; no one cares about your IQ (or your SAT scores). You should stop discussing them before you appear more pathetic than you already do.
One would have thought by now you’d have noticed that I’m not interested in your suggestions, Dr. A. Maybe I should put my scores in my sig, LOL–do they have sigs in DISQUS?
“Because only those with credentials can read or acquire knowledge…” You’re the one who flat-out refuses to read the actual studies!
When Dr. Amy and Sue tell you to read the studies, they’re not insinuating anything about you personally. They literally mean you should obtain and read the studies. Instead you’re being lazy and making arguments for which you have no actual evidence, then whining about people calling you dumb when they point out that you have no evidence.
I would say come back here with any questions you might have (about methods, statistical analysis, and so on; the scientists on here are pretty nice about helping the rest of us), but by this point you may have alienated everyone who would help you. – S
I read studies when I was linked to them (the MRCS one for instance). If abstracts are all that is available, I’m not going to purchase some expensive subscription to read them. To act like chewing the fat on message boards must rise to the same standard as presenting a paper at a professional conference or publishing it in a peer-reviewed journal is absurd.
Worse, it is a double standard, applied to me at every turn but not to those with whom you (collectively) are sympathetic. Is that how academic journals should be run? My father (who had credentials up the wazoo, a tenured professor at a “name” university with a Ph.D. from Stanford) cynically observed that this was too often the case, but it is not a standard to aspire to, surely?
Your claims have to rise to a high standard only if you expect people to take you seriously when you discuss what the scientific evidence shows. You’re free to write whatever you want about homebirth, natural childbirth and breastfeeding, and we are free to point out that you have no idea what you are talking about.
And I’m free to point out the unreasonable double standard. Everybody wins!
Talking to you is exhausting. Okay look. I haven’t read any studies at all lately, but i don’t debate most of the subjects presented here; i just read and maybe occasionally ask a question. When other people on here aren’t able to get hold of a study, they ask. Sometimes someone can find them a link to full text. Sometimes they’ll summarize the methods section or paste a relevant paragraph from the discussion. If you ask respectfully, if you’re sincere, some commenters will go to a lot of trouble (I couldn’t even begin to guess how many links Becky has dug up). I don’t expect anyone would go to much trouble for you since you’ve been neither respectful nor particularly sincere.
If someone who disagrees with you fails to provide evidence, you are certainly welcome to ask them for it.
No one’s acting like this conversation in a blog comment section is remotely comparable to a professional conference. You’re playing the martyr and pretending people are acting that way. Again, we’re not stupid. We can see the comment history.
Lastly, i believe you got a 1600 on your SATs, and i believe you have a high IQ. You remind me of certain kids at my high school (which actually requires the SAT for admission, kids come from all over the state, good reputation, blah blah). These kids were obviously used to being the smartest kids around (I think most of them had skipped a grade too) and took for granted that other people were beneath them — but their attitude didn’t make sense now that they were surrounded by other really smart kids. Unsurprisingly, they tended not to do well socially, but the funny thing is, i don’t remember them being academic standouts either (which i guess at my school means winning the Intel or some shit). It was really only their inflated perception of themselves and resulting lack of friends that made them stand out at all.
I assume those kids eventually developed some perspective, grew up, and got over themselves.
I don’t remember my point. I have the attention span of a guppy, illustrating one reason i don’t give a shit about your scores — I did alright on tests when i was a kid, and now i’m basically illiterate, mathematically incompetent, and funemployed. Those scores don’t mean a damn thing in the long run. – S
Hey, I have a short attention span too, thanks to an undiagnosed case of Inattentive ADHD (which is I think largely to blame for my graduating in the bottom half of my HS class). I was popular in high school and college though, believe it or not, and still find it easy to “schmooze” with people IRL.
You can’t always judge people in toto by what they post on a message board. I use them to keep my mind sharp since two small children aren’t going to do it for me, y’know? But you are wrong to judge me as insincere. I’m really not just making shit up to get a reaction. Honest!
I’m not trying to judge what you’re like in real life; it’s not relevant to the conversations here. I am talking about your interactions on this site.
(That last comment of mine, with the funemployment — there’s an example of self-indulgence on my part, in case you’re still curious about that. Totally not germane to anything.)
I am sure your sincerely believe your claims about breastfeeding, diet, and so on. When i say you are insincere, i mean you are insincere in the way you respond to people here. You often don’t respond to what was actually said. (I don’t mean my own possibly convoluted comments — i mean other people’s very plain, clearly understandable comments.) I’m giving you the benefit of the doubt in assuming you’re doing that on purpose. The other option is that you have serious reading comprehension issues. – S
If you’ll notice, I get about an equal number of complaints that I comment too much; then there are those who complain that I don’t respond to everything. Well, I am not *going* to respond to everything. People say I must have a lot of time; but I don’t have *that* much time. This is ultimately a leisure time hobby type activity, so I will respond to what I feel like responding to. If that doesn’t satisfy you, I’m sorry.
You respond to your own made-up version of what people say rather than what they have actually said.
I have met a few geniuses in my life (literally, certifiable geniuses (McArthur Fellows)). They are pretty amazing to talk to, because they are so bloody smart, and it’s obvious. Fortunately, all the ones I have met have also been really outstanding people, too, and the last thing they do is run around and tell everyone how smart they are. They don’t need to tell you how smart they are, because you can easily tell.
That being said, there are still lots of things that I know that they don’t, and they have learned things from me during our discussions. It’s because no matter how smart you are, as Amy says, intelligence is not a substitute for knowledge.
Then again, smart people understand that.
I guess you didn’t notice that I acknowledged learning something new about MRCS. I don’t claim to know everything, and I enjoy learning new things. But I do also know a lot of things, and have strong reasoning faculties with which to process information. If someone tries to claim otherwise, I will defend myself.
No, you do not have strong reasoning faculties. In fact, your reasoning abilities are so poor, that you don’t even recognize it. Neither I, or anyone else has the time or energy to break down every idiotic thing you say for you, because you post walls of garbage all day long. And besides, if you could understand why half the stuff you say is completely stupid and wrong, you wouldn’t have said it in the first place.
Seriously. The shit you say is so fucking stupid sometimes, I’m starting to wonder if you actually understand what words mean when you read or write them on a page, or if you translate them into your own head-speak as you go.
Well, that was…something. Sputter with rage much? LOL
Might want to try some meditation or something before you blow a gasket.
Here, try reading this and then take a few deep breaths:
http://xkcd.com/386/
HTH
I’m a fan, tND, I’m a fan.
My SIL, who got a perfect score on her GRE, is going for her PhD. Imagine the uproarious laughter of the dissertation committee if she were to defend it by staying “look, I AM smart, I have the standardized test score to prove it.” In any context, if you can’t convey your ideas in such a way as to allow your intelligence to speak for itself you needn’t waste your time telling people about your test scores.
Love what you said. It’s kind of like being a lady: if you have to tell people you are one, you probably aren’t.
Oh, great. It’s the equivalent of Al Bundy’s “four touchdowns in one game” claim to greatness.
Seriously, I got plenty of high scores on standardized tests. Y’know what? That and $3 will buy you a drink at Starbucks. What have you done lately to impress?
Alan had a similar style on the Fearless Formula Feeder a few years back and ended up being banned.
I see, trying to get banned from forums is his hobby. This explains a lot.
I think it’s a form of the flounce, since he can then fancy himself as being too smart for whatever forum has decided to no longer engage him
Well, if the shoe fits…
Wondered when someone would bring that up!
the inconsistencies are beginning multiply.
Another inconsistency I wonder about: Al is a SAHD with 4 kids and enough time to post 400 comments on here over a the last few days? Not saying it’s impossible as I know other parents are frequent posters and he does mention his wife so he obviously he has help with the kids. Every parent should of course have some time to themselves. So, if he is what he says I’m not accusing him of being a bad dad for spending some time on the net. It’s just that I really have to wonder in light of some of the blatantly ridiculous things he has said if anything about him is sincere or if he’s just creating a persona to try and get people fired up. Maybe I’m way off base here. Whatever his deal is I hope people will eventually start to resist taking the bate (goes for me too) because I for one am kind of bored of him monopolizing the discussion-just speaking for myself here.
I would like to propose some sort of sanction for anyone responding (including myself.) I keep trying and failing not to respond and need some sort of external monitoring.
You are right, auntbea. We all need to stop responding. And to monitor each other. 🙂
I’m with you guys, please feel free to give me a virtual hand slap if you catch me responding!
Whooeee. Some doozies came in over night. Help me stay strong, Mamas!
I’m with you auntbea, friends don’t let friends reply to douchenozzels (hope you don’t mind if I borrow your term). 😉
For once, I did not scathingly go after this guy other than to remark that he was very similar to other certain commenters we’ve had pop up in the past. Mansplainers are one category that I don’t touch, it’s not worth it, all attention validates their egos.
I made the mistake of winning an argument with a mansplainer a few weeks ago (he was young and not fully developed), and now I am doomed.
I don’t get all that much time to myself. An iPad with voice dictation allows me to hold the baby and post away. 😛
He doesn’t seem to understand our healthcare system (Canada) either. We don’t have rationing and pre-approval of our treatments from some government body. Indeed, I understand that the overhead is lower largely because there’s less micromanagement of what’s covered.
(Simplifying, I’m not a doctor, etc.)
My and my daughter’s medical care costs tens of thousands of dollars a year. I work and yet my taxes would not cover it.
Firstly, I want to live in a society where those with disability or terrible diseases are treated humanely and are not begging on the streets or denied medication that can enable them to live a more full life etc etc. I felt like this even when I was working full time and didn’t use many of the facilities my taxes were paying for.
Secondly, doctors and researchers learn a lot about the human body by studying those with disabilities and diseases. I’m getting a bit used to feeling like a guinea pig.
My country has decided it’s worth it and affords it.
That said, in the US the care that others with my syndrome costs over a hundred thousand per year because the insurance companies refuse to pay for a cheaper ‘off label’ drug and use an even more expensive one.
You do realise you sound like Sarah Palin? Bending the cost curve as I advocate is mainstream policy nowadays, at least outside the reactionary recesses of the GOP.
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/01/08/republicans-cant-stop-ipab-but-they-might-slow-it-down/
Starting to feel like Alan is the modern day equivalent of Grantly Dick-Read. :/
Or the real-life equivalent of Otto, from A Fish Called Wanda.
I wish I could “like” this a million times
Take comfort, the pragmatist, in the fact that Alan himself has been on medicaid.
Actually, no. I have never been on Medicaid. My wife and kids have. I am just uninsured.
So you will be paying 100% for any medical care you receive, medically indicated or over-and-above? In the case of your state taxpayer insured family, the same? Why not just pay 100% from the get-go? Since the doctor tried to get your wife to VBAC, did you go ahead and pay the extra for that C-section that you CHOSE despite the doctor’s okay for VBAC?
Alan, you’re in the US. We’ve never tried to make it work for everybody. Your statement doesn’t make any sense for us.
Isn’t most of this board in the US? Agreed that we need to emulate other countries, including a lot more cost containment (“rationing”).
Alan, has the US ever had universal healthcare?
If not, the statement “we can NO LONGER affford it” makes no sense.
Sure it does. We have had a patchwork “system” of universal-ish health care for quite a few years, at least since it became the law that hospitals could not turn away patients who were gravely ill or injured before at least stabilizing them. The cost of treating those patients in the emergency room is passed on to the society at large. Not the most efficient way of going about things, obviously.
When I say the US cannot continue to afford going along the trajectory it is on, I mean this:
http://www.pbs.org/newshour/rundown/2012/10/health-costs-how-the-us-compares-with-other-countries.html
Alan, NO.
If we (the US where you and I live) had universal healthcare, you would not be claiming a few comments down that you are uninsured.
OK?
Agreed, Box. It’s a little infuriating that Alan’s over here dictating what choices women should have in pregnancy and which brain-damaged babies get to live all based on this actuarial analysis, yet blithely ignores the fact that by refusing to be insured and paying into the system, he is GUARANTEEING that if anything happened to him the general taxpayer has the burden of paying for him.
How can you argue that women who have insurance shouldn’t have access to a CDMR when you refuse to take any prophylactic steps in your own health care? You, the uninsured, are much more of a burden to the system than the chance few who might want a CDMR. Who pays for your care if you have a catastrophic car accident? A heart attack? Or cancer? Or should we just claim that you’re “a good case for euthanasia, frankly?”
Not “refusing”, just can’t afford it. I acknowledged upthread that I am what is called a free rider, but if we had single-payer like my sister does in Canada, that would not be an issue.
Sigh. We can nitpick all day long about definitions of universal healthcare, but does not change the fact that the US does have a system of health delivery which costs too much and delivers too little.
I am uninsured, yes, which means I do not get as much prophylactic care as would be ideal. But the US now not only has guaranteed emergency care, but also guaranteed opportunity to buy health insurance even for those with preexisting conditions. So I can sign up if I ever have a serious disease. This makes me a “free rider”, which is another problem with the system as it is currently constructed.
I’m not nitpicking, Alan. You described US healthcare as “a patchwork “system” of universal-ish health care.”
That is NOT universal healthcare.
I agree what we’re doing doesn’t work very well, but you can’t say that “we can NO LONGER” afford something we never tried, and don’t do.
Don’t take this the wrong way: I suggest you put away your voice to text app, and try typing instead, as a way to get yourself to think through your comments before posting.
LOL, thanks for the suggestion. @@
You actually can’t sign up for insurance “if you ever have a serious disease.” You can only sign up for Obamacare between December and February (and for your employer’s insurance during their enrollment period–usually just the month of December). If you’re diagnosed with heart failure or cancer or whatever in March, too bad for you–hope you survive until December rolls around again!
And if that seems harsh, well, it’s how we motivate people to buy insurance before they need it instead of after, which is the only way to keep it affordable.
Bummer. Guess I’ll just have to cross my fingers.
Alan, I agree the US healthcare system is expensive, unfair and unsustainable. However, care rationing based on cost alone or a person’s ability to pay for their own care is not the appropriate response.
Healthcare is a system where “from each according to ability, to each according to need” is actually the only way to run a system that protects the vulnerable and provides good quality care for all.
Poor people need more care, sick people don’t earn as much. Nothing will ever change that.
Using cost as the main driver behind care pathways is not beneficent, not just, is not respectful of autonomy and is actively maleficent.
I think you misunderstand me. I support single-payer, strongly. I support the Marxist principle you reference. But even a single payer system, perhaps especially a single-payer system, needs to have tight cost containment.
Sigh…
I don’t think you understand how the NHS works.
I don’t have a budget, and the only cost cutting measures that directly affect my clinical decision making are directives to “prescribe generically” and “avoid unnecessary A&E attendances”, which I’d do anyway.
You can even get cosmetic surgery on the NHS if your condition is causing significant psychological distress, or your appearance would be generally considered unacceptable.
Not as much in the way of death panels as you’d imagine.
Not trying to argue with you, sincerely, because I’m sure you know far more about that system I possibly could. So I am just genuinely curious: how do you keep costs so far down below the level we have in the US? Is paying doctors less a big part of it? That is certainly where I think we could cut a lot of fat in the States.
I haven’t had much time to read up on the comments lately…. I feel so out of the loop! Oh man…. so much to catch up on….
Wow, way to turn a beautiful and natural part of life into something ugly and no longer sacred. You make it sound like an illness! I was born at home safely and effortlessly, as was my sister, and both my sons as well. It is great to have a back up plan as there are emergencies that happen, but why ruin a holy moment in our lives and act like we are dying? It is easy and natural for most women, I didn’t say painless….but we are built to do this….without drugs and knives…..most of the time. And guess what….lotus birthing is not smelly or dirty or unsafe,….as long as you are a clean person who knows how to take care of things by yourself. I did t and I still have my sons placenta and cord 12 years later, it is odorless by the way. It is interesting to him to take a look at what was with him in the very beginning. You would like us to prove why we should do these practices, but why don’t you prove why we shouldn’t? You think things should be one way,but we are all so different. Don’t forget you are floating around in space amongst planets and stars….anything and everything is possible and you can’t have all the answers. It is all so much larger than your narrow mind.
Bingo! (but as it’s Saturday night maybe a SOB drinking game might be more fun, per suggestion by Victoria in this thread)
Drink! If we do shots per bingo space I will be under the table from this one comment.
Yeah, not sure if we can endorse the SOB drinking game-lots of trolls of the tenacious variety and not nearly enough of the flounce type. We could be hungover for days : )
Unfair! I wanted to shout BINGO first.
These people are about to be very harsh to you and I kind of cringe to see it coming, but I do have to say that the whole “sacred” bit makes me roll my eyes.
That said, if any of you who are about to hold her up for ridicule are not yourselves atheists, then the shit you believe in is just as nutty, so keep that in mind.
It’s not the “sacred” bit that will induce the ridicule
But the “sacred” bit is what makes her reject evidence-based medicine in favour of woo.
It’s a false dichotomy. Just once I wish one of these trolls would come back and answer the questions we post. Mine is, how does having medical help diminish sacredness? I want this explained, in detail.
The Sacred must be very very weak. Even a heplock scares it away.
Agreed, IDHACN. I believe birth is special, sacred, and spiritual… and I am up to my eyeballs in Western, evidence-based medicine. Nice straw man.
Does that mean that since I am an atheist, I get to make fun of her to my heart’s content?
Yes.
What if her shit is nuttier than mine?
How so?
You don’t speak for ‘these people’. We’re quite capable of speaking for ourselves. That said, she just came onto someone’s blog, told us we were wrong and narrow minded. Who’s harsh?
Word, KarenJJ. 🙂
“I was born at home safely and effortlessly”
So you and your mother won the birth lottery. “safely”
As for “effortlessly”, the closest account I’ve seen to that are women who have slept through their labors thanks to epidurals, but even they had to push their babies out.
Labor is not like a Monty Python skit.
The baby walked right out, it was that effortless. And the baby was safe because it made sure to wear a headlamp for the trek.
OMG! Giggle tinkles!
Not a head lamp, it was a flashlight and it originally had been used by the doula as she helped the baby turn from breech to head down (the famous “flashlight trick”). She gave it to the baby as part of the Blessingway ceremony, but only after everyone feasted on yoni cupcakes.
We need to add a space on the bingo card for:
“It’s a mystery!”
I think the logical fallacy that fits that best is Special Plead or Special Pleading, especially for birth. After all, one of the tenets of the NCB culture is that “birth is different, therefore we should treat it differently”.
Do we have a space for unwarranted use of ellipsis?
Those aren’t ellipses. They are periods that have escaped from the middles of what are now run on sentences.
Use of ellipsis goes into the general unscientific crank category – it’s not specific to NCB.
When you can’t actually form arguments, you may find the need to express explicitly the long pauses between your ideas.
In contrast, I assume the iPad software (or Dragon) Alan uses knows to put spaces between the periods for actual ellipses.
You want a mummified placenta instead of a bronzed baby shoe, fine.
Expecting EVERYONE to want one… Nope.
To be honest, I think of Lotus Birthers as in the same bracket as people who sell things made from various dead animals on Etsy. Not my cup of tea, but there are obviously a few of them out there, and it seems pretty harmless.
You were safely born at home and here you are, telling us so. You know who’s not here? The babies/people who died in homebirth. The ones who survived but whose brains are so damaged they can only communicate by crying or smiling are also not writing here. The mere fact that you & your sister survived does not mean that home birth is safe.
Death is a holy moment, too, as well as birth. We aren’t ruining moments, here. We’re giving them the utmost respect and reverence by doing what modern medicine has allowed us to do. And by doing so, we protect the sacredness of both life and death.
Oh, Dear Lotus girl. the universe is a cruel Mistress and we are subordinate to her whims.
Modern obstetrics has exchanged the sacredness of the unknown, the thrill of participating in the ancient roulette wheel of labor and birth, in favor for the souless certitude beyond a reasonable doubt of a healthy living newborn and mother.
“It is easy and natural for most women”
Therein lies the problem. You often can’t know ahead of time WHICH woman will not have it easy and natural. 95% of births, the baby simply comes out and that’s that. But that 5% that would need skilled interventions to live…. aren’t their lives more sacred than their mother’s chance for a “sacred moment”? If not, why not?
And can you define what about interventions makes a moment less sacred? Because I believe in the sacred too, and hearing each of my babies’ cry for the first time was a sacred moment for me… in what way was this moment damaged by not being at home and instead submitting to the interventions my babies needed to be born safely?
Lotus birthing is stupid. There I said it, it’s absolutely moronic.
There’s no religious proscription for lotus birth. And certainly no culture that you belong to has any traditional roots in the practice either. You do it because of New Age fetish for Asian spiritualism, and practice it in a way that just about no one other than white, privileged Western women bothers to do. The end.
The rest of what you said was trash. Plenty of women die every single day giving birth around the world, and countless women would be insulted by your insistence that the process is easy.
I guess I should bow down to your nonsensical arguments, because I am in fact on a rock hurtling through space rather quickly. What a farce.
I guess I was one the ” exceptions.” I had a textbook uneventful pregnancy and beginning of labor. I would probably be a perfect home birth candidate. I wouldn’t call labor effortless, isn’t it why we call it “labor”? It was painful and exhausting. When my baby started having repeated heart decelerations I had an emergency C- Section. His birth WAS a beautIful and sacred moment. When he was born, he was safe. He was ok. The whole operating room was joyful, all the doctors, anesthesiologist, nurses, pediatric nurses. I don’t know what can be more special than a whole team of people working together to make sure my son and I were healthy and safe.
And last night, millions of people drove home from the bar drunk and made it safely.
Does that mean it’s safe or smart?
Lotus girl “why ruin a holy moment in our lives and act like we are dying”
Why ruin a holy moment in your baby’s life by allowing the baby to die for lack of care during or just after labor?
More like why settle for just one moment, if you have to trade it for a lifetime?
I suspect “Lotus girl” is actually a teenaged boy having fun. Nobody seriously thinks like that – do they?
And when she says “I’m Sagittarien” I confess a pigeonhole starts to form.
And is immediately filled with pigeon when she says her name is Storm.
Nice use of Minchin.
“Suddenly she insists
But the human body is a mystery!
Science just falls in a hole
When it tries to explain the the nature of the soul.”
“To gild refined gold, to paint the lily,
To throw perfume on the violet… is just fucking silly”
Your baby has been born. It has an amazing life ahead of them. Do you really need to dress up the event in pretend myths and cliches? Isn’t it amazing enough? Isn’t their first breath a beautiful moment? Does the imagery have that much of an effect on your feelings towards this creature you’ve helped bring in to this world and committed to raising?
Thank you, Dr. Amy, for sharing this heartbreaking story.
Heartbreaking? I call it more like heartwarming: Mom saved from certain death. Has a lifetime ahead of parenting her 2 beautiful healthy children. Or maybe awe inspiring. Every single individual on the team that saved her started years ago down the long path to gaining his or her specialized knowledge. Think of the surgical skills, the resuscitation skills, the blood bank skills, the skills to invent and manufacture the tools and tubes and machines. Think of the years scientists spent trying and failing and finally suceeding in discovering the secrets of transfusing blood. Think of the creativity behind imagining that something like an antibiotic could even exist and then the years of drudgery involved in searching for and finding and refining this substance. Think of the magic of anesthesia that can put you to sleep and then wake you up at will. Holy shit!
You hit the nail on the head. Science and medicine trumps glitter and unicorns every-time.
This raises an important question: where do unicorns go when they get sick?
They don’t get sick, they trust their horns and go on sparkling and appearing to women who give birth in a kiddie pool in their living room.
Hogwarts. Hagrid has a special touch.
OMG, duh! I should have known!
Well it’s heartbreaking that she went and made an irresponsible decision that caused her to have a major surgery that destroyed any potential she had for carrying future children. I wouldn’t considering it particularly heartwarming if all this happened and the woman was uninsured or underinsured.
I get your point, but at the same time, there’s much to be disappointed about here.
The insurance situation in the United States is shameful for sure. But it wouldn’t have changed the outcome in this case. She would have come in crashing and they would have saved her and her baby insurance or no. Hospital probably would have ended up eating the entire bill. She has her whole life ahead of her now and 2 healthy children so I’m going to save my heartbreaking for someone else (perhaps per Alan’s suggestion, I’ll save it for the next time I see a baby that rides in a clip-in car seat).
I do, however, agree with your statement that she had major surgery. This, for once, was what I would indeed call “major abdominal surgery”. Contrast this with simple c-section.
I’m not saying she wouldn’t have gotten the treatment, I’m saying it could have wound up being financial ruin for her family. Even if she wound up getting out of paying the bill, it still would have ruined her credit, etc.
I’m personally not shedding any tears for this woman’s uterus, but those more sympathetic than I might.
Going to have to disagree with you on this one again. If she was underinsured (i.e. large deductible plan), yes, she would have to pay the deductible, but then the rest would be covered. If she is poor, she will qualify for Medicaid retroactively and they will cover every penny. If the hospital writes it off, it doesn’t affect your credit. The only way it can affect your credit is if the hospital sends it to collections, and they would never do that in a case like this. My sister-in-law wound up in the ER on Christmas after a seizure. Turns out she has a brain tumor. Her emergency surgery, ICU stay, chemo, radiation, send-out pathology work and ongoing oncology care have all continued despite her having no insurance. The hospital social worker has helped her apply for Medicaid. If she doesn’t qualify, they tell her they won’t send her to collections as long as she continues to make good faith payments of $20 each month on her hospital bill. The oncology group she sees have said the same.
“perhaps per Alan’s suggestion, I’ll save it for the next time I see a baby that rides in a clip car seat” haha good one! I just got so mad when he said this. I didn’t make as big a deal of it as I could have at the time because talking to Alan is like getting on a crazy merry go round that never quits. I remember the first time I went to my husband’s home country. I had a 2-3 year old girl beg me for money on a crowded street in the middle of traffic–no parents in sight. I can still picture her face vividly. This was just one of many children I saw in similar situations and Alan wants to talk about the heartbreak he feels for kids in carriers?!
This specious logic (for every complaint anyone has, there is always someone else who has it worse) can be turned both ways. Why complain about midwives and HBs when there are far greater horrors in the world to be concerned about?
But HB midwives endangering people are an actual problem. The problem may be small in comparison to other problems but, at least it isn’t a made up problem like not getting a Mercedes for your 16th birthday or putting a kid in carrier. People can choose to make these things into problems if they want to but, let’s be real– they’re not.
Also, I realize my response is more emotional than logical. It’s hard to see something that is so emotional and not be a little put out by what I consider to be someone’s comparatively melodramatic description of “heartbreak”.
I would say that the horror of a dead baby (who didn’t have to die) is pretty great.
So is the horror, as I keep pointing out, of a child dying in a car crash.
Pay attention, Alan:
2 out of 3 babies who die at homebirth didn’t have to die if they were born in a hospital in the first place. That means that homebirths produce unnecessary, preventable deaths.
So, yes, you are correct that it is horrific for a child to die in a car crash, especially if the parent didn’t buckle the child in (a Dr. Amy analogy). The irresponsibility makes the horror even greater and, I would add, inexcusable.
In a similar way, the irresponsibility of having a homebirth in the US with a CPM, DEM, or “traditional” midwife makes the horror of childbirth death even greater than it already is by “nature,” and, I would add, inexcusable.
Children die in hospital births, as do buckled children in car crashes. But the difference is that a real effort was made in both cases to protect that child as much as possible in these risk-laden endeavors.
Do women have a right to have a homebirth anyway? Of course. But, thanks to this blog, they can’t say that no one ever tried to warn them.
If you pick a house to move to that is three miles farther away from your kids’ schools and daycares and stay there until they grow up, you are subjecting them to about the same amount of increased risk. Oh, the horror!
Cite?
Sorry, DNFTT, I know.
[insert social sanction here]
But even with a CNM, the time it takes to transport a woman to the hospital can mean the difference of a healthy baby or a brain-damaged one.
Yes, thank you, good point!! (I still haven’t looked into any US figures relating to CNM- or OB-attended homebirths, so I didn’t want to over-speak in this area.)
Side note: As observed on multiple occasions, Alan has a breakdown when other people make logical and/or correct statements without the stats. Yet, he himself thinks it’s fine for him to make both illogical and incorrect statements, stats or not.
It’s quite comical!
Every time I read about a hb disaster I am so very thankful I didn’t buy into all that (I have several friends who hb). I will be forever thankful that I had a mfm oversee my pregnancy and deliver my baby safely at 33 weeks. I was glad to trust an expert.
This is a tragedy of sorts though isn’t it?
I absolutely never bought the various myths of the wondrous vagina and the joyous nature of natural birth. (Babies, becoming a mother, sure – birth not so much. If we were “designed” it was by someone with a warped sense of humour!) but I do have some of the mystical feelings about hanging on to my uterus. For a young woman to lose hers, and with it the chance of more children does seem to me like a big deal that would take some adjusting to. Not to mention the shock of finding yourself in serious medical trouble. Her first birth story is too unclear – doesn’t seem like that CS was unnecessary, but I still don’t think it is entirely irrational to blame that for what happened subsequently. Finding her way to ICAN, deciding she is broken, and getting fixated on the Holy Grail of a vaginal birth to heal – I just don’t get why women do that to themselves. I was rather taken aback that pregnancy was something my body didn’t take kindly to – but in much the same way that I was once disappointed that my adult height stopped at five foot six – I would have liked to be taller! I understand the practical reasons for wanting a VBAC – but setting it as a goal I don’t understand. So you wanted six or a dozen children – life does not always provide what you want. People limit their families for all sorts of practical or involuntary reasons – and well handled repeat CS is relatively small on the scale of life’s tragedies. You ARE going to have to be strong to come to terms with a self-inflicted mess like this one – but the mental gymnastics this woman has chosen don’t seem all that helpful, resting as they do on blaming others.
” I just don’t get why women do that to themselves.”
If you dig just a little, you quickly realize they have the NCB culture helping them “do that to themselves” every step of the way. If the NCB culture accepted cesareans as necessary and useful options instead of something to be avoided, shunned and looked down on, then maybe women wouldn’t be beating themselves up because they are failures and their bodies are dysfunctional and broken.
A lot of these birth stories have enough NCB tropes that it’s easy to see that the woman bought into an existing belief system.
Exactly. See our discussion down below about that issue. NCBers spend all this time convincing women who have c-sections that “they aren’t broken.” However, they are the ones who are telling them that c-sections are the consequence of being being broken in the first place. THEY are the ones who are telling women they failed by having a c-section, and that they need to be healed.
And then they are the ones who provide the way to “heal” it.
If that isn’t classic quackery, I don’t know what it. Convince people that they have an inflction they didn’t know they had, and then sell them the cure.
A lot of these birth stories have enough NCB tropes that it’s easy to see that the woman bought into an existing belief system.
And how! The number of times I have read – here and elsewhere – relatively sane stories which still contain “Of course I accept that natural, unmedicated is ideal…”
Who said?
Uncomplicated and everybody coming out well and reasonably happy is desirable, but setting it up as an achievable ideal seems very unhelpful to me. Women have, of course, been having babies since time began, but there is not much sign anywhere I don’t think that this was regarded as an achievable ideal until the late 20th century. We may pretend to admire our more “natural” sisters – but I think their main ambition is to have it as safe and potentially pain free as we do. Who is it exactly who admires this accomplishment? Can you put it on your CV? Were actual birth goddesses worshipped for their naturalness, or their defiance and triumph over nature?
I’ll take “sentimental about babies” any day over “sentimental about birth” Prioritising the second over the first seems to me like a particularly dim form of decadence.
I actually have a stamp for my students’ papers that reads, “Says who?” I should start using it on the internet.
“This is a tragedy of sorts though isn’t it?”
If this is a tragedy, the gods have gone soft. This lady displays a level of hubris far above any of the Greek tragic heroes, and how do the gods punish her? Do the gods serve her meat that turns out to be the cooked bodies of her own children? Or perhaps do they drive the children to commit matricide? Or maybe does she poke out both her own eyes with a spike? Nope. She gets 2 healthy kids and the solitary bad thing is that she has to limit her family size to the number that most women chose anyway. How dull. The audience should boo this one right out of the amphitheater.
Let’s assume that she’s right and her first c-section was unnecessary.
So what?
The damage had been done. She was now at increased risked of uterine rupture because of that CS. Forget all the melodramatic nonsense about “healing”–there are no do-overs. I don’t understand how someone can talk about the superiority of “natural” birth when her uterus is now “unnatural.” (No value judgment meant by that, just making a point.) It sucks that she feels she got dealt a bad hand, but that’s the hand she was dealt. She needed to make plans based on the cards she had, not the ones she wished she had.
“Unnatural” uterus: interesting mental picture there…
Cue the enormous green frankenuterus stamping through the city, roaring and smashing things. “It’s ALIVE!!!!”
Sometimes I think that is one of the big points of NCB… find the “need” and then sell them a product to fill it. So sad.
“I did not lose my uterus because I chose to birth at home. I lost my uterus because I underwent a caesarean that could most probably have been avoided with my first birth.”
This attitude that c-sections are unnecessary is what lead me to this website. My first baby was breech, so I had a c-section. I have friends and family that have had VBACs, so I wanted to try to VBAC for my 2nd. It seemed every internet site on VBACs had women talking about how healing, blah, blah their VBACs were and how they really didn’t need the 1st c-section. It drove me mad. I didn’t need a healing experience and I’m pretty sure my first c-section was very much needed. (Seriously, the baby’s thigh was the presenting part!).
That’s when I found Dr. Amy. Suddenly, all the whining on these other sites started to make sense. Suddenly, I was very o.k. with however my second baby was born. Thank you Dr. Amy for helping me to see that my repeat c-section with what turn out to be a 9 lb.+ baby was the best choice for us.
Isn’t it amazing to live in a time and place where having surgical birth is accessible as well as safe? The THIGH as the presenting part?? You and baby would’ve been in a lot of trouble in many other parts of the world. (Or here, if you were an NCB idiot.)
I’m with you on the last paragraph. I never needed any healing either. My baby was healthy and we were both doing great – what on earth could I need healing from? I’ve always been okay with my choices and birthing experiences, but after reading this site, I’m more okay with it than ever.
I say thigh as presenting part because that’s where the nurse attached the internal monitor that’s supposed to go on the head. And yes, in a third world country we would have been in a world of hurt to say the least.
This has probably already been mentioned, but HB advocates do actually take responsibility for some things – successes. And that’s it.
So she’s blaming the medical professionals on the grounds that the first c-section was unnecessary. OK, help me out here, medical types, what were the likely outcomes in the first birth if she hadn’t had the first c-section? I’m assuming baby brain death of some description was definitely on the cards.
Oh Lacrima, let me enlighten you. If the first c-section resulted in a pink screaming baby, then it was clearly unneccesarry. THe only times when c-sections are possibly – possibly – needed is when ebil doctors take out a poor floppy blue thing that has obviously been in trouble for a while.
Really, how arrogant – yes, I’ll say it, I think most of these women are arrogant. Everyone here, feel free to lash out at me – must one be to flaunt their own naturalness when ebil hospital is within easy reach (let’s put aside the question of how easy said reach really is) to save them when things go naturally south and then revile said hospital?
In this story, the mother was also a dumbass. Yes, a dumbass. Let’s say her first c-section was unneccessary. So what? Like a good little girl, the dumbass thinks it’s her right to actively help things to go south this time around? Err, there is a baby here who will pay the price but well, who cares? It’s the experience we’re after!
How does this make sence?
And don’t forget that a “natural” birth that produces a blue, floppy baby is beautiful, perfect, and no problem!
And when it turns out later that the child has learning difficulties, it must have been the vaccines, or the single bar of chocolate MIL somehow managed to smuggle in past Mom’s loving guard. It couldn’t have been the birth. No sista.
Silly me, I really forgot.
The baby’s HR went down drastically at home, after endless hours in a water tub. When she got to the hospital the baby’s HR recovered. (Imagine that, HR bad at home in a water tub and recovers at the hospital. Based on this anecdote, babies do better at hospitals. Haha) She had a natural protracted labor which never would have been able to deliver her baby, but thanks to pitocin, she was able to make it further. I speculate she was refusing things along the way and ended up with a CS. I also speculate she was refusing a CS, and was allowed to push in order to apease her wishes to try anything before giving up. The baby wasn’t coming out, prolonged ROM could lead to chorioamnionits and fetal sepsis. But she feels if she had just stayed home she could have delivered the baby safely after days of waiting?
That’s it, I’m not sure where she’s getting the “unnecessary” from. I had a rather similar progress in my labor and ended up with a CS for deep transverse arrest and maternal and fetal distress after pushing for an hour or so. I was never given any expert information about what would have happened if I hadn’t been able to get the CS or other appropriate intervention, but I’ve always assumed that I would have ended up with a dead or brain-dead baby at best, and maybe a fistula or sepsis myself. If my assumptions are correct, then how can she say that “Cesareans should remain an exceptional surgery to save lives”, and not recognise that she was one of those exceptions and her first CS may very well have saved lives?
I just don’t get it.
I wanted to applaud after reading this. One of the scariest hemorrhages I’ve ever seen happened to a labor patient shortly after she delivered. She was able to save her uterus because her physician used a bakri balloon, but it was touch and go for a while and she did have a nice little stay in ICU. If she had been one of these homebirthing whackadoodles, her baby wouldn’t have a mama. Believe me, there have been some times where I wanted to say exactly this to some of our homebirth transfers!
OT:
All the usual suspects:
http://io9.com/5986209/are-women-having-too-many-c+sections-in-the-united-states
Will the hysteria over csections ever end?
The article quotes a Amy Romano and Carol Sakala report: “Overuse of cesarean delivery in low-risk women exposes more women and babies to potential harms of cesarean with minimal likelihood of benefit.”
Apparently, Amy Romano and Carol Sakala don’t think that having a baby born alive and healthy is a benefit.
Avoidance of incontinance – not a benefit. Avoidance of emergent cesarean – not a benefit. Maintenance of sexual function – not a benefit. Avoidance of a traumatic delivery – not a benefit. Avoidance of birth asphyxia or brachial plexus injury – not a benefit. Avoidance of an inability to access pain relief – not a benefit. There’s a lot they apparently don’t think are benefits.
Adhesions. Far out I wish I’d known about this earlier. 12 months of intermittent pain that couldn’t be pinned down to a specific area and seemed to involve multiple parts of my abdominal area. It wouldn’t have changed my decision for c-sections but might have helped me find an answer to the worsening pain a bit earlier.
Oh and not that they mentioned it in that article either. Just ‘chronic pain’, which is confusing because mine didn’t feel ‘chronic’ but like lots of ‘acute’ pain episodes that varied in intensity, cause and duration…
Isn’t Amy Romano associated with Science and Sensibility? And co-authored with Henci Goer? Certainly a very biased source.
I was low-risk until I suddenly wasn’t. That label is meaningless.
“Are women having too many c-section?” Well I know I had exactly the number I needed.
Love this ^^^^^. I will have to borrow it.
Me too!
I’m seething – that article is awful….
Argh. Yeah, cesareans have some very real risks. Even mainstream OB researchers are concerned about the rate of cesareans and the increases in things like accreta in subsequent pregnancies. But cesareans also have very real benefits. The benefits of c/s and the risks of vaginal delivery weren’t even mentioned in this article at all.
Te major risks of c-section are related to future pregnancies. If there are to be no more pregnancies, then there really isn’t a lot of extra risk.
OMG. Get out of my vagina!! When did it become ANYONE else’s business how I birth? You want a homebirth? Cool beans. Elective Cesarean? OMG OMG OMG OMG OMG!
I’m really confused as to what you’re trying to get at.
Just go on any birth website (mothering, babycenter) and state that you are choosing an elective Cesarean. Not for medical reasons, simply because you desire one. You will swiftly be excoriated to the nth degree. Same website, state that you want a homebirth (or even a VBAC, HBAC with twins, etc) for whatever reason and it’s all “You go, Mama.”
The NCB movement talks a big game about freedom in childbirth, even painting it as a human rights issue, until you get to maternal-request Cesarean.
Hope that makes more sense.
Ok, now I get it. Thanks.
Assuming you’re talking about a first c/s, here’s my question: shouldn’t you have to pay out of pocket for that request? Why should either the taxpayers or the premiums from others in your insurance pool pay for it?
So if you request a cesarean you should have to pay for it yourself not rely on taxes that fund a medical system or your insurance? Why? Why should someone have to pay for that?
You are in effect saying that women have to birth vaginally or at least give it the ol’ college try. Why should they? Why should we? If someone has a vaginal birth and gets 4th degree tears should that repair be covered? If a baby has to spend two weeks in the NICU after a vaginal birth should that be covered? What makes any of these (also expensive) scenarios better and therefore paid for?
If you have kidney stones Alan then you should really try to pass them – even if they exceed the 5mm mark. We may give you some pain relief if someone happens to be available to prescribe Tramadol or something but seriously – you don’t know you can do it unless you try! We will not cover an immediate stone removal procedure until you really try to pass them. I realise this might be a bit of a clumsy analogy but you kind of pissed me off and I will admit that.
The only way it would make sense for taxpayers or the insurance pool to pay for elective C/S is if the mainstream medical advice was to try to get C/S rates higher, up to 100 percent if possible. But that is the opposite of the opinion of ACOG and other public health entities, that want the rate lower. Thus if you want what you admitted was an “elective” C/S for “non-medical” reasons, you should pay for it yourself! Just like a facelift or w/e.
Mothers who request an elective C/S are making a trade off between benefit and risks. Those increased risks are very small, especially if the mother plans few children. On the other hand, the increased benefits include a much safer delivery for the baby, on average, as well as reduced risk of pelvic floor damage. There is no comparison to a facelift, which is cosmetic.
I’m not talking about risks here, I’m talking about money. Moolah, bread, cheddar, greenbacks.
MRCS are not a homogeneous group. So is the definition of “medically indicated”. I am a strong supporter of attempting a vaginal delivery when safe, but have performed several c-sections that many would consider MRCS, but I would disagree.
You are interested in cost, so consider the following. A primigravida, 40 years old, at 40 weeks, with borderline low amniotic fluid and a unfavourable cervix. She has multiple indications for induction, but after a long discussion, she requests a c-section. Why? Because her risk for an intrapartum, emergent c-section likely approaches 50% or more, and she would like to avoid a lengthy induction, possible fetal comprise and just go straight to the c-section. She want to enjoy her birth experience and enjoy the arrival of her new bundle of joy.
On average, her choice will cost the system here in BC LESS that those women choosing and induction, once the added cost of the intrapartum sections and NICU admissions are included.
Then an fine-grained actuarial analysis would catch that and greenlight her. Problem solved.
So, lets say the fine-grained actuarial analysis shows that a c/s would be less expensive. Should she have to pay out of pocket for a vaginal birth if she wants that experience? Or do you only implement your Disapproval Tax on c-sections?
Not a disapproval tax, and yes: it should go both ways.
Glad to hear you’re willing to let actuaries make your medical decisions for you. So when the actuaries determine that it’ll cost too much to keep you alive, you’ll happily take a cyanide pill or fork over all your money for the privledge to continue living.
Do you happen to know the r-squared on a typical actuarial analysis? Am I correct in assuming that even a “fine grained” one can explain less than 50% of the variation in outcomes?
Actuarial analysis leaves a lot to be desired….r-square ds aren’t nearly as high as Alan would like to believe they are.
Would be interesting to go into the math on induction versus scheduled section for a 41 week pregnancy, or something specific. See what you can come up with.
Other things that could easily be classified as “elective”: epidurals; inductions for postdates absent any sign of distress; use of the nursery. Let those greedy women pay for it all!
This is a very key point. Rarely does a women requesting a MRCS want many more pregnancies. It is totally a trade off of risks. If you want more than two kids, it’s important to at least consider avoiding that first c-section due to the cumulative risk of multiple c-sections. But if one kid it all you want, I could not care less how you delivery, and would be happy to do your c-section.
Haelmoon, I hope you get in touch with Mrs W. She gets lots of mail from women who can’t find OBs that will support MRCS
Not to mention the fact that the definition of “elective” gets pretty dicey. Some of the most common reasons for requests for “elective” C/S include a history of sexual assault and prior vaginal pain. Many patients who have been sexually assaulted do not want a C/S. But some do. Many patients who have chronic vaginal/pelvic pain do not want a C/S. But some do. Where is the comparison to facelifts?
OK, run the numbers for us. What is the cost of an elective c-section versus the weighted average cost of a labour attempt (include inductions, augmented labour, emergency c-sections, and instrumental deliveries, as well as simple vaginal deliveries). What’s the order of magnitude of the difference of cost?
This is not as complex as the comparison you are requesting, but you have to keep in mind that the weighted average with c-section is going to include cases of complications too (which obviously are more severe on average than those associated with vaginal birth, or ACOG would not be trying to reduce the C/S rate even by encouraging the far riskier VBAC), both to the mother and to the baby (I was told in the hospital that the neonatologist has to be immediately present at birth with c-sections because C/S babies often are at more risk of immediate postpartum crisis).
http://children.costhelper.com/baby-delivery.html
This link misses the point entirely.
I repeat: Are you really arguing, on this blog of all places, that what individual mothers prefer, against medical advice, is a better cost-benefit choice than what OBs recommend?
No, I am arguing that the outcome of a attempt at a vaginal birth is variable, some of the outcomes being more expensive than a maternal request caesarian (for example, an emergency caesarian).
I vaguely remember that when a real analysis is done, the difference is not that huge. But I’m not arguing that this shouldn’t be covered by insurance.
I would be fine with the insurance companies (or govt.) doing what they do with their teams of actuaries, producing a report on the average actuarial difference in cost given the woman’s particular parameters, and then requiring she pay out of pocket (separately from her other OOP charges) for that difference. Then if it becomes complicated and more expensive, they pay for it. Fair?
Really? The overhead seems likely to be more expensive than it’s worth or likely to collect. And it’s not like it would fly in here – probably violate the Canada Health Act.
I get choices about medical treatments from time to time. They don’t always cost the exactly same amount. For my recent pregnancy, when I went postdates, I was told that watchful waiting (stress tests and revisit in a week), induction, and scheduled c-section were put forward as options by my OB. Same with friends and family with cancer, or orthopedic problems. Surgery now or try bracing and drugs first? Go on a certain breast cancer drug to prevent recurrence with serious side effects or not?
No.
that kind of crap is why 20% of what is spent in the US healthcare system is insurance overhead. It would be way more cost effective to have universal health insurance like we do in canada. Our insurance overhead is 2%.
I could fund several million MRCS with that I think.
I would love to have the Canadian system my sister enjoys here!
Then stop being such a twat about who pays for what!
stop it, I had a drink in my hand and now it’s all over the desk!
Me too – had to put it down!
I have universal health care here. We pay for all sorts of lifestyle choices: MRCS, homebirth (the government sanctioned variety – not the internet stunt birth variety), transplants for addicts, lung cancer care, people that leap off tall buildings, drunk drivers that drive their cars through fences and into swimming pools, toddlers that stick peas up their noses.
We’d pay for you’re irritable bowel treatment from all that damn insoluble fibre you’re eating too, Alan.
Actually MRCS can be a bit of a battle here on the public system 🙁
I stuck a pea up my nose when I was two. My parents started to panic. My sister, on the other hand, calmly pinched one of my nostrils shut and said, “Blow.” TA-DA!
Now you’re arguing that my diet, compared to the SAD, will be a net *cost* to the risk pool? The Harvard School of Public Health has it all wrong, that it?
but then should HBers with a transfer and NICU admission pay for that, since those extra costs wouldn’t have been needed ? This kind of argument is a slippery slope….
They should pay the average difference in cost if it is higher than going to the hospital to start with, which I doubt.
Would this f’n work in reverse too – you know where it’s obvious a csection is cheaper, demanding women pay the cost difference to attempt a vaginal delivery? You are an ignorant fool Alan.
Can a doctor perform a C-section AMA?
Who said anything about against medical advice?! And a repeat section is not the same situation as an MRCS so keep them separate. Repeat sections remove labour caused rupture risk.
And if a woman has been raped and finds the idea of giving birth vaginally abhorrent, is it worth the cost savings to force her to have a vaginal birth rather than an elective c-section, Alan? Of course, if she winds up with postpartum psychosis and has to be hospitalized or kills herself and/or her infant, that might make the difference I monetary cost between vaginal birth and c-section nil. Do you also believe that women should be forced to pay for their own epidurals? If the answer is yes, no doubt remains in my mind that you are a misogynist twit. Perhaps in another life you will be granted a vagina and get to experience the attitude that labor pain is not worthy of relief.
Alan, did you read Amy’s post about how the 39 week rule appears to be leading to more dead babies? Sure, NICU admissions are down for TTN, but is it worth the non-monetary costs? ACOG allowed the MOD to drive policy, and now we’re seeing the results.
We all know that you think that vaginal birth is great, which is probably quite easy for you given that you will never actually have to do it yourself. If you think that women are selfish for wanting to protect their pelvic floors, well, that makes me think that you’re an ass.
You did catch that three of my four kids were born via c-section (the last of which was “elective” as my wife and I rejected the OBs advice to try for a VBAC); as was I, my sister and her two kids, my father, and my grandfather…right?
If you think C-sections in cases of no previous c/s or other risk factors should be considered medically indicated, lobby ACOG, the govt., etc. to change their standards. As long as they do not, the national imperative to rein in the unsustainable medical cost curve makes the case for denying payment on this a very easy one to make.
But until it’s YOU with the post baby giggle tinkles, you can’t really understand what it’s like to treasure your continence. So the next time YOU personally want to give birth vaginally and don’t want to do it in a hospital and understand the risk of vaginal birth-have at it. I am sure I am still qualified by Melissa Cheyney’s standards to call myself a midwife and I would catch the baby for free. Just understand if things go south, I am going to insist I was simply your doula for your elective UC and I can’t be held liable for any damages.
In fact I believe that may be just the post when Alan first showed up and began relentlessly pestering.
there was a study in the UK that compared a vaginal birth plan to a pre-labour c/s plan. The c/s cost only 70 pounds more, I believe.
Hardly a reason to refuse on a cost basis alone.
Link? (I would still charge her the 70 quid.)
I’m sure you would. For now go here
http://cesareandebate.blogspot.ca/2011/08/nice-admits-that-cesarean-extra-800.html?m=1
And follow the links to the sensitivity analysis done by NICE
Very nice–exactly what I was asking for, although not as fine-grained as it ideally could be if broken down by age and other factors.
But sure: go with the more generous estimate, taking into account quality of life factors with potential incontinence. Charge the lady 200 quid if she promises this is her last baby; hit her with a bigger “user fee” if she nevertheless comes back again with a subsequent pregnancy.
Didn’t Mrs W work this out for Canada and it was $75 difference. And sure Alan you would still charge a woman preserving her pelvic floor and sexual organs as well as the mitigated risks to the baby that $75, who wouldn’t want to give women and babies those things for $75? TAM called it, stop being a twat.
No it makes sense if we want to give women choice. Are you against that Alan? Or should they birth the way you think they should? A face-lift? Please. A baby’s life and a woman’s choice are at stake here not subjective standards of beauty. I thought I was stretching it with kidney stones – I see now I should not have worried. The damage to your ureters and bladder in trying to pass a large stone are acceptable risk then, just like potential damage to a woman in vaginal birth.
GMAFB: a c/s is MAJOR SURGERY.
I don’t do Internet shorthand. And yes, major surgery – and?
I love it-every time C-sections are brought up the term “major surgery” is used. Get back to me when you have spent 30 minutes doing a dressing change on a post ICU AAA patient with an open repair and we will talk about major.
As far as I can tell the designation of “major” surgery comes from the 1980s when a classification scheme fir risk was put forward and when any surgery that went into the abdo cavity was called “major.” there was a trial program in South Korea or maybe it was china where thy were able to safely discharge women 24 hrs post csection that was published not too long ago. Doesn’t seem that major, does it?
Now compare that with any number of abdominal surgeries where at least an overnight stay in ICU is per care plan.
I know! It really grinds my gears! Or “major abdominal surgery”. It doesn’t breach the peritoneum! Gnrrrr. Yes, you get a scar, but it’s like saying that a mastectomy goes into the chest cavity.
Watch out for falling NCB hyperbole!
OMG, really Alan?! Major surgery? Do tell as you’ve never actually experienced one. //snark
As if being in the close proximity of two wives after three c/s means nothing.
Stop using your wives’ cesareans to show us how open minded you are. I have been in close proximity to someone having a heart attack – I do not know how it feels to have one. Also in this thread you have not made people here realise that they should support homebirth if they support MRCS – the risks are not the same and I think it is safe to say people here support giving women accurate information to make decisions in conjunction with a qualified HCP. There are no ‘gotcha’ moments here for you.
It means that everyone was very, very lucky. Childbirth is a dangerous event, and you have no loss or injury to account for. Which makes you very, very lucky.
Alan – ever been in close proximity to a nephrectomy, a bowel resection for cancer, a repair of a ruptured aortic aneurysm? (thought not)>
I suggest you read up on cognitive error and spectrum bias.
And I promise to think really, really hard about making the choice to go down that route.
Deciding to get pregnant is a MAJOR decision too. Women can handle these types of BIG decisions, doncha think?
So…is that how you feel about HB then?
Would have been better if you’d kept it as short.
And actually it is how I feel about homebirth. Two CNMs, strict risking out and a second time mum who, for whatever reason, decides she wants to hang out at home even though there is a higher chance of killing herself and/or her infant. I’m not going to do it myself and I’m not going to agree it’s a great choice, but it is her right to make it.
And despite your waffling and attempted ‘gotcha’ moments I suspect most people here feel similarly.
Waffling? Do tell.
Not sure that waffling is the word I would choose – but I do find many of your posts unreadable and a bit lacking in point. You appear to have come here with the intention of sneering (from your lofty height) and/or educating and converting us to your own so superior point of view. Damned if I can see why you are bothering, really. Except to tease.
What is your point, Alan? I have gathered that you have strong and rigid views on diet, bf, and AP. No problem there. Of course everyone is entitled to choose and define what is important to them. But you appear to want to be judge and jury on anybody else’s (different) views, and batter them into submission.
Agreed. But why in the world would we call that belligerant? 😉 Alan agrees he’s smug, but just can’t, can’t figure out why people are using the other word.
This a thousand times KarenJJ, this is EXACTLY how I feel too
You know what is also major surgery? Incontinence and prolapse repair surgeries. Very expensive as well.
What about reconstructive surgery post mastectomy? That is elective. It’s covered by insurance, so presumably people are paying towards something that carries risks and is non medical. Maybe we should start having those vain women who want boobs even though they have had breast cancer pay for that.
I think if mainstream advice were to prevent injury to women from vaginal birth and to prevent brain injury and other birth injuries to newborns, then yes, a higher c-section rate might be part of that.
Alan,
Should insurance pay for the prolapse and incontinence surgery of a woman who chose to have 7 vaginal births, has a BMI of 40 and COPD from her 40 a day cigarette habit?
If not, why not?
If it got to a point where actuarial analysis showed HB was not cost effective and that the system could no longer afford to act as backup for uninsured DEMs, you’d be all for banning it, would you?
For charging people who choose it the marginal increase in cost to the system, yes: absolutely.
What if women want a CDMR to preserve future sexual health? Not enough of an issue to warrant government coverage? It’s an oft-ignored issue, and a CDMR can avoid perineal tearing 100% of the time. I’ll be using my vagina for the rest of my life; doesn’t it deserve preventative care if I deem so?
And doesn’t insurance also cover Viagra? I mean, you don’t NEED to preserve your sexual health. You can live without an erection. Clearly that’s just a want that shouldn’t be subsidized by the taxpayer.
Assuming you’re a proponent of home birth, here’s my question: Why should either the taxpayers or the premiums for others in your insurance pool pay for your baby’s NICU stay, early childhood interventions for brain damage, etc.?
Show me solid evidence that a HB will ON AVERAGE cost the risk pool more (or even close) than an elective C/S, and I will concede your point.
Can we include funeral expenses? And the cost of lifetime care for an injured infant and/or mother? Or are we only counting birth related costs?
This particular case cost a lot. Seven hours of surgery. Multiple surgeons. Many units of red gold. Days in the ICU. Likely weeks in the hospital. Probably months of follow up care.
So should all births ideally be via c-section then? Again: Are you really arguing, on this blog of all places, that what individual mothers prefer is a better cost-benefit choice than what OBs recommend?
No you moron, how about women make the choice for themselves in conjunction with good medical advice without someone like yourself weighing in on the matter?
And to clarify, CPMs, DEMs, childbirth educators, doulas, Henci Goer, Ina May Gaskin are not qualified to give good medical advice.
And neither is Alan!
There are ob’s arguing that the risks of vaginal birth are such that an elective c-section, particularly for an older mom who my be having only one birth, offers better outcomes. Also, this blog examines ways in which NCB philosophy inflitrates science-based medicine to recommend non-science-based outcomes. And that’s something that appears to be happening with some of the recommendations against higher c-section rates.
Editing above to read “may offer better outcomes in some cases.”
Your own situation is a good example of how homebirth with a CPM is not cheaper even in a non-catastrophic situation. Your wife still required hospital care and a CS so no money was saved at all, in fact the costs of the CPM were in addition to the hospital costs. Homebirth still requires hospital back up so all the resources required for hospital birth (and arguably more due to the emergent situations in which transfer is likely to occur) still need to be available. If everything goes great they weren’t needed, but they still needed to be available.
Also, there is an unquantifiable but actual loss to society when an individual is unable to work, such as a person who has a perinatal hypoxic injury. And loss of work for their caretakers. All this is in addition to the costs of caring and managing a chronic illness that may well have been preventable.
Part of the reason that NICUs and early intervention and aggressive screening happens is because they contribute to an individual’s well being for the next 70 to 80 years. So it’s socially sensible to spend the money, and be risk averse at the start of life. Whereas aggressive futile care is exactly the opposite, and often more expensive in actual monetary amounts, and yet is far more socially acceptable.
You’re such a big expert, you figure it out.
Alan – individuals do not make “on average” decisions they make individual decisions. Have you ever stopped to think how awful making “on average” decisions might actually be? Individuals are uniquely positioned to make the ‘best’ decisions, forcing them to make the best on average decision might actually cost the system more, because the best average decision might not be the best individual decision.
In my state, both the taxpayers and people with private insurance are paying for home births and the complications that can arise from them.
Which is cheaper per capita than c-sections for all, surely.
I disagree. The number of maternal request c-sections won’t be huge, I’d predict. How much does lifelong care for cerebral palsy or brain damage due to hypoxia cost?
You seem to be trying to compare a small number of requests with some other large population with rare complications?? It has to be on a per-capita basis, or a comparison of equal-sized populations. So if 100,000 mothers get maternal request c-sections (meaning there is no medical indication for them, a population disproportionately likely–though not, I understand, guaranteed–to have uncomplicated births), how much is that going to cost compared to if all 100,000 followed their OBs’ advice?
Are you really arguing, on this blog of all places, that what individual mothers prefer is a better cost-benefit choice than what OBs recommend? LOL
No, I was trying to make an analogy that some choices may cost a little more in the beginning (mrcs) and others cost enormously more in the longterm (vb with complications).
Are you not understanding that there are risks to VB that some women want to avoid? I doubt that there will be a “rush” on sections anytime soon, but that choice should still be available.
It is the net risk, with everything combined, that matters, combined with a cost-benefit analysis. The medical cost curve we have in the U.S. is unsustainable, and it necessarily means that ordinary folks cannot expect to have the same level of medical care the president gets (or that a billionaire can afford).
Yes, the choice should be available, but with the individual paying for it. Not for the entire cost, just for the marginal difference in cost compared to what is medically indicated.
You know what also costs a lot of money? People who have four children when they are unable to afford health insurance.
But you know what? I will absolutely advocate for your right to have those children, because, unlike you, I don’t believe I’m some kind of moral or ethical authority to decide who gets what and who doesn’t or that my opinion has more weight than another person’s rights to control their own lives and bodies.
Alan – to say that your thought process on this is “bad economics” is putting it mildly. Taking population statistics and applying it to individuals is the first error you have made – a patient is not a population but an individual and as such has specific knowledge regarding herself and her situation. The first principle of economics is that people are rational and make rational choices – as such if given all the information on the relative risks and benefits, a patient will make the choice that is best for them. This is efficient – those for whom planned vaginal birth is best will choose vaginal birth, those for whom planned cesarean is best will choose cesarean. Secondly – the population statistics with respect to planned cesarean are woefully flawed. The cost statistics commonly cited are composite costs that include both emergent and elective cesarean deliveries. Further, the current cost statistics do not include any longer term sequalae of planned mode of birth – so the costs related to pelvic floor damage, brain injuries, PTSD, or other are not included. It’s trite to say that providing no health care does not cost anything (allowing folks to die is also extremely cheap from a healthcare resource use perspective) – but that does not mean that providing care is without value.
“The first principle of economics is that people are rational and make rational choices”
An increasingly discredited principle thanks to the new insights of behavioral economics.
Uh, have you spoken to any economists about this? Or do you just read pop economics books and consider yourself informed about what economists believe?
Probably the Freakonomics book. I love both of them and so did my husband. But we won’t be attempting to apply what we learned in those books to healthcare reform.
I was thinking “Predictably Irrational” which makes the argument he does above and while doing so presents an entirely erroneous view of mainstream economics.
As I am an actual economist, I believe you are incredibly wrong.
Hee hee.
So let me summarise your position: women should have homebirths with CPMs in order to save money (that you don’t want to ‘pay’ out of tax or insurance dollars) and any babies who are catastrophically injured due to incompetence/negligence should be euthanased so that their incredibly expensive care doesn’t have to be paid for. Awesome. You should be in public policy.
My fear would be that he actually is in public policy.
You seem unaware that many OBs believe that women should have the choice between a TOL and a MRCS. Many would choose a MRCS for themselves or their loved ones as well.
Karen, see the link above-this is a girl who will be cared for her entire lifetime. Heartbreaking
The answer, of course, is a lot. And one of the risks people should factor in is being constantly reminded that your child is a Burden to the State.
A local councilor has just had to resign here in the UK for stating this rather too baldly. In his view, disabled children should be “put down” because society can’t afford them. His mistake was to state in unacceptable terms what quite a few people would agree with.
Aha, read this just after making a similar case upthread.
you said it better and with less words than i could have.
http://www.balmainphotography.com/diagnosis-unknown.html
Camille Coppernoll. CPMs cared for her mother during pregnancy. Traumatic birth. These pics were taken a few years ago and she still continues the same treatments, without any measurable change. State medical still pays too.
Are you going to link us to the stories of all the contemporaneous cases of babies born safely and cheaply attended by CPMs at home? Or just blatantly cherry pick?
No, there are plenty of women who share their home birth and free standing birth center stories that are happy and include a healthy baby. This is just the most extreme example of what can go wrong and how extensive the damages and costs can be when considering home birth and using CPMs. This story also hits close to home as the midwives involved are ones that I know well and who are still practicing.
There is no such thing as a safe homebirth, in the US, attended by a CPM.
If the baby was born alive and healthy, then everyone should count themselves very, very lucky.
Something that even around here is credited with happening 99.9% of the time is the result of being “very, very lucky”? Really? With the extra “very”, even? Huh, I know a bunch of “very, very lucky” people then. Maybe I should ask them for lottery numbers!
Is their a reasonable chance that most homebirths will go OK? Yes. Is it safe? No. Are their good reasons for taking the extra risk? For most of us, the reasons seem pretty silly. You do know the risks, but assume they will not apply; or you have been brainwashed into believing that the risks are negligible, and there is some huge benefit to staying away from a safer place. As Karen say, hardly anyone would want to ban homebirth – but is there any huge problem with discussing it and highlighting , not the magnitude of the risk, but the devastation that can come from NOT being lucky?
Do you have to be “very,very lucky” to get a live baby? Probably not. Do you have to be “very, very lucky” to get a baby in optimum condition and a mother absolutely unscathed? I think, perhaps, you do.
Yes. Very, very lucky.
but the statistics are not 99% b/c you have to factor in the rate of transfer to a hospital.
The HB lottery is not 1/1000 of having a bad outcome — it’s probably a lot closer to 1/3….not a lotto I’d want to buy a ticket for.
Where on earth do you get this figure?
I see no reason the government should fund under-qualified, uneducated, and oft-times ignorant midwives (CPMs) who have little to no training or relevant education and are seeped in woo. Sorry, homeopathy and craniosacral therapy don’t count. These providers are operating on luck.
In what other area do you suggest that the taxpayer subsidize the bottom of the barrel?
C’mon Alan. I had more faith in you than this. you can acknowledge the astronomic expense of reviving an infant deprived of oxygen during a long protracted labor at a home birth who is then transferred to a hospital where a c/sec saves the mother’s life but the infant is left with brain damage out weighs the upfront cost of an elective c/sec.
http://www.guidestar.org/organizations/52-1575751/accord-foundation.aspx
Guidestar report on the Accord Foundation. This may be a report for the wrong organization. Sorry.
Some people refuse to pay for elective C-sections, I don’t want to pay for people to have elective home births.
Some people? You mean insurance companies or what?
We paid completely out of pocket for our elective HB (attempts) and I am fine with that, even though we were low income and qualified for Medicaid (which is what paid for the hospital births after transfer).
Or what I guess.
^^
That’s the purpose of malpractice insurance.
In our current “system” the entities most likely to be sued for those costs are hospitals and doctors who care for the patients, even though they didn’t have care of the patient during the precipitating event.
The mantra of public health care is that problems can be mitigated and prevented with good primary care. This applies to ALL primary care including prenatal care.
Umm – no you didn’t pay completely out-of-pocket for your elective HB attempts – the public largely subsidized the huge risk you took should things have gone badly. You did not pay out-of-pocket for insurance that would have covered the costs of a life long disability or death that could have been avoided if you birthed in hospital.
He also apparently thinks it is reasonable for the taxpayers to subsidize his elective unemployment.
I’m sorry, what? You “paid completely out of pocket” for your HB attempts, 3/4 of which resulted in c-sections?
No, medicaid (i.e. everyone else here, including the women whose rights to control their own bodies you’d like to restrict) paid for your HB attempts. You didn’t pay for anything of value. You left that for the rest of us. Yet somehow you feel that you’re in the position to tell women that they shouldn’t be able to choose a c-section delivery because it might cost more? You might want to work on that “avoiding hypocrisy” thing a little more.
“Which is cheaper per capita than c-sections for all, surely.”
Possibly but my daughter’s top-notch NICU care for 4 days was probably worth a lot of c-sections.
I mean the total per capita cost including anything that results, like NICU stays.
I shudder to think of the costs of caring for a single HIE baby. Round the clock nursing, specialty doctor appointments,PT, OT, RT, vent, spare vent, trachs, anti-seizure meds,formula feeds for life if tube-fed, plus the boxes and boxes of supplies needed for regular care.
Sounds like a good candidate for euthanasia, frankly.
Are you seriously suggesting that HIE babies be euthanased in order to save money? o_O
God, Alan, could that comment be any more disgusting? I sincerely am beginning to think that you’re a eugenicist at heart.
Suspected you would think that. All our parachuters are so alike.
Alan, I’m curious, what do you think is more likely to result in a
NICU stay?
An elective, pre-labor c-section, or a homebirth transfer?
Seriously, did you think at all before posting that comment?
Here’s a suggestion: put away the speech-to-text ap and read some Dr Seuss to the baby. Or go outside (weather permitting) and let the baby enjoy the outdoors.
I don’t know. I do know that *my* two HB transports resulted in stellar Apgar scores and no time at all in the NICU or even in the nursery (other than brief visits for routine checks, always accompanied by me). I suspect you have read too many horror stories here to have perspective. Facts are what we need to bring to this debate. I largely changed my mind about the cost of MRCS based on the British study; if you can present something fact-based like that, you may change my mind again.
You also elide the fact that the comparison needs to be not between elective C-sections and homebirth transports, but between elective C-sections and *all* attempted homebirths, including those which are not transported.
I’ll ignore that last bit except to note that it is widely understood to be extremely poor netiquette.
Alan: “I don’t know”
Bravo!
Your n of 2 means nothing.
C-sections for _all_? Why would that cost factor into the discussion?
This is the same tired argument that conservatives use about birth control, i.e. why should the taxpayers fund your reproductive choices? Well, because they don’t. It’s an agreement between the consumer and their insurance agency, not the general public. If an insurance company agrees to fund someone’s procedure, or bill, or birth control pill, it’s no one else’s damn business.
And, frankly, this wasn’t a cost-benefits comment. The general public is always bitching about things they don’t want to pay for: WIC, SNAP, TANF, foreign wars, border security, vaccines. This is a comment about the NCB dominated ideology of freedom of choice in birth.
Well, no: now insurers do have to cover it, under Obamacare. But I’m fine with that as it clearly comes out as very cheap or probably a net benefit for the overall cost to the risk pool.
Alan – please take a flying leap, a long walk on a short dock, and think for a moment what you are saying – women should be forced to accept the treatments that society thinks are best regardless of her own needs.
If they want society to pay for it, yes, obv.
I will admit that in my early days of being a mom, I would look down on women who had elective e-sections or didn’t want to try for a VBAC. Fortunately I’ve grown up since then.
Big difference IMO between a pure elective section with no medical indications, vs. not wanting to try for a VBAC. The latter case was true for my wife and me with our last baby; I would vigourously defend our right (ultimately, HER right) not to risk uterine rupture (not to mention in our case knowing we make babies that just don’t fit through the pelvis).
To insist the general risk pool (or taxpayers) pay for your first elective caesarean is another matter altogether. (I’m not saying you shouldn’t be allowed to have one if you have the money to pay for it and find an OB willing to take your money to do it.)
Sorry, Allan (and I haven’t caught up comments missed in almost 2 days of hacking up everything), on this one you are just flat out wrong.
I read your argument as (I quote) “To insist the general risk pool (or taxpayers) pay for your first elective caesarean is another matter altogether” – as meaning you don’t want to pay for something that other people would choose in order to lower the risks involved. I note that you’ve already posted that with both wives you sought out the option of home birth.
I counter: To insist the general risk pool (etc) pay for your first birth without medical resources present, in spite of the fact that same risk pool will still be responsible for caring for any adverse outcomes due to lack of medical resources is hypocritical beyond belief.
You don’t want to pay for what you label as elective surgery? Well, I don’t want to pay for the consequences of your wishful thinking.
I pride myself on avoiding hypocrisy while decrying it where I see it. I have been convinced by a detailed analysis linked to in a comment here (linked within the link anyway) that the ultimate cost difference between a MRCS and attempting vaginal birth is only around $300 when quality of life considerations are ttaken into account. That surprised me, but I accept it.
If you can show me a similarly detailed and authoritative analysis which would convince me that attempting a homebirth (for which we paid the midwife and doula’s fees out-of-pocket) has a greater average cost to taxpayers than going to an OB starting in the first trimester, I will absolutely endorse charging a homebirth fee equal to that average cost.
As regards the particulars of my own family’s experience: keep in mind that we live on the same through street as the hospital, three-fifths of a mile from the ER door. (Also remember that my first attempted homebirth, with my ex-wife, was with a board-certified physician with hospital privileges.)
Alan, as I mentioned, I skipped a lot of comments and I’m really glad that you have come around about the cost effectiveness of MRCS.
Can I “can show sic[me] a similarly detailed and authoritative analysis which would convince sic[me] that attempting a homebirth . . . has a greater average cost to taxpayers”?
No. I’m not an accountant. But I’m also not the one who’s claiming it’s cost effective – that’s you. It’s your job: you show me. Keep in mind that you also have to account for the costs involved in the transfers, and long term care for the adverse outcomes.
Your own family’s circumstances are irrelevant if we are discussing this in terms of general risk.
*You* referred to my family in the comment to which I was responding! Sheesh.
I think the burden of proof is on the side that wants to restrict someone’s freedom to do something in the privacy their own home, or at least wants to tax said activity.
Me too. And I am fully ashamed of the years I spent steeped in the woo.
What a shame. I’m sure you missed out on a few friendships that way.
She’s MUCH crazier than Dr. T’s excerpts make her sound. Her “unnecessary” first C section was due to transfer b/c of fetal distress and failure to progress at the hospital. Do these women get pregnant because they want a baby or because they want to experience birth? I just don’t understand b/c to me birth is a means to an end. Neither vaginal birth nor C section sounded particularly appealing and I was willing to go with whatever my OB recommended at the time.
There is some truth to that, almost a fetishisation of birth (I hesitate to put it that way, because if my friend Lynn is still lurking that verbiage will most likely piss her off; but it is often true IMO).
She wanted a home birth and water birth for her first experience. First time mothers are not considered good candidates for HB and transfers are common (in countries where NHS offer HBs).
Frightening to me, as a Canadian who delivered with RMs, that this appears to have taken place in BC. So much for Canadian midwifery being touted as a great option for low-risk mothers. Over and over again, that was what I heard, from my RMs, from my GP — midwifery is a great option for low-risk mothers. Where was the low-risk in this, again?
BC midwives take HBACs. MSP pays for it.
It’s just so wrong on so many levels. HBAC, breech, twins, have nothing to do with the low-risk model of Canadian midwifery care.
It’s all a variation of normal. It’s as safe as life gets!
😛
You know, if you’ve had a few uncomplicated vaginal deliveries and you’re otherwise a good candidate, then I don’t have a problem with homebirth with a qualified RM/CNM/etc. I don’t think it’s the greatest idea…nor do I think it’s the worst idea ever. But HBACs, man — you’re asking for trouble.
I thought it was great that the MW transferred her proactively the first time. The second time? Meconium and the MWs wanted to transfer her, but she apparently refused the orderly transfer and opted for an emergency transfer instead.
I hope she scared her midwives half to death. Someone should have learned a lesson from that.
I know a midwife who did an HBAC with a woman whose previous baby had been cesarean born and sadly died – Potter’s syndrome. The HBAC was a ‘low-tech’ pregnancy, so no ultrasounds. They were lucky and it enforced their view that birth could be trusted despite the previous heartbreak.
Reinforced. Autocorrect + missing a letter in typing. Geesh.
Are the standards different province to province? I know my friend was referred when the u/s showed a twin pregnancy her in Ontario so I would be shocked if they would do an HBAC.
In Ontario, midwives are permitted to attend HBAC. However, at my clinic, my RMs were not comfortable attending HBAC. My “good” midwife was wise and risk-averse, and would not do breech, VBAC, or twins at home, amongst others.
Same with two of my friends who wanted a homebirth (both in Ontario). One would has been an hbac, both ended up being risked out for things that CPMs here would have called variations of normal. They were still cared for by the midwives, but ended up giving birth in hospital.
You know, just like with the midwife on mymidwifesaidwhat? that flat-out admitted she didn’t like babies, I wonder if this mom would say that she cares more about an in-tact uterus than a healthy baby.
Seems the problem here is her ideologically induced need to see blame as either/or – because a woman knows how to birth no matter what. A reasonable analysis of this story would come to the conclusion that she lost her uterus both because of her prior C-sections AND her subsequent choice to have homebirth. However, in relation to the C-sections, she positions herself as a victim, whereas in relation to her homebirth attempt she sees herself as an empowered actor. She sees her first 2 C-sections as the medical establishment’s failure to trust women in birth. Through this lens, her latest attempt to ‘trust birth’ was thwarted, not by being on the unlucky end of a serious but known risk factor, and also not by “bad things sometimes happen”, but by her past victimization at the hands of doctors. In this view, womanly wisdom about how to birth is never wrong, even if it results in the loss of one’s uterus, or worse. In this view, this happened not because she was wrong to trust birth but because she was ruined (by events years earlier) for trusting birth. This is the cascade of interventions story writ large, on a biographical scale.
My story and hers are very similar, except I chose a repeat c-section rather than vbac. There were some complications during the procedure and I also hemorrhaged and needed a hysterectomy. I often wonder what would have happened if I had chosen a vbac, but reading this does make me glad I chose a repeat. My repair lasted less than an hour once the cause of the problem was discovered. I also needed transfusions, but lost a third of my blood compared to 80% (is it possible to lose that much and survive??), I woke up in recovery and stayed at the same hospital. No respirator, no obstructed bowels, no NG tube, no catheter. I went home a day later than I normally would have, and I kept my ovaries and cervix so my vagina isn’t shortened.
Despite all that, it has been extremely difficult to recover from. I can only assume that she is in a ton of denial to not be terrified by such an experience. I was awake during the hemorrhage and felt most of it, and it was the most helpless experience I have ever had and I know for a fact that my life was saved by the team working on me. I’ve hesitated to tell my story publicly because I don’t want other women to think that a c-section should be avoided at all costs. But I thought it was important to point out that being not only near, but IN the OR when this happened made a huge difference for my recovery. If I had bled with that intensity at home I’d be dead. I am so incredibly grateful to my nurse for doing that last check before bringing me out, and for the expertise of the doctors, and my anesthesiologist for being next to my head and helping me through it. Everyone was so kind, even the pediatricians when they heard what had happened to us. I have nothing but good things to say about the care I received. Don’t believe the horror stories!
I also should add, that the chances of having a hysterectomy with my set of circumstances was less likely than a rupture during a vbac attempt. So don’t think it can’t happen to you! I don’t know what would have happened if I had tried a hbac, but despite everything I still feel like I made the best decision. I believe it is so important to look at your options, if you have to choose between vaginal and c-section, pick what is most likely to be safest, pick a good hospital, and cross your fingers. The (somewhat) good thing is, that I have had a hard time finding support, because my outcome is so rare.
I’m so glad you went through that, and I’m glad you had excellent medical care during it. Hugs
In the event of a major hemorrhage, first they pump fluids into you (unless they happen to have cross matched units IN the OR) while they request blood products from Blood Bank. I think it’s standard to have units cross matched for every surgical patient, but they aren’t released to the patient until there is an order.
Occasionally, when there is an uncontrollable hemorrhage and no time to match, there is a spot on the form to sign that basically says, “Patient’s going to die if s/he doesn’t get blood. Just sling some O neg in and hope for the best.” That’s a dire emergency. Most times, you cross match ahead of time.
This is another reason why a home birth can be dangerous: no type and screen in advance, no blood waiting for the patient in an emergency. Just…what’s available and probably safest. Antibodies are made that way.
I love your username.
I love her username, too! But then I have a fondness for funny usernames, like yours! (Oh, and sadly, a couple of weeks ago we had to euthanize our hamster. Funny how I think about that when responding to you. You had no part in that hamster’s birth so you are off the hook!) 🙂
The last hamster birth I took part in was more than five years ago, but I’ve kept up my certification. Sorry to hear about your little ham.
@Laura maybe you should change your name to Certified Hamster Undertaker
Ah, Pixiechick, you are too funny!
It is so hard being a rare statistic, isn’t it? I am very sorry for your awful experience and loss of your uterus. I am glad, though, that you felt you had made the right decision. So much of our mental recovery of these unanticipated losses is our processing and perception of the experience.It sounds like you are doing quite well, though 🙂
“I am a survivor. I am a fighter. I am strong. I birthed two babies through my belly.”
oh, so you get to call it a birth, but if I’m happy with my cs, I never “gave birth,” my son was “extracted”?
how insulting can you get?
And you dare ask? Because you submitted to Teh Man, blah-blah. You didn’t “survive” Teh Man. You didn’t “fight” Teh Man. You were a weak sheeple. No hero hat for you. Isn’t it crystal clear?
God, what a nutcase.
And in that final picture on her blog – the little one is not in a life preserver on that boat. I would never take that risk. Never ever. (BUT SHE BREASTFED HIM, SO THAT WILL PROTECT HIM AS HE IS PITCHED OVERBOARD…!)
ugh.
Is there ANYTHING breastfeeding can’t do?
Another :headdesk: passage:
[time frame – after her cesarean]
” I eventually breastfed my son until he self-weaned a little after he turned two. It was my biggest victory.”
Yay breast feeding. If she wants a pat on the back for extended BFing, I’ll give her one. But her “biggest victory”? I want her life, a life that has so few challenges that BFing a child for two years is her “biggest victory”.
“I want her life, a life that has so few challenges that BFing a child for two years is her “biggest victory”.”
No you don’t. It’s a life that has had so little of importance happen in it that breastfeeding for two years counts as her “biggest victory.”
TBH, I think she said that to present her crunchy bona fides. Yeah, she’s quite the crunchy granola type – BFed for two years, first birth an attempted HB, second birth an attempted VBAC, BFed #2 even after severe blood loss and surgery to put Humpty Dumpty back together again..
“Victory” over what or whom?
I like how she says she willed her body to make enough milk. Um yeah if only it was that easy none of my kids would have had formula.
Why didn’t she just will her uterus to remain intact?
I just snorted coffee. 🙂
Maybe they should start using breast milk as a surgical rinse.
But if she would have listened and talked to her cervix in the first place, she could have praised it into dilating and she could have had a two hour labor : ) At least, that is how Ina May would view it
For all of her focus on breastfeeding and its protective benefits to the child, you’d think she’d invest a few bucks in an infant life preserver while sailing the Inside Passage and holding her child on deck.
WTF ever, lady.
She trusts the sea
You know, this has bugged me all night and at first I thought it too inconsequential to the topic at hand to comment on but EGADS, the Inside Passage is my doorstep and I don’t know ANYONE who would so much as even step on a dock without an infant or child in a lifejacket. Anyone raised around the water learns to NEVER trust it. My friends put lifejackets on their DOGS who aren’t strong swimmers for crissake. This woman has a poor perception of risk which has affected her life quite negatively. The fact that her children have not been harmed is quite remarkable.
I’d be willing to bet that the obstetrician who saved her life might count that as one of their biggest victories grateful recipient or not it does feel good to save a life
You weren’t strong.
I want to make a t-shirt that says “(Name withheld) Hospital: Not only the strong survive.” Weak, strong, high pain threshold, low pain threshold, insurance, no insurance, stoic, sensitive, we’re ready to deal with it all!
Because, really, being strong is not a virtue. There’s no reason why the “weak” should not be respected and treated as worthy human beings. We’re all weak in some ways, strong in others.
Really like what you said.
Ironically, if she’d had a scheduled c-section in the hospital she’d likely still have her uterus and be able to have a third child, if she so chose.
There is a grain of truth in her statement: c-sections aren’t risk free. But neither are “natural” births. Neither is pregnancy in general. Pregnancy is a life threatening event and labor doubly so and anyone who tells you different is lying, trying to sell you something, or, in many cases, both.
I hate comments like this, “Giving birth is not an illness”, “vaginal birth is not surgery”, “giving birth is not a medical condition”. Giving birth vaginally has about the same medical risks as an abdominal birth cesarean. Lets talk about the typical risks and informed consent for a cesarean
Common risks like bleeding, infection, and injury to the surrounding tissues and organs. Bleeding may be extensive that may require suturing, and transfusion. You may require cytotec, pitocin, methergine, hemabate, a Bakri balloon, or hysterectomy. Post procedure fever and infection are not uncommon. Intravenous antibiotics may be necessary and prolong your hospital stay. Deep vein thrombosis, superficial pelvic thrombophlebitis or ovarian vein thrombosis may require anticoagulation. Pulmonary edema or pniemonia are also a rare sequalua. Injury to the surrounding tissue and organs such as the bladder, vagina, cervix, uterus, bowel, and anal sphintor can occur. Repair, reoperation, and readmission do occur. Long term issues with pelvic organ prolapse, urinary incontinence and fecal incontinence do occur. Occasional opening of an expanding hematoma and repair may be necessary. If anesthesia is used, risks associated with that may occur. Injury to the LS spine, coccyx, or symphysis pubis has occurred where physical therapy may be required. In cases of velementous insertion of the umbilical cord, manual extaction of the placenta may be needed, this may increase bleeding amout and discomfort. Precautions will be taken to help prevent these complication, such as antibiotics, planned use of massage and utero tonics at birth, early ambulation and deep breathing after birth. This is in no way complete and other risks and sequalua may occur. Now that I have discussed the risks and informed consent for natural birth let me discuss those for cesarean…….
I think there’s a lot that could be done in the way of debriefing after birth to help women process their experiences and come to terms with the reality of what occurred. I think this woman needs therapy. She needs to look at her medical records and she needs to understand what happened and why and what role her decisions (and the decisions of others) played in what happened. Obstetric violence does happen. Birth trauma happens. But not all birth trauma is the result of obstetric violence – some of it is the result of the brain washing NCB perpetrates on pregnant women.
Unfortunately she’s not goint to get any of that from the people at “Humanize Birth.” They are wack-a-loons who like to stand outside of the maternity hospital with protest signs that libel OBs.
I wish that they hadn’t co-opted the term “humanize.” And I’d love to know how it is humane to act like no woman should ever have an epidural. How the hell is it humane to demand that someone else endure pain without relief?
So tell me, how is going back to NCB actually “humanizing” childbirth? That sounds more like resorting to nature, more of “non-human-animalizing” it. Non-human animals are the ones that rely on NCB. Humans are the ones who have the ability to intervene.
Resorting to trust Mother Nature is about as non-human as you can get.
I agree completely.
Resorting to “trust mother nature” strikes me as being as anti-feminist as possible. It denies access to technology that can vastly improve experience and outcomes. I don’t see what is so abhorrent about letting women be mentally present during birth because pain is absent and still being able to get a healthy baby.
Especially given how it is generally only applied to childbirth. Men are never expected to “trust mother nature”
Probably ‘cos Mother Nature doesn’t do prostates very well either…
It’s the blinding pain that reminds you you’re human.
In that case, could I opt for being non-human? Just during delivery? Please?
How about Queen Amidala’s android midwives from Star Wars?
Agreed.
I don’t know how anyone could support Moreka Jolar. The very concept of being paid to Skype midwife a UC is wrong on so many levels.
“For over 7 hours surgeons repaired what they could, including extensive damage to my bladder, urethra and kidney.”
This honestly puzzles me. Damage to the urethra and bladder is not surprising so I gave that a pass.
Damage to the kidney?! SEVEN HOURS to deal with the damage? Okay, they probably had to haul in a nephrologist or other specialist to deal with the mess, but it must have been a train wreck.
And they transferred her to St. Paul’s (Dallas TX), a hospital that specializes in organ transplants. Highest level care possible.
And she whines about it. She is not grateful to tear. She whines about it.
Some people rather disgust me.
Anatomically I don’t think a ruptured uterus could have directly affected the kidney, unless she threw off a clot which embolised to the kidney, or shock lead to acute kidney injury from hypoxia, dehydration and poor perfusion, or she had some retroperitoneal bleeding or haematoma that lead to renal artery compression.
But hey, I’m not a surgeon, so I’m perfectly happy to be corrected.*
* This is true, I’m a GP (and funny, if you know surgeons).
If her description is accurate, she lost a lot of blood. Massive blood loss and transfusion can cause coagulopathies in either direction (hyper- or hypo-). So she might have had kidney damage from bleeding or thrombosis, though I’m not sure what type of damage acquired that way could be fixed surgically.
Depends on her understanding of the problem. I recently had a significant PPH (placenta accreta, three previous C/S and a uterine artery laceration). I accidently tied the ureter off while controlling the bleeding. She developed hydronephrosis, and she describes her second surgery as “fixing her kidney”, but in reality, they just stented the ureter.
I assumed St. Paul’s in vancouver. I think she is canadian.
oops, my bad
BC women’s is the tertiary maternity centre in Vancouver. However, it lacks an ICU (funny Canadian thing, these women and childern’s hospitals without ICU’s). Unstable and sick patients are transferred to SPH. MFM is at both, gyneonc at Vancouver General, just down the road from BC women’s.
I imagine her ureter was damaged and they had to bring in first, a gyne-onc surgeon to look at it likely followed by a urologist. Ureteral reimplantations and bladder repairs can take a couple of hours. Add an hour or two for the hyst and stabilization…I’m sure it was 7 hours in the OR and about 5 hours of operating time, 30 miin waiting for first the gyne onc and then the urologist (neither of whom would have been in house) and at least one hour of stabilization, adding invasive lines (central, arterial) and preparing for transport. The maternal hospital she went to first doesn’t have an adult ICU so she had to be transferred. SPH in Vancouver is a major center – including transplants and the specialized maternal congenital heart disease program.
I think its amazing that with a ruptured uterus she was initally stable enough for neuraxial anesthesia. Must have been a smallish rupture that was tamponaded by the fetus. I bet the OB went pale when they initially opened her up.
I am amazed at how delusional many of these home birth mothers are. I know a couple women who gave birth at home, the delusion isn’t confined to those who post their sad stories of loss on the internet. The distrust and contempt for the medical profession that saves babies’ and mothers’ lives is phenomenal. This is my first time responding to your blog, even though I have been reading it for quite some time now. I made the mistake of watching the “Business of Being Born” AFTER (thankfully for my son’s life) I gave birth to my son after a medically necessary induction. I felt a lot of guilt over allowing my CNM to order (not suggest, she never did ask if I wanted one, she said I was having one, the choice was no longer mine) the induction. My son had some mild issues after his birth, but if i had birthed at home and refused an induction, I would probably be one of those women who “trusted birth” and paid for it with their child’s life. Thank you for this blog. It broke me out of the guilt and PPD that I felt for “allowing” my body to be “forced to an artificial labor” and for not feeding my baby the proper way as nature intended and giving my son “artificial” milk. Yeah, my poor son, destined for a life of sickness, obesity, and stupidity because of the Pitocin and the formula (even though he’s rarely sick, at an average weight, and rather smart). I am rambling….. The point I was trying to make, before all the ramble, is that I can’t believe how delusional these woman who purposely put themselves and their baby at risk are and they hate the very thing that brought their baby into the world alive. I’m all for going as natural as you want to go in labor and delivery, but when things go “bad”, for heaven’s sake, just admit that life sucks sometimes and expectations sometimes get dashed and do whatever is necessary for the healthiest baby possible.
This is not a very flattering analogy, but think about how negatively your dog feels about the vet, even though the vet may be saving the dog’s life.
Oh she did thank all the HCPs who cared for her – after her HBAC attempt. The first labor, not so much, even though it was her midwife who suggested the transfer. (I have a strong suspicion she used a different midwife for the second HB attempt.)
If she hadn’t had a midwife with a modicum of sense and training she might have had an intact uterus and an “angel baby”. Or maybe a c-section and a dead baby when the transfer and failure to progress happened after the baby died of hypoxia in utero.
I think you’re right about using a different midwife. This one let her stay home with thick meconium. Not a good medical decision, but probably not particularly related to the rupture unless maybe the meconium was in response to some pre-rupture stress (I know, I’m pushing it here.)
Meconium is still one of those mysteries. Good correlation to fetal distress, but not much else.
Of course, human beings have the capacity for rational thought in which they are able to connect an unpleasant experience with long term gain, like if you have to have an infected tooth pulled – it sucks but feels better after. A dog may not understand that, sure. But any adult should be able to figure this out.
You’d think so, wouldn’t you.
Okay – not a HB story, but a delusional one. I’m friends with a natural-leaning mom on facebook, and she’s actually a very cool person, but some of her friends are just beyond-crazy.
So the other day my friend posted a status update about a new nanny and being worried about having enough pumped milk to send out with her infant son who’s, I don’t know, 4 months old? One of her friends helpfully replied: “Look for raw goat milk in your area if you need to supplement for a lil while.”
I couldn’t let that one go, so I replied “Unpasteurized milk is not an awesome supplement.” I also private-messaged my friend, saying I was sorry I couldn’t resist stating this and I didn’t mean to start a war in her status update.
So the person who originally replied with the raw-goat-milk suggestion posted THIS reply and … I can’t even. I don’t even know where to begin. I just have to laugh and say Good Luck With That, and hope that she’s not actually following her own advice. Make sure you click on the hyperlink to the Bovine Gelatin because the packaging is just oh so confidence-inspiring. And these people think FORMULA is POISON.
— begin quoted material —
Actually it is. Unpasteurized milk contains protiens, carbohydrates, fats, vitamins, minerals & enzymes necessary for complete and proper nutrition. This makes it a whole food. It is also a tremendous source of Vitamin A, B-12, Folate, B-6 and even Vitamin C.
Pasteurization destroys nutrients such as Vitamins B-12, B-6, C, A, beneficial bacteria, as well as denatures delicate milk proteins and vital enzymes. Because of the denaturization of proteins and the destruction of enzymes, pasteurized dairy promotes the growth of pathogens and potentially harmful bacteria. These same bacteria are not harmful in raw milk.
Pasteurized milk is also a DIRECT CAUSE of sinus and respiratory infections, mucus, tooth decay, allergies, colic in infants, stunted growth, intestinal and digestive issues, leaky gut, heart disease and osteoporosis. Because pasteurized dairy lacks enzyme activity, it turns putrid rather than sour. Processors must remove pus through a process called centrifugal clarification.
For people with milk allergies, it has been proven that many of them can drink raw milk without an allergic reaction. This is b/c the enzymes needed for the body to absorb/process the milk protiens are still alive and present in raw milk, unlike pasteurized milk where they have been destroyed.
Plus the FDA standards for cleanliness at raw milk dairies is far more strict then for dairies that pastuerize milk. (The low standards are actually very disturbing when you start to research the truth).
Jennifer, as for your purpose, I would recommend raw goat milk. It is said that raw goat milk is the next closest thing to breast milk. Goats are smaller than cows, so the protiens are smaller and more easily absorbed. However raw cow milk would work as well. I would recommend adding water to the cow milk though (say 2oz h2o & 6 oz milk for an 8oz bottle). Also get some bovine gelatin and add about 1/16 to 1/8 tsp to an 8oz bottle. This helps with the absorbtion of the protiens.
Here is the brand I use (purchased at Sprout’s):
http://blog.radiantlifecatalog.com/bid/49048/Bovine-Gelatin-A-Great-Source-of-Protein
Hope this helps 🙂
Bovine Gelatin, A Great Source of Protein!blog.radiantlifecatalog.com
Bovine Gelatin can be a real budget saver! Gelatin-rich, budget-sparing bone broth helps families eat nutritiously.
— end of quoted material —
Ha Ha Ha Ha Ha Ha Ha Ha Ha Ha!!!!!!!!!!!!!!!!!!!!!!!!!!!
Oh, good god…….I keep thinking that stupid has an upper limit.
I used to think that too, but if you hang around the internet long enough, you will realize that the capacity for stupidity some people have is infinite. No matter how stupid the dumbest person you come across is, someone always eventually comes along with the (lack of) equipment to reach a new pinnacle of stupidity.
Thanks, actually, just found this awesome internet thing. Guess I’ll have to “hang around” it more.
This logic makes me wonder if there is someone out there touting the benefits of mouse milk….
Great business idea! You should get on that, you’d probably make a fortune!
I guess I am not the first to think of milking the mice…
http://news.nationalgeographic.com/news/2009/06/090602-mice-milk-baby-formula.html
Awesome.
Imagine these were the options:Human breastmilk/formula/raw goat milk/mouse milk that has been genetically engineered to be identical to human milk.
Is natural raw goat milk still a good option or is frankenmouse milk now better than formula?
I am LOL like mad about Frankenmouse milk! Thanks Dr. !
I think it would go:
human milk > natural raw goat milk (eh, they can treat TB these days) > formula > identical-to-human-frankenmouse milk (genetically engineered? DOOOOOOOM)
Simpsons did it.
It was rats on the Simpsons – I was about post the same thing!
I laughed at that one too!
Um the size of the animal determines the size of the protein in its milk? I know, a small point in the crazy but is this even possible? Am I wrong in thinking that proteins are the size they are due to their chemical composition not the size of the being they are from?
I find it amazing that I can read Dr Amy’s posts and feel like I learned something but then I read stuff like this and have more questions than answers.
From a causative standpoint? Of course not.
Of course, it’s possible that some of the proteins in goat’s milk are smaller than those in cow’s milk. However, the converse is also is just as likely true. There could be proteins in mouse milk that are larger than those in elephant milk.
It has nothing to do with with the size of the animal. It’s just made up, just like the rest of the babble.
Thanks Bofa, I was beginning to think that I had really slept through Biology class and dreamed up a much more logical world.
Yes, unpasteurized milk which could contain bacteria and doesn’t have the correct balance of nutrition (being made for a goat, not a human, whose diets and nutritional needs are quite different) is safe. Yet formula which is FDA regulated and specifically designed to provide the correct balance of nutrition for an infant is poison.
Natural isn’t always better. I mean, the water in my pond is perfectly natural and I don’t add any chemicals to it. But I’d still rather drink the processed fluoridated drinking water that comes out of my tap.
Unpasteurized cow’s milk is the natural source of tuberculosis and since we do not vaccinate for TB in the US it is especially dangerous.
my dad’s brother died at 19 from bovine TB.
Good to know. Not that I’d bother trying unpasteurized milk anyway, but I’m on meds where TB is pretty bad news (as if its a walk in the park otherwise) so everytime I get a bad cough (which is 1-2x a year) I get the pleasure of a PPD and chest x-ray, and occasionally a chest CT. I had no idea it could have TB.
Did you respond to her? I would have been speechless!
I just wrote “Yeah – good luck with that.” I didn’t want to behave like a jackass on my friend’s status update…. and also I try to minimize the amount of time I waste arguing with crazy people!
ಠ_ಠ
It’s like vaccines and obstetrics: we’re so used to having these things that we as a society have forgotten the damage that NOT having them causes.
Raw milk probably isn’t so bad if you’re going right to the farm and buying it so you know every hand it’s passed through and whether it’s been out of refrigeration. My dad grew up on a dairy farm and remembers that raw milk fondly.
Waiting for it to be shipped to a natural foods store? OH HELL NAW.
I’ll admit that I’m not quite as concerned about the risk of raw milk. I do object to the claims about how it is healthier than pasteurized and such crap, but in the end, the risk is not so great in modern society.
However, what I DO object to is the friggin cost. It’s the price of prohibition, that’s it. And it is an absolutely windfall for the farmer. People talk about the CoI of Big Pharma, it’s far bigger for a raw milk selling dairy farmer.
Let’s see, sell milk to the dairy for $1 a gallon, or sell it to a sucker for $20? Yeah, right, like that is a question.
If you are paying more than $2 a gallon for raw milk, you are getting ripped off. $2 a gallon is a fair price. It’s more than the farmer would get from the dairy, but less than what you pay at the store.
Growing up, we drank raw milk. We bought it from a friend who was a dairy farmer. We drove out to their farm, went into the barn, filled our milk containers (we had a 5 gal and a 2 gal bin I think – family of 6 kids, we drank a lot of milk) right from the bulk tank, left a check on the tank, and departed. The price we paid was what I described above – we split the difference between store milk and the dairy price. Everyone benefited.
Of course, we didn’t do it because of any special properties of the raw milk, but because it was a lot _cheaper_. Can’t say that about raw milk any more.
Similar to a lot of local/organic/artisanal items unfortunately. We get farm fresh free range organic eggs, but that is really the only such luxury we make room for in our budget.
Are you talking about commercial suppliers? Because you may be interested to know that “free range organic” conditions are not necessarily all that “free range.” In fact, they often end up being completely awful.
The problem is that free range means that the chickens are given access to the outdoors, but not that they actually use it. See, chickens, like a lot of animals, aren’t very keen on bad weather. Therefore, in the winter, for example, they like to stay inside. However, many “free range” farms don’t have enough coup space for all the chickens, which means that the chickens end up cramped inside the coup, and when that happens, they react in nasty ways.
If you can get eggs from a local supplier that you can trust, then great (although I wouldn’t pay a premium for them – find out what they would get from the market and split the cost). However, I wouldn’t trust a “free range” label for the life of me.
No, I’m talking about eggs from what are essentially pet chickens raised in the back yard of an AgSci professor we know, by his tweenaged daughter. They sell them only to people they know. We pay $2.50 a dozen, and I’m fine with that.
Hmmm, but couldn’t you make the argument that producing raw milk safely (and ethically, for people who are concerned about that) is not nearly as efficient as large scale operations producing milk that is going to be pasteurized, and therefore costs more for the farmer? It’s like arguing you should be able to buy a hand knit sweater from an individual for what a factory would sell one for wholesale.
The raw milk I buy is $9.75/gal, whereas a gallon of organic milk is about $6. The difference is the outrageous costs that the raw dairies have in order to maintain the ability to legally sell raw milk. They’re not gauging anyone, they set their prices based on the cost of production just like anyone else. Oh wait…just like everyone else who is not a commercial farmer receiving government subsidies to keep their prices artificially lower.
Um, no one sets their prices based on “cost of production.”
It’s supply and demand that controls the market. It is especially true in this case.
My SIL and her family live on her husband’s parents’ dairy farm. He grew up on raw milk, and they used raw milk (which was basically free) until they had kids.
Then they stopped.
Pasteurised milk gives them peace of mind that is worth paying for.
I don’t think the farmers are making a killing off of selling raw milk. If they are doing it legally, they have to follow a whole host of super expensive practices that pasturizing dairy farmers don’t have to. It’s for safety…so that you don’t die from the bacteria. But needless to say, it adds a lot to the cost.
Still wouldn’t touch it, not even if I were married to the cow. No matter how well you know the farmer, there’s still the chance of contamination with fecal matter (ecoli – yum yum), not to mention TB. It’s basically like giving your child raw hamburger, as far as I’m concerned. But then I’m the sort who wipes down shopping carts with antibacterial wipes before I’ll let my child sit in it.
I do give my dog raw hamburger. She has stronger stomach acid than a 4-year-old human. I’m nuts about cross contamination though. I don’t eat meat myself so I’m not used to dealing with it.
I’m sure raw milk is very tasty, but I’m not willing to accept the risk.
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Wasn’t formula invented in the early 20th century exactly because babies were dying in droves because mothers were giving them raw, unpasteurized cows’ milk? Which unfortunately had been sitting on trains for three days when it was shipped into the cities. And the doctors and scientists invented the formula because it was the next best thing to keep babies from dying since women were resisting ardently being tied down to nursing infants.
That my understanding. Can’t remember the sources. Probably a social history on breastfeeding..there’s a few out there.
Ironic that 100 years later there is such advocacy about the wholesome benefits of raw milk and the poisonousness of formula, when formula was invented to save babies from being poisoned by raw (albeit rotten) milk.
In Romania, where my husband is from, and which is a pretty agrarian, traditional society in many ways, they will give babies after about one year, BOILED unpasteurized cow’s milk that they get directly from farmers. Never infants. For a reason.
Not “dying in droves” so much I doubt, but, yeah. Formula was invented (by pediatricians) not as an alternative to breastmilk, but an alternative to the crap that was being used instead of breastmilk.
Women who didn’t breastfeed needed a safe, healthy alternative, and goat milk or cow milk (or flour mixed in water) was not cutting it.
“Unfortunately, feeding bottles, pap boats, and teats during the 16th to18th centuries were difficult to clean. Subsequently, the build-up of bacteria made the feeding devices detrimental to the infant’s health. In the early 19th century, the use of dirty feeding devices, combined with the lack of proper milk storage and sterilization, led to the death of one third of all artificially fed infants during their first year of life (Weinberg, 1993).”
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684040/
A little earlier than I was referring but I think they just steadily improved practices of infant feeding over time because there was significant mortality associated with “artificial feeding,” though it was less the milk itself (my husband says they traditional gave goats milk to babies whose mothers couldn’t feed them), than the practices associated with delivering non-human milk to infants (e.g., dirty bottle teats, spoiled milk).
Also:
“In the 1880s, women began in large numbers to supplement their own milk with cows’ milk shortly after giving birth and to wean their babies from the breast before they were 3 months old. This represented a stark change from the colonial era, when mothers normally breastfed at least through infants’ second summer.3 The move to early weaning was so relentless that doctors complained bitterly in a 1912 issue of the Journal of the American Medical Association
that breastfeeding duration rates had been declining steadily since the mid-19th century ‘and now it is largely a question as to whether the mother will nurse her baby at all.'”
“Chicago’s infant mortality statistics typified the nationwide crisis. In 1897, 18% of Chicago’s babies died before their first birthday and more than 53% of the dead died of diarrhea.18 The Chicago Department of Health estimated that 15 hand-fed babies were dying for every 1 breastfed baby.”
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448139/
Maybe not droves but definitely a problem.
Interesting. What I took from this is that from the beginning of time responsible experts have advocated bf and since the beginning of time large numbers of women have avoided it. Why is that? Couldn’t. wouldn’t?
The figure of 1 in 3 is a bit less dramatic than the 15 to 1. What proportion of naturally fed babies died in the first year? Sources of infection and diarrhea weren’t restricted to dirty bottles.
Is it accurate that 90% were bf in the 20 century but that has gone down to 42% in the 21st? That does seem to imply that all the exhortation isn’t working all that well, despite more reliable information on the benefits.
Me, I was quite convinced that one should definitely have a go – that there were tangible benefits, but also failed to be convinced that formula was from the devil. If I had been subjected to the kind of propaganda around now, and had the idea pushed that it was imperative to exclusive bf for ever, I doubt I would have bothered.
Give women GOOD information, investigate seriously what puts them off, provide support to those who seek it, and control the fanatics.
“That does seem to imply that all the exhortation isn’t working all that well, despite more reliable information on the benefits.”
In Norway the strong exhortation made a HUGE difference.
http://www.skepticalob.com/2011/04/doctors-original-lactivists.html
My mom gave me an old baby book (probably c 1950-something) that had step-by-step instructions for turning sweetened condensed milk into milk for the baby bottle.
The term “formula” originally meant “recipe” – for breast milk substitute.
“since women were resisting ardently being tied down to nursing infants.” –I can so relate to that. I hate the amount time it takes to breastfeed! I hate planning outings around feedings, etc.
(Unfortified) goat’s milk is actually lacking in folate, such that infants fed with it without supplementation are at risk of folate deficiency. Cow’s milk before age 1 (raw or not) is associated with colitis and iron deficiency anemia. I’ll admit, I’m not well versed on bovine gelatin. I guess the faculty at my med school should have visited the radiant life catalog and expanded their narrow little world of evidenced-based recommendations.
It’s just JELLO, for pete’s sake!
Jello is just bovine gelatin that is flavored, so think “unflavored gelatin” (like the stuff you use to turn jello into knox blox). Bovine gelatin is protein based, unlike jams and jellies, which are carbohydrate based.
Now, my interpretation is that she is suggesting that adding it to the tepid or cold milk. If you heated the milk enough to dissolve the gelatin, you could just as well pasteurize. So that is going to end up as a powdery suspension.
Isn’t bovine gelatin just the collagen broth from boiled cow bones in a concentrated form?
Ummm tasty…milk and bone broth.
At least a get out clause from using that awful combo to feed your child would be that you kept a kosher home.
“Oh, we’d LOVE to try the bovine gelatin and goat milk idea, but, see, we’re…kosher! Yes, that’s it. We can’t use your advices not at all because it is cray-cray, but because we’re not into mixing milk and meat for religious reasons.”
Yes, here’s a good recent review on goat’s milk. http://www.pediatricsdigest.mobi/content/125/4/e973.full
Sleuther should totally post that link to her friend’s page. I thought the reason that people were so high on goat milk is because goat crap is more solid, and pelletized, kind of like a rabbit. The big problem with cows is how easy it is for germs from their crap to end up in their milk – thus pasteurization. Cow crap can be quite … sloppy … even when the farmer is careful. There were some dairy farmers in Washington State who sent a bunch of kids to the hospital with E. coli with milk from their “cow share” program in 2005. I’ve heard they sell goat milk now.
Just because goat’s milk is okay for kids doesn’t make it okay for babies.
I hope she doesn’t end up like the mom who was a featured guest on this radio show. Her two year old had HUS, a colostomy, and I forget what else after her mom fed her raw cow’s milk for her “health.” I think four kids wound up being treated for HUS in this outbreak – some of them included the farmer’s kids.
Sorry – here’s the link. http://www.opb.org/thinkoutloud/shows/raw-milk/
Oh, my gosh.
*sigh* I was fed homemade raw goat’s milk from age 2 months – and I’m totally ok! Must be fine, right? Honestly though, I shudder to think of it. I would never ask my parents “what the hell were you thinking?”, but…geez.
A little bit of back story (or what my parent’s explanation for this was): I was born with a cleft palate, so I had a very difficult time nursing. I think there are nursing aids for cleft palates now (?) but there weren’t then, and my mom said the nurses just kept insisting she had to keep trying to breastfeed. The result was a scary weight loss and “failure to thrive”. My mom said the pediatrician and GP were too casual about the weight loss and feeding difficulties, and she was freaking out (she was a young first time mother). Some hippie got a hold of her and told her all about the magic of raw goat’s milk. So they began preparing some concoction that involved the goat’s milk, baby vitamins and brewer’s yeast and God knows what else and I (this is family lore) began thriving and everything was fine!
They told this story to me a lot, and only as an adult did it occur to me wonder “why didn’t they just go get some formula? Safer, easier, regulated, etc.?” , but they had totally bought into this magical goat’s milk thing.
But this is what pisses me off about the woo peddlers – it’s so predatory. When my parents describe the weight loss and feelings of helplessness and frusteration, it’s obvious they were very scared and confused and weren’t getting the support they needed. And in swoops these g*damn hippies to capitalise on their fear and inexperience during a difficult time to promote their crackpot agenda and sell them expensive raw milk.
Sorry this is rambling…that’s my goats’s milk story.
A problem I have with this blog is that the author assumes that parents who have a homebirth or otherwise harmful practices do it solely for bragging rights, hubris and various selfish reasons. There are certainly people who do it for these reasons, but I’m convinced that a majority of these people have been brainwashed into honestly believing that they’re doing the best for their children. I’m sure your parents loved you and thought they were doing the best for you, even though they fed you blatantly unsafe food while you were a tiny vulnerable infant. Obviously, certain parents will disregard their child’s safety to satisfy their own agenda, but I am naive enough to believe that most parents actually love their children.
I agree… I think many people really believe they are making an “informed” decision when they aren’t. It really comes down to who you trust, because as this blog often states, most “laypeople” don’t have enough education to understand medicine, and if parents trust someone who can explain things in a more down-to-earth fashion rather than acting as though they are above them, that may be more attractive to them even if the person is wrong.
Don’t the homebirth sheeples follow Dr. Sears? He just said that a transgendered 6 year old girl is going to walk around the bathroom with her penis hanging out. Despicable.
http://mediamatters.org/blog/2013/02/28/pediatrician-on-cnn-transgender-girls-will-walk/192836
Wrong Dr Sears.
There are many, and it is hard to keep up with all of them.
It’s his eldest son.
Yeah, I knew it was his son, but I thought that they follow both of them. All the things the NCB people do gets confused in my brain.