MANA response to AAP: homebirth advocates are morons and will believe anything we say


The Midwives Alliance of North America (MANA) has to say something. After all, the American Academy of Pediatrics has declared that they don’t meet the minimum standards for providing safe homebirth.

Fortunately for them, they think their own followers are morons, easily tricked by mistruths, half truths and outright lies. It’s been working for them so far.

MANA routinely bandies about the high US infant mortality rate, assuming (correctly) that clueless homebirth advocates have no idea that infant mortality is the wrong statistic. Perinatal mortality is the correct measure of obstetric care and that the US has one of the lowest rates in the world.

MANA routinely compares its members to midwives from other countries, assuming (correctly) that homebirth advocates aren’t smart enough to research and learn that homebirth midwives don’t meet the midwifery standards of ANY first world country.

MANA routinely fobs off the fact that it hasn’t published the death rates from the 27,000 homebirth in its own database, assuming (correctly) that homebirth advocates are so gullible that they will believe that the death rates are going to be published “next year.”

So when basically outed by the AAP as unsafe practitioners, MANA has doubled down on its policy of relying on what it presumes to be the stupidity of homebirth advocates.

As detailed on the Science and Sensibility blog post MANA Response to Recent AAP Home Birth Statement: High-quality out-of-hospital newborn and postpartum care is standard for midwives, MANA thinks it can fool homebirth advocates with this gem:

CPMs are knowledgeable, expert and independent midwifery practitioners who have met the standards for certification set by the North American Registry of Midwives (NARM). NARM is accredited by the National Commission for Certifying Agencies (NCCA) to issue the professional credential of Certified Professional Midwife, which is the same agency that accredits the American Midwifery Certification Board to issue the professional credentials of Certified-Nurse Midwife, and Certified Midwife.

Read it quickly and it sounds as though the NCCA has passed judgment on the CPM credential and found it adequate. But that’s not what it means, because the NCCA does not certify credentials; it certifies the EXAMS used to award those credentials.

According to their website:

The NCCA Standards are comprehensive and cover all aspects of the certification program(s), including administration, assessment development and recertification. NCCA standards are consistent with The Standards for Educational and Psychological Testing… (my emphasis)

So, for example, the NCCA certifies the EXAMS administered by the Crane Institute of America required to become a industrial crane operator. Specifically, the exams for:

Certified Crane Operator, Large Telescoping Boom Crane Over 75 Tons
Certified Crane Operator, Lattice Boom Carrier 1 to 350 tons and over 350 tons
Certified Crane Operator, Medium Telescoping Boom Crane 21 to 75 Tons
Certified Crane Operator, Small Telescoping Boom Crane under 21 tons
Qualified Rigger & Signalperson Certification

It does not determine whether certified crane operators are competent. It merely determines whether the EXAM is appropriate to evaluate the skills and knowledge deemed relevant by the credentialing organization.

Similarly, the NCCA does NOT determine whether CPMs are competent. It merely determines whether the EXAM is appropriate to evaluate the skills and knowledge deemed relevant by MANA and its sister organization NARM (North American Registry of Midwives).

Apparently the folks at MANA figure that if their supporters are so clueless that they can be fooled by the deliberate use of the wrong mortality statistic, so ignorant that they don’t know that CPMs don’t meet the same standards as European midwives, and so gullible that even after several years, they still believe that MANA is going to publish its death rates “next year,” they are stupid enough to believe that the NCCA, which certifies EXAMS, has certified the CPM.

So tell me, homebirth advocates, are you as ignorant and gullible as MANA believes you to be?

72 Responses to “MANA response to AAP: homebirth advocates are morons and will believe anything we say”

  1. Lisa from NY
    May 2, 2013 at 7:46 pm #

    “The NCCA Standards are comprehensive and cover all aspects of the certification program(s)…”

    “So, for example, the NCCA certifies the EXAMS…to become a industrial crane operator. Specifically, the exams for:”

    “Certified Crane Operator, Large Telescoping Boom Crane Over 75 Tons
    Certified Crane Operator, Lattice Boom Carrier 1 to 350 tons and over 350 tons”

    Let me get this straight, I can become a certified crane operator at the same time that I do the CPM exam? How convenient.

  2. Dr Kitty
    May 2, 2013 at 6:23 pm #

    Oh Lordy, the woo is getting everywhere.
    Just discovered that not only is a local animal shelter no kill, they are also pro life (no spaying pregnant females), anti micro-chipping, anti vax and anti fluoridated water!

    It appears to have been set up by some Crazy Cat Ladies.

    I don’t think we’ll be getting a kitty from there.

    • Eddie
      May 2, 2013 at 7:32 pm #

      About 25 years ago in NJ, my roommate was getting his cat spayed at a free clinic. (He was a poor undergrad with no money.) While he was waiting, the lady working there took a call from a nut who insisted that it was against God’s Plan to neuter or spay any domestic animal. That they must be allowed to reproduce. The poor lady tried to explain about the sheer number of strays and the miserable and short lives many of them lead, to no avail.

      I’ve never run into an anti-chipping person, but I’m not surprised they exist.

      • Dr Kitty
        May 3, 2013 at 2:31 am #

        We want a Tom, so neutering is a given. No fighting, no spraying thanks.
        Rabies doesn’t exist here, so vaccination is completely optional and micro chipping is only mandatory for dogs. I just got a really strange vibe from that shelter…

        I’ll probably end up doing the traditional Irish thing, and finding out from a friend of a friend the nearest farm with kittens.

    • Certified Hamster Midwife
      May 2, 2013 at 9:47 pm #

      There are anti-vax naturopathic vets. I wonder how long that will last. Oh, and then there are the anti-speutering vets:

      Raw feeders are the homebirthers of the pet world, I think. A lot of people believe microchips cause cancer. My dog will periodically freak out and start chewing on the spot where her chip is. Probably just her FBI mind control orders coming in, or maybe the local police intercepting my wifi.

      • Eddie
        May 2, 2013 at 10:02 pm #

        The no-kill shelter where we got our dog was pretty extreme. They would not give us the dog directly, because he was a young puppy who had not yet been neutered. They would only give the dog directly to a vet of my choice to be neutered, and only then could I pick him up.

        He lucked out because one of his testicles had not fully descended yet, so the vet refused to neuter him. Thus, he got to wait until the age that vets find appropriate for that surgery, by which time he’d caught up to normal development and only needed exterior surgery. The vet told me that he really disliked being forced by the shelter to do this surgery on such a young dog, but he knew the shelter wouldn’t adopt the dog out without it.

        I completely understand the shelter’s desire that all pets they adopt out get spayed or neutered (or as I call it, “broken”), but I found their lack of trust to be surprising.

        • Certified Hamster Midwife
          May 2, 2013 at 10:12 pm #

          I get where both sides are coming from. I’m relatively uninvolved in rescue, but I’m involved enough that the number of animals killed makes my heart ache. “Be responsible and keep your pets indoors” doesn’t work as an animal control policy, unfortunately, because people are forgetful and stupid.

      • deafgimp
        May 3, 2013 at 3:44 am #

        However, what that vet is saying is true. If you spay or neuter before the age of 2, they are finding out that a whole raft of problems go sky high in pets. I’m very involved in my dog’s breed, and from tracking the health of these animals this same trends have been found to be true. I even have a contract where I cannot legally neuter my puppy before he’s 2.

        However, this is NOT for everyone. It takes a lot of concentrated effort and know how to manage behaviors and being vigilant to prevent unwanted pregnancies. It’s just too much for many people, and those are the ones who should do earlier spays and neuters for their pets.

        Females, for the record, are easier to deal with than males. All you need to do is keep them closely supervised (on leash) while outside for a month, no more than twice a year and often less since not all dog breeds cycle at 6 months (my bitch was on an 8 month cycle). Males need to be watched year round for deviant sexual behaviors like humping every bitch in site 😉 . I say this as I look at my teenage puppy, who is feeling his oats right now. This is also a reason dogs get dumped at the shelter at this age, people no longer know how to deal with this kind of behavior. They think it can’t be controlled and they are very wrong.

        • May 3, 2013 at 5:52 am #

          Unfortunately those studies are terribly biased. We will know if early sterilization has a true effect on health when a proper prospective study is completed.

        • AllieP
          May 3, 2013 at 8:59 am #

          My vet actually counseled the exact opposite — that spaying my dog before she had her first season improved health outcomes.

          And FWIW, my contract DID state that I’d have the puppy neutered between 6-12 months. And my dog is the granddaughter of a Westminster breed champion (on site, breeder owned), so it’s no slouch breeder.

          To me, the risk of accidental unwanted puppies far outweighs any perceived health risks.

          • May 3, 2013 at 9:07 am #

            For bitches, the risk of contracting a uterine infection outweighs any benefit of remaining intact unless you intend to breed her.

          • Dr Kitty
            May 3, 2013 at 9:35 am #

            We had Pyrenean Mountain dog when I was a child, my parents kept her intact (and indoors when in season) because no local vet was willing to spay her because of the anaesthetic risk in a dog that size.

            She had to be put down when she was 12 because of a uterine cancer, and the next dog we got was smaller ad spayed at 6 months old.

          • deafgimp
            May 4, 2013 at 9:54 am #

            I also have a granddaughter of a Westminster champ! As well as her cousin. I’m more happy with the care that goes into their breeding than the titles, and I value their hunting titles even more than the show titles.

        • Becky05
          May 3, 2013 at 11:07 am #

          I also understood it to be the opposite, that spaying early was better for the dog’s health.

        • May 3, 2013 at 3:49 pm #

          I don’t know much about dogs, but I know unspayed cats are miserable. We cat-sit for a friend for awhile, and that poor cat was in heat all the time. She was underweight, she would caterwaul constantly, and she was clearly miserable. She’d come out of heat into a sort of semi-heat, only to go right back into heat a month later.

          It is simply not worth it to keep a female cat intact. The cat is miserable, you’re miserable, and it’s obviously not healthy for her.

          • Eddie
            May 3, 2013 at 6:42 pm #

            This is precisely why my broke roommate finally found a free clinic where he could get his cat neutered. She was going in and out of heat constantly, and of course they would not spay her while she was in heat. She ended up escaping through the front door while in heat, so we had kittens to find homes for. That was when he found the free clinic, so we didn’t have more than one litter to worry about.

          • deafgimp
            May 4, 2013 at 9:48 am #

            Even te link given above, about the vet not wanting to spay or neuter until 2, doesn’t apply to cats! Cats generally make horrible pets if they are intact, females especially so.

      • Yammy
        May 3, 2013 at 11:00 am #

        Oh for the love of…*facepalm* You know there’s a problem when you think that the humans need more help than the animals.

        I’m bracing for when I hear about someone being barred from adoption because they couldn’t/didn’t plan to rear and mouth-feed the animal out in the wild for at least two years. “Sorry, you pretty much gotta be Freund the wolfman before you can adopt this adorable puppy”

    • Bombshellrisa
      May 2, 2013 at 10:02 pm #

      Those are the same people who want to do home visits after you get your cat, all at random times-when we went to adopt our cat, we had to explain why that wouldn’t work for us (at the time, I worked full time nights and slept all day, every day). That is terrible that the woo is creeping into veterinary practices too-I knew that there are holistic vets around, but didn’t think that anyone would be as foolish so as to endorse things like not spaying and would speak up against microchips.

      • sleuther
        May 3, 2013 at 9:56 am #

        When we adopted our cat (as a kitten) I thought the hoops to jump through were dreadful. Letters of recommendation, meeting the whole family – fine. But then they tried to talk us out of adopting the kitten because at that time both my husband & I worked full-time and “it’s not good for a kitten to be left alone.” What the ever-loving $%#$%? We did adopt the kitten (now a 3 year old cat) and she’s a wonderful addition to our family.

    • GiddyUpGo123
      May 3, 2013 at 2:04 am #

      Oh my god I thought you were joking, but you’re not. That is completely insane, not vaccinating your pet (almost as insane as not vaccinating your kids). I used to work in an animal shelter and a vet clinic and have seen plenty of unvaxxed puppies die from parvo. And I would honestly not want an animal in my house that did not get the rabies vax. That’s some scary shit right there. I didn’t think you could even legally own a dog that wasn’t vaccinated against rabies? (You can’t license them in California without a rabies shot, or at least you didn’t used to be able to … it’s been a long time since I’ve owned a dog …)

      • deafgimp
        May 3, 2013 at 3:52 am #

        Sick dogs and cats and horses and ferrets and pretty much any pet can have a vet’s note to bypass vaccinations. Those pets who have allergic reactions to the vaccination as well can bypass them. The reason they are allowed to is because the laws are enforced enough that the majority of pets really are vaccinated, and we don’t have rabies running rampant in housepets like we have measles and whooping cough in unvaccinated humans again. It also helps that rabies needs pretty direct contact to be spread, it not like you can walk past a rabid animal and get it. Just don’t put a sick deer’s head in a bucket of water like this idiot did in my state last year, after the deer attacked her. Deer spit in the water means contact with her wounds on her hands, means rabies protocol!

        • Squillo
          May 3, 2013 at 11:26 am #

          In my jurisdiction (at least a number of years ago; it could have changed since), if your dog or cat (or bunny, I guess) bites someone and you cannot produce proof of an up-to-date rabies immunization, the county can order your pet quarantined or even destroyed so that the brain can be examined for evidence of rabies. I discovered this after being badly bitten by a neighbor’s cat.

        • IDP
          May 7, 2013 at 2:27 am #

          There IS a thing called vaccine-associated sarcoma in cats, that is, a tumor that develops at the injection site. However, the recommendation is now to evaluate the cat’s lifestyle and vaccinate when necessary, as opposed to the oldschool “once a year, every year” rule. The logic being that it’s not worth elevated cancer risk to re-vaccinate a cat if it never leaves the comfort of a third floor apartment. It’s NOT an excuse for never vaccinating, though!

      • Laural
        May 3, 2013 at 10:01 am #

        Yes, parvo and puppies comes to mind, as well as feline leukemia- those are quite deadly and contagious, I think!

    • May 3, 2013 at 5:48 am #

      Welcome to my world. If I had a nickel for every owner that came in claiming ______ gave their dog cancer…….

      (fill in blank with vaccines, water, kibble, neuter, etc)

    • Allie P
      May 3, 2013 at 8:55 am #

      I used to work with a network of dog rescues and some of them don’t seem to understand the point of rescues is to get dogs into homes. There was one that would only allow dogs to be adopted by people who would feed them raw food. (Because kibble is insufficient for dogs starving in shelters, I guess?) and other “first world problems.” Eventually, I stopped doing business with the ones where I was embarrassed to present their position to potential adoptees. Antivax was the first thing on my list.

      • May 3, 2013 at 9:11 am #

        Look up “rescue hoarders” if you need more reasons not to deal with certain rescues.

      • Not My Normal Nym
        May 3, 2013 at 10:03 am #

        Broad generalization, but I’ve never met a person involved in animal rescue who didn’t have a terrible, abusive childhood. Those folks are working out trauma through the animals (some more successfully/sanely than others).

        • Eddie
          May 3, 2013 at 6:47 pm #

          I definitely noticed this about *some* involved in animal rescue, people who dealt better with animals than with other people due to past experiences. I didn’t know enough of them well enough to draw any generalizations though. Still, as long as they don’t traumatize the animals, good for them for finding a productive way to deal with their past.

          There was certainly a lot of drama in the animal rescue groups I was briefly involved with through a friend, but my exposure was brief and limited.

      • IDP
        May 7, 2013 at 2:12 am #

        I’ve seen rescue groups who only allow their dogs into the homes of homeowners with mandatory fenced yards, etc. etc. The list was quite extensive, thus barring a great deal of the population from rescuing a dog. I get not putting multiple large, active breed dogs into, say, a tiny bedroom apartment, but a lot of the things they require are as you say, “first world problems.”

    • IDP
      May 7, 2013 at 1:11 am #

      Sounds like the tales I’ve heard of “rescue” groups that are little more than animal hoarders putting a positive-sounding spin on what they do. Do they also patrol rural areas “finding” pets to “rescue”?

  3. May 2, 2013 at 5:24 pm #

    “NARM is accredited by the National Commission for Certifying Agencies (NCCA) to issue the professional credential of Certified Professional Midwife”

    So, what is the list of EXAMS that the NCCA certifies the NARM to administer as part of the process of issuing the professional credential of CPM? The list of crane operator exams is fairly easy to find, but I have never seen a list of similar exams administered by NARM or MANA. Have I missed something?

    In an attempt to answer my own question, I searched through the NARM website. My apologies to my brain, which had much better things to do at the time. There are several references to a “written exam”, which appears to be optional.

    Further information was obtained by downloading the 78 page Candidate Information Booklet. It has over 80 occurrences of the phrase “written exam”, which mostly pertain to the forms required, scheduling, venues and fees for the exam ($900).

    Under the heading “written test” it also has quite a detailed list of information that could potentially be covered in the 350-question multiple choice exam. It includes the fact that you can (should??) treat pre-term labor with the consumption of an alcoholic beverage and post-dates pregnancy with castor oil and acupuncture. “Consult and transfer as needed” is NOT indicated for either of these conditions.

    However, apparently it IS appropriate to use allopathic medication to treat thrush on nipples (the ONLY circumstances in which allopathic medication is warranted (allowed??)). I still couldn’t figure out whether passing the exam is a requirement for the issuing of the CPM qualification, or just a requirement for registration in some states.

    Back to my original question, is this the exam that the NCCA has accredited?

    • Becky05
      May 2, 2013 at 6:14 pm #

      Yup. I think all CPMs do have to pass it, though.

    • fiftyfifty1
      May 2, 2013 at 6:37 pm #

      “However, apparently it IS appropriate to use allopathic medication to treat thrush on nipples (the ONLY circumstances in which allopathic medication is warranted (allowed??)). ”
      Oh yes! That’s the exception. There is a big woo belief that a lot of breastfeeding pain comes from Candida of the breast ducts. It’s a variation of the chronic full-body candida woo belief (e.g. The Yeast Connection). Instead of saying that moms have breast pain because, well, breastfeeding sometimes hurts, they instead say that a woman has a yeast infection of her breast tissue (caused by those nasty antibiotics the docs forced you to have for that harmless group B strep obviously). Then they recommend up to a MONTH of oral fluconazole. There is absolutely no scientific evidence that breast ducts can get infected with candida. But that doesn’t stop lactation consultants and midwives from pressuring their patients to pressure their docs for a script, or buy the med illegally on line.

      • Certified Hamster Midwife
        May 2, 2013 at 9:53 pm #

        The whole systemic candida scene fascinates me. I was thinking that I might have it, but not strongly enough to go to a naturopath who would make me give up my allopathic antidepressants. So I poked around online looking for a diet to follow, and the guidelines all contradicted each other.

        • fiftyfifty1
          May 3, 2013 at 8:08 am #

          Yes, systemic candida is total bullshit. They even claim it is in your bloodstream! If you’ve ever seen someone with an actual blood infection due to yeast you will know their claims are not true. In the rare cases when yeast does get into the blood, for instance in a long-term IV patient through a line infection, the patient has a high, high fever and *serious* sepsis. Or an AIDS patient with yeast in the throat, there is no mistaking it. The person is very very sick, hospitalized, unable to swallow, severe pain. Not just feeling achy and “off” and unenergetic.

          • Becky05
            May 3, 2013 at 11:11 am #

            If you make the symptoms vague enough, then nearly everyone has it.

          • Susan
            May 3, 2013 at 3:05 pm #

            It’s sort of funny I clicked to see what you were writing about, no idea if was breastfeeding stuff, and my thought was that the make it vague enough is the same theory that makes everyone think their horoscope is incredible insightful…they just didn’t read the other 11!

          • Eddie
            May 3, 2013 at 6:52 pm #

            Just like a horoscope. Make it vague and everyone can be convinced it applies to them. (Edit: Whoops, Susan got there before I did!)

        • Sue
          May 6, 2013 at 8:59 am #

          All things yeast fits into the popular “bowel dysbiosis” model which is currently meant to explain everything from autism to fibromyalgia.

          One course of antibiotics, folks, and you are doomed to a lifetime of vague symptoms, all caused by that old imbalance of gut flora – so much worse if you didn’t exit via the germy birth canal!

      • Pie13
        May 3, 2013 at 6:47 am #

        I did get a yeast infection on my nipples – but I was pretty sure the blatant cause was that I was nursing a baby with a mouth full of thrush and not due to antibiotics I’d received three months earlier. And I didn’t take fluconazole; I used the baby’s nystatin topically. Keep in mind, this was seventeen years ago when I was twenty one years old, so my sincere question is: was I mistaken about the cause? I ask because I’ve suggested other mothers with a similar problem do the same and I’d like to make sure I wasn’t inadvertently giving irresponsible advice. Not medical advice (None of us are woo at all). Just “we-were-sitting-around-BS-ing” advice. And of course I suggested they ask their doctors first.

        • fiftyfifty1
          May 3, 2013 at 7:59 am #

          A visible rash on the outside of the nipple is one thing and is perfectly valid. The idea that candida has invaded deep into your breast tissue is the woo part. When a woman is having unexplained nipple or breast pain, even if everything looks perfectly fine many lactation consultants will tell you you have this fictional invasive thrush. In my own experience, 2 different (hospital based and certified!) lactation consultants told me I had breast yeast before I sought a 3rd opinion and got the correct diagnosis (crush-injury triggered reynaud’s).

          • Pie13
            May 3, 2013 at 6:48 pm #

            Thank you!

      • Laural
        May 3, 2013 at 10:29 am #

        Is that an extension of the ‘if it hurts you are not doing it right’ line that lactation consultants use?
        Calling BS. I’ve nursed 4 lovely babies; once I made the mistake of nursing one all the way through until the next was born 18 months later. She was sick with a mysterious something where her blood sugar dropped randomly and I was too scared that she needed those night nursings and we just moved and Daddy deployed to Afghanistan- whatever- mistake.
        It HURTS anytime I’ve nursed a new baby. Like tears rolling down my cheeks HURTS- even for an experienced mother with poor used breasts who knows darn well what a good latch is. I get cracked nipples and severe pain every time. It must be something hormonal with giving birth and new milk coming in- don’t know the scientific explanation but the phenomenon is real and for me it is normal to experience pain for the first few weeks of nursing. It goes away and, barring mastitis, we have gone on to have easy pain free nursing for the following year, but, I am no longer susceptible to feeling like ‘I’m not doing it right’ because it hurts like the flaming pit of hell. And I sure wouldn’t take oral antifungals for it, either! Unreal!

      • Serenity
        May 3, 2013 at 3:39 pm #

        Breast thrush is woo? Really? That wasn’t my experience. I had a nasty case with baby #3 was about 3 months old, way after the toughening-up-the-nipples pain for the first two weeks, and way worse pain. It’s been 10 years, so my memory could be off, but I don’t recall visual symptoms. The pain finally went away after a nightmare couple of months of gentian violet and diflucan. Partial temporary weaning may have also been involved (but I think that was a few months later–baby had (legitimate) allergies and my health was suffering from the restrictive diet–later my body was able to relactate because I was good at making milk). It definitely wasn’t normal breastfeeding pain.

        I got diagnosed with breast cancer (stage IIIC at age 32, no family history) about 3 years later, which is probably just a coincidence, but you always look for reasons for that kind of thing…

        Anyway, are we sure that there is no such thing as breast thrush, or is this just a case of medicine pooh-poohing breastfeeding pain? Has it actually been studied?

        • LukesCook
          May 3, 2013 at 6:38 pm #

          No, that’s not what was said. Nobody is saying that there is no such thing as breast thrush. Just questioning whether it occur IN your breasts rather than ON them. For what it’s worth, my experience of thrush on the nipple was that it is very painful, but not more so than the initial few weeks of (thrush-free) breastfeeding. Nystatin didn’t work on my breasts or my baby’s mouth, but daktarin in his mouth and soap and water on my breasts did.

        • Becky05
          May 3, 2013 at 6:46 pm #

          There is evidence that nipples can have thrush, but the pain is then confined to the nipples. It still isn’t the cause of most nipple pain.,f1000m,isrctn

          When Dr. Hale examined breast (rather than nipple) thrush they found no difference in Candida levels between women who reported symptoms that were considered typical for ductal candidiasis and controls.

          On the other hand, this is a new much larger study that seems to indicate it is a real phenomenon.

          • Serenity
            May 4, 2013 at 9:45 am #

            Interesting research. Thanks, Becky.

          • fiftyfifty1
            May 4, 2013 at 11:07 am #

            The BMJ article was hardly able to find candida unless they used PCR, and then it was common in both women with and without pain, although somewhat more likely in ones with pain. The problem with PCR is that because it’s an amplifying DNA technique it can give a positive result with even a single spore (and also is risky for completely false contamination results like the infamous Chronic Fatigue Syndrome mouse study). Candida is extremely common in the environment, especially in damp warm locations like the surface of irritated skin. That doesn’t mean there is an infection, just that it can be found there. The type of yeast they isolated almost always in this study is not difficult to treat or resistant. A single dose of Diflucan should clear it right up. And yet in clinical practice, lactation consultants are giving the diagnosis of Breast Thrush based on nothing more than “deep burning pain”, which can be due to many other causes, and recommending treatment for weeks or even months with Diflucan and when the woman doesn’t improve, they tell her she must need more of the medicine. It’s ridiculous.

        • fiftyfifty1
          May 3, 2013 at 8:24 pm #

          ” but I don’t recall visual symptoms. The pain finally went away after a nightmare couple of months of gentian violet and diflucan.”
          See, that’s the problem. Lactation consultants giving the diagnosis of “breast thrush” and treating for months with antifungals with no evidence. Diflucan is a powerful medicine. A single dose clears up a case of raging vaginal yeast infection. Yet women are treated sometimes for *months* with diflucan plus a topical before their breast symptoms improve. If powerful drugs are not working you’ve got to ask yourself if the diagnosis might not be wrong.

          • Pie13
            May 4, 2013 at 8:35 am #

            I agree, fifty. Even with the raging thrush I had on my nipples (seriously, they looked like baby carrots they were so swollen) one dose of just the nystatin had it cleared up by the time I woke up the next morning. I can’t imagine being on Diflucan for months. Also, I’ve nursed four kids, with up to ten years in between them, and had breast pain while nursing and even a dull ache for ten years when I WASN’T nursing…usually triggered by holding a baby or hearing one cry. My oldest is nearly twenty years old. I’m pretty sure you all would be mopping what was left of my body up off the floor if I’d had a systemic yeast infection for the last twenty years.

      • May 3, 2013 at 7:11 pm #

        None of this makes sense. Fluconazole affects human cells (although with less affinity than fungal cells), is found in breast milk in about the same concentrations as maternal blood plasma, and it’s affects on the breastfed baby are unknown. Yet, it is being recommended by the same people who won’t do an ultrasound or call a consultant OB when a women goes into pre-term labour?

        I’m sorry, i knew that this stuff doesn’t make sense. I’m surprised that I still find it surprising.

  4. Dr Kitty
    May 2, 2013 at 4:20 pm #

    OT: it s not a good thing when you have to provide a patient with the Birth Trauma Association website, tactfully suggest they consider seeking legal advice and check the NICE guidance on faecal incontinence, and reassure them that wanting a CS in a future pregnancy is totally fine.

    • moto_librarian
      May 2, 2013 at 4:58 pm #

      Ugh, I hate that so much. So sorry for your patient, Dr. Kitty.

  5. fiftyfifty1
    May 2, 2013 at 1:41 pm #

    I just sat for my specialty boards again which is required every 10 years. Last time I took it, the test was on paper and physically administered by the American Board of Family Medicine itself. They rented the hall, proctored the exam, corrected the test and sent me the results. Everyone in the room was a family physician taking the same test at the same time. In the intervening 10 years, the ABFM has outsourced the administration of the exam to a private test administration company. Now it’s computerized. The other test takers in the room were taking a variety of different exams including tests for accountants, busdrivers and gradeschool teachers. This for-profit company scored the test and certified that I took it legally. They examined my photo ID and signature and searched my pockets after every scheduled break. They may be the ones “certifying” the exam, but they sure as hell did NOT create the exam nor do they know the first thing about what makes a skilled and safe Family Physician. Nor does the fact that they also certify the busdrivers mean that I am capable of driving a bus or that the busdrivers who took their exam that day are capable of being a physician. Ridiculous!

    • attitude devant
      May 2, 2013 at 2:45 pm #

      Oh, I just did the same for OB! I had to have palm scans, turn over my keys and purse, etc., etc., etc. This was on top of my ORIGINAL certification where I had to take a written exam, submit a case list, AND do a whole-day oral exam with famous professors. Every year I have to do CME, take a self-administered test based on the most relevant journal articles, and submit learning modules on my office practice. Then every six years I have to do the written test in the regional testing center.

      • Dr Kitty
        May 2, 2013 at 3:56 pm #

        Oh don’t.
        I’m trying to put together my appraisal portfolio, with proof of my CPD, patient feedback, Significant Event Analysis, reflective learning etc etc for the last year. As a GP my reading can be fairly eclectic, and my case studies can be anything I found interesting, but the bureaucracy in recording all the reading and learning is awful.

        At least I get a civilised meeting at my appraiser’s house and a hopefully a cup of coffee while we discuss my earning goals for the next year.

        • Dr Kitty
          May 2, 2013 at 3:57 pm #

          That is LEARNING goals, not earning goals!

          Not Freudian, just bad typing.

          • Wishful
            May 2, 2013 at 4:34 pm #

            I am going to have to learn to love paper work….

          • LynnetteHafkenIBCLC
            May 2, 2013 at 6:58 pm #

            Lol! Heck, I think it’s pretty reasonable to have earning goals, with how hard you must work.

    • PollyPocket
      May 2, 2013 at 10:46 pm #

      Is there an oral portion still administered by the board?

      • fiftyfifty1
        May 3, 2013 at 8:28 pm #

        Not for Family Medicine. OB I believe yes, at least on a doc’s initial boarding test.

  6. auntbea
    May 2, 2013 at 11:53 am #

    OT: I just got an email to me asking me to sign a petition to have the Yale employee health plan cover midwife deliveries. Presumably this means CNM delivery, in hospital, though they don’t specify. As it currently stands, Yale CNM’s can do prenatal care, but not deliveries. I wasn’t planning on signing, but do I need to exert the energy take a stand against this?

    I am particularly wary of the Yale CNM program, since their chair is good buddies with Hannah Dahlen and cowrote that ridiculous c-sections as epigenetics article. And because they sent me a constant stream of email woo while I was pregnant.

    • suchende
      May 2, 2013 at 1:42 pm #

      I do think it’s important to at least share the other side of the story.

    • fiftyfifty1
      May 2, 2013 at 1:44 pm #

      just say no

    • Twila
      May 2, 2013 at 2:03 pm #

      Yale employee health plan already covers CNM hospital deliveries. This must mean CPM home deliveries. Maybe CNM home deliveries.

      • auntbea
        May 2, 2013 at 2:11 pm #

        I don’t think it does. The CNM who did my prenatal care told me that I was not allowed to have a CNM deliver me.

  7. The Bofa on the Sofa
    May 2, 2013 at 11:47 am #

    Actually, it seems to me that they are accusing the AAP of being ignorant. But…but…but we are competent, too!!!!

    The AAP response: “Do you think we’re stupid? We know darn well what you are”

  8. LynnetteHafkenIBCLC
    May 2, 2013 at 11:07 am #

    It’s kind of interesting how often the terms “certified,” “certification, “accredited,” and variations thereof are used. It comes off as a little desperate. And of course it begs the question of exactly what training is needed to achieve that certification.

    • Lost in Suburbia
      May 2, 2013 at 1:25 pm #

      Certification is just an attempt to have a something to waive over others who claim to have a similar training/experience/knowledgebase. Why be a board certified doctor? Why be a IBCLC? Because it suggests a certain level of training above and beyond average, or at least a minimum comon standard. In referencing the number of times a variation on certified is used in the text quoted from MANA, most of those uses pertain to using the full name/title of an organization of credential. but, when about 15% of the text uses some variation on certify/credential, it is excessive.

      But, I agree in the suggestion that CPMs/NARM/MANA are standing on the sidelines, waiving their credential around, saying, ‘See? You should let us play in the “credentialed” only game, because we have one, too!’

      • Certified Hamster Midwife
        May 2, 2013 at 9:55 pm #

        Remember, only a Certified Hamster Midwife is qualified to sit in the corner and knit while you gnaw open the skulls of your young.

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