I don’t know that I’ve every chortled before, but I’m chortling now. The new blog of the Midwives Alliance of North America (MANA), the organization that represents homebirth midwives, is a dream come true for me. I’m nearly giddy over the possibility of an endless stream of stonewalling and misrepresentation. If the first post is anything to go by, this is going to be a goldmine!
I wrote about the post two days ago pointing out the mistruths, half truths and outright lie in the piece. The comments by MANA executive Jeannette McCulloch trying to defend the piece are so delicious, I think they merit this follow up post.
Consider:
1. I submitted the following comment to the blog:
The heart of Gordon’s piece is this:
“What we know about using information drawn from birth certificates is that they are pretty good for capturing information about things like mother’s age and whether she is carrying twins. They are not very accurate when it comes to rare outcomes like very low Apgar scores, seizures, or deaths (Northam & Knapp, 2006).”
But the Northam & Knapp article, SPECIFICALLY says the OPPOSITE!
“Birthweight, Apgar score, and delivery method agreed 91.9% to 100%. The high-percent agreement supports the reliability of those variables …”
So the heart of Gordon’s argument is completely untrue. And Gordon referenced the mistruth with a citation that showed the opposite of what she claimed it showed.
There was no denial of my claim despite the fact that I basically said that Wendy had included a bald-faced lie in her piece. How could anyone deny it? If you can read, you can see that Wendy misrepresented the findings of the study.
There was no correction. Why correct it when the intent was to mislead? I guess they figure their own followers are not smart enough to understand the comments, so they can simply pretend they don’t exist.
2. When it was pointed out that failure to list place of birth on the birth certificate means that the study being discussed, the one that showed that homebirth increases the rate of stillbirth by nearly 1000%, likely UNDERCOUNTS the real rate of homebirth stillbirth, McCulloch responded with this bit of misleading information:
… [Wh]ile a small percentage of intended home birth deaths are wrongly attributed to hospital deaths using birth certificate data, a much larger percentage of home births with no injury to mother or baby are wrongly attributed to hospitals as well.
So what?
There were 200 times as many hospital births as homebirths, so even if a massive proportion of homebirth attempts ended in a live hospital birth, it would have NO IMPACT on the overall rate of hospital birth death or hospital live birth. However, since the number of women attempting homebirth is only 1/200th of that attempting hospital birth, and since death is a relatively rare outcome, leaving a few deaths out of the homebirth group would make a very big difference in the homebirth death rate.
In other words, the hospital birth death rate is basically unaffected by the liveborn homebirth transfers, while the homebirth death rate is considerably lowered by removing the deaths that occurred after transfer.
The study shows that homebirth increases the stillbirth rate by nearly 1000% and that’s an underestimate of the true rate.
McCulloch offered no denial and no correction.
3. The very best comment from McCulloch so far is the latest one, just another in an endless string bizarre excuses for not releasing their own death rates:
Thanks for your questions relating to the topic of MANAstats and how and when that data is available. We hope the following will help answer all of your questions. Please read this first before asking a question about MANAstats release, as we’re going to limit new comments on the subject to questions not answered here…
Midwives, mothers, and others interested in conducting research with MANA Stats data but who do not have academic affiliations and thus no access to IRB or ethics boards are invited to access the dataset through the DOR’s ConnectMe program. This program connects individuals with researchers for support and mentorship and provides the IRB access needed to allow non-academics to access the data while still maintaining ethical protection of research subjects. All academic journals require that researchers go through ethics or IRB review before conducting research, so this process also insures that applicants to the data set will be able to take their work through to publication if they so choose.
But NO ONE is asking to do research with the MANA death rate; they simply want to know what it is.
MANA has had no problem releasing other statistics from the database. As early as April, 2011, they went public with the C-section rate for the database and in July of 2012 they released all of these statistics from the database.
Obviously they could release the death rate, but they won’t.
Let’s be honest here: is there anyone in the US homebirth community who believes those death rates are anything other than hideous? I doubt it. Yet by refusing to release the death rate, MANA can maintain the illusion of plausible deniability and continue to fool unsuspecting women who are contemplating homebirth.
It’s only taken one post, and MANA has already resorted to “moderating” comments because they know the facts are not on their side.
As far as I’m concerned, this is just awesome. The first post contained an outright lie, which MANA does not deny, but does not correct, either, and is filled with obvious attempts to mislead readers.
Bravo, MANA! And thanks. When it comes to my campaign to abolish the CPM credential I am willing to give credit where credit is due: I couldn’t do it without you, MANA. Keep up the good work!
Wendy has taken her smear campaign on the road to the Science and Sensibility blog:
http://www.scienceandsensibility.org/?p=7388
Her criticisms are still invalid. She did remove the bald faced lie and linked to it instead.
I see that she’s still promoting the idea that Grünebaum et al. includes “unplanned, unattended homebirths.”
Her responses to readers pointing out that her reasoning is flawed are amazing.
“We don’t have any research on how birth certificates are completed in states where home birth midwives are underground.”
No, but they have plenty of statistics. Statistics that they won’t release.
They have secret data! But they can’t share it because…the data will lose their sparkles!
WELL my comment didn’t get through. I talked about the difference between a legal and an ethical responsibility to protect women. I argued that if they had the data they had an ethical responsibility to release it. I guess they didn’t appreciate the comment very much. This was days ago.
Welcome to the world of NCB advocacy. (Of course, they’re happy to come here and spew truly abusive invective in lieu of facts and rational argument.)
A question on point #2 – I thought that McCulloch’s response was suggesting that there are homebirths without injuries/bad outcomes that are wrongly attributed to being a hospital birth. You appeared to interpret the comment as if she were suggesting that there were not-bad outcomes that were homebirth transfers to hospital that should be included in the homebirth set. I didn’t get the sense she was talking about transfers at all, just those actually born at home. Am I misunderstanding Dr. A’s stance, or McCulloch’s comment?
As a follow up to that, if McCulloch was suggesting that there were not-bad homebirth outcomes wrongly attributed to hospital, how many of those births would have to be added to the homebirth group to actually make a difference in lessening the apparent stillbirth rate?
I think Dr Amy’s point is that, bad outcomes are a much bigger issue than good outcomes. Consider for example, if something has happened 1/100 times, if you undercount by 15 good examples, the rate changes from .01 to only 0.0087. However, if you undercount a single bad result, that doubles the rate. So from a HB perspective, you need lots and lots of non-counted transfers to make up for every missed bad outcome.
And from the hospital perspective, the effect is even worse since the impact of non-events is pretty miniscule. When you have an event of 5 in 1000, an extra 1 is a 16% increase, while those 15 good outcomes improve the rate from all of 5/1000 to 4.92/1000, or a change of less than 1%.
Lastly, I’d repeat what I said before: Are they seriously suggesting that a patient who attempted a HB, but had to be transferred to the hospital should be considered a successful HB? “We weren’t able to deliver the baby, and the hospital covered our butts. Yeah for us!”
“Are they seriously suggesting that a patient who attempted a HB, but had to be transferred to the hospital should be considered a successful HB?”
Perhaps they’re saying that, “Look, the woman transferred for pain relief, silly thing! She could have had a natural birth if she really wanted one!”
It also makes me take the reduction in second trimester miscarriage and premature birth stats with a pinch of salt, because those ladies will almost certainly have gone to the hospital, and will probably just have stopped showing up at antenatal appointments with the CPMs.
Also, does MANA keep any stats on the number of women who start out planning HB, and just change their minds at some point, cancel the appointments with CPMs and opt either to UC or go to an OB?
I.e. What a medical study would consider “lost to follow up”.
What about women who switch to a different CPM practice midway through their pregnancy, do they get counted twice?
There is also the situation, not uncommon, where the baby is actually successfully delivered in the home, but the mother requires transfer for retained placenta [or fragments], excessive bleeding, extensive laceration, etc. Problems of “the 4th stage” really need their own category, too.
The data form captures that information, so theoretically they have stats for it.
I don’t think, for the sake of statistics, they should report a transfer to the hospital as a “successful” homebirth. For reporting statistics, I think the categories should be broken down more than just “home” or “hospital”
As to the question, I do think that if a midwife transfers a mom to the hospital, it *could* be considered a ‘successful’ homebirth. I know more than a few women who do consider their homebirth-transfer-to hospital ‘successful’ homebirths, because their midwives made the call to transfer care before an emergency arose.
We can’t have it both ways – if we complain about midwives making bad choices that put mothers/babies at risk, then we should be glad that they are transferring women to hospital care before an emergency arises, instead of making fun of them for transferring care.
I wouldn’t hold a transfer against a hb situation. In fact, an itchy transfer finger, in my view, would be a GOOD thing for a home birth attendant.
However, it should not be considered a successful HB.
Yes, I think you’re right. Planned home birth ending in hospital transfer should be its own category, so we can stop arguing about transfers screwing up the statistics either way. We should also track women who plan a home birth but wind up going to the hospital for preterm labor or other emergency, or get “risked out” of home birth before the time comes.
And a midwife who does prompt transfers when indicated, one who travels to the hospital with the mother and shares records, THAT is a midwife I can get on board with. There are women who are so afraid of the hospital, they just can’t bring themselves to go unless they’re really sure the baby’s life depends on it. My grandmother didn’t like her first delivery experience, and with the second, she delayed going for hours, so long that she practically gave birth in the hospital lobby.
If you’re helping these hospital-phobic women with their normal deliveries, and telling them straight when things are not normal, you’re probably helping public health overall, especially if the alternative is letting them try unassisted birth.
That, by the way, is the essence of the UK’s “Domino” system [which was not implemented in Cambridge when I was there, but I got a lot of positive feedback from midwives who’d worked with it.]
In this model, the local midwife does all the antenatal care for the pregnant woman; then, when contractions begin, the patient summons the midwife to her home. If labor is established, the midwife transfers the patient to the hospital, delivers her there, and returns her to her home 6 hours after birth, assuming both mother and baby are OK. The home must meet certain standards, and be prepared to receive the new mother, and, legally, the midwife remains responsible for the welfare of the mother and baby until the 10th postpartum day [this is standard for all women regardless of where they deliver]. The community midwife handling the case will visit daily, or even more often, if she thinks she is needed [if the mother has bad hemorrhoids, an epi, needs help with nursing, etc]
To me, this really is the best of both worlds, and I hope it is still being used in the UK, although recently some of the articles I’ve seen about the NHS midwifery services are quite grim.
McCulloch is suggesting that the undercounting of “good outcome” transfers (because that’s the majority) offsets the undercounting of “bad outcome” transfers. Which might sound reasonable if you don’t actually do the numbers, as Bofa has illustrated. But McCulloch seems to be counting on nobody noticing.
Does anyone else find it strangely appropriate that the Midwives Alliance of North America’s initialism is the word “mana”? The term mana means a magical force,power and/or authority residing in a person, animal or sacred object. I just find that funny, for some reason.
At least it’s not “manna” or we’d have to cope with “manna from heaven” as part of the propaganda
There are so many variables to take into account. I would REALLY like to know what the homebirth stats are IF all the participating midwives were [1] CNMs, [2] adhered to the same vetting procedures for clients [such as only gravidas 2, 3, or 4 with a singleton vertex presentation; no history of any previous medical or obstetric problem in any previous pregnancy or this current pregnancy, full antenatal care, etc.].
Because, as it stands now, the definition of “midwife” isn’t standard, nor the protocols used. Therefore, it is impossible to know whether, properly conducted, what the added degree of risk to mother and baby is going to be. We know it’s higher than in hospital, but that is at least partly due to inadequate midwifery education and to some high risk women being considered as suitable candidates for homebirth, so it’s a foregone conclusion that the stats will be bad. The real question is, would they STILL be as bad, or in any case, worse than for a similar population delivered in hospital [I think it would be, but possibly not as dramatically]
Which is why the MANAStats data is so valuable. Despite MANA’s protests about it not being a research project, it holds the largest (perhaps the only) dataset that does exactly what they say they want: captures only planned homebirths with an attendant. Moreover, it also captures whether attendants are CNMs, CPMs, or other midwives and what the enrolled midwife’s educational route was.
this seems pretty cool. I know one gift that I got for my home birth that was a life saver. I also wanted a natural birth so that was also the reason why Laboraide was such a great gift.
http://www.laboraide.com
It would have been even more natural if you used a stick.
Wow, the modern version of biting the bullet. I’m amazed that this exists. Ha! So much for – if you let go of fear, then it won’t hurt. Or – it is your fault if you can’t just relax away the pain.
I’m so tempted to find a few local MANA homebirth midwives and see if they would take me on as a client. (NO I wouldn’t actually hire them my RCS is scheduled for Dec 5) My first pregnancy ended in a C/S for cord/breech at 40 weeks 4 days. This second pregnancy is transverse breech at 28 weeks and I might have GD. I get a three hour glucose test next week. I would LOVE to ask about the MANA stats but their Dr Amy detectors might go off. I would probably give myself away anyway, I tend to talk in medicalese when discussing birth.
“I would probably give myself away anyway, I tend to talk in medicalese when discussing birth.”
Same here, it makes the check-ups and follow-ups much quicker and easier for everyone.
You should do it! And take copious notes, just a “mama” doing her research. Bring your first child to the appointment, too.
I could always tell them I don’t trust the glucose tolerance tests I was given and see what they tell me. Maybe that would get me in the door!
Tell them you are willing to take Chinese herbs.
Make sure you are attended by the MAWS president-she is very big on the whole MANA stats project.
Actually, it’s perfectly OK to use medical terminology. Just make sure you use at least one word incorrectly, or take a fact from a medical book horribly out of context, and you’ll sound properly self-educated about childbirth.
someone who can access the data should give it to wikileaks. I mean seriously, I wonder what is lurking in there….
Ask Anonymous or another hacker group to see if they can get the data. I wouldn’t actually do this but I bet most hackers I know would sure try and see if MANA has the data online somewhere.
Probably dumb question but…the stats say that 91.6% of patients had a spontaneous vaginal delivery. If you add up all other forms of delivery (c-section, forceps, vacuum), they add to 6.33%. That accounts for 97.93% of births. What happened to the other 2.17% of patients? (Probably lost to follow up, but it gives the unfortunate impression that 2% or so of patients just didn’t deliver.)
But *ALL* babies are born eventually! (isn’t that one of the lines?)
Well, no, some of them die in obstructed labor, along with their mothers, and are buried still in utero. It’s not supposed to happen in the US and I doubt that’s actually what happened to the missing 2%, but given everything else I’m not quite ready to rule out the possibility entirely…
They didn’t trust birth enough. (as per above, I’m just trotting out NCB lines. I have as much faith in MANAs stats as I do in their professionalism and stuff)
I’m guessing the lost 2.17% are inductions.
Inductions! How could I have forgotten inductions?
It depends on how they count inductions. The stats form allows midwives to enter whether the induction is “pharmacological” or by “herbs/castor oil, homeopathy, nipple stimulation, AROM, or membrane-stripping”.
You can see the client data entry form by logging into the demo: demo.manastats.org
ARGH!
Herbs/castor oil ARE pharmacological, in that they are subtances being taking for their suppoed medical effect!!!
phar·ma·col·o·gy (färm-kl-j)
n.
1. The science of drugs, including their composition, uses, and effects.
2. The characteristics or properties of a drug, especially those that make it medically effective.
There is a world of difference between homeopathy (magical placebo water) and AROM! The categories need work.
Let’s focus more what the Apgar zero paper says about the outcomes of midwives’ deliveries in the hospital. It is the best outcome of all. Better than doctors (likely because doctors have more high risk patients).
The Apgar score zero paper is as much about the horrible deadly outcomes in home midwife births as it is about the excellent outcome of hospital midwives. A celebration to hospital midwives!
Maybe Wendy Gordon should congratulate hospital midwives (mostly CNMs) for their great work and PR in this paper and acknowledge home midwives failure (mostly not CNMs) to provide safe deliveries.
Wendy Gordon actually tweeted about “MANA data key outcomes” back in July, but strangely, nothing about mortality rates:
–@WendyCPM, July 11
How is 91.6% “almost 94%”? Dishonest rounding to go with their other dishonest use of statistics.
I submitted several polite (really; I save my snark for here) comments yesterday morning, none of which has made it past moderation thus far.
My comment about IRB requirements didn’t go through either.
I suspect they’re done with comments.
Looks like they’re still posting “Go MANA!” comments, but no questioning comments.
Either they had IRB approval to collect and store these data, and therefore no one else needs approval to use it or they didn’t have IRB approval, which means they collected it unethically and should not be publishing their results either.
These stats are also 6 to 9 years old. Isn’t that odd? Or are stats this old common in the medical field?
2007-2010 is 2-6 years ago. The most recent CDC data are from 2010 and they are included in that study.
Where are you getting those dates from? The MANA chart is from 2004-2007 .
Right. The vital stats in the study that spurred MANA’s post were from 2007-2010.
There is one place where I agree with Wendy Gordon. She complains that the press release (out of Cornell) conflates stillbirth with Apgars of 0. As she notes, in the paper, the authors themselves take note of the difference:
The press release is misleading.
“there is likely less antepartum testing and no continuous electronic intrapartum fetal monitoring, both of which may have affected adverse outcomes.”
IS this saying that if antenatal testing and intrapartum continuous monitoring were done, they might prevent the adverse outcomes? Would not expect much agreement on this…except from most obstetricians.
My personal favorite among the comments:
Who cares if there is accurate data on homebirth? If you don’t think it’s safe, don’t have one… and you can just use your vaginal divining rod to decide if you think it’s safe enough. And we just know there are loads of problems in hospitals… those places where no one ever studies outcomes.
? Outcomes are studied all the time. and there aren’t huge problems with the hospitals. Gah. They aren’t perfect, but huge issues? Nit here anyway.
Whether or not the problems are huge, at least someone goes to the trouble of identifying and quantifying them (e.g., the new study in the Journal of Patient Safety–a whole freakkin’ journal devoted to safety, who knew?) and entire organizations, governmental, professional, and other, are devoted to addressing them.
How many homebirth organizations or professionals participate in that kind of research?
People screw up everywhere, so it depends on how you define ‘huge problem’. The difference is that you can actually sue if someone screws up in the hospital, and you can get the person who messed up in trouble (in theory anyway).
Moreover, there are entire organizations, governmental, professional, and private, devoted to identifying, quantifying, and addressing medical mistakes.
How many homebirth organizations are involved in projects related to safety?
I have a feeling their definition of problem is not the same as ours.
I just noticed that if you add up all of the transfer rates, there is a 13% chance of having to transport to the hospital during labor or shortly after the birth. So even by MANA’s numbers, about 1 in 8 homebirth attempts end up in the hospital. I would imagine that primip and HBAC numbers are much higher than that, and multips are lower.
Even the best transfers are not fun. It’s not a happy time to give up the dream home birth, move ever so slowly while in heavy labor, and to transfer to an unfamiliar provider in an environment you probably distrust (otherwise you would have chosen the hospital to begin with). Add to that the worry and trauma of dealing with the emergency situation that many of these transports are. And add to that the great expense of paying both the midwife and the hospital (and in some cases an extra transport fee to the midwife). If I, and especially my husband, had been told how high the risk of transport was and what that would mean financially, I don’t think I would have chosen my HBAC attempt.
My birth center claimed their transfer rate was 10% I probably would’ve chosen hospital. Oh, and they dismissively said that the transfers were usually due to wanting pain relief – it was presented as if some women just can’t tough it out. Having now experienced labor and a transfer I can say no one transfers unless things are pretty awful and there is no end in sight.
I was told that the transfers were for exhaustion and pain relief, at a place that KILLED a baby and transferred for an abruption (due to missed chorio). The MW was negligent through and through, and was totally lying about their transfers and safety record.
Thankfully, they are closed now.
Yikes. Yes, the cynical part of me wonders what they called my transfer since it was not an emergency but I wouldn’t have called it optional, either.
I have since learned that the staff at the nearby hospital (which I was NOT transferred to) do not have a high opinion of the birth center.
The birth center near my employer uses their proximity to the hospital in their advertising. Their extremely questionable practices have earned them a poor reputation at the hospital. They also don’t tell families that mom may be transferred to a hospital elsewhere if the nearby one is full and the transfer is not emergent.
Sick.
Someone who posted here went through a transfer and ended up at UW hospital
Happens a lot. The unit has been full for days on end several times this year.
I just don’t get it – if the data exists women should know about it, anything less is a deprivation of informed consent. They might be hideous – but they should not be hidden. I’ve got some choice words for this kind of propaganda….
Why would MANA care about women’s safety? That is the state’s responsibility. ” Ensuring safety of the public is the responsibility of individual states, not a professional organization.”
Then why has ACOG and all the other doctor associations been so worried about it?
Except when the state actually tries to regulate. Then they should trust midwives to be self-regulating, like doctors do.
They invite the kind of regulation that allows them to bill 3rd-party payors, as long as it doesn’t impinge on their ability to do exactly what they want.
Publishing only lower intervention rates but not outcome data is right up the alley with MacDorman from the CDC who has been hiding outcome data forever while at the same time using birth certificate data for her own agenda.
Her publication on the increase in homebirths got huge applause by homebirth midwives, when in fact one-third of these homebirths were unassisted and likely disasters.
Homebirth advocate MacDorman has had the CDC outcome data that were just published in AJOG always in her hands but chose not to publish these dead baby numbers because they are plain embarrassing to homebirth midwives.
A crime of omission by MacDorman is right up there with a crime of commission by the home birth midwives.
You wonder why the CDC which is an otherwise reputable and objective organization that we as taxpayers support continues to employ homebirth deaths outcome denier MacDorman. When will they start an investigation into her unprofessional behavior?
I also loved where she said:
But the BC Perinatal Registry releases quarterly reports to the public, including data on stillbirths and perinatal deaths. The other one is a service the American Association of Birth Centers. Shockingly, they do not release data from their registry publicly either. I guess we could go pick on them, but given that it costs non-member providers $199 to $299, I doubt they have enough records to make it worth anyone’s while.
I especially love that they include the preemie and low birth weight rates, since the place of birth and birth attendant has absolutely nothing do to with that.
“Oh, my baby’s two months early? What a surprise!” I would seriously hope that all but the craziest of crunchies would head to the hospital for preterm labor!
A couple months ago a mom on the MDC UC forum UC’d a 35 weeker. On purpose.
So, no idea what happened to the Kennedy’s 35-weeker, then.
Jackie didn’t eat enough kale, I hear.
Here is Lisa Barrett bragging about supporting a home water birth of a 33 weeker.
http://www.homebirth.net.au/2009/01/premature-babies.html
It’s normal don’t you know.
Premmies don’t need a clear plastic box or cocktail of lethal drugs. “That’s just thoughtless science”.
Kangaroo care for the win. After all “kangaroo care has sense and mother love running through it”.
Well, in this case it seems like they were lucky because not all 33 weekers need the NICU. Also, that story about the medicines in the NICU is horrible. Sorbitol is not a sugar substitute it is a sugar alcohol that is naturally in many fruits. Also, most NICUs use unflavored and uncolored medicines.
This article is hilarious, because it implies that kangaroo care would be just fine as a substitute for babies needing these meds. Hate to break it to anyone, but if they are giving your kid diuretics it’s probably for a really good reason! Last time I checked moby wraps don’t leech fluid out of babies bodies.
If Kangaroo Care doesn’t cut it then the baby should be allowed to pass peacefully.
No joke, that is what some of them believe…
Glad I’m not that heartless. Very silly to just throw all the wonderful advances we’ve made as a species in the garbage.
So, regarding the furosemide – my daughter was on the plain old liquid from the pharmacy when she was a newborn, which is 11.6% ethanol. She was taking .4ml a day for CHF, so .046ml of ethanol a day. Which, is the equivalent of me drinking… 1.66ml of ethanol a day, or 11.62ml a week. Which sounds to me like less than one drink a week, not 7? Is my math bad here somewhere or is that article insane. Or are they giving preemies way way more lasix than they are giving to CHF patients?
The run of the mill preemie without CHF is probably getting way less Lasix than a baby with CHF. Usually it’s not used long term. Diuril is the daily diuretic I see most often at work. I can’t bring myself to read the link, I will probably want to strangle Lisa Barrett if I do.
How much do you weigh Tim? Maybe it’s my math that’s off but your point is still valid.
About 250. So a 7lb baby is 1/35th of me, and .046ml of ethanol a day * 35 becomes 1.6ml a day or 11.3ml a week. Which is less ethanol than a 1.5 oz serving of vodka or some other 80 proof liquor. (17ml or so)
I know they do 1-2mg/kg for CHF dosing, and you’re saying a run of the mill preemie with respiratory problems is likely getting less.
the weird part is in this statement
“A study of babies in Britain who were up to 13 weeks premature found that those prescribed the diuretic furosemide, which contains ethanol, could be ingesting between 0.2 millilitres to 1.8 millilitres of alcohol a week, the equivalent of a 70-kilogram man consuming up to seven standard drinks”
1.8ml of ethanol a week would assume .25ml of ethanol a day, is like a 2.2ml /day dose of furosemide. Which is 22mg – the top end dose for a 25lb infant. Not exactly what I think of when I think of preemie.
I realize I’m much larger than a 70kilo man btw – I just think their estimates on how much a NICU preemie is getting are wildly overblown based on my experience.
Oh ok I wasn’t using a standard shot, haha
And then, on top of that, the original point of “they don’t give diuretics to babies for fun” – pretty sure that choice is made because, uh, the need outweighs the risk. It seems like some people want to assume they are just trying to have a contest for which baby can make the heaviest pee diaper, not save their lives.
When I have nursing students ask me what I think of CPM and homebirth I tell them about MANA not releasing the death stats. That makes them think! I have never had a student think homebirth is the great thing they thought it was after they dig a bit more!