Homebirth and natural childbirth advocates keep throwing memes against the wall, hoping one will stick.
Obstetricians don’t follow scientific evidence! Except that they do.
The media is to blame for the pain of childbirth! Except that it isn’t.
Homebirth is a human right! Except that it’s not.
A healthy baby isn’t enough! Except that for most women, it is.
My personal favorites, though, are the pitiful attempts by homebirth and natural childbirth advocates to harness to their cause scientific disciplines about which they clearly are ignorant. Their invocation of quantum mechanics and chaos theory aren’t merely pitiful, they are hilarious.
Now they’re about to throw a new meme against the wall: MicroBirth.
That’s the breathless announcement from One World Birth, the same clowns who nominated Lisa Barrett, a one woman birth-crime wave, as a “National Birth Hero.”
What is MicroBirth?
Over the past three years we have been on a journey, trying to connect the pieces of the jigsaw puzzle that is birth…
The more we discovered, the more convinced we were that there was a vital piece missing from the picture.
A piece that connected everything…
The reason it has proved to be so elusive for so long is because it is not visible to the naked eye.
It is microscopic.
What does that mean?
It is supposedly:
… brand new science investigating crucial microscopic events that occur during and immediately after birth.
And, more importantly, what happens when the natural processes of childbirth are interfered with or bypassed completely…
[I]ncreased medicalization of childbirth may be having severe consequences on the life-long health of our children.
What’s more, it could be having a devastating effect on the future of our entire species.
Holy hyperbole, Batman! What could it be?
They don’t say, but I have a guess. I’m going to guess that it’s another pitiful attempt to harness cutting edge scientific disciplines about which they are painfully ignorant, in this case epigenetics and the microbiome.
For those who have no idea about the science of the microbiome and the science of epigenetics, such an effort makes perfect sense:
Natural childbirth and homebirth advocates have a massive problem. The scientific evidence does not support their claims. Natural childbirth isn’t safer and hombirth isn’t safe at all. You might think that would cause them to re-evaluate their core beliefs, but you’d be wrong. Natural childbirth and homebirth are cults, and their core beliefs are non-falsifiable. Therefore, they must abandon their original claims that natural childbirth and homebirth are visibly safer. No problem! Natural childbirth and homebirth are safer on the microscopic scale!
We’ve already seen a preview of this approach. In January 2012, a group of midwives convened a panel on Epigenetic Influence and Impact on Childbirth.
Hannah Dahlen, an Australian midwife, says it could increase respect and demand for vaginal birth. “We’re at the beginning of a very exciting time,” Dahlen says. “I think in 10 years we will potentially look back at what we are doing now and think, ‘What on earth did we do?’” …
They were all frustrated “that despite the research, political activism and efforts they and many others were putting in to increase the rate of normal birth, intervention during childbirth kept rising and arguments about safety and outcomes all had a short term focus,” she wrote in an email.
How frustrating that obstetricians and mothers are focusing on the such short term outcomes as whether the baby lives or dies, is born intact or has suffered a brain injury. Sure, childbirth interventions like C-section make childbirth safer on the macro level (duh!), but at the level of DNA, interventions cause severe consequences on the life-long health of our children (only the ones who survive childbirth, of course) and OUR ENTIRE SPECIES!!!
And not only that, but childbirth interventions might change to microbiome of the gut cause severe consequences on the life-long health of our children (only the ones who survive childbirth, of course) and OUR ENTIRE SPECIES!!!
There’s just one teensy, weensy problem. THERE IS NO EVIDENCE TO SUPPORT THOSE CLAIMS.
Epigenetic changes, the chemical modifications of DNA that are the result of environmental influences, are the results of long term events lasting months or years, like famines. There’s not a shred of evidence that ultrashort term events like childbirth cause ANY changes to DNA, let alone deleterious changes.
Similarly, there is not a shred of evidence that altering the microbiome of the gut of the newborn (if indeed such alterations occur) has any long term impact on health.
But wait! Childbirth interventions and C-section rates have been rising steadily and look at the long term impact on health! Since the advent of modern obstetric interventions …. we live longer and healthier lives than ever. Oops!
I predict that this meme isn’t going to stick, either. First of all, “More babies die at homebirth, but the ones who live have better genes!” and “More babies die at homebirth, but the ones who live have better gut bacteria!” are not like to be an effective rallying cries. Second, the central premise, that obstetric interventions are safer on the macro level but cause long term microscopic health problems is obviously nothing more than nonsense.
Natural childbirth and homebirth advocates are (once again) making themselves look like fools, while failing to advance their cause in any meaningful way. They are simply flailing around trying desperately to justify a failed philosophy that has put, and continues to put, the lives of babies at risk.
“Similarly, there is not a shred of evidence that altering the microbiome of the gut of the newborn (if indeed such alterations occur) has any long term impact on health.”
The above statement is simply no longer true.
http://www.ncbi.nlm.nih.gov/m/pubmed/26994839
http://www.ncbi.nlm.nih.gov/m/pubmed/27001445
http://www.ncbi.nlm.nih.gov/m/pubmed/26980815
http://www.ncbi.nlm.nih.gov/m/pubmed/26839074
(And many, many more.)
I would also encourage you to peruse Pubmed for articles discussing the newfound influence of the microbiome on our epigenetics.
I am certain that most conventional doctors have the patient’s best interest at heart, but I don’t believe they necessarily have the desire, ability, or clinical experience to fully understand the ‘big picture’ of health. If I choose to have a home birth for my next child, it will be based on my own thorough understanding of the potential short and long term risks associated with each scenario.
Please show us what a normal infant gut microbiome looks like.
I especially love how you say, “natural childbirth isn’t safer”… I guess we’re the only species with a defective weak uterus, vagina, and so on. I guess they are just there for looks. Guess procreating, laboring, & delivering wasnt at all what my body was designed for… how ever did humans become the dominate species of the world?! Especially, before idiot greedy doctors like you came along?! Yes, because we were all meant to be pumped full of drugs. We’re just meant to be cut open & have major abdominal surgeries!!! …Do yourself a favor, next time you actually want to be taken seriously, don’t say stupid shit like that. -_-
Sweetheart, do the world a favour and push your head into your so strong and non-defective vagina. Don’t take it out. You aren’t designed for belonging in the real world but the Yoniland.
You know, there’s a reason that the veterinary memoir “All Creatures Great and Small” starts out with a birth scene. By the way, thanks for proving that natural childbirth is really just eugenics for lazy people. I guess the millions of women and babies who died during childbirth throughout history are just acceptable losses to you.
Spoken like a true member of the “dominate” species.
Here you go:
http://www.talkorigins.org/origins/faqs-evolution.html
Educate yourself.
Childbirth without medical interventions (i.e. natural childbirth) isn’t safer than childbirth with medical interventions. That doesn’t mean you are, or women in general are, defective. It just means that you aren’t increasing your and your baby’s safety by having a home birth or refusing all interventions.
Because Natural childbirth simply isn’t better. And no, we are not the only specie with a ‘defective weak uterus’
Birth is a very dangerous moment in the life of every single living animals, wild or domestic. No specie is perfect at birth and no specie has a ‘perfect’ vagina and uterus. Complications of birth in nature in animals are very common, you just don’t see them happening because those animals either die quickly or are killed off before they can recover.
C-sections are a very common procedure on dogs, cats and cows. I’ve operated on a cat with a uterine rupture, two other with retained dead babies with terrible uterus infection. Multiple cases of eclampsia, puppies stuck in birth canals, uterine inertia, massive blood loss and the likes.
Birds will often have retained eggs or egg yolk coelimitis.
Prematurity and dysmaturity are very common problems in horses.
Thinking that ‘natural’ is safest at pretty much anything shows how little you actually know about nature. There is a very obvious reason animals in zoo will usually live 2-3 times longer than it nature. ‘Natural’ life is extremely hard and dangerous in every single aspect.
You’re right, procreating et al aren’t what your body was designed for. Your body wasn’t designed for anything, it evolved. There’s a great big difference between the two.
More or less:
http://www.americanscientist.org/issues/pub/why-is-human-childbirth-so-painful
Homebirth isn’t a human right?! Why, because it’s less money in your pocket? Sorry but not all of us are brain washed sheep looking to feed your pockets. Long before hospitals became a thing women gave birth at home with midwives. Last I checked, this is supposed to be a free country, and current midwives for through years of training & becoming certified just like doctors do. It is a human very much so a right. My body, my baby, my money, my right!!! Pregnancy isn’t an illness. Not all women need a surgeon (Obgyn) & a sick-infected hospital to give birth in. Especially since a low-risk healthy pregnancy gets ruins by interventions & greed! This entire article altogether made you sound like an ignorant ass. Good job! smh!
Am I against doctors & cesareans? No. When they are not overused & abused, such things are great for high-risk pregnancies & saving lives. But to say it isn’t a human right to choose how we birth is bullshit!
I would never in a million years let you near my vagina or my babies. You aren’t skeptical, you’re stupid. Doctors like you harm and kill mothers and babies.
me neither.
Dorito, do you have any examples of things Dr. Tuteur has said that led you to that conclusion? Or is it just a scared/defensive reaction to reading things that challenge your beliefs?
How so?
What make you think I would take you on as a patient?
Why would I want to waste my time with an fool who thinks she knows more than I do just because she read some crap on the internet?
Don’t forget to add in..
Cowardly hiding behind an ‘imposter’ user account.
There seems to be a great disturbance in the troll universe as of late.. they’re coming out of the woodwork. And.. with even more inane and asinine nonsense.. if.. that’s possible.
When you state that there is no evidence that the event of childbirth has an impact on the Microbiome, you discredit everything else you could possibly say. Apparanyly you haven’t paid attention to two decades of research. And thus, I can only assume you are equally uniformed for other relevant scientific and medical advancements in your field that have occurred in the past two decades. This would concern me if I were your patient.
References, please? As you are so well informed, I’m sure you have them handy. Peer review only, please.
Amy, are you ACTUALLY a doctor? How terrifying. You do realise that women’s “perceptions” are actually women’s experiences, right? Whether you think it’s right or not…. right? Right? Please tell me this blog is a joke? 1/3 of ACOG guidelines aren’t evidence based. Have you read THAT paper? Congratulations on spouting ignorance, I hope you’re deeply, deeply ashamed.
Hold up. One third of the American Congress of Obstetricians and Gynecologists guidelines aren’t evidence based?
What paper?
It’s been written about here before. It’s a bit misleading.
And MANA doesn’t have any guidelines.
Your point?
What do you guys think about this ACOG position paper? It is from 2011, but reaffirmed last year.
http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Planned-Home-Birth
It says in the first paragraph what has been mentioned in comments to you for the past few days: women have the right to birth at home, should be informed of the risks of setting and birth attendant when OOH and the absolute risk is low for women who are low risk. The numbers talked about reaffirms the statement that the stats your midwife has are terrible.
I’m confused. Dr. Tuteur said no such right exists.. it’s right there in the beginning of this post:
“Homebirth is a human right! Except that it’s not.”
… and from the post that she linked to…
“…there is no legal or ethical right to have a homebirth”
http://www.skepticalob.com/2012/09/human-rights-in-childbirth-does-the-baby-have-any.html
You are getting confused between positive rights and negative rights. There is no positive right to have a homebirth. There is a negative right to be left alone. Therefore, no one has to provide you with the means of having a homebirth, but no one can stop you if you choose to give birth at home.
OK. Now I understand the difference. Thanks for clarifying.
Well… can you see how it might be less confusing for people coming to your blog if you were a bit more specific with your word choice?
Speaking for myself… when I read that sentence I interpreted it to mean that you were saying that women do not have the right to choose their venue for birth.
Do you see? That initiated an emotional reaction within me, which led to an emotional response, which led to all the fallout here over the last few days.
I’m willing to take responsibility for my unskilled response.
But are you and your readers willing to take any responsibility for repeatedly making me out to be a “homebirth advocate” and for dogpiling on me before you swoop in for the coup de grace?
My head on a plate? Really? It this something that brings you satisfaction?
“Let’s leave aside for the moment the fact that there is no legal or ethical right to have a homebirth; the right of autonomy allows for the refusal of hospital care (or any medical care), but it does not mandate an obligation on the part of others to provide a specific form of care.”
I Was specific. You didn’t bother to read it.
No I DID read it. I see now what you meant, but it isn’t immediately apparent that when you said NO right.. you meant SOME right. Capisce?
In addition, I read that after I responded to THIS blog post, in which you wrote, “Homebirth is a human right! Except that it’s not.”
When I said you should have been more specific, I was referring to THIS post, not the other post. Understand?
Finally, you have STILL not taken any modicum of responsibility for your mischaracterization and treatment of me here, and you didn’t answer my question…
(Well at least he spelled ‘capisce’ correctly.)
Matt, you’re BEYOND obnoxious. Maybe YOU should have been more specific yourself. Why anyone should answer ANY of your questions or even respond to you any longer I have no earthly idea.
And now I’ll go back to my previously scheduled programming of dealing only with people who are actually interested in engaging in dialogue.
Don’t let the browser close on you on the way out, buddy.
She means that it’s not a protected right such that we are obligated to provide you with a means of having a homebirth. The only people who misread it are the ones who are primed to misread it. You seem to have your heart in the right place in that you want the best for your wife and unborn child, but you also seem as though you are looking for justification that her choice to have a homebirth is safe. The reality is, and you at least should know this so you’ll transfer her ASAP if something seems like it’s going wrong, that even low risk homebirths can go bad. Please, please, please read Hurt by Homebirth just so you can see some of the things that can go wrong. Maybe you’ll learn to recognize shoulder dystocia or something else and you’ll know when she needs to transfer, even if she doesn’t.
That is if the midwife and her assistants don’t block the cars in and take his cell phone away.
I’ve been an interested viewer here since this particular thing got going. You’re keen to be affirmed in the choice to have a homebirth. This is the wrong crowd for that.
Sincerely, I hope everything goes really well, and no one gets hurt. If you persist in this choice, I’ll just have to hope three times (or maybe more) harder.
Matt, I am catching up from the weekend. I now realize that you and your wife are planning a home birth with a CPM. You need to understand the following things about this:
– CPMs do not carry malpractice insurance. If your wife or child are harmed or killed as a result of negligence, you will get no financial redress from her.
– CPMs are incapable of self-regulation. If malpractice occurs, there is little reason to believe that your midwife will be punished in any meaningful way.
– If things go wrong and you have to transfer to the hospital, you will have to pay the midwife AND the hospital. When my son and I had complications, we racked up $50,000 in bills in three days.
– Unless your wife has a proven pelvis (meaning, a successful previous vaginal delivery), she cannot be considered low-risk. Home births are discouraged for primips in the UK for this very reason.
– If your wife’s pregnancy goes postdates, know that most OBs would be pushing to deliver her baby between 41 and 42 weeks, and they would suggest BPPs and NSTs to be sure that the placenta and baby are holding up. The doppler alone cannot tell you how well the baby is doing.
– You should pre-register at the hospital in case you need to transfer. The hospital may be “five minutes away,” but without access to your wife’s records and history, you will face delays. Also know that even if you preregister, you can’t just walk in the door and have a c-section. Your wife will have to be prepped, typed and cross-matched, anesthetized, and taken into the O.R.
– Be sure that the hospital that you pre-register at has a NICU. If it does not, be prepared for you baby to be transferred to a facility that has one.
– Be sure that your midwife has your wife tested for GBS. If she is positive, she needs to deliver in the hospital so she can have I.V. antibiotics. This is done to prevent GBS sepsis, which can and does kill babies.
– If your wife’s water breaks, she needs to transfer to the hospital within 24 hours. If your midiwfe encourages your wife to wait it out, or to lie about when her water broke, you are dealing with an unethical provider.
– If there is meconium in the amniotic fluid, transfer to the hospital.
– Make sure that your CPM can carry pitocin, and ask her about active management of the third stage.
I would write more, but you should get the drift. I am not a medical professional, but everything that I have written above is based on the realities of home birth in the United States. I am also writing this as a mother who delivered both of my children with CNMs in a hospital. Had I not done so, I would not have survived my first birth, a totally natural vaginal delivery that resulted in a cervical laceration, massive pph, and surgical repair in the operating room. Any naivete that I had about child birth was stripped away, and I now know that even a “textbook” labor and delivery can go south in an instant.
Thanks for the info!
But are you really listening? Are you taking it seriously? I ask because everything she said is true. Home birth is fine, but too many women have lost babies to pneumonia because they were GBS+ and they didn’t know they really needed antibiotics. Or they didn’t realize their midwife didn’t have insurance. I hope your home birth goes well, but please don’t be afraid to transfer if something seems wrong.
Yes. I am listening! I am taking it seriously.
I never had the illusion that homebirth is safer… therefore I don’t need to be disillusioned about it.
I would be interested to get more info on GBS and pneumonia. Isn’t that something that can be treated ahead of time?
Swabbing for GBS is standard during the third trimester. If GBS is found, antibiotics will be given during labor via an IV.
Why not treat it beforehand, and re-swab?
says the guy who below is bemoaning the overuse of antibiotics…
LOL- A documented bacterial infection that could threaten the life of the baby is not “overuse” in my opinion. Geez… you’re really gunning for me aren’t you?
The point, Matt, is that it isn’t an infection.
GBS, for most women, is a commensal.
Swabs, BTW, don’t give instant results- you don’t have time to wait for cultures in labour.
Or, in other words, GBS is part of their normal micro biome for many women. Therefore any course of antibiotics will only ever get rid of it temporarily.
GBS is not a commensal of newborns, it is a pathogen.
So you need antibiotics IN LABOUR to prevent the transmission of GBS, because it kills the bacteria in the vagina AT THE TIME OF DELIVERY.
Swabbing and treating before labour is no good, because the GBS can come back.
Swabbing at the onset of labour and treating based on results is no good, because by the time the results come back it is sometimes too late.
Swabbing after delivery is also no good for the same reason.
No one wants to wait for a symptomatic GBS infection to develop in a neonate before they treat.
Intrapartum antibiotics based on a prior swab is the best we have.
So IF your MW doesn’t offer a third trimester swab, or does and suggests ANYTHING other than intrapartum IV antibiotics if the results are positive, you are not getting gold standard care and your baby is being put at risk of GBS sepsis.
Thanks for the info. If you have any readily available links for stats on that, please share. Otherwise, I will look for myself.
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5111a1.htm
http://www.perinatology.com/protocols/GBS.htm
http://fn.bmj.com/content/98/2/F188.extract
http://www.ncbi.nlm.nih.gov/pubmed/23219695
This is from the first page of Google.
From the last study
“The incidence of invasive early-onset GBS disease decreased by more than 80% from 1.8 cases/1000 live births in the early 1990s to 0.26 cases/1000 live births in 2010; from 1994 to 2010 we estimate that over 70,000 cases of EOGBS invasive disease were prevented in the United States.”
Do feel free to do your own research.
As I said above… some midwives are so crunchy, they suggest putting garlic in the vagina. I literally just can’t even imagine. If someone told me to do that, I’d be out the door before they even finished talking.
Which is why they treat it. At delivery.
If they were to treat it when it is detected, when it isn’t affecting anything, there is a chance that it could recolonize and then they’d have to treat it again at birth. So the best approach is to treat it at birth, WHEN IT IS NEEDED.
It’s not hard to gun at you when you are so readily hanging curve balls.
You know what, Matt? I am done. You are far more interested in arguing about tangential issues than really learning about how to make the birth of your son safer. By hiring a CPM, you are NOT doing everything possible to make home birth as safe as it can be, and you seem to take a fairly nonchalant view to actually determining if your wife’s provider has any level of competence whatsoever. There is nothing laughable out that.
If you are so concerned about your baby’s health, use the prompts that I have provided and start doing your due diligence. I think you are behaving like an ass, but
I do not want to see any harm come to your wife and child.
It’s a bacterial colonization in the mother, not an infection. You give antibiotics when the baby is at risk, during the delivery. Not before. There is no LOL about malpractice with GBS.
It’s not an infection. It’s a colonization. Huge difference. You are a walking case of Dunning Kruger.
Also, Matt, see today’s blog post October 13th. Perfect in your situation, or maybe your wife’s since you keep denying you are a homebirth advocate.
GBS naturally lives in the gut and can come back after antibiotics are given. You can test positive certain times and negative others too, so it’s most effective if antibiotics are given during labor.
You obviously don’t understand the idea of colonization and infection. GBBS management has been around for decades, and for you to comment about treating a colonization and reswabbing rather than prophylaxing when the time is important proves you haven’t the faintest idea about medicine or obstretrics. Since you are ignorant about something as simple as GBBS, I worry about your convictions about the safety of your planned Homebirth with a CPM. Maybe you think it’s safe like treating GBS with antibiotics before labor and reswabbing, but in reality your baby and your wife are at risk. Please reconsider.
A bit about GBS…
GBS
Affects 15-40% of pregnant woman.
Vertical transmission when in labor or ROM, but can occur with intact membranes.
1996 cultured based approach versus risk-factor based approach.
However, majority of cases of early onset disease occur with no identifiable risk factors!
Rectovaginal cultures at 35-37 weeks. Negative predictive value of cultures performed 100.4
Delivery 18 hours
GBS bacteriuria
Previous infant with GBS disease
Positive culture
Unknown culture status
Intrapartum NAAT positive GBS
No need for Abx:
Previous pregnancy +GBS
Planned CS
Neg culture with 18hrs or fever.
Antibiotics:
PCN G 5 million, 2.5 mill q 4
Amp 2g, 1g q 4
Allergy: D-zone testing for inducible resistance to clindamycin
Ancef 2g, 1g q 8
Clinda 900mg q 8 (20% resistant)
Vanco 1g q 12 (based on weight)
(Erythro 30% resistant)
Why IV?
Pregnancy has decreased gi transit time and vomiting for oral meds.
IV meds achieve rapid high concentrations both in maternal serum for placental transfer to fetal systemic circulation and in the amniotic fluid, which is inhaled and swallowed by the fetus. Oral doses needed to accomplish this would be too high of a dose. In non-laboring women, prospective studies found oral therapy did not substantially reduce rectovaginal colonization.
Outcomes:
80% reduction in early-onset GBS disease and neonatal death. Late-onset GBS disease has remained stable or decreased.
Early onset GBS disease, 0-6 days
Pre 1993: 1.5/1000 live births
Post 1993: 0.52/1000
2002: 0.31/1000
2010: 0.24/1000
Late onset GBS disease, 7-89 days
Stable 0.35/1000 live births
Missed cases: 4% false neg culture.
60% of early onset GBS occurs in these women.
“Why not treat it beforehand, and re-swab?”
Seems like a logical strategy, but the science has been done and it doesn’t work. For a real life example of it not working, read the story of baby Wren in Hurt By Homebirth. His mom showed GBS in a urine sample at the beginning of pregnancy. This means you are heavily colonized and even though you treat the UTI with antibiotics, you must consider yourself high risk for carrying GBS at all times in the pregnancy and get abx in labor. His mom decided to follow the advice of “It’s good enough don’t worry” from their homebirth midwife and baby died of GBS sepsis.
I read down farther, but I’ll just say here (I said it above), read Hurt by Homebirth. Those are stories of babies who have been lost or damaged by homebirth. There are a couple of stories about babies who died because of GBS infections. Wren’s mother was told to put garlic in her vagina. Yes… garlic. There’s no evidence that garlic will kill GBS.
His father talked himself into homebirth by rationalizing that the hospital was 5 minutes away and it was “whole foods”: no better for you than regular food, but no worse, either. And that seems like your opinion. That’s not a bad one. But the reality is that after Wren died, his parents realized that if they had just gotten the antibiotics when she was in labor, that baby would have lived. And not been sick most likely. They didn’t know this until AFTER he died. So you can think you know things and then realize you’re not as educated as you thought. His dad said that it was 6 minutes from the time they saw he wasn’t breathing (and he’d been lying on his father’s chest for an hour before that, so it probably wasn’t too long that he hadn’t been breathing) to the time he was in the NICU, and he still died.
I don’t think anyone wants to scare you, but there are a lot of things you don’t know… you didn’t know about GBS+ for instance.
Don’t tell your wife… just read the Hurt by Homebirth blog. Dr. Amy hosts it but she didn’t write the stories… the parents wrote them. No one is saying you’re likely to have those things happen… in fact, even Dr. Amy will say you’re LIKELY to have a healthy baby… but they CAN go wrong. Just know what you’re up against. I think reading other people’s stories are the best way to learn in this case.
Matt, since you said you were in Michigan, maybe you should be reading and posting on this blog. Here’s a good place to start:
http://safermidwiferyformichigan.blogspot.com/2014/06/danger-audra-post-cpm.html
Your CPM isn’t Audra, is it? I hope not. Lots of facts about midwifery and homebirth there (especially in MI), at that blog and the website that was designed to honor Magnus Snyder, a victim of mismanaged treatment by midwives at a birth center.
You may also like to watch the video Not Buried Twice (on Youtube) explaining what is wrong with the US homebirth industry.
Thanks for the link and info. Others have also posted that link. I will check out the site. And no… it isn’t Audra.
Believe it or not, I get what is “wrong” with the homebirth industry. It is the same things that are “wrong” with any kind of “alternative” health field… lack of standards, lack of accountability, misinformation.
But I also get what is “wrong” with the medical industry… For example did you know that a prominent oncologist around here was recently found to have been willfully misdiagnosing people with cancer and recommending treatments to people that they didn’t need?! Can you imagine that… telling people they have cancer when they don’t?
http://www.myfoxdetroit.com/story/26548660/cancer-doctor-who-misdiagnosed-patients-pleads-guilty
Let me tell you… stories like this have a lot more to do with people’s mistrust of medicine than Jenny McCarthy and a few nutjobs in the hills.
Yes, I did hear that outrageous story. It took longer than it should have, but he is now being punished harshly.
Contrast that with stories of alternative health folks who lie about having a cure for cancer, or tell people they have disease they actually don’t, and are NEVER held accountable.
Also note no one is defending this doctor except his paid lawyer. There are no petitions to free him, no colleagues complaining about his unjust persecution.
Sure we can contrast them… but I don’t think it is a fair comparison.
The alternative health folks who say and do those things did not attend medical school. They did not pass board exams. They were not issued medical licenses. They did not build multi-million dollar practices and sit on hospital boards, and earn respect from physicians and the scientific community.
Look up Dr. Burzynski, and say that again.
Wow! OK- so what is going wrong with our “vetting” system when this happens? Why should a health consumer trust anybody about anything health related?
If we cannot rely on education, licensing, credentials, regulatory bodies, medical boards… why continue to throw those things around as if they carry weight?
The only reason he’s still practicing is because his patients actually petitioned Congress. Congress then forced the FDA and other authorities not to move against him. It’s a long and horrible story.
Dr Robert Biter, California, surrendered his license after multiple complaints including a homebirth death. His patients are now rallying around to help him practice without a license at a new birthing center.
Well, they still want respect. Why else would chiropractors and NDs insist on being called doctors if they didn’t think it meant something to attend school, pass boards and get medical licenses?
I’m not sure I follow your comment. Are you saying chiropractors and NDs didn’t attend school, pass boards, and get licenses?
No, I am saying they want the respect of everyone for what they are and what they have “achieved”. They often tell people they have cancer when they don’t, and suggest treatments that are not proven to do anything. They use the titles and letters after their names to lend credibility to what they are saying.
Who is doing this? The licensed DCs and NDs? Or the lay practitioners? Or are you saying they are all the same?
The only practitioners that I have personally witnessed giving diagnoses of cancer are licensed in the state where I live. One ND who is also a CPM who diagnosed a pregnant woman with cancer of the esophagus and a chiropractor who gave a diagnosis of colon cancer.
Well wherever that occurs, I think that is very concerning. The NDs that I know about that are involved with oncology have additional training, and work in coordination with MDs. But there are licensed MDs that have done similar things, and engage in all manner of questionable practices.
These NDs have training in oncology-the university they attended has an integrative cancer treatment facility as part of its training. They are partnered with Fred Hutchison cancer research center. They prefer their woo.
They are much less likely to because MDs are held to a standard of care. They are accountable. (And then you have redress if they still **** you over.)
Yes, they did all that. But a professional certification in nonsense is still nonsense. It’s a problem when politicians decide for political reasons that unqualified people who invent impossible treatment modalities should be given professional status and certification because that’s what the public wants to hear. It’s a real problem.
Sciencebasedmedicine.org is an excellent site for understanding that issue generally.
Yes.. I’m familiar with that site. I was happy to see a discussion of Dr. Fata to balance out the tirades on alternative practitioners.
(http://www.sciencebasedmedicine.org/when-conventional-doctors-betray-science-based-medicine-for-money/)
In this post, he says, “Optimally, this standard of care should be rooted in science- and
evidence-based medicine and act swiftly when a practitioner practices
medicine that doesn’t meet even a minimal requirement for scientific
studies and clinical trials to support it.”
In my experience, there actually are NDs whose care is rooted in science- and evidence-based medicine, and who base their recommendations on scientific studies and clinical trials.
They address questions such as:
“Are there herbs or supplements which might help mitigate the side effects of my cancer treatment?”
“Is there anything else that my daughter can do to help GERD besides taking the PPIs that her GI doc has her on indefinitely?”
“Is there anything I can do with diet, lifestyle, or supplements to help get my cholesterol down so I can get off of statins?
“I’m thinking about taking probiotics… which one should I take?”
“Is there anything I can do about chronic pain to reduce my dependence on NSAIDS?”
“Are there nutritional gaps in my diet that can be addressed with food and/or supplements?
I think those practitioners have their place, and provide helpful services… assuming they practice within the scope of their training.
Many don’t. But then again, neither do all MDs, or any other type of professional anywhere. Dishonesty and unethical behavior is endemic to humanity, and no profession is immune to it, no matter how “rigorous” the education and regulatory system is.
The alternative for these people would be heading down to the “health store” and purchasing whatever supplements the clerk recommends for them, or that they read about on some “health guru” blog somewhere.
But if and when these other groups seek some kind of certification, licensing, or other regulatory process… in order to establish standards and be held accountable to them… those efforts get shot down too.
Sounds like a mess to me.
The ND training does not include the scientific thought process. NDs are taught good information and bad information interchangeably and given no tools to distinguish between them.
Hmmm… I don’t know if I would say they aren’t given the tools. There’s a lot of NDs that don’t use homeopathy, for example. I get the criticism.
But at the end of the day, if I am going to try an herb or dietary supplement to help co-manage a disease, or in an attempt to avoid medication if possible, I am certainly going to consult with an ND.
You -DO- realize that many MDs still say things like “dietary supplements aren’t regulated by the FDA” when what they really should say “dietary supplements aren’t approved by the FDA for treatment of disease.”
How do you think THAT looks to a patient credibility-wise?
SOURCE: http://www.fda.gov/Food/Dietarysupplements/default.htm
“FDA regulates both finished dietary supplement products and dietary
ingredients. FDA regulates dietary supplements under a different set of
regulations than those covering “conventional” foods and drug
products. “
Dietary supplements are not USEFULLY regulated by the FDA. In fact, the supplement industry has lobbied vigorously against real safety standards and fought to undermine the tiny inadequate standards that exist.
The only power the FDA has is to ban given ingredients, and only retroactively, that is, after people are seriously injured or killed. There is no quality testing. Take a look at the FDA’s recall page sometime, screen after screen of dietary supplements recalled because they contained illegal ingredients, in many cases prescription drugs.
Under the current legal structure, the FDA is unable to provide reasonable assurance that a given supplement is effective, is safe, or even that the label accurately describes the contents of the bottle. I’d call that unregulated, myself.
What does this mean to you?
“Under FDA regulations at 21 CFR part 111, all domestic and foreign
companies that manufacture, package, label or hold dietary supplement,
including those involved with testing, quality control, and dietary
supplement distribution in the U.S., must comply with the Dietary
Supplement Current Good Manufacturing Practices (CGMPs) for quality
control.”
No quality testing? Do you mean by the FDA itself? I don’t follow.
I don’t care what the laws on the books say. We have this: http://www.biomedcentral.com/1741-7015/11/222/abstract
as clear-cut proof that the regulatory structure is useless.
There are other classes of dietary supplements besides herbs. Also- Was this a random sampling? How many of them were from “weight loss,” “body building,” or “sexual enhancement” supplements?
How many of the products tested were manufactured in a facility that participates in third-party quality testing, or are cGMP certified?
And what about those FDA-approved drugs? Did they do safety tests to determine if there are any deleterious effects on the gut microbiome before allowing them to go to market?
Because obviously “This drug might have subtle uncommon long-term side effects we haven’t found yet” is just the same as “This supplement may cause acute liver failure, and may contain substances known to be poisonous which are not listed on the label.”
Of course that is not the same thing! But you didn’t answer the question….
Moreover, is there any evidence to assume that such effects are both “subtle” and “uncommon”? Or is that just your opinion about it?
If millions of dollars of premarket research, tight regulation and years of postmarket research haven’t found anything, then yes, it’s subtle and uncommon.
Huh? What I’m asking is…was any of that research actually assessing impact on the microbiome? Did they look?
They looked at whether people who take the drug are healthier than people who do not.
Looking at the microbiome is irrelevant since we have no idea what to look for. Researchers take a holistic perspective and look at the whole person.
If (for instance) the diabetes associated with some antipsychotic drugs is mediated by microbiome effects, the concern is the diabetes and whether the tradeoff between control of psychotic symptoms and a risk of diabetes for an individual person.
Yes, someone may some day decide that we don’t know enough about how risperidal raises the risk of diabetes, have a reason to suspect that it might be partly mediated through effects on dental plaque, and take a look. But that isn’t necessary information when you are conselling
… when you are counselling someone about the risks of taking certain drugs and the risks of not taking certain drugs.
How come millions of dollars of premarket research, tight regulation, and postmarket research didn’t identify the problems with Vioxx, or Bextra, or Rezulin, or Avandia?
If drug manufacturers have to submit to such “rigorous” proof that their products are not contaminated… then how does contaminated Tylenol end up in the shelves?
Matt,
The problems with Vioxx, Avandia etc were identified, and those drugs are no longer available.
Sometimes if the adverse outcome is rare it takes more people using the drug than the initial research groups to identify the issue.
Sometimes, if the outcome is common (for example heart disease in known diabetics who are taking medication for diabetes, as with Avandia) the signal from the drug gets lost in the background noise from the disease.
And sometimes pharmaceutical companies are bad actors and they suppress research results they don’t like…and then they are fined and sued.
The system is not perfect, no system is.
When it fails there is some redress.
Because despite what the news would have you believe, side effects from most of those drugs are pretty rare, and it takes millions upon million of doses to get statistically significant information.
Drug side effects are submitted along with efficacy to the FDA when a drug is up for approval. Are you suggesting that subtle changes in microbiome should now be listed as a side effect and affect the approval of drugs to treat serious problems like schizophrenia, diabetes, thyroid dysfunction, and rheumatoid arthritis? Why? On the grounds of what good quality clinical research that provides a *causal* (NOT associative) link between microbiome diversity and health outcomes. Even if said research does exist, which it generally does not, are you suggesting that the microbiotic diversity of a schizophrenic is more important than dealing with hallucinations and paranoia? That it’s more important than whether or not a woman with rheumatoid arthritis can walk or get dressed in the morning?
As I stated in an earlier post, there is no good evidence that any one input to microbiota has a disproportionate affect on its diversity OR health outcomes.
No, I’m not saying that treatment recommendations by physicians should be changed without sufficient evidence to support a change.
Let’s just look at antibiotics. We know that antibiotics are overused, right? We know that overuse of antibiotics contributes to drug resistance in bacteria, right? (I’m sure you will let me know if I am wrong.)
And yet… do you know how many stories I hear of people being prescribed antibiotics without any confirmation of a bacterial infection?
And even if they were bacterial infections… how many of them would have probably cleared up on their own within 7-10 days without any intervention?
Is that an “evidence-based” practice?
My my, you do like your non-sequiturs, don’t you?
Ok, now you want to talk about whether on-the-ground antibiotic use is science-based. Sigh. (When you change subjects like this why not start a new thread?)
Answer: sometimes, not always.
Sometimes a clinician knows it’s bacterial without taking a swab.
Sometimes the risk of not using antibiotics when they’re needed is higher than the risk of using them when they aren’t.
How many times have you rushed to the doctor at the first cough or the first throat tickle? If you’re like most people you don’t go unless the cough isn’t going away on its own
… unless it’s been a while and the cough isn’t going away on its own or unless the symptoms are distressing or alarming. If you’ve had a cough for two weeks and it’s not getting better, even if it started out viral you probably now have a bacterial infection too. Treating with antibiotics may be evidence-based.
Sometimes that doctor’s patient base, for cultural reasons, doesn’t think they have received medical care unless they get a prescription. Sometimes a doctor just gets tired of the interminable and fruitless educating and just gives up and writes amtibiotic prescriptions. No of course that’s not evidence-based, nobody says it is.
If you’re wondering how warranted a given prescription is, why not just ask for the rationale?
Maybe some patients… for cultural and other reasons, would like to try dietary supplements before getting a prescription from the MD. Is that so wrong? If they want to do this… shouldn’t they have access to whoever has the most training on dietary supplements? Don’t they deserve to know who are the reputable manufacturers of dietary supplements?
Don’t they deserve something more than… dietary supplements… could be dangerous.. don’t use them.
If however many MDs aren’t practicing evidence-based medicine, then why not don’t MDs *police their own* before going off on other professions for their lack of evidence-base… or attacking what evidence-base there is even if it isn’t multiple double-blind placebo controlled studies funded by wealthy drug manufacturers?
There are cultures who may wish to avoid seeing a doctor and try to fix whatever is wrong with things accessible to them first. There was a discussion about this on another thread and the reasons behind it are legitimate but have nothing to do with over prescription of medications.
Can you be more specific?
My grandmother takes lutein and zinc prescribed by her MD in the hopes it will slow her macular degeneration. Is that what you mean?
My doctor prescribes SSRIs instead of Saint-John’s Wort or cannabis because they have a better risk-benefit profile. If you were already taking SJW for depression and cannabis for anxiety when you went to see her, she would probably tell you that the SJW was fine as long as you were ok with the risks but that cannabis for anxiety is both unsafe and counterproductive. She would talk to you about alternatives to the cannabis. Is that what you mean?
Can you be more specific?
Sorry… I thought I did start a new thread. I don’t think this comment format is very conducive to discussion.
This whole side-discussion was originally with DiomedesV. You kind of jumped in the middle of it, so maybe that’s why it’s confusing.
Thanks for the discussion on diet and nutrition. I’m going to let this thread drop now.
Prior to approval, drugs were safety-tested by giving them to people and observing the side effects. If the drug changed the microbiome in ways that were important to health, health effects would be observed. Therefore, logically, either the drug does not change the microbiome, or the change does significantly affect health.
The exception, of course, is antibiotics, which are known to reduce normal flora. Currently, some real scientists are working on the best way to replace it.
Unlike manufacturers of regulated drugs, manufacturers of ‘supplements’ (unregulated drugs) are not required to demonstrate that they contain what they say they do. The FDA can only prosecute if they do their own testing and discover that the manufacturers were making shit up.
Manufacturers of regulated drugs have to supply their own proof that the drug is what they say it is.
If I want to make aspirin, I can’t sell it unless I prove rigorously that what I am selling really is aspirin.
If I want to sell a herbal sassafras supplement, I can make capsules and fill them with litter from my cat’s litter box and Viagra that I ordered from China. I can write a book explaining that sassafras is better than aspirin. I can sell both the book and the capsules. I will get away with this fraud until the FDA decides to analyze my capsules and discovers cat shit. I’m really small potatoes so they probably will never get around to it.
So no, practically speaking, unregulated drugs really are not regulated.
That’s correct. There is no meaningful regulation of supplements. Nor should there be. The FDA has enough to do. They don’t need any more excuses to avoid taking steps that will actually save meaningful numbers of lives– like actually preventing the misuse of antibiotics in animal husbandry.
Yes- I understand that overuse of antibiotics is a real problem, not only in veterinary medicine, but in human medicine as well.
Sorry… but when I hear stories (and they are many) of people getting prescribed antibiotics for what very well be a virus (nobody ever checked) and with the thought “oh well it can’t hurt anything”… I have a really hard time finding that to be a credible practice, or one that could be considered “evidence-based.”
If you believe that they are not USEFULLY regulated… hey that’s fine by me!
But that is different from saying they are *not* regulated. I get the concept… but I’m not sure if health professionals realize the kind of impact they have on people when they say those sorts of things.
It’s similar to saying there is “NO” evidence, when what you really mean is there is no good evidence.
Maybe it’s just an artifact of interacting with other doctors, scientists, professors, all day… but when you are speaking with laypeople… NO means NO. It does not mean SOME, or a LITTLE BIT, or NOT ENOUGH TO MATTER.
It means NO.. none… nada… zilch. So when a health professional sits there in their office, or worse- on some kind of news broadcast and announces “Dietary supplements are not regulated by the FDA.” and then the health consumer goes to the FDA’s website and finds pages of information on exactly HOW they are regulated… how do you think that looks to the consumer?
For at least some people… it makes the doctor look like a fool, and it undermines their trust in them.
Why not just speak correctly? Would would happen if people started writing research papers and using the word “NO” when they mean “SOME” or “INSUFFICIENT”?
Would that be an acceptable practice?
Actually, the problem is that you don’t understand how strongly the word “no” applies in these cases and how deceptive the word “some” would be.
So we should apply alternative definitions of words because somebody might take something the wrong way? We should lie to people for their own good? No- I don’t understand that. And by no, I mean no.
Anyway, we can disagree here. I still suggest that such a practice might not actually be having the impact that some health professionals think it is. Maybe somebody should do a study on it, write it up, and subject it to peer review. Otherwise, it’s just an unproven hypothesis with only anecdotal evidence to support it.
What practice, and what impact? Telling people that dietary supplements are unregulated is causing people to lose faith in their doctors? That is a hypothesis that would be remarkably difficult to confirm, speaking as someone who has done opinion surveys.
What are referred to misleadingly in the US as “dietary supplements” are unregulated drugs. The “regulation” in the US consists of labeling requirements (the pills called “Menopausa” with directions on the side to take one pill twice a day or as needed must not state that the pills will treat menopause symptoms).
They are supposed to contain what they say they contain but they aren’t required to prove it.
I would not ask an ND for an unregulated drug in order to avoid taking drugs. That makes no sense at all. If I’m going to take drugs then I want the drugs with the most evidence, the best risk/benefit ratio, the ones best-understood and documented, and the ones most likely to be what they say they are. Which means that I get my drugs prescribed by an MD.
If you don’t want to take drugs, then don’t take drugs — including the unregulated ones.
Actually, according to my understanding of the current regulations, something cannot be called a “drug” unless it has been approved for treatment of disease. Kind of a catch-22
I’d call it a loophole. If you call your drug a “nutritional supplement” then it doesn’t have to meet any of the standards that protect patients. As long as the label doesn’t claim that “Menopausa” treats menopause symptoms or that “Sleepytime” is a sleep aid, you’re good. Nudge-nudge, wink-wink.
I don’t have any respect or patience for nudge-nudge, wink-winkers and I would not entrust my health to them. If it does what you say it does, safely, then the evidence exists and my MD will be fine prescribing it. If the evidence does not exist then you have no business marketing it.
If marketers of “nutritional supplements” were ethical they would be lobbying for improved legislation to protect the public from unethical practices. Similarly, if CNM groups were ethical they would be publishing data whether or not it supported the safet
Speculation and hypotheses are not evidence.
… whether or not it supported the appropriateness of homebirth. They would be publishing and enforcing standards for their members. They would be working actively to phase out untrained midwives.
I would never entrust my or my child’s life or health to someone who thought nudge-nudge wink-wink was ok. All it means is that they have no concern for safety standards.
*Speculation and hypotheses are not evidence.
From my perspective, MDs do not get as much training in the scientific method as I would like. I say that because in my opinion, you don’t really appreciate the requirements and limitations of that thought process until you engage in a problem of your choosing, do your analyses, and then try to convince your colleagues of the soundness of your methods and your conclusions. Most MDs never publish research. Not only that, in my opinion and most of the scientists and statisticians I’ve discussed this with, the MDs that publish are still… deficient (sorry folks). I routinely see basic statistical and logical errors in papers on human medicine that I do not believe would pass muster in a, shall we say, purer science. I think it’s lack of training and the fact that the really good statisticians are working with scientists on improving methodologies, and that stuff trickles down slowly. In that sense, the peer review system is better than nothing, but still flawed.
BUT, the level of training in the sciences of most MDs is still far superior to that of folks in virtually any other medical profession, including nurses. NDs — not a chance.
So do you appreciate the perspective from a health consumer when there is a sort of societal imperative that says “you should trust your MD” as if having that credential somehow automatically means that they have the ability to evaluate research, or publish proper studies of their own.
The level of training in the sciences of most MDs is more than in other professions..particularly if you are including pharmacology and surgery. But that does not automatically mean they are the best expert to consult in all things health. Or do you think it does?
There’s no question that having an MD does not qualify you to publish studies of your own. In some sense, publishing studies qualifies you to publish studies, and too many studies get published.
Yes, I think that MDs are the best people to consult because training is everything and they still have the best training. But you’re never–or shouldn’t be, obviously access is an issue for too many people–restricted to just one MDs opinion. And of course, an OB knows more about obstetrics than a psychiatrist, but still probably knows more about psychiatry than a plumber or even many RNs.
So then are you saying if I want to consult with somebody about diet and nutrition… I should still consult with an MD because they have the “best training”? Can you elaborate on that?
An MD could help, but probably wouldn’t have the time. The best option is a registered dietician.
No, in that case, and if the questions were relatively general, I would consult with a dietician that works with an established practice. If your question is: “how can I find out if I have celiac”? you should see a doctor.
But nutrition science is…. decidedly subpar.
I’ve often wondered about nutrition science… I mean… can we really ever hope to produce any kind of “Grade A” research when diet is involved? How can a study be properly controlled?
And if the is the case… then what? Should people just be told “eat whatever you want” because there is “no evidence” to support eating more healthy foods, or avoiding unhealthy foods?
What I’m getting at… is it reasonable to hold all health research to the standards required for FDA approval of a drug? And even those standards sometimes fail. :/
We have very good evidence about what constitutes a healthy diet.
People who can’t swallow can live long and healthy lives being tube fed out of a can. Wolves in zoos fed kibble are healthier than wolves in zoos fed carcasses. We clearly have a good handle on nutrition if we can keep animals healthy on these kinds of synthetic foods.
For,the rest of us, the recommendation is to eat a wide variety of fresh food with an emphasis on fruits and vegetables. This ensures that we get all the nutrients we need plus exposure to a wide variety of what are popularly called “nutraceuticals” without the risk of eating so much of one thing that any problematic components of that particularfood
… of that particular food pose a problem.
Supplementing with individual nutrients is recommended in well-defined cases. For instance, Vitamin D for children in gloomy climates or who are being protected from sun exposure to prevent adult skin cancer.
When it’s hard to tell whether tweaking food intake improves [a particular aspect of] health, that just means that food just isn’t that big a determinant once certain criteria are met. Not that diet has no effect, but that other things are more important. That shouldn’t be surprising since the human animal has been surviving and thriving in a wide variety of circumstances and climates for hundreds and thousands of years.
Given that following the recommendation to eat a wide variety of fresh food is already
… fresh food with an emphasis on fruits and vegetables is already a high bar for most people, focus on that rather than obsessing over superfoods or toxins or untested pills from the health food store.
Michael Pollan is hard to beat:
Eat food.
Not too much.
Mostly plants.
http://michaelpollan.com/articles-archive/unhappy-meals/
I like Michael Pollan! Personally… I don’t find eating fresh food all that high of a bar.
I do wonder when people are told by their MDs that diet doesn’t matter… and maybe that’s surprising to you to hear but yes… it does happen.
One thing I have a hard time contending with is the constant repetition of “you can get everything you need from food.”
Well, yes, you can. And yes, it’s better to do so. But it is not actually that easy, even for a healthy eater.
I’ve actually tracked my micronutrient intake using the recommended intakes by the IOM, and let me tell you, there were a few things I wasn’t even coming *close* to. And if I’m not getting close… the vast majority of Americans aren’t even in the ballpark.
And yet… look in the media and there is always some “expert” ranting on and on about how “useless” multivitamins are, how they might be harmful, and how you can get everything from food.
But interestingly… they almost never talk about HOW to get everything from food, or recommend that people work with a professional to make sure that they are. I think that’s irresponsible communication.
Not fresh food. A wide variety of fresh food with an emphasis on fruits and vegetables.
That means meat and dairy, a variety of legumes, a variety of nuts and grains both boiled and baked, a variety of brightly-coloured fruit and a variety of brightly-coloured vegetables. If you’relike people have a go-to repertoire of only five basic recipes.
If you aren’t meeting your recommended intakes, then broaden your variety. Take a multivitamin if you want, but don’t worry about marginal theoretical speculative hypothetical benefits of special alternative pills until you’ve fixed your diet.
Remember that dietary recommendations are for populations, not individuals. (You can look it up if you don’t understand why it matters.)
Your assertion was “science can’t tell us how to eat right.” I explained that it can and does and you’re arguing with me saying 1) that you eat fine but you aren’t getting all your nutrients from your diet and 2) other people don’t eat as well as you do.
That other people don’t eat as well as you do and that you don’t eat as well as you think you do does not constitute evidence that nutrition cannot be studied scientifically. (You jump around a lot. You’d learn more if you would answer questions.)
MDs do NOT say that diet is not important. You’re making that up. They do a lot of diet and lifestyle counselling.
They DO say that diet doesn’t seem to make much difference for various particular things. Eating kale is not going to cure your cancer and eating too much of it will cause thyroid problems. For instance. Doctors hate fad diets.
Diomedes said that nutrition science is “subpar.” My reply included five questions.
Anyhow of course kale doesn’t cure cancer. I don’t believe that and never did.
I am talking about micronutrient and macronutrient intakes from the IOM. And yes, I understand there are differences for individuals.
Yes, I also understand about variety. Variety is good… but it is not foolproof either. I could eat a lot of variey of fruits and vegetables and still come up short on zinc and vitamin E, for example.
I’ve actually taken the recommendations from the IOM, and (along with other sources like nutritiondata and whfoods) tried to construct meal plans that meet all of the micronutrient recommendations within the acceptable macronutrient distribution ratios.
It was not at all easy to do. And I found it impossible to do with less than 2200 calories. I promise you it’s not as simple as “wide variety” it takes a very specific variety. Try it for yourself- you will see what I mean!
Anyway the point is not that multivitamins (or kale) cure cancer or prevent death… since they don’t. The point is about health professionals poo-pooing multivitamin use in a population that not only doesn’t know how to get all of their nutrition from food (they were never taught) but probably wouldn’t do it even if they know how.
Zinc is most available from meat.
Vitamin E requirements are proportional to PUFA content of the diet, which works because vitamin E is found in polyunsaturated oils.
Yes… I know where they come from. I looked them all up, remember?
Assuming I had correct data from nutritiondata.com and whfoods.com…. 4 ounces of red meat has about a third of zinc… other meats are considerably lower. I eat red meat, but not 12 ounces every day.
The next best sources I found were nuts, seeds, and legumes. About 25% for a quarter cup. I eat those too.. but not every day. And too much nuts/seeds and I go over on the fat.
All I am saying is that it is definitely possible to get everything from food. But it is also possible to be eating a diet of a wide variety of healthy foods and still miss the mark.
And if that is the case… why are drugs the first line of treatment for chronic illness? Why not nutrition? And give the state of affairs of people’s diets… even some healthy eaters…. why all the poo-pooing of multivitamins? What’s that about?
You’re probably underestimating your zinc intake. You’re probably meeting the RDA without even trying. Apparently the median zinc intake for adult men in the US is 14 mg/day, well above the RDA for adult men of 11 mg. I wouldn’t sweat it. http://download.nap.edu/cart/download.cgi?&record_id=10026&file=442-501
The reason that supplementation is not routinely advised for most people is that the evidence that it helps anything is not always there. Multivitamins sound sensible but when you look at health outcomes, people who take them are not healthier than people who don’t.
However, women *are* commonly advised to take iron supplements. Vitamin D supplementation *is* recommended for babies. Fluoride supplementation of low-fluoride water and iodine in salt *are* recommended public-health measures. In these instances the evidence is there that it’s beneficial. Saying that supplementation is never recommended is outright false.
Drugs are not the first line for all chronic illness. For chronic pain, a combination of moderate exercise and pain medication or spinal blocks. But for moderate hypertension or elevated blood sugar, first line is diet and exercise. If the patient rejects that option, or implements it but it’s not sufficient, then medication
… not sufficient, then safe, effective and (sometimes) inexpensive medications exist.
You keep saying that MDs don’t do lifestyle and nutrition counselling. I don’t know why you say that. The ones I know do. A lot.
I do. Because people think “lifestyle and nutrition counseling” consists of crazy exercise regimens and getting all crazy about testing and supplemental “micronutrients.”
Instead, MDs say things like, “Exercise, eat lots of fruits and vegetables, and limit your amounts of meat and carbs. Oh, fish is pretty good, too.”
My doctor says this to me at every physical exam.
Bastyr trains holistic nutritionists : )
Run, Forrest, run!!!!!!
I dunno… maybe the ones you know have newer/better training? Maybe you live in an area where diet and nutrition are taken more seriously?
I actually don’t go to the MD that often, because (as far as I know) I am healthy. But I can’t remember a time that the doctor asked me about diet and lifestyle, other than whether or not I smoked.
I’m just going by stories, and yes I understand that can be skewed. But from what I see around here, there are a lot of very sick people who seem totally oblivious to (or in denial about) the fact that their diet has anything to do with their health.
They go from one pill to the next, from one surgery to the next, each time convinced that THIS is going to be the solution… and nothing works. They just run up huge medical bills, and then bitch about having to contribute to payment.
Often times they say they “can’t afford” to eat healthy food… yet they’ve got a new iPhone6 and drive a luxury car….
I just want to say that I am so sick of people telling me I wouldn’t have lupus if I just “ate better”. Do they have any idea how rude that is? They are basically telling me that I caused my body to start attacking itself. That really pisses me off.
Your macronutrient levels weren’t coming close? Are you sure you were counting correctly? Because I’ve measured some diets, and unless you literally never eat anything that ever saw a fruit or vegetable, it’s hard not to get there.
No… macronutrients were fine. Even most of the micronutrients were fine. But a few of them were pretty off as I recall.
Have you ever tried a tracker for yourself… one that has the micronutrients not just the macronutrients. I found it very instructive!
Sorry, that was a typo on my part. I wrote macro when I meant micro. Yes, I did try tracking micronutrients. I stopped after a few days because I always had enough or almost enough of everything. Over a 3-day period, I averaged enough of every nutrient.
Cool! 🙂 Which tracker did you use? What does your diet look like?
I used the one at FitDay. My diet is not extraordinary healthy, although I get some fruits and veggies every day.
A registered dietitian belongs to a professional organization which means they are trained to certain standards. This is different from being a “nutritionist” which has no meaning at all. Your cat can be a nutritionist just by saying so.
Yes, most MDs are pretty good about diet and exercise advice. They will counsel you appropriately. One advantage that an MD has is access to a wide range of tools. If you have hypertension an MD can counsel you on diet and exercise if that’s what you want, prescribe medication if that’s what you want, follow up to see if whatever-it-is is working and suggest changes. If you elected to try diet and exercise first and there’s been no change in six months an MD can continue coaching and encouraging you on diet and exercise and also prescribe ap medication to get your blood pressure down while you get a handle on it.
An MD has a good understanding of the limitations of dietary interventions. An oncologist will not try to convince you that kale will cure your cancer, because it won’t. Naturopaths and nutritionists have been known to.
If you have cancer, an oncologist will want you to bulk up so that you don’t die of starvation and will refer you to a registered dietician who will help you do that while you are sick and undergoing treatment. Naturopaths and nutritionists have been known to put cancer patients on very restrictive, “healthy” vegan diets and starve them to death. This is why cancer patients using alternative diet treatments as an adjunct to medicinal care often do *worse* than cancer patients who stick to just medical care.
If all you have is a hammer, everything looks like a nail. An MD has a complete toolbox and will be able to choose the right tool for the job.
Another thing– what motolibrarian said about CPMs being unable to regulate themselves is true. And there was a time when that was true of doctors, too. We no longer rely upon doctors to completely police themselves because the exact same types of abuses occurred that are routinely seen in midwifery, although some would argue they still have too much latitude in that direction.
CPMs are not automatically worse people ethically, but still, they are not willing to submit to a meaningful regulatory structure where they are held to account and can be disciplined or even disallowed from practicing. And who would, if they could choose not to? It’s not intrinsically evil, but it does mean that as a patient, you are entirely at the mercy of your provider. If you would not be willing to jump into a time machine and see a doctor in 1935 because you have qualms about the ethical standards of that time (I do!), why would you see a provider that is basically following and probably even promoting the same standard — or lack thereof — of patient care and accountability?
I’m afraid that you and I have very different understandings of what constitutes science- and evidence-based medicine.
I’m with Steve Novella.
http://www.sciencebasedmedicine.org/evidence-thresholds/
And Tim Minchin.
“By definition, Alternative Medicine has either not been proved to work, or been proved not to work. Do you know what they call Alternative medicine that’s been proved to work? Medicine.”
http://www.youtube.com/watch?v=ujUQn0HhGEk
Why can’t we contrast them? They are willfully misleading people to take their money. Just because they didn’t go to medical school they should get a pass at killing people? Why shouldn’t the quack(s) that advised Steve Jobs face the same penalties as this oncologist?
Eh? What about the MD quack who was telling people they have cancer when they don’t, who was giving people treatments they didn’t need, and who all the while was a “respected” member of the medical community?
What I’m saying is… why not fix whatever is allowing THAT to occur, and maybe less people would be herded into the arms of dubious lay practitioners?
Ummm… yeah. They ARE fixing it. They are most likely taking it very seriously. He will lose his license. His insurance will pay out a lot of malpractice claims. In fact, there are probably fraud lawsuits out there, and fraud judgments aren’t dischargeable in bankruptcy. So this will follow that guy for the rest of his life. Contrast that with midwives like Christy Collins who managed to have a bunch of things go wrong in California births, so she just wandered over to Nevada and managed to kill Gavin Michael.
And yet, the home birth community rallies around midwives who have presided over numerous deaths. They says forcing midwives to carry insurance would ruin their practices. They give midwives who don’t recognize a baby is in danger (look at Aquila, who died because her mom had a placental abruption) a slap on the wrist… a six month suspension, or less.
How is that fixing the problem? The medical community has ways of monitoring itself. The home birth and alternative communities have none.
Who was the midwife who’s “punishment” was to write a letter of apology to the parents?
Is there any better indication that they have the perspective of a high schooler/adolescent and not of responsible adults?
That was Faith Beltz. Then you have the serial killers like Brenda Scarpino Newport who make themselves out to be the victims.
So then it would have been Aquila’s midwife again. I believe Liz’s midwife was Faith Beltz… that “hearing” with the other midwives was horrid.
That’s actually worse. The fact that people believe them is scary, to be honest.
*sigh* I see we are still dealing with Mr. “I will make an outrageous statement and then backpedal like the wind when confronted with actual evidence and/or an intelligent argument.” I’m getting tired of reading ‘But I didn’t say that! You misinterpreted me, you silly woman!’ Real tired.
I know. Sigh.. I am starting to feel sorry for the man.. I think he is so defensive about the home birth thing and the choice of a CPM because he knows deep down it’s not a good choice.. he’s come here to argue why we are all “wrong” and in the process he is realizing that maybe those horrible,mean medical people might know a little something about childbirth…
As a somewhat long term reader 3+ years), I’m going to suggest that you guys need a “suggested/required reading list” in the sidebar. I came here trying to decide whether it would be safe to have a homebirth with my first child, or whether I should wait till subsequent births, basically. I didn’t like you guys; at the time it seemed that any woman who used the term “high pain tolerance” to explain not getting an epi was viciously attacked in the comments. But I was after facts, and I perused 90%+ of the archives before commenting. And I got facts.
It is shocking to see someone who believes they are already educated and just want some minor points cleared up citing things like the WHO’s retracted recommendation of a 15% CS rate. I can understand why long-term commenters get snippy. Every two days someone arrives wanting an individual course on home birth with their own set of links to refute the standard set of arguments and a 1:10 student-teacher ratio. I seriously think Dr Amy should open a post where links to previous posts as well as outside info can be submitted, discussed and organized to be placed in the sidebar. Then when someone comes along wanting to discuss the same-old same-old, refer them to this post and say “come back with any specific questions when you’re ready for more.” Would it work? Probably not. But it would be less tiring, and it might actually convince a lot of people who are willing to be convinced.
Great suggestion. It’s emotionally draining trying to reason with them especially when they can’t seem to see the forest for the trees. Focusing on study after study and micro-analyzing every little statistic is just counter-productive and really doesn’t give them real-life information. When they start making claims about so-called “unnecessary interventions” and the rhetoric that goes along with that with nothing to back up their statements, it really is frustrating.
Many other blogs state clearly in their comments policy that they don’t engage in any Feminist 101 or Racism 101, or whatever and post a link to relevant material.
If there was such a link posted here, all of us regulars could just post that. Of course, the discourse that follows a parachuter is always interesting.
I honestly think an eBook might be an appropriate effort. Personally, I’d like to have something printable and non-inflammatory to share with a few people. It could start by inventorying the “arguments” in BOBB since that’s where a lot of women get their start. Call it something like”Being Born Safely.” Take a page out of the”other side’s” playbook and intersperse the stats and logic with real life stories of the potential consequences of ignoring risks. That’s how parents are being convinced anyway. They don’t care that vaccines are 80% effective in individuals and the protection of the cocoon effect outweighs the small risk of individual bad reactions, because some woman on Baby Bump got the flu shot during pregnancy and her daughter has developmental delays and she thinks it might have something to do with the vaccine. So all that to say, I think an eBook with arguments, testimonies and pics might help some people.
I have done some freelance proofreading and could probably be convinced to help with that part, as a limited number of hours.
That’s a good idea! I’d be willing to help some as well, although time is tight for me at the moment. I can attempt to do things like explain numbers, put risks into context and discuss good evidence vs bad evidence.
Yes- I think it would be helpful to put risks in context, and to also inform people about relative vs. absolute risk.
Also I think it would be awesome to discuss good vs bad evidence rather than ranting in all caps about “NO” evidence. It would just be more instructive, and less condescending.
Example of context: The .11% increased risk of home birth is similar to the risk of driving your child around without a seatbelt–for his or her entire childhood.
The 0.5% death rate of a higher-risk home birth is the same as the probability of a child dying between the ages of 1 and 18 from any cause at all.
Thanks. That is helpful information.
I agree. Let’s put the risks of childbirth in context…
For example, in the US, the chance of a mother dying in childbirth is 50 times greater than that of a guy who drives home 8 miles from the bar.
The chance that a low-risk baby born in a hospital will die is the same as the chance of that same drunk driver either getting into an accident or even getting a DUI.
That’s your context, bud. That’s how risky it is. Compared to childbirth, drunk driving is kittens.
I’d love to be involved in a project like that. Given raw material, I can do a lot of writing and editing, but I need a qualified reviewer and fact checker.
Replying to my own post because I don’t know which of you to reply to – I think Dr. Amy’s posts would provide a good starting place for material. They would need some careful reading to make sure they were suitable for a general audience, though…IYKWIM. Doubtless some supplementation also to make them complete in themselves as an information source, instead of the individual blog postings they currently are.
My thoughts are something like this… It would need to start with a defense of America’s medical system – specifically, an explanation of neonatal mortality vs. perinatal mortality and how the measures directly related to prenatal care and birth show that our system is working pretty well with regard to that. That’s where they scare women, implying they’ll get substandard care in the hospital. This might not need an entire story unto itself, but pertinent personally applicable info could include women who were denied access to an OB in the Netherlands, say. That would shock a lot of US women.
Next would be “The Myth of the ‘Cascade of Interventions.'” You’d have to deconstruct it completely, from explaining why not augmenting labor in the presence of certain risk factors is…risky (oh the simplicity), to why Pitocin doesn’t cause the bad outcomes “they” say it does. Because average women are swallowing this stuff hook, line and sinker in the absence of accurate information. Lots of stories here, either my own (I was scared to get Itocin but lo and behold, I had a great birth) or a story about what happens when your water breaks and you DON’T do anything.
Some way to address the idea of “birth trauma” and that the reason your hospital birth was rough isn’t that doctors don’t care about you – it’s that you were looking at potentially a much worse outcome. And on and on.
I think a lot of the material already exists; it just needs effective editing and compilation. I also think it would be appropriate to have one ebook restricting itself to the average arguments women everywhere are hearing, and (if anyone had the patience) a separate point-by-point rebuttal of the more involved arguments upon arguments.
Doula Dani has written an excellent series of posts on her blog. They cover the BOBB and another one about the MANA study (I think). Her blog is an excellent go-to for newbies to the discussion because she presents everything so clearly.
Yeah – I don’t think it’s really going to work to tackle an ebook up front. I think a good first step would be to do a post compiling links to existing material that answer a lot of the objections that we see on at least a weekly basis. Once that was done, some people might or might not see their ways clear to making it into a stand-alone work, with the blessing of the various authors, of course, and personal stories voluntarily submitted to drive home the reality of the statistics (like what’s already on Hurt by Homebirth, etc.).
A series of childbirth education type posts would be fantastic. There is really not a good internet resource for childbirth issues for lay people. The resources available are either too dumbed down, too vague, or just a bunch of crap.
Check out the author of pregnancy info on about.com, if you haven’t. (That’s not a recommendation.)
Oh my…
Exactly
Yeah, in my first pregnancy I was reading those articles and assuming they were objective until I ran across her name here and it sounded familiar.
Wowee! Now this is pretty interesting and hilarious! After all the resistance I’ve encountered here to the idea that maybe we should be doing less C-sections, and all the tireless defense of the blog author, I thought to myself… Matt, what do you really know about Dr. Amy? I thought a good place to start would be back at the beginning of this blog. Guess what I found as the very first post? You may not have seen it, as I noticed it has exactly -zero- comments.
How to lower the C-section rate: step 1, look in the mirror
“Everyone agrees that the cesarean section rate in the US is too high.”
“a C-section rate of 32% cannot be medically justified if the normal parameters for medical justification are used.”
“As the C-section rate rises, the percentage of unnecessary C-sections rise and that is a bad thing.”
But woe be to anybody that raises the hypothesis that passing through a (healthy) birth canal might confer a health benefit to baby. That it might be one additional thing to consider before jumping into an elective C-section.
No… we can’t consider that. Because “crunchy granola homebirth moms” think that… and if we think that too… that must mean we’re one of them!!!
You know what? I’ve changed my mind about Dr. Amy. She clearly cares a lot about babies. It’s too bad that she felt the need to make an early departure from obstetrics. It must be really difficult to try to do something you love, and make the right decisions, while constantly under the threat of lawsuits from whackjob parents who refuse to take any responsibility for themselves, and who refuse to accept the sad, sad truth: Some babies die.
No really, I’m serious.
I get why Dr. Amy is so concerned about the “homebirth community.” It sounds like there are a lot of hacks and posers who fall prey to the naturalistic fallacy, and who spread misinformation and falsities to justify their position. It must suck for somebody who cares so much about babies to see something like this going on, and seemingly getting out of hand.
But to Dr. Amy, and her readers here on the “Skeptical OB” I would ask you to consider a new perspective. In her original post here, Dr. Amy laments about the malpractice suits being out of control, and how doctors are merely trying to respond to unreasonable patient expectations.
Have you considered that at least part of the recent move by some patients away from conventional medicine, and toward more “natural” or “alternative” methods is actually just part of the fallout of this ongoing firestorm of malpractice litigation?
Think about it. Really consider it for a moment. I know from my own experience that the women I’ve talked who have had homebirths, or are considering homebirths, are driven a lot by fear of the medical system.
They’re scared shitless to step foot in a hospital… and why? Because they perceive that medical staff are too quick to push interventions like c-section, induction, and episiotomy on them. And they are. Certainly, it seems to me like Dr. Amy would agree:
“Virtually every American obstetrician is sued. Most are sued several
times. An obstetrician must assume that she will be sued for every bad
outcome, and therefore, she must take whatever steps she can to preserve
a legal defense. Of course, the only acceptable legal defense is a
C-section.”
Could it be that interventions are increasingly offered sooner and sooner at the very first sign of something abnormal during the birth process because the medical staff is scared shitless of what might happen if they DIDN’T offer an intervention?
Could it be that procedures are now being recommended against a physician’s better judgment, not because of what might be best for mother and baby, but because they are working under duress?
Could it be that maybe… just maybe… there is something driving women to homebirth that isn’t just “pseudoscience” and “woo” but actually based on a very real problem with our healthcare system that continues to go largely unaddressed.
I can’t speak for women, since I’m not one. But I can say that if I ever had to step foot in a hospital, I sure would hope that the physicians and staff were looking out for ME and placing MY HEALTH AND WELLBEING as a priority over their fear of litigation.
But it doesn’t seem like that’s the case. It seems like hospitals, and their employees, are too concerned about protecting their own asses. It’s understandable, but it’s not right. It’s a disgrace.
“Could it be that interventions are increasingly offered sooner and sooner at the very first sign of something abnormal during the birth process because the medical staff is scared shitless of what might happen if they DIDN’T offer an intervention?”
Like…someone might die?
WHY do people sue doctors? They sue because something happened to their baby, something that could have been prevented. Usually, it is something that could have been prevented by *doing more interventions,* or doing them sooner.
Shame on you for repeating the trope that “some babies just die.” Yes, that’s true. But in modern times, we have the ability to save a lot of them…with c sections. Would that we all had crystal balls; then we’d be able to tell ahead of time which surgeries were “necessary” and which ones weren’t. Until we have crystal balls, we’ll just have to keep doing the best we can, with the baby’s and mom’s safety put foremost and ahead of their comfort. As a mom, I can live with that.
Could it be that women are ready to jump on the intervention train at the very first sign of something abnormal during the birth process because they are scared shitless of what might happen if they DON’T accept the intervention?
Like, their baby dying or being damaged?
You’re making it sound as if every second woman is thinking of homebirth. This isn’t so. The overwhelming majority of women – around 99 percent – are very happy to have their babies at hospitals just in case and – gasp! – maternal satisfaction rates are massively positive.
It’s just this 1 very loud percent that is so, so concerned with interventions. Thank God, most women think along the normal human lines of, “Even if the risk is small, why would I risk my baby?” and happily agree to interventions.
Of course, Professor Hannah Dahlen (guess what her specialty is?) offers the following pearl of wisdom, “Perinatal mortality is a very limited view of safety, maternal satisfaction should also be considered” and then keeps spinning it as if mothers would be happier with a dead or brain-damaged baby, as long as they felt empowered during their homebirth.
No… YOU’RE making it sound as if I said something I didn’t. Holy hell… is it even possible to write something on this site without somebody jumping in and making gross mischaracterizations and false assumptions?
I never said, nor insinuated in any way, that “every second woman is thinking of homebirth.” Who are you arguing against? It’s not me.
Then why does it matter that obstetricians are supposedly too quick to intervene? You’re making it sound as if it is being done TO women while in reality, women are perfectly happy to TAKE PART into decision making leading to interventions at the first sign of a problem.
The only ones who see it as a problem are homebirthers and homebirth advocates.
I am arguing against you making it sound as if preventative medicine is a problem. And yes, I am most certainly arguing against you since you insinuate that it is.
I was commenting on the blog author’s ***own post*** about unnecessary c-sections resulting from fear of litigation.
I was just taking her word for it… so why don’t you go argue against her?
Why should I argue with her? I have no problem with doctors acting out of fear of litigation. Their interest coincides with mine – not taking that additional risk that could lead to a worse outcome.
I don’t understand the reasoning behind, “I want my doctors to act with my best interest in mind, not their own!” My interest and theirs are one and the same. I do not consider myself this special snowflake that stats don’t apply to.
I do have a best friend, thank you very much. I don’t need a doctor’s love. Just their sound clinical judgment, to protect both our interests.
“Think about it. Really consider it for a moment. I know from my own experience that the women I’ve talked who have had homebirths, or are considering homebirths, are driven a lot by fear of the medical system.
They’re scared shitless to step foot in a hospital… and why? Because they perceive that medical staff are too quick to push interventions like c-section, induction, and episiotomy on them. And they are.”
And why do they “perceive” that? My guess would be they’ve been fed a lot of crap by the NCB folks and home birth midwives. I’ve been working in Obstetrics for a long time and I can tell you we don’t “push interventions” at least not in my 10 + years experience. We do, however inform patients what is happening and recommend a course of action based on the clinical picture, our experience and education.
“But I can say that if I ever had to step foot in a hospital, I sure would hope that the physicians and staff were looking out for ME and placing MY HEALTH AND WELLBEING as a priority over their fear of litigation.
But it doesn’t seem like that’s the case. It seems like hospitals, and their employees, are too concerned about protecting their own asses. It’s understandable, but it’s not right. It’s a disgrace”.
Hmmm.. it doesn’t SEEM like that’s the case. Based on what? Your “vast” experience? I hate to break it to you, but we actually DO have YOUR HEALTH and well-being as our top priority! Your perception of “defensive medicine” could be that when distrustful, combative people seek out medical care, we get frustrated. They either refuse every treatment offered and/or recommended or argue about it, taking our precious time away from sick and dying people actually wanting help. It’s really difficult to try to help people who really don’t want it. It never ceases to amaze me. You criticize the healthcare system, yet we are your “back-up” should a disaster occur. And why is that? Because underneath it all you really do trust modern medicine, otherwise you would “handle it yourselves.” My suggestion to all of you who distrust “hospitals and their employees” is to spend about a week with one of us, then tell us what you think.
Thanks for the response, but have you read the original post that I was referring to? It was written by the author of this site… she was lamenting that fear of litigation is contributing to unnecessary c-sections.
What do you have to say to that?
Did you not actually read my post? I directly quoted you and responded to your statements.
“Hmmm.. it doesn’t SEEM like that’s the case. Based on what? Your “vast” experience?”
Based on the blog author’s ***own post*** to which I referenced. Are you serious?!
“Based on the blog author’s ***own post*** to which I referenced”.
And to which you stated your opinion, which, again, I quoted your statements and responded to.
LOL- OK I am seriously lost. Let’s try something simpler.
Dr. Amy expressed her concern that more unnecessary c-sections are being performed because hospitals and physicians are attempting to avoid lawsuits.
What is your opinion on that?
She was not lamenting it. She was saying it as she sees it.
Matt, you might be one of the lucky guys who count 5 million dollars as a loose cash. Most of us, though, invest heavily in our education. Do you really think it’s a vile thing that an obstetrician might be unwilling to risk all the years of their training, all the student loans they have yet to pay, potentially their savings, and for sure harm their chance of future employment for the sake of the gamble that the baby MIGHT turn out just fine?
Hmm. Well thanks for asking me what I think, instead of telling me what I think. That’s helpful. 😉
No, I don’t think that “it’s a vile thing” for OBs to look out for their own personal, professional, and financial interest.
I think it’s a vile thing that people are being recommended treatments that they don’t need, and that institutions (and their employees) aren’t standing up to being held hostage to this sort of situation.
It undermines trust in the system. On all sides. That’s vile. Whatever is the cause of THAT… should be eliminated.
See, that’s where we differ. How do you know that patients don’t need the treatment? There is the chance that things could go bad beyond repair without interventions while with interventions, the worse thing that can happen is they might turn out to be useless – but no one knows that before it’s over.
Until the crystal ball is invented, obstetricians will keep recommending treatments on the basis of problems that are indicated. Because when they know for sure, it might be too late.
And since you liked me asking you what you think so much, let me ask you another question: Do you really, really think it’s ethical to see something that has the potential to ruin a child’s life – and a mother, by extension – and not recommend a course that would avoid the risk when the risks of the exchange are so small in comparison?
If you think it’s ethical, do you think it’s ethical of the doctor to withhold the same recommendation from the next woman with the same indication, or would it be ethical for him to go two times a day, every day, to the home of the woman who turned out to have needed the intervention to help her with the wheelchair of her brain-damaged child for the next 30 years?
I *think* I see what you are saying… there is no way in advance to know if they are truly necessary.
But where does that lead? I mean… why not just run all sorts of genetic tests while a baby is still in the womb and initiate treatment then?
What if we have technology that can detect a single cancer cell in the body? What do we do then? Just start treatment.
And who is going to pay for all of this treatment?
” Do you really, really think it’s ethical to see something that has the
potential to ruin a child’s life – and a mother, by extension – and not
recommend a course that would avoid the risk when the risks of the
exchange are so small in comparison?”
No. But I do think it is equally unethical to overstate and understand risks.
I do think it is unethical to impose one’s own value equation upon another.
I do think it is unethical to deride a woman for deciding that something else did in fact outweigh the 0.11% increased risk of neonatal mortality from attempted homebirth.
Matt, I suggest that you read a few of the posts here before you rush to conclusions. No one is deriding women who choose homebirth. We’re deriding the current homebirth advocates practice to deceive them into choosing homebirth without knowing that they choose an additional percent of perinatal mortality, no matter how low it is.
Do you want an example? MANA’s own data showed 3-fold increase in perinatal mortality. What did they say their data was showing? “Homebirth means less interventions and no increase in adverse outcomes!”
That’s what we are against. You might also want to have a look at Dr Amy’s post about a forced c-section of a woman. Almost everyone here agreed that no matter the reason, the choice is hers. I advocated the opinion that in her circumstances, her choice was reckless and endangering the baby – but it was her informed choice and she should not be deprived of it.
Again, until crystal ball is invented, obstetricians and mothers will always veer on the side of caution. Totally fine, IMO.
I really, really doubt that telling a woman, “This might indicate distress, it might be a threat to your baby’s life, your baby’s brain, your baby’s quality of life, that’s why I suggest Intervention A” is imposing one’s values to a helpess patient. First, it’s the truth of the situation. And second, mothers generally prefer not to take the risk.
That’s fine… I will take your word for it that some of the other posts are different. Again… this post was my first experience of this blog.
The numbers I had come across (long before I ever came to this site) from published research was 0.09% neonatal mortality rate in the hospital vs 0.20% in the hospital.
I found that information pretty readily on Pubmed… so I’m not sure why anybody would attempt to obscure or hide it… but it they did then yes, I would agree that is unethical.
But anyway… I think it is equally unethical to only report on ***relative risk**** while not mentioning absolute risk. It is leaving a very important piece of information out of the equation, and it is misleading and dishonest.
In fact, the first statistic I ever came across was what you referred to… a 3-fold risk of neonatal mortality for homebirths.
Yes… but three times the risk of WHAT, exactly..?
Oh… three times the risk of 0.09%. Well DUH but the biggest contributing factor to the 3X stat is the fact that ****neonatal mortality rates in the hospital are so low***.
The difference in absolute risk is 0.11%. Why not say the whole truth?
I have seen other controversial health topics discussed in this way… why people should do such and such because it will “cut their risk in half” or some such thing, but all the while never bothering to mention that the overall risk was **really low to begin with**
That’s just as dishonest a practice, IMO. If you believe differently, that’s fine. We can agree to disagree here.
Have you looked at the stats regarding long term injuries? So many people who post here have had uncomplicated pregnancies and home births but the ones who have had losses or injuries to themselves it their babies could shed more light on this.
No, if you have links to that information, please share.
Ok, I am out and about at the moment-but I do want to post some links for you. Meanwhile, there are two links to blogs on the right hand side. The two that can best sum up what I am talking about are Hurt By Homebirth (which also talks about babies who suffered injury or died in hospitals, so it’s not all about home birth) and Better Midwifery Michigan.
http://www.ajog.org/article/S0002-9378%2813%2901604-9/abstract
You beat me to it. 🙂
There’s another great article that I had highlighted a bit in the commentary stating that the primary driver of neurologic damage seemed to be the delay in treatment. Not that the cases were more severe initially, but that the delay in treatment caused by transferring from home automatically results in worse outcomes. No matter how close you are to the hospital, you are never close enough in a true emergency. I’m still looking for the actual article.
Yeah, I was trying to find one that got the point across.
I am still remembering the young woman who attempted a homebirth, she lived in the apartments I could see from the hospital parking lot. The transfer took a long time, she was asystole for 8 minutes before they could get her into the ER. Crash section, her baby boy died a day later, she died two days later. She left behind a husband and little girl. I will never forget the little girl coming in with the husband the morning the woman died. I don’t think I have ever cried so hard on my way home from work.
I found it – It’s in Grunebaum’s Apgars of 0 at 5 minute paper. Posted above.
RE delay in treatment: http://www.skepticalob.com/2012/05/pediatric-er-doc-homebirth-5-minutes.html
Did you find the article?
https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585
This talks about home birth midwifery vs hospital birth in Oregon. There many midwives there who have repeatedly attended births where babies are injured or have died and instead of being held accountable, the community circles the wagons and defends the midwives, shuns and ridicules the parents for speaking out and arranges gofundme sites for the midwives.
2014-01 – Increased risk of HIE (hypoxic ischemic encephalopathy) necessitating cooling following homebirth: http://www.ajog.org/article/S0002-9378%2813%2901604-9/fulltext
“Women who delivered at home had 16.9 times the odds of neonatal HIE compared to women who delivered in a hospital.”
Homebirth carries an increased risk of an Apgar score of 0 (ZERO – no heart beat, not breathing, limp, blue, floppy baby) at 5 MINUTES of life:
http://www.ajog.org/article/S0002-9378%2813%2900641-8/fulltext
“We emphasize that the increased risks of poor outcomes from the setting of home birth, regardless of attendant, are virtually impossible to solve by transport. This is because total time for transport from home to hospital cannot realistically be reduced to clinically satisfactory times to optimize outcome when time is of the essence when unexpected deterioration of the condition of either the fetal patient or pregnant
patient occurs.”
In other words, it doesn’t matter what “certs” your CPM has, whether she has taken a “neonatal resuscitation” class or if you’re “only 5 minutes” from the hospital. By the time your baby or your wife are in danger, it’s much, much too late.
Dude, I linked to a study showing exactly that two days ago. Are you even reading the links that people are giving you? It’s the same study that Stacy48918 has kindly posted again for you (the 5 minute Apgar score of 0 study).
Babies who suffer from prolonged loss of oxygen at birth will have permanent brain injuries (there are *very* rare exceptions). Permanent brain injuries to the extent that they may be confined to a wheelchair for life, might require feeding tubes because they can’t take food orally, and will generally require constant care 24/7 for the rest of their natural lives (which will inevitably be shorter and more painful than they otherwise would have been).
These injuries are very costly on every scale imaginable. I’ve seen families emotionally exhausted and financially ruined because of these injuries. OBs pay high malpractice premiums because lifetime care for birth injuries can easily cost millions of dollars.
I read elsewhere on this thread that you and your wife are planning a homebirth with a CPM in Michigan. I hope that you read the Safer Midwifery for Michigan website. I hope you look into what kind of liability/malpractice insurance your midwife carries. I hope you look up your midwife’s license and history. And I hope you read From Calling to Courtroom, a guide for midwives who are being sued after a poor outcome (the book is free to read online).
And while your wife’s planned homebirth is likely to go well, please remember that there are far too many that end in tragedy. Many of us who post here do so out of concern for those women who were inadequately informed and who didn’t realize the additional risks they were taking on.
He’s clutching at straws. I think their OB got his wheels turning when he told them he would have to drop them if they chose home birth. Now he is scared and defensive.
Matt: “a 3-fold risk of neonatal mortality for homebirths.
Yes… but three times the risk of WHAT, exactly..?
Oh… three times the risk of 0.09%.”
That’s the question, isn’t it? Risk of what, exactly?
Death.
“neonatal mortality” means your baby died during birth.
It’s not a risk of dealing with a rude hospital employee, or the risk of getting a headache from anesthesia. It’s the risk that the baby you’ve (the mother) just spent 9 months gestating won’t get a chance to enjoy life, at all.
While you spend all this mental energy minimizing the absolute numbers, please recall what that absolute number represents.
You cannot do a risk assessment without acknowledging the severity of the consequences.
We are talking about the absolute risk of DEATH – of a newborn.
Is this a risk you want to decrease, or increase?
Well that’s a fair question, but not one that I have any faith can be reasonably addressed in this forum. So I will pass. Thanks for the discussion.
Decrease, Matt, Decrease the risk of death, that is the only logical answer. No thought required.
This is the primary problem with the NCB/homebirth crowd. A complete unwillingness to address the increased risk of neonatal death. Bury your head in the sand beforehand. Bury the baby (figuratively and literally) afterward.
You really need to address this before attempting a homebirth. Why don’t you want to consider the increased risk of death?
The problem with *this* crowd is that people keep engaging me as if I am one of the NCB/home birth crowd. Do you see? People keep acting as if I’m “one of them” when I am not. I am my own party. I am not a “homebirther” in disguise, and yet many people here keep insisting on treating me as if I am. This is kind of rude, don’t you think?
By your own definition, I do not fit the criteria. You say I am unwilling to address the increased neonatality rate… but if you actually read what I have written… I have brought it up several times. I have never once said homebirth is safer. In fact, I’ve given the exact statistic… a 0.11% increase in absolute risk of neonatal mortality for homebirth vs hospital birth.
Do you see?
Ok, not a home birther. Having a home birth because the risk is there, but it’s low and you figure most births are uncomplicated and since your wife is low risk, choosing the more cost efficient home birth route makes more sense since you MAY have problems with at home, but paying out of pocket for hospital care is for sure an expense you can’t afford when everything is most likely going to be ok anyway. But still, you are nervous about that small percent of “what if”. Everyone here is supportive of you grappling with that, since your questions and concern indicate that you aren’t just some guy who thinks they know everything about birth and is too cheap to engage proper medical care for his wife and baby cause “women are made to give birth” and actually might believe birth could be orgasmic.
But you are planning a home birth! You’ve hired a CPM! You ARE “one of them”!
Since you are willing to address the increased neonatal mortality rate in home births, why not just fire the CPM and go with the OB? I read in one of your previous posts you don’t have Maternity Coverage with your insurance. I think another poster had a suggestion regarding Medicaid maternity coverage. It would be worthwhile to check into that. Do you really want to take the risk of the overwhelming cost of an emergency hospital stay if the home birth goes bad? Not to mention the risk of damage to your wife and baby?
Matt, your insurance should cover pregnancy and birth unless you have an individual policy that was grandfathered in under Obamacare: https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-get-pregnant/
If you want to know whether you qualify for Medicaid, use this calculator: https://www.healthcare.gov/screener/
I’d hate to see someone opt for a homebirth because they mistakenly believe they don’t qualify for coverage.
You came here, vomited a bunch of studies you hadn’t read and knew nothing about by way of saying “Ha! You don’t know anything! Look how harmful C-sections are!”
And you’re not “one of them”?
I’m not trying to be completely condescending Matt, but you are so deep into the woo that you can’t see it. There are glimpses of the light making it through in some of your comments, but you are unwilling to question the risk of neonatal death, you write dead babies off as “just happening” and you’re planning a homebirth with a CPM. You ARE a NCB/homebirth advocate, willing to ignore dead babies just to get the “experience” you and your wife are after.
In other words, you can’t come up with a response. You can’t and won’t argue the increased risk of DEATH to your baby and your insistence that home birth is “safer.” Especially now that you have asked and you have the facts. That would make you look like a monster.
No… I never said home birth is safer. Not once. In fact, I’ve posted the statistics indicating otherwise several times. I already had those facts before I came here.
The reason I am not continuing to engage is because it is nearly impossible to say something where without somebody jumping in- as you did- and attempting to put words in my mouth and mischaracterize what I am saying.
I’ve pointed it out several times now, and not once has anybody taken responsibility for it.
It’s not just an increase in death, it’s an increase in severe birth injury. But I agree with you, the absolute risk is low, and there is a benefit to the mother, who is less likely to get C-section. In fact, I think women who make that choice are explicitly engaging in that tradeoff. I think they might not be aware of the risk in injury, though.
Women who make that tradeoff may also drastically overestimate the reduction in c-section risk, and may not realize that they are accepting a much higher risk of the kind of hemorrhage that causes disabling anemia after the birth.
The MANA study had a 5% c-section rate, but, because they were mostly low-risk, if all those women had gone to the hospital, the c-section rate would probably have been 9-10%. By contrast, 15% suffered postpartum hemorrhage.
I agree that they may not precisely understand the exact tradeoff they are making, and have underestimated other risks to themselves, but the C-section is currently the most prominent risk that expecting mothers are aware of. I’m not sure I accept your estimate of a 9-10% C-section rate in the hospital, either, especially since many of them were not low risk. They were women with breech babies, with Pre-eclampsia, and women who went postdates.
I’m not claiming that these women are perfectly or even well-informed. Unlike many commenters here, however, I believe that they know that their baby is more likely to die and they are willing to take the risk.
I read the other study on APGAR scores and injury… I only saw relative risk reported. Where can I find the data on absolute risk for these in a physician-attended hospital birth?
I don’t know, but some of the commenters here will probably be able to provide that information.
OK. Perhaps you might have an explanation for why the authors of a study would choose to report only on relative risk. Why not throw in a table with the absolute risk? Certainly, they require the latter to calculate the former.
I understand why relative risk is calculated. I’m not as scientifically illiterate as you might think. But no- I’m not a published scientist. I do think that reporting absolute risk along with relative risk gives a more complete picture.
Why do you think researchers would choose to not report absolute risk?
Absolute risk is listed in Table 2 of the study in the results section. He also provides a link to the CDC data in the materials and methods section so you can play around with it yourself and confirm his findings.
The absolute risk of a baby having a 5 minute Apgar of zero is 0.16 per 1000 for those delivered by MDs in hospital, and 1.63 per 1000 for babies delivered by “home midwife” (CPM in most cases).
Why don’t you read the studies carefully before running your mouth off?
Yes. I see that in the link you provided. I may have clicked on a different link to an article that was summarizing the research. In any case, yes the data is there. Thanks.
I also found a CDC powerpoint presentation in a Goodge search for “hospital birth apgar score distribution” so here is a link to that search if anybody is interested. They’ve got slides on the absolute risk in there.
http://goo.gl/LKM3xK
What study of homebirth death fails to report absolute risk? None I’ve seen.
Sorry- I think I had clicked a link to an article that summarized the research, and only reported relative risk. Well… I thought it was kind of strange so that’s why I asked about it. But a quick search on my own yielded the info I was looking for anyway.
You might be surprised… since you have your nose in the research and work with this kind of data all the time… when these things get “reported” say… in the news, they typically only mention relative risk.
It’s sort of more sensational that way… don’t you think?
Oh, definitely. It’s a common reporting error. Which is why, if you want to understand something, the popular-press report is the beginning and not the end of your learning process.
I would barely even call it a good starting point. 🙁
Unfortunately… that’s where most people are starting from.
But you know… it hasn’t been much easier to get good information from this particular source, either.
I will acknowledge coming in with “fists flying” but they weren’t flying for the reasons most people are trying to make them out to be.
They were flying because of the derogatory, derisive, and dismissive attitude of this blog post. So… apparently a lot of people here believe that this kind of behavior is actually appropriate for health care professionals.
That’s pretty problematic when the same people are saying “trust us” we’re healthcare professionals. Don’t you think?
Were you actually thinking of hiring Dr. Tuteur? No? Then why do you care about her tone?
What was the tone of the CPM that you hired, I wonder? Trust birth… I’ve attended about 100 births and not lost one yet!*
*You’ll just have to believe me though. I’m not required to report my statistics to any health authorities or state medical boards, let alone clients.
I think you’re kind of grasping here. If you really think that a medical doctor on a blog going off with that kind of tone shouldn’t affect her credibility in the eyes of the reader… I don’t know what to say… I’m kind of shocked. But apparently a lot of people here think this kind of behavior is justified and acceptable.
The CPM we talked to wasn’t derogatory toward hospital birth. She didn’t insinuate it was a risk-free scenario.
You’re not as bad as some others here… but there seems to be some kind of subtext going on here where people are trying to “guess” my story… tell me about myself and what I believe… or the worst… talk about me as if I’m not here reading the comments. It’s really immature, and unprofessional.
In the conclusion slides for the CDC presentation I just looked through, they say:
“Women may opt for homebirth if over-medicalization and unjustified interventions continue.”
So… at least according to the CDC, over-medicalization and unjustified interventions are real issues. I saw a suggestion above for some permalinks and maybe an intro guide.
I would suggest: How about a guide as to how to avoid over-medicalization and unjustified interventions in a hospital setting? I think that might be of some real use.
In addition, they conclude that “Obstetricians should be trained in and consistently demonstrate professional and humanistic skills.”
Those “professional and humanistic skills” do not shine through in Dr. Amy’s post… and I happen to think that matters too.
Matt, I speak to people like they are adults.
I assume that they have enough basic intelligence to read scientific papers (not the abstracts, the papers).
I assume that they know enough basic logic to realize that reading what lay people write about medical literature that they haven’t read makes absolutely no sense.
I assume they have a maturity to deal with being shown to be wrong.
I assume that they don’t need to be called “mamas” or “warriors” or constantly praised as if they small children.
That’s not unprofessional. That’s how science is done. It’s not about making friends and boosting your own self-esteem. It’s about establishing what the scientific evidence is and letting people decide for themselves how they want to incorporate it into their decision making.
You also assume a lot of other things, which apparently you and some other here believe is part of being a skeptic. If you take a look at the evidence here in this blog, I think it is fairly clear that I am a person that understands, and responds to, logic and reason.
Making announcements in a public forum about who people are, what they “truly” believe, what their education level and background is, and then persisting in maintaining that image after the person has demonstrated by their words and actions to the contrary… that has nothing to do with skeptic inquiry.
That is a pathological behavior known as bullying.
Now that being said- I apologize for flying in here and causing chaos, however I was having an emotional reaction to your emotional post.
If you will extend me the courtesy to start over…
I’m still curious about your comments regarding microbiome research. I understand you don’t appreciate the spin that the film producer and their marketing are putting on this documentary.
But I watched it… and I am really intrigued by some of the comments made by the researchers… particularly Dr. Blaser.
I have a Bachelor’s Degree in Biology… from 15 years ago. As it turns out, the university I received it from is now doing quite a bit of research on the microbiome.
I’m very curious about something… I don’t recall learning anything about the microbiome in undergraduate school? Why is that?
I understand we just didn’t have a lot of the technology we do now to study it…. but when I went back and looked in the literature, I saw that the concept has been around for about 100 years.
It seems really important. I just think it’s really odd… when I was in school we were talking about all the wonders that will come from mapping the human genome… but I don’t recall the term microbiome being mentioned a single time..
Why do you think that is?
“I’m very curious about something… I don’t recall learning anything about the microbiome in undergraduate school? Why is that?
I understand we just didn’t have a lot of the technology we do now to study it…. but when I went back and looked in the literature, I saw that the concept has been around for about 100 years.
It seems really important. I just think it’s really odd… when I was in school we were talking about all the wonders that will come from mapping the human genome… but I don’t recall the term microbiome being mentioned a single time..
Why do you think that is?”
I’ve no idea, but I’m really interested in why you believe it was left out of your 15yo undergraduate biology degree. So why do you think it was?
I really don’t have a logical explanation… that’s why I asked.
Just observing and asking questions. That’s part of scientific inquiry… right?
There’s a whole ‘nother level of biological organization that exists… and all throughout 16 years of science education… nobody ever mentioned it? It wasn’t in the textbooks? Huh?
I think that’s pretty bizarre, don’t you?
There’s a lot of stuff that isn’t in undergrad textbooks. That doesn’t imply a cover-up of any kind. (In your third- and fourth-year courses you were presumably using journal articles more than textbooks anyway.)
Thirty years ago I did a BSc in Human Nutrition. Microbiology was part of the course. I wrote papers on gut flora and learned lots of things that weren’t in the texts. I have no idea whether the word “microbiome” was used. If it was, since it wasn’t a trendy, poorly-understood catchphrase being thrown around by people overestimating their own understanding it didn’t have the resonance it would have today. It would be just another word used by microbiologists. ;Actually, most Other people wrote other papers and learned other things that I didn’t learn. That’s okay because we had different goals.
[sorry, I’m having trouble editing in Disqus]
(Actually, most of the gut flora research I found was being published by surgeons who wanted to know the impact of doing various kinds of bowel resections and creating blind pouches.)
Other people wrote other papers for their microbiology courses and learned different things. Those who went on to do more than the minimum required six credits in microbiology, or who actually majored in it, would have learned more. Maybe the microbiologists talked about the microbiome. Maybe they didn’t have any need for the word because they were able to talk in specifics. I don’t know and I have no reason to conjecture about conspiracies, which is what your “just asking questions” seems to be leading to. (The fact that your undergrad biology course didn’t cover “microbiome” Isa really weird thing to be “just asking questions about.
… is a really weird thing to be “just asking questions” about. I’d hazard a guess that 1) it wasn’t a buzzword yet so they didn’t feel the need to examine that concept; 2) you weren’t concentrating in pre-med microbiology. Occam’s razor suggests to me that these are sufficient and obvious answers. Why don’t you think they are?)
Because I’m wondering about the implications. I’m wondering… when safety tests were done for medications (like antibiotics, PPIs, NSAIDs), novel food additives, agricultural chemicals, etc… did anybody demonstrate that these things do NOT have a negative impact on the microbiome?
Were these questions asked? Why not? And if not, what does that say about continued reassurances from the scientific community that Agent A is safe, when its impact on the microbiome (positive, negative, or neutral) was never reported?
No, we haven’t done most of those studies. Why not? Because we still don’t know what a healthy vs unhealthy microbiome even looks like!
So… then if we don’t have the studies proving these things are safe, why were they declared safe in the first place?
I think we do know *something*… or at least have a very plausible hypothesis on the table about healthy vs. unhealthy microbiome, and it has to do with the diversity of the microflora.
I mean… the assertion that greater diversity is a good thing seems very much in line with a basic axiom of biology. And- I’m sure you’ll correct me if I am wrong- but I believe that there is some decent- if preliminary- evidence to support such an assertion.
*bump* Any comment here, CC? I’m interested to know your response.
They are declared safe on the basis of the empirical evidence that the benefits outweigh the harms, meaning that patients who need the drug and get it do better than those who need it and don’t get it.
Do antibiotics affect the microbiome? Definitely. Are you suggesting that we should go back to letting children die of strep to avoid microbiome damage? I seriously hope not.
And can you cool it with the spaghetti flinging? Every time I counter one of your arguments, you bring up another completely unrelated topic.
Why is it weird? I haven’t launched a conspiracy theory about it… I’m just curious that an entire level of biological organization somehow didn’t make it into the textbooks.
Because it’s poorly-understood and effects on function are highly speculative. This means that most of what we think about it now is probably wrong. Most things that are speculative are wrong. Even more thinking about the microbiome was speculative fifteen years ago. Few interesting initial studies turn out to be replicable and when they are the effect is never as large as initially suggested. This is not because of anyone’s incompetence. There are good statistical reasons for it.
Because there are — say — 50,000 well-understood, highly-probable, clearly-relevant things that should be in introductory textbooks for generalists and room for only for 2,000 of them.
Given the state of knowledge about the “microbiome” when your introductory generalist texts were being written years ago, and the fact
… And the fact that the word “microbiome” wasn’t on the popular radar yet, it would have been weird if it had been in your texts.
If one of your profs had done their doctoral work on skin flora, they would probably have shared extra insight on microbiomy topics in your courses. Instead, you got extra insight on parasite lifestyles or sleep rhythms or whatever it was that your profs had specific, deep knowledge of. THERE IS NOTHING WEIRD ABOUT THAT.
If you had done a PhD in microbiology or a medical ID specialization in the past ten years then it would be totally weird if you had not found lots of microbiomy stuff in your reasearch. THERE IS NOTHING WEIRD ABOUT THAT.
tl;dr:
tl;dr: Not ready for prime time fifteen years ago. It’s that easy.
Why doesn’t “Star Trek” get credit for inventing cell phones? Just because people were discussing, speculating, or even performing experiments related to symbiotic bacteria 100 years ago, that doesn’t mean they had evidence to confirm what we now know about the microbiome. Some of them had ideas that we now know are true. It doesn’t necessarily make them smarter than the dozens of other scientists from that era who had interesting ideas that were eventually proven wrong. By the same token, when a loony theory is proven true, that doesn’t mean the people who ignored it back when it was a loony theory with little evidence are stupid.
But I’m not making a commentary on who was smart or stupid.
I’m making a commentary on a pattern of behavior among the scientific community where individuals are ridiculed, derided, and ostracized for ideas that later turned out to be more correct than incorrect.
You mean “the conceit of the brilliant heretic.” That ploy is common among advocates of alternative health and reflects a profound ignorance of the history of science:
http://www.skepticalob.com/2009/08/alternative-health-and-conceit-of.html
No, that’s not what I mean. I didn’t have Galileo and Darwin in mind. I was thinking more of people like Metchnikoff and Dubos. I was thinking more along the lines of how scientific research that is has potential to profit private industry is favored over that which does not. I was thinking about how this might shape the conversation around certain ideas, and how that dovetails into skeptical treatment of new ideas and the notion of “weighing the evidence” when the evidence is heavily biased toward what is profitable.
Those two have absolutely nothing to do with the problem of profit bias in today’s medical research arena. You keep throwing ideas at the wall, and right now they’re sitting in the corner in a big pile of spaghetti.
Alright… so what does have to do with the problem of profit bias? What is being done about it? And how does that impact arguments for or against emerging theories or new hypothesis based on a “preponderance of evidence” if the evidence is biased by profiteering?
Let’s assume that there are 1 million people out there with some education and a radical theory about science. (I don’t think this is unreasonable.)
Most of these ideas are unlikely. Some have already been disproven, thought the idea holder doesn’t know it, others are implausible.
Now let’s say there are 10,000 with no good evidence for or against, and, within 50 years, one of them will be proven true.
Should we take the other 9,999 seriously in the meantime? No, that’s absurd. There’s nothing shameful about ignoring wild theories promoted without evidence. The only thing that’s shameful is refusing to consider a new theory AFTER solid evidence has been presented, and within the past few decades, that hasn’t happened much.
Hmm… but I’m not talking here about “wild theories.”
I’m talking about Dr. Blaser’s “Disappearing Microbiota Hypothesis.” Do you think that’s a wild theory?
The Jetsons invented Skype, btw…
And the Roomba
(our robotic vacuum cleaner is called Otto, though, not Rosie)
Was your CPM honest about having no malpractice insurance? Or her lack of ACTUAL medical training? Or that all she needed to do to get her CPM was have 60 catches and write a multiple choice exam? What about that even if she does know nrp there’s only one of her and she can’t legally carry meds in most states? Did you know that you have to take her word about her experience or her history? Google Brenda Scarpino, or Christy Collins, they are just 2 CPMs who “forgot” to mention their losses or at best dismissed them. Read the posts on here about Abel, who was injured at a HB and really think about how all of these “small” risks add up and what the sad, heartbreaking reality of those absolute risks.
Then go to CDC wonder and look at the mortality rate for CPMs in Oregon. OR is one of the only states that tracks intended place of birth, which is why I say there. Guess who fought the birth certificate change? CPMs.
If you don’t like Dr. Amy’s style, why are you here?The truth is not always pretty but it must be told. What medical training/education/experience do you have? You’ve come here and made untrue statements about “unnecessary interventions” in childbirth, but you haven’t provided an ounce of evidence to back that up. How do you know an intervention is “unnecessary” ? Unless you have the education, training and experience to make that assessment, you have zero credibility. And until you have worked in the field and experienced what we face on a daily basis, you cannot understand. Or maybe you can’t handle the truth. I don’t know. I do know that we all share Dr. Amy’s passion for justice and that includes promoting competent care from educated providers. Until you have been on the receiving end of a unnecessary medical disaster caused by incompetence and ignorance, you can’t possibly understand. If you are willing to trust your wife and baby’s lives to a CPM with little more than a high school education, there is not much more to say. Hospitals and doctors are not the villains no matter what the home birth crowd tries to tell you. You now have additional education and information from numerous health care professionals on this blog to make a reasonably informed decision and I wish your family the best of luck in whatever you choose.
Promoting informed choice, actually. When expectant parents get their information from laypeople or from people who can only make a living if people believe homebirth is safer or better than hospital birth, they typically hold many misconceptions and are unable to make informed choices. If they understand the risks, that’s one thing. They are entitled to make the choices they want. But more typically they do not understand the risks. That’s a problem.
I think you said something like your wife’s OB recommended your CPM for your homebirth but asked you not to tell anyone, to keep it hush-hush? Also that he would stop caring for your wife if she were choosing homebirth? I’m not sure I understand exactly. I know that some CPMs claim to be working with OBs when they are not. I hope that is not your situation.
No- he said that he is “supposed” to drop her from care if he knows she is considering a homebirth. Something to do with malpractice insurance. He didn’t ask her to keep it a secret from the world.
Why would he stop caring for her? Well… he wouldn’t. That’s why she’s still being co-managed. But apparently that isn’t something he is supposed to be doing.
I looked up your comments.
“She is also receiving concurrent care from an OB… he told us that if he knew she were planning a homebirth that he would have to drop her from care, or else he would run the risk of being dropped by his malpractice insurance.”
“What I can say is that the OB seemed to think she was a good choice.”
Finally, http://www.skepticalob.com/2014/01/microbirth.html#comment-1619839017
“She also has done normal vital checks, and has previously comanaged with our OB. She offered the doppler, but we declined since we had just had it done two days prior at the OB’s office. They have a friendly relationship… although that is on the “hush hush” because I guess it is a no-no for an OB to even SEE somebody considering homebirth?!”
So.
1) The OB says he will drop your wife as a patient if she’s considering homebirth because he will be responsible for any negative outcome and he can’t take that responsibility.
2) Somebody says that the CPM and OB secretly comanage homebirths.
Can you reconcile the two statements? Did the OB or the CPM make Statement 2?
Sure. The reconciliation is that we are considering homebirth so long as no additional risk factors pop up. Since they could pop up at any time, we have currently opted for comanagement with the OB and the midwife, both of who know each other, and neither of which tried to talk us out of working with the other.
For some reason I don’t fully understand… an OB can apparently be dropped from malpractice insurance for comanaging? I don’t know if that is really true. It seems odd to me. Maybe I misunderstood the OB.
So you don’t trust the CPM to be able to identify complications?
Trust is not a black or white thing… it is something that is built over time.
So far she seems able to identify complications. I’m weighing that against my trust in the OB to make decisions about interventions during delivery that are not clouded by his (or the hospital’s) fear over malpractice lawsuits.
I haven’t come to any firm conclusions..
What specifically are you afraid will be done that is unnecessary? I can tell you that a small intervention early on can save having to resort to a bigger one later on.
Too risky and huge payout if there is a lawsuit and the MD loses. And we all know insurance companies are all about minimizing risk.
That sounds like you are planning a homebirth but will consider a hospital birth if your least-trained, least-experienced provider insists on it.
By your rationalization of “planning” vs “considering,” you won’t have planned a homebirth until after the baby is born at home because at any time during labour you might decide to transfer to hospital care and your baby might be born there. Does the OB, his insurance company, his hospital and their insurance company all accept this understanding of “planning” vs “considering”?
If this is not your understanding, at what point before the birth of your child are you going to tell the OB you no longer require his care?
Since your CPM is uninsurable (because she is so underqualified that no insurance company would underwrite her, and if they did her fees would be many times the cost of a hospital birth) you will sue the OB and the hospital for damages if your child is one of the 0.21% of babies who die during a planned home birth or the 3.5% of babies who suffer permanent, preventable brain and organ damage during a planned home birth.
If you don’t have an OB then you cannot sue your OB. You will still sue the hospital if you show up with a dead or compromised baby that they can’t resuscitate or rescue from permanent disability, but you can’t sue a nonexistent OB.
And you will sue. Not because you are a vengeful person but because if you don’t have the money to pay for a hospital birth then you definitely won’t have the money to care for a disabled child.
Can you reconcile your statement that your OB did not ask your wife to be discreet about the fact that he is comanaging a planned/considered homebirth, with your statement that his “friendly” relationship with your CPM is hush-hush?
Who said “hush-hush”?
Me, I said that.
You made it up?
It is a figure of speech, not a direct quote. Unfortunately, people use quotation marks when communicating both direct quotes, and figures of speech. Sorry, I know it’s confusing.
The OB said he is not supposed to know that we are considering homebirth as an option, and that if he did know, he would have to discontinue giving care to my wife in the meantime.
That sounds totally backasswards to me. No, I don’t remember what exact words were stated. Maybe if you divulged your reason for splitting hairs over that comment, I could give you more pertinent information.
Thanks for clarifying. I’m not trying to split hairs, I’m trying to understand. “Hush-hush” is a figure of speech meaning we don’t tell other people. It doesn’t mean we don’t tell eachother. It sounds like you meant “wink-wink”?
Ok, so your understanding is that your wife’s OB has asked her to lie to him. The CPM doesn’t lie and is completely open about the fact that she is comanaging a homebirth with the OB. The OB, however, will lie in court and deny up and down that it ever occurred to him that you might be planning a homebirth. By doing this he will attempt to keep his insurer and prevent you from getting an insurance payout if you ever need one.
Have I got this right? It doesn’t seem to me that you are getting optimum coordinated care or any kind of insurance protection in the case that
… in the case that your child (or wife) suffers a preventable injury during a homebirth.
Personally I would refuse to work with anyone who asked me to lie, under any circumstances. I would not hire someone who wanted me to lie and I would not work for an employer who required me to lie. Not just because of my extra-special touchy-freely ethics but because that’s a good sign I’m about to get fucked. And not in a good way.
I’m trying to pin you down on who said what because it might not be the OB who asked your wife to lie. Is it possible that the OB said, “I can’t care for you if you’re planning a homebirth” and that the CPM said, “ayes, the insurance companies make him say that ,” implying that it’s not a serious requirement when really it is.
It might make sense to try to get some clarity from the OB and the CPM.
Yes…l suppose *wink wink* would be a more appropriate term.
How would you suggest we go about getting optimum coordinated care?
If it were me, I’d either drop the CPM (if she were the one insinuating that the OB wasn’t serious when he said he couldn’t care for me if I were planning a home birth) or switch OBs (if he were the one telling me to lie to him for his protection) and then drop the CPM.
That would be me. It doesn’t sound like that’s an option for your family, so what would work for me isn’t relevant for your circumstances.
Is in-hospital birth with a CNM an option in your area? Have you asked the OB who can help you determine whether you are eligible for any kind of public insurance?
However your family decides to proceed, I strongly urge you to find out who it is who thinks the truth is fudgeable.
Drop the CPM, find a hospital based CNM and find out what options you have for insurance assistance and call the billing department of the hospital after the baby is born and talk that bill down. I have seen people without insurance have hospital births and get the bill down to less than $3000. Also take a tour of the hospital and ask to talk to the nurse manager of L&D. Knowing the person you will want to talk to about any concerns with your care can be reassuring.
If your wife were asking for my opinion (which she is not) I would urge her to give birth the first time in a hospital and then think about homebirth for a second if the first went well. Second births are typically easier than first births even if the first time was a little tricky, and your wife will know how her body feels when things are going right (or wrong).
If in-hospital CNM care is an option I would urge her to consider that option for your first child. To me, that would be your best option for coordinated care with a midwife. Then when it’s time for the second you’ll have direct experience of both “the system” and birth and you’ll be better placed to make decisions.
But it’s not up to me and your wife isn’t asking me. You’ll make your own decisions. Even if you have an unassisted childbirth at home your wife and child will probably both be fine. You only need expert assistance when things aren’t fine, and when things aren’t fine is w
When things aren’t fine I don’t want an expert in ‘normal birth’ (things are fine) I want an expert in 1) proactively making sure things will be fine [so, someone who might suggest I reduce my risk of c-section by choosing an elective induction and then supporting my choice either way] and 2) reactively getting the baby out NOWNOWNOW if that turns out to be needed.
When things aren’t fine I don’t want a CPM and when thing are fine I don’t need a CPM — my cat could attend the birth.
So, clarity in goals I think is what you want. And being fully prepared for all risks, including low risk of injury but insurance when it happens vs high risk of injury and no insurance to help care for an injured child. As long as you understand your risks, your choices are yours.
Does this sound like a page out of “From Calling to Courtroom”?
This is late to the party, but it makes sense to me that an OB could be dropped for comanaging a homebirth. I work in insurance, though not medical insurance, so I understand the basic principles.
Insurers, like all businesses, want to turn a profit. That means that they want to insure you only for risks that are unlikely to happen or won’t be too costly if they do happen. That serves you too, since it makes your premiums affordable. OBs are already really expensive to insure, because dead or injured babies are very expensive payouts especially if there was any smidgen of a hint of medical malpractice. That’s cold, I know, but that’s how it works. In fact, no insurer would ever take on an OB except that it is in the public interest that OBs have malpractice insurance. So what they do is they form a high-risk pool and divvy up the OBs by company so that everyone has to take on the ‘bad risks’ equally.
Homebirths are even riskier than hospital births by a lot. The actuaries looked at the numbers from homebirths and said, nuh uh, no way, that will cost us a lot of money. We can’t make premiums on that kind of risk affordable, and we will have to pay out a lot because homebirths are always substandard medical care, so the provider will always be found legally liable for bad outcomes. So they don’t insure homebirths at all. If you have a homebirth, and if something goes wrong, you can sue your OB for millions of dollars if he cleared you to have the homebirth. Insurers do NOT want to pay that out, so anyone who does such a thing will find it impossible to find insurance in the future because they are doing things the insurer explicitly said weren’t allowed.
Matt-why seek care from both a CPM and OB? If you are sure your wife is low risk and the CPM is such a great choice, then why not just continue seeing the CPM? Someone else posted about seeing both a CPM and OB but couldn’t explain the rationale.
Because if it were totally up to my wife… she would be seeing the CPM only. My influence so far has been to keep the OB in the picture.
Which also explains why the continued accusations and mischaracterizations of me flying around here (I see you have toned it down) are largely baseless.
Normally, that would just be rude behavior. But coming from a group of supposed skeptics seems particularly questionable.
Many people on this site have tried to be helpful to you, yet here you are again complaining about “mischaracterizations and accusations” from us. One thing about this site, is your comments, opinions and questions won’t be deleted (unless they are racist, or otherwise outrageous and inappropriate) and you won’t be banned. Try challenging someone on a pro-home birth website and you will be kicked off in a New York minute. If you think we are rude and accusatory, and our behavior is “questionable” why do you continue to engage with us?
Because *some* people have been helpful. That’s why.
I’m glad these comments won’t be deleted. They stand for themselves. Go ahead and look and you will find one person after another making sweeping generalizations and assumptions, about who I am and what I believe, and then not even having the decency to apologize when they are shown to be wrong.
You like evidence right? Go ahead and look for yourself. Or else take my word for it, and stop being such an ass about it. Or if you are going to continue being an ass, at least write your name with your posts. That would be a decent thing to do.
O
Well, now you’ve resorted to name-calling. I think DiomedesV was right, quoted from the post:
“I suspect what really gets to you is people who know a hell of a lot more about a subject than you do — and are willing to say so”
Yup- you are right… I sure did. Writing about somebody in the third person, as if they are not there reading the comments is pretty much being an ass. Sorry, I don’t have any case-control studies to back that up… so it’s just my layperson’s opinion. I hope that’s alright to share here.
No, actually that is yet another false assumption from DiomedesV.
I actually like talking to people who know a hell a lot more about a subject than me… so long as they don’t condescend in the process, or become offended if I question them.
So, now I’m saying them directly to you without re-writing them all. I’m with DiomedesV, I’d much rather try to help someone who is interested in availing themselves of the excellent medical care this country offers. It’s too tiring trying to convince people who think otherwise.
No…I think we can say for certain that *none* of your posts will be deleted, Matt. They will be here for everyone to read, for as long as you want. I have spent the past few days reading through them and, indeed, the way this discussion has unfolded has been quite illuminating. Just not in the way you think.
Is she picking the CPM because she wants to try and keep the expenses to a minimum or is she convinced that a natural birth is best? I don’t think anyone is accusing you of anything, although I see why you might think so. When partners don’t agree on the type of healthcare professional and level of care needed, it can be hellish for everyone involved. Personally, I get prickly about guys who insist on natural and home births and who say it’s because of “unnecessary interventions”. I was hired as a doula more than once by couples who read having a doula reduces your chances of interventions. 75% of the time it was pressure from the partner, not the pregnant woman, to avoid these.
I have also seen laboring women be bullied into “toughing it out” at home when they want to transfer to the hospital for pain relief. It cost too much and insurance won’t pay all of it, their partners reminded them. Not to mention the fact that “they will cut you cause they don’t want to be sued”. You haven’t seen a perfectly low risk woman labor within reasonable limits with no complications only to deliver a stillborn because the midwife couldn’t tell she was listening to the mother’s heart rate, not the baby’s. Just yesterday I had to listen to someone call me and tell me that she transferred to the hospital after 40 hours of labor and 8 hours of pushing and insist she was “threatened with a C-section”. Supposedly all is well so she says that it would have been unnecessary to have a section.
Look- I appreciate your comments and attempts to be helpful. You are one of the people who have been helpful to me.
But continuing to deny and/or defend your cohorts’ behaviors here is pointless. Go ahead and look for yourself, and then tell me again that nobody here has been throwing shadows and projections at me.
I have had to defend myself against varied accusations of being one of the “homebirth crowd.” It was declared several times, by several people, that I claimed homebirth was safer then hospital birth. The claims persisted even after I made *crystal clear* that I did not believe it.
There is at least one individual- inaptly named “Guest” who has proceeded to talk about me, as if I am not even in the room reading the comments.
And what is the worst of it all- so far not one person- not a single person here- has stepped up and acknowledged in the *slightest* fashion that anything is amiss with this kind of behavior.
Anyhow… to clear out hopefully the remainder of your fears… it is not me who is insisting on the homebirth. I am fine with a hospital birth with an OB I can trust. Yes, I am concerned about unnecessary interventions, but I feel confident in my ability to navigate those kinds of conversations.
I am most definitely concerned about recommendations for a c-section where the OBs concern about being sued seems to be clouding their judgement about what is best for the patient.
And apparently, Dr. Amy shares these concerns since she wrote about them in her very first post here.
Yes, cost is a concern. But it is not the only concern. She could get a new plan that covers pregnancy and delivery. But for $2500 more a year, she’d still have a $5000 deductible. I’m just not sure if that makes sense to pay $2500 more every year to avoid paying $10,000 more next year.
These are numbers we can work with. We can afford to pay cash at a hospital. Unfortunately, trying to find some reliable information on what it really costs is proving exceedingly difficult.
Yes… adding on procedures that aren’t necessary is not only a health concern, but a money concern. I’m sorry, but I don’t agree that running up hospital bills “just to be safe” makes sense in all cases, at all times. Sorry, I just don’t.
Hi Matt, would you please elaborate on what constitutes “unnecessary interventions” ?
Actually, it might be more instructive if you elaborated.
Here in slide 30 of this CDC presentation:
http://www.iom.edu/~/media/Files/Activity%20Files/Women/BirthSettings/6-MAR-2013/Chervenak%20PDF.pdf
“Obstetricians should learn to avoid unnecessary interventions.”
What do they mean there by “unnecessary interventions”? And why are there obstetricians out there delivering babies who apparently require more instruction on this?
Actually, I am genuinely curious as to what you believe constitutes an unnecessary intervention. I can only speculate as to the authors’ definition since the term doesn’t appear to be defined in your link; since I am not a medical professional, my opinion would not be instructive.
I am taking the word at face value… if there is some specialized definition that is more applicable, maybe somebody here who is qualified to comment can do so.
Okay, but that is at odds with your statement above: “Yes, I am concerned about unnecessary interventions, but I feel confident in my ability to navigate those kinds of conversations.”
So you have already defined or have an acceptable definition of what constitutes unnecessary interventions, to the point where you feel confident to navigate those kinds of conversations…but you cannot or will not define your parameters here?
That is because I am trying to better define the parameters in my mind, not because I have already decided what they are, but don’t want to disclose them.
How can you be confident in your ability to discuss something you have not yet fully defined?
Even if you haven’t fully arrived at your parameters, can you share your criteria?
I will give you an idea as to what I used to believe was an unwarranted intervention — postdates induction. As term pregnancy is generally defined with parameters of 37 to 42 weeks, I held the belief that induction prior to 42 weeks simply because the baby was “overdue” was unnecessary. Additionally, I know many women who’ve gone to 42 weeks and beyond, with good outcomes. I have since revised my opinion on this subject, based on personal experience and the facts on morbidity and mortality.
What I mean is that I feel confident in navigating through an offer for intervention.
My understanding is… an intervention will be offered at the moment that an indication arises.
But that doesn’t necessarily mean that the offered intervention is what that self-same doctor would choose for themselves, in the same circumstances. It just means they are ethically obligated to offer it. The patient can either accept or reject the intervention.
The doctor may or may not agree with the patient’s decision… but the malpractice risk to the doctor of recommending against an intervention, and have things go poorly is a confounding factor that I am not sure many patients realize.
The “sweet spot” so to speak is to be able to navigate in that space between when an intervention is offered because it is simply indicated, and when the doctor truly feels it is the best choice.
Unfortunately, in the context of an impending childbirth, there isn’t much time to hem-and-haw over these things.
What I am attempting to discern between the strength of an indication for intervention… and how to correct for the C.Y.A. factor.
It would be unethical for a doctor to offer only what course of treatment they would prefer for themselves.
Yes, I know. But when I get a recommendation, I would much prefer it to be… this is what I really, truly think is the most beneficial course of action. Not… this is what I am going to recommend because I’m scared you will sue me if I don’t recommend it, and something goes wrong. Do you see?
This is where the relationship you have and build with your care provider comes into play. The problem with OB is that most people go to a practice where they rotate through a few doctors and then are never sure who will be on call for them. In fact, because fatigue and exhaustion can impact decision making, you want the fresh OB to take your case when you go to the hospital. But it does mean that it can be difficult to fashion a relationship with that person.
That is a limitation and I think that is where the allure of CP-midwifery comes into for a lot of people, but you have to understand that conveying a sense of positive certainty is not the same as being right, or showing good judgment. In that sense, I would rather get a few options, followed by my pointed question of “what would you recommend for your daughter…”, for example, than deal with someone who is positively certain of something that they know less about, and whose training is sufficiently deficient that they don’t know what they don’t know.
So how does a woman- with no post-secondary education in science- even attempt to engage an OB with the “right questions” and “build a relationship” over a few awkward 7-10 minute visits, many with her legs spread open?
How exactly is that trust supposed to be built?
You say: “conveying a sense of positive certainty is not the same as being right, or showing good judgment.”
I agree. But isn’t that “sense of positive certainly” exactly what is being asked of the public by the medical system? Shouldn’t we all just “trust the good doctor”… look they have a fancy diploma and work in a big hospital! *wink wink*
Given your previous comments elsewhere, along with the plentiful examples we can think of where MDs acted in poor judgement and/or poor ethics… by what merit does the profession have to command such unquestioning respect from the public?
Or more specifically, why should an Internet passerby happening upon this here rant by a retired OB think to themselves, “Oh yes, this looks like a highly credible individual whose opinion I should accept without questioning ?”
First, no one here has said that doctors should command unquestioning respect from the public. And no one has suggested that anyone take Dr. Tuteur position without questioning. You questioned… but ineffectively. You didn’t challenge the content, just her right to an opinion.
I believe there are resources where patients can learn how to ask their doctors questions and build a relationship. Probably other people who practice can suggest some.
Second, how let me flip that around: “how does a woman with no post-secondary education in science decide that she can trust the clinical judgment of a practitioner that refuses to get the minimum level training required of midwives in all other developed countries”?
Finally, yes relationship is important and making your concerns known is important and getting a second opinion, blah blah blah…. but we’re talking about two choices here, and one is associated with starkly worse morbility and mortality outcomes for babies. Not sort of worse… much, much worse. Levels of mortality and morbidity worse than other stats that are sources of concern in other countries. Of course, if neonatal morbidity and mortality are not your only outcomes of interest then I guess you’ll just have to decide where they weigh in the grand scheme of things.
Honestly the vast majority of women in the US are satisfied with their OB care and their experiences in the hospital. Even Lamaze International has had to admit that. And yet, the vast majority of them also have no post-secondary education in science. How do you think they manage it? Are you implying that a doctor can’t care well for someone who isn’t constantly checking their work?
But you think that just anyone is qualified to choose a competent CPM?
If your doctor does not inspire trust, switch doctors. Anyone knows if they dislike someone. It doesn’t take a post secondary science degree to know that.
See another doctor. Any doctor. You may not get the very bestest most perfectest doctor this way, but the odds are overwhelming (not certain) that you will get good-enough care.
If you see a CPM in the US, no matter how nice she is the odds are overwhelming that you will get bad care. You will probably still have a healthy baby, but not because of the CPM. She simply does not have the experience, training or resources to provide good care. She just can’t.
Please explain why you believe that a suggested form of treatment is offered more to avoid being sued then because it IS the best course of treatment. It’s always the choice of the patient to refuse treatment, as long as they understand what can happen if they do. So when a doctor “plays the dead baby card”, it’s to let you know that refusing the treatment might result in the death of your baby. Or injury that will leave them profoundly disabled. It might seem like they are just trying to cover their behinds, but it’s about treating women and their partners like adults who can comprehend the domino effect their choice to refuse can cause.
And if the OB doesn’t recommend it, and something DOES go wrong, and the child dies or is profoundly damaged…isn’t that a worse outcome than, say, having to get an IV? Having to do continuous monitoring? Having the labor augmented? I don’t know what specific recommendations you are scared of, or that you think the docs will recommend for no good reason. But just think about WHY people sue health care providers. It’s because something bad happened, right? So just maybe, what a doctor recommends to you is what he/she feels is likely to lead to the best possible outcome.
No, I don’t see.
If my doctor is trying to keep my baby alive and healthy on the most dangerous day of its life, and is therefore very risk-averse … well yay, because our priorities are aligned.
If you care more about some other outcome than a living and healthy baby, then you will not be nearly so risk-averse. You need to communicate your priorities clearly.
“I want to have twenty kids, so it’s more important to me to keep my uterus unscarred for future childbearing than to keep this particular child alive. Do what you need to do, but no c-sections.” The doctor can document the conversation in your file.
No, I don’t see. Bombshellrisa points out that the OB has an ethical obligation to offer patients a range of choices so that the patient can make the choices most aligned with her own priorities. Doctors offer pain relief because that’s what they would want for themselves and it’s what most patients want, but if a patient declines it that’s fine too.
You say you agree, but then you say you believe that doctors secretly know what is best but are refusing to tell you and that you have to guess. So you would be happier if doctors did not offer choices, but required all their patients to have epidurals because that’s what they would want? Or something?
No, I really don’t see. Are you aware that OBs are the group most likely to deliver their own babies by maternal request c-section? If your own OB delivered her children by c-section at Week 39 because she believed
… because based on her knowledge and experience that’s what offers the best outcome for both baby and mother, do you think she should then tell all her patients to do the same? Or do you think she should lay out the risks and benefits of different options and let her patients choose what suits them best?
Your OB is not going to suggest something bad or dangerous. If it’s offered as an option then it’s perfectly reasonable to accept. If it sounds terrible, say that it sounds terrible and ask why they are offering. They will explain.
I really don’t see the guessing game you think you are playing.
You can talk to your doctor about your concerns before hand. Mention your desire to avoid a C-section, if that’s important to you. Mention that no matter what happens, establishing breastfeeding immediately is important to you, if it is (I really have no idea, and I don’t care, remember? 😉 ). It’s always better to be upfront about your concerns and keep engaged in a dialogue than to stew about the lack of communication while not doing something about it…. see what I’m saying?
Yes, that’s why people keep pressing you for specifics. Not to accuse you but so that you’ll look more closely.
Lots of things feel self-evident but when we think about them carefully they aren’t, and then the whole conversation changes.
Sometimes I wish informed consent showed a video of a shoulder dystocia, a true resuscitation and what a PPH looks like.
Because at this point, we could argue that just seeking care during pregnancy is an unnecessary intervention if everything turns out well in the end. Isn’t that how it’s always diagnosed? Since nothing ended up being wrong, it was unnecessary? I could argue the antibiotics I got during labor were technically not necessary, since my GBS status was not known.
What does the CDC mean? Do they define it? If they don’t, is the presentation meaningful?
Matt, I could almost feel sorry for you.
You came here loaded for bear, prepared to argue with professionals based on what you had learned from the echo chamber that is the world of natural childbirth, which I’ve described elsewhere as an alternative world of internal legitimacy (http://www.skepticalob.com/2012/04/alternate-world-of-internal-legitimacy.html). You came with the intention of schooling us and you came thoroughly close-minded with the intention of proving the correctness of your beliefs.
You’ve had your head handed to you on a platter. On the one hand, you are to be commended because you’ve have stuck with it. On the other hand, it seems that you have stuck with it because you don’t truly understand what is being said to you.
As I told you before, you have no idea what you are talking about and no intention of learning about your deficiencies. You are committed to homebirth despite arrangements that ring all sorts of alarm bells.
If you truly wanted to learn you would have come to one obvious conclusion right away: you’ve been bamboozled by natural childbirth advocates, who make their money by preying on people like you. You would have realized that there are gaps in your knowledge wide enough to drive a tank through and you would have asked yourself why, in all your reading on homebirth, you never came in contact with that information. But instead, you are still desperate to confirm what you already believe about the “safety” of homebirth.
I wish your wife luck with the homebirth. If anything goes wrong, she’s going to need it since the uneducated clown whom you hired is certainly not going to be able to prevent or treat a real disaster. You are gambling your baby’s life, and fortunately the odds are in your favor. But if everything turns out okay, it doesn’t make you smart; it makes you lucky in the exact same way that someone who drives drunk and doesn’t kill himself or others is lucky.
Ask yourself, Matt, is there anyone who claims homebirth is safe who doesn’t profit from it in some way, either monetarily or by bragging of their own superiority. If the answer is no, and it is, give serious thought to the idea that you are being bamboozled and your baby may pay the price.
It is truly astounding to me how many times on your comment above you can continue to tell me:
1. What I already knew (or thought I knew) coming here.
2. What my intentions were.
3. How close-minded I am.
4. That I now- or ever did- believe that homebirth is safer.
5. What my desired outcome from this experience is, and my level of “desperation” for it to be a certain way.
You keep making these claims… and no amount of evidence or experience to the contrary seems to cause you to question your assumptions. Instead, you just keep digging your heels in!
Apparently, you are unwilling or incapable of seeing how similar this behavior is to those behaviors among the homebirth advocates that you are apparently railing against.
Do you really think I would continue to persist in denying these kinds of allegations if they were actually true? What would I possibly have to gain from that?
The reason I persist is because: 1. A small minority of the commenters here have actually been helpful, and 2. The hope that you might actually reflect upon your so-called writing “style” and if it is truly resulting in the outcome you are seeking with this blog.
QED.
QED indeed. Actually, I already read those posts, but that was after this one. I don’t have any argument against them. But I suspect you will find some way to take whatever I say and twist it to conform with your preconceived notions about me.
Again… I didn’t know anything about the film before I saw it. I wasn’t fed any propaganda about it. I just watched it.
I watched it in the same manner that I watch most documentaries… it went something like this…
blah blah blah… Dr. Blaser… blah blah blah… Dr. Dietart… blah blah blah Dr. Modi.
I never cared about the “agenda” behind the the film… I knew nothing about the filmmakers when coming to this blog.
In fact- I came to this blog because I had searched for “microbirth” to learn more about the background to the film, and it came up high in the search results.
What I *thought* I might encounter in this post was a bona fide skeptical view of the ideas presented by the researchers interviewed in the film.
What I *found* was a rant against exaggerated claims made by advocates of the film of what those researchers said. But you see… I don’t care what “advocates” have to say about the film… I only care about what the researchers actually said.
Anyway.. I will try to wrap up my side discussions with the people in this thread who were actually *helpful* to me, and leave you and your followers to attend to your metaphorical beheadings.
http://www.skepticalob.com/2014/09/microbirth-an-object-lesson-in-the-ignorance-gullibility-and-desperation-of-natural-childbirth-advocates.html
http://www.skepticalob.com/2014/09/microbirth-doctors-present-at-medical-conferences-natural-childbirth-advocates-make-a-movie.html
I am not talking to them, I am talking to YOU. I don’t have to take any notice of or responsibility for anyone else commenting here.
I read your comment about the child with allergies that you believe had something to do with their c-section birth and the fact that they were not breastfed. I read that you are concerned about tests and procedures being done that are absolutely necessary. It doesn’t make me believe that you don’t understand that there isn’t some risk to the path you and your wife are choosing, it’s that it seems that you are more concerned about interventions and c-sections being done with an absolute, 100% guarantee that it’s necessary.
As for the money part, I have been dirt poor and on Medicaid and privileged with a great insurance plan. I urge you to see what is available through the state. You can even apply after the baby is born, because if you are approved the start date will be from the time pregnancy was confirmed and everything is covered from that date. It didn’t seem reasonable to shell out $400 (what we were responsible for) for a free fetal cell test to rule out a condition I only had a 1:392 risk of having but when you realize your child’s future (and your own) hinges on knowing so you have a plan in place, it’s a price you will pay.
Because the CPM cannot order and/or perform the tests to maintain continued assurance she is low risk.
“I would suggest: How about a guide as to how to avoid over-medicalization and unjustified interventions in a hospital setting?”
For whom? Providers or consumers? When I had complications in my pregnancy I looked through the recent ACOG guidelines regarding gestational hypertension/pre-eclampsia and to me (as a consumer, not provider) I thought it was very helpful that they laid out the best approaches based on certain criteria, as well as the level of evidence supporting those approaches. To me, that’s exactly what you seem to be asking for, and its accessible to both providers and consumers to see what the decision making basis is for this set of conditions.
The problem is, when you get into some groups that complain about “medicalized” birth, they do not turn to ACOG & obstetric science as a guide. Just going to a medical authority for advice medicalizes birth in some way. Cynicism about hospitals and the claims that hospitals and docs are doing nothing to reduce unnecessary procedures doesn’t meant that’s actually true.
“The CPM we talked to wasn’t derogatory toward hospital birth. She didn’t insinuate it was a risk-free scenario.”
If you make this statement to point out why your CPM’s approach was right, and Dr. Amy’s is wrong, that kind of fallacious tone argument doesn’t really mean anything.
It doesn’t change the fact that preventable infant and even maternal deaths occur in the unregulated homebirth midwife industries in the US and elsewhere. It doesn’t change the fact that these deaths often occur with no retribution, very little proper investigation and that CPMs and their organizations often rally around the “persecuted” midwives whose clients have died and charges actually have been brought against them.
Just to add my own anecdote, my HB midwife also never spoke about hospitals in a derogatory way during my prenatal care. No, no, no, she thought hospitals were wonderful. She had given birth in hospitals. She knew ob’s that she loved and all of that.
But when I actually ended up in the hospital because she didn’t take my labor signs seriously and didn’t show up, she told me over the phone “I thought you wanted a homebirth. Now that you’re at the hospital, they’re going to want to cut you.” Wonderful thing to tell a first time mom who is already terrified of hospitals, right?
I’m sorry, but a little bit of justified outrage on Dr. Amy’s *blog* is a lot better than a CPM who, in the course of her professional practice, lies about her relationship with doctors and hospitals, shirks her duties and then turns around and attacks her client(s) in their most vulnerable moments.
Then you must really hate Orac’s blog, huh? I suspect what really gets to you is people who know a hell of a lot more about a subject than you do — and are willing to say so.
Dr. Tuteur is not a practicing medical professional. And her tone gets results. I’d suggest that it’s one of the reasons you’re still here.
Finally, you overestimate my interest in your personal life, your reasons for choosing homebirth, or even the outcome. Many of the commenters here care about people like you. I don’t. I don’t waste a lot of time worrying about the tiny percentage of people who are willing to reject excellent medical care on the off-chance that the worst possible outcome won’t happen to them. I’m here because I don’t like to see the creep of this garbage into the level of care that’s offered to the overwhelming majority of women in this country– women who don’t think an otherwise perfect vaginal birth is a reasonable trade-off for a dead baby.
LOL- Really DiomedesV if you don’t care about me or my personal life, that is totally fine with me. But then why continue to make characterizations about me?
I notice a few people here claiming that Dr. Tuteur’s tone is successful at achieving her aims. But all I see is a couple of anecdotes. Does anybody have any evidence to suggest that speaking to people in this way is actually more effective than using a more civil tone? Do we really know that the benefit outweighs the risks?
Or do we keep just rallying around a pathological behavior because we want to reinforce our preconceived notions about how we should be treating people?
You know… some years ago I was on the other side of this kind of situation. I was one of the ones attacking and justifying my behavior publicly to others. When somebody suggested that I and others were actually just being bullies, I got really pissed and defensive too.
Do you know why I was so pissed and defensive about it? Because he was right.
So anyway, thanks for the conversation. You are one of a small handful of people here who have actually been helpful.
Your calm explanation of facts, willingness to consider my questions, and to behave differently from the rest of the herd is why I’m still here. So just in case you really -do- care just a teensy weensy bit, thank you.
No… let’s see here are the stats:
Total Births Attended as Midwife: 419
1st time mothers: 86 Repeat mothers: 333
Reasons for Transport of Referred Care (54)
No progress in labor (25)
Non-reassuring fetal heart rate in 1st or 2nd stage (11)
Preterm births (3)
Requested medication (3)
Posdates w/ non-reassuring heart tones (2)
Pre-eclampsia developed at term (2)
2nd degree tear for suturing (4)
Placenta covering cervix (2)
Retained placenta (2)
Reasons for c-sections (19)
Mal-presentation with big baby (9)
Malformed uterus (3)
Cord issues (4)
Acute toxemia (1)
Placenta previa (2)
Newborn deaths (1)- 3 days of age with congenital heart and lung defects
Maternal deaths (1)- 33 weeks pregnant with PE
419 births over how many years?
11. With an additional 102 in 3 years as an apprentice/assistant to another midwife, and 87 in 13 years as a doula (the timeframe overlaps with her midwife experience.)
Ok-so broken down that is about 38 births a year, 3 a month. Remember how you asked why I felt that it’s more likely a CPM would miss signs and symptoms during labor? It’s numbers like that.
What sort of numbers would you prefer to see? And why?
A hospital midwife or obstetrician attends several births a week. And one maternal death out of less than 500 patients is shocking! The national average is one death in 10,000. One death out of 500 babies WITH preemies all risked out is pretty scary, too. The overall neonatal death rate is about 1 in 500, but 2/3 of those are caused by complications of prematurity.
Like most home birth midwives, she’s attending the healthiest of women and getting terrible outcomes.
An average OB will deliver (on the low end) about 250 babies a year, about 20 a month. This doesn’t include the hospitalist OBs who only deliver babies (they work in L&D exclusively) so their numbers will be different. It’s about keeping up your skill, keeping yourself sharp so you can spot things before they become crisis situations.
As others have mentioned, the numbers suggest this midwife doesn’t risk out women from her care.
If I understand the terminology you are using correctly… she “risked out” 53/419, or 12.6% You are saying it should be higher? Such as what number?
Let’s leave the numbers out of it for a minute. She didn’t transfer care for women who needed a higher level of care than what she could give. Heart and lung defects? Something that is looked for at the 20 week ultrasound and if they are found, another more detailed ultrasound is done and then you consult with a mfm and they will usually be consulting along with a high risk OB for the rest of the pregnancy. Not a midwife. Placenta previa is always looked for at the 20 week ultrasound, also something an OB is consulted for. Same with a woman who has a bicornate uterus, even though I know a lot of CPMs will still care these women.
40% for first-time mothers. 25% for second or subsequent births if the first birth and pregnancy had no complications.
Wow, substantially worse than average for neonatal death rates, and extremely bad for maternal death rate. Proper prenatal care can identify many women at risk for PE and prevent clots by proper anticoagulation. I also note that she does not mention the outcome of the baby of the woman who died of PE. Likely it was death. Why doesn’t she report that in her stats too?
These are really bad numbers, and especially sad because her CS rate is not much below what you would expect for a population of mostly multips. A low risk multip has only about a 5% chance of having a CS in subsequent pregnancies. So you put yourself and your baby at very high risk of a bad outcome, and what does it get you in return? Not much.
Omg I just saw the infant death from congenital heart and lung defects-which should have been diagnosed during the anatomy scan, right? Which means a maternal fetal med should have been caring for this woman, not a CPM
When did she actually refer patients? That is a huge issue, particularly in regards to post dates, placenta previa, and pre-eclampsia. Finding out how quickly she realized there was a problem is key here.
I don’t know. I’m not sure how to ask without going through every single case and making a distribution graph… LOL Any suggestions?
Pre-eclampsia: “So if my wife’s blood pressure starts to spike, do you want us to see the OB for blood work and a consult?”
You mentioned she was comfortable with going ten days past the due date, after that, ask her if she transfers care to an OB for a non stress test and consult about inducing. Does she suggest drinking raspberry leaf tea, using evening primrose oil, blue or black cohosh or castor oil to do a “natural induction”? It’s worth asking about
Between 5% and 10% of pregnant women in North America and Western Europe develop preeclampsia or eclampsia. Still, women in these countries have access to adequate care so only about 1 in 100,000 of them die of it. Your CPM clearly was either very, very, very unlucky or… offered inadequate care.
Your wife wants to bet her life that your CPM just had very, very, very bad luck?
Did you expect a warm welcome and a walk on a carpet of roses when you came in with “fists flying”?
Just looked at the paper…
Isn’t the absolute risk reported in Table 2? They may not have chosen to report one absolute risk because they look to have had two low-risk hospital birth cohorts, those attended by OBs and those attended by hospital midwives. Looks like the absolute risk in the hospital for a low risk birth attended by an OB (which is a larger population and thus more reflective of care in the US) is 0.16/1000. The absolute risk for a homebirth for all groups attended by CPM is 1.63/1000. (Per 1000 is typical reporting for risk in medical contexts.)
It’s interesting, too, that the absolute risk for patients treated by OBs doesn’t seem to change by parity or other subgroup, which implies to me that overall, babies delivered in the hospital in the US have access to the best care possible when it comes to resuscitation. For babies born anywhere else, it’s basically a crap shoot.
The risk of neonatal death for hospital born babies doesn’t vary by parity. It does vary enormously by gestational age, size of course, and, to a lesser extent, by race, maternal age and maternal marital status.
With out-of-hospital birth, parity is a HUGE risk factor for neonatal deaths, and if you break it out by cause, most of the excess is labor complications.
So do the risks reported in this paper lump death and brain injury together? I’ve never been quite certain on that score.
That’s a good question… and then what about the outcomes? How many of the babies that are resuscitated get discharged with a clean bill of heath? How many of them end up dying in the NICU or within the first year of life?
I don’t know (and other people here do), but I do know that, per the Grunebaum paper, if a baby is born with an APGAR of 0 far from qualified personnel to resuscitate him/her, their prognosis is as grim as it can possibly be. I guess if a parent doesn’t want to deal with an injured baby at all though, maybe that suits them.
By contrast, as an example, I heard a few days ago of a term baby born in hospital with APGAR of 1 (VBAC uterine rupture, placental abruption, C-section within 5 minutes, so 5 minutes without oxygen). Worked on by nurses and neonatologist, APGAR increased to 6 after 5 minutes. Placed immediately in cooling treatment, after three days was nursing and in another day was discharged after a “normal” MRI (I say that because it is impossible to rule out long term effects, even if the MRI looks normal). That is the best-case scenario for a situation like that. That will never happen to a homebirth baby. Ever.
You are right. Even if the midwife is NRP certified, she still doesn’t have the additional people, equipment or drugs to effectively perform a complete resuscitation.
There are several different papers. Some report on neonatal death, some report on Apgar 0, one studied the incidence of brain injury severe enough to require cooling therapy.
But what is the difference in risk between babies of normal size and gestational age?
It is the difference reported in Table 2. From the Materials and Methods: “This study therefore includes only singleton term births (deliveries ≥37 weeks) and infants weighing ≥2500 g.”
You’ve also made a big deal about risk, relative risk, and absolute risk. But of course, risk and its increase is not the only thing you need to know. You need to know the severity of the outcome that is being risked. These are RR and AR reported for truly terrible outcomes. If this is your first baby, your AR for APGAR of 0 (not death, that’s something different) looks like it is somewhere between 2.40-19.96/1000 (taking the lower and upper bounds of the CI reported for first time moms).
*Edited to correct AR.
Yes, of course you are right. I understand that… just trying to construct information piece by piece. Obviously… death or severe disability of the baby weighs differently than the risks of c-section.
The range you calculated spans nearly an order of magnitude. That causes me to wonder how meaningful that particular result is.
Also, am I correct in assuming that is among a general population? Are there known subpopulations with lower risk profiles?
The reason the range is so large is because 1) the numbers of patients are small, and 2) homebirth midwives cannot be relied upon to report their outcomes accurately. In fact, we know from other publications that CPMs routinely inflate their APGAR scores. The fact that they’ve reported an APGAR of 0 at all should actually impress you. And you have no reason not to incorporate the upper range of that estimate in your calculations of whether this is a reasonable risk. In fact, based on their tendency to assign APGARs of 10 when it is clearly unwarranted, the actual risk may even be higher.
I didn’t assume you were scientifically illiterate. I assumed you were intellectually lazy. More specifically, I assumed you had staked out an opinion on a subject on which you knew little and were desperately trying to justify your position without actually, honestly re-examining it.
At the time you just looked like another gullible person persuaded by a documentary. But in fact, YOU scheduled a homebirth BEFORE you could even be bothered to look up, for yourself, the absolute risk involved. Then you came charging in here accusing Grunebaum et al. of obscuring the issue by not reporting something which I located in 2 minutes by scanning for the appropriate table.
I’d say my assumption was correct.
Well, your assumption was actually not correct.
I had not staked out an opinion on the impact of mode of delivery on the microbiome and long-term health consequences. That information is not anywhere close to being known yet.
I was thrown by Dr. Amy’s claim that there is *NO* evidence to support a meaningful connection, when there is in fact evidence. I’m not sure what your standard of intellectual laziness is, but if it means not reading and analyzing every potentially relevant study from cover to cover before I engage in a conversation about it… then I think that is a little over the top! 😉
Somebody- I think it may have been you- made an argument for why a physician or scientist is within their right to say there is “no” evidence when they actually mean there is no convincing evidence, or some such other thing.
Personally, I would call THAT intellectually lazy. It is speaking in absolutes, when the reality is not as black or white.
I have not staked out a final opinion on the impact of mode of delivery on the microbiome, either. When I see convincing evidence for it, I will change my mind.
On the other hand, I didn’t make a choice about place of delivery without looking up the risk, or almost coming out and accusing researchers (Grunebaum) who know a hell of a lot more about that subject than I do of practically misleading people by hiding a piece of information that was included in Table 2 of their paper.
The remainder of your assumption is not correct either. Firstly- I did not make a choice about place of delivery. I am a man. Secondly- I did already know about the neonatal mortality risk data long before I ever came here.
Thirdly… my apologies to Grunebaum but I didn’t see that Table 2. Whatever it was that I looked at had a Table 2… but that wasn’t it. So that is why I asked about it. I would hardly escalate that post to an accusation.
Grunebaum excluded, I still think it is intellectually dishonest of anybody… media, doctors, family and friends, etc. from spouting off alarming sounding relative risk data…. THREE TIMES! FOUR TIMES! TEN TIMES THE RISK! without concurrently mentioning absolute risk.
It happens all the time… you might not see it because you are a scientist and presumably mostly conversing with other scientists.
It’s kind of like… WHAT?! You’re going to jump out of an airplane?! Don’t you know that you are a bagillion times more likely to die from from skydiving, if you actually jump?!
It’s sort of silly… and personally I don’t find that conversation productive for anybody involved.
Fair enough, although presumably a man has some influence over place of delivery.
I agree that the media is egregiously terrible about this and it’s one of my pet peeves. In fact, the world peeve is an underestimate. Fellow scientists specialize more in presenting results to media and often come to me for examples of poor presentation. I never have a shortage.
No convincing evidence *is* no evidence.
As several people have explained, there are hypotheses flying around but there is no evidence they are correct. The hypothesis that c-section will damage humankind (or an individual) forever has exactly as much evidence as the hypotheses that it will improve humankind forever or that it will have no effect. That is, none. If you think there is microbiome-based evidence that a c-section will permanently harm your child, why don’t you think that there is microbiome-based evidence that it will permanently benefit your child? Why isn’t your wife talking to her OB about the possibility of a maternal-request c-section to assure your child the permanent benefits of the superior microbiome associated with c-section?
Finally,
You’re right, I should have started by saying, “In my opinion”. Gee Matt, your wife is seeing a CPM and you are planning a home birth. It doesn’t take a brain surgeon to conclude you are supportive of home birth. Since you have posted statistics indicating home birth is NOT safer and you stated you already knew this, why are you planning one? If you and your wife are questioning your decision, good for you and I truly hope for her sake and the sake of your baby you decide on a hospital birth.
“But where does that lead? I mean… why not just run all sorts of genetic tests while a baby is still in the womb and initiate treatment then?”
Genetic screening using free fetal cells can be done, depending on the test, from 8 weeks on. Just draw up a couple tubes of the mother’s blood and It can be screened for things like trisomy 21 and Edwards syndrome. Depending on a family’s medical history, there are lots of other things they can look for. It’s being offered by more and more doctors.
Matt, any time a patient presents with any problem there is a list of tests and treatments that may be “indicated”. Only once we have a diagnosis or outcome can we truly know which were “necessary”. You want all doctors to be omnipotent and know beforehand precisely which tests and treatments are “necessary” for every single woman and that’s not possible. Yes, unnecessary testing and procedures happen. Every day. But that doesn’t mean they were not indicated.
I agree that it’s unethical to impose ones own value equation upon another. Unfortunately, midwives have no issue with this, and in fact proved it by writing a book entitled “From Calling to Courtroom”. You see, they value above all else their “calling” and should a baby or mother be seriously injured or die in their care, you will see what they value is being able to slither away from taking any responsibility for what they have done. Some of the midwives who are mentioned have had multiple babies die with them as the midwife. All they value is being able to keep catching babies, even if they clearly should not be doing so. http://www.fromcallingtocourtroom.net
Keep in mind that in countries with very different healthcare systems, the c-section rate isn’t a whole lot lower. You want a rate below 20%, you’ve got to look at a country where a lot of people don’t have any access to healthcare.
What about countries that are much higher?
http://www.npr.org/2013/05/12/182915406/c-sections-deliver-cachet-for-wealthy-brazilian-women
“Brazil has one of the world’s highest rates of cesarean deliveries: Some
80 to 90 percent of women in private hospitals in the country give
birth via cesarean section. In some hospitals that number climbs to 99
percent.”
What do you think about that statistic? Is that fine with you? Why or why not?
And what about this comment from the WHO:
“he World Health Organization says more than 15 percent of women giving birth by C-section is too many. It cites increased medical costs and neonatal complications as potential problems.”
Neonatal complications from c-section… but I thought it was totally safe!
Most of Brazil’s c-sections are not medically necessary, and no one claims they are. It’s a cultural difference there, that women and doctors prefer cesarean birth.
And that 15% only applies to countries without the resources we have. In India, for example, when a woman delivers by c-section, she may be forced to deliver her next baby without any real help, which is very dangerous. Here, we can provide a safe repeat c-section or carefully monitored trial of labor the next time.
What about the neonatal complications from c-section. What are they? What is the incidence of these?
Isn’t there something wrong with performing- or allowing- unnecessary medical procedures when there is a known risk?
Why does this happen in Brazil and not here? Why do doctors “prefer” cesarean birth?
If a woman is only having 1-2 children, scheduled c-section and planned vaginal birth are approximately equal in risk for both mother and child.
Scheduled c-section is associated with a much LOWER rate of neonatal complications (and especially serious complications) than is attempted vaginal birth. The only complication that occurs at a higher rate in the c-section babies is something called transient tachypnea of the newborn.
I would LOVE it if you wanted to learn more about these topics. It’s complicated, and it’s going to take a while, but don’t be afraid to dive in.
I would be more than happy to learn more, and I’m certainly not afraid to dive in. I do have a college education. (Not that anybody asked.) Please post any resources you might suggest. Even a textbook would be fine with me.
For some reason- which I can partially understand- people keep attempting to characterize me a certain way, and launch strawman arguments against things I did not, in fact say.
I actually came to this site hoping to find some useful information… but so far most of what I’ve encountered is derision, ridicule, and fear… and the blog author apparently thinks this is appropriate behavior to model on her site, and condone among her readers.
Realize that a huge percentage of the posters here are actual obstetricians, midwives and nurses, and that some of what you are saying comes across in an unfortunately arrogant sort of way.
Reading some of the posts here, and their sources, is actually a good place to start. Most of the books I can think of either presume a huge level of existing knowledge or don’t go into nearly enough depth. Anyone else want to chime in with some recommended books?
Thanks for the suggestions.
But I think you are still *somehow* missing the entire fulcrum of my presence here.
Let me spell it out for you. I googled “microbirth” and this site came up almost near the top.
I clicked on it, and was shocked, amazed, and surprised to find a *****medical doctor**** RANTING IN ALL CAPS with a clearly derisive and derogatory tone, and a bunch of followers who seem to think THAT’S AWESOME!!
I will give you that “some of what [I am] saying comes across in an unfortunately arrogant way.”
But EVERYTHING that Dr. Amy says in her post comes off in an arrogant and derogatory way.
Why is that OK with you?
That’s Dr Amy’s way of being heard. Because nice bloggers do not get a tenth of the attention she’s getting and their message remains unheard.
Her tone is totally OK with us because this isn’t a blog devoted to microbiology, it’s a blog about homebirth and it seems that being nice doesn’t help with the nutjobs.
Why is Dr Amy’s tone not OK with you while Hannah Dahlen’s claim that perinatal mortality is a limited view of safety is totally OK? How can you have any respect for the people who used such a woman to help them with Microbirth?
But if that is *my* way of being heard… then that’s a problem? *huh*
Seriously, I hate to break it to you, but I think if you guys (and ladies) believe you have any sort of chance at helping change the minds of nutjobs… and more over you believe in your heart of hearts that fear, ridicule, shame, and derision is ACTUALLY going to accomplish that… then you are the bigger nutjobs.
I hate to break it to you but we’ve changed the mind of more than one fence-sitter… it isn’t the nutjobs we’re targeting.
And since you’re advocating against preventive obstetric interventions, aka you’re advocating the preventable death and injury of children for the sake of minor risks to the mother, yes, it is a problem.
Why don’t you go and tell this mother how great it was that her hospital was so aiming to save her a procedure that she did not need that it chose inaction at the first sign of something abnormal happening?
http://www.skepticalob.com/2012/03/cascade-of-non-intervention-emilys.html
I haven’t “advocated” for anything. Why do you keep putting words in my mouth?
Seriously… are you people crazy? You’re health professionals?
I thought you wanted to be “heard”? Now it looks like you have nothing meaningful to say?
Yes, we’re crazy. Wanting to prevent unnecessary death and brain damage. Crazy, I’m telling you!
Lucky us, we have the sane man Matt to keep the situation under control. Hurry, fellow crazies, let’s sing His praises!
You seriously can’t help but throw projections out, can you? It’s OK. You probably can’t help it.
Don’t worry. I’ll be gone from here soon, and then you, your web friends, and Dr. Amy can go back to shaming and deriding people into making the “right choice.”
Bye, Matt. It was nice chatting with you. We’ve been missing some tone trolls who trot out MANA’s lies about informed choice and how we hate it and throw in some “unneeded interventions!” for good measure. It’s always refreshing to see people caring about the lofty future and taxes of humanity in general since our small brains prefer to minimize the possibility of a current damage.
That’s why I stopped responding to him. He’s looking for a fight and he sounds like he’s trying desperately to justify to himself why his wife should have a home birth.
Matt, you aren’t fooling anyone. Over the last few days you have managed to raise all the usual NCB myths (and been shot down every time).
Worked for me.
I had my first child at home, my second was a homebirth transfer. I was WAY deep in the homebirth woo for a while there.
After reading this blog and the studies linked here, I will NEVER risk my child’s life at homebirth again. It’s way too risky.
Dr. Amy is “meen” but so are homebirth/NCB advocates that call all OBs evil, cut-happy doctors.
http://www.skepticalob.com/2014/02/oooh-dr-amy-is-meen.html
Eh, she helped to change the mind of this nutjob.
“Why is Dr Amy’s tone not OK with you while Hannah Dahlen’s claim that
perinatal mortality is a limited view of safety is totally OK? How can
you have any respect for the people who used such a woman to help them
with Microbirth?”
I never said I agree with her view. Did I?
“Isn’t there something wrong with performing- or allowing- unnecessary medical procedures when there is a known risk?”
Do you have the same level of indignation toward all elective plastic surgery? Or is it a woman’s right to do with her own body as she sees fit?
If I want a nose job, I should be able to get one. Period. If I want a C-section rather than a vaginal birth, no one (especially someone on the internet with no knowledge of my personal or medical history) should be able to deny me that.
But if a woman wants a homebirth, rather than a hospital birth… what about that? She should be denied that?
Who’s denying any woman the right to give birth at home attended by whomever she chooses? No one.
But I thought they didn’t have a right to give birth at home..? Didn’t you say that? Or did I misunderstand you?
“…there is no legal or ethical right to have a homebirth”
http://www.skepticalob.com/2012/09/human-rights-in-childbirth-does-the-baby-have-any.html
Anyway. I’m willing to start over with you, if you are willing to accept that I am not a “homebirth advocate.”
I am a husband whose wife wants to have a homebirth. I’ve made sure she knows about the risks.. both relative and absolute. She still wants to have a homebirth.
Let me tell you about our experience thus far.
First… my wife went looking for a midwife. She wanted to have a midwife with the highest level of training and experience possible… which we understand to be a Certified Nurse Midwife.
What we learned (and please correct me if it is wrong) is that a CNM is not *allowed* to participate in a homebirth. Therefore, we went for the next best thing… a Certified Professional Midwife.
My wife searched for all the CPMs in the area. She researched all of them, and selected the one with the most experience. We actually interviewed another one who was very nice, but who hadn’t attended enough homebirths for my wife’s comfort level.
The CPM we selected fully disclosed all of her statistics, experience, and education. She did not intimate that homebirth was safer than hospital birth.
My wife wants to have a homebirth, so long as there is no medical reason to have a hospital birth. By medical reason, I mean gestational diabetes, pre-eclampsia, etc. We aren’t considering an “unproven uterus” to be a medical reason, though I understand you might.
Now since the CPM does not have the equipment to do all the necessary evaluations… blood tests, ultrasound, etc. to establish if there is a “medical reason” we decided that it would be best to be co-managed by our OB.
We thought it would be a good idea to have him concurrently running the tests, performing the exams, etc., to make sure that everything is looking good.
Unfortunately- when my wife told the OB that she wanted to attempt a homebirth, he told us that he could be dropped from his malpractice insurance if he knew about it.
Therefore… he could continue to see her, but only if we “pretended” that we were going to have a hospital birth right up until labor begins.
So this is the system we are contending with. Maybe it is different in other states… I dunno.
But that sounds pretty back-asswards to me. Here we have a woman who wants to attempt a homebirth, but get the highest standard of care available within the context of a homebirth.
Unfortunately, she found out that she does not have access to that care. It is denied to her because… why? I guess I don’t know. Why don’t you tell me?
Sorry… a correction… apparently it *is* legal for a CNM to practice OOH in Michigan… just very rare to find. I just looked again, and like this blogger here… couldn’t find a CNM who does homebirth anywhere nearby.
“If I could have hired a certified nurse-midwife (CNM) to
attend my home birth, I think would have. It is legal in my state for CNMs to
practice out-of-hospital, it is just very rare. It is also legal in the nearby neighboring
state for CNMs to practice out-of-hospital. Again, it is very rare. There was
no CNM practice providing home birth services within a hundred of miles of me.”
http://safermidwiferyformichigan.blogspot.com/2012/08/home-birth-story-women-deserve-not-to.html
And why do you think that is?
Here is the conundrum that I have never understood:
Doctors and CNMs, those who are best educated and most experienced in delivering babies, won’t do homebirths because they feel that they are too dangerous, whether it is due to their experience or due to the fact that insurers won’t do cover them.***
Therefore, the solution is to use the services of someone less qualified?
That makes no sense.
It’s like calling a bunch of licensed, bonded and insured electricians to your house to have them do some rewiring for your project. They all tell you, no, I can’t do that, it creates too big of a fire risk. So after all the electricians tell you they won’t do it, you call your neighbor’s brother-in-law, who’s not really an electrician but has installed a couple of ceiling fans in his house. He’ll agree to do it.
That’s just stupid. But that is exactly what you are doing. Real, qualified professionals are telling you that they won’t do this because it is too dangerous, so your solution is to let someone less qualified do it instead.
***Remember that insurance companies don’t give a rat’s ass about the morality of anything, what they worry about is how much it is going to cost them. If the insurance company won’t cover it, it’s because they have determined that the risk of a bad outcome is too high for the level of premium they are getting. Actuarial science is as dispassionate as you can get on these issues.
Because the providers know they can’t provide a level of care that is appropriate in a home setting.
We have talked a lot about what if about the baby so far, and I realized we have not really addressed your wife. Having an OOH birth puts her in a setting where she is not going to have access to adequate pain relief. Maybe she has done Hypnobabies, prenatal yoga, read every book and has a high tolerance to pain. It can still be a shock how much the pain of a contraction can shake you to the core, making all your breathing and focusing techniques fly out the window. Once your are in that much pain at home, transferring to the hospital is even harder and it still might be quite awhile before an epidural can be placed once she is at the hospital. Homebirth midwives are notorious for not being able to tell how severe tearing is and don’t have to skill to stitch up most tears. There are people who post here who had perfectly low risk pregnancies and textbook labors, who ended up with cervical tears and postpartum hemorrhages. Setting does matter when you are dealing with things like that.
Well if you think I’m going to have any kind of leverage telling my wife what she is or is not capable of withstanding, I can assure you that you are quite mistaken.
Actually… she doesn’t do all that well with pain. But that doesn’t seem to deter her from wanting to try.
I promise you… all the “horror stories” in the world will not change her mind. It will just make me out to be an “unsupportive” husband.
She has all the facts. She’s made her decision. She’s seen the CPM’s stats and is OK with them.
She would prefer a CNM, but can’t get one. She would prefer concurrent care with an OB, but that involves playing games to satisfy the underwriters of malpractice insurance policies.
That is the reality. So now what?
You don’t have to tell her horror stories-it’s best you don’t. I am suggesting that considering how slow a transfer can be and how quickly tears or a PPH need to be treated that she should take it into account before she is in a situation where she is hurting terribly and has no access to pain relief or is in critical need of medical attention and isn’t going to get it at home.
What influenced her decision to birth at home?
Well I can’t speak for my wife, but only for my perception of my wife. Here are some of the influences, to my perception:
1. She feels emotionally, and in some ways physically, safer at home. The tradeoff between the additional physical safety conferred by a hospital setting in the case of an adverse outcome, and the emotional comfort of being in a familiar environment, is sufficient for her.
2. She does not feel confident that she can be assured sufficient control and influence over the birthing process. Part of this is the uncertainly over the environment. There is also the question about when, and how insistently, interventions would be offered. She is not blindly against interventions, but she doesn’t not want any of them. She is concerned that a nurse or physician might try to talk her into a c-section, induction, and/or episiotomy, and she won’t be in a state where she can advocate for herself.
3. In addition, the undeniable “C.Y.A.” factor among physicians and hospitals- while perfectly understandable why they exist- for example if I’m not mistaken, Michiganders are particularly litigious when it comes to these things… so that is an impediment to trust in the system.
4. She has a strong feeling that there is spiritual purpose to the birth process that will be minimized by health care professionals who do not acknowledge or understand those dimensions of health, and how important they are to some women, and even more so during birth. (And no we are not religious nutjobs… we don’t go to church at all.)
I’m sure there are some others, but why don’t we start with those. I believe they are the largest factors.
Actually, there are at least three other important factors that I can think of… but those have more to do with personal psychological things… experiences of family members in hospitals not being cared for properly, and family members who ARE health care professionals, each with their own set of views.
But I won’t even try to touch those here. o.O
Oh, and there’s the financial and health insurance factor. We have pre-Obamacare policies with HSAs. Currently we have (on each policy, we haven’t combined them) $5000 deductibles, with 100% in-network coverage after that.
The maximum OOP expense is $15000…. about the amount of a hospital birth… I think… ???
To get a policy that covers hospital birth would cost an additional $2500 a year… for one with the SAME deductible that we already have on the current plan.
We’re not poor. But we don’t have fixed incomes either. There’s a real decision to be made about spending $10,000 to mitigate a small absolute risk of something going wrong… and it also being uncorrectable WITH a catastrophic outcome.
Just remember that in countries where midwifery and homebirth are well-integrated into the health care system, the transfer rate for first-time mothers is 40-45%, These are women like your wife – otherwise completely low risk who required transfer during labour because something unexpected happened (often stalled labour or wanting pain relief).
If your midwife doesn’t transfer first-time mothers at that rate, she is not practicing safely. If she does have such a transfer rate, there are good odds that you’ll end up paying for both a hospital and a home birth.
$15000 sounds excessive for an uncomplicated birth-but again, you can call the hospital and find out what they can do for you if you don’t have maternity coverage.
re: number 2… that’s what you’re there for. You are supposed to be her advocate. Does she really think that if she’d be that weak at the hospital such that she wouldn’t be able to advocate for herself that she’ll be able to think straight enough at home to say that she needs a transfer? It’s not about being pressured to do something… it’s about having the wherewithal to say “yes” or “no”… and that capacity isn’t going to suddenly increase at home. What if your midwife pressure her to stay home when she should transfer? Is she going to be able to make the right choice then? I don’t think #2 is a good reason to stay home. It’s a good reason to make sure you’ve got someone to advocate on your behalf.
You guys could come up with a safe word. That way if she was screaming “I want pain meds” and you weren’t sure if she meant it, she could say “Grapes, Matt! Grapes! I’m serious this time” and then you’d know she was serious (yes, “grapes” is a weird word… I was eating frozen grapes earlier and it came to mind).
I do understand her apprehension.
She does sound like she has been handed a lot of misinformation about pregnancy and birth, and it’s clouded her judgement. If you approach something from a place of mistrust and misinformation, even the best doctors and nurses will appear to be pushing courses of treatment that are not needed and potentially more dangerous than they are. It’s much harder to get an elective C-section and epidural than people would have you believe. As someone who was talked OUT OF an epidural even though I very much wanted one, I can say it’s much worse when someone refused to listen to your very real request for an intervention then when they speak to you about an intervention like you are an adult making a decision based on facts.
Perhaps there is a spiritual element to birth, it is certainly life changing and amazing. It’s also painful, unpredictable and you are more likely to poop during it then have an epiphany.
As long as she understands the risks to her and the baby, she has the right to choose what course of action she will take.
Which one of those reasons is about what is best for your child?
You’ve just said your wife is willing to trade off the physical safety of your baby for her emotional comfort. Maybe she doesn’t see it that way but, I’m sorry, that’s what it boils down to.
You are still not listening to people. You and your wife are saying that the worst thing that you can imagine – and the one you’ll put your effort into avoiding – is the ‘unnecessary’ intervention. We are trying to say to you that the worst thing that can happen is that your baby dies or is permanently injured. You are telling us that you know that already, but emotional security and location-specific birth mysticism is more important.
Birth is a powerful experience anywhere, Matt, because your child starts on the inside and comes to the outside. The stars don’t need to line up in some magical way. You just need to be able to hold that precious life in your arms and marvel at the fact that it wasn’t here yesterday. That’s the point.
It sounds like the loss of control that being a parent entails is freaking her out. She is a person who needs to feel in control, so she’s concentrating on giving birth as something she wants to keep within her control, something that will prove that she’s still in charge.
(Am I anywhere close?)
More realistically, giving birth is something she does not and cannot control. Going through the painful process of learning to accept that is a good spiritual exercise in preparation for the arrival of your child.
You seem to be working on the assumption that since only 0.21% of babies die at or around a homebirth that it won’t happen to you. You are deliberately ignoring permanent injury, which brings the combined risk of death or permanent injury to something like 3.7%.
Your CPM has already let one mother die. Presumably you’re confident you are taking care of that by seeing an OB. If you think the OB is better able to keep your wife alive and healthy until labour begins
It could actually be a lot higher than 3.7%. The injury:death ratio is much higher in homebirth than hospital birth. http://www.skepticalob.com/2014/01/risk-of-anoxic-brain-injury-is-more-than-18-times-higher-at-homebirth.html
This isn’t primarily about you or your wife, Matt. It’s about your child. YOUR child. As a father, you can do better by your child than just shrugging your shoulders.
Again, everything will probably be fine. You probably don’t even need a midwife at all. Given the incompetence and recklessness of your CPM, the marginal benefit to having her around vs going for a UC stunt birth is probably minimal. Yet you hired her. Presumably you recognize thatmyoumwill need help.
Here’s the thing about insurance underwriters: they are the least political people on the planet. They are a business and they don’t give a shit about anything other than making money. They don’t care if something is popular or unpopular. They don’t care about being politically correct or trendy. They look to cold hard numbers about what will lose them $ and what will make them $.
And that is why you can trust them! If they won’t insure something it’s because they know it is too dangerous and will end in bad outcomes that will lose them $. If it were safe, they would insure it in a heartbeat. What better way to make money than charge people for insurance when you know that you won’t have to be paying out claims!
My friend did hynobabies. She said it was an utter failure. She was dead set on natural birth and was begging for an epi when labor started. She never got one because they wouldn’t give it to her at 3cm and then she progressed to 9cm too quickly. She was traumatized by her birth. She tore, also. So yeah, even people who are convinced they will do it all natural can change their minds.
With my first child, I had concern about having an epidural (would I be able to drive? What if it doesn’t take? Does it slow labor?) and figured I would see how it went but since I had been trained as a doula and midwife that I would be able to relax and use what I had learned. Except I couldn’t. I was triggered terribly, my husband called my family and they showed up at the hospital and bugged the crap out of me during labor and the nurse fed into my fears and told me (among other things) that I wouldn’t be able to drive for six weeks and the epidural would indeed slow down and probably stall my labor. She SHOULD have called the anesthesiologist in and had them address those concerns. I didn’t get that dignity and I ended up howling and screaming through dd’s birth and the repair of the second degree tear I had. To say it was traumatizing doesn’t feel strong enough.
Why doesn’t your midwife have a doctor she collaborates with? Why is she practicing when she can’t provide basic prenatal care? That is extremely disturbing to me.
What an impossible position to put your OB in! He doesn’t recommend homebirth because he knows that it is unsafe. But you basically are saying to him “No don’t tell us that it’s generally unsafe, do tests on her and tell us when it’s starting to be EXTRA unsafe, and if you don’t indicate that it is extra unsafe, then we will take that to mean that it’s SAFE”. And the doc (and his insurance plan) are supposed to be all hunky dory with your bullshit and just trust that a straight-up guy like yourself wouldn’t sue if and when the shit hit the fan? Sure buddy, sure.
Matt look up recent research re the move to Homebirth in America???you might be reassured.
The article on Science and Sensibility by Wendy Gordon and the articles on Improving Birth can hardly be called reassuring.
No.
What I want is for women who are considering engaging care from a CPM and having a home birth to have is informed consent, meaning that they understand exactly what it means to have care from someone who can’t do anything for them the minute there is any less than a unremarkable and uneventful pregnancy and birth.
Nobody here thinks women should be denied the option of choosing homebirth.
They think that untrained, inexperienced, uninsured, unaccountable people should be denied the option of lying about their qualifications, lying about the realities of birth, calling themselves midwives and charging money for substandard care.
But no amount of training, experience, disclosure, regulatory framework, licensure, etc. is enough to bring the level of care up to “acceptable” standards? Huh?
OBs and Certified Nurse-Midwives meet all those standards, they are also able to work in settings that allow them to use their knowledge
I don’t know why you would say that. Several people here have pointed out that CNMs meet the standard.
That’s the thing… pro home birthers get pissy at anyone who would choose an elective CS, but then claim they are allowed to endanger their babies at home birth. And it IS dangerous. But we acknowledge they have the right to have their children at home. Just like I should have the right to choose an elective CS. And I guarantee an elective CS is far safer than a home birth.
Where did I say that?
Have your homebirth. But recognize and admit that in a crisis your baby might day and might not have in a hospital. You don’t want to analyze the risk of death. You cannot truly have informed consent by burying your head in the sand.
Seriously!
I think the WHO finally agreed that the 15% rate was pulled out of someone’s ass…. No one knows what an “optimal” CS rate is.
“Could it be that interventions are increasingly offered sooner and sooner at the very first sign of something abnormal during the birth process because the medical staff is scared shitless of what might happen if they DIDN’T offer an intervention?”
When something seems abnormal in a labor, they are most definitely scared shitless of what might happen if they don’t offer intervention, like injury or death of mother, baby or both. Being scared of a lawsuit is secondary, if you avoid “what might happen” by using interventions when they seem called for, you have no reason to fear a lawsuit – no one can sue if they don’t have a bad outcome to sue for.
“Guess what I found as the very first post? You may not have seen it, as I noticed it has exactly -zero- comments.”
BTW, the reason that post has no comments is because it is from the period of time that Dr. Amy was making the transition from her old blog (“Homebirth Debate” – http://homebirthdebate.blogspot.com/) to this blog; most of the earliest posts on this blog don’t have comments for that reason. That post was located on the old blog, this blog, as well as on Dr. Amy’s Open Salon page: http://open.salon.com/blog/amytuteurmd/2008/08/14/how_to_lower_the_c-section_rate_step_1_look_in_the_mirror
So, I would venture to guess most of us have seen it, or if not, we are still aware of the opinions and arguments that Dr. Amy made in that piece, because it is not the only time and place she has discussed them.
Thanks for the additional info. Anyway, I thought it was a good post. It concerns me that fear of litigation is such a prominent factor in the decision-making process. It also concerns me that so many people have unreasonable expectations of our health care system
I’m not so sure fear of litigation regarding birth outcomes really is a bad thing. It’s just responding to what woman want. What the typical woman wants has changed over the years. Fifty years ago the typical woman started having children in her late teens or early 20s. She planned a relatively large family. If a birth “went wrong” it typically ended in the death of the baby because medical technology wasn’t yet advanced enough to save damaged babies. A baby’s death was God’s Will and although it was sad, the woman, being young, could always go on to have more. A woman really did not want a CS because CS at the time was still fairly dangerous.
The situation is very different now. Woman wait often until their 30s to have babies. They may struggle with subfertility, and if this current pregnancy doesn’t result in a healthy baby, there may be no second chance. C-sections have become very safe, and most women desire 3 or fewer children, so an un-scarred uterus is not a priority. Our society has become more reliant on brain-power jobs rather than manual labor jobs, and so women are very motivated to preserve the brain cells of their babies. Most women, when given a chance, want to ere on the side of caution and are willing to have a CS rather than risk a situation that is borderline and find out in the end that they fell on the wrong side of luck and have a permanenly damaged baby. There is nothing unreasonable about that choice or unreasonable about doctors responding to this preference by being cautious.
So the solution is home birth? How about if the solution is not to be so sue happy? Did you ever consider that maybe physicians are freaked out because we file too many lawsuits? That maybe that woman who screamed she didn’t want to the CS, whose baby ended up brain damaged because she refused the CS, should accept that she was the cause of her baby’s problems and not sue? No? So there are only a couple of solutions: 1) people stop filing so many lawsuits, or 2) doctors protect themselves and make SURE their patients are as safe as possible. You’re blaming the doctors for jumping to CS, when they only did that because everyone is litigation happy. And that’s coming from an attorney.
“So the solution is home birth?”
No, that is not a solution.
“How about if the solution is not to be so sue happy?”
That would be a good solution, but not one that seems likely.
“Did you ever consider that maybe physicians are freaked out because we file too many lawsuits?”
Yes, of course. I understand why. I even said so.
“…should accept that she was the cause of her baby’s problems..”
Haha… do you know how much “outrage” such a statement would provoke? Unfortunately, it seems to me that the predominating belief system among Americans is that disease “just happens” to them. You know… like the disease fairy came by in the night and cursed them with illness. It has nothing to do with their crappy diet, lack of exercise, excess stress, attitude, etc. They are just victims of circumstance… they’ve got “bad genes” so… *wink wink*
“You’re blaming the doctors for jumping to CS, when they only did that because everyone is litigation happy. ”
No, I’m not *blaming* the doctors… I’m wondering how the hell one is supposed to navigate this insanity.
“And that’s coming from an attorney.”
Have you considered that maybe attorneys have played a role in creating this problem?
Ohhhh… you seriously just did one of things that pisses me off royally. Do you have any idea how freaking rude and inconsiderate it is to imply that diet causes disease?
I have lupus. I’ve been told a bunch of times that it’s because I “eat sugar” or some other such nonsense. That’s right. It’s because I don’t live on a diet of uncooked vegetables that my body decided to start attacking itself. And I’m sure I’d be cured if I just changed how I eat (which isn’t bad, btw… and no, I know you didn’t fully say this… but the implication is partially there… at least to a small extent… I’ve read your other posts).
It couldn’t have anything to do with the fact that my dad had psoriatic arthritis, his mom had rheumatoid arthritis, and my mom’s dad also had rheumatoid arthritis. No… autoimmune disease running in my family has no relevance.
Also not relevant is the fact that my disease showed up right after my daughter was born. Pretty sure I had this since I was a teenager, but it never bothered me much until my daughter was born. Pregnancy is a known trigger for autoimmune diseases.
Let me put it to you this way: did you ever consider that by saying what you basically said (that diet has something to do with disease), you are basically blaming me for my body attacking itself? That is beyond rude. Seriously.
As for attorneys, I will say this: Of course people wouldn’t sue if attorneys didn’t make it possible, HOWEVER, the only reason there are attorneys willing to bring these suits is because there is a demand for them. Attorneys aren’t forcing people to bring lawsuits.
Further, I don’t do medical malpractice or any kind of personal injury, so I don’t consider myself part of the problem. I mostly handle real estate fraud, which is a justifiable area of law. So I can bag on attorneys who are ambulance chasers all I like.
Diet and lifestyle are implicated in some diseases- smoking related cancers, high fat and sugar diets with diabetes and heart disease, alcohol and liver disease, vitamin D deficiency with rickets, gluten and coeliac, fava beans in G6PD, folic acid and NTD etc.
However, one CANNOT extrapolate from that the existence of a perfect diet or lifestyle which will prevent all disease, because a) some diseases are not influenced by personally modifiable factors and b) shit happens.
Matt, you probably don’t have a chronic illness. You’re not being particularly sensitive to those who have, and you know what, sometimes people are indeed the victims of crappy genes and bad circumstances.
I’ve seen enough smokers living into their eighties and non smokers dying from lung cancer to be under no illusions that some people just have crappy luck.
I don’t disagree with those, for sure. Of course diet is relevant to diabetes, smoking to lung cancer (though as you said, not always… I know a guy whose good friend died of lung cancer at 31… never smoked… they said when you get that type of lung cancer, it’s pretty much a death sentence), etc.
It’s the implication that sugar or gluten causes inflammation in the body that caused an autoimmune disease that irks me. As you noted 🙂 Crappy genes for sure…
AND FURTHERMORE:
There is a gigantic difference between someone with cancer or an autoimmune disease and a woman who makes a bad choice and whose baby suffers because of it.
If a woman at a hospital is told “You need a CS…your baby’s heartrate is dropping and it’s starting to look like you may have an abruption” and she says “screw you, I’m having a vaginal birth!” and the doctors say “fine, just sign here to show you know the risks and consent to them” and she does and the baby dies, then honestly, that is freaking on her 100%.
Now compare that to someone who has cancer, or, like me, lupus. And you seriously just implied we gave ourselves those diseases. That’s right. I eat basically the same food as everyone else, but I just HAPPENED to get lupus. Do you know how INSANE that sounds?
Think about it for a second. If diet caused lupus, then in theory everyone who eats a regular American diet should be coming down with an autoimmune disease. Otherwise, OF COURSE there has to be a genetic component. Even if you want to buy into the idea that diet is causing inflammation in the body, why is MY body attacking itself to the point where I have an identifiable disease and all the people over here are just overweight? Just bad luck? Or possibly a genetic component? Probably a combination of both. But I guarantee that people who eat ridiculously healthy food still get sick. So for them it’s just bad luck, but for the rest of us, we were the predominating factor in our sickness manifesting itself?
Hi Matt. I know it’s been a while since you wrote this, and you’re probably wondering why nobody responded to this comment. Honestly, you damn near lost me in this post because it’s just so damn long. And, really, you offer nothing new – everything you say here, you said earlier. So, my guess is that none of the regular posters here made it through this super long rant, because, again – it offered nothing new.
Here’s what I know. I’m a NICU nurse who has never, ever, ever put my fear of litigation over a patient’s well-being. And I’ve never seen it happen amongst my cohorts either.
I know it’s been a while since this conversation occurred, so I’d love an update on what you and your wife decided to do. I hope you realize that the majority of the people who regularly post on this blog (myself included) have personal ties to homebirths gone wrong…we’ve seen the worst of the worst. and just want women to know – REALLY know – the risks involved with deciding to deliver away from a hospital setting. We’re coming from a genuine place of concern…and sometimes fear….because we’ve seen the negative side of the unpredictability of birth.
And finally, you claim you want doctors and health care providers to practice without fear of litigation…you want us to focus first and foremost on the health and well-being of our patients. I want you to know….WE do that. Do you know who isn’t focused on outcomes? Midwives. Because…well, they don’t have to. They aren’t subject to the same consequences we are…they can’t lose their licenses because they don’t HAVE licenses. When a baby or mom dies during a homebirth….do you thing that the Midwife in charge faces any legal consequences? Are they held accountable for any deaths or injuries sustained?
We are.
First and foremost, we love our patients. Medicine is both an art and a science…we’ve spent years studying the science we need to drive our practice, but at the end of the day, it’s our patient who make us smile and thank the heavens we’re working hard everyday in a profession we love…it’s our passion.
I hope everything is great with you and your wife and your expected little bundle. And I do hope you’ll pop back in and update us…
Gosh… I’m really turning out to be an evidence spammer here. I’m sorry folks, but since the author is such a fan of evidence- I went looking for some and keep turning up such interesting information that I can hardly contain myself from excitement in sharing it with you all!!
Here’s another one of those systematic reviews and meta-analyses.
Li, Y., Tian, Y., Zhu, W., Gong, J., Gu, L., Zhang, W., … Li, J. (2014). Cesarean delivery and risk of inflammatory bowel disease: a systematic review and meta-analysis. Scandinavian Journal of Gastroenterology, 49(7), 834–844. doi:10.3109/00365521.2014.910834
CONCLUSION:
Results of this meta-analysis support the hypothesis that cesarean delivery was associated with the risk of CD but not of UC. The total rate of cesarean delivery of IBD patients was similar with that of control subjects.
But wait… I thought the blog author very confidently stated to her audience that there was definitively NO evidence in support of the hypothesis that C-section is associated with a higher risk of chronic disease. Hmmm… maybe did she mean there was NO evidence 30 years ago when she graduated from med school??
Hmmm…chronic disease or dead baby? I’ll take chronic disease for $1 million Alex!
Thank God for C-sections! Woo!
LOL- Sure one might still take the C-section after a careful risk-benefit analysis. But I think you missed the point. The point is that the author is claiming there is NO evidence, when there is. Simple as that.
Alex, the question is: “Who is a fake skeptic?”
The evidence of a statistical association between cesarean birth and chronic disease later in life is weak and conflicting. One study finds an association with disease x, but not y or z, another finds one with y but not x. None of these studies are able to fully control for the critically important confounding variable of maternal health, and none of the decent quality ones have demonstrated a large difference in risk.
So, as a matter of philosophy, I tend to place real and immediate risks, even if small, above future risks that may be statistical artifacts.
My institution does not have a subscription to that journal, so I can’t read the full text. However, the abstract does note: “Overall, we did not observe a positive relationship between cesarean delivery and IBD (95% CI: 0.99–1.30; p = 0.08).” So it does make me wonder if they were starting to see some statistical oddities of small sample sizes when they broke IBD down into UC and CD.
Yes, we are starting to see SOME evidence. I’m not so sure why there is so much resistance to that statement- as it is pretty much all I am trying to say.
The blog author says there is NO evidence. There is SOME evidence. Therefore the author is wrong. That is all.
I’m saying that I do not find that evidence convincing. I wish I could read the paper and dive deeper and know for sure, but when you take an overall condition with no association with procedure X, and then break that condition down into smaller bits and find a bit that does have an association with procedure X, I want to take a closer look at the numbers to make sure it’s real and not spurious. That is, I am not sure, from just looking at that abstract, that we do indeed have _some_ evidence.
CD is an interesting and heterogeneous disease (more so than UC) with very poorly understood etiology. Part of my work is with IBD, and with the microbiome, so I know all too well how high the known-to-understood ratio is, and how easy it is to go nuts if you hack off one little portion and think you _have_ it. 🙂
I would absolutely agree with everything you have said. We certainly do NOT know way more than we DO know. There are many questions to be answered.
Again, my whole point is that there is indeed SOME evidence. It may indeed be the case that the evidence is not convincing, and considering how new microbiome research is, I would be surprised if any of the research could be considered “convincing” other than to simply say that the microbiome seems to be a really important factor in health and disease.
Thanks for engaging in a civil dialogue. 🙂
“the microbiome seems to be a really important factor in health and disease”
It might be an important factor in some aspects of health and disease. But I believe it to be a highly overstated factor, currently (it was an understated factor, IMO, back when I first got into this field – it’s funny how the pendulum swings). The basic ideas of correlation vs causation and cause vs effect are still barely being scratched at when it comes to the microbiome, e.g.
Where I disagree with you is in counting things on the level of what you posted as ‘some’ evidence. It’s a hint, a whiff, that might be evidence and might not be. I’ve just seen a lot of ‘evidence’, across various fields, at that level go out with a whimper and not a bang.
In my opinion, the difference between “some” and “none” makes all the difference between having a healthy dialogue, and no dialogue at all.
I think that’s important, and is part of what fuels the pendulum swings you referred to.
Matt, in the article Dr. Amy says “THERE IS NO EVIDENCE TO SUPPORT THOSE CLAIMS”: maybe I’m wrong, but to my non-native understanding, this sentence doesn’t necessarily mean “there is no evidence at all”, but rather: any evidence there might be, it is not enough to support claims such as “increased medicalization of childbirth may be having severe consequences on the life-long health of our children…What’s more, it could be having a devastating effect on the future of our entire species”. The video is presented as a revolution in the history of humanity! Don’t you see the disproportion?
I certainly see the disproportion- which is why it is even more important to use precise language. The sentence means what it means, and Dr. Amy reiterated it in several different ways, and in each instance used words to indicate an absolute.
Your argument can easily be turned on its head… take a closer look at the stated claim:
“increased medicalization of childbirth may be having severe
consequences on the life-long health of our children…What’s more, it
could be having a devastating effect on the future of our entire species”
Here you can see that they said “MAY BE” and “COULD BE” which, to my understanding of the English language, implies that they are speaking in conjecture. They are speaking in terms of possibilities… what might or could be true… not what IS true.
Now I can speak for any of the “buzz” or promotional materials surrounding the film, since I am not privy to it. I wouldn’t be surprised if things have been spun and overstated in that regard.
Fair enough – I see your point and I’ve even voted you up for your neat explanation above here 🙂
But, since we’ve moved to linguistic, I want to reply to your “defence” of the quoted claims. Register and word choice have enormous importance in communication. A supposedly scientific-based speech cannot use expressions like “life-long health”, “devastating effect” “future of the species” and then hide behind conditional verbs. They are deliberately provoking an emotional response, they are suggesting and evoking, if not stating, something they can’t prove.
A totally fair argument- I have no counter to it. But the filmmakers are filmmakers and their promotional team are promotional people.
What is Dr. Amy’s excuse? I did not notice any real logic or reason in her criticism. I did not notice any genuine “skepticism.” Instead all I see were ALL CAPS RANTS, absolute statements, accusations, and an all-around derisive tone.
I won’t provide any excuse for Dr. Amy since she is able to account for herself. If you ask for the reason of such an article, maybe you should know that there are plenty of supposed experts who would use such a film, made by filmmakers and promoted by promotional people, as “scientific evidence” to “educate” pregnant women and couples about the risks of medicalized birth. This is what (many) NCB advocates do. In most case they are not able to recognize real scientific evidence from pseudoscience themselves, despite their scientific degrees. This is at least my personal experience.
Yes, I would agree with your comments and experience.
But derision is not going to make the situation any better.
When reading this blog I usually understand derision as a means to draw these people’s attention, to provoke them, to force them to answer and account for their behavior. Does this work? I don’t know.
I’m inclined to say no… derision doesn’t work. But that hasn’t stopped medical professionals from continuing to attempt to deride people into doing what they feel to be the right thing.
Back in the early 19th century, Dr. Semmelweiss was derided by his peers for hypothesizing on why more women were dying in the obstetric clinic than in the one run by midwives. He proposed that some invisible disease agent was being transmitted by the doctors who were performing vaginal exams after working in the cadaver labs and without washing their hands in between.
He was laughed out of the medical profession, and it wasn’t until a couple decades after his death that we realized… oops he was right! Germs really do exist!
In the early 20th century, Dr. Metchnikoff hypothesized that consuming fermented foods conferred health benefits, and that many disease processes were a result of toxic byproducts of harmful bacteria gaining access to the bloodstream because of a “leaky gut.”
“Leaky gut hypothesis” became the laughing stock of the medical world… and a surefire way to identify a quackpot as far as most doctors were concerned. Nowadays you can hardly find a journal article on GI disease without some mention of “impaired intestinal permeability.”
Dubos was writing about gut microbiota and the gut as an ecosystem back in the 60s. The 60s! Was anybody listening? No no those were “fringe topics” that sounded too much like the “Gaia Hypothesis” to be taken seriously by any “legitimate” researchers.
What do all these situations have in common? The use of derision and ridicule by the scientific community to edge out highly advanced thinkers who were later proven to be more right than wrong.
What has science and medicine learned from the last couple centuries of folly? Apparently, not a damn thing.
Today, doctors and scientists like to blame the likes of Jenny McCarthy for all their woes. Does anybody ever perhaps consider that the reason they have so little trust with the public is that they continue to be proven catastrophically wrong, and yet continue to persist in taking a derisive attitude any time their ideas are challenged?
Does anybody consider that maybe the reason trust is undermined might have something to do with the number of massive drug recalls that have occurred over the last decades after we found out that highly touted medications were actually killing people?
Does anybody consider that it might have something to do with recommendations like eating trans fat in order prevent heart disease? Whoops wrong on that one too!
No no, it couldn’t be any of that… it’s all because of Jenny McCarthy. 😉
Derision as a motivating factor for positive change. Fail.
Um, leaky gut hypothesis has never been accepted. And it’s a bit dishonest to reach back into history, pull up the ONE crackpot theory out of a giant pool of forgotten crackpot theories which happens to have been proven partially correct, and then claim that therefore, all of science is untrustworthy.
When scientists realize they are wrong, they change their minds. Doctors change and improve their practices all the time. Pseudoscience never sees the need to change, no matter how much evidence piles up against a theory.
Did I claim that all science is trustworthy? Did I say that? Show me where I said that.
Or are you ***yet again*** projecting ideas onto me and putting words into my mouth?
Also, please explain the difference between “leaky gut” and “increased intestinal permeability.”
“reason trust is undermined.”
The difference between the two proposed conditions is only their causes, mechanism of action, treatment options, and in the level of evidence that they really exist.
“Trust is undermined” does not equate to “all science is untrustworthy” Now does it?
Please explain the differences in causes and mechanism of action.
I don’t disagree with that at all – that when we’re in the ‘none’ region, there’s not a lot of meaningful dialog that can occur.
The pendulum swings because scientists, like everyone else, are excited by new and different data. I remember the first time I heard about hookworms and IBD, I was SO damn excited. Then I looked a little more closely, and turned it down a whole bunch of notches.
“when we’re in the ‘none’ region, there’s not a lot of meaningful dialog that can occur.”
Exactly my point. 🙂
“The pendulum swings because scientists, like everyone else, are excited by new and different data.”
Yes, though I would also add that scientists, like everybody else, get defensive, and even go into denial, when new and different data contradicts their pet theories or established dogma. 🙁
Hey, I heard a lecture from a paediatric gastroenterologist a couple of years back that suggested UC and Crohn’s were probably the same underlying disease with somewhat different manifestations (or at least that was his prediction). Any thoughts?
The phrase “starting to see some evidence” implies that the truth of the hypothesis is in fact a foregone conclusion, and it’s just a matter of time before we find real evidence that supports its. In fact, most published scientific studies contain at least some errors, and a huge fraction are wrong. This is true for a number of reasons, one of which is the well known publication bias in favor of studies that conclude in favor of a new hypothesis. I have seen manuscripts rejected for failing to find evidence to reject the null because, in the words of the editor “it’s not interesting.” This was not Science or Nature, and it was a hypothesis that is very much still up for debate. The editor didn’t want to waste print on a study that didn’t support the latest most controversial hypothesis.
Personally, I find it rather ironic that you’re lecturing the blog author on the rigor of language, when, faced with the need to support the claims made by a documentary that has faced absolutely no real standards of intellectual rigor or merit (the kind of evidence you apparently find convincing), you have so far managed to produce a study with a sample size too small to conclude anything, a review paper that basically summarized well known connections between vaginal and amniotic flora and poor outcomes in labor and birth before attempting to rescue what would have been just another OB review article with a few attention grabbing sentences about long term health implications, and a review article published in a trash journal.
Not all evidence is equal. Scientists are well within their rights to dismiss a publication or an association as “no evidence” because it does not meet their standards of rigor. If this were not true, then the only thing required to establish a hypothesis would be to get it published somehow, somewhere. That is not acceptable, although it is a favored tactic of creationist “scientists” and homeopathic “doctors” everywhere.
“Starting to see some evidence” does not equate to affirming a hypothesis. Though you are right, not all evidence is equal.
The greater irony here is you jumping in to defend a poorly written rant loosely disguised as a so-called skeptical blog post against actual articles published in actual scientific journals, however questionable they might be.
Pseudoskeptics fighting the “good fight” against pseudoscience. It would be funny if it weren’t so pitiful. Clearly, I’ve made an error challenging the unassailable beliefs of the Great and Powerful Dr. Amy. Enjoy your minionhood.
Ah, I see what you did there: the irrefutable”minion” gambit, closely related to the”pharma shill” gambit. What a shame, it seemed like there was some useful dialogue beginning there, but you’ve shut it down. At least you can leave with your cognitive biases intact – it’s much more comfortable that way.
No, actually there was no meaningful dialogue, as the comment began with a false framing of my position:
“The phrase “starting to see some evidence” implies that the truth of the
hypothesis is in fact a foregone conclusion, and it’s just a matter of
time before we find real evidence that supports its.”
No… it didn’t imply that at all. I understand fully what a hypothesis is. I understand what bias is. I understand that an idea that appeals to one’s intuition- or even sensibilities- could turn out to be false once thoroughly vetted.
The actual reason there is very little “useful dialogue” going on in this blog is because people appear to be approaching discussion somewhat like a chess game… attempting to anticipate my moves and characterize my “style of play” based on previous experience with others.
The minion comment isn’t a “gambit” as that would imply I believe that we are playing some kind of game that can be “won” and that I am willing to sacrifice something in order to gain an advantage.
The minion comment has to do with the bizarre lack of questioning of the blog author’s comment that there is “no” evidence to support a given hypothesis- even though there is clearly demonstrable evidence.
The quality of that evidence is another question, but based on my experiences here thus far, not one that I feel stands much of a chance of any sort of reasonable treatment.
To be fair, there are several people in this comment thread which seem to have some sort of normal sensibility, plain respect for others, and a willingness to explore new ideas.
Unfortunately, there’s too many trolls and minions also present who apparently have no purpose here other than to tirelessly defend Dr. Amy (I mean really, does anybody here thing this blog post is a meritable piece of writing??!) or just simply being sadistic.
No, the difference between you and I, as a scientist, is that I do NOT place undue confidence in something merely because it has been published in a scientific journal. The concept of critically evaluating published scientific evidence is clearly beyond you.
Enjoy your naivete.
Really? Are you a scientist? Then you should know better than to make those kinds of assumptions about what I do and do not understand.
If you actually read my posts, I didn’t defend any of those studies. I simply pointed out that they exist, and by virtue of their existence that proves the falsity of the assertion that they don’t exist.
Enjoy your prejudice. And remind me to never take anything you publish seriously.
You have ignored my point. The existence of a published study =/ evidence.
You’re caught in a tautological bind, and you don’t even realize it.
Ah, but if I’ve published something, whatever it is, it must be evidence of something, right? No matter who I am or what I’ve published? By your very own logic? After all, you don’t even have to defend the quality of my work– you don’t even have to read it! It’s been published! Maybe I published an article proving the coexistence of humans with dinosaurs…. and now there’s evidence of that! No one can forthwith declare that no such evidence exists. Doesn’t matter where I published it or whether it’s correct, it’s evidence! (And yes, I have had that conversation with someone.)
Most papers are probably wrong, and many of them are egregiously wrong. The attitude that the act of their publication constitutes evidence is highly problematic. Because once something has been published, it can become part of a very convincing story that takes on a life of its own. That story enters the collective consciousness of a society and effectively never leaves, even if it is proven wrong, even if that proof comes in the shape of — you guessed it — another published paper! How many people still believe that vaccines cause autism? How many of them will believe it no matter what additional evidence demolishes that erroneous hypothesis? How much more convincing it is if someone made a documentary about it?
This article in Nature outlines some of these problems:
http://www.nature.com/news/replication-studies-bad-copy-1.10634
Dr. Tuteur has the right to declare that there is no evidence for a phenomenon. You have the right to claim that the evidence published is of sufficient quality to be included as evidence. But as you so correctly point out, you haven’t even done that. You’ve simply declared that because someone published something somewhere, the evidence exists.
The mere existence of a study does not equate with “evidence”. Studies must be correctly designed, sufficiently powered, adequately processed (statistics) and repeatable. THEN we can start to say that there is evidence of one thing or another.
Since the author claims to know a whole heck of a lot about what kind of EVIDENCE there is out there… I thought it might also be interesting to share this little tidbit. This from the Cochrane Database of Systematic Reviews. If y’all didn’t know… Cochrane reviews are generally considered highly credible.
Benefits and harms of planned hospital birth compared with planned home birth for low‐risk pregnant women.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0010623/
Authors’ conclusions: There is no strong evidence from randomised
trials to favour either planned hospital birth or planned home birth
for low‐risk pregnant women. However, the trials show that women living
in areas where they are not well informed about home birth may welcome
ethically well‐designed trials that would ensure an informed choice. As
the quality of evidence in favour of home birth from observational
studies seems to be steadily increasing, it might be as important to
prepare a regularly updated systematic review including observational
studies as described in the Cochrane Handbook for Systematic Reviews of Interventions as to attempt to set up new randomised controlled trials.
Hmm.. wowee now that seems like a little bit more of a balanced and rational conclusion than the author’s rants here in this blog. Don’tcha think?