You may remember from yesterday that homebirth midwife Marlene Waechter equated me with Satan. I beg to differ!
It’s not surprising that she’s confused. I’m not Satan; I’m the serpent in MANA’s Garden of Eden.
Think about it: MANA created a Garden of Eden where it has free rein to trick women about the death rate at homebirth, with no onerous education or training requirements, and no pesky safety standards. They told all the homebirth advocates living in their Garden that they could attend any birth, that every complication is a variation or normal, and that some babies are just meant to die. There was only one rule: don’t eat from the Tree of Knowledge.
Then I come along and tell the residents of the Garden that if they eat of the Tree of Knowledge, they will learn that MANA lies about its death rates, that Jan Tritten crowd sources life or death decisions on Facebook, and that the folks from MANA couldn’t meet the licensing requirements for any other country in the industrialized world.
See! I’m the serpent!
But don’t worry. Jan and Marlene are praying for me.
You know what? I’m not praying for them; I’m praying ABOUT them. I’m praying that “midwives” like them are recognized as ignorant, unethical fools who think nothing of crowd sourcing a life or death decision on Facebook, and then deleting the evidence when the baby dies.
If Jan Tritten thinks that I’m going to let this baby be buried twice, she doesn’t know me very well.
I’ve publicized this every way I know how and revulsion with Jan’s behavior has been noted as far away as Croatia:
You are your buddies are not getting away with it this time.
A baby is dead, and you are acting like a callous clown, as if this is some sort of joke. I don’t know if this poor baby’s body is in the ground yet, but you’ve already deleted him from your Facebook page and apparently from your conscience, too.
You are the poster child for everything that is wrong with American homebirth midwifery:
Uneducated
Untrained
Unethical
Unconcerned with safety, and
Unmoved by the deaths of babies who didn’t have to die.
Instead of apologizing for your role in this tragedy, you’ve treated it like some sort of inconvenience; just delete the existence of the baby, hide for awhile and try to divert attention to hating on me.
But people have noticed. So far 475 people have signed the petition expressing revulsion with your behavior.
Stop hiding! Stop deleting! Stop pretending that this baby’s death doesn’t matter!
I may not be Satan, but I’ll be damned if I let you get away with this outrage!
I cannot believe how very disgusted I am with Skepchick. I had hoped their new venture would actually be fact based, not just another ignorant ode to NCB and HB WOO.
They are so proud that they are “intelligent, so proud to be “skeptical” of religion and homeopathy, and so proud to be “feminist”. But then they go and post the most ridiculous, anti woman, anti feminist, anti intellectual, garbage?
Gross, all of it, and super disappointing. I hope all the cool raptors that write for them quit. Or at least protest.
Superannuatedgoodness,
Where are you in your studies?
How much hands on clinical experience have you had?
You relate your “experiences” of hospital and birth, please elaborate further.
I want to know EXACTLY what your clinical and educational experience is.
Because you don’t understand basic chemistry, appear to have a very limited understanding of anatomy and your comments don’t read like someone who has been providing care to many postpartum women.
Me, I’ve had undergraduate and post graduate experience in OBGYN and currently provide antenatal and postnatal care on a daily basis as a GP. When I tell you that a lot of your comments are mistaken, ignorant or just plain wrong I’m not trying to be mean, I’m telling you that your comments do not fit with what I have learned so far, and I’m wondering how your education could have taught you so many wrong things.
What I want to know is, where did she actually learn the things she is saying? For example, where did she learn that it “takes 6 weeks to recover from c-section pain” (which is illogical, as pointed out, but whatever). Who told her that? Was it something said at MW school?
Similarly, who taught her about oxytocin vs pitocin? Was that something she learned in school, too?
Or was it something that she thinks she knows, and therefore spouts it?
Me thinks she has been getting her education from blogs and mothering.com. We only have her word that she is a legit CNM student.
I admit, I do take people at their word, to a fault.
Then again, this is why you call their bluff and subtlely ask for more information.
I have no idea if she is or is not an actual midwifery student (in Canada we have a 4 year direct entry bachelor with no nursing background required), but I have to tell you, having taught student midwives I would sadly not be surprised if she was an early years student in these programs. Though they are located in universities, they tend to teach from a very ideological, not-scientifically rigorous perspective.
And…crickets….
C’mon lady.
You can tell us where you learnt stuff.
It does read like that…but I’d like to give her a chance to tell us about her educational and clinical experience.
I do have one question… why is it illogical that it takes 6 weeks to recover from c-section pain? 4-6 weeks was right for my 1st, 2nd, and 3rd c-sections (though returning to exercise took a lot longer than that to not be in pain). My doctor told me 4-6 weeks recovery as an average and, in my cases, it was spot on. For some others I know it was much different (some just a week to feel recovered and others upto 8 weeks).
It was a good 8 weeks for me, but really 4-5 months til I stopped having abdominal pain when moving certain ways.
Yes, 5-6 months is when I was able to start working out again using dvds (not just walking). I would get those painful twinges every so often the first year (that could be because I was always pregnant again during that post-partum year though). Obviously the c-sections were totally worth it, but the surgery was not a walk in the park for me. But neither was my vaginal birth. It helps remembering that we are not entitled to life being a certain way, to experiences being what they “SHOULD” be, etc… it is what it is and we are thankful for the blessings! I can deal with the pain if it means my kids won’t have to! 🙂
I think it’s also good to remember that experience s of c-sections can vary greatly just like vaginal births can. I sometimes think there’s a bit of selection bias in SOB’s commenters, because I think people who had easy c-sections and/or horrifying vaginal births might be a bit more likely to be attracted to the site in response to the NCB claims they’ve personally had to fight against. I tend to see claims on these threads like c-sections are easier, you’ll be on your feet with just ibuprofen in a day or two — I’m glad others had that experience, but I didn’t at all. It’s a big reason why I wanted to VBAC if it could be attempted safely.
I think people are reacting against the idea that a C-section is automatically a nightmare. It is for some, but not for all.
There are two issues here: one, superannuated claimed that if you have a c-section, you WILL be in pain for 6 weeks, which is obviously not true. Some people will have pain for that long (or longer), but not all of them by any means.
Second, after multiple people pointed out that they weren’t in pain after a c-section for nearly that long, superannuated shifted her ground and said that it takes 6 weeks to “recover” from the pain of a c-section, which is nonsensical. You have pain or you don’t — superannuated seemed to be saying, “Well, okay, so you didn’t HAVE pain for six weeks, but you were still RECOVERING from the pain.” Which is BS.
ETA: If she had just said, “It takes about 6 weeks to fully recover from a c-section,” leaving out pronouncements about pain, there wouldn’t be much to argue about. Of course, 6 weeks seems to be a reasonable time for recovering from a vaginal delivery too, so… that wouldn’t have propped up her demonization of c-sections very well.
Taking 6 weeks to recover from c-section is not illogical (it can happen, and can be longer). Taking 6 weeks to recover from “c-section pain” doesn’t make sense (how do you recover from “pain”?)
Pain is a state – you either have it or you don’t as part of your recovery. If you have it, you can have it in various degrees. You don’t “recover from the pain” you recover from the procedure.
They’re praying for you to shut the fuck up and go away, maybe, but not for your recovery from personal trauma. That is a homebirth advocate standby and should be in the drinking game, that anyone that disagrees must be in the grip of some repressed pain and only needs love to come back away from the dark side. It never occurs to them that normal people are saddened by the deaths of innocents and that’s why we disagree so vehemently.
I don’t think they grasp the enormity of the impact on families that are affected either. It’s seen as something that you need to hurry up and get over and heal from. They don’t understand that it’s impossible to just heal and pretend that your baby never existed. There is absolutely NO closure for us and no help or caring from them. We are left holding the bag here.
I am so very sorry, Bambi. You are so brave.
I’m so sorry for your loss, Bambi, and I am grateful to you for speaking out. Yours was one of the stories that majorly helped to sway me away from attempting another home birth when I was pregnant two years ago, and (because of the complications I developed towards the end of that pregnancy), that decision certainly saved my son’s life and likely spared my health and maybe life too.
My heart just aches for this little boy’s family. The HB midwifery community is vigorously trying to close the book on this tragedy, but for the family…their grief is only just beginning.
ETA: this is prolifefeminist – apparently I CAN log in to disqus, but I have a different username.
We can use #notburiedtwice for any home birth death right? I used it in this post about talking w a politician who pushed for voluntary licensing in Utah and is now running for office again. She is in total denial about what happened here in 2012. http://safermidwiferyutah.wordpress.com/2014/02/28/holly-richardson-responds/
I’m confused by your title The “Skeptical” OB. Are you skeptical regarding both modern medicine and homeopathic remedies? Are you claiming to be just as skeptical of studies that stress the dangers of homebirth than those that don’t? If you were an OB who was not biased toward ACOG recommendations, then that would be refreshing and blog-worthy. But like most of humanity, you are simply skeptical of one side of the issue. So you are not a skeptic, you are biased. The Biased OB would be more honest. It is understandable that you would be defensive regarding your profession. But I see no philosophical virtue in criticizing what you already believe to be faulty. It also doesn’t help the advancement of scientific progress, which should always be self-critical.
Huh? You lost me.
Of course she’s biased. She’s a doctor and deals with the real world. She is biased towards reality.
Careful, Alison. You’re showing your bias!
You clearly haven’t read this site. Dr. Amy has also attacked ACOG’s 39 week rule quite often. Anytime either side comes up with things that are not supported by scientific evidence she will talk about it.
MANA and homebirth supporters have a history of lying about safety in order to try and justify their aesthetic choice for homebirth over hospital birth. When people lie to themselves it’s sad. When they are lying to other people, leading women to have homebirths because they mistakenly believe that it is safer than hospital birth, that is something that needs to be rigorously fought against. It’s not a philosophical exercise, it is about trying to get truth into the NCB echo chamber.
You’re correct that I’m not a follower of this site. I visited here yesterday to read Dr. Amy’s take on the new breastfeeding study, which I appreciated. Realizing that she had written on homebirth (I’m expecting and currently decerning my options), I checked out several posts, which were, not only excessively critical of the homebirth movement, but also condescending and often needlessly insulting. This would not bother me except that the name of her blog had given me false expectations.
I realize that my post was glib and rash. I appologize for that.
Both sides want to use statistics to back up their claims and justify their way of life. I’m glad to read that Dr. Amy supports a woman’s right to alternative birth options, as long as its an informed decision. The issue is informed in what? Are women fully informed regarding the risks of every medical procedure and intervention they will be subject to in the hospital? I know of a woman who died from a routine epidural during her labor at a local hospital. Medical mistakes occur frequently. Which is why medical malpractice is so high, particularly for OBs. But where is the outrage when unnecessary deaths occur in the hospital? Deaths from unnecessary interventions that would have not occured in a home or bithcenter. A friend of mine had a c-section during which the surgeon accedentally cut her bladder with the scalpel. Because she was pressured into undergoing the c-section, which she is now convinced was unnecessary, the pain of the experience has been very difficult for her physically and emotionally. Hospital deaths are justified because they occur in a highly medicalized environment — because the patient puts her life and the life of her baby into the hands of the prevailing medical system, she is not blamed for any harm done. But, even if she is “informed” and chooses an alternative option the blame is laid at her feet. As if she should have know better.
Yes. Its funny and sad that some called Dr. Amy satan. But Dr. Amy shouldn’t be a snake in MANAs garden (attempting to destroy) she should be a thorn in there side (calling them to improvement.) Dialog, encouragement, and respect will change minds. I have not witnessed these things here.
In what way?
Yes, both sides WANT statistics to back up their claims, but the midwives are lying about what the statistics say. In particular, MANA claimed that their results showed “no increase in adverse events.” This is trivially shown to be not true. Their own data showed that death rates increased multifold. That means that their claim that there was no increase in adverse events is bullshit. What else can you call it? Unless you want to suggest that death is not an adverse event.
So this “both sides want to use stats” is a complete red herring. Why don’t you actually address the point instead of rambling on?
oh wait…
So you are a tone troll. That explains it.
How do you know she is overly critical of homebirth? How do you know it is not YOU who are biased? All of us have intuitions and belief and all of us can be wrong. Which is why those of us who care about truth rely not on intuition and belief but on evidence and data. In fact many of us are so determined to rely on evidence and data that we have degrees in data analysis. And when we analyze the data they show VERY CLEARLY that homebirth is less safe than hospital and homebirth with a cpm is more dangerous still. Now, if you have evidence to override the hours and hours that people on this blog have put into crunching the numbers, I would be very interested to see it. But I don’t actually think you have that.
“Excessively critical?”
Tell you what, pburg. You go read this post:
http://www.skepticalob.com/2014/02/in-memory-of-a-baby-boy-who-did-not-have-to-die.html
in which a CPM admits to letting a pregnant woman go over two weeks past due, convincing her to ignore medical advice from an actual professional, performs inadequate testing, delays action, CROWDSOURCES WHAT TO DO ON FACEBOOK, and delays more while a baby dies in utero.
Also in that post (and ones related to it), notice how A) the midwife tries to blame the mother; B) how the midwife takes to her own FB page four days after that baby dies due to her negligence to post some doggerel about how babies aren’t library books with due dates; and C) how all of the midwives rally around the midwife and don’t even think about or consider the dead baby or his devastated parents.
Take a look at these posts, where the midwife in question and other midwives try to pretend the midwife responsible did nothing wrong and throw blame off on anyone else to whom they think they can maybe make it stick. Look at the long FB thread where several hundred midwives insist it wasn’t the fault of the original midwife and she should be left alone. Look at the original “crowdsourcing” post, at some of the suggestions made by the midwives (stevia, massage therapy) and how completely, totally ignorant they all are of the very real potential consequences and problems that could–and in this case DID–happen:
http://www.skepticalob.com/2014/02/update-2-to-the-notburiedtwice-campaign.html
http://www.skepticalob.com/2014/02/update-to-the-notburied-twice-campaign.html
(Note: Disqus won’t let me post more links than that. Please follow the links back.)
Now you tell me how in the world it is possible to be OVERLY critical of these people?
If YOU were the mother spending the night in a hospital bed holding your dead baby because your CPM crowdsourced your case on Facebook and withheld medical information from you, and then outright said publicly that she had nothing to do with your case while all the other midwives offered her hugs and comfort and said she’d done nothing wrong…would you think Dr. Amy or any of us were being “overly critical?”
And that case, btw, is not particularly unusual.
“Overly critical.” Give me a break.
I’m not even going to bother with the rest of the misinformation and logic-free CPM Talking Points you’ve posted. If you honestly believe we’re being “too critical” of a midwife and a community of midwives that played around online while a baby suffocated on his own feces, you won’t listen anyway.
And this happens over and over and over again, baby dies, mother is blamed, midwife is rallied around. And I expect to see several more documented here before the year is out. But let’s not be “too critical.” Sheesh.
Yes, absolutely, things do happen in hospitals, because it isn’t a perfect world and humans aren’t perfect. The difference is in how those errors are handled. As an obstetrician, I am subject to peer review. Whenever our unit has an adverse event, we do a full and complete review that is transparent, communicated to the famalies, and often result in policy changes that improve patient safety. We have programs for parents who have lost children and we provide ongoing support. We can’t eliminate human error, and it is ridiculous to think otherwise, but we can take opportunity to learn from our mistakes and endeavour to do better in future. I don’t see that happening with midwives.
Thanks for the response. Yes. Human errors occur in hospitals and at home. When a mother or baby needlessly dies at home, it is highly publicized and the midwife’s career is certainly finished. But, when human error resulting in death occurs at a hospital, it’s not publicized and the health care professional at fault is less likely to have his/her career irreparably tarnished, let alone finished. One reason for this is that causes of death at a hospital often result from different types of error than at home. The passive (negligent) death is seen a tragedy, but a death resulting from unnecessary intervention is more easily rationalized. Since interventions, themselves, demonstrate attempted care.
For all I know the midwife in question should never have been allowed to practice midwifery. But, Dr. Amy is name-calling and the death of a baby is being exploited to justify a point of view.
Birth is dangerous business. Risks on both sides need to be weighed using the best information we have at the time. But scientific results are in constant flux (sometimes detailed, other times, major revisions.) So, modern studies may be one important rule of measure, but they cannot always be trusted — any statistician will tell you that. And what are we measuring? Death rates, of course, trump other issues. But birth is such a unique event, an intimate, and powerful experience that comfort, familiarity, and a personalized care need to be put into account. Not just because those thing can change an outcome, but because they are ethically called for. I realize that I put myself at risk for hippy/crunchy feel-good thinking. But, all I’m saying is that there exists aspects to birth that aren’t involved in taking out an appendix. There are both OBs and Midwives who don’t seem to grasp this. And, I know OBs who are much more likely to be alternative thinking than some midwives that I’ve encountered.
Btw, most midwives are subject to peer review. I’m sure some independent CPMs are not. But, I have met some incompetent docs who create in me doubt regarding to what degree peer review is efficacious. And perhaps the patient would rather hire a midwife who wasn’t under review than choose a practice (midwife or OB) which included practitioners with bad reputations among her friends and family. In some places, these two options may be here only choice.
I would beg to differ about homebirth deaths (and homebirth injuries for that matter) being highly publicized. They remain soooo hidden. That is one of the reasons I’m thankful for Dr. Amy and her efforts.
Pburg, I respectfully disagree that midwives are subject to peer review. Please check out hurtbyhonebirth.com to read stories about babies who were damaged or killed by CPMs who, in some cases, had multiple injuries or deaths under their belts and continue to practice today!
Aarg, DYAC! Hurtbyhomebirth.com.
Or the blog Midwife from Hell about a twin home birth. The mother is trying to press an inquiry with her state midwifery organization, in vain.
Or hell, even sistersinchains! “Midwife fined in connection with home birth death, now must jack up price on Etsy store goods knitted while holding the space as a result.” Oh no! I don’t think there is one on there who did not keep on trucking after screwups of a magnitude that would be career ruining for most people, much less most doctors.
Please list all the homebirth midwives whose careers were ended by presiding over a death at homebirth. It shouldn’t be too hard since it is a very, very short list.
We’ll allow you to include all of those who stopped practicing “voluntarily”.
I’ll give you one:
Evelyn Muhlhan, formerly a CNM.
No longer practicing due to a string of complaints against her including at least one death. You can look up the details of each case.
This is a CNM who lost her license and ability to legally practice. Does any CPM have this type of regulation and accountability? Anywhere?
CPMs can have their whole credential stripped from them and keep practicing. They find a new state.
Valerie El Halta and Christy Collins seem to be apt examples of this.
Deaths because of medical error occurring in the hospital certainly do have consequences.
You have the wrong idea about “interventions.” Many have risks, which are explained, and have the goal of preserving a vaginal birth, or saving a life!
I thought that what is discussed in peer review is private and talked about with the families? I wish that I knew whether my obgyn went to peer review and what was discussed!
I am glad you came to this blog to sort out the conflicting information on birth, breastfeeding, parenting etc. I have been humbled by the thoughtfulness and by the high level of education typified by the posters here. Ask questions, pburg, and take comfort in knowing that here you won’t be patronized and here birth won’t be romanticized.
How about this post of hers, “You heard it here first: new paper opposing home birth is poorly researched, relies on bad studies and is woefully paternalistic”? http://www.skepticalob.com/2012/11/you-heard-it-here-first-new-position-paper-opposing-homebirth-is-poorly-researched-relies-on-bad-studies-and-is-woefully-paternalistic.html
The recent skeptic movement relies on science, not “other ways of knowing” or in homeopathy’s case – “magic” water.
Dr. Amy has just as much right to have a blog about the dangers of home birth as the NCBers have to blog about c-sections and hospital births. Do you say the same things on THEIR sites?
Actually you could have saved all the typing and just called her “Satan.”
(Yes, I am having a great time with that one)
More fun to have a typo and call her Stan
(yes, I realize that Santa would be funnier, but it’s not an easy typo to make)
I keep seeing “Stan” too – I’ve been reading too much Orac.
Why?
What’s wrong with ACOG recommendations? Be specific.
The best you got is criticism of her blog name? Care to weigh in about the content?
Of course Dr. Amy is biased. She is biased towards live, healthy babies. I wouldn’t have her change at all.
Because bias towards live, healthy babies and mothers not being denied informed consent by willfully ignorant ‘care professionals’ is a bad thing? Please enlighten me as to why?
And homebirth midwives write papers crowing about the glowing safety of homebirth out of the purity and goodness of their moral virtue. Oh bless their little hearts!
Not.
CPMs are FAR more biased than Dr. Amy. If this was reversed, your questioning post would have alredy been deleted by the homebirth crowd. They’re VERY good about scrubbing their message boards, websites and blogs of any questioning posts or comments.
Have you noticed that the Facebook thread that is the discussion of this post is NON-EXISTENT now (except for screen caps) because the gloriously unbiased CPMs deleted it to cover their baby killing tracks?
Come on now, catch up.
One of the definitions of skeptical is “denying or questioning the tenets of a religion.” So there’s that, too.
Just saw Jan’s facebook. Now my phone even feels crunchy.
I’ve
been contacted privately by a person with a tremendous amount of
information about the case. I’m am checking the details and will publish
them as soon as I can.
Whatever you think is best.
I don’t care for much except for one thing: is it true that Christy Collins was the midwife.
She has denied it. If she is lying, that is highly disturbing.
If she’s not, she’s a ticking time bomb. From her website, homesweetbirth.com, downplaying the risks of HBAC: “The rate of uterine rupture in women who have had MORE than one previous cesarean section is only slightly higher than the uterine rupture rate in women with one cesarean, but ruptures in the reported series tend to be asymptomatic and without serious consequence.”
Ruptures tend to be asymptomatic?!?!?!?
I guess dead and brain damaged babies aren’t “symptoms.”
There is a type of rupture that is better thought of as scar separation than a true rupture. These are sometimes called asymptomatic uterine ruptures because they don’t have the terrible consequences of a full rupture. Asymptomatic ruptures are not uncommon in pregnancy after childbirth (I think I’ve heard 30%) but they are also a totally different animal from uterine rupture during TOL. It’s like comparing a cut to an amputation. (http://www.patient.co.uk/doctor/Uterine-Rupture.htm)
So basically Christy is saying that the chance of a rupture is rare and not to worry about it, because even if you do rupture it will be the asymptomatic type which is not really all that bad.
Yes. But she’s confusing the types of ruptures. Asymptomatic ruptures are not rare at all. Full uterine rupture in VBAC is at least 1/100 (although other studies place it as high as 5). The fact that most ruptures and not full ruptures do not have any impact on that VBAC stat which only looks at full ruptures.
I’m wondering if she’s confusing it or if she knows and it’s one more piece of misinformation that could seem technically correct in retrospect when something goes wrong.
Thanks!
Is it possible to have a uterine rupture that isn’t a big deal? I’m not a medical professional, but if my uterus ruptured I’d think that was bad.
Can someone please explain to me how a uterine rupture could be asymptomatic?
I have no idea whether she’s right or not, but I would think the last thing you would want is an asymptomatic rupture where presumably only the baby suffers but you can’t tell it’s happening???
Melissa explains below what asymptomatic actually means.
I seem to remember a discussion in a previous thread of partial ruptures. Don’t remember their significance, but it appears to be a common area of confusion.
This article distinguishes between rupture and dehiscence.
http://reference.medscape.com/article/275854-overview
It’s possible that she’s counting dehiscences as ruptures, but she doesn’t cite her source.
Sure, the ruptures do not always kill, but that is because they are IN THE HOSPITAL!!!
Rupture at home is a death sentence for the baby, period. There is not enough time to fix this emergency if you are at home.
If 1 in 200 risk sounds good to you, go for it. I doubt people realize that this is what they are signing up for.
Even if there is no serious consequence wouldn’t you want it sewn back up? I mean really who would want to run around with a partially open uterus? That can’t be good at all for mom. Plus that would cause issues with any pregnancies that could come after.
Yes, she is the midwife. She basically outed herself.
Wasn’t she threatening to sue you for suggesting that she was the midwife? Threatening to sue you on the grounds of… being right, I guess.
I wish I had some Dexter in me because I would love to take out these incompetent midwives.
It’s why I’m glad to know the one I had is dying.
It really was royally stupid of her to put all those details on Facebook on a public thread.
But have you confirmed it from your independent source?
Doh
Dr. Amy, are you aware of her history? (http://www.sistersinchains.org/our-sisters-in-chains.html) This is scary stuff! She’s still technically on probation!
Christy Collins, CPM (midwife), 2011Charged with practicing medicine without a license. Took a plea of misdemeanor practicing midwifery without a license. Ordered to pay nearly $10,000 in restitution to the state and put on probation for three years.
Jugoslava Ilankovic, you win the Internet today 🙂
More interesting reasoning:
These stats are pulled from old crevices in my frontal lobe and occasionally from my caudal vault, so I will gladly stand to be corrected on the details, but here goes.
(About) 10% of pregnancies deliver prematurely, 10% are complicated with toxemia, 5% with gestational diabetes, 2% with ectopic implantation, 1% with multiple gestation, 5% with breech presentation. At minimum, there is a 10-15% need for C/S. About 5% of babies are born with significant congenital anomalies. About 15% of pregnancies spontaneously abort in the first trimester. Now, throw in the odd things like placenta previa, accreta, abruption and insufficiency; isoimmunization; thrombophilias and anti-phospholipids; cord prolapse; and pre-existing maternal disease. Now, I fully realize there is a lot of overlap amongst the categories. But, even still, how and why are we supposed to “trust birth”. How indeed did we get here as a human race (there were likely more bison than Homo sapiens in North America prior to the European invasion in the 1500’s). Throw out primigravidas and TOLACs like they do I Europe, I can’t see many women at low enough risk to even consider an informed consent for home birth.
During my studies in the UK, it was quite difficult to amass the necessary minimum number of homebirths to qualify for licensure precisely because the criteria were so strict. They have since been somewhat relaxed [accepting primips is, I think, the main change], and the statistics for maternal/fetal complications have risen.
I can imagine in the past that there might have been many many more cases for midwives. More women having more than 1 or 2 children and less women surviving what were once fatal complications during their first labours.
Retaining a doctor for a delivery is, historically, quite a recent phenomenon and initially, it was for the rich or aristocratic. Prior to the development of obstetric forceps by the Simpsons in the 18th century, most obstetric complications just ended in death for the mother. No anesthesia, no effective means of infection control, no understanding of blood groups or the ability to transfuse…doctors really weren’t much better than midwives. And, of course, some midwives operated within a dynastic situation, with mothers handing down to their daughters the benefits of experience and, in some cases, keen observation of what worked and what didn’t. But “folk wisdom” has its limits.
Interesting reasoning here. CPMs say:
1. We demand you practice evidence based medicine.
2. (Which implies) We practice evidence based medicine.
3. (Which implies) We practice medicine.
4. We do not have a license to practice medicine.
5. (Which implies) We are breaking the law.
6. (Which implies) We need to be fined and/or imprisoned to protect the public safety..
Am I missing something here?
Reasoning doesn’t really seem to be their strong suit! Or “reasoning” really. Incidentally, i love the scare quotes trend. HB advocates started it with their “Dr” Amy phrase, but yet it seems so apt to apply them liberally to all the nonsense they come out with! Their “evidence” they base their “practice ” of ” midwifery” on , is FB crowd sourcing. Hardly number one strength in the hierarchy of research evidence.
Marlene’ s comment is actually more revealing of the parlous state of her (or midwifery’s) own soul , (Dr Amy’s “satanic ” attack notwithstanding, lol !! Is she serious?? !)! A precious newborn baby is dead , parents grieving, a tragedy completely preventable and yet she concerns herself with posting petty comments about Jan being “picked on”, as though this debate is of no more consequence than a schoolyard squabble. A religious variation on the Dr Amy is being meeeeeeen catch cry. The real ” wolf in sheeps clothing” in this scenario is the callous disregard these women have for the baby and its family and the demonstration of their true priorities, ie protecting their self interest and demonising (literally) those that offer legitimate criticism of their conduct. Disgusting.
I completely agree.
I’ve also found it interesting that by talking only about how “she” is “picking on you,” she acts as though Dr. Amy is the only critic here and no one else has a problem with it. (Also, isn’t it interesting that while Dr. Grunebaum has been quite vocal, they’re not talking about him “picking on” them? Is it because he’s a man, or do they not want people to look him up and see his other work, or…?)
I think many of them genuinely don’t know who he is, because they’ve mostly ignored his studies. Since his studies show that home birth is bad, they haven’t made their way into the NCB echo chamber. He’s not famous to them the way SOB is.
But yeah, it’s also because he’s a man, I bet.
CPMs belong in the same category as faith healers. Not HCPs.
If your solution to criticism is to pray it away, it doesn’t bode well to your response to a medical crisis.
Off-topic: Mommyish.com has a post from a woman who complains she is being judged for planning a homebirth, and she says that pain management is 90% mental: http://www.mommyish.com/2014/02/27/birth-horror-stories/
Let me guess. She’s a first time mom.
Ok, I clicked. I was wrong.
Well, my MIL had 12 babies, and you know what her only advice was? Every pregnancy and labor is different. I like to say that when women who have had two or three kids get all know it all about childbirth.
Yeah, it’s 90% getting over the mental block of getting a needle in your back for an epidural. The rest is a downhill snap.
Ahaha. This is my favorite comment this morning so far.
That’s what it was for me because I HATE needles but I wanted the epidural anyway because I had a fast and REALLY painful labor with a big baby. Turned out that I was worried about something that was not very painful at all(for me, I realize everyone’s experience is different). The anesthesiologist had me sit sideways on the bed and lean over with my arms crossed. Turns out the leaning over my beach-ball of a belly was more uncomfortable than the needle, I barely felt it , even though he had to try twice to get it in(my vertebra are kind of tightly packed together).
Funniest thing: I was 4 and half or 5 cm dilated when he started the epidural. 30 minutes later I was at 9 cm.
I blush to admit this, but…before labor, I thought I had a pretty good chance of having a “natural” birth. Not to the point of refusing to consider pain control or anything, but still I was fairly confident that it wouldn’t be needed. I’ve always heard early labor compared to menstrual pain and I’m one of the lucky women who has fairly mild menstrual pain. So maybe I’d have fairly mild labor, right? (Magical thinking at its best/worst there, I know.) And I was the classic healthy pregnancy: I ate reasonably healthy (modulo pregnancy induced nausea), exercised regularly, had a head down, normal sized baby. I’d also had a reasonably low-woo birthing prep class with an instructor whose philosophy was “Use what you have to to get through labor pain. Here’s some ideas…(she included everything from epidurals to singing “99 bottles of beer on the wall” in the discussion.) So I felt ready. What could possibly go wrong?
Well, the answer, in short, was obstructed labor. Obstructed labor is painful as crap and is never, ever going to result in a live baby being born from a living mother without a c-section. I hope this woman doesn’t find out about the fragility of birth plans the way I did, but if she does, I hope she gets prompt attention and comes through with nothing worse than a scare and maybe an “unnecessarian”. Too many dead babies already.
I didn’t want an epidural so I got Demerol (before I had a reaction) and Stadol. Even though relaxing and breathing can help, she would do better to educate herself about her pain management options.
I did labor med free and the best way I have to describe it is mental pain management. I used the same mental tool box I use when running and either trying to get faster or run longer. You set small goals repeatedly. I took it one contraction at a time. Relax into the pain is NCB speak for embrace the suck.
That being said I have had awful vomiting with fentanyl and other pain drugs in the past and was lucky enough to have a 4 hour near precipitous labor. I woke up with a contraction and my water breaking at 5am and had a baby by 9. After having BH contractions starting at 23 weeks and painful and long but not regular contractions from 32 weeks. So not sure how long I would have made it if it was hours and hours. I also labored in water and it defiantly got more painful when I had to get out to deliver. I’m short and petite so I could stand up and squat and be neck deep in the tub or be on all fours in the tub. Being weightless in the water definitely helped. Not sure that would have worked if I was 5’6 or taller.
Homebirth is Wackadoodle and dangerous, but there are lots of reasons to avoid pain meds.
Wait, you’re saying this worked for you but it might not be for everyone?? But, but that’s so…. reasonable!! Seriously though, I see what you’re saying, especially if you have a history of not tolerating pain medication. And there’s a difference between saying “pain is 90% mental” vs. its possible for some people to manage pain through mental exercises, your mileage may vary.
Did you read the original article? It says that med free might not work out for you and that’s ok. I suck at copy and paste on my iPad or I’d insert a quote. I didn’t think it was a judgy article especially to have come from a homebirther. I was just agreeing that the running metaphors she used rang true for my experience.
Guilty! I should have explained the mental leap in my head: Your story was pleasing measured, it made me think of the difference between that and people who think it must work for everyone if it works for them, thus my judgement was based on a fictional argument, not actually reading the article. 🙂 Does that make sense? I appreciate that she didn’t try to foist it on everyone. That’s a universal irritation of mine.
I did my last labor pain med free, not by choice, it was just so fast I never got my epidural. Still bugs me! I was offered IV pain meds but they make me woozy and I was worried about the effect on the baby, especially since he was coming so quickly. That said, I had taken a hypnobirth class and the breathing exercise and directions to relax were pretty much what got me through the intense contractions. Not that I was actually relaxed, but like you said, “embrace the suck”. It was really hard to do and I only had to do it for an hour and a half.
The serpent worked by speaking in half-truths, so I’m not sure proudly owning that comparison is a good idea.
I love Dr. Amy but I agree. I am truly puzzled by this analogy. Some expository say the snake is satan or his agent.
I think maybe she was going for someone speaking uncomfortable truths. Some like Jonah or Noah?
Perhaps she should be the apple instead.
“Don’t go read the Skeptical OB!” That’s what they say. Because if you eat the fruit of the Tree of Knowledge of Good and Evil, then you will no longer be able to claim that, for example, encouraging high-risk women to home birth is good.
I think maybe she was going for someone speaking uncomfortable truths. Some like Jonah or Noah?
I expect she sometimes feels more like Cassandra.
Ha! Priceless!!
Lets not be so wedded to the details, which seem to be different in different faiths.
The idea is clear.
It is my understanding that the serpent was Lucifer (the devil) who was thrown out of heaven for trying to usurp God. I understand what Dr. Amy was trying to say. The people calling her Satan probably don’t have good Bible understanding.
I think that the Christian and Jewish interpretations of this scripture are slightly different.
Katy Perry CPM
http://www.usatoday.com/story/life/people/2014/02/27/katy-perry-helps-deliver-baby-in-living-room/5868609/
It continues to be an uphill battle, I guess. Katy Perry, pop star helped her sister with a home birth. I imagine lots of her fans will want to emulate her sister.
I wish they emulated Katy herself, in her clip of Roar. Have you seen it? Her happy life in the jungle? They can all go there and live naturally and leave unnatural things like hospitals and computers to us.
This said, romance usually doesn’t last. I love the Roar clip but each time I see her painting the elephant’s nails, I have to wonder, how much nail polish would an elephant take? I just bought four bottles of those. Think they’ll be enough?
Same with homebirths. Romance wears off.
Good lord, they dusted that hoary old concept off?
Happy noble savages without a care in the world?
Ah yes, Katy Perry, the purveyor of songs like “Ur So Gay”, pretend lesbianism, and pseudo-“geisha”-style performances on TV. A real model of cultural sensitivity and intelligence. 😉
It was actually more along the “strong wombyn” lines. Useless and vain mahn got eaten and she had to fend for herself.
I quite like the video, actually. Makes me laugh. The nail polish shade, however, was awful. It wouldn’t suit even me and I am quite pale, compared to a grey elephant, at least.
What’s natural about an elephant with painted nails?
I LOVE JUGOSLAVA ILANKOVIC!!
What about the father of this poor baby? Was he there watching his child die while this she-monster was on Facebook asking the peanut gallery for advice? Did anyone ask this poor man whether he wanted a hospital transfer for his child? Did anyone even care what he thought? My god, the grief and powerlessness he must have felt.
He was probably fully on board and soaked in the Kool-aide. I think a man who wasn’t brain-washed would be possessed by a strong urge to protect his family and would be a very good convincer.
How horrible, l hate to just assume anything about these poor parents without knowing anything. We can’t make assumptions about them, especially with the midwifery community trying to play “own your choices”
Please stop hating on homebirths in general. When they are attended by CNMs and doctors there is not the risk you discuss. Overgeneralizing causes widespread panic – please clarify that it is the CPMs who are responsible.
When do doctors attend births at home?
In rural areas where transportation to hospital is difficult. There are still doctors who perform home visits in these situations.
And in such situations, if transport to a hospital was necessary, then a trained physician would – I hope – do everything they could to make it happen. Perhaps I’m completely ignorant as to how far women might need to travel in rural America to get to a basic hospital (and I mean that seriously; I’ve only lived in larger-ish cities) but we’d still be discussing a situation of necessity, not preference. It’s my understanding that in MOST circumstances, doctors (and even CNMs?) don’t attend births in someone’s home out of preference.
In most instances they do not – as the insurance and liability would be impossible. That is not to say that it is dangerous to have a home birth. With complications there are always signs, and transfer to hospital is an option. Perhaps what should be done is increasing the number of birthing centres in the US so that if transfer of care is necessary, it is easier to do than with a home birth. But, the likeliness for transfer when one is working with a CNM or doctor is not often.
I don’t agree that there are always signs of complications. Sometimes they happen very quickly and unexpectedly.
Not sure if you saw my post above talking about the services available at my local hospital, which is pretty much identical to the things you’d have at a birthing center (pools, chairs, a doula or midwife with you throughout your labor, self directed pushing, no efm if the mother does’t want it, etc.) You even have to file a birth plan with the hospital when your register asking about the music you want and if you want them to ask if you want pain relief.
I don’t live in a big or even very progressive city. If this is the norm here I suspect it is already the case in many other larger hospitals. Since hospitals have been willing to change to accommodate the complaints that NCB made about them why do we even need birthing centers or homebirth except possibly in places where hospitals haven’t progressed (in which case the infrastructure to allow for qualified people to run a birthcenter or to have timely transfers to a hpspital are problematic)?
With complications there are always signs,
Would that it were so! The reality is that, very often, when the axe falls, it falls very fast indeed. Especially when the woman’s pregnancy and labor have been entirely “by the book” up to that point.
The problem with birth centers, unless they are situated literally down the corridor from a hospital which can handle any emergency, is that, in order to be safe, they have to be able to replicate hospital facilities: OR, labs, blood bank, NICU [and sometimes even adult ICU].
So what’s the point? IMO, the problem is the terminology as well as the decor. “Hospital” seems grim and utilitarian, a place for pathology; “birth center” sounds warmer, cozier.
Oh… oh, oh. I used to believe that. I think I’ve said those exact words even. Once you have a few emergencies under your belt, you’ll learn better. Hopefully not at the expense of a mom or baby.
You can’t be sure that you will transfer to the hospital in time. That’s no guarentee.
So CNMs can perform an emergency csection at home? And CNMs have been swayed by the woo and the siren call of vaginal births at all cost too.
What makes you think that c-sections are going to happen? For a normal, healthy pregnancy this should not happen. I personally would not want a home birth but that doesn’t mean it shouldn’t be an option. I think as a society we should come up with more creative solutions for care. Would you be against birthing centres? Making the experience feel less like the woman is being hospitalized will ultimately increase everyone’s happiness with the process. You can’t tell me that you enjoy being in a hospital bed with fluorescent lights and a hospital gown? Increasing the value of the experience with access to emergency cesarean care nearby is the real option here.
Homebirth has worse outcomes. End of story. The Netherlands study is a good example that even in countries where homebirth is used in an ideal way it is not safer than hospital birth. In a low risk pregnancy a woman might decide that she’s willing to accept the slightly greater risks in order to not have to go through the experience of being in a hospital. But that should be the analysis, an honest look at the risks. If people look at the risks and still want the homebirth that is there right. But the NCB community has made it impossible for parents to make an informed choice by lying about the risks of homebirth while also neglecting to point out how far hospitals have come in allowing for alternative treatment.
I live in a fairly small city (less than 200k population) but our hospital asks you to submit a birth plan when you register. If you don’t have one they will give you a sample one with check box options for things like “labor in a pool” and “no pain relief will be offered” (vs. offer pain relief if I seem to need it and an option for I want pain relief). They also have boxes for skin-to-skin contact immediately and delayed cord clamping. They offer you a doula or midwife to stay with you throughout your labor.
The fact is that almost every city already has created the non-medicalized birth atmosphere thus negating any need to birth at home. The fact that people still are (and that the numbers may even be climbing) makes no sense if the concern was hospitals being too medical since they have worked hard to become more friendly to NCB.
Do you work in the hospital system? How many hospitals have you seen that create these accommodations? In my experience it is not the case (unfortunately). I think that both extremes (NCB and also Tuteur) are painting pictures that are a little too rosy. Every option has its downside. That is the reality. End of story. Please just give accurate information to people instead of creating unnecessary fear surrounding childbirth.
I don’t work in a hospital system. I’m a doctoral candidate in public policy and administration. I don’t know how many hospitals have these things because I don’t actually study the hospital system. But I know that if it is available at in a smaller Southern city that it can’t be all that rare.
Every options has a downside but the downsides of hospital births can be (and in may times has been) mitigated as hospitals have responded to the demands of patients to allow different birthing options. The downsides of homebirth can’t be mitigated in the same way. We can do a lot to make hospitals feel more welcoming and nicer places to labor in, but we can’t do anything to make a home have a NICU and surgical suite available.
Nevertheless there are instances where homebirth is the desired option for the mother and appropriate staffing should be made available (CNM/family physician) in order to accommodate this. People are so different, as are the potential individual risks involved in each childbirth. Not everyone has easy access to a hospital, or perhaps for various reasons cannot go to a hospital. Oh, and in most instances these health professionals can handle most birth emergencies. Extremely rare problems are normally recognized prior to labour and transfer of care can be provided. We should focus on proper education so individuals can recognize these signs and how to deal with them appropriately.
“Oh, and in most instances these health professionals can handle most
birth emergencies. Extremely rare problems are normally recognized prior
to labour and transfer of care can be provided”
Nope. Amniotic fluid embolism recognized before labour? Ultrashort cord recognized before labour? Nope.
There is no science or woo available to anyone on the planet to accurately predict how a birth will go. But if you have the technology, please hand it over because we really need it. We know that certain groups are more likely to have certain complications, but the person who is most vulnerable is the least available for assessment … because they are INSIDE ANOTHER PERSON. Bad outcomes in hospitals are rare (and I don’t mean “unneccessareans” or hurt feelings), because they have a huge range of interventions available to them at short notice. When the most vulnerable individual in the equation has the least amount of reserve, and the most to lose, then you don’t prepare for “most birth emergencies”, you prepare for all of them.
And the idea that qualified professionals like doctors and LMs should provide subpar care for homebirth in order to satisfy a minority is unfair. It undermines the reason that many of these professionals end up in their fields, because they want to provide care. Good care, where people go home with a well, live baby, and reassured that they were cared for by professionals.
I agree with you. If people want to take the risks of having a home birth, they should pay for it. Here in a large metropolitan US city where I live a reputable CNM charges $7,000. for a home birth last I heard. I believe this midwife had hospital privileges, too. Another reputable CNM charges about $4,500 and does not have hospital privileges that I am aware of. This might be old info, but you see dollar for dollar how expensive appropriate care is.
What signs and symptoms should the provider be able to recognize before a cord prolapse occurs? What about placental abruption? How long does the average transfer take? How long does it take before the baby dies, or suffers serious brain damage in those instances?
Those who think a transfer is such a snap should watch the last part of The Business of Being Born.
I think you have more than a little fear yourself — fear of the establishment being unsympathetic. The conditions you describe are not as common as you think.
I believe you have a biased view of one system being greater than the other, and that one model should be completely abolished. So, no I do not have any fear of the hospital system. I just know it isn’t for everyone – and that as NM you and everyone else should respect a mother’s wishes.
Babies die at least 3-4 times more at homebirths than at hospitals.
Yup, I have a biased view of one system being greater than the other.
That is because of individuals who lack proper medical training to deal with homebirths (CPM or LM)
Yes, exactly – unqualified individuals make up the majority of the “health care providers” in one of the systems.
One system is greater than the other.
I have no problem respecting a mother’s wishes as long as she really understands the risks and understands that I will not participate in any actions that will endanger her and/or her baby. Actually, in my experience, when a patient is given a proper explanation, I have found that most of the time the patient agrees with my viewpoint. Opposition happens when the the patient feels she is being ordered about for no good reason.
Uh, no – you definitely are far more biased.
I am in Canada. All of my local hospitals offer a birth plan with boxes to tick off as Melissa described. Instead of helping hospitals provide nicer maternity wards (and they’re not terrible by any means), the province just spent $10 million on a birth centre for midwives to use that has beautiful L&D suites that are far nicer than my living room without any of that pesky life-saving medical equipment to get in the way. I think it is completely unfair for the province to provide this cozy environment for low-risk women but not for women who must give birth in hospital due to elevated risk factors.
And everyone else, this lady’s attitude is the reason I don’t trust Canadian midwives.
My n=3, but the three were in three different cities, two different states. Texas twice, Massachusetts once. I didn’t even have to look very hard to find these hospitals either.
Says you. Some women prefer to deliver their babies by c-section.
I know some women do – thinking it is easier. I say it is foolish to elect to have surgery on your body should you be capable of natural childbirth (which I realize is NOT always the case – not everyone is capable). Most women are.
Patronizing much?
Would you really elect to have surgery that will allow you to be in pain for 6 weeks? I can’t understand why anyone would elect for pain. I am sure there are situations where there is emotional reasoning for it – as there are always exceptions. But an individual should not do it because they think it is an easier option. That is not informed choice on the part of the hospital staff.
It’s not always a choice between pain and no pain. Plenty of women who gave birth vaginally are still dealing with pain at six weeks postpartum.
I prefer to birth vaginally, but with my first vaginal delivery my tailbone felt busted for at least 2 weeks.
Obviously you have a very unfortunate view of C/S. Women nowadays go home 4 days after the operation, function with mostly mild soreness for about 10. I have no idea where you get the “6 weeks” from.
[Indeed, I flew to the US from Israel 9 days after my first C/S, nor did my subsequent two C/Ss impede me in any way whatsoever after I was discharged from hospital — and I think quite a few of the contributors here have had similar experiences]
I HAVE seen women, after NSVDs, in significant discomfort, both in clinic and in home visits, for a month or more, due to laceration and episiotomy repair, btw.
It takes six weeks or more to recover from the pain of a c-section. That is fact. A laceration of the abdomen and uterus is no easy thing to bounce back from. I never once stated that tears are not painful (as they can be). But the reality is it is easier for the body to heal from a tear than it is a cut from a c-section.
I keep trying to come up with a calm way to say this- but whatever, here goes… Are you kidding me? I would take a csection over a 4th degree tear everyday of the week. If you asked the vast majority of women I’m confident they would agree. The types of tissue involved are virtually identical, but the vagina and rectum have the distinct disadvantage of being extremely difficult to immobilize, constantly moist and in a bacteria laden area, in addition to being absolutely packed with nerve endings and extremely important for sexual function.
Your assertion that a csection is always more difficult to recover from is both scientifically inaccurate and demonstrably false.
And I agree with you. But, the tears to that degree should not be happening. And when they do happen it is because your body is pushing prematurely. When labour takes it’s course in the final stage the tears should not happen to that degree (or at all).
“Should not” does not mean “are not.” So you cannot say so definitively that it is easier for the body to heal from a tear than a c-section.
It depends on the person.
Absolutely.
Again, are you aware of the literature in your own field? I just did a quick search and rcog, acog and an Ontario evidence review make no mention of pushing prematurely. Generally understood risks are large baby, persistent op baby, primip, Asian race and instrumental delivery. In general, those are not modifiable risk factors, and the incidence rates are very stable over time.
OB friend , who is Asian, calls it “Asian tissue perineum”
“Shoulds”… well, they do. I had that tear after a shoulder dystocia. Better than a dead baby, but still took 3 years to fully heal and have no pain during sex.
You have a lot to learn. One day, after you actually have been in practice for a while, come back and read your comments here. You’re going to want to slap yourself.
It’s OK. I said a lot of stupid, arrogant stuff when I was in training, too.
Please put that in writing, to all of your future patients. I assume you’ll have no issue with any of your future patients suing you when they tear, right?
You need to do some research…
I hope you’re in your first semester. You need to know what an ideal vaginal labour and birth look like so that you can recognize when a non-ideal one is in progress, and refer or intervene.
Major perineal tears happen when things are not ideal. If the baby might not fit, but you try to deliver vaginally anyway, you might end up with an operative vaginal delivery and a fourth-degree tear. Or you could opt for a c-section.
C-sections happen for a reason. You don’t compare the outcome of a c-section with the outcome of an ideal vaginal birth progressing perfectly with a happy fetus. You compare it with the outcome of an attempted vaginal delivery in the same circumstances that have folks worried enough to recommend surgery.
Significant 2nd degree tear here, delivered with RMs, in Canada.
I guess with their combined 30 years of experience, they had yet to learn your superior student ways…
Not to mention fecal and urine incontinence. We are not just talking pain, we are talking embarrassment.
I shall inform my labia minora of that fact immediately, as the scar still aches every time that I have my period after being torn by a nuchal arm.
This comment is based on your personal and professional experience, no doubt.
Well, my abdomen and uterus choose to disagree with you.
Mine too. 3 days of major pain, 2-3 weeks of mild pain with exertion. I believe I said at 3 weeks that I felt ready to go to the gym and try to get my abs back.
It’s a FACT? Really? Says who???
It most certainly is NOT fact.
Again, I think you’re confusing “recovery time” with “time you’ll be in pain.” They are two separate things.
I believe most women actually do bounce back fairly easily, actually. How many c-sections have you had? How many women recovering from c-sections have you discussed the matter with? Anecdota is not data, of course, but I’m very curious as to how you know beyond doubt that c-sections are “no easy thing to recover from.”
Please cite your source for “it is easier for the body to heal from a tear than it is a cut from a c-section.” (BTW, you do know that a tear is also a laceration, right?)
Really?? I had a tear that took several months to recover from.
What the heck?? What does “recover from the pain” even MEAN? You either have pain or you don’t. It’s not something you need to recover from. Also, is a clean incision really a “laceration”?
I’m sorry, how long are we supposed to keep responding as if this person is rational, and participating in a good faith discussion?
Ha! I was just thinking the same thing, as my eyes are starting to dry out from staring at my phone.
It took me six weeks to even begin feeling normal after my first vaginally birth. My cervical laceration was very painful, and I was severely anemic. You are full of shit if you think it’s easier to heal from a tear than a cut.
Because you know how everyone’s body feels?
superannuatedgoodness
“It takes six weeks or more to recover from the pain of a c-section. That is fact.”
No, it’s not a fact.
The fact is you’ve swallowed a lot of ideology and misconceptions without thinking things through.
Have you ever even encountered actual c-section patients in real life? Because if you had, I doubt you’d be repeating this kind of nonsense.
It took me six weeks minimum to recover from the pain of my vaginal birth of a 9.5 pounder. I couldn’t sit at all between the trauma you’d expect to the area, plus a giant second ass crack?? No idea how that happened except guessing that everything stretched as he was coming out to the point where the skin in my back split. If you think that everyone just “bounces back” from a vaginal birth, you’re crazy.
Quick question- Have you seen a 3rd or 4th degree tear repaired?
I don’t mean a video or a photo or a diagram, I mean HAVE YOU BEEN IN THE OR AND SEEN A MAJOR PERINEAL TEAR REPAIRED?
Have you seen an elective prelabour CS performed?
Again, not on TV or Youtube, HAVE YOU SEEN IT DONE IN FRONT OF YOU?
I doubt it, because no-one who has seen the difference would make that kind of comment.
It took my OB less than 15 minutes to sew me up and staple my abdominal incision closed. I’ve known him to take over an hour repairing a complicated tear.
Uterus, peritoneum, rectus muscle and skin in a clean line, versus a jagged tear through skin, vaginal mucosa, pelvic floor muscles, anal sphincter and possibly rectal mucosa… and sutures through all the layers…
I’ll take the abdominal incision every time.
“Paging Dr Bear, paging Dr Bear”
No, cuts heal better than tears.
Look at everyone you know with scars.
Which are worse, the ones done deliberately by surgeons or the ones sustained by accidental trauma?
Can’t you read Dr Kitty? 4th degree tears shouldn’t be happening! There, problem solved.
It is not a fact. I wasn’t in pain anywhere near 6 weeks with my c-section. Three days postpartum I was only taking ibuprofen as needed. Seven days postpartum I didn’t need pain medicine at all. By two weeks all of the soreness was gone. If this is a fact then I guess my body didn’t get the message.
Don’t you see? Your body has FAILED you! Mine, too, as I had the same experience. I know it’s been 3.5 years already since that CS but for the first time, but I may really have to rethink how I mentally framed that delivery as a positive experience. Now I think it must have been negative, if I recovered so quickly! 😉
It takes six weeks or more to recover from the pain of a c-section. That is fact.
Um..what? I had a c-section. An emergency c-section even (though I did get the bikini cut). I had a PCA pump for the night after surgery, took one percocet the next day, and had an ibuprofen when I got home from the hospital a couple of days later. That’s it for me and c-section pain. I expect that c-section pain can last 6 weeks in some cases, but it doesn’t inevitably last that long.
No, the restrictions extend for 6 weeks after this particular abdominal surgery (can anyone weigh in on other types of abdominal surgeries? Is 6 weeks typical or is it all different, in regards to restrictions on lifting, etc.). Every person tolerates pain different, so how could it possibly be stated that it takes X amount of time to recover from the pain of ABC procedure?
Six weeks is a guideline.
You can do what you feel able to do, when you feel able to do it.
The guidelines say I should have taken 3 weeks off work after getting a laparoscopic appendicectomy. I felt fine after a week and went back to work after 10 days. They aren’t hard and fast rules. Some people heal quicker and feel better sooner than others. Some people get really bored at home and figure that they may as well be sitting behind a desk as sitting on the sofa.
Six weeks is a reasonable timeframe to be back to 100% after abdominal surgery. It isn’t that you feel terrible fir 5 weeks and six days and then wake up and feel great at the start of week six!
It is not a fact, it is your opinion. Neither is it ‘reality’ that it is easier for the body to recover from a tear. Ask any woman who has had a third or fourth degree tear leaving them with all sorts of horrible complications.
In my nursing rotation on the postpartum unit this week I had one patient that had a primary c/s and had barely any pain at all and another mom with a vaginal delivery who tore almost to her rectum. She could hardly walk. It was interesting to note the comfort level of each type of birth. Based on what I saw, the c/s mom fared better than the vaginal delivery, at least in her initial recovery.
I had pain for 4-6 weeks with my c-section. Yes, I was up walking around the next day. But I still was taking motrin till the 4 week, on and off. Could be because I had 4 babies in 4 years and couldn’t just rest when needed.
There is absolutely no guarantee that the recovery from a vaginal delivery will be less painful or quicker than a csection. Vaginal tears can be absolutely horrifying, unpredictable and are not that rare. And before you say that the cause is mismanaged delivery I can tell you that in both instances that occurred in my group of friends Canadian midwives were the primary caregivers.
I would. I can’t understand why anyone would want to risk a LIFETIME of sexual dysfunction, prolapse, or incontinence when we have the technology to avoid it (AND decrease the risk of brain damage to the baby). Especially when there’s still a risk of emergent c-section and getting the worst of both worlds. Cut me the hell open! The only reason a woman “should” give birth vaginally is that she wants to.
I would upvote this 10 times if I could! I so agree!
I wasn’t in pain for six weeks and I had 4 csections. At most I needed medication for a week after the surgery. With my youngest son I didn’t even need them leaving the hospital. It drives me nuts when people like demonize csections and make them seem so much worse than they are.
Well, every person is different. Some do not have this experience and that is unfortunate.
So why are you saying that all csections are the same? Clearly they are not and some people prefer csections as a way to give birth myself among them. I was terrified by people like you when I had my first csection but it was very necessary as my son was transverse breech. I could have sought after a vbac but chose not to because I was happy with how my first csection went. If I had known then what I know now I would not have been so terrified and I would have sought after a primary csection.
Agreed. All c-sections are not the same because all people don’t heal the same. And all situations are not the same. I have had six deliveries. They most certainly were not the same.
I think the more exposure you have to different women and their birth stories, both c/s and vaginal births, the more you will understand how different each woman, each birth, and each experience can be. You will understand that judgments and generalizations tend to get thrown out over time and that you will be sad for those women who are sad over their births and be happy for those who are happy. You will see that over time, too, women become grateful for the children they have had and the birth experience tends to minimize over time. This is particularly true if the woman is supported, cared for and has an informed perspective about things. I am preparing to train as a Certified Nurse Midwife in the years to come and am glad to have this perspective starting out. Having had 6 babies and being a little bit older really helps! I do wish you success in your training and your future career. There are a lot of things to learn on this website, and I don’t agree with everything here or the tone at times. But I have learned A LOT here and really, really appreciate the educated, thoughtful, and informed commentators here.
How likely is it, though?
As noted above, “some women” have bad experiences with vaginal deliveries, too.
The question is whether it is typical or not, and the answer is obvious.
Could it be possible that the person making these ”superannuated” comments is studying midwifery in a tertiary institution? For real?
For me, even though I was in pain for 6 weeks of recovery it was STILL an easier option than having another child of mine become injured due to shoulder dystocias. Much easier to recover than to cart another infant/child to children’s hospitals for therapies, surgeries, etc. Much, much easier!
Neither of my c-section recoveries left me in pain for six weeks. With both of them my pain–well-managed by medication–was hugely improved by the end of the first week, and almost nonexistent by the end of the second. With both of them, by the end of the third week I hardly even thought about my incision, and experienced no difficulties or issues.
Six weeks is the amount of time you should wait before exercising, having sex, or lifting very heavy items. It is most certainly NOT the amount of time you’ll experience pain. I’m frankly shocked that you don’t know that.
Also? It’s not like labor and vaginal birth are pain-free experiences, from which one recovers immediately and experiences no pain afterward. (Tell that to a new mother gingerly having a sitz bath, or using a squeeze bottle after waste elimination because toilet paper hurts, or sitting on one of those inflatable donut pillow, or having difficulty walking.) Six weeks is the recovery time from vaginal birth as well, WRT exercise, sex, etc.
Oh, and if it means my baby is delivered safely alive and healthy, you bet I’d elect to have surgery that will “allow” (I think you mean “cause”) me to be in pain for six weeks. Or six months. Or six YEARS. Are you kidding with that question? The lives of my children are so worth that, that I wouldn’t even consider the question for a second. If the doctor told me my baby would only live if I cut off both my legs, I’d do it in a second. That’s my BABY’S LIFE. What else matters?
My c-section recovery was cake compared to my vaginal delivery recovery, which included a fourth degree tear.
Since when does a c-section cause pain for 6 weeks?
Jeez, my wife had two C-sections. Both times, they sent her home with a think a week’s worth of vicodin, and she never used it all.
Anecdotal, I know but the fact they only gave her a week’s worth of pain meds indicates that there is no expectation of 6 weeks of pain.
What they hell are they teaching you at midwife school?
I had 3 days of pain post CS lady.
3 freaking DAYS.
Another few days of what, at worst could be considered discomfort.
There are HB women with long labours who are in pain for longer than I was after my CS.
Some people have been known to opt for C-sections because the pain management is so much better and reliable than for surgery than for vaginal births.
I don’t remember being in pain for weeks, let alone six weeks. I think anyone who is in pain for six weeks should be seen by a doctor.
Pain for 6 weeks? Huh? I sure wasn’t in pain for 6 weeks after my c-section, and if a health-care provider told me incorrectly that I would be, he or she would NOT be allowing me to make an informed choice.
And what about perineal tears from vaginal birth? Do those just not happen?
You don’t know why anyone would elect for pain, yet you advocate home birth where little to no pain relief is available? Cognitive dissonance much?
Well, I personally would have preferred C-section pain to the 2 tears and the episiotomy I ended up with…
I had a large baby(about 9 pounds, I am 5 feet tall) and very fast labor( just over 6 hours from start to finish) late in the delivery my daughter started having late decels, her heart rate was not recovering from the contractions, that combined with meconium stained fluid convinced my OB and me that they needed to do an episiotomy and used the vacuum to get her out fast.
He asked before cutting and was very sorry as I had wanted to avoid that if possible but it was in the best interest of my daughters health. The NICu team cleared her lungs and she was fine after a day or two.
The stitches and pain in the perineum were so much fun! I could not sit or stand comfortably for weeks, don’t even ask how much fun pooping was! And now I have stress incontinenece.. I would have prefered a nice abdominal incision …
That’s awful – and not at all an uncommon tale! I’d much prefer my abdominal incision to all that other pain. Yikes!
superannuatedgoodness
“I can’t understand why anyone would elect for pain.”
I hope you offer all laboring mothers epidurals, then.
Pain for 6 weeks after a c-section? With a scheduled c-section, that’s unlikely to happen.
You seem to be veryinexperienced and naive .
HA! You are basically electing for pain when you get PREGNANT.
Hmm, after my third degree tear, I spend 3 days in the hospital and was in pain for a year. After my c/s, I also spend 3 days in the hospital and was in pain for 10 days. I must be doing it wrong . . .
I only had pain for like, 5 days. And actually, it may have been less – I took the pain meds exactly as prescribed. I was dumbfounded how quickly I recovered! Mind you, I was very careful to follow all the precautions, but pain was only an issue for a handful of days. And I am a BIG wuss when it comes to pain.
It is easier. And arguably safer.
Maybe you should get out of that profession if you’re going to make such harsh judgements about women’s choices (exactly what you’ve accused those of us HERE of doing about homebirth).
Oh, I see. I’m foolish and lazy.
First of all, if I prefer to have a c-section it’s not your place to judge me for it or speculate as to what my reasons are and how “correct” they are.
Second, aren’t quite a few women who choose homebirth with a CPM doing so because they think it will be easier (none of those awful painful interventions! No fear! Their own comforting, familiar belongings nearby!) and more peaceful? You yourself have basically said here that you think being at home makes labor easier, because there’s no fear and adrenaline to interfere with and stall labor. Why are homebirth women not wrong for wanting “easier” but women who prefer c-sections are foolish–especially when of those two options, one has an enormously higher risk of ending the process with a dead baby? It’s “foolish” to choose “easier” when it as much as guarantees a live mother and baby, but smart to choose “easier” when the odds are 450% greater that the baby will not survive (and who knows how much greater that the baby will suffer severe birth injury)? On what planet does that make sense?
I don’t think you care about the happiness or comfort of mothers at all; if you did you wouldn’t judge them for wanting c-sections. I think you care about them doing what YOU think they should do, regardless of their preferences or scientific evidence.
I’m applauding you right now.
Everyone’s been so nice, so I’ll stop that. Eff you. My body, my choice. I prefer a nice clean scheduled pain-free surgery to the risks of ‘natural’ childbirth and who the HELL are you to tell me I’m foolish.
superannuatedgoodness, as you said above, that is just your opinion, I do hope you won’t enforce it on others.
Also, what you meant to say was a “vaginal” birth, right? Not a “natural” birth. “Natural birth” implies forgoing all pharmacological pain relief, and reallly, do you want to imply that everyone who is physically capable of forgoing painrelief (i.e.everyone- pain won’t kill you) MUST do so?
Maybe a woman chooses a CS because she needs to do everything possible to keep her pelvic floor intact.
Maybe she has suffered trauma from sexual abuse or a previous traumatic delivery.
Maybe she just doesn’t want to push a baby out of her vagina when there is a low risk, predictable surgical alternative to the crapshoot that is L&D.
I wouldn’t call any of those reasons “foolish”.
In fact, I wouldn’t make a value judgement about anyone’s choice to have a planned prelabour CS.
How do you know it isn’t easier? I’ve had three babies, all birthed vaginally. My recovery was straightforward and easy with all of them. My longest labor was 4 1/2 hours, and I never had to push for more than 20 minutes. They were all also over 8 1/2 pounds, with my first just shy of 10 pounds. I now suffer from pelvic floor damage. Not a ton, but I pee on myself when I cough, or jump, or run. For the rest of my life this will happen. Sex is not as pleasurable, because my vagina did change. This is also going to be life-long, unless I have surgery to fix it. When considering the life long issues vaginal birth can cause, c-sections may have been easier.
Yeah, because unmedicated natural birth that resulted in a cervical laceration and massive pph was such a great experience for me. If you plan to provide care to women, acknowledge how damned awful vaginal birth can be and stop demonizing c-sections.
And I say you should mind your own business. What on earth gives you the right to pontificate?
Vaginal. Vaginal birth not “natural.” It’s a body part that you’ll be dealing with a lot in the future. Say it with me now – vaginal vaginal vaginal.
What makes you think that c-sections are going to happen? For a normal, healthy pregnancy this should not happen.
The whole point is that YOU CAN NEVER REALLY KNOW THAT. The most normal, uncomplicated pregnancy can turn into a life-threatening emergency in literally moments. Even the most normal, uncomplicated labor, even the most normal, uncomplicated birth, can do so. Just off the top of my head, think of abruptio placentae, or uterine atony. Prolapsed cord, real fetal distress.
This is where the lay public can be forgiven for simply lacking the knowledge to be aware of risk — why should the average person know everything there is to know about obstetrics any more than everything there is to know about, for example, their cars? The average person can know a fair amount, but only the specialist REALLY knows because of their education and experience.
I agree that hospitals can be “nicer”. But I think priorities are skewed when “nicer” trumps “safer”.
Are you not a part of the lay public, or am I mistaken? I am currently obtaining a degree in midwifery in Canada. Definitely not a part of the lay public. I will admit I have a great deal to learn, as even health professional do. There is always learning to be had, and I am all for furthering studies on this topic and informed choice.
And your comment on hospitals being “nicer”. It is not safer for the baby or the mum should her natural oxytocin be interrupted if she has a fear of the hospital setting (as many individuals do). An increase in adrenaline interrupts this cycle and causes undue stress on the baby and pain for the mother. That is fine if an individual wants to give birth in the hospital and they are comfortable with it. Perhaps you should be more considerate of other people’s needs and their desired birth setting?
No, I’m not a lay person. I have been a maternity caregiver since I graduated from nursing school in 1967, a certified nurse midwife since 1975, and I’ve worked in all branches of maternity care until my retirement a year ago. My career has spanned 45 years and I am licensed in three countries: the US, the UK, and Israel. [My homebirth experience is from the UK]
I regret to say that your comment indicates the degree to which you too are swallowing considerable amounts of woo. [there isn’t any difference between “natural” and synthetic oxytocin, for one thing, and being at home doesn’t prevent production of adrenalin, btw. Once labor is established, women rarely care where they are as long as they feel secure with the staff caring for them. As I’ve written elsewhere, many women who have had a homebirth find the recovery unexpectedly exhausting because they get no break from housework, and decline booking a second homebirth. The “romance” dies quickly.]
Hopefully, once you get some practical experience, your views will moderate.
Please cite the study that says there is no difference between natural and synthetic oxytocin – I have never heard that before.
I never professed any romance surrounding any type of birth. I do however think that certain individuals may have that perspective and they should be free to do so. Each person is different. It is regretful that your homebirth experience has been negative as a NM but that doesn’t always have to be the case.
superannuatedgoodness “Please cite the study that says there is no difference between natural and synthetic oxytocin”
Atom for atom, bond for bond, they are the exact same molecule.
Please cite the studies that show that the exact same molecule behaves differently if it’s “natural” vs “synthetic.”
Aren’t CNMs required to take any chemistry, particularly organic chemistry?
I haven’t taken chemistry beyond high school, and the concept still seems painfully obvious to me.
They are the same molecule. There is no basis for thinking that a two molecules, made of the same atoms, in the same configuration, will behave differently because one was assembled in a body, and the other in a lab. None.
And that is what I thought. No study cited. Here is a study for you: http://www.sciencedirect.com/science/article/pii/S030698771300368X
Here is the one from 1957 that you are probably thinking of: http://ovidsp.tx.ovid.com/sp-3.11.0a/ovidweb.cgi?WebLinkFrameset=1&S=ALAMFPLMNHDDPOGGNCMKHGFBFDLGAA00&returnUrl=ovidweb.cgi%3fMain%2bSearch%2bPage%3d1%26S%3dALAMFPLMNHDDPOGGNCMKHGFBFDLGAA00&directlink=http%3a%2f%2fgraphics.tx.ovid.com%2fovftpdfs%2fFPDDNCFBHGGGNH00%2ffs047%2fovft%2flive%2fgv039%2f00006250%2f00006250-195803000-00006.pdf&filename=Synthetic+Oxytocin%3a+A+clinical+evaluation.&navigation_links=NavLinks.S.sh.22.1&link_from=S.sh.22%7c1&pdf_key=FPDDNCFBHGGGNH00&pdf_index=/fs047/ovft/live/gv039/00006250/00006250-195803000-00006&D=ovft&link_set=S.sh.22|1|sl_10|resultSet|S.sh.22.23|0
THIS INFORMATION IS OUTDATED
The odent article you linked to is in the journal Medical Hypotheses” a well known vanity journal with no peer review which is infamous for publishing numerous articles on aids denialism.
This does not count as a reference.
Do you have a reference then on how they are the same?
I am not a midwifery student, I do not have a full understanding of the literature in this area. I will happily do a lit search and post about it tomorrow, but are you honestly telling me that the links you posted were your best understanding of the literature? That is your proof that endogenous and exogenous oxytocin are different?
If I were you I would want to understand the literature in my field and would do my own search ASAP. If they are as different as you seem to think I can’t imagine it will take you long.
superannuatedgoodness, “Do you have a reference then on how they are the same?”
Try this:
http://upload.wikimedia.org/wikipedia/commons/5/55/Oxytocin_with_labels.png
Also, here is a more relevant reference: http://www.sciencedirect.com/science/article/pii/000287036390317X
No medication is perfect. Yes, sometimes it is necessary. But no medication is perfect.
This reference has nothing to do with labour and delivery and is not comparing endogenous and exogenous oxytocin in any way.
I cannot for the life of me see how that study is relevant here!
It’s not.
Took the words right out of my mouth.
I love your arrogance. You’re currently obtaining your degree in midwifery, and you already think your knowledge is far superior to someone who’s worked in this field for decades. How charming!
I only hope you don’t head to do homebirths the very moment you have your degree because in a healthy pregnancy a C-section can never happen under your competent care.
I hate hospitals. With my first, I was terrified that I would need a caeserean because ever since I can remember, my mother told me I would. I expected that after a TOL, I would end up with an emergency caeserean, and so planned for that by organising hospital-based antenatal midwife and Ob/Gyn care. Despite my anxiety, my baby was born safely and happily in the hospital with everything that I wanted.
I was relaxed and happy for the next two babies, I was just tired and asked for pitocin to keep things moving along nicely.
Perhaps you shouldn’t make generalisations.
I wasn’t making a generalisation – I am saying that for some women this is there experience. Not everyones.
You were, actually. I fell into the ‘fear of hospitals’ group when I had my first, and yet my ‘natural oxytocin’ was not impeded.
And that is wonderful for you. Not everyone has this experience. I am not saying that we should instill fear in individuals about hospitals, that is absurd. I am saying that better care and environments in the hospitals should be demanded across the board and that should a woman choose to have a homebirth (or whatever) that should be her choice.
Actually, I am aware of that. My best friend did not have the positive experience that I did. In fact, she very nearly lost her baby, who was lucky to escape serious injury. If they’d been at home, we’d have lost both of them. If she’d been in L&D from the start, she might not have had such an awful experience. She also was scared of hospitals and so was in a home-like Birth Centre environment with a woo-filled CNM that did not want to transfer, and did everything she could to prevent it. It was nothing to do with the environment and everything to do with stubborn incompetence.
That is why I want accessible and decent medical care from professionals with every option to keep both mother and child safe.
I imagine the CNM was trying to do everything she could to comfort your friend and provide the best care she could (or at least I hope so). Everyone wants the mother and child to be safe, and to have access to care that is necessary and good for them.
That is different for everyone. I hope that we can change birthing culture so more informed decisions can be made.
Even I, as a layperson, knows that pushing against an incomplete cervix is not a good idea. The CNM began directed pushing at 8cm, while only partially-effaced. This resulted in a lip, which she pushed against for 5 hours with a CNM that kept saying “Just give it a few more minutes, and then we’ll transfer you.”
She ended up demanding to leave and managed to get into L&D, where it was found that her child was mildly distressed and that her cervix was swollen. She got her epidural, and the Ob/Gyn helped bub out with the ventouse because it was the best option. At that point, he was not expecting to have a good outcome thanks to the CNM’s idiocy. Luckily, once the shoulder dystocia was resolved (3 people required), bub was fine.
Yes, we do need to change the birth culture, and not in the direction that you seem to advocate for.
Pushing against an incomplete cervix is not a good idea I agree. That would be the fault of the midwife in that instance.
That is not to say all midwives are like this though. You clearly haven’t been listening to what I would like. But I should expect no less from this sight, where an extreme viewpoint has been taken.
The extreme viewpoint that mothers and babies should have happy and healthy lives? How perfectly awful!
We all want the same thing. I thought that an overarching view is that obstetrics and c-sections on this site was considered the only healthiful practice of giving birth and that individuals did not respect other forms of perinatal care (NM for example).
Dr. Amy is very supportive of CNMs as long as they stick to their scope of practice, which I think is a fair thing to ask.
I hope she makes that more obvious as many people see this political front which is seen as overgeneralization of midwives (including CNMs).
And I wish everyone would stick to what they are qualified for… a lot of processes would operate more smoothly. But that is dreaming.
Another victim of Pablo’s First Law of Internet Discussion…
Yes, and every time someone repeats that, it’s clear they are sloppy or lazy readers. People who believe fervently in NCB seem to have trouble with nuance. Anything that isn’t “breast feeding is the best thing evaaar!!!!” Or “Vaginal birth is the only TRUE birth!!!!” gets interpreted as “she thinks everyone should formula feed!” or “Dr Amy thinks every woman should get a c-section!” which are both ridiculous.
Wouldn’t it be a marvelous thing if every woman on Earth got to give birth in a place where she COULD get a c-section if she needed one? Really, how is that a goal that anyone could disagree with?
Your reading comprehension needs some work, then. What did you read here that could possibly give you that idea? It couldn’t be the number of times Dr. Amy has said that she worked with and highly respected hospital based CNMs. Or the time she posted about the study that showed that inducing at 41 weeks resulted in FEWER c-sections than “watchful waiting” did. Or the number of times she has posted explaining how interventions can make a vaginal birth possible. And it really couldn’t be the times she posted saying that she wouldn’t ban home birth even if she could.
I think, instead, it must have been your feelings that anyone pointing out clear, obvious, and acknowledged disadvantages of the home birth system must be opposed to all of the things you are in favor of. That is an issue with you, not with this site.
Superannuatedgoodness, I think you mentioned in another comment that you’re in Canada, right? The system up there is light years away from what we have here. That might be where this strong difference of viewpoints is coming from.
I’m in Australia, that’s probably contributing to it as well. We’re known for not mincing words 😉
I’m curious, for births are NM in Australia normally the primary care providers for women (of normal births?)
That really depends on the woman, there are quite a few different options. As far as I know, hospital-based CNM care with Ob/Gyn back-up is the most common primary care model for low-risk pregnancies.
I had CNM antenatal care for all 3 babies. All of the tests were ordered and interpreted by CNMs, with only 6 Ob/Gyn visits over 3 pregnancies – 1 standard visit per pregnancy, 1 laceration repair, 1 breech consult, and 1 appointment for an external version to resolve a breech position (bub resolved it herself, the Ob/Gyn could tell by looking at me but asked for an ultrasound to confirm). CNMs delivered all of my babies, the only times I saw an Ob/Gyn in L&D was when I was checking in and when a CNM asked one to come in and look at a tear, which he quickly and neatly repaired for me.
Honestly, it was the comfort of a homebirth with the safety of being in a hospital and I’d recommend it to anyone.
That is fantastic to hear. Sounds like a great model that I hope can become more prevalent in Canada. Our system is still developing for midwives here (where many of our midwives are imported because around twentyish years ago it became standardized education).
I love hearing about different solutions to maternity care – thank you for sharing.
Ha, you think your medical care is better than what we have up here.
Jolly good for you then.
That is NOT what I was saying. I meant that your home birth system is far superior to ours. Yours is integrated into the general medical system. Ours is the Wild Wild West.
I apologise, what I said was rude and I misunderstood.
There seems to be some positive change approaching in the American medical system though, at least from what I understand there is.
That’s all right, I can see how it could have been misunderstood.
You nitwit! She said it was different, by which she meant that Canada has a system that incorporates home birth into it and offers real healthcare providers. Unlike these damn fool home birth midwives wreaking havoc with their ignorance here in the US. She was basically saying that your system was actually better in this case.
It’s all right, she understood her mistake; I don’t think there’s any reason to call names.
You’re right, this is why I’m not allowed out very much.
😀
I misunderstood, such things can happen.
Yes you’re right and I’m sorry, that was uncalled for.
You do realize that you’re blaming women for birth issues because they are fearful, right? Of course the hospital experience could be better for everyone, no matter what they need it for. Unfortunately, money is usually the only thing that can guarantee that.
It’s so good to know that women who lived in places with wars raging about, women who got raped, women who live in fear don’t have to worry about giving birth and taking care of the child. Their fear and stress will simply stop them from giving birth. Awesome!
It’s kind of like how when women are raped they don’t get pregnant because their body has ways of shutting that all down, right?
I fell into fear of hospitals group too… and delivered at home fully trusting it’d go well. No fear of a bad outcome… which I had. What does superannuatedgoodness think about that? After that disaster of a homebirth, what did I do to ensure safe arrivals of my other babies? Worked through my unfounded (and encouraged by others) fear of hospitals (it is something that can be worked through with effort and prayer, for me), and with some nervousness, delivered my babies there… safe and sound… and with room service!
The adrenaline and stress about going into labor four weeks early and being terrified of having to labor in a hospital that is big into being “baby friendly” didn’t stop my labor from chugging along. Checking into triage dilated to nine and shaking because I was so scared to give birth without benefit of pain medicine didn’t stop anything.
You know, I’ve heard a number of people quote this theory that fear interferes with labor. Can you provide evidence for it?
I’d like to see that, too. I’ve always wondered.
Anecdotally, pain causes fear and increases in adrenaline. This might explain why an epidural sometimes results in rapid dilation. If fear and adrenaline really interfered with labour i dunno why more midwives wouldn’t be recommending epidurals…
Because no woman in history has ever feared giving birth. That only happened after men invented those silly hospitals just in order to take over birth.
I believe the Canadian health care system provides mental health services as well?
The UK NHS offers counseling to women who have tokophobia. They should also offer counseling to people who have irrational fears regarding hospitals.
This person, who asserted ”What makes you think that c-sections are going to happen? For a normal, healthy pregnancy this should not happen” is ”currently obtaining a degree in midwifery in Canada.”
WOW. Just wow.
Yes. Strange what she is learning. I had a normal and healthy pregnancy and a c-section. If the baby doesn’t fit, it doesn’t fit. Thank goodness for a surgical option these days.
Ditto.
Hi Canada!
I’m not sure you really understand how the American situation differs. Anyone here would be thrilled if the U.S. would adopt training requirements that are comparable to B.C.’s for example. Where I live, the state started keeping really good records on planned homebirth safety about two years ago. The baby death rate for birth with our most common type of midwife is six to eight times higher than hospital births. https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585
I dunno – if this is the best BC midwifery education can offer I’m not impressed. Downright lies misunderstandings and illogical statements? Our midwives are falling deep into the WOO. Presumably bc that is what impresses the consumers. But that’s no excuse, midwives should be professionals and keep their practice and belief firmly grounded in science not wild conjectures and stories told by Odent and Ina Mae
See how her username says “CNM”?
That’s bunkum about natural oxytocin. Any published studies on that?
oh, please. That oxytocin crap is right out of the NCB playbook.
If you are not yet degreed/licensed, I believe you’re actually still part of the lay public. (And some of your statements so far lead me to believe you’re still early in your course of study, although it’s highly possible you’re just being taught a bunch of nonsense with very little facts thrown in.)
Look at her name. She is a CNM. As in, she has *completed* her degree and she has been practicing for years. So, while YOU are a member of lay public, SHE is not.
A birth setting is great, but does not trump a healthy baby.
If only it was so easy to disrupt “natural oxytocin”. Literally no baby would be born premature, because that shit is terrifying!
You are so full of ignorance.
I am Canadian, I gave birth in Ontario with RMs. You and your woo ilk are a huge part of the growing problem here.
Except that neither of my hospital rooms had harsh lighting and I spent most of my hospital stays (with the exception of my time in the OR) in my own pajamas/lounge clothes, being comfortably attended to by caring nurses, doctors, and CNMs. Whoops!
A lot of hospitals are changing for the better. Many of them have upgraded their L&D wards or have plans to in the relatively near future because that is what’s in demand. I know the majority of hospitals in my area have modified their practices greatly over the last 15 years due to changing needs and desires of their patients.
And that’s wonderful. But this is not the case everywhere. Please understand this.
iPod docks are not comparable to taking home a live baby. Please understand this.
I think it’s now more common for hospitals to have these luxuries than not now. The small town hospitalS near us do as well as the even smaller one I travel to a distance from us, the big hospitals in the nearby bigger cities, the hospitals my friends and family have given birth in in a variety of different states all had dim lighting, bigger rooms, large tubs, etc…
Please understand that low lighting, ugly hospital gowns, and impersonal hospital beds in NO WAY equal the life of your baby. Ask any loss mom if she would have cared about those things. Why do you?
I went to a hospital and had natural childbirth. Did I care about the lights, the bed, or the gown? NO WAY. I cared that I was in a place that could pull out all the stops in an emergency.
When my son ended up needing otolaryngological surgeries, did I care about his gown or the room where parents only had a hard cot to sleep on? NO WAY. I cared that he was in the best children’s hospital in the area being operated on by a specialist. I was pretty upset about the entire situation until I saw a few bald toddlers with IVs in their heads.
Perspective, that’s all I am saying.
You’re right, it isn’t.
I spent 3 days in a six bedded bay on an NHS postnatal ward after my CS.
Would a private room have been nicer, sure.
Did I suck it up, draw my curtains for privacy when I wanted it and get the hell on with parenting a newborn? You betcha.
I have very little sympathy for “the lights were too bright so the hospital is evil” crowd.
BTW I could have paid for a private room, which we could totally have afforded. Not worth it.
3 days In a nice friendly atmosphere where I could chat to other new mums and coo over their babies for free…
Nah…comfort is over rated.
I wish people could see the small, community hospital I gave birth at. The tubs in the birthing suites are gigantic, and each room has a mirror so you can watch your progress, a birthing ball and in demand movies and tv along with iPod docks and channels that are peaceful scenery channels to be relaxing.
That’s fantastic! I wish this was possible everywhere.
Okay, I change my mind. The next time I go to the hospital, I want to be in the birthing suites. Maternity did NOT have on demand movies!
It was nice to have a movie to distract me between contractions.
The hospital room where I recovered from my second c-section was bigger and nicer than my bedroom at home, with a large TV, a lovely private bathroom, a big behind-the-bed cabinet/shelving unit, and a comfortable pull-out couchbed where my husband could sleep in the room with me (our toddler was welcome to do the same, but we decided having her stay home with her grandmother would be better for her), and while it was a rooming-in hospital (thanks to the NCB crowd no local hospital had a nursery) the nurses were happy to keep my baby in the nurses station for me so I could rest (my anxiety was such with both my children that I couldn’t sleep if I thought no one was watching them). It was clean and quiet and pretty, the nurses were angels, and I wanted to stay at least one more day. The food was even really good!
Well um what if there is a cord prolapse? That is the kind of random emergency that needs a section stat. Uterine rupture, ever hear of those? They can randomly happen with little warning. Again csection needs to happen like now and that can not happen at home even with an OB in attendance.
Do you think that a mother should be restricted from the choice of having a home birth or giving birth in a birthing centre because of this?
My personal feeling is that there should be no homebirths period end of story but not everyone here feels that way.
Well, that is your decision. I hope you don’t enforce it upon others.
How the hell would I enforce it on others? I can’t hold people at gunpoint and force them to a hospital it is a bit illegal and I prefer to live outside of prison. You are incredibly dense and I am glad you are in Canada where there is zero chance I will run into you and your dogmatic love for homebirth.
You might force them by gunpoint. You might be “Satan” like Dr. Amy (I am joking).
Don’t you feel how obnoxious you’re being? A baby died, Goodyshoes. A baby died and you chose this moment to come and grace us with your drivel of hospital infections and free choice?
Read the studies. Not the MANA blatant lies, including the ones interpreting their own data. If you’re comfortable with the numbers, by all means go and have a homebirth. But don’t try to paint us as the evil witches who wants to take your pwecious chooooice away.
I can see the appropriateness of home births for a very specific population of women and providers. That is, women who are extremely low risk (the list of excluded conditions from home birth is VERY long), CNMs with hospital privileges and at least 2 back up doctors, and a woman who is already pre-registered, blood-typed, etc at a NEARBY hospital. Unfortunately, not many CNMs or lay midwives mandate all these factors for their clients or themselves. They wouldn’t make enough money to bother! That’s why some CNMs who work at hospitals might do home births as well and that can be a decent scenario. At least hospital-based midwives have their skills reinforced by the volume of patients they see. This experience and practice is very important.
The list of risk factors includes being a first-time mother, by the way. For women who’ve had previous births that ended in uneventful vaginal deliveries, AND had all appropriate testing during pregnancy to rule out medical issues, AND had the baby’s position checked by ultrasound, the risk of disaster is still higher than in the hospital, but far less so than for any other group.
Continuing to be low risk is never guaranteed.
It’s practically impossible to “prevent” homebirths, but you can certainly not enable them.
For example, you can make it illegal for any HCP to deliberately assist in planned HB.
If women want to do a HB, that is their business, but the state has absolutely the wherewithall to decree that it will not accept health care providers assisting with it.
Alternatively, the state can put restrictions on those who want to attend homebirths that make it impractical. For example, and this is not unreasonable, it could require that only OBs are allowed to attend homebirths. Or at least that any provider who is doing homebirths has to be adequately insured against medical malpractice, and held to the proper level of standard of care.
And really, who could argue with that? Given the risks of childbirth, why shouldn’t we require the best expertise for a homebirth? Or at least why shouldn’t we require that the provider insure against malpractice? That’s what responsible professionals do. Shoot, the plumber that comes to my house is insured against malpractice in his work! So let’s expect it from those attending homebirths, too, right? Seems reasonable enough.
But the midwives won’t accept it. You know why? Because they know that these methods would pretty much put an end to homebirths. Doctors generally don’t do homebirths, and they are right – absolutely insurance premiums would be extremely high.
Then again, why do you think that is? Do you think it is because insurance companies care whether women do homebirths? Of course not. What they care about is covering the costs. What they do know is that a bad outcome in a homebirth is going to be a guaranteed lawsuit that they will lose, and so they have to set premiums high enough to account for that. IOW, the reason insurance costs for MWs are so high is because HB is so bloody risky that proper care will not do them.
Similarly, doctors won’t do HB because they also know that they are too risky.
This leads to a very bizarre situation. Legitimate providers, such as OBs and CNMs generally do not attend homebirths because they consider them too risky (yes, there are some CNMs who do them, but they are only a small fraction of CNMs). Therefore, since HBs are too risky for the best providers we have, we allow less qualified practitioners to do them instead! This makes absolutely no sense. Generally, when you have a challenging situation, you want the best expertise you can have. But when it comes to childbirth, if it’s too risky for an OB, our solution is to let someone who may or may not have a high school diploma do it instead?
That’s just idiotic.
I’ll be willing to admit that the hospital experience is not perfect, but shouldn’t be totally abandoned. I can’t tell you how many times I have had to deal with rude staff, or people who wanted to treat me like a child just because I was pregnant. Most of these things are minor and rude people can be told they are rude. Usually that cures the rudeness.
Are you the same person that contacted me through my blog to discuss this site?
I did not. What is your blog?
Irrelevant, but someone sent me some extremely similar talking points, with a nearly identical writing style. They contacted me through my personal blog, which is fine, but very odd.
Interesting. It is good to know there are skeptics everywhere.
Maybe you’ll learn something from them.
I listen to both sides of the story.
I believe in informed consent and I hope you do too.
Sure, but I don’t believe in misinformation.
Like c-sections have 6 weeks of pain. Or that oxytocin is different from pitocin.
You, otoh, apparently have no qualms about bullshit.
superannuatedgoodness
“I listen to both sides of the story.”
Unless I’ve missed your retractions regarding recoveries from c-sections, your previous comments demonstrate that this is not true.
Again, the major proponents of home birth in the US are CPMs and LMs, not CNMs or MDs, and the narrative they put forth is anything BUT informed. If they told it straight, this would be a different discussion.
Zing!!!
And people with normal, healthy bodies can still end up with chronic or acute health problems. You’re healthy until you’re NOT.
Even a normal, healthy pregnancy has a pretty damn high chance of needing a lifesaving c-section, for many different reasons.
Personally…I loved it (being in the hospital bed and gown). My water broke at home. Coming into the hospital and putting on that nice dry gown and huge super absorbent pad… Wow. I still remember how good that felt! And every time it got too wet these magical nurses came and whisked it away and I was dry again! And if the sheets got dirty, they were cleaned! And people brought me food! And water! And anything I wanted!
If it didn’t mean I’d have to have another baby, I’d go back right now. I could use a break.
What makes you think they aren’t? What about being at home makes cord prolapse less likely to happen? Abruption? Malpositioned baby, or inadequate pelvic outlet size?
And yes, I did enjoy being in the hospital for each of my labors. I even liked the hospital gowns, because it meant I didn’t have to worry about getting blood and amniotic fluid out of my own clothes! When they got dirty or damp from sweat, there was an infinite supply of fresh clean ones! And someone else changed the sheets on the bed, and mopped the floor! I also liked the continuous monitoring.
Why wouldn’t they happen? Why shouldn’t they?
http://www.skepticalob.com/2009/07/whats-safest-c-section-rate-higher-than.html
http://www.skepticalob.com/2010/03/dont-ignore-obstetrician-liability.html
http://www.skepticalob.com/2011/06/electronic-fetal-monitoring-gives-much.html
I had a “normal, healthy pregnancy” and yet I had a c-section, because my daughter just wouldn’t fit through my pelvis — which had nothing to do with how healthy or normal my pregnancy was.
I do not remember whether my hospital had fluorescent or incandescent light, and I certainly preferred being in a hospital gown to leaking amniotic fluid all over my own clothing.
Having access to an emergency c-section is very important, but birthing centers don’t give you that — if it’s an emergency, the safest thing is to have the OR just down the hall and operating staff who have been warned of the first sign of trouble.
Count me in this column!
When my son’s NST went completely south (after just having a good ultrasound about 20 minutes prior) the fluorescent lights and hospital gown really weren’t much of an issue. However, I would be open to looking into responsible birth centers.
I gave birth in a hospital that had a birthing center for low risk women. You could wear your own clothes, if you wanted (personally, I wanted to get the hospital’s laundry dirty, not mine, but the option was there.) It had soft lights, private labor and delivery rooms with rocking chairs, a jacuzzi, birthing balls, a small refrigerator for light snacks…and discreetly placed monitoring equipment and an OR down the hall in case something went wrong.
Well, it’s been five weeks, so perhaps my memory is faulty, but I actually really liked the hospital bed and hospital room. Enormous south-facing windows for sunlight, a bed in which I could raise or lower my head without major pillow architecture, lots of lighting options (including but not limited to the dread fluorescent.) Despite giving birth in a small community hospital where the rooms have not been significantly remodeled since my mother first gave birth there thirty years ago.
But my very favorite part of the hospital experience was the soundtrack: my son’s soft heartbeat coming from the CEFM machine next to me. I would have put up with a lot of discomfort to know that he was safe. It was nice that I didn’t have to.
Ah, windows! My room had huge windows that gave me a view of the whole valley. I even got to watch fireworks from my bed one night.
Its been 19 years for me but I had a private room with my own bathroom, a foldout bed for my husband and easychair for my best friend who also was at my daughters birth. The lighting was dim-able and I had a nice window. There was a lactation consultant and a nice photographer if you wanted baby portraits.
I loved the adjustable bed and the menu they brought around every day so I could choose my meal(they kept us an extra day because she had a few minor issues, they wanted to watch her for a while)
And this was in a Catholic inner city hospital…almost 20 years ago. Also no shaving, no enema, I could labor and push how I wanted to but found that semi-reclining worked best. They delayed the eye drops and Vitamin K shot for a while so we could hold her and get to know her in the first few minutes. They also let me try to breast feed in the delivery room. I gave it a try even though I did not really want to breast feed. I figured maybe I would change my mind. Obviously hospitals can be different in their procedures but I quite liked mine.
I had a health, uncomplicated pregnancy by any standard and I also had an abruption during labor and a CS. I think that the attitude that it can’t or won’t happen is naive. I’ve also gone on to have two uneventful pregnancies and vaginal births and like the concept of low intervention births when possible and desired. But it doesn’t always work that way.
If said birth centers have an operating room with a surgical team on call, ready to jump into action when the unplanned occurs, yes – build birth centers on every corner for all I care. Every second counts in an emergency. There’s no way you can foresee certain emergency where the baby has to come out NOW. No amount of “creative care” can eliminate that potential. Yes, the odds are slim that it will happen, but it DOES and it’s preventable and if it was my baby, I couldn’t care less about creative care options beforehand.
I hated the hospital, hated it with a passion. Still do and try and avoid them at all costs. Do you know what I would have hated more? The death of my youngest daughter if I had followed my ill informed feelings and had her at home. Luckily I was talked out of it, something I have been profoundly grateful for every day of the 23 years since her birth.
I agree, CNMs are true HCPs. The CPM credential should be abolished. Dr Amy points out the distinction frequently, but I suppose it can’t be in every single missive. Look, CPMs were hoping the name confusion would work in their favor, and it has for over 20 yrs.
That simply isn’t true. Birth ALWAYS has the potential for serious, even life-threatening risk, no matter how well educated and skilled the birth attendant.
Life would be so much simpler if everything had a single cause. Homebirth adds risk because of the additional factors of being in a place without all the equipment and facilities for emergency care AS WELL as lack of qualified staff.
I know; I’ve done home births in a situation where all the factors have been maximized: skilled, well-educated attendants, truly low-risk patients, homes checked for suitability and properly prepared, availability of a dedicated ambulance service containing equipment and specialists to care for both maternal and neonatal emergencies. It is still riskier than being in the right place at the right time — in hospital with EVERYTHING and EVERYBODY to cope with ANY emergency.
And hospitals pose an increased risk of infection for the mother and baby. There is risk in everything. Each mother/partnership should be given honest and true statistics regarding homebirth or hospital birth for their areas and weigh the options.
I advocate for informed decision making. As should everyone else. There are costs and benefits to every decision – and one is not always right for everyone.
Discus eated my comments twice.
The infection thing bugs me (see what I did there!). The people that get hospital associated infections are not the ones usually around on a maternity ward. Like the ventilated, those with long term devices (not a heplock that comes out after 48hours), the immunosuppressed, the systemically unwell. And when these people have a baby, they trade off the risk of infection against the risk of a much more serious complication. Surgical site infections are usually endogenous flora, so the only real criticism is the “necessity” of the procedure. Maternity wards have several features that are conveniently also infection reducing. Like single rooms for privacy, and continuity of care. Like disposable or sterilisable equipment. Clean linen instead of a poopy, bloody tub or bed. Sterile gloves for VEs. Episiotomies cut, rather than torn, reducing the surface area for possible colonisation and infection, (and also improving healing – go team primary intention!).
And if you’re worried about hanging out with the dirty folk in the lobby, then you should be more worried about hanging out with the people in your street and catching a CA-MRSA strain, which are arguably much more terrifying, given that they tend to affect the young and healthy in devastating and pustulent ways. And also clean the shopping cart before you touch it.
Not to mention that both chiorioamnionitis from prolonged rupture of membranes, and neonatal sepsis, are caused my maternal organisms – not caught in the hospital.
Math is hard, isn’t it?
The most serious risk of infection for the baby is Group B Streptococcus. About one in four pregnant women are asymptotic carriers. The standard of care is to obtain a culture from the lower third of the vagina and lower rectum around 37 weeks. Carriers should be treated with IV penicillin (or alternative antibiotics in case of allergy with a dose at least 4 hours prior to delivery. The CDC has plenty of evidence based studies that prove the tremendous efficacy of this approach. Do CPMs do these cultures? Do they start an IV and run IV PCN per standard of care? Or do they just put a clove of garlic in the vagina? Dr. Amy has posted the case of a newborn delivered at home who died within 48 hours of GBS sepsis as the garlic woo did not work.
Do you have any evidence based studies that show that the benefit of water birth outweigh the risks? Dr. Amy has posted a case where a baby delivered at home in a kiddie pool a fecal boulion died of aspiration pneumonia within a few days of birth. Please don’t cite any dolphin research woo since that bunk has been thoroughly disproven in humans.
I will not deny that there are nosocomial infections. Very few mothers die of them. Y’all like to speak of absolute risk – there are fewer than 600 maternal deaths per 4 million deliveries each year in the US – hemorrhage, pulmonary embolism, toxemia, pre-existing medical condition, sepsis and anesthesia complications are the leading causes.
GBS in the otherwise healthy term newborn is a very serious problem that is many orders of magnitude more deadly than the risk of nosocomial infection (which typically arises in premies in the NICU.
So, it would be advisable for you go slow on the hospital infection schtick and concentrate your efforts on eliminating negligent treatment of GBS carrier status in the home birth setting.
Never said I support CPMs.
So what, exactly, is your issue?
But, LMS, the IV is right up there with fluorescent lights and hospital gowns when it comes to ruining birth experiences. Sheesh.
Do you have a source that cites neonatal and maternal deaths and morbidity due to infection in the hospital that we can compare against neonatal and maternal death risk for homebirth?
And make sure it is a matched cohort
Hi, sorry I couldn’t find anything for neonatal and maternal deaths due to infection (at least after a five minute glance) so I’ll try and see if there are findings for that.
However, here is one for c-sections vs vaginal deliveries in the US that is interesting. http://onlinelibrary.wiley.com/doi/10.1111/j.1523-536X.2006.00102.x/full
I can’t read the article, since I don’t have a subscription, but since you’ve read it, can you summarize the findings for us?
Neonatal mortality rates (1998-2001) in the US:
c-section: 1.77
vaginal: 0.62
Live births
c-section: 311,927
vaginal: 5,762,037
Neonatal Deaths
c-section: 551
vaginal: 3,586
For primaparous mothers, infant mortality rates for no indicated risk mothers were 56 percent higher for cesarean deliveries (2.85 per 1,000 live births) than for those delivered vaginally (1.83). For multiparous mothers, infant mortality rates for primary cesarean deliveries (4.51) were more than twice those for vaginal deliveries (2.18).
What does this have to do with infection rate?
Also, please note that this data is 15 years old.
You just copy and pasted that last paragraph straight from a free copy of the study: http://homebirthaustralia.org/10/07/2010/infant-and-neonatal-mortality-for-primary-cesarean-and-vaginal-births-to-women-with-no-indicated-risk
This doesn’t convince me that you have read or understand the study.
Experience tells me that you don’t actually read the studies you cite before you deem them “relevant” or “interesting”. Did you even read this one?
I see a hell of a lot more community acquired MRSA on a regular basis than I do nosocomial infections.
The medical establishment agrees with you that the risk of nosocomial infection is too high. In fact, they’ve taken steps to reduce the risk of hospital acquired infection. If you’ve been in a hospital recently you may have noticed little hand sanitizers everywhere. Those are there so that all personnel can clean their hands between patients. This has reduced the risk of infection significantly. (Will dig up documentation if you’re interested.)
More recently, there have been new guidelines published for reducing infections spread via clothing. Ties and long sleeves are out. (Bowties are ok.) Jewelry must be minimal and hair kept out of the way or cut short. White coats must be laundered frequently and may be going the way of the 19th century surgeon’s blood soaked coat (which showed how busy and therefore how good he was).
So, hospitals recognize that there is a problem and are trying to fix it. MANA, confronted with the evidence of the danger of home birth, refused to even consider restricting home birth for high risk groups such as twins or breech. I’d rather trust the group that’s trying to fix its problems than the one flat out denying its.
“which showed how busy and therefore how good he was”
Please let us not cite the survival rate of 19th century surgeries. This is getting ridiculous.
Ok…I’m not sure how someone could read what I wrote and conclude that I was praising the safety of 19th century surgeons, but apparently it’s possible and therefore I need to be clearer.
Nineteenth century surgery was highly dangerous. There were few survivors. But one of the ways people knew who a “good” surgeon was was by how disgusting the coat he wore during surgery was. The dirtier, the better: it showed that he was busy and therefore must be quick and maybe even have patients who survived. Of course, the coat also carried a massive infectious risk. (Infection being what killed most people in the post-op period in the 19th century.)
The analogy I was drawing was to the white coat of today. People see the white coat as symbolic of the doctor and his or her education, care, etc. The problem is, unlike street clothes, the coats don’t get laundered daily and so get a bacterial load. There is discussion currently of possibly getting rid of the white coat, possibly also making use of scrubs the standard in order to minimize the transfer of bacteria on clothes from one patient to another. This is still under discussion, i.e. whether laundering the coats weekly or more often is enough versus doing away with them, but the point is that people are thinking about the risk of infection in the hospital and how to minimize the risk. And taking steps to minimize the risk. Not just saying, “well, most people don’t get infections and there are some very beautiful stories of hospitalizations that went well so there’s no problem”.
What are CPMs doing to make home birth safer based on the MANA data that show higher risk of neonatal mortality in a home birth and vastly higher risk for breech babies?
That is one of the biggest reading comprehension failures I’ve ever seen.
Are you just skimming everything?
What’s getting ridiculous is your lack of even attempting to understand what you read before you are outraged by it.
The bloody coat was a visual reminder of what the surgeon had been doing with his time. Obviously a surgeon who has been soaked in blood has been very busy. Just like a mechanic with big hands. It’s not a particularly controversial idea.
The white coat is filled with all sorts of symbolism. Expertise. Education. Respect. Responsibility. Trust. And it has kick-ass pockets for all the medically gadgets those silly docs love tinkering around with. But like the bloody surgeon’s coat, it’s a filthy vector for transmission of infection.
TCAMN wasn’t “[citing] the survival rate of 19th century surgeries”. She/he was giving examples of practices, that may arguably have some value, that are being phased out of medicine with the aim of increasing safety.
The point is, when has MANA ever done that?
Which risk is bigger, the risk of infection in the hospital or the risk of something going wrong during a homebirth?
Small risk of infection (temporary) or small risk of death/brain injury (permanent). Really?? How are these remotely comparable??
Or an amputated penis, as Dr. Amy pointed out in one of her stories.
“one of her stories”
There are many positive birth stories that you seem to be ignoring.
No one is ignoring positive birth stories. They just aren’t that relative to the discussion. No one is saying all homebirths will be disastrous. Birth works out ok for a decent chunk of the time so plenty of people will not die if they have a baby at home. But bad things can happen to any mom, and when they do, it often leads to disaster. Those stories are important because, obviously, people don’t understand statistics very well. They illustrate the problem. They show exactly what the bad outcomes look like and who they can happen to. They show that glaring incomparable of CPMs.
Positive bith stories are simply examples of a mom who took a gamble and got lucky. And midwives and posters on MDC repeat the stories as though that validates their choice.
Just as my high school classmates used to tell their great stories about how they got so wasted last weekend and still drove home safely.
Do you complain that no one talks about them at the MADD website?
You remind me of my little brother when I chastised him for leaving his shoes on the floor in our small entryway instead of putting them on the rack. He said “But what about all the other times I put them away that you’re ignoring”. Like you, he completely missed the point.
I am talking about the stories Dr. Amy talks about on her blog. I don’t ignore good birth stories, I have several of my own!
My second birth was amazing. I had absolutely no pain thanks to an epidural. I was totally present in the moment, and even watched my little boy being born in a mirror. Is that a positive enough story for you?
But that’s the problem, and the entire point of this blog: organizations such as MANA are distorting the risks therefore denying women of making a truly informed choice. People assume Dr. Amy et al are out to ban home birth – this simply isn’t so.
Unfortunately, CNMs who deliver at home aren’t speaking out against CPMs, DEMs, and LMs so they all get lumped together by their own omission of outrage against women who give responsible home birth CNMs a bad name. Perhaps I’m wrong, though. Are there people in the home birth community who are expressing outrage at under trained, unprofessional and insensitive people in their community who are hurting mothers, babies and entire families by their recklessness?
I am not aware of expressed outrage at this point, because the number of homebirth CNMs in the US is still so small. The few I know who do practice homebirths are upset with the situation.
Publicly upset?
or
Privately upset?
It’s their right to react any way they want. One way protects the incompetent and guilty, the other way calls them out.
And what are they doing about it? Have they lobbied the ACNM to take a stand against CPMs, for example?
There have to be at least several thousand of you. There are maybe 50 regular commenters here…why are we making a bigger stink than you?
I don’t think that is true? There are many individuals who have similar beliefs to my own, but I can’t see them posting on this blog.
I wanted to know if there was any base to this blog aside from fear, which is why I’ve joined the discussion. The facts about CPM and LM I agree with. Other points less so, as I have yet to see real statistics.
I think simply hearing that not all women have 6 weeks of pain after a c/s should provide enough information to help form a more educated understanding of recovery from a c/s. I come here for information, to hear stories, and to understand the current issues in American childbirth circles, hospital and home birth alike. If you stick around long enough you’ll sift through what you don’t agree with but pick up a lot of relevant information about the way people think about and experience childbirth as mothers, fathers, midwives and physicians.
I am hearing you say two things that seem in contradiction to me. Perhaps you can explain it to me. First, you say we shouldn’t lump all home births together, because only those done by CPMs are dangerous, and we risk overgeneralizing. Then you say that there are so few CNMs doing home births in the US as to make it unsurprising that we haven’t heard any outrage from them.
If the numbers of CNMs doing home births is so small as to excuse them from having their voices heard, how exactly is speaking of the problems with home births in the US without specifying home births with CPMs every single time, an over generalization?
Sorry, reality doesn’t work like that. No matter how low risk the pregnancy is there’s always going to be a chance of something horrible going wrong during birth. No home has the facilities a hospital has. Of course, it’s your right to test the odds.
Thank you! Exactly what I was thinking. I wouldn’t even want a homebirth attended by Dr. Amy simply because there is no way she could perform a c-section in my home if I needed one. I hate to think what I would be cut open with.
superannuatedgoodness “When [homebirths] are attended by CNMs and doctors there is not the risk you discuss”
You mean like the homebirth discussed in this news article, attended by a doctor in the San Diego area?
http://www.nbcsandiego.com/news/health/Robert-Biter-Medical-License-Suspended-Indefinitely-California-Medical-Board-185651121.html
For those who did not click on the link – it’s Dr Wonderful, Robert Biter, and the baby died.
On the bright side of things, the state of CA did suspend his license.
One “good” thing about the Biter and Muhlhan stories: they got suspended. It took too long, too much damage, but they did eventually at least get suspended. What happens to the unlicensed and completely unregulated CPMs when they make the same sorts of mistakes? Nothing. Because there’s little too be done. They just go on their merry ways, continuing to practice medicine without a license and endangering people.
I’m pretty sure Magnus Snyder would have disagreed, had he been alive to say so. His mom Sara strongly disagrees.
Dr Amy has been very clear about who she is criticizing. Primarily, it’s CPMs, lay midwives, and their supporters. If we got to the point where home birth only happened the way it does in Canada, I’m betting shed be thrilled.
It’s worth noting that the death rate for CNM home birth is/still twice as high as hospital birth.
Really? What about Evelyn Muhlhan?
Also suspended by the state where she practiced:
http://www.mbon.org/disc/public_orders/rn_lpn/muhlhan_evelyn-R060032-SS.Order-20111006.pdf
Who is panicking, exactly? And why is it bad? If this blog sends people stampeding into the hospital to deliver among the best-qualified staff and most advanced life-saving technology, that is a problem…how?
1) In the US, it’s almost only CPMs who attend homebirths because CNMs and doctors understand the risks and couldn’t afford the insurance anyway. CPMs deny the risks and are uninsured so it doesn’t matter to them.
2) When midwife-attended homebirth is part of the medical infrastructure it can (not always: see England vs the Netherlands) be very safe but that is largely because of stringent elimination standards that midwives must respect. In England, which I think has the best homebirth outcomes, 40% of first-time mothers wanting homebirth are transferred to the hospital. The increased safety of homebirth with a trained attendant has less to do with the expertise in baby-catching than the expertise in hospital transfer (though both are important).
3) Women too far from the hospital to get there easily are *not* good candidates for homebirth with a doctor. If the doctor determines that she is one of the 20% to 40% who need to be transferred, then what? The more usual practice is to schedule an induction at the hospital.
It is very clear to me that your agenda is to promote “normal” birth. You think that there are no valid reasons for choosing an elective c-section, that the hospital creates an atmosphere that slows a woman’s labor, and that there is a difference between natural and synthetic oxytocin. You are unable to back up any of your assertions with facts. You also state that you are training to be a midwife in Canada. If you cannot learn how to make true evidence-based decisions about care, you need to stay the hell away from pregnant women.
I say this as someone who gave birth with CNMs both times in a hospital. My first was a “textbook” unmedicated birth, until I delivered the placenta and began to hemorrhage. Turns out that I had a cervical laceration. Even with prompt surgical repair, I narrowly avoided a transfusion, and my recovery was long and painful. This is the type of complication in which you do not have time to transfer, and it opened my eyes to the reality of childbirth and what it is like in the absence of medical advances. When I got pregnant the second time, I had very frank conversations with my CNMs, and they made it clear that they would do everything in their power to make sure that I got an epidural as soon as I was admitted. They repeatedly said that it was MY birth, and that they were there to keep me and my son safe. Wanting pai relief was of no consequence to them, which is as it should be. Until all midwives can divest themselves of the idea that there is only one truly authentic way to give birth, we will not have achieved quality care for women.
Actually you are wrong.
CNMs still have a 2x higher death rate than they do i the hospital.
So few MDs do HB, and it seems those that do are ones like Biter and Fischbein, ones that lost their privileges and have many lawsuits pending. Biter killed a baby at a HB, IIRC.
IF you want to suggest OOH birth is “safe”, you can use the AABC study, for ACCREDITED ONLY birth centers. They seem to have a very good rate of success. (However, some also do HB, and offer riskier moms that option…..) This also cannot be used to say other OOH births have this record of safety.
Jan’s question about midwife ratios is so idiotic that I don’t know where to start. She’s like an under-performing employee who argues for a big promotion and raise based on facts she’s read about what high-producing employees in unrelated companies make, and not based on her own poor work.
Dr. Amy, YES, you ARE the serpent in the Tree of Knowledge! Don’t let up, keep hammering at this HARD because this event has a rare momentum. We are all with you and bringing the fight to them in many ways. I’ve never seen such a high level of engagement in this group and on the associated FB pages. You Rock!
Thanks!
Not even a “we are reviewing our policy on mentoring midwives via facebook” or “we are so sorry for the loss and are reviewing our role in the tragedy” or “we are formulating an appropriate response to the tragedy that unfolded on Jan’s page” or any other innocuous lack-of-action response they could have given to at least pay some respect to the family. Nothing. Just silence and deletion and pretending like nothing happened. So gross.
I know! As if *we* – the dissenters, the trouble makers, the demons – are the issue. It’s pathetic!
Hey Safer, paste those sentences over there at Midwifery Today’s FB page as helpful “thought starters”. A crisis can be paralyzing to an organization. Sure, part of the job of PR is knowing how to deal with these embarrassing communication/messaging emergencies. However, it’s just impossible to think of all the possible things that could go wrong and what your organization should do if they did 😉
Someone posted this on the MT page half an hour ago: “We are getting more information now that seems to indicate Christy Collins was, in fact, the midwife responsible and that she was not, in fact, working with a physician. Care to comment?”
Is there some new information that I missed? Or is this still based on her detailed knowledge of the circumstances of this baby’s death?
its in this thread. http://www.skepticalob.com/2014/02/update-to-the-notburied-twice-campaign.html but Dr Amy has not yet verified the identity of the person claiming to be a friend of the family.
Thanks. If that’s true, it’s shocking. Actually, that’s the wrong word. I’ve lost the capacity to be shocked by these maniacs. I’ll just say that it’s appalling.
I posted a link to a paper on oligohydramnios. Let’s see how long it stays up (other side of the world – they;re probably asleep)
Carla ‘Trust Birth’ Hartley posted this on her FB today:
Sometimes
I let myself imagine at the beginning of a day, that every baby born
today will be unmolested, every birth allowed to unfold according to the
chemistry and physiology of mother and babe, and that every mother
will be respected from start to finish…….and that their “There you
are” completely uninterrupted….no hatting, chatting, patting or
cutting of cord…..In other words the birth they deserve. I can dream
huh?
That’s what she dreams. I dream that every baby born lives. I note that she doesn’t seem to mention that.
Putting a hat on a newborn= a horrible act of violence.
Letting a baby choke on its own excrement and die= eh, shit happens. What’re you gonna do?
Wait, what? That’s what “hatting” refers to? Putting a hat on the newborn? FFS, these people are UN. REAL.
http://www.skepticalob.com/2012/07/save-natural-birth-stop-outrageous.html
Just when you think the bounds of credulity can’t be stretched any further…
Huh. And I always thought that my knitting helped with the Idle Hands problem, but apparently my hat-making hobby is akin to the work of the Devil! Whatever. They can pry these needles from my cold, dead, demon-possessed hands. 😉
Well you must be SATAN too!
I agree with you, but I’d amend it slightly: that every baby born lives AND IS WANTED. I’ve been present at too many births where the baby was facing a very uncertain future with parent[s] who wish he’d never been conceived.
Well ammended.
Marlene probably thinks gambling is the devil’s work, but it doesn’t stop her from doubling down on the odds and attending breech VBACs. http://community.midwiferytoday.com/forums/p/2492/8644.aspx#8644
You caught my comment there. Just to be clear, I am in no way trained in midwifery since I do not count my own birth experience to be a relevant source of knowledge for that, I just translated the Croatia law on midwifery on the go as I was typing which is available here : http://www.zakon.hr/z/397/Zakon-o-primaljstvu . What irked me into commenting is the fact that the person who posted that question (Jan Tritten) displayed the same disregard of facts and legitimate sources of information like the midwife who posted her own negligence that killed a baby the other day on that same facebook page.
They were both just *doing her own research on the internet* and in both cases I find it appaling, wheter it is a midwife in an emergency situation or an owner and spokesperson of a professional organisation supposedly completing a survey.
I feel that exactly the same behaviour being repeated on public display in such short time-frame is more than just contemptuous – it is amoral, unethical and utterly insensitive. And it speaks volumes of everything that is wrong with midwifery in your part of the world I guess.
Keep them away from my countries, our health care is bad enough as it is on its own without them. 🙂
You are so right! Keeping these freaks from disseminating their propaganda across the world would save a lot of babies. Some time ago I learned that NCB crap is becoming really fashionable in Russia and Ukraine. The scary thing is that even the followers of NCB ideas don’t know that truth about CPM “credentials.”
Well, I couldn’t resist throwing a quote in Croation from one of the songs of Marko Perkovic ‘Thompson’. I found his ‘angry’ music great for getting through a nasty divorce so I thought I’d aim one of his barbs at Jan.
That was you? Ha ha. I pasted that into Google Translator and thought, “Wtf does St Elias have to do with this?” Lol.
Just for fun, it’s from this song. It was written during the Balkan wars in the 1990’s and the singer is pissed right off (though at Serbs, not midwives). I find it good music to listen to when I’m angry.
http://www.youtube.com/watch?v=ucuQH8flctw
I find characters like that guy abysmal in any context and such anger venting counter-productive but hey, whatever rocks your boat (as long as I am not in it) . I always advise people not to go into any line of conversation or remarks involving ethnicity when on Balkan subjects – you never know who you are speaking to and how they will interpret it .
Here is a document in English that details how the educational requirements for anyone to be called a midwife in Croatia had to be increased to comply with EU regulation: http://www.esteri.it/MAE/doc/HR_08_IB_SO_01_TL_Nurses_and_midwives.doc
The local midwife in that conversation is claiming that the *numbers are all over the place*. From what I can see in public official documents, statistics report and studies published by the state statistical office, proposals for health care program strategy as well as review of registry by the chamber of midwives in Croatia numbers are pretty consistent and quite good. If a specific ratio needs to be calculated that is not presented in any of these sources she ought to contact the statistical office and ask qualified people for assistance, especially in light of grave consequences of what happened on that facebook page because a midwife used *ask your friends* methodology and a baby died.
I posted your link over there for Jan with a note 😉 I hate it when a leader of a group assumes that legitimate sources of information don’t exist! That attitude flows down from the top, and soon everyone in the group, company, etc, acts like that.
The prayer threads for Dr. Tuteur are comical.
It is infuriating that there are no prayer threads for the family that lost their child.
Oh my goodness, that is pathetic!
Second post from the top: UNREAL!
This is from Jan’s page
Jan Tritten
5 hours ago
“I
have been taught where women are free, we will learn how they give
birth best. They will show us. They will trust us. Look at them and
listen closely.” -Dr. Michel Odent From Ana Paula Markel ‘s email newsletter. Thank you Ana!
What?
Yes, that’s why countries where women can’t drive or vote or go to school have such an enormously high rate of inductions, c-sections, epidurals, EFM, etc.
Oh, wait…
…and then babies will have bad NSTs and need c-sections.
In case you’re wondering, Amos Grunebaum is still posting to Jan Tritten’s page:
Amos Grunebaum Croatia is part of the EU and as such is responsible to follow European Union standards for midwifery education: http://www.euro.who.int/…/pdf_file/0005/102200/E92852.pdf
As
you can easily see, midwives in Europe usually follow very clear
educational and academic standards not dissimilar to certified nurse
midwives (CNM) in the US. I have worked as a doctor in Europe so I know
firsthand their wonderful education. In Europe, someone with the CPM
background would never ever be allowed to call herself a “midwife” and
would not be allowed to practice. That would be a nono. The laws are
very clear on that. Contrary to so called “CPMs” in the US European
midwives cannot practice without liability insurance. European midwives
and CNMs are true professionals.
52 minutes ago · Edited · Like · 7
I am proud of Dr. Grunebaum for being willing to get his hands dirty with this. Before this, it was only Dr. Tuteur who was willing to be so vocal.
He’s awesome!
What would be the punishment for lay midwifery? Prosecution for practicing medicine without a license?
I asked Jan that if her true intention is to teach other midwives, why won’t she enlighten everyone as to what the proper course of action should have been. I was promptly deleted and banned. We should comment on her Jan Tritten’s Birth Page, FB page.
If there is nothing to hide, why did you delete (or lock down) your private FB page, Jan Tritten? You know, the one where everyone read about this scenario, where the midwife took great pains to note that she was in a state with full autonomy for midwives, made no mention of doctor involvement, etc.? And Donna Zelzer, is Jan going to answer the questions asked of her on the Midwifery Today page?
I am so disgusted by all of this. Midwives who are so poorly trained that they can’t recognize an emergency situation. Supposed leaders of the midwifery practice who also don’t know the proper course of action and crowd source for answers on FB. Constant back pedaling and obfuscation about what happened. And a complete lack of regard for the death of a baby and the massive loss of the family. I will do everything in my power to see lay midwifery legislated out of existence and laws that will put people who operate outside of the scope of their practice in jail. If you defend the status quo, you are monstrous.
Her page is still public, you must’ve gotten the banhammer.
Are you sure? She had three – I am talking about her personal page.
But if I am banned, I will wear it as a badge of honor.
Yes, I checked on my wife’s computer. She can access it. I cannot. She’s just banning people who question her horrendous judgement.
It’s still possible to post on “Jan Tritten’s Birth Page,” though.
but but but, the info is there for educational purposes! how will we ever learn?!