Beware Big Birth!


It’s often an “aha” moment for women when they realize that birth is an industry.

I’m not talking about hospital birth. While that, too, is a money making proposition, no obstetrician is afraid of running out of patients. For better or worse, pregnant women need obstetricians, will always need obstetricians, and obstetricians have no need to convince women to give birth in hospitals since 99% already do so. Obstetricians are not afraid of losing business to “birth workers.”

Moreover, a substantial proportion of obstetricians are salaried or paid by insurance companies that offer no premium for extra services. There is no incentive to do any more than what he or she thinks is necessary to ensure a healthy baby to a healthy mother.

No, I’m talking about “Big Birth,” the industry of birth workers (doulas, childbirth educators, and midwives to some extent). They sell services, books, products and courses. No one actually needs any of those books and products; they are entirely discretionary. Therefore, the entire industry of Big Birth depends on convincing women that they need these books and services. Although many women don’t realize it, advocates of natural childbirth (and virtually all “birth workers” are advocates of natural childbirth) must be engaged in full time marketing in order to make a living.

That marketing involves two major prongs: convincing women they need what birth workers are selling, and warning women that obstetricians are not to be trusted.

What is Big Birth selling?

They are selling their personal view of the ideal birth.

It is important for women to understand that natural childbirth is one-size-fits-all approach. It doesn’t matter who you are, what your medical problems are, what your specific fears and concerns are, what you think is the ideal birth for you; all of that is irrelevant. Big Birth must convince you that unmedicated vaginal birth is what you really want and need.

There are important obstacles in the way. The first is pretty obvious: hours of agonizing labor pain. Ever since the discovery of chloroform for easing labor pain, women have avidly adopted analgesia in childbirth. Indeed, in the early years of the 20th Century, pain relief in labor was recognized by women’s groups in nearly all industrialized countries as a fundamental right. All women were seen as entitled to pain relief in labor regardless of their ability to pay for it, just like all women were entitled to anesthesia during surgery regardless of their ability to pay for that.

Because childbirth is inherently agonizing (it so impressed the writers of the Bible that the only way they could explain it was as a divine curse) and because human beings natural wish to avoid agonizing pain, it’s been an uphill battle for Big Birth, but they finally hit on a double barreled solution. The first part is to convince women that epidurals, the only truly effective method for abolishing the pain of childbirth, are dangerous for their babies; that’s nothing more than a lie, but as I explained yesterday, lying is central to natural childbirth advocacy. And although Big Birth does not lie outright about the maternal risks of epidurals, they grossly inflate the risks and minimize the benefits.

The second barrel is the imperative to convince women that the “ideal” birth as envisioned by birth workers (an unmedicated vaginal delivery) is somehow superior to other ways of giving birth and that women who “achieve” an unmedicated vaginal birth are somehow superior to women who don’t. Why would a woman buy any of the services and products sold by birth workers if they weren’t convinced that they needed them? Obviously they wouldn’t, so it is absolutely critical for Big Birth to convince women that there is a “best way” to give birth and they can help you achieve it.

The other important obstacle to Big Birth is that they don’t have the knowledge and skills to offer life saving services. The marketing solution to that is simple: just convince women that birth is so safe that almost no one ever needs those life saving services. It’s a lie, but, once again, a lie is no problem for the marketing gurus of Big Birth.

To summarize, the first part of the Big Birth marketing strategy is to convince women that unmedicated vaginal birth is “ideal,” that pain relief is dangerous, and that birth is so safe that almost no one needs the interventions recommended by obstetricians.

The second major prong in Big Birth’s marketing strategy is to create distrust of obstetricians. Women need obstetricians. They don’t need birth workers, so thy must be convinced that obstetricians are out to harm them and that only birth workers can prevent that harm. That, too, is a lie, but in Big Birth the ends (profit and autonomy for birth workers) always justifies the means. Most of the claims of Big Birth are ludicrous on their face and no one would believe them of other doctors, but it is a testament to the marketing genius of Big Birth that they have managed to convince a great number of women that the people who devote their lives to caring for pregnant women and their babies (obstetricians, obstetric anesthesiologists, perinatologists and neonatologists) actually want to harm women and babies. Or, equally ludicrous, the idea that obstetricians don’t follow scientific evidence while “birth workers” do. Obstetricians don’t merely follow scientific evidence, they are the ones who create it. Birth workers, on the other hands, follow their hearts and prejudices, with their own autonomy as their only fixed lodestar. They simply make stuff up and then pretend that it is true.

Case in point, Barbara Harper, the doyenne of American waterbirth, and basically a buffoon when it comes to neonatal physiology, is revered in the world of Big Birth as an “expert” on waterbirth. She just makes it up as she goes along and major childbirth organizations from Lamaze, to the American College of Nurse Midwives throw ethics and intelligence to the wind to back her.

Indeed waterbirth is an outstanding illustration of the marketing tactics of Big Birth.

Whatever you want to say about waterbirth, no one can deny it is unnatural since no primates, let alone human beings, give birth in water. But for Big Birth the truth is irrelevant and waterbirth is marketed as “natural” pain relief.

Waterbirth was never tested before birth workers implemented it as a “treatment.”

Point out to midwives and other birth workers that waterbirth has deadly iatrogenic complications ranging from drowning to tearing off the umbilical cord while lifting the baby out of the birth pool, and midwives and birth workers won’t even bother to investigate the reports before dismissing them out of hand.

As Dr. Clay Jones notes in today’s post on Science Based Medicine, An Update on Water Immersion During Labor and Delivery:

A fine example of complementary and alternative reality in regards to labor and delivery can be found at Waterbirth International, which is run by >Barbara Harper, a nurse who preaches the benefits of waterbirthing all over the world and who is a proud proponent of rebirthing-breathwork. Rebirthing-breathwork is the concept that suppressed negative emotions can be healed by reliving one’s birth…and breathing a lot. Also there is something in there about cells having feelings. Harper gets the last word in the NPR article:

“I think this is backlash from the gaining popularity of water birth,” says Barbara Harper, founder of Waterbirth International, an advocacy organization…One thing that happens in a water birth, you as the attending physician pretty much have to stand there with your hands in your pockets and let it happen without your participation. That is pretty scary to a physician-oriented institution.”

How’s that for a straw man? Medical experts are apparently only skeptical of waterbirth because we don’t get to participate, which I have little doubt is code for “we don’t like it cause we don’t get paid.” I wonder if she works for free.

I believe that most rational people, even those with no medical experience, intuitively understand that delivering a baby into a body of water, even a sterile one, would be inherently risky. Human newborns, as with all other primates (take that Discovery Institute) breathe almost immediately upon arrival into this world. This helps to initiate a chain of events that assists the neonate in transitioning from fetal to adult circulatory patterns, and there are millions of years of evolutionary momentum behind this process. But besides being a completely unnatural act, something that usually sends proponents of pseudoscience running, there are numerous potential risks involved with giving birth underwater.

In other words lying (about the risks), denying (the complications), decrying (obstetricians) and defying (science).

Birth Big is a business. They are selling a product (unmedicated vaginal birth) that has no real benefits so they’ve had to make up the benefits. Many birth workers have no real skills, and even the best educated lack the lifesaving skills of obstetricians, so they’ve had to deny the need for such skills (Trust birth!), and demonize both the skills and the obstetricians who wield them.

There is an old Latin aphorism that comes to mind in this situation: Caveat emptor! Let the buyer beware!

That’s good advice when it comes to Big Birth. Pregnant women should be savvy consumers and understand that Big Birth is trying to sell them products and services that they don’t really need. If women want to buy them, it’s up to them, but they ought to recognize that Big Birth markets its products the exact same way that Big Business markets theirs: convincing you that you need the product, that buying the product will indicate that you are a superior person, that the competition is not to be trusted, … and that the safety standards of the competition aren’t really necessary at all and just add to the price of the product.

Would you buy a car from a manufacturer who claimed that buying their car indicates that you are a superior person, that other car manufacturers are ignorant fiends who want to hurt you, and that airbags are unnecessary because most people never crash? Probably not.

Then why would you buy a birth from a provider who claims that there is an “ideal” way to give birth, that if you do it their way you are a superior person, that the people who are experts in every kind of birth (obstetricians) are ignorant fiends who want to hurt you, and that safety features (interventions) are unnecessary because most women won’t have life threatening emergencies?

128 Responses to “Beware Big Birth!”

  1. Old Mom
    April 2, 2014 at 7:14 pm #

    The hospital at which I gave birth to my last child had both a labor and delivery hallway and a midwifery right next to it on the same floor. Both were next to an operating room. The midwives were masters level nurses supervised by hospital doctors. The labor and delivery hallway was pretty standard. The birthing rooms in the midwifery looked like hotel rooms and were equipped with birthing tubs, birthing chairs, balls, etc. Siblings were welcome for the birth if a mom opted. You could hire a doula. There was no pain management through the midwifery, but if you got to the point where you changed your mind you could opt over to labor and delivery. You could have a specialist from the local children’s hospital present at the delivery by request whether you were in the midwifery or in labor and delivery.

    I gave birth in the midwifery with the specialist from the children’s hospital present for my baby. I knew that I could end up in labor and delivery or in the OR. I wasn’t trying to have some ideal birth. The ideal birth was whatever one that got my baby to me safely. I’m not the type to make a birthing play list (but go for it if that’s your thing!) or go in the tub. I labored at home and went in when it was time to push. I was just an older mom who didn’t want any medication that to go through my baby until it was necessary.

    At any rate, I was wondering if you were aware that there are programs out there that have birthing tubs right in the hospital and have midwives supervised by doctors and even use the same office exam rooms. Do you think this is a danger or a safe way to give women who want a home birth the option of having that type of environment in a hospital setting?

    • Ash
      April 8, 2014 at 11:50 am #

      Yes, Dr Amy formerly practiced with both CNMs and OB/GYNs in the US. I don’t know of any OB/GYN practices that reserve special clinic rooms for midwives vs physicians unless some rooms have equipment for procedures that only physicians do. The patient gets roomed, the provider scheduled to see them does the visit, no matter if midwife or physician. it’s also been discussed that there are US hospitals that offer birthing tubs.

      See Dr Amy’s post March 22, 2014 about waterbirth and there are previous posts about waterbirth by using the search function and searching for “waterbirth”. There are risks inherent in waterbirth no matter the location.

      Personally, I am not sure that renovation of L&D units to have 1 hallway look different makes a difference in outcomes. Every healthcare system in the world is trying to control costs. People do like more aesthetically attractive environments and many hospitals want business in their L&D units. Thus, you will find many L&D units in the US putting money into renovating their units to have nicer interior design, “spa style” amenities, etc. I like to spend time in nice looking places, but it undoubtedly costs money and actually the nicer looking L&D wards can draw patients away from smaller hospitals so their L&D units have to close down.

      Anyways, I don’t really see much point in separating out the units, although both the midwifery unit&L&D unit you described are both in the hospital building with ready availability of physicians as needed. The hospitals with birthing centers here have OBGYNs and CNMs working on the same unit. The rooms all look the same no matter if it’s attended by a CNM or OBGyn. They allow doulas. They advertise having spa-like showers and and family sleep space in room. Birthing balls too. I just don’t really get separating them out: after all, if you were on the L&D unit and they asked if you wanted an epidural or other pain relief, you can decline.

  2. Deena Chamlee
    March 29, 2014 at 1:10 pm #

    I had to ponder this post a bit. When one is immersed in a culture, on call day in day out, many times others are surviving pay check to pay check. I know this is true in nurse midwifery. So questioning ones reality regarding surroundings and culture is not instinctively done.

    One knows about trauma because of what we experience at homebirth but one still doesnt stop to question their reality. WHY? Questioning ones culture takes courage, fortitude, and the ability to stand up against abuse and intimidation. Not an easy task if you want to keep a job no matter how low paying.

    But the time has come for all midwives who do not care for exploitation of themselves or others to STAND UP FOR CHANGE! All around the world because midwifery must mean something besides self serving, exploitating, dishonest, unethical, and immoral. We must fight for change because there are those who arent disordered who care.

    • Laura
      March 29, 2014 at 7:02 pm #

      I wish you courage on your journey!

  3. Jessica
    March 29, 2014 at 12:23 pm #

    OT update on my nephew: after 11 days in the NICU, he is coming home today. We’re all very grateful for his recovery and for the excellent care he received from the nurses and neonatalogist. And for everyone who shared their well wishes and expertise here, thank you. I was able to reassure my mother last night that my SIL’s OB acted appropriately (her main concern was that the doctor should have tested lung maturity while the 24 hour urine catch was in progress and then offered steroids at that time. She agrees that the delivery itself was necessary and had to be performed at that time).

    • Jessica S.
      March 29, 2014 at 12:30 pm #

      Yea! Such great news. Thanks for following up.

    • Box of Salt
      March 29, 2014 at 12:55 pm #

      Thanks for the update.
      Would you pass along to your family both congratulations and best wishes for speedy recoveries!

  4. March 28, 2014 at 10:54 pm #

    “You can make a lot of money off scared women.”

    Yes, you surely can, can’t you, Ina May Gaskin.

    When Ina May Gaskin said that, she was comparing how animals aren’t afraid of birth but people are. And yet here we have the home birth propaganda every where which aims to scare women away from hospitals, scare them away from doctors, scare them away from interventions, scare them away from c-sections, scare them away from formula….. the list goes on and on.

    • Susan
      March 29, 2014 at 1:08 am #

      So true. The irony of the “dead baby card” as fear mongering when fanning fear of hospitals and OBs is their bread and butter. So true.

      • birthbuddy
        March 29, 2014 at 1:58 am #

        The ‘terrible hospital card’?

    • Mindy
      March 29, 2014 at 2:37 am #

      I don’t understand this comparison of animals? How do we know they are not afraid of birth? Just because they do not talk and can’t verbalize their feelings doesn’t mean they can’t or don’t feel fear.

  5. Laura
    March 28, 2014 at 7:50 pm #

    I volunteer on a labor and delivery unit and today I was talking to the unit secretary about the water births done at this hospital. She told me that the parents had to bring in their own birthing tubs. I asked her if they rent or buy them. She didn’t now, but with all the sanitary considerations I hope they buy them! Let’s see – someone is selling those tubs….This hospital allows CNM deliveries. The secretary also noted that many of the patients who bring their own tubs to have water births invariably have birth complications and have to deliver on dry land. She also told me about the M & M conference (morbidity and mortality) coming up in a week at the hospital for – you guessed it – water birth. I’m only a volunteer but I’m wondering if I can sneak in….(Laura Learner)

    • Trixie
      March 28, 2014 at 7:55 pm #

      When I was in labor we barely remembered to bring the bag…let alone an entire kiddy pool.

      • Laura
        March 28, 2014 at 7:59 pm #

        I can’t imagine all the trouble those parents go through to drag it to the hospital and blow it up. Yuck.

    • Bombshellrisa
      March 28, 2014 at 8:04 pm #

      Usually it’s rent and you buy a plastic liner.

    • Jodi Hilla McCormack
      April 1, 2014 at 11:20 pm #

      A friend of mine had a water birth at home and her husband spent most of the time she was in labor blowing up and filling the pool. Her labor was short, so the midwife spent most of it prepping as well – not much time for, you know, monitoring the laboring mother. During my hospital labors my husband actually got to talk to me, make sure I was comfortable, check with my nurse and make sure we understood what was going on, etc. They weren’t rushed and I was never just left to labor by myself because there were other preparations to be made. Just logistically, I know what I’d rather be doing.

  6. Guestll
    March 28, 2014 at 6:32 pm #

    Slightly OT: My eldest sister had severe HG, PICC/TPN, the works. Ended up hospitalized for the last few weeks of her pregnancy. Started going in to organ failure. Baby arrived at 37 weeks on the nose, 6 lbs 6 ozs, everyone was fine.

    A former friend questioned me on this about a year or so ago — a friend of hers was hospitalized with HG. Said former friend is deep into the woo. She said, and I quote, “It’s really too bad they took your nephew so early. They should have waited it out until he came on his own.” I seriously wanted to toss my margarita in her face. Instead I said, “I guess you missed the part where my sister was dying?”

    Said 37 weeker is now 18 and in his first year of civil engineering. He stays with us on weekends sometimes as my sister is several hours away and he gets real food and a washer and dryer. He’s a slob who plays his guitar too loudly, he’s wonderful with our toddler, and he’s thriving and well. 🙂

    • Dr Kitty
      March 28, 2014 at 6:46 pm #

      He sounds like the coolest cousin!

      Your poor sister, that must have been miserable for her.
      I’ve looked after women who have ended wanted pregnancies because of severe HG. It is one of the most unpleasant pregnancy complications to live with.

      I had the mild kind (only dehydration and acute renal injury that was fixed with 48 hrs of IV fluids and Zofran ) and it was hellish.

      • Guestll
        March 28, 2014 at 6:54 pm #

        He is very cool, and bonus, he will take her to the park/watch Frozen/read her books — he’s a great kid and a nice help.

        I’ve heard about women terminating due to HG and I can’t imagine how awful that must feel, those poor women.

        My sister had tears, I can’t remember what they’re called? Where you vomit blood. Her pregnancy was truly awful and her kidneys took a beating but she ended up being fine in the end. Though in addition to her husband getting snipped, she got an IUD…

        I had bad NVP for 20 weeks. My sister had it with her first for 15 weeks, then HG with her second. I was told that it can worsen in severity in subsequent pregnancies and it’s one of the reasons why we’re stopping at one. I wasn’t nearly as sick as my sister with her second, not even close, but I don’t want to tempt fate, either.

        • Dr Kitty
          March 28, 2014 at 7:01 pm #

          Mallory-Weiss tears. Not fun.

          The vomiting was certainly a barrier to be overcome when deciding to have more kids (call me crazy, but 18 weeks of vomiting 4-8 times a day isn’t that appealing).

          The decision we’d try hasn’t, as yet, turned into a viable pregancy, but at least I know to get the Zofran started early if one occurs.

          • Guestll
            March 28, 2014 at 7:13 pm #

            I really hope you’re successful and that you don’t have NVP or HG this time. I was told that starting the drugs early could be of benefit if we were to have another (my NVP started at 4 weeks, I hurled in my RE’s office getting the PG test results!) Zofran was only so-so for me but I know it’s a Godsend for others. My magic cocktail was 2/2/3/3 daily dose of Diclectin + 100 mgs Gravol suppository for breakthrough barfing (usually once a day).

            People misunderstand and downplay NVP and HG, it’s such a shame. That was never more apparent then when Catherine Middleton had it with George.

          • Lion
            March 29, 2014 at 12:04 pm #

            I also had HG. The Zofran stopped my vomiting but did nothing for the nausea, but just no longer vomiting six or seven or more times a day was good enough for me.

  7. Trixie
    March 28, 2014 at 3:58 pm #

    Has anyone else read about this thing in Kenya where the church is trying to stop a campaign to vaccinate all women of childbearing age against tetanus because they suspect that it’s actually birth control? (I realize this does not reflect the Catholic Church’s official stance on vaccination, and is probably the action of one cardinal.).

    • Young CC Prof
      March 28, 2014 at 4:52 pm #

      “He questioned why it was only being administered to females aged 14 to 47, hinting that it could be a family planning method.”

      Right. So Kenya’s 10,000 deaths a year from neonatal tetanus have NOTHING to do with this campaign. Wow. Postpartum tetanus, that’s made-up too, right?

      • Aki Hinata
        March 28, 2014 at 4:54 pm #

        Yeah. Don’t get your medical advice from people who aren’t medical professionals.

      • Trixie
        March 28, 2014 at 7:53 pm #

        Infuriating. Especially when here on this country Dr Sears sells books claiming that newborns don’t really get tetanus.

      • Siri
        March 30, 2014 at 10:06 am #

        Tampons are a form of birth control. They must be; they’re manufactured SOLELY for menstruating women. I sense a conspiracy. Come to think of it, the rubella vaccine I received at 13 must have been birth control too; I didn’t have my first child until eight years later…they stole my fertility! I want it back!

    • Coraline
      March 30, 2014 at 7:58 am #

      Yeah, it’s definitely the action of ONE Cardinal, and not representative of the Catholic Church in general. I can understand his concern, in the sense that there was a vaccine created by the same person which included tetanus AND artificial birth control, but of course the Cardinal’s paranoia is very misplaced, and it was very irresponsible for him to publicly make such comments. I don’t know the “full story,” this is the first I’ve heard about it, but I think it’s very unfortunate that a Church figure has placed fear in the minds of his flock about vaccines.

      • Siri
        March 30, 2014 at 10:01 am #

        Yes, because God forbid birth control be made available to women and girls in developing countries! They must all enjoy their fertility to the full, even if it ends up killing them. Cardinals, on the other hand, rarely die preventable deaths from eclampsia, pph or septic abortion.

      • Trixie
        March 30, 2014 at 11:18 am #

        Here’s the thing though, couldn’t the Vatican just shut this down pretty quick? Why are they letting him keep talking about this?

        • Coraline
          March 30, 2014 at 11:31 am #

          Well, they likely could! But that’s the thing…the Vatican NEVER works quickly, they never have, particularly in a case with a not-very-well-known Cardinal. I wouldn’t be surprised if they say something, eventually, but it really does take time. I wish it didn’t, but that’s often just the way it works.

          • Trixie
            March 30, 2014 at 12:32 pm #

            That’s unfortunate. Babies are dying of tetanus there every day.

          • Coraline
            March 30, 2014 at 2:47 pm #

            I know, it really is unfortunate! And it’s a crying shame that this Cardinal took his strange, paranoid personal views on a lifesaving vaccine and made them public like that. Shameful, and completely irresponsible.

          • The Bofa on the Sofa
            March 30, 2014 at 12:59 pm #

            Sorry, the Pope has a sermon every Sunday. He has a ton of Cardinals at his hand, all that is required is one to call the guy and say shut up.

            No, the Vatican doesn’t get off the hook here. This is the church – the bishop is not protected by academic freedom that forces them to tapdance around.

  8. Guest
    March 28, 2014 at 3:32 pm #

    While I agree with many points in this post, I have been a doula for 8yrs and *never* charged for a birth. I have had clients who insisted on paying me, but I truly love supporting women (C/S, epidural, home, you name it), and there are *some* of us who really avoid the marketing and selling of NCB. Just FYI

    • Bombshellrisa
      March 28, 2014 at 3:57 pm #

      You are awesome! In my area, doulas charge close to a thousand dollars for two prenatal visits and attendance at a birth. Postpartum doula service costs between $28-35 an hour with a four hour minimum commitment per visit.

    • Lion
      March 29, 2014 at 12:15 pm #

      We had a doula for the birth of our second child. She charged a nominal fee. It really was nice having someone with us to make us tea, argue with the nurse when she refused to phone the anaesthetist when I asked for an epidural, hold my hand and comfort me through the rest of my labour which was unintentionally drug free. Before we hired her, I told my husband we needed her to do everything he learnt at ante natal classes and refused to do. Afterwards I overheard him recommending doulas to other soon to be dads. I know some doulas overstep the mark, but before we hired ours I asked our obstetrician to please recommend someone who was professional and wouldn’t play us whale music or wave crystals around. He laughed and said that wasn’t possible, but gave me a list of women he had worked with before and found pleasant. I had a traumatic first birth (things were going wrong and my son was delivered by forceps and I heamoraghed) and was scared going into the second (is anyone not actually scared?) and that calm person with us was great.

    • Coraline
      March 30, 2014 at 8:01 am #

      Wish there were more doulas like you! I hate that doulas have been associated SOLELY with the NCB movement. My husband suffers terrible anxiety, particularly in hospital settings, and having a doula attend my births has not only been helpful for me, but also especially for HIM.

  9. attitude devant
    March 28, 2014 at 3:14 pm #

    So, suppose we wanted to study water delivery, with an appropriate attention to neonatal outcomes. Knowing what we know about the risks, would it even be ethical to run such a study? Could we even get it past an IRB?

    • Ash
      March 28, 2014 at 3:20 pm #

      A randomized trial? Doubtful. A registry of outcomes for hospitals that offer waterbirth deliveries via chart review? Sure, is already occurring now (but I don’t think there’s any multi-center registries)

      • Laura
        March 29, 2014 at 12:28 pm #

        That’s why the m&m regarding water births at the hospital I volunteer at so intrigues me. They are not doing trials, but rather looking at case studies and situations they are aware of that didn’t go well.

  10. Jessica
    March 28, 2014 at 2:39 pm #

    If the enlightened and knowledgeable commenters here will indulge my OT question related to a family situation: if delivery of a baby becomes medically necessary before 39 weeks (say, 37w6d), would the standard of care be to perform an amnio to test lung mature before delivery?

    • attitude devant
      March 28, 2014 at 2:41 pm #

      No, because if it’s truly necessary, it’s truly necessary, and even if you documented the lungs weren’t mature you would deliver that baby.

      • Jessica
        March 28, 2014 at 2:46 pm #

        Thanks. My SIL developed pre-e last week and was in the hospital for 24 hours on bedrest while her doctor did a urine catch. No amnio was done and no steroids were given, and when the results of the urine catch came back she was in surgery within a couple of hours (my understanding is she opted against an induction and went straight for the C-section). They think she had developed undetected gestational diabetes, given baby’s size, and unfortunately the baby had respiratory distress. He has been in the NICU since birth and has been diagnosed with persistent pulmonary hypertension.

        I had chronic hypertension during pregnancy and my OB always said that if he thought I needed a delivery before 39 weeks he would do an amnio first. My mother is now convinced my SIL’s doctor wasn’t cautious enough and she is extremely angry over the situation.

        • Young CC Prof
          March 28, 2014 at 2:54 pm #

          Um, TTTN is caused by immature lungs. I think persistent pulmonary hypertension is caused by not getting the baby out fast ENOUGH when things go wrong.

          • SNM1
            March 28, 2014 at 4:57 pm #

            Persistent pulmonary hypertension is seen frequently in very premature babies but you are right in that late prematurity would be unlikely to cause PPH in this case. I lean towards there being another medical cause (not necessarily not getting the baby out fast enough as it sounds like it happened pretty quickly in this case). I would be curious if she had gestational hypertension or ore existing undisguised chronic hypertension before pregnancy or what her amniotic fluid levels were as those things can definitely contribute to PPH in the late preterm or term neonate.

          • Young CC Prof
            March 28, 2014 at 4:58 pm #

            Good to know!

        • attitude devant
          March 28, 2014 at 2:57 pm #

          No, the doc did right. You wouldn’t delay her delivery if mom was that sick, and typically PIH moms have already accelerated the maturity of the baby’s lungs. Also, steroids are of minimal-to-no benefits after 34 weeks. As for your care, chronic hypertension and PIH are different and are managed differently. Sounds like your SIL was very sick indeed.

          Please post and let us know how the baby is doing.

          • Jessica
            March 28, 2014 at 3:06 pm #

            Thank you again. I had no frame of reference other than my own pregnancy and the convos with my OB over the plan if I developed pre-E or a BP spike late in pregnancy. The neonatalogists have said the undiagnosed GD may have complicated the situation with my nephew and his lung maturity, but I am hearing this all second or third hand.

            Nephew was treated with nitric oxide last week and improved very quickly. He’s still receiving some oxygen through a nasal cannula but has been able to nurse, though is still not nursing effectively enough to not need supplementation. SIL just said he may come home this weekend; has to pass the carseat test and I’m sure they’ll want to make sure a good feeding plan is in place. The NICU docs are being very cautious and the level of care he’s gotten is excellent.

            Thank God!

          • Young CC Prof
            March 28, 2014 at 3:17 pm #

            Here’s another problem with the 39-week campaign:

            They’ve reduced a complex medical decision to a one-dimensional slogan, and in the process they’ve got quite a few people excessively frightened even of medically necessary early-term deliveries.

            It really sounds like the doctors did the right thing. Past 37 weeks, major complication has occurred –> immediate delivery. And I’m glad both mom and baby are improving!

          • Guestll
            March 28, 2014 at 4:03 pm #

            My best friend is scheduled to deliver her first via section at 37 weeks on the nose next week. She’s had three major third trimester bleeds and spent two weeks in the hospital. Suspected abruption but no one (including the MFM) knows for sure. Baby’s coming out at 37 weeks via section — and there was no pushback from hospital administration whatsoever.

            That’s how it should be. It’s sad that such a nuanced issue has become such a cluster.

          • Young CC Prof
            March 28, 2014 at 4:54 pm #

            I doubt any medical people would push back against a 37-week delivery for that kind of situation, but I certainly have seen pregnant women and their families unduly afraid of them when it’s clearly appropriate.

        • attitude devant
          March 28, 2014 at 3:10 pm #

          Also, I surely do hope your mother doesn’t breathe these concerns to your brother or your SIL. Hard enough to be a new mom with a serious illness AND with a baby in the NICU and to hear your MIL is more concerned about the baby’s illness than the mom’s.

          • Jessica
            March 28, 2014 at 3:15 pm #

            Yeah, she knows enough to keep her mouth shut (and I reminded her of the importance of doing so), but I want to be able to tell her something to calm her down.

            SIL was discharged from the hospital four days after delivery and is doing very well.

          • attitude devant
            March 28, 2014 at 3:18 pm #

            So glad to hear that. And I apologize for butting in to tell your mother not to butt in!

          • Thankfulmom
            March 29, 2014 at 3:46 am #

            Your nephew was too far along gestationally for steroids to be used. I got steroids at 30 weeks. On my third admission, the mfm said they would do another 24 hour protein test and take 24 to 48 hours to determine if my bp was due to my chronic hypertension or the pre-eclampsia getting worse. He came in early the next morning and said he was delivering now because the protein level was high enough they weren’t going to wait around for the 24 test to be completed.

            CHT is managed differently than pre-e so that is why the care plan for you and your sil was different. Pre-eclampsia can be deadly, sounds like her OB did exactly the right thing. It might help your mom if you or she checks out Lots of excellent information there. Last thing your sil needs is to be criticized for her early delivery. My mil thought if I had taken the Shaklee vitamins she suggested I wouldn’t have gotten pre-e.

        • ngozi
          March 28, 2014 at 3:12 pm #

          When I developed a case of pre-enclampsia during one of my earlier pregnancies, I was admitted to the hospital and was given a shot to help develop my son’s lung. He was born at 35 weeks.
          My placenta was starting to breakdown, so I am glad they got him out of there instead of keeping him in their because they wanted his lungs to mature. Sometimes it is just better to get the baby out.

        • Dr Kitty
          March 28, 2014 at 3:51 pm #

          If she had frank proteinuria the baby needed OUT.
          Not for his sake, for hers.
          All the signs said your SIL was very sick and needed to deliver ASAP.
          Keeping him in longer may have lead to eclampsia or DIC.
          If there was no time for an Amnio and steroids (which aren’t usually given after 36 weeks) then there wasn’t time.

          Better your nephew has a condition which is treatable than your SIL started seizing while still pregnant.

          The Dr was cautious about you SIL’s health and prioritised it above the small risk the the baby of delivering earlier.
          If the pre-e developed that quickly 48 hrs waiting for steroids to work could have killed you SIL. For reals.

        • Renee
          March 28, 2014 at 4:28 pm #

          She is angry because she doesn’t understand. All she knows is there is a baby in the NICU.
          She needs to be told that NOT delivering him could have meant stroke, coma, death to the mom, period. Its a well known risk. So they delivered baby, he will get a short NICU stay, then all will go home healthy. Much better then waiting.

    • Therese
      March 28, 2014 at 3:36 pm #

      I’ve heard that amnios for lung maturity also have a high rate of false negatives, meaning the test will often say the lungs are not mature when they actually are.

      • attitude devant
        March 28, 2014 at 3:38 pm #

        This is correct. But the more important thing is that if delivery is medically indicated, it’s medically indicated. For instance, if someone ruptured membranes at 33 weeks and the cord prolapsed, you’re not gonna be checking the fluid for lung maturity before you get that baby out.

    • SNM1
      March 28, 2014 at 4:50 pm #

      Respiratory distress may also be related to undisguised gestational diabetes… Babies born to uncontrolled diabetics frequently have respiratory issues. ACOG recommends delivery for pre-e if mom is at 37 weeks or if it is medically indicated for mom (if the pre-e is severe) they even recommend it be done earlier…

    • Paloma
      March 29, 2014 at 7:00 am #

      In my country, it depends on the gestational age (or at least that’s what I was told in med school, I start as a resident in May, so I’m not an expert by any means). If the baby is over 34 weeks, they just deliver, if the baby is under 34 weeks, they get tested and also they start steroids before delivery. Correct me anyone please if I am wrong, but that’s what I remember from my text books 🙂

      • Medwife
        March 29, 2014 at 10:36 am #

        That is the standard of care where I work. We would never test for lung maturity past 34 wks.

    • Captain Obvious
      March 29, 2014 at 9:45 am #

      If it becomes medically necessary to deliver a baby at any age, no amnio needed. If you have severe preeclampsia at 28 weeks, just deliver. If you have gestational HTN that is worsening at 38 weeks, just deliver. Cholastasis at 37 weeks just deliver.

    • fiftyfifty1
      March 30, 2014 at 8:50 am #

      Early term, rapidly developing pre-e happened to my sister. They didn’t check for lung maturity because baby needed to come out. She seemed stable enough at the time so she opted for induction and it ended up going very badly. She rapidly developed liver and platelet involvement and got VERY sick. Actually ended up with an emergency *high forceps* done by some ancient OB. Apparently there was some concern they could lose them both. Anyway, my sister told me the story afterward and I thought maybe some exaggeration was involved (e.g. “The room had 30 people in it and they did a high forceps, not mid forceps”). But I later ran into a young OB who had trained where she delivered and she confirmed all of the details. She had been one of the 30 in the room. Baby went to NICU but ended up fine in the end.

      • Medwife
        March 30, 2014 at 9:11 am #

        It’s so amazing and scary how fast the pre-e patients can get sick. Glad your sister and her baby were ok. High forceps, good lord.

        • fiftyfifty1
          March 30, 2014 at 11:32 am #

          Good Lord indeed. They do get sick fast. Last year an in-law of mine developed pre-e at the cusp of viability. But in addition fetus appeared to be growth restricted so wasn’t even a candidate. Doctor recommended D&E as the safest because based on how quickly mom was going downhill they thought an intact induction delivery type termination would take too long to be safe. Very sad to not even be able to hold baby. Mom had a touch and go hospitalization afterwards. They can get sick fast and stay that way for a chunk too.

  11. March 28, 2014 at 2:33 pm #

    They always pull out the ‘no one gets rich doing this!” line, but they get a damn lot richer than they would doing a job they are actually qualified for.

    • Trixie
      March 28, 2014 at 3:09 pm #

      Especially since most of them probably don’t report their income, or all their income.

      • Bombshellrisa
        March 28, 2014 at 4:00 pm #

        Well, it’s a little hard to claim things like gold, silver, gasoline and hay on a tax form

  12. AllieFoyle
    March 28, 2014 at 1:46 pm #

    I’m often critical of proponents of NCB and midwifery, but even I have to admit they’ve figured out a brilliant strategy: create and then dominate an entire birth preparation industry that is not only financially lucrative but also serves as propaganda to prime women for purchasing their “services” later. Who knew that “other ways of knowing” could include such shrewd marketing instincts?

    • March 29, 2014 at 2:22 am #

      To be fair, the entire business of becoming pregnant, all the way through child raising to adolescence has become a giant industry, with “essential” services and equipment being pushed at every stage. My daughter, expecting #2 in a couple of months, was clearing out some cupboards the other day and commented that she’d so “overbought” with #1 that she might just open a store herself to get rid of all the extra things she was assured were necessary.

  13. March 28, 2014 at 1:35 pm #

    Where are the advocates for the women? I mean it’s obvious that Big Birth has vested interests – it may even be obvious that the health insurance industry also has vested interest (although are much better aligned with the interests of mothers). This is where regulators should be involved, making sure the interests of providers and those they serve are aligned – that is why there’s malpractice insurance, that’s why there are minimum qualification standards. Anyone else notice that those things apply to one set of providers but not the other? For the record, I’m not against people/organizations with a product to sell – but I am against those who do so unethically.

  14. March 28, 2014 at 1:00 pm #

    “to major prongs” should be “two major prongs”.

  15. Captain Obvious
    March 28, 2014 at 12:01 pm #

    Analyze coding, billing, and global period of care. Pregnancy is a global fee for most pregnancies. The initial visit including the “routine” first visit ultrasound and the 32 week 3D/4D ultrasound is part of that global fee. Most insurance companies will pay extra for monitoring in high risk pregnancies, but you need a diagnosis and medical necessity to bill it. Now lets go to delivery, also included in the global fee. If the baby delivers in 1 hour versus another delivery that requires internal monitors, amnioinfusion, AROM, episiotomy, repair of a laceration, management of PPH, or shoulder dystocia, the doctor gets paid the same-> global fee.
    Epidurals can cause maternal hypotension that may cause fetal bradycardia. Usually preprocedure maternal hydration is prophylactic enough. If it occurs anyway, rapid IV (need IV access of course) hydration, maternal position change, stopping pitocin or giving one shot of terbutaline, and possibly one dose of ephedrine fixes 99% of that NUCB “reason” that epidurals are so evil.
    NUCB birth affirmations are so obviously pathetic. It is wish list. Call me a pessimist, but I would rather hope for the best but prepare for the worst. A recent comment on that water birth article states ACOG doesnt endorse elective CS for macrosomia. A cheap plea at how doctors don’t follow evidence medicine or ACOG guidelines. Lay people read that and say, “wow, didn’t know that. Why are doctors such money grubbing lazy quacks?” But when you actually read ACOG’s practice bulletin, it does state that when an estimate of fetal weight is over 5000g, or over 4500g if diabetic, an elective CS can be indicated. Expert opinion also includes having a history of shoulder dystocia or large laceration, or having an AC greater than HC may indicate elective CS. But hey, your body won’t produce a baby that your body cannot deliver.

    • Jessica
      March 28, 2014 at 12:35 pm #

      The only people I know who think having an unmedicated vaginal delivery of a baby over, say 8.5 pounds, is a GOOD thing vis-a-vis a C-section are those who’ve consumed the NUCB Kool-Aid. Every other normal woman cringes at the thought of giving birth to a macrosomic baby.

      • Guestll
        March 28, 2014 at 12:47 pm #

        I had an unmedicated (failed epidural) birth of an 8.8 ozs baby who was also posterior, and while I would have strongly preferred working analgesia, I wouldn’t have wanted a section just because she was large. My mother’s first three children were unmedicated vaginal births, her last (me) she had a pudendal block and forceps. She strongly prefers the memories of the first three and she didn’t want a section either. Not everyone who prefers a vaginal delivery (even of a larger baby) is a drinker of the Kool-Aid.

        • Jessica
          March 28, 2014 at 1:05 pm #

          Eh, I strongly preferred a vaginal delivery and was terrified of a C-section, but if I’d been told my kid weighed 9, 10+ pounds, I might have felt differently. Most women I know feel the same way. Different strokes for different folks, but the NUCB crowd doesn’t really accept that some women might not desire to vaginally deliver a large baby.

          • AllieFoyle
            March 28, 2014 at 1:11 pm #

            And I would have preferred a c-section, both beforehand and afterward. The NCB crowd probably would count that birth as a win, but for me–the individual involved–it most definitely was not. The best interests of women like me are simply not acknowledged by NCB, except in dismissive and insulting ways like assuming that there is something fundamentally wrong with me psychologically for not wanting what they think I should want or for caring about what they seem not to think is important.

          • March 28, 2014 at 1:20 pm #

            NUCB can’t accept that some women don’t want to vaginally deliver a baby. PERIOD.

          • Young CC Prof
            March 28, 2014 at 1:24 pm #

            Or that some women are basically OK with either option, as long as the baby gets out safely without too much damage to her, and are happy to accept whichever method the experts think is safer for her particular situation.

          • mythsayer
            March 28, 2014 at 2:06 pm #

            And that would be me! Elective C-Section all the way here. Had a Japanese OB so he didn’t tell me why he said it was okay to do it, but he must have had a reason because I know two other people who asked for C-Sections and were told no because he thought they could do it the “regular way”… they both ended up with CS… that was my fear. Laboring for hours and then converting. So yeah… not everyone wants to even attempt a vaginal birth.

          • anion
            March 28, 2014 at 2:13 pm #

            Me, too. I did go through labor with #1, but didn’t want to, and was thrilled to end up with a section. The idea of vaginal birth absolutely did not appeal to me or interest me, ever.

          • Guestll
            March 28, 2014 at 1:33 pm #

            Great, but you said, “The only people I know who think having an unmedicated vaginal delivery of a baby over, say 8.5 pounds, is a GOOD thing vis-a-vis a C-section are those who’ve consumed the NUCB Kool-Aid. Every other normal woman cringes at the thought of giving birth to a macrosomic baby.” And I said, not everyone who prefers a vaginal delivery feels that way because they’re immersed in NUCB.

            Some women would prefer to avoid a section, for a variety of reasons. There is nothing wrong with that. These polarizations on both sides of the argument serve no one’s interests well.

          • ngozi
            March 28, 2014 at 2:29 pm #

            I always wanted to avoid a c-section (not at the cost of my newborn, of course) but that is because I don’t like surgeries at all, not just c-sections. It isn’t because I’ve drank the NBCers “kool-aid.”

          • Jessica
            March 28, 2014 at 2:36 pm #

            I was making an observation based on the women I know. Which is, that the people who think OBs are negligent or irresponsible for offering C-sections to mothers in the event of suspected macrosomia (those who’ve drunk the Kool-Aid) are imposing on those mothers a value that said mothers might not share – vaginal delivery above all else.

          • Young CC Prof
            March 28, 2014 at 2:52 pm #

            And that the women who wanted vaginal delivery, but immediately consent to c-section when it became necessary must be ignorant sheeple who have no faith in their own essential goddess powers and need to be edumacated.

          • Guestll
            March 28, 2014 at 3:52 pm #

            8.5 lbs is not macrosomia. I don’t mean to be pedantic, but there’s a difference between a baby estimated at 11 lbs and one estimated at 8.5 lbs.

          • AllieFoyle
            March 29, 2014 at 11:04 am #

            It’s very close though. What I’ve never understood is the insistence on 5000 g as the cutoff– as though there isn’t any anatomical variation between women. It isn’t as though something magical happens precisely at that point but not before. I know the number comes from analyzing large data sets to figure out on a population-level the point at which it makes sense to routinely do c/s, but why would individual doctors and patients need to be bound to some theoretical number when they have additional information that is specific to the patient including patient preference, maternal size and anatomy, past obstetrical history? It’s simply common sense that as infant size increases, the difficulty of the birth will also increase, in general. It makes no sense to willfully ignore this up to some arbitrary point.

          • thin_red_line
            March 28, 2014 at 7:46 pm #

            I want a living baby above all else, I was offered a c-section and I accepted. I’m a nurse and I know if they offer the surgery, it’s for a reason. I could honestly care less about giving birth vaginally, it doesn’t appeal to me. Plus, I have seen some pretty serious “blow-outs” and preferred having a pelvic floor when all is said and done.

          • Renee
            March 28, 2014 at 4:35 pm #

            Key phrase “only people I know”.
            This isn’t a generalization to the whole world of women, its a comment on her personal reality.

        • guest
          March 28, 2014 at 3:29 pm #

          I get what you mean. I strongly preferred a vaginal delivery, not because a C-section would have been a failure of any sort, but because I want to have a big family and I know that having more babies after a section can be much riskier. I was happy that my OB was willing to try other “interventions” before doing a C-section, and I was lucky that those other interventions were successful and no C-section was necessary. (My kiddo was posterior too, and the one still in the oven is breech and had better turn over in time!) If you prefer C-sections, that’s fine, no judgment here. And if you end up with a C-section you and/or your baby needed but didn’t necessarily want, I won’t patronize you and say “Oh, gosh, I’m so sorry,” but I understand why you wanted to avoid it.

          • Guestll
            March 28, 2014 at 3:57 pm #

            Yes, this. This isn’t a black and white issue, and women who want to avoid sections shouldn’t be demonized or collectively tarred with the NCB brush. I wanted to avoid surgery if I could — my reasons are just as valid as the woman who wants to avoid vaginal birth.

            FWIW, my posterior princess was breech until she flipped right at 36 weeks. I would have had a section had she not flipped to vertex. My reasons for wanting to avoid surgery did not include foisting the risks inherent in a vaginal breech delivery on my baby.

            I hope your little one flips for you! 🙂

          • guest
            March 28, 2014 at 10:30 pm #

            My little guy too! He was breech until he finally flipped at 36 or 37 weeks (I’ve forgotten now, but I know it was pretty late in the game). This lil gal on the way still has time to turn over, and I hope she does for reasons previously mentioned. But like you, I definitely wouldn’t choose to try a vaginal breech delivery. You’re right, it just isn’t a black and white issue, and as long as everyone is safe and healthy, women should be allowed and encouraged to do what they want. Thanks! 🙂

    • AllieFoyle
      March 28, 2014 at 1:04 pm #

      Recommending or providing the choice of an elective c/s outside those strict criteria can also be an act of caring and compassion. Read the latest entry on Mrs. W’s blog Awaiting Juno (link on the blogroll to the right) for a personal example of this.

      NCB propaganda makes it seem as though vaginal delivery is always the greatest good, and that any lost opportunity for having one is some kind of professional or systemic failure. For many individuals though, it really is not that simple, and the best, most compassionate care provider recognizes this and attempts to embrace the complexity of each patient and situation and do what is in the best interest of those involved, whatever kind of delivery that means.

    • Bombshellrisa
      March 28, 2014 at 2:28 pm #

      My (female) OB called the birth plan template they hand out at the 34 week visit “the birth wishes list”.

    • thin_red_line
      March 28, 2014 at 7:43 pm #

      I’m glad you brought up the global fee, OB’s get paid a straight $4k per patient for prenatal care and delivery. The price is the same for vag or c-section delivery, it does not matter.

  16. Amy M
    March 28, 2014 at 11:57 am #

    The anti-vaxx movement works the same way. Those people make up or grossly exaggerate the risks of vaccine injuries, deny the complications of the diseases they prevent, decry doctors and Big Pharma (who are trying to make a buck and kill you simultaneously), and defying science and logic with their inane, insane crap about homeopathy and various other cures and preventatives for VPDs. Only they are more dangerous than birth workers because they can kill a whole bunch of people at once with an outbreak, rather than picking them off one at a time with homebirths gone wrong.

    On a happier note, I had a great discussion about waterbirth with a science friend last year. She has a PhD in a math field, and was never into homebirth or anything, but she had wanted a natural water birth in the hospital. She had an unmedicated birth, but they didn’t allow it to be in the water because there was some meconium, her son was fine, life went on. I sent her some of the articles that Dr. Amy has previously cited about how birth into the water can be dangerous, though laboring in the water was fine and she was totally sold on it and understood why the waterbirth didn’t happen and why it was safer that way.

    • Zoey
      March 28, 2014 at 12:03 pm #

      You know what the only thing “better” than a regular birth worker is? It’s one with “training” on vaccinations! A friend of mine recently got her doula certification and one of her elective courses through her training program was called “Educating Parents about Vaccines”. I can only assume this isn’t educating them on the importance of following Health Canada’s vaccination schedule. So now we have uneducated birth workers giving medical advice about two things they have no training in. Wonderful.

      • Amy M
        March 28, 2014 at 12:32 pm #

        Oh that’s just great, how long before an increase in infant pertussis deaths? Or has that already happened?

        • Young CC Prof
          March 28, 2014 at 12:45 pm #

          Those have definitely gone up over the last 5 years, unfortunately. Of course, almost all of those deaths happened to babies under 3 months who caught it before they had a chance to get vaccinated. I really hope we avoid deaths of older babies whose parents rejected the vaccine…

          • Amy M
            March 28, 2014 at 1:53 pm #

            Yes, I was thinking more of the chances of the newborns being exposed increasing because the doula won’t be up to date on vaccines and if she convinces the mother, the mother won’t be, nor would any older children either. Of course, those babies are already at risk, as you pointed out, but less so when they are born into families who believe in getting the booster into anyone who will be around the newborn.

          • AllieFoyle
            March 28, 2014 at 2:09 pm #

            And they all tend to socialize with other families who don’t vaccinate either, creating a nice little network for outbreaks.

            When my last child was a newborn, there were outbreaks of chicken pox and pertussis going around the area. The crunchies were thrilled about chickenpox, organizing chicken pox “parties” and the like, and downplayed pertussis (“it’s just a minor illness, people used to get it as a matter of course, see–the vaccine’s no good”, etc.) but I didn’t appreciate having to worry that my older child would bring home germs from infected classmates and make the baby sick. It was such a relief to finally get those vaccines.

          • Young CC Prof
            March 28, 2014 at 2:31 pm #

            My cousin got chicken pox at one week old, right after her mother caught it from her brother, which is when we learned that her mother is one of the small percentage of people who completely lost her childhood immunity. (This was just a couple years before the vaccine.) 3 weeks in the hospital fighting for her life. Yeah, let’s NOT go around spreading chicken pox, geniuses.

          • AllieFoyle
            March 28, 2014 at 2:51 pm #

            Oh, that’s horrible. I wish people could hear those stories when they decide not to vaccinate.

          • Trixie
            March 28, 2014 at 3:31 pm #

            That’s horrible.

          • Jessica S.
            March 28, 2014 at 10:05 pm #

            I mentioned this on another post the other day. I had a friend who took her kids to one of these “parties”, turns out the “hosts” had hoof and mouth disease (or is it hand/foot/mouth disease? Whichever.), NOT the chicken pox. I’m glad I kept my son away from the whole lot of them, even though he’s had all his shots. It never occurred to me – which is sad, it should’ve been obvious – that there could be some other disease in the mix.

          • The Bofa on the Sofa
            March 28, 2014 at 10:33 pm #

            There’s not a hand/foot/mouth vaccine. Yet.

            The idea that someone would deliberately give their child HFM is really, really scary.

            Although it is brief (just a couple of days) that is one nasty-ass sickness.

            I just remember my younger guy when he had it, taking a drink of milk and screaming in pain. It was terrible, because milk was his security at the time – whenever he felt bad, he’d drink some milk. But with HFM, it was torture for him.

            That is the most miserable our kids have ever been, when they had HFM. And my older guy even had a mild case of it – he only had spots on his mouth (the doctor even thought it might only be herpangina; we don’t think so, though, because when our younger guy got it, the older guy went through with nothing). Despite the mild case, it was awful.

            Anyone that would deliberately inflict this upon their kids is an absolute monster.

          • Jessica S.
            March 29, 2014 at 11:27 am #

            Well, since the hosts found out it was HFM *after* the party, I wonder if it was a wake up call to any of the “guests”, realizing they had in essence, as you said, deliberately exposed their kids (and themselves! I’ve heard it’s worse for adults, or can be?) to it, however unintentional.

            Aside from an unwarranted fear of vaccines, I don’t understand why exposure to one virus/disease is ok but another is not. It brings to mind the latest post on RI, about Dr. Bob Sears and his “measles, shmeasles” rant—> subsequent “mini” culpa-but-not-really. A doctor in the comment section states, bizarrely, that even though he’s “pro-vaccine” he doesn’t think measles are a big deal. He says, shucks – we used to code it as a usual childhood disease, so what’s the fuss? Same logic for chicken pox and influenza and vaccine refusal therein, even though measles is arguably a step more serious than the latter two. But that’s the thing: why make your kids – or yourself! – suffer if it’s not necessary? The only explanation is a lack of confidence in vaccines (ok, not the “only” but you know what I mean). It’s a completely understandable concern, but one that’s easy to overcome through education on the matter.

            I’m babbling, but it just really annoys me, the lack of critical thinking. The pure abandonment, in some cases.

          • S
            March 29, 2014 at 12:00 pm #

            I can’t read that Dr. Sears rant without thinking very unkind thoughts toward that man. It’s pretty clear that he’s just not concerned about newborns and immunocompromised people. Nice attitude for a pediatrician.

          • S
            March 29, 2014 at 11:16 am #

            I can understand why, in the absence of a chickenpox vaccine, parents would have preferred their children to get the disease earlier rather than as an adult. But what is the rationale for doing it now? If it’s just a minor illness, then why pay it any mind at all? Do they also purposely infect their children with every cold and gastrointestinal illness that goes around? I wouldn’t want anything to do with those people!

            I never got chickenpox as a kid, and then the vaccine came out when i was a teenager… so i would be a yay vaccines success story, except my dumb ass forgot all about completing the series before i got pregnant. Not immune, and i kick myself every time i see the word chickenpox.

          • Jessica S.
            March 29, 2014 at 11:30 am #

            I basically said the same thing to Bofa, typing as you posted. Great minds! Can you not get the vaccine when you’re pregnant? I don’t know the restrictions. I’m currently pregnant, but have just followed what my doc recommends and CP is not one I needed. (I don’t recall having CP as a kid, but I just have had a minor case, b/c I have immunity. Weird!)

          • S
            March 29, 2014 at 11:54 am #

            It’s a live virus, so not during pregnancy. I’ll have to find out how soon after the birth i can get it.

            That _is_ weird! Guess you got lucky with that one. =)

          • mythsayer
            March 28, 2014 at 2:07 pm #

            Yes, but if there had been proper herd immunity, they wouldn’t have caught it in the first place!

  17. Mel
    March 28, 2014 at 11:43 am #

    Also from SBM:

    ” When waterbirths take place in cold water, which they never do because that would interfere with the pleasurable experience of the mother, they can talk about the diving reflex. Or if they are delivering a seal.”

    True in that seals have a much better diving reflex than humans. False in that MOST seals give birth on solids – ice or land. Yes, even most other mammals give birth on land….

    • Clay Jones
      March 28, 2014 at 1:58 pm #

      Sorry. Blame my taking liberty with the truth regarding pinniped birthing practices on my zeal to have a sardonic quip at the end of that sentence.

      • Amy Tuteur, MD
        March 28, 2014 at 2:13 pm #

        Your piece is terrific!

      • attitude devant
        March 28, 2014 at 2:45 pm #

        I have been giggling over your piece all day. My favorite phrase is “A fine example of complementary and alternative reality…” You have a lovely way of taking a usual phrase to set the reader up with one set of expectations for the end of a sentence just to drop us into a witticism like that. Nice comic touch, that.

        I only wish the link to Pediatrics didn’t hit a pay wall.

        • Clay Jones
          March 28, 2014 at 3:49 pm #

          The Naked Emperor piece is an excellent article. Sorry I can’t do anything about that paywall!

      • Jessica S.
        March 28, 2014 at 4:51 pm #

        Excellent post, Clay! Thanks for writing about it. I always enjoy your SBM posts!

      • March 28, 2014 at 7:40 pm #

        I thought that was great!!

      • Mel
        March 28, 2014 at 9:14 pm #

        I loved it! I couldn’t help piggy-backing on how absolutely ridiculous the “natural water birthing” craze is. Shoot, the only mammals I can think of that birth in the water are the large aquatic ones whose body weight will crush their internal organs if they are on land…..

        • Medwife
          March 29, 2014 at 10:42 am #

          I think otters give birth while swimming. Saw it on a documentary once. It was amazing, the mother swam in corkscrews and twisted the baby out.

  18. Mel
    March 28, 2014 at 11:39 am #

    From Science Based Medicine:

    “The only variable in a delivery that can lead to fresh water drowning, for instance, is the choice to have a waterbirth.”


    I like swimming. I find it really relaxing.

    I would not, however, drop a newborn in a swimming pool to calm them down. The feeling of inhaling water is not calming – so why the hell would you have your baby’s first experience after birth be a near-drowning?

    • Therese
      March 28, 2014 at 2:34 pm #

      Yes, it is true, NCBers have water births specifically because they want their baby to feel the terror of drowning. That is their whole intention behind choosing water birth. Now let’s all discuss how evil they are for feeling this way, it will go so far in making progress towards convincing them that water birth is a bad idea.

      • Renee
        March 28, 2014 at 4:46 pm #

        I think that is a normal reaction to the insanity.

      • KarenJJ
        March 28, 2014 at 6:56 pm #

        Of course NCBers don’t really think that way (and I don’t think that’s what Mel was saying), but I feel that they haven’t taken the idea through to the natural consequence of what happens if a baby does try to take its first breath underwater. Suddenly waterbirth would not be calming and relaxing for baby.

        The big issue with water birth is that mothers are told that the baby won’t try to breather underwater (not true) and that the cord will continue to provide all the oxygen that the baby needs until the placenta is delivered and the cord stops pulsing (also not true). Once those myths are busted and the fact that epidurals are a safer and more effective pain relief for most mothers, the idea of a water birth seems a lot less appealing.

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