Who has the greater incentive to lie about deaths at homebirth, obstetricians or midwives?

Greater financial incentive flat Xsmall

Follow the money!

At first glance, it appears that this is one of the most persuasive arguments marshaled by homebirth advocates. Obstetricians supposedly oppose homebirth because it represents a loss of income. They supposedly lie about the risk that the baby will die at homebirth for no better reason than to preserve their profits. This argument appeals particularly to those who like to believe that they cannot be duped by authority figures or are in possession of secret, special knowledge that makes them more “educated” than the rest of us.

But a closer look demonstrates something else entirely. If anyone has a motivation to lie about the risk of death at homebirth, it is homebirth midwives.

Why? At the moment, homebirth with an American homebirth midwife represents approximately 1/2% of US births each year. That translates to 1/2% loss of obstetric income for OB-GYNs and no loss of gynecology income, meaning that for most OB-GYNs, homebirths represent a potential loss of income of around 1/4%. That’s hardly likely to be a motivation for scare mongering. Moreover, there is currently a shortage of OB-GYNs willing to deliver babies, so there’s no reason to believe that homebirth with a homebirth midwife represents any loss of income for doctors who practice obstetrics.

On the other hand, homebirth represents 100% of the income of homebirth midwives. They charge upwards of $3000 per patient, often in cash, often paid in advance, non-refundable and typically not covered by health insurance. It is an especially impressive amount of money considering that American homebirth midwives require no more than a high school diploma, and no further formal schooling of any kind, to be eligible for the homebirth midwifery certification of CPM (certified professional midwife). There aren’t many people with only a high school education who can command that kind of money, and for most homebirth midwives, they cannot possibly earn as much in any other way.

So you tell me who has the greater financial incentive to lie about the risk of perinatal death at homebirth, obstetricians, for whom homebirth represents no loss of income, or homebirth midwives (CPMs, LMs, DEMs and lay midwives), for whom homebirth represents 100% of income.

177 Responses to “Who has the greater incentive to lie about deaths at homebirth, obstetricians or midwives?”

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  2. Sara Barnson
    October 21, 2015 at 3:50 pm #

    I’d never really looked at that math before. Here in rural Idaho (where homebirth is more common because lack of good insurance and far away hospitals combined with relative poverty), a midwife charges about $4,000 for a birth. If she has 26 clients in a year – one for every two weeks – that’s more than six figures. Less if it’s over the table, because of taxes. If she has more clients, one every week, it can be multiple six figures. Granted, quite that many clients is hard to come by around here, but a Nurse-Midwife caps out in the richest areas of America at about $118,000 per year working full time.

    Follow the money indeed. The education of an orderly for the pay of an OB.

  3. Amy Tuteur, MD
    March 6, 2014 at 9:17 pm #

    From the Midwifery Today Facebook page:

    • Daleth
      October 21, 2015 at 4:24 pm #

      Distance education. Omg distance education. That’s SO INSANE.

  4. Bombshellrisa
    March 6, 2014 at 2:39 pm #

    Not sure about that birth center, but the ones around here not only charge extra but you have to bring your own birth kit for them to use.

  5. Bombshellrisa
    March 6, 2014 at 2:38 am #

    Direct quote from Sister in Chains Katie McCall “don’t let the high cost of midwifery care prevent you from having the birth of your dreams” and goes on to say that they have a sliding scale fee.

  6. CanDoc
    March 5, 2014 at 6:03 pm #

    I practice in Canada and I’m paid fairly for my expertise. BUT $3000 FOR A BIRTH? That’s more than twice what I make for even the most complicated cesarean delivery, and six times what I make for a healthy low-risk delivery, including all intrapartum and postpartum care. Maybe I should become a CPM! 😉

    • Ducky
      March 5, 2014 at 6:49 pm #

      I’m curious how much an OB makes on average for a c-section or vaginal delivery. I know it must vary (some hospitals salary their OB’s, according to some articles I’ve read).

      This article quotes one woman’s hospital statement, which includes a $4000 charge for OB: http://www.nytimes.com/2013/07/01/health/american-way-of-birth-costliest-in-the-world.html?pagewanted=all

      Now granted, that’s the billed, not negotiated rate, you are a getting a WHOLE lot more value with an OB as in experience, insurance, etc.

      But birth is rather expensive in the US, so it does not surprise me that CPM’s are able to get that amount from women who think they are getting a “deal”.

      Not sure why our births are more expensive here- perhaps someone more educated than I could comment? I know some say it is because of insurance costs/greed etc but I sense the issue is more complicated?

      • WhatPaleBlueDot
        March 5, 2014 at 7:47 pm #

        From what I understand, most OBs are on salary unless they own their own practice. In other words, they aren’t paid per birth.

        Oh and don’t forget the $200-400 grand in student loans compared to the $300 internet course or $100 series of Ina May books.

        • Trixie
          March 5, 2014 at 10:18 pm #

          You forgot to factor in Midwifery Today conference fees!

          • MLE
            March 5, 2014 at 10:57 pm #

            Lolz. Speaking of, I want to picket their next conference, especially if it is someplace where I could also vacation. Wasn’t it in Germany or someplace ridiculous like that last year?

          • Trixie
            March 6, 2014 at 7:28 am #

            It’s beside a highway exit ramp in beautiful Harrisburg, PA. One of America’s most financially distressed cities!

      • thankfulmom
        March 5, 2014 at 9:23 pm #

        theI thought the level of care I got from the mfm was excellent. He had me page him once a week in the evening to tell him what my blood sugar numbers were and adjusted my insulin doses as necessary. I went in every three weeks at the beginning. He always gave long explanations for any questions I had and told me what to expect in the upcoming weeks. He was friendly and inquired about my older kids and talked about his kids. When I was admitted from triage, he spoke to me on the phone to tell me what my lab results were and the plan of care (we want to keep you pregnant, hopefully to at least 32 weeks). He was in & out during my labor a lot and was very encouraging. Had me come in three times during the first six weeks postpartum and I was put on Lovenox.

        As far as I’m concerned, the hospital probably doesn’t pay him enough for the level of care he provides. I was so glad to have a doctor who clearly loves his career and genuinely cares about people. I’m thankful there are people willing to invest the time and money in a medical education. I appreciate the doctors who post here to share their expertise and opinions!

        • guest
          March 6, 2014 at 12:35 am #

          I get the same salary whether I do zero, one or ten C-Sections – no difference at all, no incentive whatsoever. I also don’t play golf.

          • March 6, 2014 at 1:25 am #

            What’s wrong with you? No golf? It’s part of the job description of an MD! [Well, maybe tennis instead] 🙂

          • Dr Kitty
            March 6, 2014 at 2:42 am #

            Thankfully my specialty (GP) is low on golfers. My friends and colleagues have a variety of interesting hobbies.
            Runners, cyclists, clay pigeon shooters, bird watchers, GAA players, Irish Traditional musicians, assorted arts and crafts, rock climbers, yoga enthusiasts and off road drivers are the ones that spring to mind.

            But GP is always where the people who were more about work life balance than status gravitated, I think the surgeons are still quite golf and rugby focused.

          • Spamamander
            March 6, 2014 at 7:35 pm #

            Oh good. My daughter has zero interest in golf, and she is looking towards being a GP. I did tell her to work on making her handwriting worse, it’s much too legible.

          • ihateslugs
            March 6, 2014 at 3:20 am #

            Not a lot of golfers in pediatrics, either. I think they gravitate more towards the surgical specialties?

      • March 6, 2014 at 1:24 am #

        Up to a point, it depends on the patient’s insurance. When I taught a Lamaze-based “preparation for childbirth” course in NYC in the 70s, I was amazed to be asked by expectant parents if there was any way to predict having a C/S. It seems that Blue Cross [medical ins.] paid a flat amount for a vaginal birth, no matter what the doctor charged, while Blue Shield [surgical ins.] covered ALL costs for a C/S. So it turned out that while hoping for an NCB, many couples secretly would be relieved at being spared a considerable financial burden if there was a C/S instead.

        Of course nowadays it might be entirely different.

        • Elizabeth A
          March 6, 2014 at 7:44 am #

          Insurance billing is different now, and BC/BS have merged and are no longer separate systems. How exactly it works is highly variable. Some women have high deductibles, and until certain provisions of the ACA kicked in, some insurance plans were able to simply not pay any costs related to pregnancy.

          I have been lucky to have very good insurance, which meant that my out of pocket costs for prenatal care and delivery were a single $20 co-pay collected at my first appointment. But I’ve seen the benefit statements for my daughter’s birth birth (ambulance transport, c-section) and the hospital’s non-negotiated rate was in five digits.

      • The Bofa on the Sofa
        March 6, 2014 at 11:20 am #

        The bill the insurance got for our first c-section, which included an extra day of hospital stay for our baby (24 hrs under the bili light) and use of a breast pump for 48 hrs was $6500.

      • Mac Sherbert
        March 6, 2014 at 12:56 pm #

        I’m sure it varies based on Insurance. The cost of my prenatal care and delivery and follow up were same regardless of vaginal birth or c-section (Also, it included an extra visit for a c-section follow-up, so I’m thinking the OB would have actually come out better if I had had a vaginal birth. Now the hospital charges would have been different, but the fee to the OB was same regardless.

    • realitycheque
      March 5, 2014 at 7:21 pm #

      Uncomplicated 12 hour home birth (of which the midwife only attended for ~6hrs and missed half of our appointments that began in the 3rd trimester) cost me $5000 here in Australia.

    • Reb, former LM
      March 5, 2014 at 7:35 pm #

      I charged $4500. And was on the low end of the price scale in my community.

      • March 6, 2014 at 1:19 am #

        Gee whiz, what I’ve been missing all my professional life! [I’ve always been on salary, since I have been employed either by a hospital or HMO]

        I could have been RICH!!!

        • Reb, former LM
          March 6, 2014 at 12:13 pm #

          I probably should have specified this is Southern California, where even chewing gum seems to cost more. I think in other areas, the midwives charge less.

          • Bombshellrisa
            March 6, 2014 at 2:38 pm #

            You are right at with rates in WA state for CPMs. Although there are lots of midwives in the Eastern part of the state who are willing to accept gold/silver/other valuable stuff in trade.

          • Reb, former LM
            March 6, 2014 at 2:56 pm #

            WTF? Are they John Birch/End the Fed types?

          • Bombshellrisa
            March 6, 2014 at 4:05 pm #

            Not really-but they know that they are charging too much for literally nothing but an hour long hand holding session each month and calling it a prenatal.

          • Spamamander
            March 6, 2014 at 7:32 pm #

            Oh, great, give me even more reason to not want to admit I live in eastern WA.

          • Bombshellrisa
            March 6, 2014 at 7:50 pm #

            I LOVE your display pic!
            I am in Western WA and my husband and I have driven through Eastern WA on our way to Eastern Oregon and I prefer Eastern WA by far! My husband lived in Grandview when he was little

          • Sara Barnson
            October 21, 2015 at 4:02 pm #

            Nope. In rural Southeastern Idaho, which is arguably one of the poorest sections of white-dominated western America, a CPM charges more than $4,000 for just the birth and basic prenatal care. Tests are extra.

      • ihateslugs
        March 6, 2014 at 3:18 am #

        Wow! I’m still about $200K in debt from student loans, and didn’t start really “working” until well into my thirties. As a pediatrician, (albeit part-time), that is just about my monthly salary. Of course, no one chooses peds for the money… Still, unbelievable!

    • Stacy21629
      March 5, 2014 at 11:49 pm #

      It is completely ridiculous. I had/attempted a homebirth with a CNM in 2 different states, both charged about $2500 for everything – prenatal, delivery, postpartum care. Labs and anatomy scan were extra. When I had to transfer with the 2nd birth I had to pay the hospital bills AND the CNM fee.

      A friend of mine, pregnant just before me, spent $4500 on a CPM but did no labs or US of any kind…then delivered a 10# baby at home 45 min from the closest hospital.

      The local CPM birth centers all charge roughly $5000 to use for a birth ON TOP OF whatever your midwife charges.


    • yugaya
      March 6, 2014 at 3:18 am #

      You can always move to some dark(er) corner of the planet where corruption is ripe, medical negligence goes unpunished for lack of malpractice regulation and professional ethics, and best of all even highly educated patients are culturally programmed to be thankful every time you don’t kill them:


      So very much akin to situation with lay midwifery in your part of the world.

  7. Mac Sherbert
    March 5, 2014 at 5:53 pm #

    Yes. The evil OB’s just want money argument never made much sense to me. My OB’s office was always overflowing with patients. Also, OB’s have patients that aren’t pregnant!

    • The Bofa on the Sofa
      March 6, 2014 at 11:22 am #

      Jeez, when looking for OBs, you have to call around because a good chunk of them aren’t accepting new patients.

  8. thankfulmom
    March 5, 2014 at 5:36 pm #

    Question: How is it that Christy Collins cpm was barred from practicing in one state because her negligence killed a baby, but is seemingly getting away with yet another death in another state? Why is midwifery illegal in one state and not another? I’d like to see a Gavin’s Law in every state to protect unsuspecting mothers from hiring women who think an online degree is enough to handle life & death situations.

    • Reb, former LM
      March 5, 2014 at 5:57 pm #

      Also, since she was on probation in CA, how did she legally move to NV to open a practice there? Am I mistaken in thinking that staying put is usually a condition of probation?

      • Ducky
        March 5, 2014 at 6:52 pm #

        Agreed, what a mess. It seems incredible to me that you can get this type of negligence with an alleged “professional” accreditation and not have cross-state consequences. If there were any well-trained CPMs out there you’d think they would be up in arms over how this reflects on their sham of a credential.

      • An Actual Attorney
        March 5, 2014 at 7:23 pm #

        No, often probation does not be staying in one place. Often you can get permission to either terminate supervision early or just transfer supervision.

        Also, my understanding is that in NV, she didn’t need any license.

        • Reb, former LM
          March 5, 2014 at 7:33 pm #

          So because NARM is not an actual licensing body, but instead a private certifying organization, they don’t revoke credentials the way a licensing body would. Got it. Ick.

          • Squillo
            March 5, 2014 at 9:49 pm #

            NARM does occasionally revoke credentials (see http://narm.org/accountability/revocation-of-certification/ — you’ll note some familiar names). If the midwife’s state requires a CPM credential for licensing, she will be unable to renew her license if her credential is revoked.
            Of course, not all states require a CPM credential.

          • Reb, former LM
            March 5, 2014 at 10:45 pm #

            There are only six names on that page… How egregious must a violation be to cause someone to make THAT list?

          • Certified Hamster Midwife
            March 6, 2014 at 8:24 am #

            I think some of them forgot to pay their dues.

        • thankfulmom
          March 5, 2014 at 8:59 pm #

          So CA has stricter standards and a cpm can be held
          accountable for a death, but not in NV . How did they get different laws in CA? The inconsistency across the U.S. puzzles me.

      • Trixie
        March 5, 2014 at 10:19 pm #

        She only moved this past summer, so maybe she moved right after she got off probation?

        • Reb, former LM
          March 5, 2014 at 10:49 pm #

          Maybe. In my mind, it’s yet another unanswered question, though.

      • Certified Hamster Midwife
        March 6, 2014 at 8:23 am #

        She could live right on the border.

    • Bombshellrisa
      March 5, 2014 at 8:20 pm #

      Her friend and fellow sister in chains Katie McCall moved from California to New Hampshire and is currently attending births again. Not sure how she managed to do that

      • Elizabeth A
        March 6, 2014 at 7:48 am #

        Yeah, she’s perched right over the New Hampshire border, advertising that she travels to all of Massachusetts.

        Which I’m sure will be a great comfort to patients out on the Vineyard. Or to some poor woman in Weymouth or Hingham who’s scared of the hospital, right up until she realizes that her midwife is stuck in rush hour traffic on 495, and will be charging her full price for a birth she won’t even make it to.

    • March 6, 2014 at 1:26 am #

      This is the reason that there has to be Federal oversight of the entire profession, beginning with educational standards, through licensing, and mandatory record keeping.

    • laypersonincali
      March 6, 2014 at 2:26 pm #

      I don’t believe the case against her in CA involved a child’s death.

  9. guest
    March 5, 2014 at 5:05 pm #

    I wonder if anybody knows more about this 2008 case that apparently just had a hearing last month. On some support pages, the supporters of the CNMs are saying mother and child were both healthy and mother merely filed a complaint because she was disappointed in her birth experience. They are saying that CNM’s shouldn’t have to work under OB supervision because CPMs now don’t, and because California has no doctors willing to supervise them, and that it is all a bunch of bureaucracy.
    But in the Board of Nursing complaint, it seems to indicate the mother passed out from postpartum hemorrhage after the midwife left and had to be taken to the hospital for two units of blood.
    What is up with this case? Why is it getting litigated now? And am I misplacing my faith in CNM vs CPM?

    • guest
      March 5, 2014 at 5:09 pm #

      Having trouble with that first link: http://www.rn.ca.gov/public/rn384979.pdf

    • An Actual Attorney
      March 5, 2014 at 5:54 pm #

      I love this part from the “Gofundme” site: Midwives working out of the hospital find themselves unable to comply with the letter of the law, due to the refusal of malpractice insurance carriers to insure physicians who enter into supervisory relationships with them. Yelena and Kavita are practicing in the same manner as virtually all home birth midwives in California. The current accusations do not allege either substandard care or negligence; rather, the midwives are to be severely disciplined for a regulatory infraction.

      Oh, those pesky regulations. Yup, professionals have to follow professional regulations.

      • Young CC Prof
        March 5, 2014 at 6:04 pm #

        But Mom, everyone else does it!

      • DaisyGrrl
        March 5, 2014 at 6:28 pm #

        See, I read that part and immediately thought that apparently the regulatory agency clearly isn’t keeping close enough tabs on homebirth CNMs if they were able to practice for so many years without being called on the carpet. Sounds like it’s time for a systemic review of homebirth CNMs in California!

      • anion
        March 6, 2014 at 8:00 am #

        It’s not fair! Insurance won’t cover me doing this, so I’m forced to do it without insurance rather than get the qualifications that would satisfy the insurers! Don’t you see? If I want to do what I want, I have to do it illegally! I literally have no other choice!

        Think that would work as a defense in other situations and elicit donations? “But nobody would give me the money for a Porsche, so I had to steal it! I really wanted to have one and it’s not fair that I can’t! I shouldn’t have to work hard to earn the money–I should be allowed to just get what I want because I want it!”

  10. LMS1953
    March 5, 2014 at 3:56 pm #

    The current rate of home birth in the US is 0.72%. About 2/3rds of these are attended by CNMs according to the CDC report I referenced below. Of note, crunchy states like Vermont and Oregon have a rate of 2%. While still small from an economic viewpoint, it is not trivial from a transfer standpoint. According to Dr Chervenak (AJOG Jan 2013 Vol 208 No. 1 p 33), in the Netherlands 49% of primips and 17% of multips attempting home birth transfer to the hospital. Traditionally, transfers have not been tracked very well if at all on birth certificates which artificially raises the hospital neonatal death rates while lowering the home birth rates. That said, I will assume a transfer rate of 25%. In Vermont and Oregon, that means a transfer rate of 0.5% or 1/200. Assuming that most OBs attend to at least 150 deliveries per year, that means once a year, s/he will have to stop whatever they are doing and attend to an emergency OB transfer, quickly assessing a situation that has deteriorated to goodness knows where due to substandard care. There may also be continuing conflict with the Woo to cause the OB more consternation. The calculus of the true cost of home birth seldom . includes the cost of maintaining the transfer system, as Chervenak points out. However, he fails to mention the cost of maintaining the OB crew 24/7 to be available for the transfer (as is mandated by EMTALA law.

    • Squillo
      March 5, 2014 at 7:05 pm #

      The data brief says only 19% of OOH births were attended by CNMs. The remainder are other midwives (43%), physicians (5%), and “other” (33%). Or am I missing something?

    • areawomanpdx
      March 6, 2014 at 1:40 am #

      The majority of OOH births are attended by CPMs. Just look at the CDC stats and compare CNM vs. “other midwife.”

  11. hmm hmm
    March 5, 2014 at 2:56 pm #

    Midwifery Today
    19 hours ago
    Posted to the Midwifery Today FB page:

    “From anonymous
    I have a question and I apologize for it’s length, but I feel more information is better than less.

    Some background info:
    I have a 6 year old son who was born at 34 weeks. I am Rh neg and had rhogam with him at 28 weeks and delivery

    In may I gave birth to a still born daughter (Harper) at 39 weeks. My pregnancy was uncomplicated, and was completely taken aback by her stillbirth. Around 28-30 weeks my blood work had come back positive for antibodies but nothing else was said about it after subsequent blood work. I still have no real evidence of the cause of death but I do the technicalities. She basically suffocated bc my body attacked her red blood cells, something that usually occurs when and Rh pos babies blood and Rh neg mothers blood crosses. But studies showed our blood never crossed.
    I also recieved rhogam around 28 weeks and delivery.

    I am now 16 weeks pregnant and my blood work came back positive for antibodies- anti D antigen (still waiting on titers)

    I am worried this is what caused my daughter to be born still. Does anyone have any information at all on the anti D antigen and pregnancy?

    Thank you”

    • yugaya
      March 5, 2014 at 3:01 pm #

      How a medical professional responded ( both comments have since been deleted):

      • Trixie
        March 5, 2014 at 3:06 pm #

        Every day I become a bigger Amos Grunebaum fangirl.

        • KarenJJ
          March 5, 2014 at 5:44 pm #

          I’m glad to see another obgyn seeing the BS on facebook and responding to it. I can’t believe they’re deleting him. Perhaps he is a “troll” now too?

          • An Actual Attorney
            March 5, 2014 at 7:02 pm #

            I believe that is “Internet Troll”

          • yugaya
            March 5, 2014 at 7:49 pm #

            Aren’t we all?. 🙂

      • Ash
        March 5, 2014 at 3:11 pm #

        Fortunately, the original poster has come forward and says she is seeing both OBGYN and midwife.

        • Trixie
          March 5, 2014 at 3:12 pm #

          Why even see the midwife at that point? She’s high risk! Why pay an absolutely useless midwife also?

          • guest
            March 6, 2014 at 12:42 am #

            Knitting skills?

        • yugaya
          March 5, 2014 at 7:44 pm #

          She is telling a lie in one of these two statements posted in the comments section:

          -” Should I be asking for a referral to a high risk OB.. Or should I wait…”

          – ” And my “so-called” midwife has referred me from the beginning to see a high risk OB and I see him in conjunction with my midwife.”

          Anything to defend the wondermaker “so-called” midwife, mind you, including giving a lecture to a f-in’ pro.

      • DaisyGrrl
        March 5, 2014 at 6:34 pm #

        What’s the over/under on how long it takes for him to be banned and blocked?

    • Amy Tuteur, MD
      March 5, 2014 at 3:04 pm #

      Proving that you can’t fix stupid.

      • Karen in SC
        March 5, 2014 at 3:31 pm #

        Do you mean stupid that she is asking on FB, or stupid for not understanding her Rh issues? I’m Rh negative, and had Rhogam, and even I’m confused how that could cause a stillbirth when the shot was properly administered.

        • Young CC Prof
          March 5, 2014 at 3:46 pm #

          I think the stupid is once again crowdsourcing a question that ought to be answered with, “This is a high-risk situation, see an obstetrician ASAP.”

          • March 5, 2014 at 4:54 pm #


            I am so sick of reading all this woo nonsense about ultrasounds being the worst thing that ever happened.

            A homebirther friend of mine was horrified to hear that my OB does a quick scan every time I am in the office. I happen to have pretty severe anxiety and she knows that the 60 seconds of seeing my little girl kicking makes the next four weeks much more bearable for me. My friend, dead set, told me that my baby will have ear trauma and a higher risk of autism because of these ultrasounds.

            This same person was lucky her birth went okay because she had a true knot in the umbilical cord when her daughter was born with minimal monitoring and her midwife had no idea until the placenta came out.

        • Mer
          March 5, 2014 at 3:47 pm #

          Maybe it was that the responses are stupid? Someone was suggesting that ultrasounds would increase her risk of still birth and that she should avoid chemical meds, whatever that means. Pure stupid there.

        • Susan
          March 5, 2014 at 3:59 pm #

          I took that to mean stupid for hosting an internet forum where people ask life and death questions of… whoever.

        • Karen in SC
          March 5, 2014 at 4:32 pm #

          According to Wikipedia, a small percentage of mothers are still susceptible to Rh disease even after taking the Rhogam shot. An OB would have told her this and advised about future pregnancies.

          Note: In olden times, before the Rhogam shot, Catholics were advised to find out the Rh status of any potential partner “before it got too serious” as the resulting children from the wrong pairing would be at risk. Even in this situation, birth control would still be a sin. (from a 1950s era marriage booklet my mother had).

  12. Alexandra
    March 5, 2014 at 1:42 pm #

    OT: Posted by someone on Jan Tritten Facebook Page:

    “Jan, I would like to express something from my heart about the power of our words here on social media. I know that most midwives highest priority is the safe passage of the mother and baby, and although they might prefer to use natural remedies whenever possible, they would never allow this preference to prevent them from transferring care, using medications, or transporting to the hospital and even supporting a surgical birth when these are indicated by conditions not yielding to more natural methods in a timely manner. I know from 35 years of experience in the fields of holistic health and birth that there are many modalities that can and do save lives, relieve suffering, and prevent detrimental outcomes, and I believe we should have the right to use them. But here on this forum, I have seen well-meaning comment on potentially dangerous situations needing urgent and powerful solutions, advising simple and natural methods such as massage or an herbal tea or other modalities that are often a comfort, and in some cases can make a real difference, or can be powerful over time, but could not possibly be enough to ensure that safe passage in an urgent situation. My two main thoughts on this are #1: We must be aware that our kind words could influence someone to make a decision that could lead to harm; and #2: We must keep in mind that the midwifery profession is perceived as a threat to some, and they have Internet Trolls out there on this and other social media forums, looking for any opportunity possible to make midwives appear incompetent. I think that if we are going to openly offer solutions on social media, we need to be ready to back it up with evidence that this solution is very likely to succeed, otherwise we are fanning the fires of those who oppose us, and this could very well result in making quality midwifery care even less supported and available as a profession, leaving midwives, mamas and babies in a world that does not adequately support their right to a natural birth with the quality of care they need in the location of their choosing. Many people do not realize that while social media is a great way to share information, t is also a place where information is gathered, and can be used against you in a court of law. Please keep this in mind before sharing anything that you would not want used against you or the midwifery profession. I also would love to see posts asking for help to be worded differently, in such a way that respects others privacy, and is not actually even about a particular mama or baby, but a general quest for information, and it should be made clear when it is you, Jan, who is speaking, or when it is another person who sent their question to you.”

    I guess the fact that she used the words “Internet Trolls” in capitals means she’s on “their” side and therefore her comment was allowed to stand.

    I find it amusing that she is basically saying some of the same things we have been saying – that the advice given was horrible, uneducated, and deadly – that Jan Tritten should never have posted it in the first place – that Jan Tritten should have made it clear just who the midwife was, or at least that it wasn’t her – and that it made midwivery look incompetent.

    It also is NOT to her credit that one of her main concerns is that the advice given could be used against them in a court of law.

    This is about a dead baby, but their main concern is over getting caught for sub standard care. Urg…

    • Susan
      March 5, 2014 at 1:50 pm #

      Yeah, some of that is fine but some of it reads like “don’t get caught”.

      • Alexandra
        March 5, 2014 at 2:50 pm #

        Sadly, not ONE mention of the baby who died, Gavin Michael. Not one.

    • guestguest
      March 5, 2014 at 1:56 pm #

      I just saw that the two new comments by dr Amos Grunebaum were removed from Midwifery Today page , one urging a woman to seek legitimate information and help from a doctor who specializes in high risk pregnancies, and another one where he pleaded with the magazine page admins to stop crowdsourcing medical advice in light of what happened recently – he is an “Internet Troll” as defined by Jan Tritten and her fellow quacks.
      The lolol moment is that the woman actually posted after him telling him off: “I
      did not come asking questions to treat myself or seek medical advice.
      Rather, I came here seeking out others who may have been in my shoes, as
      this subject seems to be a tricky one.”


      • Dr Kitty
        March 5, 2014 at 2:21 pm #

        “I didn’t come seeking medical advice…but others who may have been in my shoes…”

        How many angels are dancing on the head of her pin? How exactly does she like her hairs split?

        I’m ALL ABOUT patient information leaflets and support groups. I’ve had more than one person joke that my patients leave with a small forest’s worth of paper, and some heavy bedtime reading.

        I tell my patients I don’t want them to Google. That the info I give them is reliable, accurate and not trying to sell them anything, and that the same can’t be said of the internet in general. I will give them contact information for support groups I know are actually of benefit.
        I tell them that if they read something they want to ask me about to call up or come in and see me.

        • guestguest
          March 5, 2014 at 2:33 pm #

          So you troll your patients in real life too with omg actual valid facts and proper sources of information and people to consult and talk to aside from yourself ? How “medical” of you , to be undermining their efforts to become *educated* like that. 🙂

        • thepragmatist
          March 5, 2014 at 2:59 pm #

          You are great. Not enough doctors do that. It is something I adore about my long-term psych. I’ve had him for most of my adult life. Every time we do a medication change, prior to the medication change, he gives me a literal magazine of information. All current prescribing standards from both sides of the pond, the pharmaceutical information on the medications (because he knows I can wade through it), and then encourages me to send him an email when I am ready to make a change or if I want to wait. He usually gives me more than one option. He carefully writes out titration instructions and how to work new medications into my medication routine, when to look for side-effects, what they will be. (In contrast, I’ve had other doctors who WON’T tell me what the side effect profile is for a drug, because I will “think myself into having them”.) Hell, he is the reason I know what a “titration schedule” is. He will lay out a number of treatment options so I can have a good idea of my choices. He taught me a lot about medicine, and when I go to other specialists, they think I’m being a cocky ass for expecting similar treatment. I think some physicians basically push their patients to the UofG by not providing enough information. We’re not lemmings out here.

        • Anj Fabian
          March 5, 2014 at 6:17 pm #

          I’m totally biased in that I love online information, but I also try to vet my sources.

          The highly biased, cherry picking websites are good for a headache or a headdesk, but not much else.

      • Trixie
        March 5, 2014 at 2:22 pm #

        Ooh, did anyone screenshot that?

        • guestguest
          March 5, 2014 at 2:37 pm #

          Yup, I learned on this blog to *take a screenshot first and laugh/cry in despair later* 😀

          I think I have to register on Disqus to be able to post images, will do that.

          • thepragmatist
            March 5, 2014 at 2:55 pm #

            Good work!

      • theNormalDistribution
        March 5, 2014 at 4:16 pm #

        “I did not come asking questions to treat myself or seek medical advice. Rather, I came here seeking out others who may have been in my shoes, as this subject seems to be a tricky one.”

        What the hell is the difference?

      • anion
        March 5, 2014 at 5:39 pm #

        These women really need to learn the meaning of the phrase “ask for advice.” They keep doing it and then insisting that’s not what they’re doing.

      • Amazed
        March 5, 2014 at 8:08 pm #

        He’s the Most Trollish Troll Who Ever Trolled. He is a maaan. And he dares bring science on the table, undermining the other ways of knowing – the Only Real Ways of Knowing.

    • thepragmatist
      March 5, 2014 at 2:06 pm #

      I just saw the same flaw in thinking on Barb’s post, as good as it was: self interest. It is ALL about self-interest to these women. Not about the baby, the DEAD baby, but about the self-interest of the midwife or the cult of NCB and preserving its integrity. There is no cult of modern medicine. In my experience of medicine, it is an insular culture with some blind spots that have not served me well, but NOTHING that compares to the kind of victim-blaming and negligence you see amongst midwifery. I’ve never had one of my physicians cover up the mistake of another. In fact, my physicians occasionally disagree vehemently with each other, and that’s good, it’s how I know that they’re watching out for me. I’ve had specialists just flat out tell me another specialist was wrong or my family physician was wrong, and why, and I’ve had to take these different opinions into account when making choices– that’s the POINT of a second, third, fourth opinion. MORE IMPORTANTLY, when I have had poor treatment from another physician (and this happens to me rather frequently, unfortunately), my other physicians don’t say, “Well, don’t complain because you don’t want to undermine modern medicine.” They say, “This is the complaints process. File a complaint. Write the College.” Sometimes they step in and do it for me. That’s integrity. I worked with a marginalized population and it was similar: I would not have sat by and watched another colleague do something destructive to a client, and done NOTHING or supported the colleague in order to protect the venerable institution of social work.

      I am pretty sure my physicians file my bad experiences away to refer to as cautionary tales of how not to treat a patient like me. I know for a fact it angers some of them when I am treated badly. I would hope that the times I’ve suffered at the hands of a physician who was either just careless or downright cruel or negligent, sits with my other physicians as a reminder of how not to be, and that in some way it improves the experiences of others.

      What I’ve seen of good physicians is an openness to be a better physician at every turn. There’s no interest in protecting some cult of medicine or their own ego. I had a psychiatrist make a very bad mistake with my medication. I didn’t blame him because I knew exactly why he was making the choice he was making and it was within standard of care, but the outcome was terrible. He didn’t abdicate responsibility. He said, “This was a horrible mistake. I will fix this.” Then he wrote a letter explaining what had happened so that others would know that I had been made sick by a choice he had made. (Of course, this happened in a country where physicians don’t live in fear of being sued because they have very good legal representation– sometimes, I think, too good!)

      They talk about physicians closing ranks, but that’s not what I’ve seen. I’ve seen physicians stick up for me and take flak for it for their own for it, but have done it because I am their patient, they actually know me, and because I am a marginalized woman, they have to fight just a little bit harder to make sure I’m getting the care that I need and deserve– that’s called putting the patient FIRST. I’ve seen them take hell for it. I see this criticism of one another as a healthy thing: it keeps everyone on their toes. I do not want all my doctors to be self-serving, self-interested narcissists patting each other on the back in an echo-chamber. Thank GOD they don’t act like midwives, because they’d be falling all over themselves to protect each other and their own careers and I would not get the standard of care I receive.

      • Reb, former LM
        March 5, 2014 at 5:55 pm #

        I see what you’re saying about the flaw in Barb’s piece, but I see it as the major strength of her piece. If folks are providing unsafe care, then they should be persuaded (in the language they speak) to rethink things. If self-preservation is the chief motivator, then so be it; as long as the net result is safer care, then isn’t the destination more important than the journey?

      • Amazed
        March 5, 2014 at 6:04 pm #

        I didn’t like that note either but I think it might be the strongest point of it. Barb wasn’t addressing the homebirth community as a whole (she has done so before and her tune was much different), she was addressing homebirth midwives. And we saw how appeals to do the moral thing work wonders with them *snark*.

        Barb is walking the fine line. She isn’t in our camp but she isn’t in their either. Her tone sometimes irks me (far more than Dr Amy’s, the lout that I am) but I appreciate the fact that she’s trying not to gloss over things – as much as it’s possible for a former homebirth midwife. My mom is still a teacher, although she no longer teaches at school. Still, I see traces of that thinking years after she quit. I suppose it’s the same with Barb.

    • MrG
      March 5, 2014 at 2:33 pm #

      Actually, the way I read this: “.. I think that if we are going to openly offer solutions on social media, we need to be ready to back it up with evidence.”
      She is saying that if solutions are offered on social media only, then they must be backed up with evidence. But if solutions are offered to people directly, it’s OK if they are non-evidence based, because they are not public. And that is where most of the problems are with these American Midwifery Certification Board “un-certified AMCB providers” (or UCAPs from now on).

    • The Bofa on the Sofa
      March 5, 2014 at 2:35 pm #

      I like the part about how, if midwives keep acting like idiots in public, no one is going to take them seriously any more. To paraphrase.

      I can’t argue with that.

    • Medwife
      March 5, 2014 at 3:13 pm #

      They’re making themselves look incompetent, no internet trolls needed.

      • KarenJJ
        March 5, 2014 at 5:48 pm #

        I got my driver’s license from a cornflakes packet and I can’t believe that there are trolls out there on the road pulling me over for all sorts of issues. What are they doing? Trying to make me look incompetent? It’s not like I’m going to kill anyone.

        • DaisyGrrl
          March 5, 2014 at 6:20 pm #

          You got yours from cornflakes? How official! I drew mine in crayon. I don’t bother with insurance, but that’s okay because I make friends with everyone I crash into so they don’t care about pesky things like paying for damages (plus, my license doesn’t have my real name on it).

          • KarenJJ
            March 5, 2014 at 7:03 pm #

            There is NO respect for other pathways to driving!!! Those insurance people just want your money. Deaths due to driving are really rare. I trust my intuition and haven’t had an accident yet and I’ve driven 500km over the past 7 years!!!

          • Young CC Prof
            March 5, 2014 at 7:18 pm #

            I shall now declare myself a Certified Professional Truck Driver. I can deliver your goods by any road you choose!

    • anion
      March 5, 2014 at 3:30 pm #

      “Hey, guys, when we publicly spout the nonsense we believe, it makes us look bad. I mean, we obviously believe some outrageously stupid shit, amiright? Furthermore, when our ignorance kills babies and we try to hide it and blame the mother, it makes us look even worse. In future, let’s keep our deadly lack of knowledge, our victim-blaming, and our general useless nonsense to private spaces and, of course, ‘client’ care, where nobody can see it and realize how uneducated and ridiculous we are and how dangerous our ‘care’ truly is, and where it’s way easier to cover up the dead babies and ruined lives we leave in our irresponsible wakes.

      Now, remember: we’re not saying you shouldn’t *believe* utter nonsense or use outrageously stupid shit as a guideline in practice. Just don’t SAY you’re doing it in public, okay, because then people can prove our incompetence, and then how will we earn money while getting our birth-junkie highs?”

    • Arwen
      March 6, 2014 at 1:11 am #

      “We do this for babies, but really, we’re doing it for ourselves, so don’t make us look stupid.”

      That’s what I read.

  13. Josephine
    March 5, 2014 at 1:20 pm #

    This is my favorite one so far, I think. It really cuts to the heart of the matter, I think. CPMs have the biggest financial incentive to lie out of anyone, and it’s amazing how brazenly they attempt to flip that on its head. It’s not as if OBs are standing around twiddling their thumbs, anxiously staring at the clock in hopes that the 1/2% will show up.

  14. Josephine
    March 5, 2014 at 1:18 pm #

    My apologies for this being OT, but I couldn’t think of a better place to bring this. I feel so frustrated and angry at this person’s unprofessional conduct.

    I am expecting twins (I’m currently 32w, 4d) and my doctor’s determined that I should have weekly NSTs and BPPs. Yesterday I went to the office for my first NST and met the monitoring nurse, who seemed perfectly nice at first. The NST took a good while (a bit over 40 minutes) because Baby B was apparently sleepy. I was already rather uncomfortable, because I was on my back for the better part of an hour with a bunch of stuff strapped to my belly, and the last thing I wanted to do was stay there even longer, especially since my husband took time from his workday to drive me to the appointment and stay with me.

    Once the NST was completed, instead of unstrapping me and letting me leave, this nurse loomed over me with this beatific look on her face like she was lactation Jesus and started interrogating me about breastfeeding my last child and what went wrong. Then she started talking about how I should strongly consider breastfeeding the twins or exclusively pumping. At this point I was annoyed but still polite, telling her the reasons why I’m not interested in exclusively pumping with two newborns and a toddler at home. Then she starts calling breastmilk “gold” and goes on about how formula is “one size fits all” vs. the wonders of breastmilk, and tops it all off by suggesting I delegate the bottle feeding my children so that I have more time to pump (sounds like a great recipe for bonding and general happiness, doesn’t it?). This patronizing speech went on for about ten minutes, and I had to do a sufficient amount of nodding and polite mm-hmms to get her the hell away from my bed so I could get up off my back. I think the words “did you know” were uttered about a half dozen times. I was too stunned to defend myself or tell her to stop. It completely blindsided me.

    Needless to say, I’m utterly furious at being treated like a child while I’m basically lying there captive, still hooked up to machines. She did not unstrap me or move to allow me room to get up until she was done speaking. She’s not involved in my regular care at all. The rest of the office has been great – the fact that I intend to bottle feed is right in my chart, and they occasionally reaffirm this with me with absolutely no judgment or lecturing.

    What should I do from here? I feel strongly like I should file a complaint. I don’t want to be a huge pain, but I also don’t want anyone else subjected to this woman’s unbelievably inconsiderate and inappropriate lecturing. Am I just hormonal and overreacting? Should I bring it up with my MFM? I have to see this woman five more times before the pregnancy is over so I may wait to file a complaint – would that make the most sense? Or should I simply speak to this woman face to face about it? I have some bad history with HCPs in the past and it’s taken a long time and a lot of capable, kind doctors and nurses to restore my trust and faith in the first place. Now I’m feeling powerless and harassed all over again.

    Apologies again for this being OT from the main post.

    • Mel
      March 5, 2014 at 1:22 pm #

      No, you are not over-reacting. I’d bring it up with your MFM provider.

      I had a probl

      • Josephine
        March 5, 2014 at 1:55 pm #

        Wow, that sounds incredibly tiresome! I’m glad you got some resolution. Thank you for sharing your experience and thoughts.

    • Dr Kitty
      March 5, 2014 at 1:30 pm #

      Ask to see your MFM’s complaints procedure. They should have one.
      That might help you see who best to direct the complaint towards.

      Sometimes complaints are managed initially by office managers or the chief administrators, rather than clinical staff.

      But yes, a complaint about how you felt that your clearly documented choices were being ignored, you were being patronised and that you weren’t physically able to remove yourself from the situation is warranted.

      • Dr Kitty
        March 5, 2014 at 1:44 pm #

        Oh, I should say, you have entirely legitimate complaint.

        Sometimes Drs have…not so legitimate complaints (the patient didn’t like the art in the waiting room, the receptionist who has blue hair, the doctor questioned the legitimacy of their request for 4000 morphine tablets, the Dr was too busy performing CPR on someone who had collapsed in the waiting room and they had to wait 30minutes to be seen…you get the idea).

      • Josephine
        March 5, 2014 at 1:54 pm #

        Thanks, that was very helpful. I haven’t decided completely if I’ll file a formal complaint or just mention it in passing to my MFM and ask for her input, but either way, knowing the steps is very helpful.

    • Susan
      March 5, 2014 at 1:38 pm #

      I may have some insight as to why that happened. I recently completed the Baby Friendly curriculum and there is emphasis in it about bringing up breastfeeding at every prenatal visit. Perhaps she was taking this too literally. Some people are emotionally tone deaf. I do think you should bring it up to the MFM. I also suggest that if you have to interact with people trying to convince you to breastfeed you use some words along these lines… I have been informed of the risk benefits and I am making an informed choice to formula feed. That should shut down most people. What we are taught, and there is some truth in it, is that when a mom chooses to formula feed often there is some breastfeeding myth, like my mom couldn’t breastfeed so I can’t, I am too thin, fat, large or small breasted, so it’s worth digging just a little to make sure that she has all the information. But I know I would dig no further if a patient said that to me. It would be good information for the office to know how she is coming across though.

      • Josephine
        March 5, 2014 at 2:48 pm #

        Good information to know, thanks. My hospital is very into BFHI so that may have been a contributing factor. I’m wishing now that I would have been more frank with her, seeing as how she wasn’t very good at picking up my not-so-subtle signals that I was done talking about the matter.

      • antigone23
        March 5, 2014 at 10:00 pm #

        EVERY prenatal visit?? The more I read about BFHI, the more I hate it. I understand giving information and dispelling breastfeeding myths, but bringing it up at every visit is just nagging. It’s annoying and patronizing.

      • Jessica S.
        March 5, 2014 at 10:14 pm #

        That IS good information to know! Now I know I can just say “Yes, I’m making a fully informed decision to feed my baby formula and my reason for not wanting to breastfeed is simple: I DON’T WANT TO.” I suppose it doesn’t make for the coziest of talks, but it should be a short one. 😉

    • thepragmatist
      March 5, 2014 at 1:45 pm #

      You’ve got great advice on what to do about the intrusive tech.

      I just wanted to say two things:
      The Fearless Formula Feeder is a great site and Facebook page to go to for support around bottle-feeding. Just give it a google.

      I think lactivists rob women of the third choice: supplementing. So I wanted to put it out there, in case there was a part of you that wanted to do some breastfeeding. I live in a place where breastfeeding is talked about from the second trimester on, encouraged, and shoved down your throat. But NO ONE told me I could just supplement the baby, and enjoy the benefits of nursing (because it is nice at times) and use formula as I wanted, when it was convenient, when I was tired, etc. In fact, I was told formula would ruin the breastfeeding relationship. Well, it didn’t. It made mine better. Mostly because it felt like a choice then, and it removed the pressure. So I don’t know if it’s an option for you and I don’t want you to think for a second I think you should, but I just wanted to put it out there because I wish someone had told ME before I laid myself on the alter of exclusive breastfeeding and basically tortured myself for 4 months. I thought it was either/or because that’s how it was presented to me, and I HATE that this is the way it is presented to women. It’s not: combo feeding was a far more relaxed way to breastfeed, and you might like it. I did. I am still nursing my son at 3YO– not everyone’s bag, but I just say so because all the BS out there says that’s not possible if you supplement and here I am! And I do value it. Supplementing made life a whole lot easier. I nursed when I wanted and bottled fed when I wanted to. My son got the “benefits” of breastmilk as far as I can see. And I was happy being able to have the choice.

      If this was out of line, I’m sorry. I’m just sick of lactivists forcing women into black and white thinking and wanted to make sure you realized there is always that third option!

      • Josephine
        March 5, 2014 at 1:52 pm #

        The part that annoyed me most about the whole encounter is that I have actually strongly considered putting baby to breast and seeing how it goes day by day, putting absolutely no pressure on myself to succeed. In a perfect world, I could try it just to see if by some miracle I birth one or two champion latchers who can overcome the challenges of my moderate to severe nipple inversions.
        However, the L&D/postpartum ward is so zealous about breastfeeding that even breathing a whiff of that to them means multiple LCs coming into my room, nurses coaching me around the clock, people shoving nipple shields at me, etc. – this just makes me feel like my instincts are correct, and that I have to take a hard line of bottle feeding only just to get some peace. Sigh.

        I appreciate your input. I don’t think it was out of line at all! In a perfect world both feeding choices would be respected and so I could try both without being pressured.

        • thepragmatist
          March 5, 2014 at 2:14 pm #

          It’s so stupid that lactivists can’t see that they are actually actively preventing women who would like to just try nursing and would probably nurse part-time happily from doing so in the name of DOGMA. Women through out the ages have found ways to lessen the burden– and it is a burden– of extended, exclusive breastfeeding. They’ve fed their babies all kinds of things to do so.

          I didn’t have the obnoxious pressure in hospital. All the pressure came FROM ME and from what I’d been told ahead of time. The culture here is so pro-BFing it’s not possible to avoid. My OB/GYN wanted me to not nurse at all once she saw me PP in hospital, because she knew it was driving me crazy. But the nursing staff left me mostly alone as I was a survivor of sexual abuse, and so I got a free pass there, to not have my breasts touched, in particular. But I tried anyway because I’d already absorbed so much of it. SUPPLEMENTING wasn’t actually presented as a choice. It was, in all reality, a necessary step because my LO had crashing sugars, but it was presented as something to do for a very short time and then stop. So I did it for a very short time, while pumping night and day, and then stopped.

          I should’ve just kept supplementing, and enjoyed my baby. I’m a bit bitter that I lost any time at all to suffering for breastfeeding. Why? Why suffer. We have a great alternative in formula. The day I went to combo-feeding, and all that pressure disappeared, was AMAZING. And I enjoyed nursing after that, every bit of it.

          My son still loves his night-time boob, before bed, and if he is sick, sometimes a few times during the day. And I am glad I stuck it out for that. At the same time, I am glad I didn’t torture myself with SNS and drugs and even more “nursing vacations” and so on, and called it quits. I couldn’t believe I still had people– including my family doctor– urging me to keep going even when my son was rapidly losing weight and it was obvious he wasn’t thriving on the breast.

          • Josephine
            March 5, 2014 at 2:24 pm #

            That sounds horrible. I’m so sorry you went through all of that because of the ridiculous pressure. I, too, am a sexual assault survivor, so I get very, very touchy over the thought of being bullied into doing something with my body that I may not want to do. Between that and my hospital’s extremely pro-breastfeeding policies (the joys of living in Portland, OR, I suppose…), the thought of being descended upon by less-than-helpful LCs gets my metaphorical back up against the wall.

            I think the obsession with exclusively breastfeeding is such BS, just like you do. My mother breastfed me for over a year (which in the mid-1980s was a pretty long time, I imagine), and she supplemented freely with formula as needed. When I arrived home from the hospital last time, a bit of an emotional wreck over having to use formula, she brought out my old baby calendar and showed me the first time I had a bottle of formula…at a whopping three days old. And yet by some dark magic, apparently, she still managed to feed me mostly breastmilk for all those months. I’m trying to keep all that in mind.

          • thepragmatist
            March 5, 2014 at 2:30 pm #

            There is an obvious truth in breastfeeding being supply and demand. The failure is this: there is no thought to whether or not the woman WANTS to produce enough to exclusively breastfeed. This is because of the intense fear that if women knew that it was also possible to combo feed and produce enough milk to combo feed (and just enough for that) that women wouldn’t choose to breastfeed exclusively. My feeling is that women will do what is right for them regardless of what kind of fear-mongering crap you push on them… eventually… it might not be the first child, but by the 2nd, they will be wiser. Women who can and who want to nurse exclusively will, and have through out time. Women who want to combo feed will. And ditto for not nursing at all. But the sad thing is that they may just throw the entire thing out and to be truthful, I liked many aspects of breastfeeding EXCEPT FOR THE FACT I HAD TO. Once I felt free to make a choice each time I nursed, it became something I was freely doing, and that changed a lot.

          • Mac Sherbert
            March 6, 2014 at 10:44 pm #

            This! I wouldn’t have quit entirely with my 1st, if I had know you could combo feed. Thanks to this blog I exclusively BF my 2nd until I got tired of it and switched to combo feeding. Still nursing some at 15 months.

          • Karen in SC
            March 5, 2014 at 2:50 pm #

            I love how your mom supported you!

          • Josephine
            March 5, 2014 at 2:53 pm #

            My mother is an amazing woman. 🙂 We don’t always see eye to eye but darn if she isn’t a very strong advocate for all her children, grown or not.

          • Amy M
            March 5, 2014 at 4:16 pm #

            You’ve already btdt with your first, but just to add a real-life anecdote—my twins were basically formula fed (tiny bit of breastmilk for the first 4wk) and they are fine. They didn’t mutate any further, and they are behave like normal 5yr boys now (aka, neanderthals). That annoying nurse needs to eff-off and mind her own business. You can simul-feed with bottles, btw, if you want some tips, let me know.

          • Josephine
            March 5, 2014 at 4:18 pm #

            I would absolutely love some tips on that!

          • Amy M
            March 5, 2014 at 6:00 pm #

            1)For newborns (and as long as they fit, my boys have been pipsqueaks since birth): Put a boppy or equivalent around your waist and sit on a comfy couch (or floor or bed or wherever). Put a baby on each side of the boppy, so their heads are close to meeting in the middle. With this setup, and a bottle in each hand, you can kind of lay your arm across the baby, with arm comfortably bent at elbow. (see pic below)

            This did involve taking them both out of their cribs and carrying them to another room because their room was too small to get anymore furniture in. When we first brought them home, they were so small, we pretty much stacked one on top of the other for a second to get them at the same time. Soon, that wasn’t really an option, so it was just a matter of taking one out, putting him somewhere safe, most likely the floor, then going back for brother.

            Set up several shifts worth of bottles at once, that way you aren’t making bottles at 3am. Just pull them out of the fridge and pop in microwave for 10secs (and shake!) Get the bottles before you get the babies.

            2)When they outgrow the boppy method, get two bouncy seats. We found two options here. One was to put them on the floor and sit on a footstool between them, one bottle in each hand. The other was to put them on the coffee table in front of the couch and sit in front of them, bottle in each hand. We did that until they were about 6-7mos old and could hold their own bottles, and then we’d just hand it to them.

            Most nights, husband and I did bedtime feeding together, so we each took a baby. This was definitely better for cuddles and bonding, but when only one person was available for feeding, or for overnight feedings where we took shifts, so both of us didn’t have to be up all the time, being able to simul-feed was priceless.

            Good luck!!!

          • Josephine
            March 5, 2014 at 10:11 pm #

            Thank you so much for all the tips! The picture was helpful as well. Are those your boys as babies? So adorable. I’m going to have to invest in a boppy.

          • Amy M
            March 6, 2014 at 6:54 am #

            Yep! I’m pretty petite, yet my whole hand covers their whole torso and half their face…they were pretty small! (Now at 5, they are a whopping 32 and 33lbs).

        • Trixie
          March 5, 2014 at 2:27 pm #

          Well, look, if you’re interested in giving it a shot, don’t let them being jerks stop you. Just do whatever you were planning to do and tell them to eff off.

        • anion
          March 5, 2014 at 5:02 pm #

          As an FYI, that–the no-pressure, “I’ll try it today and see how it goes, maybe I’ll try it for a week and see how it goes, etc.” is exactly how I ended up breastfeeding my second for seventeen months and really, truly loving it, after only doing it a couple of weeks with my first and disliking it. I told myself I’d do it for the first few days for the colostrum, and see how that goes. It went very well, so I said, “Okay, I’ll do it for a week.” Which stretched to two week, then into a month, then six weeks, then I decided to go for three months, then six, and then it was basically a matter of when I was going to have to force myself to stop.

          And we gave her one bottle a day (usually formula but often breastmilk) to give me a chance to make dinner/shower/stand up, and my husband a chance to feed her. It worked extremely well for us. Some days I skipped it, but for the most part the break really helped, and my husband loved having time with her, too.

    • March 5, 2014 at 1:47 pm #

      You should not have been flat on your back for your NST, for starters. In my clinic I persuaded the admin. to get TV recliners; much more comfortable and adjustable, too. Lying on one’s back can compress the vena cava and cause a flat EFM reading or bradycardia.

      If she continues lecturing you on subsequent visits, and you feel hectored, you should speak up about it. I don’t think you are overreacting. If she begins again, try saying “I’ve heard what you have to say. I will make my own decisions on how I feed my children. Thank you for your input, now help me up” which may be enough, but if not, take action.

      • Josephine
        March 5, 2014 at 2:07 pm #

        To be fair the bed was slightly reclined and I did have some (pretty flat) pillows behind me, so I wasn’t completely flat, thank goodness. But I was still enough on my back to be very uncomfortable and I could feel the backs of my thighs falling asleep. I will probably request some adjustment next time so that I’m more comfortable, but this was my first time to the rodeo so I wasn’t sure what to expect. Maybe that contributed to Baby B being “sleepy”, so that’s really good to know.

        Thank you for the advice. I need to be prepared to fight for myself a bit, I think.

        • March 6, 2014 at 1:18 am #

          It also helps to have either a sweet drink or several glasses of water [if you have GDM] prior to an NST. Pregnant women often do not drink enough, and it is surprising how quickly babies perk up if Mom has some added fluid.

    • LibrarianSarah
      March 5, 2014 at 1:56 pm #

      Next time she invades your personal space to talk about breastfeed give her the ol’ fork in the eye. Problem solved.

      • An Actual Attorney
        March 5, 2014 at 6:29 pm #

        When I was pregnant, I spent 9 months so nauseated I could almost throw up on command. I finally see how that might have been very useful.

    • March 5, 2014 at 2:06 pm #

      Have you heard of the Fearless Formula Feeder? She might be able to offer some advice – this sounds like it’d make a great blog post. You deserve to be supported in medical decisions without judgement, what she did was uncalled for.

      • Josephine
        March 5, 2014 at 2:26 pm #

        I have! I love that blog. I don’t know why it didn’t occur to me to go there first, but I imagine that would be helpful as well. Thank you.

    • Trixie
      March 5, 2014 at 2:25 pm #

      I would absolutely complain. It’s not within the scope of her job. It would have been one thing if she asked you if you would like a referral to lactation counseling or given you their contact info.
      Next time tell her you plan on starting them out on Mountain Dew.

      • Josephine
        March 5, 2014 at 2:29 pm #

        Haha! I told my husband that I should have told her we started out on Pepsi but quickly switched to chocolate milkshakes and the baby seemed to do better on those. I need a time machine that only goes a few hours back in time for all those decent comebacks I think up later in the day.

        • Susan
          March 5, 2014 at 4:02 pm #

          Me too. I rarely hit on the right thing to say in the moment!

    • moto_librarian
      March 5, 2014 at 3:05 pm #

      Tell your OB and file a formal complaint. I am so sick of this infantilizing bullshit.

    • anion
      March 5, 2014 at 3:48 pm #

      Ugh, I am so sorry that happened to you.

      I would complain, yes. And if she ever does it again, look at her coldly and say, “Does how I plan to feed my babies affect the results of this test?”

      Or you could smile brightly when she asks if you’ll breastfeed/starts talking about breastfeeding and say, “I do plan to feed my babies, yes.” If she asks how, say, “Of course I’ll feed my babies.” (I won’t suggest you say “Well, through their mouths, of course!” because that may alert her that you’re just having fun with her, but it’s an option, too.) No matter what she says, reply with something about how of course you’re going to feed your babies, what kind of person would starve their babies, you appreciate her concern but your babies will definitely be fed, she doesn’t have to worry. (The fun option here is to say you’ve already started aging the steaks which will be their first at-home meal, or you plan to feed them a flour-water paste because that ‘looks like something babies would eat’, or you’ve been saving old dinner scraps in a baggie because it’s your understanding that babies don’t have taste buds anyway…but of course we don’t want CPS to be called, so those may be better to privately enjoy rather than actually saying out loud.)

      Don’t engage and don’t let her lecture you. Don’t be too polite to ask her why it’s her business, or to interrupt and say you’ve already discussed this with the doctor or made your decision and can she please let you get up now. She’s being rude and nosy, and you do not have to lie there and take it; she’s not your boss.

    • March 5, 2014 at 4:56 pm #

      I would absolutely make a complaint. That is unprofessional conduct and, frankly, the fact that she didn’t let you move until she was done lecturing you is unacceptable and bullying as far as I am concerned.

    • An Actual Attorney
      March 5, 2014 at 6:18 pm #

      First, I love “lactation Jesus”!

      Second, OMG, please complain! Totally out of bounds, and what a freaking power trip, with you all strapped up. Sometimes I wonder if the drs know how much woo and BF BS has invaded the nursing. If no one tells them, they just don’t know.

      Not exactly the same, but I once had another party contact me to tell me how inappropriately an intern worded an email. I was grateful to her both for the opportunity to apologize and to correct the intern. And also happy she demonstrated she knew I wouldn’t direct that sort of crap. I would expect a good doc would feel the same way.

  15. March 5, 2014 at 12:44 pm #

    I’d like to see the following meme: “What your CPM isn’t telling you…” with all the things that CPMs don’t tell their clients… ending with “could kill.”

  16. Are you nuts
    March 5, 2014 at 12:24 pm #

    My last OB/Gyn quit delivering babies and it took me a long time to find a new one because a lot of OB/Gyns in my area aren’t accepting new patients. I don’t think OBs are hurting for patients.

  17. Jocelyn
    March 5, 2014 at 12:15 pm #

    I really like the “Thinking about homebirth? Think again.” slogan that you’re putting on these graphics.

  18. moto_librarian
    March 5, 2014 at 12:10 pm #

    One of the things that pisses me off the most about lay midwives is that they never face financial consequences related to malpractice. If a family decides to sue, their only hope of getting any compensation is if they are able to sue the hospital that was unlucky enough to deal with the aftermath of the midwife’s incompetence. It wasn’t too long ago that we saw a lawsuit against a hospital because the family claimed that a c-section didn’t occur quickly enough after the transfer. While I am certainly sorry for the family, why should the midwife get off Scott free when her poor decision making led to a late transfer? Midwives rarely (if ever) have their patients preregister at a hospital, which means that in an emergency, there are no records or basic information on hand. We also have seen time and again midwives being combative towards hospital staff, lying about how long a woman has been in labor, how long her membranes have been ruptured, failing to provide records, etc.

    And while the financial piece is certainly a factor, I cannot even begin to imagine the emotional trauma faced by the professionals that have to deal with these disasters. In the case of poor Gavin Michael, we are told that staff worked on him for 47 minutes. They then have to console the family that is left bereft of a much-wanted child. The hospital staff are the ones offering true compassion and care, while the midwife starts working to cover her tracks and convince the mother that the tragedy was her fault. It is disgusting.

    • March 5, 2014 at 1:55 pm #

      While some midwives are undoubtedly in it for the money, I think we underestimate the simple “playing doctor” aspect of it. It is an ego trip with financial benefit. Proclaiming oneself a midwife gives one a status, allows one to pretend to a professionalism of which the pseudo-midwife is usually more or less ignorant. To the outsider, medicine is woo, so real woo must be as good, right? Hence suggestions like stevia, etc. And midwifery is such a “womanly” thing to do, in a world where in the major professions such as law and medicine, a woman usually is at a disadvantage if she is perceived as extremely feminine.

      The thought came to me while watching my 3 year old granddaughter play with her toy stethoscope. I was the patient, and she dutifully “listened” to my knee although I’d told her my tummy hurt. I began to think, isn’t this like the CPM who thinks that because she’s got a hand-held Doppler she can do an NST?

      • anion
        March 5, 2014 at 5:30 pm #

        It is Medical Professional: The Role-Playing Game.

        They want all of the accolades and respect and importance without all that irritating *work* that would delay their gratification. They’re in it for the life-and-death power, for the blog and Facebook posts thanking them for being “the greatest midwife EVAR!” Our Friend Christy was so hooked on the idea of being thanked and heralded by the parents–and on the accolades she’d get from other midwifes when she stuck the landing on a 42.3 stunt birth–that having the parents LIKE her was more important than actually delivering the baby safely. She wanted the *credit* for delivering the baby, not to actually do it; the baby and his safety was incidental to the vision of another “And thanks to Christy Collins, who totally made my birth possible! If there’s a better, more supportive midwife out there, I don’t know who it is!”

        Ever noticed how many HBers/NCBers go out of their way to laud their midwives? I suppose we could say it’s just because the moms are particularly generous or whatever, but I suspect it’s largely because CPMs present themselves as the ONLY option for the birth X wants, the one who will make it all happen, the one who will fearlessly do what no one else will. So it becomes a case of the midwife almost seeming responsible for the baby itself, her role is so huge. Those one-hour appointments aren’t to encourage closeness, they’re to encourage dependence and an artificial bond. Like a vampire the midwife feeds on the attention, gratitude, and power, and sadly, like a vampire she leaves dead bodies and ruined lives in her wake while she moves on to hunt for another victim.

      • An Actual Attorney
        March 5, 2014 at 6:28 pm #

        I deal with a lot of law enforcement officers in my work. Most are great, but some are clearly in it for the power. Being a jail guard is about the most power you can get if you only have a GED. They become the abusive nightmare officer, lording life and death over everyone unfortunate enough to be in their wing. I was thinking yesterday that a lot of CPMs seem to be cut from the same cloth. With about as much education.

    • Anonymous
      March 5, 2014 at 2:04 pm #

      Mainly because the average midwife doesn’t have anything. It’s like the nutters that killed my neice. They had a 10 year old ford escort and some crappy laptops. What are you going to get from that?

      • thepragmatist
        March 5, 2014 at 2:37 pm #

        And if they did have insurance, they would’ve voided it ANYWAY. That’s the frustrating thing. They’d be so outside their scope of practice as to be criminally negligent… oh wait.

      • moto_librarian
        March 5, 2014 at 3:07 pm #

        I am so sorry about your niece.

  19. Mel
    March 5, 2014 at 11:58 am #

    Mean income for OB/GYNs in the USA in 2011 – $220,000.

    $220,000 x .0025 = $550 dollars.

    OBs are taking on the home-birth-industrial complex to earn an additional 550 bucks a year. Yeah, that doesn’t make sense.

    What DOES make sense is that OB/GYNs are sick of dealing with the aftermath of home births.

    Who does the CS to deliver a baby that died during labor at the hands of an incompetent midwife? Who tells the parents that the baby is dead – or being kept alive by machines for now – or that the mom survived, but she’ll never have another biological child? Not the CPM; the OB. The OB who knows that this never needed to happen.

    • Trixie
      March 5, 2014 at 2:31 pm #

      Not to mention, they pay a hefty tax rate on that $220k. So let’s say after all income taxes and withholdings, it’s like $300. About 1/10 of what a home birth midwife gets paid for one birth, and what are the odds she’s reporting all that income?

      • thepragmatist
        March 5, 2014 at 2:39 pm #

        Plus usually paying an office staff, too. And fees for various organizations and publications and conferences to stay up on the craft. I suppose midwives do go to those conferences where they all eat yoni cake and hang out in the red tent, right? That counts as updating your professional craft, right? /snark

        • Trixie
          March 5, 2014 at 2:50 pm #

          Well, I’d assume the $220k is after expenses, if the OB owns or is a partner in a practice.

          • thepragmatist
            March 5, 2014 at 3:22 pm #

            If I understand it correctly, not here (in Canada) where the pay-out is a flat rate and the OB/GYN pays out to the office staff. I know this makes family doctors crazy to fill their time slots with as many patients as possible. My family physician has a quota of 1 patient every 10 minutes. I know because he puts me at the end of the day, and often stays after the other doctors are gone, because I can’t fit into a ten minute appointment. 20 min appointments have to be prebooked. Ostensibly there is nothing else, other than a 10 or 20 minutes appointment, but some of us have medical issues that need to be addressed, and more than just one. My OB is also not “supposed to” spend an hour with a patient but she routinely does spend a lot of time with her patients. If the physician chooses to do this, then the pay out at the end of the day is smaller, and so it is a disincentive to provide thorough care. My family doc has expressed a lot of dismay in this, and my long-term specialists and my SON’S specialists have called me from home at bizarre hours (sometimes as late as 8 at night) or from the side of the road to finish up with me, and I know I am not the only one)… so I guess I was thinking of Canadian medicine.

          • Dr Kitty
            March 5, 2014 at 5:51 pm #

            I know Drs pay here is quoted as the gross figure, before tax, insurance, mandatory NHS pension scheme payments and professional fees are taken into account.

            A GP who “makes” £100,000 will pay 6-8k in insurance, 15k in pension contributions, 2k in professional fees, plus whatever in taxes.

            It’s money, but it isn’t Wall St money…

        • Dr Kitty
          March 5, 2014 at 2:53 pm #

          Malpractice insurance.
          You’re forgetting OBs have to pay that.

  20. Stacey
    March 5, 2014 at 11:44 am #

    Thanks for the great post (as usual), Dr. Amy. I just wanted to let you know that “therefore” is misspelled in the graphic if you want to correct it.

    • Amy Tuteur, MD
      March 5, 2014 at 11:53 am #


      Fixed it.

  21. Susan
    March 5, 2014 at 11:20 am #

    Another great post Dr. Amy. I want to add this point. What business wouldn’t mind losing their most difficult and unhappy customers? Unlike the picture the natural birth advocates paint, most patients are very happy with their OBs. Generally, OBs have great relationships with their patients who usually are very loyal to their doctor. As a OB nurse, I see this all the time. Patients almost all think they have the BEST doctor and have great relationships with them. Sometimes, this is also true of the “crunchy types”. But, often, if the patient is refusing things left and right, and the relationship becomes an ongoing negotiation, it is taxing to the OB. These aren’t usually the OB’s favorite types of patients, the ones who question them and second guess them right and left. After all, they are human. As I have said many times, I have seen OBs literally doing the happy dance in the halls when I come out of the room of a patient bragging about how she fired her. It’s like dodging a bullet for an OB. I think a lot of these patients would be a relief for an OB to not have, yet some still feel they need to speak up for the public health menace that many CPMs pose. I really think, if it’s about self interest, that most OBs would have NO problem with someone else caring for most of these patients.

    • anon13
      March 5, 2014 at 11:51 am #

      I had a little crush on my OB, and I don’t think I’m the only one. 🙂

      • thepragmatist
        March 5, 2014 at 2:47 pm #

        I have a crush on my OB/GYNs choice of boots. That sealed the deal for me. I never expected my OB to have better taste in boots than me. No fair. LOL.

    • Monica
      March 5, 2014 at 12:33 pm #

      I sure love my OBGYN. I just saw her this week for a check up actually (it has been 3 years because I’m terrible awful at getting to my doctor) and we had a nice little chat about the kids and how my oldest is in high school which immediately made her feel old. She even offered to prescribe for me the medication that I take for my Rosecea. I do wish she was at the birth of my youngest. The doctor on call I think viewed me as one of those difficult patients who was going to tell him how to do his job because I was having a vbac. I had no intention of telling him what to do. I was completely okay with a repeat c-section if that was needed, but he didn’t know that. But anyone in my area who’s looking for an OBGYN I always recommend my doctor because I do feel she’s just that good.

      • thepragmatist
        March 5, 2014 at 2:45 pm #

        I have to laugh because I am always recommending my poor OB/GYN to the most difficult people because she’s good with difficult people. I am a difficult person. Ha. And I also think I have The World’s Best OB/GYN and have had arguments over whether or not the town’s other reigning World’s Best OB/GYN is the best OB/GYN or whether the retiring other World’s Best OB/GYN is the best… so I think there is truth to this. And I think there is something, also, to be said for the loyalty you feel to the person who safely brought your children into the world. I’ve had a difficult relationship over the years with my primary care physician and everytime I think about firing him and getting a new one, other than the difficulty in doing this, I ALWAYS come back to… but he delivered by son (with my OB)… I can’t can him.

        Which really makes it even more reprehensible to have these midwives preying on women in what is the most transformative time of a woman’s life. It is probably safe to say that women have a sacred relationship to the person who delivered their baby. If I am honest, I would admit I question my OB/GYN far less than I do my other doctors and if she said jump, I’d say, Ok. She can suggest things that if anyone else said them I’d want to kick them.

    • Mel
      March 5, 2014 at 1:46 pm #

      My OB/GYN has been awesome. I started seeing her before I got married for BC. She spent 30 minutes talking about what I wanted and she gave me some additional options that I hadn’t thought about.
      One of the things I really like about her is how honest and straight forward she is with me. I wanted to use Implanon first. She explained the higher rate of side effects that she saw in her practice, but respected my choice to use Implanon. When I called a few weeks later because my 2nd period after placement never ended, her awesome staff had a prescription in for the pill in a few hours – with instructions on how many pills to take to try and stop the bleeding. She also said point-blank that if the BC pills didn’t stop the bleeding, I should think hard about another form of BC. I appreciated that. As a patient, I don’t always know what’s normal and what’s abnormal. Having her tell me that bleeding for that long and that hard was abnormal made it very easy for me to decide to switch BC methods.

    • Mer
      March 5, 2014 at 2:57 pm #

      I love my OB/GYN group! I’ve seen three of them because of a rather unlucky year but each of them was very nice and most importantly, competent!

    • KarenJJ
      March 5, 2014 at 6:04 pm #

      I didn’t love my obgyn. Frankly he was a bit of an ass and didn’t have great bedside manners. But he didn’t infantilise me and he was competent about childbirth. He was just a bit of an idiot about something (and rubbed another of my specialists the wrong way – a specialist that I did have a bit of a crush on because he was such a great doctor). I’ve moved and have new specialists and seen a really good obgyn for some gyn issues here that was fantastic. So I do get it now and should have probably switched obgyns previously.

      • Susan
        March 5, 2014 at 6:21 pm #

        I sometimes think these crushes ( which I got one once too ) are a great reason to choose a female. I frankly don’t like feeling attracted to my doctor. Sort of makes me feel … pathetic?? Not saying anyone else is it’s just an emotion I prefer to avoid!

        • KarenJJ
          March 6, 2014 at 2:39 am #

          I haven’t had it with another doctor before or since, but this particular doctor was a big driver in getting good and thorough care for myself and my family after years of going nowhere and getting no answers and being told ‘it’s in your head’. So I’m a huge fan of someone that “saved” me for want of a better word. It wasn’t really a physical attraction as such, but I did feel a bit of a ‘crush’ in that idolising kind of way.

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